Defunding Planned Parenthood Is About More Than Abortion

So now we want to defund Planned Parenthood? I’m always interested in how our legislators apply critical thinking to their decisions.     I’ve been taught that when making decisions, you look at all possible implications of the decision. You look at all ramifications, all of the pros and cons. So I’m trying to understand the logic here.

Of course, the issue is that Planned Parenthood performs abortions. Abortions are performed in other places as well, but Planned Parenthood is up front about it. However, abortions only constitute 3% of Planned Parenthood’s care delivery.  The reality is that 80% of services provided by Planned Parenthood prevent unwanted pregnancies.  They provide confidential contraceptive services to women who could not afford it anywhere else. Most of the patients who take advantage of Planned Parenthood’s services have incomes below the poverty level.  Planned Parenthood serves men as well as women.  The organization provides evaluation and treatment for sexually transmitted diseases, provides education to help patients makes responsible sexual decisions, and provides sex education. About 7% of their services involve cancer prevention. They perform breast exams, pelvic exams and PAP smears and vaccinations for human papilloma virus.

Abortion is a controversial issue. But abortions will not stop if Planned Parenthood is defunded. SAFE abortions will stop. If men and women don’t have access to affordable sexual health care and contraception, there will be more unwanted pregnancies.

There is more to this than the focus on abortion because that’s a small part of what Planned Parenthood does.  Defunding Planned Parenthood will primarily affect poor women. Women who have financial resources go to private gynecologists. Though many lower income people now have medicaid, not all do. Many private doctors don’t take medicaid.   This is a not-so-subtle slap in the face to women who have few resources. Many legislators seem to believe that people who are poor (yes that’s probably not a politically correct term) don’t deserve help. They believe that people who live below the poverty level are there because it is their own fault. It’s much more complicated than that.  Most legislators, including our new billionaire President-elect Donald Trump, have no clue how low-income people live day to day.

The logic is interesting. We don’t want women to have access to abortion, and we don’t want them to have affordable access to sexual health care to prevent unwanted pregnancy, and we don’t want them to be on welfare after they have the unplanned babies that they didn’t want in the first place but had because they weren’t on the birth control that could have been provided by Planned Parenthood. That makes a lot of sense.

The lack of concern on the part of our lawmakers and our citizens in my state of Kentucky for those who are struggling appalls me. The defunding of Planned Parenthood is just one example.

Hmmm. . .  I think we have a major deficit of critical thinking here.  It seems to me that our legislators have very little understanding of the complexities of poverty and the lives of many women.

Not Just Any News

Medical news that has an impact on your life. 

Results from a study presented at the European College of Neuropsychopharmacology in Vienna created a buzz in medical news recently. The study was done at the University of Siena College of Medicine, and Dr. Andrea Fagiolini was the lead investigator. The study found that serum testosterone levels, and therefore sexual desire, significantly increased in men after 2 weeks of exposure to a light box for 30 minutes per day.

The study included 39 men who had been referred for treatment for hypoactive sexual desire. Their testosterone levels were measured prior to start of the study. The men were given the Structured Clinical Interview for DSM 5 sexual disorders and a rating scale for sexual satisfaction. They were divided into 2 groups. One group received active treatment which consisted of 30 minutes upon rising in the morning sitting in front of a light box at one meter from the cornea with a UV filter rated at 10,000 lux. The placebo group also spent 30 min. in front of a light box, but the intensity was only 100 lux. After 2 weeks, testosterone levels had risen significantly in the active treatment group, while there was no change in the placebo group. The men in the active treatment group reported an increase in sexual satisfaction.  By scientific standards, the change was considered significant.

According to Dr. Fagiolini, testosterone levels naturally decline during the winter months in the northern hemisphere.  Therefore, it makes sense that testosterone levels are somewhat influenced by light.

Certainly the study does have limitations. There were a small number of study subjects. It needs to be replicated. It would be interesting to know how long the increased libido lasted after the study was completed.  Also, does the effect continue if the light therapy is continued longer term?

Light therapy has been shown to be effective for depression, particularly seasonal depressions that are worse in winter. Is it possible that some of these men were depressed? That was not evaluated. Perhaps now there is more than one benefit from light therapy at least for men. Could that benefit extend to women?  A cheap alternative to Viagra would be welcomed by men and women.

The above study was reported by Liam Davenport at Medscape.com on Sept. 20, 2016.

