Give Thanks

November 24th, 2018

 

Map of Total Fertility Rates courtesy of M. Tracy Hunter

At the risk of seeming overly optimistic, I would like to make a list of good things that are happening in the world of family planning and demography. Here goes:

My perception is that people are starting to realize the advantages of having small families. Their motivation is two-fold. Many people are realizing that it is possible to be married and have a good life with just one child, or with no children at all. In the USA and in many other rich countries this is practical because we have old age benefits, but more difficult where these benefits don’t exist so people have to rely on their children. There is another, altruistic reason a few are limiting their fertility. They see that the world is already overpopulated and don’t want to contribute further to the problems we are causing.

There are better, safer and more effective contraceptive methods than 52 years ago when Gail and I got married. The number of women using highly effective methods is rising, and (thanks to some good people running altruistic organizations) some are more affordable. An example is Medicines 360 which makes the Liletta™ IUD available to nonprofit clinics for just $50.

Colorado was chosen several years ago for a 5 year experiment. Women were able to receive LARCs (Long Acting Reversible Contraceptives, such as IUDs and implants) at no cost, even if they didn’t have insurance. The result was phenomenal—the unplanned pregnancy rate in our state dropped dramatically, and so did the abortion rate. I like to think of all the young people who were able to finish high school and go on to college because of this experiment. That experiment is over, but funding has continued thanks to private and state funding.

Emergency Contraceptive pills are now available without a prescription. This medication is so safe that there are essentially no cases of serious harm from taking it. It is not the best solution, because it is used after a failure—failure of a man to respect a woman, failure of a couple to use contraception or failure of a condom. Nevertheless, EC pills have prevented thousands of unplanned pregnancies.

There is also a movement to make birth control pills available without prescription (www.freethepill.org), or with a prescription from a pharmacist. Now a woman can purchase “the pill” over the internet, and in some states (including Colorado and New Mexico) pharmacists can prescribe hormonal contraceptives by following a protocol. Planned Parenthood has been doing something similar for years. A woman can purchase pills there, if all is ok, after answering a health questionnaire and having her blood pressure checked.

Although the need for abortion is decreasing, there are still all-too-many unplanned pregnancies. Access to abortion services is being curtailed in many parts of this country, causing women to have unsafe abortions. This is similar to what happened before Roe v. Wade in the USA, and is common in countries where abortion is illegal. The good news is that mifepristone and misoprostol, the pills used for a medical abortion, are available over the internet.

There are problems with internet-aided abortions. Most of these pills come from India, are expensive, some are of low quality, and they can take weeks to arrive. Unfortunately, medical care by internet has some inherent issues that will be difficult to resolve. It lacks the personal support that is so important when making an important decision. Also, there are two possible complications. Unless a woman has an ultrasound she might not know that the pregnancy is ectopic. These medications won’t cure a tubal pregnancy, which can rupture and cause serious internal bleeding. And the medications aren’t always effective in ending a pregnancy, so follow-up pregnancy tests are important.

Many countries now have Total Fertility Rates (TFRs) below the replacement rate—the number of children needed to replace the two parents. Replacement rate is slightly more than 2 because some kids die before they reach the age of parenting. This means that the countries’ populations will eventually decrease. Don’t be fooled, however—with few exceptions, all countries have increasing populations due to population momentum and increasing longevity. Of the CIA’s list of countries, only 105 have a TFR above 2.1, and 119 are less. The average TFR for the world is 2.4. We are getting closer to slowing population growth, but still adding about 80 million people to the already overcrowded planet each year.

I’ll be attending the International Conference on Family Planning this month and hopefully will have more good news for you soon!

