A Frank Ob/Gyn's Message

An honest assessment of all things medical and ethical.

Archive for the month “March, 2012”

How the Irish are saving civilization…again!

I write today’s column with a sense of profound gratitude for my Irish heritage and for the privilege to write to the people of my ancestral homeland. Just two days in advance of celebrating Ireland’s most well known hero, St. Patrick, the Irish government issued a report confirming its affirmation of existing laws protecting preborn life–thereby rejecting recommendations and mounting pressure by the United Nations (UN) to legalize abortion on demand. Indeed, it appears the Irish are once again being called upon to save Western Civilization. 

Hypocrisy upon hypocrisy is the theme when one looks into the details of the international pressure and coercion to legalize abortion on demand. For starters, the two UN agencies most vocal in such efforts to increase abortion are the UN Committee against Torture and the UN Human Rights Council. These are the very bodies who should be doing the opposite and urging other countries to follow Ireland’s example of protecting the human rights of preborn children while simultaneously preventing the most frequent forms of torture against women and their children. During the UN Human Rights Councils so-called Universal Periodic Review process of Ireland last October, six member nations called on Ireland to follow their example of legalized abortion on demand. These were the United Kingdom (UK), Spain, Norway, Slovenia, Denmark, and the Netherlands. Before we examine some demographic statistics, bear in mind that the calls for such unrestricted abortion are increasingly being made on grounds of maternal health and safety. The idea being promoting is that legalizing abortion procedures makes them safer, hence the slogan “safe, legal abortion.” Even though countless repetitions of these three words together do not make it true, the shear repetition does deceive many— if only on a subconscious level.

 What does do the best data on maternal health as compiled by the UN’s own World Health Organization (WHO) show? Since Ireland is so “far behind” other European nations (especially the six aforementioned) in terms of women’s health, she should have the poorest record in maternal health, right? Wrong! Of the 172 nations in the WHO’s most recent report of 2010, Ireland ranked #2 in the world for lowest maternal mortality rate (MMR). Incidentally, Greece’s maternal mortality rate was slightly lower (by only 0.001 %) even though Irish women are having almost twice (1.75 times) the number of children. As for the six nations most arrogantly telling Ireland to follow their example of legalized abortion: Denmark ranked #5, Spain #6, Norway #7, Netherlands #9, UK #12 (MMR nearly triple that of Ireland), and Slovenia #18 (MMR nearly 4 times that of Ireland). The United States ranked #24 with a MMR 8 times higher than Ireland! For further perspective, of these nations I’ve described, the United States is the one whose birth rate is closest (though still lower) to the Irish.

 Clearly, a truly objective assessment of such data should prompt one to examine Ireland as a model for the rest of the world to follow in terms of women’s health. The UN Human Rights Council and the UN Committee against Torture would both be more worthy of their respective titles if only they will follow the wisdom of the courageous members of the Irish government who continue to defend Ireland’s constitutional protection for preborn children. Indeed, this time, not only western civilization, but the future of the entire world may depend on the courageous leadership from the Land of Saints and Scholars. Éirinn go Brách (Ireland forever)!

St. Patrick, pray for us!

–Dr. Frank

Is the Church against science?

Today, I’d like to address a frequently believed myth and bias against members of the Catholic faith. Namely, there is an ungrounded prejudice that faithful Catholics are somehow opposed to sound scientific thought, research, and advancement. Fortunately, nothing could be further from the truth.

History provides a record of more than 1000 years of tremendous scientific advancement achieved only because of, not despite, the tireless work of Catholic men and women, many of them priests, religious brothers, and religious sisters. The amazing fruits of modern science and technology that we usually take for granted today would not exist if not for contribution of this hard work inspired by a love of God and humanity. To the extent our society returns to a suppression of Catholics and their work in the public square, we will be suppressing further advancement of authentic science and good technology Worse, such a course would set us back into a more barbaric and inhumane culture.

