AIDS, ignorance and misinformation

A survey out yesterday, courtesy of the National AIDS Trust, has shown shocking levels of ignorance among old people and young on the subject of AIDS and HIV. About a fifth of the adult population could not identify “sex without a condom” (man/woman or man/man) as a way of getting HIV or AIDS. About a third could not identify that “sharing a syringe” might lead to infection. Only a handful (mostly women) knew that a breastfeeding mother could pass infection to her child.

Almost all the figures were worse than the last surveys in 2000 and 2005. Scarily, the group that seemed least clued up is the group in my age range, those who were subjected to relentless awareness campaigning back in the 1980s and early 1990s when people actually seemed to give a damn and Tom Hanks was in Philadelphia and everything. This is the group who are now raising their own children.

Why is sexual health awareness going backwards? How did we get so ignorant? How did so many of the children I went to school with just forget what was drummed into us all those years ago? These aren’t rhetorical questions. I want to know. This shouldn’t be happening. It is the stuff of despair.

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Having said that, it is not surprising if some people are getting confused when sloppy reporting results in misinformation.

Take the Metro. Oh, how I despise the Metro. Today, they report that “the four main ways” that HIV is spread are: “unprotected sex, blood transfusions, shared needles and via breast-feeding” (my emphasis).

That is just wrong.

The NAT survey and press release did NOT suggest that breastfeeding is one of “the four main ways” that HIV is spread. What the survey did was to list possible transmission routes (e.g. “Blood transfusions”, “Spitting”) and participants had to say which were correct and which were false. Although the survey report did suggest that the four transmission routes mentioned were “key” and could itself have been clearer, it certainly did not say that these were the main ways of passing on HIV.

And anyone with any knowledge about this area - let’s face it, someone working as a health correspondent on a national daily newspaper ought to have some background knowledge - knows that breastfeeding is not a main way of catching HIV.

Breastfeeding can in some cases be a transmission route* , but it isn’t either fair or accurate to say it is among the top four risks.

[* Especially if appropriate precautions are not taken e.g. ensuring that breastfeeding is exclusive for six months, and that breast problems such as sore nipples or mastitis are treated promptly.]

For one thing (according to UNICEF) breastfeeding only accounts for about a third of parent to child infections - which is less than the number that occur during delivery (about half), so that right there is one way of spreading HIV that is more significant than breastfeeding.

More to the point, the problems of sexual transmission / infected needles / infected blood are much much bigger than parent to child transmission. Breastfeeding isn’t even in the same ballpark.

In fact, the dangers of denying breastmilk to children can be so serious, especially in developing countries where access to clean water and adequate supplies of formula is just not readily available, that they significantly outweigh the risks of infection.

One study in Africa showed that (a) the risk of a mother passing on HIV to her breastfed child is as low as 4% if the child is breastfed exclusively for six months and also (b) the mortality rate for exclusively breastfed infants was much lower than for exclusively formula fed infants: Fifteen percent of babies with HIV infected mothers who did not breast feed them died by age three months. Only six percent of babies who were only breast fed died at age three months.

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Incidentally, when I visited the NAT site they had a survey: “Do you think Gordon Brown should make sex and relationships education compulsory in schools?” I think you can guess how I voted. 91% agreed.

 

New ambulances: dignity for big people

In June of this year, Sandra Teague died after ambulance staff decided she was too fat to get into an ambulance.

The Great Western Ambulance Trust has now decided to replace some of its old ambulances with new ones that are designed to cope with larger people.

It is worth noting that according to the BBC news report, the old ambulances were equipped to deal with people up to 30 stone in weight (or 20 stone, depending on which of the reports is correct). Sandra Teague was 17.5 stone. Go figure.

 

Gloucester: fat hatred capital of the UK?

Paramedics in Gloucester allowed this 52-year-old woman, Sandra Teague, to die of a heart attack in her dining room because, what?

They were too busy making jokes about how fat she was to figure out how to get her in an ambulance. Would you want to have to wait two hours or more while paramedics faff about wondering if you are too fat too move instead of just bloody well getting you to the hospital? This woman died. All they had to do was put her in a wheelchair or on a stretcher or one of those trolley things that every ambulance has, or carry her between them in a fireman’s lift or god damn it something other than stand about cracking jokes about cranes or tractors or whatever the hell… can you tell I’m incoherent with rage?

She weighed 17.5 stone. 111kg. How many people weigh that much or more in Gloucester? What about the pride of Gloucester?

Will James - 122kg
Terry Sigley - 121kg
Jack Forster - 119kg
Olivier Azam - 118kg
Alex Brown - 115kg
Christian Califano - 113kg
Peter Buxton - 112kg
Adam Balding - 111kg
Patrice Collazo, Marco Bortolami, Adam Eustace, Nick Wood, Carlos Nieto - 110kg
Ross McMillan - 109kg
Jake Boer, Jonathan Pendlebury, James Forrester- 108kg.

