Saturday, March 31, 2012

Putting Compassion into Contraception


From Life magazine April, 1971


True or False?
There are about 3/4 million teenage pregnancies in the US every year.
85 % of these are unintended.

Both statements are True.

Without getting into the papal and microbiological details of how the "morning after pill" (better now named mornings after pill because it can be used for up to five days following unwanted sperm contact) actually works, suffice it to say that there is an existing, legal and safe solution to many of these unintended pregnancies.

Emergency Contraception is a safe method of pregnancy prevention (and therefore birth control) that can be used when other methods (condoms, rhythm, withdrawal, diaphragm, nuvaring, pills) have failed.  Its most common version, sometimes called Plan B,  is essentially a potent dose of progestin, one of the hormones in most typical birth control pills.  

For everything you want to know about EC, have a look here. It is available over the counter to women aged 17 and over.

And that is the point of this post. Its availability.

A recent study in the journal Pediatrics neatly demonstrated that access to EC is not always as simple as it is meant to be.  The researchers in this study had female callers make scripted calls to almost 1000 pharmacies in 5 US cities where teens over 17 can legally purchase emergency contraception.  Some of the callers posed as 17 year old teens and others posed as female physicians to inquire about availability.   Here is what they found:

*80% indicated to adolescent callers, and 81% to physician callers, that EC was available on the day of the call.  That sounds like a good thing. 

*However, 19% incorrectly told the adolescent callers that it would be impossible to obtain EC under any circumstances, compared with 3% for physician callers. What is this? Contraceptive counseling after the fact, over the phone?  Or is this passive-aggressive punishment? Or is this just mean?

*Pharmacies conveyed the correct age to dispense EC without a prescription in 431 adolescent calls (57%) and 466 physician calls (61%).  This sounds like ignorance of the law to me!

*Compared with physician callers, adolescent callers were put on hold more often (54% vs 26%) and spoke to self-identified pharmacists less often (3% vs 12%, P < .0001). I don't think this will surprise anyone whose ever tried to talk to a pharmacist and I know from where I make calls that I can use my MD voice to get through.

*When EC was not available, 36% and 33% of pharmacies called by adolescents and physicians respectively offered no additional suggestions on how to obtain it. Again, is this about being too busy to stop and care? Is this too busy to have a list of alternatives if they've run out (like it's the day after prom or something?) Is this just lack of concern or is it ignorance and mean spirited?  

Then I wonder what happens when that pharmacist hangs up and turns to the next person in line who happens to be an 18 year old mother with a crying infant on her hip waiting to fill her prescription for Amoxacillin for the baby's ear infection.  What then?  Does she get an attitude too?

Monday, March 12, 2012

Rubber Chicken Substitute?

I am a big fan of Mark Bittman's.  His fabulous "How to Cook Everything..." cookbooks are staples of my pantry as well as frequent gifts for friends and family.  In recent times I have turned to him as I have found a proliferation of brussels sprouts,  kale, or garlic in my own garden.  His creative and delicious twists on vegetables have spurred me on to experiment beyond steaming and grilling.

As Bittman has moved from cook to commentator on food, foodism, food fads, health and food politics, I have continued to follow him as he feeds another kind of curiosity and need, although I miss his clever recipes.

So I was happy that my culinary hero merited the front page of the Sunday New York Times yesterday with his article "Finally, Fake Chicken Worth Eating".  And although I am not (yet) a fan of fake meat in almost any form, I read on.

If nothing else captures one's attention it's this appeal:
Really: Would I rather eat cruelly raised, polluting, unhealthful chicken, or a plant product that’s nutritionally similar or superior, good enough to fool me and requires no antibiotics, cutting off of heads or other nasty things? Isn’t it preferable, at least some of the time, to eat plant products mixed with water that have been put through a thingamajiggy that spews out meatlike stuff, instead of eating those same plant products put into a chicken that does its biomechanical thing for the six weeks of its miserable existence, only to have its throat cut in the service of yielding barely distinguishable meat?
If Bittman is willing to give this stuff a chance then so am I.


image from grist.org via Googleimages

Wednesday, March 7, 2012

All Politics is Local

Just last week  I began waxing about the pleasures of my new job at Barnard College.  I was describing how with each new patient I call in to my office for a visit I feel as if I am turning over a Tarot card.  Full of color, some mischief, history, problems, issues, stories, and of course fortune and future. You just never know, I said, when you might be looking at the next secretary of state or the next president of the United States.

No sooner had I thought these words--but not yet turned them into a blog post (gotta be quick in these express times) than it was announced that Presdient Obama will be delivering the commencement address at Barnard's 2012 graduation ceremony,  to be held across the street on the campus of his very own alma mater, Columbia College.

But given some of the vitriolic give and take which the New York Times would like us to believe is just sibling rivalry gone amok, maybe they are Big Brother and Little Sis.   Or maybe the rudeness taken to sexist, anti-intellectual and almost pornographic levels available on BWOG, the Columbia student-run blog is merely a reflection of all the things that can run amok when allowed to grow like weeds on the web. As the blog itself states:  "Bwog comments are a mirror held up to the student population, soberly reflecting our microcosm of society with all of its imperfections intact." Indeed.

While I am new to Tarot, I would note that the high priestess card may have something to offer, as she represents power and balance.  She denotes the equilibrium between masculine and feminine;she is quiet and contemplative.  Sounds a bit like the Obama of 2008 to me.  And maybe, just maybe, the Obama of 2012 who can bridge the gender gap that this campaign has generated across the country and brought right home to our doorstep at Barnard.

image from tarotseer.com via Google