Since current events and interest involved the life sciences, I’ll give a few examples among the hundreds of devout Catholics who have greatly contributed to this field. Dr. George Agricola (d. 1555) is considered the father of mineral sciences and wrote extensively on geology, mining, and smelting. Closest to my specialty, Gabriello Fallopio (d. 1562) a medical doctor and Catholic priest whose anatomy research also included the head, ears, and sinuses, is most famous for describing the tube leading from the ovary to the uterus which still bears his name—the Fallopian tube, where conception occurs. I still remember my university studies about the fascinating work of the Augustinian friar named Gregor Mendel (d. 1884), whose clever experiments with pea plants established the foundation for our understanding of genetics and inheritance (commonly known as Mendelian inheritance or genetics). Interestingly, this humble priest is now considered the “Father of Genetics” even among the militant atheists who might object to this honourable title of “Father” if they knew that in his earthly life he was addressed as “Father” by the faithful to whom he administered the sacraments.

The Scottish biologist, Sir Alexander Flemming (d. 1955) whose discovery of penicillin in 1928 later helped him earn the Nobel Prize in Medicine, was also a devoted Catholic, member of the Pontifical Academy of Sciences, and husband of Sarah Marion McElroy of Killala, Ireland. It has been estimated that well over 200 million lives have been saved with penicillin. To this day, we regularly use penicillin in during labor to prevent live-threatening infections in newborns. Finally, let us remember that great French chemist and microbiologist, Louis Pasteur, the “Father of Microbiology” whose name lives on in the “pasteurization” process to prolong the shelf-life of beverages. His epitaph reads “ Happy the man who bears within him a divinity, an ideal of beauty and obeys it; and ideal of art, and ideal of science, an ideal of country, and ideal of the virtues of the Gospel,” (translated from French).

“Faith and reason are like two wings on which the human spirit rises to the contemplation of truth; and God has placed in the human heart a desire to know the truth—in a word, to know himself—so that, by knowing and loving God, men and women may also come to the fullness of truth about themselves (cf. Ex 33:18; Ps 27:8-9; 63:2-3; Jn 14:8; 1 Jn 3:2),” (Faith and Reason, B. John Paul II)

Additional information on Catholic scientists can be found at the following links:

en.wikipedia.org/wiki/List_of_Roman_Catholic_cleric-scientists

en.wikipedia.org/wiki/List_of_Catholic_scientists

www.catholiclab.net

Sincerely,

–Dr. Frank

 

What is the da Vinci Robot?

Today, we’ll shift gears slightly and talk about some of the great advances in gynecologic surgery. Lest anyone mistake my appeal to sound medical ethics as a rejection of technology and innovation, I’d like to discuss a few modern developments that help me to better care for my patients.

The Ob/Gyn specialty is unique in that it is the fusion of what was traditionally a medical specialty (obstetrics) and a surgical specialty (gynecology). As a surgeon, I sometimes find it necessary to use a scalpel to effect the necessary cure for my patients. However, I still believe strongly in that noble dictum of Hippocrates “Primum non nocere,” famously translated “first do no harm.” Therefore, when I do find a surgical procedure needed, I strive to perform the surgery in way that is least painful and scarring for the patient. Accordingly, I advocate a principle know as minimally invasive surgery.

In the last 30 years, laparoscopic surgery has revolutionized surgery for both general surgeons and gynecologists. In the last 5 years, the da Vinci Robot has revolutionized urologic surgery for men and gynecologic surgery for women is currently undergoing the same dramatic transition. For men, a prostatectomy for prostate cancer used to require a large (greater than 12 cm abdominal incision) laparotomy. Now with the assistance of robotic equipment, this procedure can be accomplished with a laparoscope through a few incisions (3-5) each less than 1 cm. In a similar way, gynecologic procedures such as hysterectomy, removal of fibroids (myomectomy), and even removal of advanced cancer can be more frequently be completed through the same type of small abdominal incisions.

How has the da Vinci robot system been so important? In the past, in order to perform may surgery, we needed to make an incision large enough for at least 2 sets of hands, the surgeon and the assistant. Such incisions ranged anywhere from 12-30 centimeters in length. Now, many if not most of these same procedures can be performed with laparoscopic equipment. These incisions only need be as large as the diameter of the laparoscopic instrument (approx 8mm or the size of a nice pen). While traditional laparoscopic instruments have been available for decades, they are much more difficult to use because of limitations with their maneuverability. The robotic tools on the other hand, are capable of performing hand-like movements in direct response to the surgeon’s precise movement using specialized hand controls. In other words, the robotic system is simply the most highly advanced set of tools available to perform laparoscopic surgery.