Do you really believe that Olivier Azam or Christian Califano would have been left for two hours, dying, while paramedics joked about their weight?

Gloucester - be ashamed with me. Be ashamed of what our ambulance service has done to one of our citizens. Even if those paramedics couldn’t have saved her, surely they could have treated this woman with dignity and respect while she lay dying. This is disgusting.

[HT Kate Harding]

 

Wonder drug, Part 2

Some additional remarks. (Click here for part 1. Thanks to mhatrw for the NEJM link.)

This Gardasil is not as effective as they say. Claims that it is 98% effective against two of the 13 HPV strains that can cause cervical cancer may technically be true but they fail, monstrously, to reflect the true picture.

As mentioned in my earlier post, none of the women in the study (control group or vaccinated group) actually contracted cervical cancer. The analysis of Gardasil’s efficacy was based on rates of precancerous lesions, also called neoplasias, which were treated as “cancer surrogates” for the purpose of analysing the study data.

The lesions that can be caused by HPV are categorised into three grades. Grade 1 lesions are generally not considered precancerous and treatment is not usually indicated. Grade 2 lesions are usually but not always treated and 40% of them regress spontaneously. Some experts consider that Grade 2 lesions are sufficiently “precancerous” to be a good indicator of a vaccine’s efficacy against cervical cancer, others do not. Grade 3 lesions are the least likely to regress and the most likely to result in cancer.

The two main studies used to demonstrate the efficacy of Gardasil are called FUTURE 1 and FUTURE 2 (acronym for some puke-making proper title).

FUTURE 1 found that vaccination reduced the total number of lesions from 5.9% in the control group to 4.7% in the vaccinated group, reducing your total risk for such lesions by around 20%. However, analysis showed that most of this reduction related to the more-or-less benign Grade 1 lesions. There was a modest different in the rates of Grade 2 lesions and no detectable difference in Grade 3 lesions.

The larger study FUTURE 2 found that, looking just at Grades 2 and 3, the risk in the vaccinated group was reduced to 3.6% from 4.4% in the control group, a reduction of 17%. There was no data identifying the effect on Grade 3 lesions.

And, in case this didn’t sink in the first couple of times you read it - there is NO EVIDENCE as to the number of cancers that were or might have been prevented by the vaccinations in these trials. We do not know how many of the lesions prevented would or might have gone on to cause cancer. What if the vaccination only targets lesions of a more benign type? What if, as the limited data from FUTURE 1 suggests, the vaccination actually has NO impact on the total number of Grade 3 lesions, those most likely to end up as cancer?

The results of these studies show that at best Gardasil can modestly reduce your chances of getting HPV lesions that may or may not lead to cervical cancer. That’s it.

These figures - a maximum of 20% risk reduction even on the most generous interpretation - show something very different from the 70% risk reduction that we are led to expect by the headlines. If the vaccine is nearly 100% effective against the two virus strains causing 70% of all cancers - why did the rate of precancerous lesions reduce by a far, far lower percentage?

There are a few possible explanations for the very modest benefits of Gardasil despite its apparently very good results in creating immunity to the two strains of HPV that are currently implicated in around 70% of all cervical cancer:

Pre-existing, undetected lesions

It is possible that some women who developed lesions during the fairly short period of the study had undetected lesions before the study started which only showed up during the study. These would be equally prevalent in each group, and accordingly they would make the relative difference between the vaccinated and control groups appear to be lower than is fairly the case. Would it make the efficacy appear to be a mere 20% or, probably, less? Only a longer term study would give any indication of an answer, and no longer term studies have yet been conducted.

Pre-existing HPV infections

As previously mentioned, the vaccination only works if you don’t already have an infection with one of the two strains of HPV that Gardasil is supposed to protect you from.

If you include in your data population people who have a pre-existing infection and who we therefore know will get no benefit from the vaccination, this is bound to skew the figures by making the vaccine look less good than it really is.

BUT (1) it remains to be seen whether there were so many women with a pre-existing infection that they could skew the results this badly and (2) if pre-existing infections are so common, shouldn’t we be recommending that tests be done before giving the patient a $360 shot of something that has limited safety data? To avoid exposing them to unnecessary risk and cost?

Oh, wait. The proposed patient is a girl of 11 or 12, and the test involves vaginal swabs. Stuff it, let’s jab them all - it’s all money in the bank, right?

Effect of vaccination on other strains

Of even greater concern, to me, is that the vaccinated group, while suffering almost no lesions attributable to the two vaccinated strains, suffered nearly as many lesions in total. So it appears that the vaccinated group developed more lesions, compared with the control group, caused by the other 11 strains of HPV: the reduced number of lesions caused by the vaccination strains was counterbalanced by an increased number caused by other strains.

