Archive for the ‘Women's Health’ Category

UPDATE: AAP Compromise Statement on Female Genital Cutting – RETRACTED!

May 25, 2010

Please see UPDATE at end of article!

On April 26,2010, the American Academy of Pediatrics (AAP) issued a new policy statement seen by many as essentially advocating the practice in this country of female genital mutilation (FGM)[sometimes  this ‘tradition’ is referred to as female genital cutting (FGC) as well].  In pertinent part, the policy advocates for “federal and state laws [to] enable pediatricians to reach out to families by offering a ‘ritual nick’,” such as pricking or minor incisions of girls’ clitorises.

Yes, I said this was issued by the American Academy of Pediatrics. How, in the world, you ask, could such an august body promote such a misogynistic practice?

For those who may not be familiar with this barbaric (you fill-in the other adjectives – the list is simply too long) ‘ritual,’ a recent online article by PRNewswire sets the chilling background of this controversy.

FGM is a harmful traditional practice that involves the partial or total removal of the female genitalia and is carried out across Africa, some countries in Asia and the Middle East, and by immigrants of practicing communities living around the world, including in Europe and the U.S.  It is estimated that up to 140 million women and girls around the world are affected by FGM.

Putting aside my personal opinions regarding the overall chauvinistic cultures of – to name a few – Africa, Asia and the Middle East, what would motivate any culture to engage in such a ritualistic practice?

In an NPR interview of Professor of Law, Cleveland-Marshall College of Law, Cleveland State University, Dena Davis, on May 14, 2010, Professor Davis,  a consultant to the AAP and the lead author of the policy statement, the ‘rationale of this ‘tradition’ is explained.

RAEBURN: Do you have a sense I’m just I can’t help but interrupt. Do you have a sense of why in these cultures, there may be different reasons, but why this is done or what is supposed to be the benefit of it?

Ms. DAVIS: Right, it’s a wide array of things. On a positive side, it’s seen as a growing-up ritual, as a celebration of ethnic or national identity. It became politically important as a response to colonization, for example, but it’s also done to remove sexual pleasure from women so that they can be controlled, to guarantee women’s virginity so that they are marriageable and to protect the family’s honor.

So just how did this ‘celebration of ethnic or national identity’ work its way to our shores? How did it conceivably become a part of a policy statement by the AAP?

Professor Davis offers the following explanation:

Ms. DAVIS: Well, I want to start by reiterating what you already said. The statement ends with four recommendations, and none of those mention this compromise. The recommendations are that the American Academy of Pediatrics opposes all forms of female genital cutting that pose risks of physical or psychological harm, encourages its members to educate themselves about the practice, recommends that members actively seek to dissuade families from carrying out harmful forms of FGC and recommends compassionate education of the parents of patients.

Having said that, the controversial part, as you made mention, is a discussion toward the end of the possibility of pediatricians offering what would literally be a nick. And in the statement, we analogize it to ear piercing.

And the idea here was that we knew that some pediatricians in Seattle a number of years ago who had a good relationship with the Somali immigrant community around their hospital had been asked by mothers of girls for this kind of compromise. And they had gone down the road of – they’d had meetings with mothers and so on, and they were about to do that…

RAEBURN: So this was mothers from some of these cultures where this is practiced had suggested that…

Ms. DAVIS: Right, were Somali immigrant mothers.

RAEBURN: Okay, so it was their idea?

Ms. DAVIS: Well, I’m not sure whose idea it was, but they embraced it to the extent that they held off on doing something worse until the doctors could get set up to start offering this. But before that could happen, Congresswoman Pat Schroeder wrote to tell the hospital that it would be criminal under her new law that had recently passed in Congress.

The concern is that we know that in many cases, when pediatricians turn down parents, girls are taken back to Africa for the worst possible procedures done, you know, with no painkilling and no, you know, no infection control and extremely severe forms of these procedures where girls’ labia are scraped away, for example.

And there’s really that’s very difficult to stop…

The uproar from this AAP statement advocating a ‘compromise’ – ostensibly premised on the concept of the ‘lesser of two evils’ – comes from virtually every group in this nation.  One I quite frankly didn’t anticipate was posted by Jihad Watch: “[T]here are those four words of the Hippocratic oath that the American Academy of Pediatrics seems to have forgotten: First do no harm. And if it is supposed to be harmless, let the AAP doctors line up forthwith for their own “ritualized nick.” The comments to this posting by Jihad Watch, which refers to this practice as being “primarily enforced in Muslim countries, ” are also quite revealing. One person identified as ‘Ccoopen’ had this to say:

I’m not sure why this is listed under dhimmitude, considering that FGM is not Islamic. Sure, it is practiced by Muslims, but it is not a Muslim practice. It is a cultural practice which predates Islam by hundreds, if not thousands of years. In fact, the majority of practitioners in Africa are of the African Tribal religions, not Muslim. While it is a horrific practice, it doesn’t need to be tied to Islam since it has nothing to do with Islam, but with culture.

