A Frank Ob/Gyn's Message

An honest assessment of all things medical and ethical.

Archive for the month “December, 2011”

Are pregnancy and childbirth good for my health?

In light of the Christmas season, we’ll discuss some of the little appreciated health benefits of having children. Too often, we are given the impression that pregnancy and childbirth is in one way or another a health detriment and burden. However, few people are aware of the ways in which their physical and psychological health benefits from childbirth.

According to national health statistics, approximately one in eight American women will have breast cancer in her lifetime and accordingly an estimated 175,000 women are diagnosed with breast cancer in the U.S. Each year. These numbers have led in recent years to a numerous well-publicized campaigns to educate women on breast cancer prevention and treatment. However, have you ever heard or read in any of these public discussions the fact that having a full-term pregnancy has been linked to a decrease in breast cancer risk? It’s true, and the earlier in life the pregnancy the better. For example, the World Health Organization’s published study of 250,000 women from around the world found that those who have their first child by age 18 have only about one-third the risk of breast cancer faced by women whose first birth occurs at age 35 or later. Similarly, another large study published in 1989 by the Centers for Disease Control examined data from eight U.S. cancer registries and found that lactation (breast-feeding) also plays a role in reducing breast cancer. The data showed that the more children a woman had and the longer the duration of breast-feeding after birth, the lower her risk of developing breast cancer―a point I routinely discuss with my patients.

But wait, there’s more! Pregnancy and childbirth have also shown preventative benefit against ovarian and endometrial cancer. Studies consistently show that women who have never had children are at least twice as likely to develop ovarian cancer as compared to those who have given birth.. In a similar pattern as seen with breast cancer, the more full-term pregnancies a woman has, the lower her risk of ovarian cancer. Ironically, birth control hawkers will readily argue that the pill reduces the risk of ovarian cancer in part because of a “pregnancy-like” effect on preventing ovulation. However, they are shamefully silent and remiss in their responsibility to warn women that this same pill has the opposite effect of pregnancy in terms of the even more common breast cancer.

In the not too distant past (1995), the U.S. Department of Health and Human Services once admitted that “childbearing is the most important known factor in preventing ovarian cancer.” Further still, studies have repeated the theme, wherein having children and more of them also decreases a woman’s risk of endometrial cancer.

Finally, we need also to appreciate that childbirth has a notably positive impact on a woman’s mental health. A 1992 Canadian study that examined more than 1,000 women health care workers, lawyers, engineers and accountants found that married women with children had the highest levels of psychological well-being compared to married and single women who did not have children. A Finnish study examining all women of reproductive age over a seven-year period revealed that women who carried to term were half as likely to die within the following year as women who had not been pregnant, even more striking―they were three-and-a-half times less likely to die as women who underwent induced abortions.

In summary, I’m not suggesting we see children as a mere means to improving women’s health (as a utilitarian might argue). Rather, we need to see through the lies that suggest children are a terrible burden and threat to a woman’s health. What better time of year than now to reflect on how much we can be blessed through that humble event of a child’s birth.

–Dr. Frank (Ob/Gyn)

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Are condoms as safe as filtered cigarettes?

During my training, I remember dreading those patient visits where I was expected to provide “safe sex” counseling to my patients. It wasn’t necessarily the awkwardness of speaking about such matters to a complete stranger so much as it was the difficult position of trying to meet the expectations of my evaluators without personally contributing to this irrational and flawed set of beliefs held by the “secular” medical establishment. Ironically, the ones promoting biased, false, and misleading information are not the abstinence-based programs, but the condom devotees who arrogantly discredit such abstinence-based programs as failing to provide medically accurate material. In other words, the most scientifically accurate answer to the problem of sexually transmitted diseases and so-called “unwanted” pregnancies is not a wider distribution of condoms and more promulgation of condom awareness. Undeterred by objective data to the contrary, we are still taught “if only we have enough faith in condoms, we will be saved; don’t get bogged down and encumbered by scientific data, just believe and you will see…” What is the fruit of the worldwide conversion of hearts to a sincere faith in latex? Are we still cursed with HIV and AIDS because there remain a few infidels who obstinately insist on that dreary scientific evidence showing that self-mastery and marital fidelity is the real answer?

