Archive for August 10th, 2010

Mull Over these Videos

Tuesday, August 10th, 2010

Mull Over these Videos—7-2010

© Richard Grossman MD, 2010

One of the funniest videos I have ever seen is a French advertisement for glue: http://www.canneslions.com/lions/lightbox.cfm?sub_channel_id=103

The video opens with a pair of young nuns strolling in a cloister. Music is playing as the nuns carry bouquets of spring flowers. When they approach a white marble sculpture of a young boy, one realizes that a terrible accident has happened: his protruding member (not his nose!) has been broken off. The member is found, and taken to the Mother Superior, who knows just how to fix his broken penis. She reaches for a tube of rubber cement and heals the poor fellow. The video closes as a young novitiate sneakily turns the member from the resting to the ready position.

This hilarious video brings up some serious food for thought for us in the United States.

Yes, even those pledged to abstinence still have urges. The pretty young nun in the video didn’t leave her libido behind when she put on her habit. The Roman Catholic Church in this country is finally (although tacitly) admitting this by paying out huge sums because some priests did not live up to their vows and abused children.

In the past women became nuns for many reasons. Desire to have power and education in a society that didn’t respect women, poverty, and lack of pulchritude were all secular motives. Fear of childbirth was another, although one we might not even think of today. Until recently a woman had a substantial risk of dying from a complication of pregnancy. Furthermore, there was no reliable way to prevent pregnancy until the twentieth century. Serving God had a notable side effect of saving your neck!

The video illustrates the differences in mores between France and the USA. For instance, this advertisement could never be shown on our TV. Furthermore, we in the USA live in an era that gives young people mixed messages. Sex is used to market products, is featured on TV and draws crowds to the movies. We are continually exposed to the sexual high jinks of our celebrities such as Tiger Woods and Jimmy Swaggart. Yet we often fail to give teens the straight scoop on sexuality and how to protect themselves against infections and pregnancy.

Not long ago teens were not taught about contraception, and were supposed to keep their virginity until marriage. Yet many studies show that modern “abstinence only” programs do not work, and indeed, may expose our adolescents to greater risks because of their ignorance.

In 2007 Colorado voters showed their wisdom in rejecting abstinence-only idiocy by passing a law that requires any sexuality education curriculum to include accurate information about STDs and pregnancy prevention. Nationally, the current administration has put a nation-wide stop to “abstinence only” programs.

The teen birth rate in the USA is at least four times that of any other rich country. Our teen pregnancy rate is more than five times that of the French. The difference between teen birth rates is not due to more abortions in France, since the teen abortion rate is lower there than in the USA. The principal reason for this difference is that French teens use more contraception. Why? I have some ideas, although I am not a sociologist. We have mores left over from the Victorian era, when sexuality was swept under the carpet. We still pretend that adolescent sexuality will go away if we ignore it.

Remember: the best way to lower the abortion rate is to encourage the use of effective contraception.

Commenting on the rubber cement video, a French woman said that sexuality is just part of life in her country. People talk more freely about sex in Europe. She also observed that the separation of church and state is stronger there. A program such as our “abstinence until marriage” (which was spearheaded by born-again Christians) would never have been adopted in France.

Another video illustrates the differences between our cultures. Search the Internet for “Teens & Sex in Europe: A Story of Rights, Respect & Responsibility”. Its producer, Advocates for Youth, is a leading organization in the field of adolescent reproductive health. Working both here and internationally, they lead study tours to European countries. This film documents the differences between the different cultures.

What can you do to help your children be more rational about their sexuality? One step would be to sit down with them, watch these videos and then talk about them. You might be surprised what you can learn from your kids!

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.

Happy Birthday to “The Pill”

Tuesday, August 10th, 2010

Happy Birthday to “The Pill”—5-2010

© Richard Grossman MD, 2010

It was fifty years ago that the Food and Drug Administration approved “the pill”. What a half-century it has been!

The birth control pill made it possible for couples to have sex without concern about pregnancy. True, before hormonal contraceptives there were other contraceptives—but the condom, diaphragm and spermicide took away much of the spontaneity of sex. One of the advantages of the pill is that it separates contraception from intercourse.

Shortly before getting married in 1966 my wife visited a doctor to get on birth control pills. I remember that she brought home a bottle of tablets. Packaging has changed since then with the package helping the woman to remember to take her pill. There is even a pill pack with a reminder alarm!

The amount of hormone in each tablet has also changed; it has decreased immensely. The estrogen in today’s low dose pill is one seventh that of the first pill. If you have wondered why pills are different colors for different days, it is because many of today’s oral contraceptives vary the dosage during the month to get good cycle control with a very low level of hormones.

One formulation is not optimal for all women. Although all of today’s combined pills contain the same estrogen, the dosage varies between 20 and 50 micrograms. They also have different progestins (hormones similar to the other major hormone the ovary produces, progesterone). Some are excellent in controlling menstruation, others excel at helping with acne and others are best in alleviating PMS.

Initially every woman took active hormone pills for three weeks then stopped (or took placebos) for a week, then went back on the active pills again. That pattern has changed. Some pill formulations are designed so that the woman only menstruates every three months, and one prevents any bleeding at all. Suppressing periods is especially helpful for women who have problems such as heavy bleeding or bad cramps. We now recommend against a “vacation” from hormonal contraception—this only increases the risk of pregnancy.

“The pill” is one of several ways a woman can take hormones. In China the hormones are available as little dots on rice paper. We have patches that women wear; the hormones are delivered through the skin. There is also a plastic vaginal ring that slowly emits the hormones.