For those who have dedicated their life’s work to obtaining equality among the sexes, the AAP’s attempt at a ‘neutral’ statement of compromise has been vehemently rebuked:

“Encouraging pediatricians to perform FGM under the notion of ‘cultural sensitivity’ shows a shocking lack of understanding of a girl’s fundamental right to bodily integrity and equality,” says Taina Bien-Aime, executive director of the human rights organization Equality Now. “If foot-binding were still being carried out, would the AAP encourage pediatricians to execute a milder version of this practice?”(See “An End to Female Genital Cutting?”) See our source – Time online article.

In its online posting, Time, a partner of CNN, reports (as do many others) reports a legislative twist to the timing of the AAP’s policy statement:

On the same day the AAP published its new recommendation, the Girls Protection Act, which would make it illegal to take a minor outside the U.S. to seek female circumcision, was introduced in Congress. “I am sure the academy had only good intentions, but what their recommendation has done is only create confusion about whether FGM is acceptable in any form, and it is the wrong step forward on how best to protect young women and girls,” said one of the bill’s sponsors, New York Representative Joseph Crowley, speaking to the New York Times. Davis counters that such a law would be extremely difficult to enforce.

So where do you stand on the issue? Has the AAP done more harm than good? Is the ‘compromise simply dangerous folly or adoption of ‘the lesser evil’ for the safety and well-being of these children? You be the judge. Share with us and our community of readers your reaction.

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UPDATE: in response to my posting this blog on Twitter, one person using the Twitter name kvetchingguru brought to my attention a posting which is a ‘call to action.’ It is entitled “Urgent Alert: Call on the American Academy of Pediatrics to retract their endorsement of Type IV FGM.” A form letter is made available and the names of the Executive Director/CEO of AAP, the Chair of AAP and the President and CEO of the American Board of Medical Specialties are provided.

As I wrote earlier today, this ‘endorsement’ in any fashion – call it ritual snip or piercing – has created a groundswell of reaction.

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UPDATE: May 27, 2010

It appears that the uproar reported in this article has taken its toll.

The American Academy of Pediatrics has retracted its policy statement on female genital cutting after sparking controversy by apparently endorsing the illegal practice of “ritual nicks” to forestall more extensive mutilation.

“The AAP does not endorse the practice of offering a ‘clitoral nick,'” according to a new statement by the organization’s board of directors. “This minimal pinprick is forbidden under federal law, and the AAP does not recommend it to its members.”

The following from the AAP president about says it all:

In a new statement, AAP president Judith Palfrey, MD, of Harvard Medical School, clarified the academy’s position. “Our intention is not to endorse any form of female genital cutting or mutilation,” she said. “We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere in the world.”

The source for these quotes: medpagetoday

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A Baltimore City Ordinance Fuels The Abortion Debate – Archdiocese Goes to Court To Have It Declared Unconstitutional

April 21, 2010

According to a recent article in the Baltimore Sun, a Baltimore City ordinance requires local crisis pregnancy centers to post signs in their clinics disclosing that they do not offer abortion or birth control services. Apparently, this ordinance has angered the Archdiocese of Baltimore, which has decided to file a lawsuit in the Federal District Court, seeking to have the ordinance declared unconstitutional.  Its argument is that the government should be prohibited from compelling speech by requiring the clinics to post signs.  Why would the Archdiocese want to get rid of an ordinance, which, in essence, tells the public “you cannot get an abortion here?”

It appears that the Archdiocese’s remonstration has more to do with what the clinics do separate and apart from what the ordinance requires. Because the clinics must disclose that they do not offer abortion services, some of the clinics choose to post another notice, which informs the public about clinics that do offer abortion services. The ordinance does not require such a notice.

The Archdiocese seems to assume that the clinics would not have the incentive to post information on abortion clinics in the absence of the ordinance. This assumption appears attenuated at best.  Were these notices voluntarily posted by the clinics before the ordinance was enacted? Even if the ordinance were to be repealed, would the clinics still choose to post these notices? After all, they are not compelled to post the notices under the ordinance at the present time.  Whether or not a clinic chooses to post information on abortion clinics, can a patient simply walk in and inquire about abortion clinics?  The bottom line is that these clinics disclose information on abortion services because they want to and not because they have to.