Consider the following epidemiologic data. In 1987 (shortly after the discovery of HIV), two Asian nations of similar population had approximately the same number of HIV patients. In Thailand there were 112 cases and in the Philippines there were slightly more—135 cases. Over the next 16 years, these two countries approached the problem with very different tactics. The government of Thailand embraced the theology of condoms and successfully implemented a “100% condom use” campaign wherein every man, woman, and child had ready access to a superabundance of condoms and where thoroughly indoctrinated on the apparent benefits of latex barriers. In the Philippines, however, something very unusual happened when their government rejected the internationally popular condom movement and decided instead to promote sexual abstinence and marital fidelity. How did these two radically different tactics fair? By 2003, Thailand had 570,000 people with HIV, whereas the Philippines had 9,000 people with HIV. In other words, the rate of HIV was 80 times higher in Thailand! Fortunately, this remarkable contrast didn’t go unnoticed by all of the mainstream media. A 2003 New York Times article in 2003 reported on this unexpected data in the Philippines. However, the author was clearly perplexed and unable to see the logic and reason behind it. In pitiful desperation, he suggests a theory that prostitutes in the Philippines must be less promiscuous! Would he further conclude that we should encourage prostitutes to be more chaste, all the while standing by the belief that teaching the same to school children is irresponsible and dangerous? Absurdity upon absurdity. Could anyone really believe that the HIV rate in a country saturated with condoms is 80 times higher simply because it’s prostitutes are more promiscuous than the prostitutes in a neighboring country where condoms are far more sparse? Even this far-fetched idea supports the concept that behavior is a far more influential factor than material barriers in the spread of this deadly disease.

The medical community has had to reform itself in a similar way over the past century with another issue. I speak now of a behavior that is even more habit-forming than the various sexual behaviors so vigorously promoted by the more influential members of modern society—cigarette smoking. When physicians first recognized an association between smoking and lung disease, an early approach that gained widespread popularity was adding filters to the cigarettes. Since people were going to smoke anyway (so it seemed), what better solution could there be than “safe smoking.” What foolish and religious nonsense to think that you could ever convince people to stop smoking, especially since so many youth were beginning to smoke. I wonder if anyone ever thought of passing out filtered cigarettes in schools to protect the children of the close-minded parents who didn’t accept this new progressive wisdom. Surely someone must have come up with a plan to teach the more sheltered school children about all the different varieties of tobacco products and the various ways in which they could be ingested. Imagine how much danger these children would face if not given such life-saving “health” information?

Hindsight is 20/20. We have since learned that “safe smoking” with filtered cigarettes wasn’t so safe after all. It simply forced people to suck harder while drawing the smaller carcinogenic smoke particles to deeper parts of the lungs. We then saw a shift from cancer in the large airways (like the trachea and bronchi), to the smaller airways (like the alveoli). Guess which cancer was more deadly. Yes, the ones involving the smaller airways. Fortunately, the medical community recognized this and made a radical shift in policy. We decided that as challenging as this may be, we had to encourage people to fundamentally change their behavior and abstain from cigarettes altogether. It’s not an easy answer, but we unanimously agree that it is the only one we can with integrity endorse. In fact, a physician would be thoroughly condemned if he or she failed to counsel a smoking patient to quit such harmful behavior. The attention given to smoking cessation is now unrivaled among health advocacy topics; unrivaled except perhaps by the current “safe sex with condoms” campaigns. Let us hope that sound reason and logic can soon correct the false religion of salvation by latex.

Are condoms safe?

We’ve already reviewed some of the medical harms against women caused by hormonal contraception like the birth control pill. Today we’ll discuss why the condom-based “safe sex” propaganda campaigns are misleading and irresponsible. I frequently provide my patients with counseling on what is genuine “safe sex.” However, I’ve never endorsed the use of latex barriers as a means to make intercourse somehow “safe” or merely “safer” (as most contraception proselytizers have now been forced to concede).

As I’ve alluded to previously, seldom do we see such widespread faith and even religious zeal backing a belief in an idea that is consistently refuted by objective science. The idea I speak of is the notion that latex barriers in the form of condoms are the solution to the HIV epidemic and the answer to the unacceptably high rate of sexually transmitted diseases (STD’s). Anyone who dares to question the wisdom of this condom dogma is not only derided as an ignorant fool, but is even accused of contributing to the plight of those suffering from HIV and AIDS. I can think of no better example that the media’s unfounded attacks against Pope Benedict XVI when he has accurately pointed out the deficiencies of this condom-based approach.