Did the reduction in some strains therefore simply make way for others which became (speculating here) more successful in the absence of “competition” from the vaccination strains? Did the vaccination itself in some way strengthen the other strains? Or what? I guess we don’t know why the non-vaccination strains increased in the vaccinated group, but I think it is safe to say that this is something we should find out before we let the vaccination loose on an unsuspecting public.

So is it worth the risk?

A lot has been made of Gardasil in cost-benefit terms, in addition to the possible cancer-prevention effect. Even ignoring cervical cancer, if the vaccination only reduces the total number of lesions this would save the cost and distress of those lesions. One course of treatment at $360 could prevent who knows how much expenditure in treating lesions. Or so the argument goes.

However, taking the 0.8% absolute difference in risk level shown in the FUTURE 2 study, you would on average have to vaccinate 129 women just to prevent one lesion at Grade 2 or 3.

(We do not know how many women would need to be vaccinated in order to prevent one Grade 3 lesion. Given that lesions do not necessarily lead to cancer, we do not know how many women would need to be vaccinated in order to prevent one case of cervical cancer.)

So if you have to give 129 courses of Gardasil vaccination at $360 a time, you would need to weigh that cost, all $46,440 of it (before you consider distribution and administration costs or the overhead of compensating vaccine damage victims), against the cost of treating a lesion. Does it really cost the health service more than $46,440 to treat the average lesion? I doubt it.

What about the girls? Please, won’t somebody think of the children!

It is quite instructive to review the information on Merck’s own website. There is an awful lot about “why you need Gardasil” - but very little about the evidence for its safety and efficacy. Even the patient information leaflet doesn’t tell you how good the drug is - or isn’t.

What you get is a whole lot of sales talk glossing over any possibility of any concerns over either safety or efficacy. What you get is information in an easy explanatory tone, skilfully pitched to create patient demand without creating any significant awareness of possible disadvantages or reasons for caution.

Take the “Who should receive Gardasil” page, for example:

GARDASIL AND YOU

GARDASIL is for girls and women ages 9 to 26*. GARDASIL works when given before you have any contact with HPV Types 6, 11, 16, and 18.

If you’ve already been infected with HPV**, you may still benefit from GARDASIL because it is unlikely that you have been infected with all 4 types of the virus covered by the vaccine. Your doctor or healthcare professional can help you understand more.

WHY SHOULD I GET MY DAUGHTER VACCINATED WITH GARDASIL NOW? CAN’T IT WAIT?

Like other vaccines your daughter has received, GARDASIL works to help prevent illness. GARDASIL works when given before there is any contact with HPV Types 6, 11, 16, and 18. That’s why it’s important that you talk to your daughter’s doctor or healthcare professional about getting GARDASIL now—not later. You’ll be helping to protect her future*** from cervical cancer and genital warts before she’s even old enough to worry about them.

GARDASIL IS PART OF YOUR DAUGHTER’S RECOMMENDED**** VACCINATION SCHEDULE.

Talk to your daughter’s doctor or healthcare professional about getting her vaccinated with GARDASIL.

* Actually, it is not “for” that age range at all. It is licensed for that age range, but it is targeted at the young girls in whom a pre-existing infection is much less likely, and it is these young girls who are likely to be the subject of any mass/mandated vax programme.
** Oh - really? Pre-existing infection is not a problem? Forget everything the studies have shown. Forget the risks. Forget the adverse reactions. Jab them all regardless!
*** Yeah, you better get your daughter vaccinated, or is that you don’t want to protect your daughter? Isn’t she worth that measly $360?
**** By whom? Being officially licensed is not the same as being officially recommended - so who is doing the recommending? Merck researchers perhaps? It is worth pointing out that the license granted to Merck was on the basis that further trials be carried out and therefore, presumably, on the basis that there was not as at the date of the grant of the FDA licence sufficient evidence as to its safety and/or efficacy. Some recommendation.

It is worth reiterating that:

• This vaccination has never been tested for efficacy in girls of the target age.
• This vaccination has had only limited safety trials for girls of the target age.
• Girls of the target age would not be offered vaginal swabs to identify whether they have any pre-existing infection that would prevent the vaccination from working.
• Nobody knows how long the limited protection provided by the vaccination would last. Girls are being vaccinated to provide long term protection on the basis of trials lasting about three years, or less.

Sources:

www.Gardasil.com - Merck website.

HPV Vaccination — More Answers, More Questions
New England Journal of Medicine - Sawaya and Smith-McCune, 10 May 2007

Gardasil Not the Dream Vaccination Women Expected
Associated Content - Summer Banks, 10 May 2007

 

Women, behold! We made you a wonder drug!