This week, the American Academy of Pediatrics called for formal restrictions on the use of codeine in children. The FDA issued a safety alert on codeine in 2012, and required a black box warning in 2013. There have been serious, adverse respiratory reactions in children using codeine for pain or in cough syrup.  Codeine is converted to morphine when metabolized. There is a lot of genetic variability in how this drug is metabolized; some patients are ultra-rapid metabolizers, therefore their blood levels will rise quickly. They are very susceptible to respiratory depression (slowed breathing which can lead to low oxygen and death). Children and people with sleep apnea are especially likely to be ultra-rapid metabolizers.

Surprisingly, codeine is available without a prescription in cough medicine in 28 states.  So the message here is to avoid using codeine containing cough medication for your children and ask questions even when your pediatrician wants to prescribe it.

You can read more about this study, reported by Troy Brown, RN, at Medscape.com.

 

 

Let’s Talk About Hepatitis C

You’ve probably seen the advertisements for Harvoni, the new medication for Hepatitis C.  Hepatitis C has become more and more common with the rising incidence of IV drug use. About 2.7-3.9 million people in the US have chronic Hepatitis C.  That means that if you don’t have Hepatitis C yourself, you probably know someone who does.

In order to understand how Harvoni works, it helps to understand some things about Hepatitis C. Most people don’t really know the difference between Hepatitis A, B, and C.  They are caused by 3 different viruses. Infection from the Hepatitis A virus usually comes from contaminated food or water. It can be passed through feces.  It’s usually an acute infection that does not become chronic. Hepatitis B virus infection usually occurs when blood or body fluids, such as semen from an infected person, enter the body of an uninfected person. This can occur when IV drug users share needles with other users. Hepatitis B can also be transmitted during birth to the newborn from an infected mother or through sexual contact. Hepatitis B can become chronic though it doesn’t always happen. There are vaccines to prevent hepatitis A and B, but not Hepatitis C.

Hepatitis C is acquired through blood to blood transmission. It can be sexually transmitted if there is some blood/blood exchange, but that isn’t common. The most common cause of Hepatitis C is IV drug use. Hepatitis C can be transmitted to a newborn during birth. Rarely transmission could occur if a non-infected person uses a razor that has blood from an infected person, or if somehow blood from an infected person enters an open wound of a non-infected person, for example needle-sticks in the health care setting.  It can be acquired through tattoos is the tattoo needle was not cleaned properly and has the blood of someone with hepatitis C on it.  People who received blood transfusions or organ transplants before 1992 are at risk because there was no screening for HIV and hepatitis C in blood donors before that.

Common symptoms of Hepatitis C are decreased appetite, abdominal pain, dark urine, or light, grayish stools, or jaundice.

Harvoni is unique in that the dose is only one pill per day. Several years ago, when hepatitis C was treated with interferon, ribavirin, and proteases, patients took up to 18 pills per day and the chance of cure was not that impressive. So a 95 % cure rate with a dose of only one pill per day is pretty amazing. However, there are some caveats.

First of all, patients need to be tested to determine the genotype of their Hepatitis C virus. There are 6 different “strains” of Hepatitis C virus. The most common strain in the US is Genotype 1. Harvoni is effective with genotype 1 Hepatitis C.  Most patients need to take it for 12 weeks though sometimes it only takes 8 weeks.  Or course, people who are generally healthy other than the Hepatitis C usually have the best response.  In January, 2016, two more medications were approved that are effective for the other genotypes. They are just becoming available. So Hepatitis C can be cured.

There are some side effects. Most people taking any of these hepatitis medications feel tired. Some patients feel a little weak or lightheaded or foggy in their thinking.  With the older medications, such as interferon, there was an incidence of severe depression. That is less common with the new medications.

Unfortunately, it can be difficult to get insurance companies to pay for the new drugs until the person has fairly advanced disease. That makes no sense because people are more likely to respond quickly before they are extremely ill. But that’s how insurance companies operate.

If you have risk factors, it is definitely worth being tested for Hepatitis C. Most people don’t even know that they have it early in the course of the disease. Occasionally, some people can clear the virus without treatment. However, if you do have it, you need to be monitored. It can progress to cirrhosis if not treated.

NOT JUST ANY NEWS

Medical News that Impacts Your Life.

Week of July 11

It happened to Betty Crocker!!

Even Betty Crocker is not immune from recalls. Recently, General Mills announced a recall of two Betty Crocker cake mixes in the US – party rainbow chip and carrot cake mixes. The problem was the Wondra flour used to produce some ingredients in the cake mixes. The flour was recalled after the CDC found E. coli contamination in June. The contaminated flour caused sickness in 38 people.  That is only the latest in a series of E. coli recalls. Remember the recent problems with produce from Mexico.