 

A little background in undisputed effectiveness statistics should better illustrate my point. Medical textbooks and lay educational materials alike typically quote the effectiveness of male condoms at preventing pregnancy to be 85%. Accordingly, the “failure-rate” of condoms in terms of preventing pregnancy is reported to be 15% (meaning, of 100 women, 15 per year would become pregnant despite using condoms). The latest science of reproductive biology has shown us that on average women are only fertile for 2-5 days per month or 7-17% of the time. In other words, at least 83% of the time, a woman is infertile anyway (thus the basis for the fertility awareness methods frequently called natural family planning). In this context, the condom’s 85% effectiveness rate to prevent pregnancy is even less impressive.

What about STD’s? Two basic facts will help put this issue in better perspective. While a woman is capable of becoming pregnant only about 15% of the time, she is susceptible to STD infection 100% of the time. Furthermore, in the case of HIV infection, the HIV virus is about 500 times smaller than a sperm cell and up to 50 times smaller than “voids” (holes) in latex materials like gloves and condoms. Since these facts were first pointed out in 1993 by the latex expert, Dr. Roland (the editor of Rubber and Chemistry Technology) much damage control arguments have been made in attempt to refute this objective data. Among them, it is claimed that condoms are made to higher standards and that ionic charges help prevent the HIV particles from penetrating these microscopic holes in latex. Despite wild claims in their zealous defense of the salvation by latex dogma, they can no longer honestly claim that latex constitutes an impenetrable barrier to virus (like HIV). According to the few published studies on the effectiveness of condoms to reduce the transmission of HIV (by organizations heavily invested in condom campaigns no less), their data suggests about an 80% effectiveness per year. For example, the World Health Organization (WHO) has published an 80% effectiveness rate and the Planned Parenthood’s Guttmacher Institute has admitted this rate may be as low as 60%. Quite revealing is the curious fact that the Centers for Disease Control (CDC) whose website is bloated with statistical data of every stripe imaginable, has refused to post any statistics to support their repetitive claims that condoms are “highly effective” in preventing HIV.

Unfortunately, the data supporting a claim that condoms prevent other STD’s is more sparse and even less convincing than the data on HIV prevention. Next time, we’ll discuss what constitutes a truly responsible and medically accurate discussion of “safe sex.”

Sincerely,

Dr. Frank

 

What if my child has a terminal diagnosis?

This column is modified from a response written to a woman’s comment to my prior column “Is abortion ever necessary?” She explained that her physician was recommending a very premature delivery because of the child’s serious medical condition. The problem with this situation is that the likelihood of a child dying soon after delivery cannot justify a decision to arbitrarily choose to end the pregnancy and therefore the child’s life early.

As long as neither the mother’s health nor her child’s is endangered by continuing the pregnancy until term, an early delivery would not be necessary. The scenarios I wrote about are ones where both the child and mother’s health are in imminent danger. Sadly, there do indeed exist situations where prenatal ultrasound examinations can diagnose certain pathologies which indicate pre-born child is indeed likely to have a significantly shortened life after birth. Whether this is hours, days, or years depends on the severity of the disease and we can never be fully certain by mere ultrasound examinations before birth. Furthermore, the length of time the child may live after birth should have no bearing on how we treat that child in terms of provision of standard obstetric care. Frequently, however, women are advised to proceed with “termination,” one of the most popular euphemisms for induced abortion. The previously discussed examples appealing to the principle of double effect do not apply, because the only thing an early delivery would do in these situations is shorten the child’s life unnecessarily.

I fully appreciate that the motivations for an “early delivery” or “early termination” in the setting of a child with a “terminal diagnosis” are quite different when compared to the woman trying to undo an inconvenient or so-called “unplanned” pregnancy. I grieve with anyone whose child has a terminal diagnosis. We do well to recall, however, that each one of us have a terminal diagnosis. The only difference is that most of us don’t yet know our unique terminal diagnosis and when “approximately” it will take our earthly life. All we really have is the present and both you and your pre-born child are alive right now. In my experience, the problem with prenatal “terminal diagnoses” is that we start to treat the situation as if the child were already dead! Only in this context does “early termination” seem more palatable. Sadly death will come for us all, some much sooner than others. But let us not err in making ourselves a god by arbitrarily deciding where and when anyone should die.

In summary, I would not recommend a pre-term delivery for children with prenatally diagnosed lethal conditions, unless this becomes truly necessary to protect either the mother’s life or her child’s (although when necessary for the health of one it is usually necessary for the other as we discussed previously).

Sincerely,

Dr. Frank (Ob/Gyn)

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