I noticed today a front-page article from Wednesday’s edition of The Metro. The headline:

Jab that beats cervical cancer

A ‘wonder drug’ to beat cervical cancer has proved almost 100 per cent successful in trials.
Gardasil blocked the two major strains of a virus which cause most cases of the disease, tests involving more than 12,000 women showed.
The results prompted health campaigners to call on the Government to make the vaccine readily available for girls in secondary schools.
However, critics have warned such a move will only encourage sexual promiscuity in the young.
In the latest research, women aged between 15 and 26, from 13 countries, were monitored for three years. The vaccine was 98 per cent successful in targeting two strains of the human papilloma virus and preventing pre-cancerous changes which can lead to the disease.
In nine out of ten women, it also blocked two other strains of the virus which cause genital warts.
US researcher Dr Kevin Ault said: ‘Severe reactions to the vaccine appear to be rare.’
His team’s findings confirm those of Australian researchers who tested more than 5,450 women.
Writing in the New England Journal Of Medicine, two experts said: ‘Investigators in these trials have hit their mark soundly.’
Gardasil was approved for females aged nine to 26 by the EU in September but is available only privately in Britain. The jabs are most effective when given before a girl becomes sexually active.
Cervical cancer charity Jo’s Trust wants a nationwide programme of vaccination in secondary schools launched by the end of the year.
‘This new data is a significant breakthrough,’ it said.

A person reading this report could be forgiven for thinking that a miracle is upon us. Let us all go forth and vaccinate! But it aint necessarily so.

Some Gardasil facts:

• According to the studies done so far, Gardasil is very effective against two strains of HPV which can cause cancer. It has no effect on the other 13 strains of HPV which can lead to cancer. These strains cause around 30% of current cervical cancer cases.
• Gardasil only works if you are not currently carrying any of the targeted strains around with you. Since HPV infection rates are high (most of us will get infected with at least one strain at some point in our lives), there are going to be a lot of people for whom this vaccine just doesn’t work.
• Since HPV infection rates are especially high among young people in their mid to late teens, when they start to have more of the sort of skin-to-skin physical contact with each other (NOT necessarily sex) that can transmit the virus, it would make sense to catch them before they reach that age. That is why the jabs are most effective before a person becomes sexually active. This would mean vaccinating girls who are pre-pubescent, let’s say at around the age of 11 or 12. The research so far on girls under the age of 16 has involved 506 girls. I do not know how many of them were aged 11 or 12, which is the age we are talking about giving this vaccine, but I suspect it is a relatively small proportion because of the ethical problems involved, which must increase as the subject is younger and more vulnerable. The drug is actually licensed for girls as young as 9 and NONE of the research subjects were younger than 10. What all this means is that we do not know whether the vaccine works for younger girls and we do not know whether it is safe for younger girls.
• The research done so far has taken place over a total period of around 11 years, with each study lasting no more than about 3 years. One consequence of this is that the study period was not long enough for cervical cancer to develop in any of the subjects, so that Gardasil’s “effectiveness” as established in those studies relates not to the prevention of cancer but to the prevention of cervical precancerous lesions - it may be highly likely that preventing the HPV-related lesions will prevent the cancers, but the studies did not in fact test this because they were cut short.
• Nobody has undertaken any research on how long the protection might last or whether a booster might be needed. No booster has been developed or approved. This gives rise to some questions. What if protection only lasts for, say, 5 to 10 years? Are girls to be vaccinated aged 11 and then find that their protection wears off by age 16 to 21, just when they need it the most because they are most likely to be getting off with loads of people? If a booster is needed, how long will it be before one is developed and approved? Will the booster arrive on time. If not, what then?
• Adverse reactions rarely make the headlines but they do happen, as with all vaccines. Common reactions (i.e. more than 1%, and more likely to occur in the test group than the control group given a placebo) include: soreness at the vaccination site, swelling, erythema (redness or inflammation), fever, nausea, pruritis (itching), and dizziness. These reactions are described as “mild and moderate” by the FDA. Other, more serious reactions have occurred - and the sample sizes have been too small to identify whether there may be any really rare but actually life-threatening reactions.
  

Here’s something else to bear in mind. A lot of the “anti-HPV” sentiment you will see in the media focusses on the fear that little girls who are vaccinated against a sexually transmitted disease might decide they have a free pass to go out and be promiscuous and reckless. I’ve already commented on the stupidity of this objection in this old post. I think it’s also worth mentioning that this promiscuity objection is the only one you will normally see in media reports - perhaps it is juicier than the real problems with this vaccine. It is also the one that immediately springs to the average punter’s mind when reminded that the vaccination is “controversial” or “hotly debated”.