E. coli is actually common bacteria, and is even found in our bowel. That strain of E coli does not cause illness to humans for the most part, though it can sometimes cause urinary tract infections. But there are over 700 strains of E. coli, and the one causing serious illness is E. coli O157:H7.  This particular E. coli strain releases a toxin called the Shiga toxin. The Shiga toxin is very similar to that released in Shigella infection.  As a matter of fact, one theory is that there was a transfer of genetic material from a Shigella bacterium to a common E. coli bacterium, and that launched E. coli O157:H7.

This strain of E. coli is very easily transmitted, and it doesn’t take a high concentration of the bacteria to make people really sick. The primary symptoms are severe abdominal pain and diarrhea which sometimes progresses to bloody diarrhea. Most people do recover, but those with weaker immune systems, such as the elderly, young children, or people with chronic illnesses, are more likely to die. Antibiotics don’t help, as a matter of fact they can sometimes make it worse. Supportive care is the main treatment. The development of hemolytic-uremic syndrome, which is the result of massive spread of the toxin, causes a shutdown of the kidneys due to small clots in the vessels supplying the kidney with blood.  Once the infection progresses to that point, it is often fatal.

This strain of E. coli has been found in the GI tract of cows and other animals. It ends up in raw meat. If the meat is undercooked, the potential for transmission is there. However, this is not the only source of E. coli O157:H7. It has been found in produce such as lettuce, spinach, carrots, and other field grown crops.  It makes sense the E. coli could end up in meat since it is primarily found in the GI tract of animals, but how does it end up in produce? Scientists think that the soil where the vegetables and fruits were grown was contaminated by manure from infected cattle or wild animals going through the fields leaving droppings or contamination of irrigation water with manure or droppings. However, there is not a definite answer to that question.

For more info about E. coli check out about-ecoli.com. There is a great section on prevention of E. coli infection. The primary method of prevention is fully cooking meat to 160 degrees F for 15 seconds and scrubbing vegetables and fruits.   The site points out that if someone in the house has diarrhea, special care should be taken to avoid contamination by using gloves when assisting that person and scrupulous hand washing.

 

NOT JUST ANY NEWS

Medical News that Impacts Your Life

Week of July 4, 2016

Physical Activity and Diabetes:  If you are pre-diabetic and frustrated because you haven’t lost weight, take heart. A new study from the Diabetes Prevention Program shows that for some individuals, 150 minutes of brisk walking activity per week reduced their risk of developing diabetes whether or not they actually lost weight. The even better news is that people who were inactive to start with were more likely to see this benefit.

Furthermore, the Diabetes Prevention Program just finished a 15-year study that took 3234 people who were pre-diabetic (overweight, middle aged, and with slightly elevated fasting blood glucose) and randomized them to 3 groups: placebo, medication only, or intensive lifestyle intervention. The placebo and medication groups received some basic instruction about diet initially. The medication group received metformin, a medication to lower blood sugar. The intensive lifestyle intervention group received 16 individual sessions on diet, exercise, and behavior modification plus a group session monthly.  They did not receive medication. The goal was for the intensive lifestyle patients to add 150 minutes of physical activity (usually brisk walking) per week to their regimen. Over the first 3 years, the patients in the intensive lifestyle group were 58% less likely to develop diabetes than those in the placebo group, and over 15 years, they were 27% less likely to develop diabetes.  So for some people it only delayed the onset of diabetes, but this is still a good thing.  You don’t have to be a marathon runner. Brisk walking for 150 minutes per week is possible. You could do 25 minutes per day 6 days per week and meet that goal.

Children and Sleep Apnea:  Most of you have probably heard of obstructive sleep apnea (OSA). It’s usually thought of as a disorder most common in adults. OSA occurs when throat muscles relax during sleep and cause the airway to close. As a result, your breathing stops and starts during the night. Snoring is the hallmark of OSA.  OSA can cause problems during the day such as sleepiness because of poor quality sleep, difficulty with concentration, depression, memory problems, and heart problems. The heart problems occur because, due to the off and on breathing, your oxygen saturation gets very low during the night. This causes the heart to have to work harder to get oxygen to your organs.

OSA can occur in children. At a recent meeting of the Associated Professional Sleep Societies, Sara Honaker, Ph.D., reported on a study showing that the rate at which pediatricians are identifying OSA in children is extremely low. This isn’t because OSA is rare in children; the pediatricians are not properly screening for the disorder. The American Academy of Pediatrics and the America Academy of Sleep Medicine both recommend that children with frequent snoring be referred for an evaluation for OSA. Snoring more than 3 nights per week is a strong indicator of OSA.  Children are subject to the same problems related to OSA as adults are.

If your child seems to snore frequently, talk to your pediatrician about Obstructive Sleep Apnea.