Of the two hormones, the progestin is the one most responsible for controlling fertility; the estrogen is added for cycle control. Unfortunately, the estrogen also increases the chances of blood clots, stroke and heart attack, especially in older women and those who smoke.

Progestin-only contraception without estrogen is available in “the minipill”, in a shot that is effective for 3 months, as an implant that goes under the skin of a woman’s arm, and in an IUD. All of these methods have the advantage of safety, but they often cause erratic bleeding.

We prescribe “the minipill” for women who are breastfeeding and for older women and those who are at risk of blood clots. This pill carries a very low risk of blood clots, but has a higher pregnancy rate and many users have irregular bleeding. It is important to take it at the same time every day, preferably at night.

Emergency contraception is a high dose of progestin that can prevent pregnancy when taken after unprotected intercourse. Although it can cause nausea, it has no serious risks and is up to 90 percent effective.

Birth control pills are safe for almost all women despite the slightly increased risk of blood clots. There are many beneficial side effects, including less bleeding and pain with periods, more predictable periods, and fewer ovarian and breast cysts. They also decrease the risk of developing several types of cancer. Overall, studies show that women who use “the pill” live longer than women who are “pill-free”.

“The pill” caused a revolution. This was the first widely available family planning method, and allowed women to have a sexual relationship without fear of pregnancy. It also has been a large part of programs that have slowed the growth of the human population. Historically, our growth was controlled by high mortality rates, especially by the deaths of children. It is much better to prevent undesired pregnancies than to rely on high mortality rates.

We just spent Mother’s Day with our son Dave, who was conceived after we had been married several years. Gail, my wife, took “the pill” and it was a blessing that we could wait before starting our family.

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.

Beware of Technology

Tuesday, August 10th, 2010

Beware of Technology—6-2010

© Richard Grossman MD, 2010

The chief cause of problems is solutions.

(Eric Sevareid)

I once sat on an airplane next to an engineer specializing in failure analysis. I told him about my “rip-stop” condom invention, which I hoped would be less likely to tear. “I’ve never had a condom break,” he said. Then his face clouded and he added: “Well, just once. In Thailand.”

As a physician I am used to things not working out as planned. There is so much variability among people it’s unreasonable to anticipate the same level of success with every patient. However, people’s faith in technology is such that we expect a perfect cell phone connection every time and spill-free offshore drilling. We are shocked when our expectations are disappointed.

I will not write about how BP grossly underestimated the amount of crude oil spilled into the Gulf of Mexico with the Deepwater Horizon disaster. Neither will I dwell on the executives’ culpability in this catastrophe, nor the dishonesty that allowed industry and watchdogs to make an incestuous agreement about safety. Nor will I highlight BP’s reckless decisions and actions. I will write about the risk of our overdependence on technology.

I know a few of the local BP executives. They are intelligent, well meaning and honest. Like you and me, they are just trying to earn a living. It is not their fault that BP has taken advantage of our social and legal structure that allows large corporations to run roughshod over the environment and the rights of people.

Engineers don’t assume that their projects won’t fail. Rather, they estimate the “time to failure.” For some highly refined mechanisms, that may be many years. For complex new technologies it may be impossible to estimate the time to failure. Don’t ever believe a claim that anything is entirely reliable.

One of the ways to increase safety is to have redundant systems. This is a bit like what we have in a car. There are brakes to avoid an accident. If the brake fails (or if you fail to use it in time) the seatbelt will keep you from going through the windshield. Air bags offer a second level of safety.

Every gas well drilled in La Plata County has redundant systems in case of a blowout. There are annular valves to squeeze the pipe, and rams if the annular systems fail. If any one valve type were perfect, a second set wouldn’t be needed.

There were valves at the Deepwater Horizon drilling site that failed. Perhaps the failure was because the explosion cut the control cables—we don’t know yet what caused the problem.

BP won’t tell me if there was an “acoustic switch” on this drill rig. This type of valve is triggered to shut not by wires but by an acoustic signal. It is required in some areas, but apparently not for rigs in the Gulf. An acoustic switch has the advantage that it can still be closed if the wires to the drilling platform are cut.

This oil spill is a tragedy, but I can think of much worse. What if there were a nuclear accident instead of one with petroleum? As bad as crude oil is to the environment, it is far better than spreading highly toxic radioactive isotopes over the Atlantic!

I view the Deepwater Horizon tragedy as a wake up call: any technology can fail. Large, complex technology can fail disastrously. Even with “failsafe” precautions, disasters happen.

Coal and petroleum fueled the industrial revolution and revolutionized the way we live. Fossil fuels have also allowed our population to grow enormously over the past two centuries. Regrettably, growth cannot continue indefinitely. Continued growth and dependence on fossil fuels are major issues that our society is just beginning to examine.

Renewable energy is one way to avoid large disasters. Most of the electricity for our home comes from solar panels on our roof. Our generating system is small, safe and doesn’t burn fossil fuels. We depend, however, on natural gas to cook and keep us warm.

I draw several conclusions from the Deepwater Horizon experience. We shouldn’t allow any more nuclear power plants. Consideration of drilling in the Arctic Ocean must be stopped. Any further offshore drilling must be carefully supervised by governmental agencies that are also carefully monitored. There must be contingency plans laid out ahead of time for dealing with an emergency such the Horizon’s blowout. Perhaps the most powerful lesson is that we must become less dependent on fossil fuels.

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.

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