What are less often cited are objections based on public health concerns, which - you would think - are what we should actually care about and are what people who actually do care about women more than money are raising. Here are the main objections that I have come across, even excluding the concerns about this vaccine’s unproven safety and efficacy as noted above:

• It is likely that many women having had a “cervical cancer jab” (as it is marketed - it is in fact an HPV jab) will not bother with smear tests. But smears will still be essential to detect the many cervical cancers that this vaccine will not prevent. And smears will still be essential in the long term in any event, given that we do not know how long the vaccine’s protection will last - would you trust a vaccine to protect you for life, when studies only followed their subjects for about 3 years? No, perhaps not - but many people would. The result could be that while we eliminate around 70% of cervical cancers for the (unknown) period of protection we suddenly find that instead, we end up failing to diagnose a lot of cancer that will still develop in time to treat them - either because they were cases not affected by the vaccine in the first place, or because the vaccine has worn off. The incidence of cervical cancer could even go up.
• This vaccine is given by a course of three shots over a six month period. One of the reasons normally cited for insisting that children should be given MMR rather than single jabs has always been that if you have to undergo a course of three shots the chances of a child completing the course are very much reduced. That is going to be an even bigger problem if the vaccinations are to be given through schools - what if the child is off sick on the relevant day? - you can bet the nurse won’t be coming in specially, just to jab the stragglers. What will happen is that a significant number of children will run the risks of undergoing this vaccination without getting the benefit because they do not complete the course.
• There will be another large chunk of the population who get the jab but do not get any protection because they already have the relevant HPV strain(s). They will think they are protected, but they are not. The only way to tell whether a girl or woman has the strain is to do a vaginal swab - are we going to do that for 11 year olds? I don’t think so.
• This vaccination costs $360, roughly £200, for the course of three shots. Multiply that by, say, a million children per year, and add in the staff costs and other overheads involved in distributing and administering the vaccination. How far would that NHS money go towards the fight against other diseases - things like lung cancer and heart disease - which are much bigger killers of women than cervical cancer will ever be?
• Most women and girls fight off the HPV vaccine using their natural defences. Far more are infected with HPV than ever develop precancerous lesions or cervical cancer. We just don’t know whether this vaccine might interfere with our natural protection, and we just don’t know what public health consequences might flow from that.
• Boys get HPV too. Why are only girls being expected to take this vaccine? Boys get HPV with just as much frequency as girls do, if not more so. Boys and men can contract genital warts and cancers as a result of such infection - Are boys missing out on vital protection? Or are girls standing in as guinea pigs in a great big public health experiment? Are we, and our daughters, being vaccinated for the benefit of men?

I don’t pretend to know whether it is a good idea for a girl to have an HPV vaccine. It might be as safe and effective as we are told. The concerns expressed might be outweighed by the benefits. The point is - hardly anyone is talking about these questions; and NOBODY knows the answers.

Two heroes in the fight for truth and beauty are Diane Harper and her media ally Cindy Bevington. I urge you to read the following articles:

Researcher blasts HPV marketing - 14 March 2007
Researcher adds to vaccine comments - 21 March 2007
Legislators misguided about vaccine, researcher says - 21 March 2007
Medical journal sides with HPV scientist - 11 May 2007

I also urge you to read Grace Householder’s article detailing her interview with pro-Merck researcher Darron Brown: IU researcher claims Gardasil is “safest vaccine” - 11 April 2007 as well as an editorial which I suspect she also wrote: Ten reasons why HPV vaccine is “murky” issue - 4 February 2007.

Other sources:
FDA approval announcement - 8 June 2006
Medical News Today - 3 November 2006
eMaxHealth article - undated
How Stuff Works article - undated (warning - this article should be subtitled: “America’s Shut-the-Fuck-Up Guide to Medicine the Patriarchal Way”)

and, of course, Sparkle*Matrix - here and here.

 

Doctor Switchblade

Oh my.

Here is a nice man who looks after labouring women. My own words are failing me, so I’m just going to give you his (via Twisty):

I never understood (and still don’t understand) why a birthing woman in pain would not want pain control any less than a person with appendicitis would not want anesthesia for an appendectomy.

Curiously, the women who pressed for epidural free labor were of two sorts, upper middle class white women or young Hispanic girls.

Patients in the first group seemed to be in search of some New Age birthing experience, convinced that the resources used by lesser women would somehow be unfulfilling for them… They often spoke of a desire to bond with their baby or a need to feel the pain of childbirth, neither of which made any sense to me… The small percentage who did succeed without epidurals nearly always traumatized the rest of the delivery floor with hours of yelling and crying.

The second group demurred epidurals simply because they received bad medical advice. Most of the Hispanic girls came from community centers managed by certified nurse midwives (CNMs), nursing “specialists” perhaps even more incompetent than CRNAs (how OB-GYNs tolerate them I do not know; they’re acerbic, ignorant and foolhardy and generally built like linebackers). For some reason, CNMs preach a sort of gospel of minimalism when it comes to childbirth…

… some educated women choose to play Russian roulette with their children and shun conventional medicine in favor of ridiculous New Age birthing plans. It simply doesn’t make any sense to me. I understand why young, Hispanic girls with limited education get bamboozled by CNMs to forego modern medicine and its accoutrements, but New Age yuppie mothers-to-be simply have no excuses….