I am curious if the Archdiocese would still want to pursue a lawsuit to repeal the ordinance if the clinics did not post notices with information on abortion clinics. Would it still have a problem with an ordinance telling the public “no abortions here.” Your thoughts?

Contributing author: Jon Stefanuca

Study Finds Stents as Effective as Surgery to Prevent Strokes; European Study Finds Otherwise

March 18, 2010

A few weeks ago, the NY Times published a story about a recent North American study designed to examine the efficacy of stenting versus surgery of the carotid artery for the prevention of strokes. Known as the Crest (Carotid Revascularization Endarterectomy versus Stenting Trial) Study, the project was designed to determine if the less invasive procedure known as stenting (i.e. placing a small tube inside the carotid artery) was an equally safe and effective treatment option to surgery for the prevention of stroke.  

Strokes are reported to be “the third leading cause of death in the United States and a major cause of disability among adults. Each year, almost 800,000 Americans suffer a stroke, and more than 140,000 die.”

Of concern, however, is a European study published online in the Lancet the day before the announcement of the Crest Study results.  According to Dr. Martin M. Brown, chief investigator for the European trial, the International Carotid Stenting Study, their investigation showed “dismal results” from stenting versus surgery in their study group population of 1,173 randomly selected patients (the Crest study involved 2,502 patients from more than 100 hospitals in North America).

Dr. Brown said that although differences in the groups studied might explain the disparate results, “nobody has really shown stenting is better than surgery, so why choose a stent?”

Dr. Brown added, “Even if Crest shows little difference between the two, there are three other trials that suggest surgery is safer.”

On the other side of the debate, however, are the statements of the lead author of the Crest Study, Dr. Thomas  Brott, who is quoted in the NY Times article as saying:

“We had outstanding results, and our study, we think, is representative of these treatments in the United States and Canada. Prior to the Crest trial, we really did not have the best evidence, but these results indicate that we have two very safe and effective methods to prevent stroke.” Though there are differences in risk between the two procedures and individual variations, he said, “the results from stenting are very comparable to those for carotid surgery.”

The differences in the two studies in terms of mortality and morbidity are summarized in the Times article.

What to make out of all this remains the question.  Hopefully further studies will provide a clearer answer.

I am not a doctor, and I suspect, you, the reader, are probably not either.  What I can say is this – and it is what I have been advocating throughout many of our blogs – be an educated patient.  Ask questions if you find yourself or a loved one presented with this option of surgery versus stenting and ask the right questions of your doctor.  Why is one option being suggested by your doctor over the other?  What are the risks of each procedure?  While one procedure may be “less invasive” than the other, there are still risks associated with each.  “Less invasive” is not always the answer.   I further encourage you to ask your doctor what his or her experience is in performing carotid artery stenting.  Remember, the Crest Study had one key element – “carefully screened … doctors doing the stenting procedure, including only highly skilled physicians with a lot of experience.”  Make sure your doctor fits that description.

Strokes – Family History a Significant Risk Factor

March 9, 2010

According to an article published by WebMD, individuals whose parents have had a stroke by age 65 are more likely to have a stroke.

Strokes are generally defined as disturbances of blood flow in the brain as a result of a ruptured blood vessel, a blockage within the lumen of the blood vessel, or some other ischemic process. The ischemic process can cause brain tissue to die, resulting in death or permanent brain injury. In all respects, strokes represent medical emergencies.

Among other things, the following are generally considered to be risk factors for developing a stroke: previous history of strokes, brain trauma, advanced age, increased lipid levels, increased blood pressure, diabetes, atrial fibrillation, and smoking.

The results of the study suggest that a person’s family history of strokes should also be considered in assessing the risk for developing a stroke.

Researchers studied 3,443 people who initially were stroke free and second-generation participants in the Framingham Heart Study. The participants’ parents had reported 106 strokes by age 65, and offspring 128, over the 40-year study. People with a parent who had a stroke by age 65 had twice the risk of having a stroke at any age and four times the risk by 65, after adjusting for conventional risk factors.

Contributing author: Jon Stefanuca

Univ of Michigan’s Cancer Center Study Tests Freezing Technique for Breast Cancer Tumor | Testing It Up – Test Country Blog

March 6, 2010

Is there a new treatment for breast cancer on the horizon? Read this blog report –  Study Tests Freezing Technique for Breast Cancer Tumor | Testing It Up.