© Richard Grossman MD, 2018

Acknowledge this Symptom of Overpopulation

October 29th, 2018

By the time  you read this it will be too late to attend the Climate Change Symposium. However, there are several points I want to make by broadcasting information about this symposium:
A small group of committed activists can make a difference in their communities. The Fort Lewis College Environmental Center is a wonderful organization that has reached hundreds of students through the years; their two person staff has taken on this large project with some volunteers and great aplomb.
It is important to involve young people–by the latest count, we will have over 300 high school students attending
Top speakers are willing to come to a little community such as Durango. Katharine Hayhoe will be in Canada, but she will reach us by a video made just for this symposium. We will also be showing one of her YouTube videos. Travis Rieder will be at his office at Johns Hopkins University but communicating by Zoom. Dr. Rieder spoke in Durango a couple of years ago and won a lot of praise for his presentation on the ethical imperative of having small families.
Thank you for reading!
Richard

 

“Humans are at the centre of global climate change: …social change is key to effectively respond to climate change”   IPPC Special Report

Do you remember the politicians in North Carolina who passed a law in 2012 that prohibited calculating sea level rise based on climate change predictions? They said only historical trends could be used.

That law, promoted by real estate developers, postponed planning for the consequences of climate change. Only 6 years later they were visited by a wrathful storm that dropped 3 feet of rain on parts of the state!

I wonder how the legislature feels now that they have been visited by reality in the form of Hurricane Florence. (Although the law concerned sea level rise, immense precipitation caused the damage.) My hope is that legislators have learned that they cannot mess successfully with the laws of nature and physics.

Many of the changes we’re experiencing now are due to anthropogenic (human caused) climate disruption. The list includes more destructive hurricanes; the estimated cost of Florence is 38 billion dollars and the human toll is 53 deaths.

Michael is the most recent hurricane; it was another monster. Almost a category 5 storm, it hit with terrifyingly destructive winds. There was “unimaginable destruction”, to quote Florida’s Governor Rick Scott. “So many lives have been changed forever. So many families have lost everything. Homes are gone. Businesses are gone.” 

Yet Scott does not believe in climate change. Apparently staff at the Florida Department of Environmental Protection were told not to use the terms “climate change” or “global warming” after he became governor.

Why have we been punished with so many destructive storms recently? Part of the problem is that governments are failing to recognize that climate change is increasing the frequency of these deadly and costly storms. Even a slight increase in the air and water temperatures gives significantly more energy to form cyclonic storms.

Senator Inhofe of Oklahoma wrote a book about climate change titled “The Greatest Hoax”. I don’t think that people in Florida and the Carolinas will be reading that book much now.

How is it possible that some people who don’t believe that climate change is real, or think that it is all just natural cycles that are causing it? How is that possible when these people know that humans are increasing greenhouse gases in the atmosphere? How does one talk with someone who denies climate change?

“Climate Change Solutions” is the second symposium at Fort Lewis College on the subject. It will be held Tuesday October 30th. Last year’s meeting focused on the science, this year will focus on ways that individuals can help deal with this global problem.

The symposium is coming just in time! Evidence is mounting that there is urgent need for solutions to climate change. Earlier this month the Intergovernmental Panel on Climate Change (IPCC) published a special report which can be summarized: “…drastic action must be taken in limited time to avoid severe and worsening consequences.”

Highly respected climate scientist Kevin Trenberth was one of the speakers last year. He wrote: “…humans are the main agents of change.” This is a bit ambiguous; in context, he meant that climate disruption is anthropogenic. It can also mean that we can also solve this global problem. Trenberth explained the destructiveness of this summer’s storms thusly: “While hurricanes occur naturally, human‐caused climate change is supercharging them and exacerbating the risk of major damage.”

Climate Change Solutions will have 2 sessions, starting at 12:30 and 6:30, at the Community Concert Hall on the Fort Lewis College campus. Because cimate change will affect today’s kids much more than my generation, we have invited several hundred students from area high schools. All College people will have free admission.

A member of US Senator Michael Bennet’s staff will urge people to vote for politicians who don’t deny climate change, and update us on what is happening in Washington to fight this global disruption There will be suggestions about effective ways to talk to climate change deniers.