Now, Gentle Reader, I’m not a woman, but I’ve worked around laboring women long enough to learn what is worthwhile and what is not. For a safe and satisfying birthing process, here are my recommendations: 1) avoid nurse midwives because they’re ill-educated and dangerous; 2) don’t waste money on doulas, yoga balls or hot tubs; 3) make sure that an anesthesiologist is controlling your pain (in Wyoming or the backwoods of Tennessee, anesthesia nurses often masquerade as anesthesiologists); 4) get an epidural as early as possible, for the safety of you and your baby and the mental health of those around you (to do otherwise is irresponsible and simply crazy).

In response to comments (including a number from qualified health professionals) asking whether the good doctor had read the research on natural childbirth, wondering whether his lack of experience and his lack of any genuine dialogue with mothers who seek to avoid medicalised births should get in the way of his expressing an opinion on their motives, and asking whether he knows much about the positive experiences that many women do have of natural births, he replied:

• you’re obviously referring to the childbirth research found in “The Archives of Retarded Nurses”….Personally, I’m tired of having to manage precarious medical situations (that are wholly avoidable!) because New Age mothers prefer to be irresponsible and are encouraged to be so by insufferable clowns such as yourself who have no expertise in anything apart from being obnoxious and dispensing bad quasi-medical advice. You do a huge disservice by drawing patients away from the mainstream.
• I really don’t think that I need to actually give birth in order to realize that shunning modern medicine in favor of “natural” childbirth is both stupid and dangerous… I’m also guessing that you’re autistic. Keep up the fine work, you inbulbitating underwhelp.
• Bleeding to death at home in the bath tub isn’t exactly a positive experience.
• You’re insane. I pity your children.
• Words such as “empowering” let us all know that you’re a New Age wack job.
• Rock on, you para-medical professional.

In response to commenters who asked for evidence that epidurals are safer than undrugged deliveries, or even an explanation as to why this might be so, or asking how many actual labours he had witnessed from start to finish, he replied:

• …
• These aren’t exactly an educated bunch that I’m dealing with here. It’s no use, I’m finding, to contend with the issues in a rational manner.

And finally: Epidurals make it so you can give surgical anesthesia quickly and safety in case a C-section is needed. If you don’t have an epidural it’s a dog and pony show and you have to do a rapid sequence intubation, general anesthesia (big risk of aspiration, baby gets sedated), etc

That’s it? That’s the ONE medical reason he can come up with why it is stupid, dangerous irresponsible, crazy, inexplicable, insane, and a whole lot of other stinky things, to decide against a routine epidural? Because in the event of an emergency C-section (often caused by a lack of proper support in the first place, I might add) it makes the anaesthetist’s job harder?

Oh, and the man thought he would say hello at Twisty’s place too: This is apparently a blog which caters to rabid (and exceedingly retarded) lesbian manhaters.

Nice work. Hateful, I would call it. Hateful. Apparently he is an actual doctor. I wonder how many other actual doctors think this way too?

 

How to avoid a Caesarean

A recent article in the British Medical Journal (click here for an abstract, and here or here for a summary of and commentary on the contents - BMJ don’t let you read for free!)

In short, the article says that too many Caesareans are being performed on women in emergency situations where these are unnecessary. Surprise!!

Over a third of all Caesareans, for example, are carried out because of a failure to progress, and in more than half of these cases the obstetrician did not even attempt a vaginal delivery using forceps or ventouse. Many consultants will reverse the decision of a more junior doctor to go for a Cesaerean and will then successfully deliver the baby using forceps or ventouse.

What can we conclude from this?

The authors conclude that more experienced, more skilled obstetricians are needed because the junior doctors are letting their patients down. There is almost certainly some truth in this - and I would not argue about whether junior doctors are letting their patients down if they routinely promote Cesaerean delivery without first exploring the option of assisted vaginal delivery properly.

However, I think what may be more interesting is what the authors did not conclude. For example, there was no discussion it seems of whether “failure to progress” is even a proper ground for surgical intervention. What does “failure to progress” mean, anyway? Only that the delivery is not proceeding quickly enough for the liking of the doctors. If a relatively junior obstetrician doesn’t have the time to let labour take its natural course, what hope would mothers have relying on the even busier, even more self-important consultants?

Why not try getting rid of the doctors altogether, for a while at least, to let the mother relax somewhere peaceful with a patient, calm midwife to encourage and support her, and to guide her journey with respect? Why, if doctors are getting it so badly wrong, is the “obvious” solution that we just need more and better doctors? Don’t many (most?!) of these women just need more time, and more space, and a better environment in which to bring forth a miraculous new person?