Cryoablation – freezing – has been successfully used in mice to stop the spread of breast cancer.  The research was conducted by a team at the University of Michigan Comprehensive Cancer Center, which is affiliated with the university’s medical school.

Dr. Michael Sabel, who led the team of researchers,  explained the following in a news release:

“Cryoablation has strong potential as a treatment for breast cancer… Not only does it appear effective in treating the primary tumor with little cosmetic concerns, but it also may stimulate an immune response capable of eradicating any cells that have traveled throughout the body, reducing both local and distant recurrence, similar to giving a breast cancer vaccine.”

The original report on this important research was done by BusinessWeek – for further information read the posting by that publication.

If you go to the Center’s site,  you will also find fascinating and important stem cell research being conducted by that institution and an informative video done by the Center’s director, Dr. Max Wicha, regarding their stem cell research efforts.

It was at this Center that breast cancer stem cells were first discovered in 2003.

While there has been a steady decline in the death rate related to breast cancer since 1990, the bad news is that approximately 41,000 women are still dying each year in the United States alone from this horrible disease.

Ovarian Cancer – The Smear Test Won’t Tell You Much

February 28, 2010

According to an article published by the UK Press Association, a UK study revealed that one in three women mistakenly believe that a smear test can diagnose ovarian cancer. The test is also known as Papanicolaou test, Pap smear, Pap test, or cervical smear.

[The smear test] is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. … In taking a Pap smear, a tool is used to gather cells from the outer opening of the cervix (Latin for “neck”) of the uterus and the endocervix. The cells are examined under a microscope to look for abnormalities. The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses (HPVs). The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The test may also detect infections and abnormalities in the endocervix and endometrium.

While the smear test is customarily used to diagnose cervical cancer, it is not very helpful in diagnosing ovarian cancer. Cervical cancer and ovarian cancer are distinct medical conditions with distinct symptoms. Cervical cancer refers to malignant tissue developing in the cervix – the organ, which connects the uterus and the vagina. Last year, there were about 4,070 deaths associates with cervical cancer. The smear test is effective in diagnosing cervical cancer.

Ovarian cancer refers to malignant tissue in one or both of the ovaries. Last year, there were about 14,600 deaths associated with ovarian cancer – a much higher mortality rate when compared to that of cervical cancer. Symptoms of ovarian cancer include, but are not limited to : abdominal pressure, abdominal distention, urinary urgency, abdominal pain and discomfort, indigestion, constipation, changes in menstruation, lethargy, and pain during intercourse.

According to the article,

Almost one in three women (29%) mistakenly believe a smear test will pick up signs of ovarian cancer. …  Only 4% are confident they could spot symptoms of the disease themselves and many believe it is less common than cervical cancer. … The poll of more than 1,000 women found that twice as many (66%) had been given information about cervical cancer as those who had details on ovarian cancer (33%). Of women diagnosed with ovarian cancer, more than half (56%) did not know anything about the disease beforehand.

These numbers reveal a dangerous misconception about ovarian cancer. Many more women are diagnosed with ovarian cancer than cervical cancer. Moreover, many more women die as a result of ovarian cancer than as a result of cervical cancer. Early diagnosis is key in both instances. In this regard, being knowledgeable about these medical conditions can be a matter of life and death. Be mindful that a smear test is not helpful in diagnosing ovarian cancer.

Contributing author: Jon Stefanuca

Women With Migraine Headaches At Higher Risk For Developing Multiple Sclerosis (MS)

February 23, 2010

A recent article published by Reuters Health indicates that there might be a positive correlation between migraine headaches and the incidence of Multiple Sclerosis (MS) in women.

Multiple Sclerosis (MS) is a disease in which the nerves of the central nervous system (brain and spinal cord) degenerate. Myelin, which provides a covering or insulation for nerves, improves the conduction of impulses along the nerves and also is important for maintaining the health of the nerves. In multiple sclerosis, inflammation causes the myelin to eventually disappear. Consequently, the electrical impulses that travel along the nerves decelerate, that is, become slower. In addition, the nerves themselves are damaged. As more and more nerves are affected, a patient experiences a progressive interference with functions that are controlled by the nervous system such as vision, speech, walking, writing, and memory.

The study involved 116,000 participants who were examined over the course of 16 years. Researchers found that women diagnosed with migraine headaches at the beginning of the study were 47 % more likely to develop MS than women who did not suffer from migraines.