The benefits to the patient of such minimally invasive surgery are many. Less pain, less blood loss, fewer infections, and shorter convalescence are some of the most important benefits. Like many advances in medicine, however, such benefits do come at a significant upfront cost. The initial investment of the robotic equipment and the ongoing maintenance expenses has been criticized by some as being not affordable or worse—wasteful. Such criticism, though, is short-sited and fails to appreciate the whole picture in terms of cost. Good cost analysis studies are now coming forward that actually show monetary savings when all the factors are considered as a whole. For example, shorter hospital stay and fewer re-admissions for infectious complications alone are usually enough to more than make up for the initial higher equipment costs. When you factor in less use of pain medication and sooner return to work, the cost benefit analysis even more strongly favors the robot-assisted surgical approaches. Hence, sometimes, even the most utilitarian of arguments will support an approach that is not only best for society, but most importantly best for the individual person.

Sincerely,

Dr. Frank (gynecologic surgeon)

What exactly is endometriosis?

In this post, we’ll briefly discuss a fairly common yet enigmatic female pathology—endometriosis. A basic definition of endometriosis is the presence of endometrial cells in places outside of normal location on inner lining of the uterus. Some of the more common sites of endometriosis include the ovaries, uterine ligaments, and bowel. The most common symptoms of endometriosis are infertility, pelvic pain, and bladder pain. Most physicians are aware of endometriosis as a cause of pelvic pain, however, many do not fully appreciate the effect it has on a woman’s fertility. For example, up to 50% of infertile women have endometriosis, even though she may not have any pain symptoms.

The management options for endometriosis, like many gynecological conditions, can be grouped into three categories: 1) expectant (i.e. doing nothing and waiting to see if the problem improves without intervention), 2) medications, and 3) surgical treatment. Expectant management might be reasonable option in some situations, especially in light of the fact that about 25% of women will actually have spontaneous regression of their disease after 1 year. However, since the other 75% of women will have either persistent disease or progression of it, intervention in the form of medicines or surgery is usually recommended.

Most gynecologists today recommend medications and “birth control” pills in particular as the main stay of treatment for women whom they believe may have endometriosis. The problem with such an approach is threefold. First, birth control pills have not been clinically proven to be any more effective than simple pain relievers like ibuprofen for the relief of endometriosis related pain. Secondly, birth control pills do nothing to improve long-term infertility that is caused by endometriosis. In fact, the birth control pill actually contributes to the risk of infertility through its effect on cervical mucus function. Finally, the cumulative risks (especially of cancer) most pronounced in long-term use of the pill do not justify their use for this when much safer treatments are available. The second most commonly used type of medication for endometriosis is an intramuscular injection of a medication known as Lupron (leuprolide). While this medication is much more effective at relieving pain than any other medications, it is fraught with its own problems of annoying side-effects and health risks. The Lupron muscular injection acts by putting a woman’s body into a chemical menopause state—hence the source of both the most bothersome side-effects (hot flashes, night sweats, etc.) and the health risks such as osteoporosis.

The most effective and definitive treatment for pain and the only treatment that preserves or restores fertility in patients with endometriosis is surgical. The purpose of surgery in this setting is to either excise or destroy all endometriosis lesions. The trend of increasing laparoscopic surgery has been a particularly beneficial situation for women with endometriosis. Personally, I have found the robotic laparoscopic system effective enough for even the most severe forms of endometriosis that only a few years ago would have required a large abdominal incision and about 3-4 days in the hospital for recovery. Now, these same types of patients go home the same day. I truly believe that a good surgeon knows when not to operate; and believing strongly in the Hippocratic principle of “do no harm” I am cautious about recommending surgery for anyone. However, the medical science to date still shows that surgical treatment remains the “gold standard” in terms of treatment for this troublesome condition known as endometriosis.

–Dr. Frank

Is contraception only a Catholic issue?

The bulk of this article came from a good family practice doctor friend who stopped prescribing contraception after discovering how harmful it is to women.

Too frequently, contraception is dismissed as merely a Catholic issue and one that only the most serious and devoted of Catholics care about. The recognition of universal truths pertaining to matters of human dignity is not limited to faithful Catholics.