 

Sexual morality, vaccinations and the USA

It has long been a legitimate source of feminist outrage in the United States that social conservatives oppose moves to make the HPV vaccine - which protects against cervical cancer - mandatory, and thus a part of the routine vaccinations given to pre-pubescent girls.

The reason is that the vaccine works by boosting immunity to a cancer-causing virus which is sexually transmitted. (Apparently, it is the same virus that causes genital warts.) Moreover, the vaccine apparently works best if given to girls before they become sexually active, and therefore it is suggested that it should be administered to pre-teens - say, in the range 10-12 years.

This has the social conservatives up in arms. That girls might become sexually active at such a young age is horrible enough, they say, but this should not be “encouraged” by the state giving them a free pass. Pre-pubescent girls might start to think: Hey, I’m all vaccinated up and protected. It’s now perfectly safe for me go out and have sex as much as I want. The doctor said it’s OK. Let’s party!

If you don’t believe that people think this, then just take the comments cited in this May 2006 ABC article as an example:

But beyond the medicine, there are questions about who should get the vaccine and when… conservative family groups say parents should have a choice.”This is a disease that’s sexually transmitted,” said Linda Klepacki, spokeswoman for Focus on the Family. “Because of that, this is a very personal subject and we feel parents should make that decision for their children.”

Other opponents go further. Hal Wallace, head of the Physicians Consortium, says the vaccine would send kids a message that, “you just take this shot and you can be as sexually promiscuous as you want.”

Last year, a Centers for Disease Control and Prevention study found 11 percent of physicians worried that the vaccine might encourage more risky sexual behavior…

Is this not completely insane? Don’t give kids protection against cancer in case it makes them feel safe to have sex?

While we’re at it, let’s not make condoms available - or any contraception at all, that would be better, certainly not emergency contraception. And let’s not bother with sex education either, at least we’ll pretend to do sex ed and really we’ll just tell’em all to say No. Otherwise they might get all loose-moralled and start having sex outside marriage and then we’d really be in trouble.

Oh wait, the social conservatives in the USA already support that notion. They already enforce it wherever they can. Thank God I don’t live there.

As Angry Black Bitch so eloquently puts it in a post earlier this month: “We are at war with a movement prepared to see us die rather than live outside of their strict moral code.”

Since when did fear of disease really stop people from having sex anyway? Fear of disease, when coupled with strong safe-sex campaigns can make people more aware of the need to use protection (the use-condoms-or-get-AIDS ads of my youth worked on me, anyway). But it doesn’t make people abstain. It just doesn’t work. Just look at the AIDS epidemic throughout Africa - where the Catholic church’s refusal to support safe sex campaigns, and insistence on abstinence-only preaching, has had devestating consequences.

For various reasons, despite my interest in both feminist issues and vaccination policy* I hadn’t got around to blogging about this topic before.

(* See this post for a round-up of my other posts on the subject of vaccinations - and maybe I will add this to the sidebar too - watch this space)

Mainly, this is because it’s definitely more of an Across The Pond issue, where the sexual morality police are much stronger and more commonplace than is the case here in the UK. But also, I was kind of conflicted after my own research into vaccinations about what I really thought about yet another one being pushed on children universally. I don’t agree that vaccines should be mandatory, because I believe in informed, indivdual choice, so I’ve been uncomfortable about the whole question.

However, said Angry Black Bitch post - which I came across today - has stung me into action.

In the UK it is very easy to speak of informed patient choice and to chatter about how we should none of us be forced into having any vaccinations we do not want. It is very easy to criticise people who insist that vaccinations should be universal and compulsory as they are in other countries such as the USA. The only area of debate around mandatory-or-not is in the sphere of public health in the case of infectious diseases. Short of evidence to support the herd immunity theory, which does not appear to be forthcoming, there is little that a mandatory-vaccine supporter can do or say to plead their case.

In the USA, it’s not quite so simple.

If a vaccine is mandatory, everybody gets it. Even poor people, who get it free on Medicaid. They don’t get any choice about it, but they do get it.

If a vaccine is licenced but not mandatory, not everybody gets it. Those who can afford it and want it will get it. Those who could afford it but have other things to spend their money on, will understandably allow financial considerations to affect their judgement about whether or not to get it: many will reason that if it was that important, the state would mandate it and therefore that it is no big deal. And those who cannot afford it just won’t get it. No choice.

So a decision whether to mandate the vaccine is only a decision about choice when it comes to rich people. For the less well-off, it is a decision about what choice to make for them. Either way, poorer people get no choice. And that stinks.