Another speaker will tell us about the most effective way to quell climate change. You guessed it! Climate change is really a symptom of overpopulation and of overconsumption. Choosing to have a small family is the most effective action in the long run an individual can take. We also need actions that will work in the short run.

For more information about Climate Change Solutions and tickets search the calendar at: https://www.durangoconcerts.com. I hope to see you there!

©Richard Grossman MD, 2018

Avoid these Causes of Infertility

September 30th, 2018

A solution has been found for overpopulation! Unfortunately, this is not a reason for celebration.

This essay is another in my all-too-long series of bad ways to control population. It joins essays on genocide, the Doctrine of Discovery and gun violence.

Sperm counts are declining around the world. Fortunately, most men still have enough sperm to become fathers when they want, but that might not be the case forever. There are even predictions, if the current trend continues, that the human species will cease to exist! Just how worried should we be about declining sperm counts?

A review article suggests that the average sperm counts in European and other “western” countries has declined markedly. The overall count has declined 50 to 60% from 1973 to 2011. Another study found the same—or worse—is true for Africa. Between 1965 and 2015 they found a decrease of more than 70%! Fortunately, as you remember from biology class, only one pollywog fertilizes an egg. However fertilization requires that a crowd accompany that one lucky sperm.

I look at these studies with some concern about their accuracy. However, it seems that men truly are making fewer sperm. In addition to this decrease, genital abnormalities and testicular cancer have become more common. What is affecting men so badly? Perhaps we can learn something by consulting “man’s best friend”.

Veterinarians have studied the reproduction of a group of guide dogs for decades, and found decreases in sperm quality and increases in genital abnormalities and testicular cancer. The dogs seem to reflect the same problems as men are facing! The question is: what is causing these problems?

The vets did something that most men would object to—testicular biopsies. These little bits of tissue were tested for several chemicals with names such as “PDBE28” “PCB153” and “DHEP”. The chemicals were found in the dog food, and in the biopsy tissue, too, in levels that inhibit fertility.

These chemicals have been developed in the last few decades to promote “better living through chemistry”. They are some of a huge number of organic chemicals that have beneficial uses and have found their way into our homes—and into our bodies.

Although we may not be aware, when we bring home new furnishings, they are often treated with chemicals such as PDBE28 to decrease the rate at which they burn. These chemicals are also in building materials, vehicles and plastics—they are ubiquitous. They may have saved lives because of their fire retardant properties, but they may also have changed many lives because of their biological effects. Almost all—97%—of people in the USA have detectable levels of this group of chemicals in their blood!

The shape of these artificial molecules is similar to the shape of some hormone molecules. Hormones are chemical messengers that tell distant parts of our bodies what to do. They fit into receptors that receive hormonal molecules and activate cells. The analogy of lock and key is often used because the hormonal molecule is usually specific to certain receptors on certain cells. Because their shape is similar, endocrine disrupting chemicals fit in receptors. The disruptor can either stimulate the cell or, if the “key” gets stuck in the “lock”, the disrupting chemical can block the action of the real hormone.

Switching to women, now. Female fertility is also decreasing. The epidemic of  obesity is affecting fertility, as is some women waiting too long to have children. Their bodies are also sensitive to the effects of endocrine disrupting chemicals. In a study of California women, those with high levels of PCBEs took longer to conceive a pregnancy than women with lower levels. 

There hasn’t been enough written in the press about endocrine disruptors, perhaps because this subject is very complicated. Two facts that stick in my mind are that endocrine disruptors have their strongest effect when they are very, very dilute— because of their combination of stimulating and blocking effects. This means that the usual testing done by the FDA may find little risk because they didn’t dilute the chemical enough—the opposite of the usual when testing for toxicity. Indeed, endocrine disruptors may have an effect when they are equal to a pinch of salt in an Olympic-sized swimming pool!

I plan to write more about endocrine disruptors since they are so pervasive and have so many bad effects. Time will tell if these chemicals will cause a significant decrease in our population. If they do, it will be involuntary—which is tragic.

©Richard Grossman MD 2018

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.