To millions around the world, Mahatma Gandhi is justifiably one of the 20th century’s exemplars of wisdom and compassion. Few people know, however, that he was an impassioned opponent of contraception who spent decades writing and speaking out against the artificial birth control movement that targeted his native India in the early 1900s. Convinced that contraception poised a grave threat to women, human dignity, and the good of society, Gandhi’s many arguments for his position are summed up in one paragraph he penned in 1925:

It is an insult to the fair sex to put up her case in support of birth-control by artificial methods. As it is, man has sufficiently degraded her for his lust, and artificial methods, no matter how well meaning the advocates may be, will still further degrade her. I urge the advocates of artificial methods to consider the consequences. Any large use of the methods is likely to result in the dissolution of the marriage bond and in free love…Birth control to me is a dismal abyss.

Forty years later on the other side of the globe, the opportunity arose to test Gandhi’s hypothesis. American scientists invented the birth control pill in the late 1950s, and the 1965 Supreme Court decision in Griswold vs. Connecticutmade contraception legal for the first time throughout the US. Within a decade natural sex became the exception in America and artificial methods the norm.

Evidence today suggests that Gandhi’s prediction could not have been more accurate. In a survey released in November 2010, the Pew Research Center reported that:


– in 2008, 52% of adults were married (vs. 72% in 1960)
– in 2008, 26% of adults in their 20s were married (vs. 68% in 1960)

– only 32% of Americans believe that premarital sex is wrong (vs. 68% in 1969)

-41% of babies born in 2008 were born to unmarried mothers (vs. 5% in 1960)

Gandhi was not alone in his prescient understanding of the harm contraception would bring. For almost its entire 2000 year history, all of Christianity (Protestants, Catholics and Orthodox) forbade artificial birth control, which existed in various forms, and warned of the danger it poised. Like Gandhi, this teaching was not based on religious dogma, but rather on a profound understanding of morality and human nature. How did we in less than 50 years almost completely forget this 2000 year old tenet?

As physicians whose mission is to serve broken families in a society where almost 30% of pregnancies are aborted, where over 40% of children are born into single parent households, and where over 50% of marriages end in divorce, we should have a strong professional as well as a personal interest in this issue.

The bulk of this article came from a good family practice doctor friend who stopped prescribing contraception after discovering how harmful it is to women.

 

Too frequently, contraception is dismissed as merely a Catholic issue and one that only the most serious and devoted of Catholics care about. The recognition of universal truths pertaining to matters of human dignity is not limited to faithful Catholics.

To millions around the world, Mahatma Gandhi is justifiably one of the 20th century’s exemplars of wisdom and compassion. Few people know, however, that he was an impassioned opponent of contraception who spent decades writing and speaking out against the artificial birth control movement that targeted his native India in the early 1900s. Convinced that contraception poised a grave threat to women, human dignity, and the good of society, Gandhi’s many arguments for his position are summed up in one paragraph he penned in 1925:

It is an insult to the fair sex to put up her case in support of birth-control by artificial methods. As it is, man has sufficiently degraded her for his lust, and artificial methods, no matter how well-meaning the advocates may be, will still further degrade her. I urge the advocates of artificial methods to consider the consequences. Any large use of the methods is likely to result in the dissolution of the marriage bond and in free love…Birth control to me is a dismal abyss.

Forty years later on the other side of the globe, the opportunity arose to test Gandhi’s hypothesis. American scientists invented the birth control pill in the late 1950s, and the 1965 Supreme Court decision in Griswold vs. Connecticut made contraception legal for the first time throughout the US. Within a decade natural sex became the exception in America and artificial methods the norm.

Evidence today suggests that Gandhi’s prediction could not have been more accurate. In a survey released in November 2010, the Pew Research Center reported that:

 

– in 2008, 52% of adults were married (vs. 72% in 1960)

– in 2008, 26% of adults in their 20s were married (vs. 68% in 1960)

– only 32% of Americans believe that premarital sex is wrong (vs. 68% in 1969)

-41% of babies born in 2008 were born to unmarried mothers (vs. 5% in 1960)

Gandhi was not alone in his prescient understanding of the harm contraception would bring. For almost its entire 2000 year history, all of Christianity (Protestants, Catholics and Orthodox) forbade artificial birth control, which existed in various forms, and warned of the danger it poised. Like Gandhi, this teaching was not based on religious dogma, but rather on a profound understanding of morality and human nature. How did we in less than 50 years almost completely forget this 2000 year old tenet?

As physicians whose mission is to serve broken families in a society where almost 30% of pregnancies are aborted, where over 40% of children are born into single parent households, and where over 50% of marriages end in divorce, we should have a strong professional as well as a personal interest in this issue.

 

–Dr. Frank (with help from a friend)

 

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