This comment by Farmer Tracy sums it up neatly:

“It is totally outrageous and incredibly racist that being on Medicaid means that you can’t make your own health care choices, and that you are either denied a potentially life saving vaccine or forced to get one against your will. HPV can cause cancer, and childhood vaccinations may cause autism. But it scares the HELL out of me that people can’t make those choices themselves. We’re talking about the government and corporations duking it out over what can happen to OUR bodies, and saying, “Poor people of America, we’ll sorta help you out, but only if you listen to us because we know what’s best.” I am not advocating libertarianism — nobody should have to pay for health care in my radical opinion. But to me the war isn’t about protecting poor folks’ right to not get cancer, it’s about protecting their ability to decide what’s best for themselves.”

Hear, hear.

And what stinks more is that by pretending that the argument is about whether abstinence-only parents should have the choice to avoid sex-mania-inducing vaccines, these conservatives are hiding the fact that it is really about whether poor children should be denied access to potentially life-saving vaccines. Now that really stinks.

 

Some Top Three Countdowns

According to the ONS, the most common causes of death for women in the UK are: circulatory diseases (including heart disease and strokes), then cancer, then respiratory disease (e.g. pneumonia). For men, the top three causes are the same: circulatory diseases, then cancer, then respiratory disease.

I’ve taken a more detailed look at cancer specifically (based on statistics from the Scottish NHS website and from the ONS).

The most common cancers suffered by women are breast, lung and colorectal cancers. The most common cancers suffered by men are prostate, lung and colorectal cancers. Other cancer sites, including all the other sex-specific cancers, are numerically quite a way behind all of these.

It strikes me from this that, although there certainly are material differences between the numbers and prorportions for causes of death and cancer incidence for women and men, the differences are less stark than I for one had expected.

Both women and men are massively affected by heart disease, for example. Both women and men suffer from high rates of lung cancer and colorectal cancer. So “Women’s health” needs to mean more than wearing pink ribbons and doing the Race for Life because, however much we might prefer to focus on exclusively* female problems, there has to be a point at which we need to fight our corner in other areas too.

* Well, nearly exclusively. Men can get breast cancer too, just that it’s in underwhelming numbers so it isn’t a very visible issue.

 

Women’s health / Health for women

When you hear the words “Women’s Health”, what do you think about?

Chances are, you think about what you are conditioned to think of as women’s health issues: diseases affecting women only (or women disproportionately) and life changes affecting women only (or women disproportionately).

Thus, women’s health means stuff to do with menstruation, fertility, pregnancy and childbirth, and menopause. It means cancers and other diseases affecting the breasts, uterus, ovaries and other girly bits. It means migraines and headaches, and it means eating disorders and weight problems, and it might even mean STDs.

(Whatever “Women’s Health” may mean to you, it does not seem to mean a lot to the NHS. On the NHS Direct website, the section on Women’s Health is almost laughable. There are a few “commonly asked questions” relating to sex and fertility, menstruation and motherhood, one on herceptin, the breast cancer drug, and then - bear in mind that there are only 19 questions listed altogether - three questions on “beauty”! How do I go about getting a breast enlargement? How can I sizzle with style on a budget? How can I get my legs looking lovely? I may have some scathing things to say about all this in future posts, and about the fact that I could not find almost no other NHS information online specifically aimed at women.)

I do wonder whether this conception of women’s health issues as being more or less exclusively about “women-only” issues is itself harmful. Heart disease, for example, is a major killer of women in this country, but it does not affect the girly bits so it is not generally the first thing that springs to mind when thinking of women’s health problems.

Does this focus on women-only health issues prevent us from thinking hard enough about wider health issues that affect both women and men Does it lead to women being marginalised, or left out of consideration entirely, in relation to those wider health problems? Maybe we are better off thinking of Health issues for women rather than Women’s health issues so that we remember that women amount to more than just their sex-specific organs and conditions.

Unlike the NHS websites, the BBC does at least have a significant amount of space devoted to Women’s Health, albeit that the content is largely restricted I think by the same limited view of what counts as a health issue for women.

So in the BBC’s section on women’s health, we find a selection of the “Health Issues” (i.e. “The most common illnesses and conditions affecting women”) in which women are expected to be most interested: Anaemia; Breast cancer; Cervical cancer; Ovarian cancer; Vulval cancer; Womb cancer; Endometriosis; Fibroids; Heart disease; Osteoporosis; PCOS; Alcohol; Smoking; Cervical smear test. The only Health Issues mentioned by the BBC which are not exclusively or disproportionately “female problems” are heart disease, alcohol and smoking. (Note - there are other sections in the Women’s Health area dealing exclusively with reproductive and sexual health!)

What in fact are the most common causes of female deaths in this country? What are the most common cancers suffered by women? What are the most common illnesses suffered by women? Does this picture really reflect the BBC’s selection of women’s 14 top “health issues”? Are we really restricted even in illness to specifically “female” problems?