Although the research seems to indicate a correlation between migraines and MS, it remains unclear whether migraines contribute to the development of MS. Dr. Illya Kister, the research investigator noted:

Over 99% of migraineurs will not develop MS, since MS is a rare disease, while migraines are quite common; about one in 5 women in the U.S. will have a migraine over the course of a year.

Researchers called for closer scrutiny of the relationship between migraines and MS.  It is worth noting that,  despite extensive research,  the causes of MS are not well-understood.  In this regard, further research of migraines in MS patients could be illuminating.

Contributing Author: Jon Stefanuca

Study: Screening Tools Accurately Identify Postpartum Depression – Focus Group: Urban Minority Moms

February 20, 2010

In a study led by the University of Rochester Medical Center and published online by the journal Pediatrics, researchers have determined that there is a high degree of accuracy in making the initial determination of postpartum depression (“baby blues”) in urban, minority women when using three depression screening tools.   This research was funded by the National Institute of Mental Health 

This study is reported in a recent article posted in Medical News Today.

Many women experience the so-called “baby blues.” When the feelings persist or worsen it may be clinical depression. The symptoms include insomnia, persistent sadness, lack of interest in nearly all activity, anxiety, change in appetite, persistent feelings of guilt, and thoughts of harming oneself or the baby. Postpartum depression affects up to 14 percent of new mothers in the United States, with higher rates among poor and minority women.

These screening tools have previously been evaluated but this is the first time they have been tested with a group for whom there is not much data – low-income women, especially African-American women, said Linda H. Chaudron, M.D., associate professor of Psychology, Pediatrics and of Obstetrics and Gynecology.

The three screening tools being evaluated were the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory II and the Postpartum Depression Screening Scale.  By clicking on any of the links we have supplied to these tests, the reader can readily see just how simple they are and how quickly they can be administered (as reported – 5 minutes or less).

These screening tests are just that – screening mechanisms.  Healthcare providers dealing with new mothers should be mindful of using these tools and thereby be in a position to help these mothers during this difficult time in their lives.  This is not something restricted to obstetricians  – it is for all healthcare providers who come in contact with any new moms, whom they suspect may be suffering from “baby blues.”  Don’t assume all is well on the home front – ask!  It won’t take much time, but it could provide much needed help for your patients.


Aspirin Found to Decrease Mortality in Breast Cancer Patients

February 17, 2010

A recent study reported in Medical News Today and published in the Journal of Clinical Oncology suggests that women who take aspirin at the conclusion of chemotherapy are less likely to die from breast cancer.

The study involved 4,164 female registered nurses who were diagnoses with breast cancer between 1976 and 2002. Because aspirin is contraindicated during chemotherapy, those patients who took aspirin generally began taking the drug a year after their breast cancer diagnosis.

The result of the study suggests a positive correlation between taking aspiring and decreased mortality rates. Women who took aspirin at least two days a week reduced their mortality risk by 64% to 71%.

Fibroids during pregnancy increases risk of stillborn birth.

February 9, 2010

Fibroids, which occur in an estimated 5% to 20% of women, have been reported by researchers at Washington University in St. Louis, Missouri  to increase the risk of stilborn birth. The study was presented Saturday, February 6th,  at the annual meeting of the Society for Maternal-Fetal Medicine in Chicago.

It is known that many women who have fibroids are without any symptoms.  What is of importance is that women typically undergo sonography at 16 to 22 weeks.  It is at this time that such asymptomatic fibroids can be detected.

This study looked retrospectively at over 64,000 births.  After numerous other factors were excluded and a subgroup identified, the investigators found that women with  fibroids and in whom there was evidence of intrauterine growth restriction (IUGR) were at a relative increased  risk of having a stillbirth (fetal death in utero – FDIU).

“Our results showed that women with a combination of fibroids and fetal growth restriction were at two-and-a-half times the risk of having a stillbirth, though the absolute risk remained rare,” said Dr. Alison G. Cahill, one of the study’s authors. “This may lead to a future recommendation for serial growth scans to monitor fetal growth in women with fibroids.”

One related question remains: will the cost-effectiveness of serial sonograms for this group at risk drive the decision-making on setting a new standard for surveillance?

If you are pregnant and know you have fibroids, this is a subject for discussion with you obstetrician.  If you are unaware of the presence of fibroids and undergo the usual 16-22 week sonogram, it might not be a bad idea to inquire about the presence of asymptomic fibroids when this test is interpreted.  We have been involved in a number of cases of FDIU and the emotional devastation it causes a family when it occurs is simply awful.

Should you be interested in more information about fibroids, the US Department of Health and Human Services has a good FAQ on this topic.