Comment policy

I don’t have an official policy. I obviously don’t routinely censor anyone who disagrees with me. I am all for constructive conversation.

I do have my comments set that any new commenter has to be cleared by me, and I get notified of every comment. So, just a tip to anyone who wants to post comments calling Med Students for Choice “fucking liars”, that killing an abortion provider is somehow defensible as a “choice” with equal footing as termination of early pregnancy or anything else along those lines, it’s not going to get through. I will use such comments as proof that so called anti-choice activists are unreasonable fringe elements that defend murderers, however, and are not pro-life. So, thanks for the fodder.

I also don’t allow anonymous posting, so I will have your email address. Not that I would want to communicate with someone with that point of view on purpose, I’m just saying, spewing hate with a trail is kind of….stupid. Especially if it’s a work address or you are affiliated with a university.

If you are of the anti-choice persuasion and for some reason enjoy reading my blog, however, please feel free to check out my blog for choice day post from this January and see if you are believing any of these myths and letting them guide your comment attempts.

I have wanted to do a post on common ground for a while, and I may have time to do it soon. I am totally cool with people wanting to support women with unplanned pregnancies and who want to help them keep their pregnancies and raise happy, healthy children. Hell, I carried two unplanned pregnancies to term. Obviously I support that option. However, hateful rhetoric is not welcome here. Exercise your freedom of speech on another site where such filth is welcome. Thanks!

I write letters, activist style

A double hat tip to Shakesville, one tip for the title and another for the story.

CNN has a headline referring to Scott Roeder, the confessed assassin of Dr. Tiller, as an “anti-abortion activist.”

Here is my letter:

I was shocked to see Dr. Tiller’s assassin referred to as an “abortion activist” by your website (http://www.cnn.com/2009/CRIME/07/28/kansas.doctor.killed/index.html ) in a headline.

I am an abortion activist as a member of Medical Students for Choice. This man was many things: an assassin, a murderer, a terrorist, or simply “accused murderer” would have been accurate. He was not an activist.

Many people have complained that the popular media has normalized violent targeting of reproductive health care workers, and have theorized that this euphemization may embolden such “activists”. Please keep this in mind when covering this issue.

Signed,

A future provider of a legal, safe, necessary, common medical procedure who is sick of being maligned while violent nuts on the fringe’s feelings are coddled by the “most trusted name in journalism”.

Here is CNN’s Feedback form if you are so inclined.

Reply turned post, fair fight style

I was inspired by Shakesville’s Quote of the Day yesterday, (sorry, been busy!) which was the always inspiring (laughter / horror / disgust ) Michelle Bachman complaining that the public option “would offer equal or better benefits than any plan—but cheaper.”

I was listening to NPR this morning, and they had an interview with one of the representatives from Tennessee who identifies as a “blue dog” democrat. He is in some group that is trying to work out a “bipartisan” bill with 2 other blue dogs and 3 republicans. According to the NY Times today, a similar group in the senate is most likely coming out with what will be the successful Senate version of the bill.

So, what we have, is bills written by groups shutting out the liberal democrats that were elected en masse to reflect the public’s will. 70 to 80% of the public want a public option. So….

…this Tennessee representative today said he is one of the few in the group who actually was OK with the public option (way to represent- snort) as long as it operated on a level playing field.

I’m sorry, sir, does this mean the public option has to be expensive, bureaucratic, confusing, and deliver few benefits with poor service? Is he agreeing with Michelle Bachman that a public plan that covers people and isn’t prohibitively expensive was somehow unfair or undesirable?

So, if it works, it’s bad. And if it doesn’t work, it’s good?

The Belmont Report

I am reading the Belmont Report in order to work with human research subjects. I am an ethics and research dork, and I love this kind of stuff.

Autonomy, beneficence and justice are pretty noble concepts, ones I would like to see more of in obstetrical practice. Although the Belmont Report draws a distinction between practice and research, it holds clinical practice to a higher standard for beneficence (the obligation to do no harm, pretty much).

I was struck by this part about justice:

There are several widely accepted formulations of just ways to distribute burdens and benefits. Each formulation mentions some relevant property on the basis of which burdens and benefits should be distributed. These formulations are (1) to each person an equal share, (2) to each person according to individual need, (3) to each person according to individual effort, (4) to each person according to societal contribution, and (5) to each person according to merit.

I was just thinking about this the other day. I remember reading “From each according to one’s ability, to each according to one’s need,” I think it was in some Green party literature a while ago. I was brooding over politics and conservatives, and thought that this was probably not a statement to which they would generally agree.

I am definitely a #2. If I had to rank them, I would go 2, 1, 3 = 4, 5. What is “merit”, anyway? A badge? How about y’all?

When the boat rocks, go with the flow

For those of you who don’t follow my life like a soap opera, let me explain. No, that would take too long. Let me sum up. (A race to see who names that butchered movie quote first).

I just got a predoctoral research fellowship at my medical school. I am taking a year off to do research, both my own research project and helping my mentors with their work. I had anticipated doing a randomized controlled trial (RCT) of doulas (trained labor attendants) in a population of women on Medicaid, which would be largely African American and Hispanic urban women. These women have dramatically worse birth outcomes than the rest of the population. My hope was to, eventually, encourage Medicaid to cover the cost of a doula.

Well, that plan had several obstacles. It would be very difficult to apply for funding, get awarded, conduct, analyze, write and submit an RCT of that magnitude in a year. Based on calculations, to have adequate power to claim any sort of confidence, I would need an intervention group of about 45. Paying for doulas and scheduling that many births would be a stupendous and annoying task.

To top it all off, there is already a great body of research supporting doulas. In fact, there is a 2007 Cochrane Review that concludes “All women should have support throughout labour and birth” based on the available research, and a United States Preventative Services Task Force evidence based review of labor and delivery in 2008 that gives continuous support by a doula a rating of “A”, which means “the USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the
service] improves important health outcomes and concludes that benefits substantially outweigh harms.” Only one other birth intervention got a rating of A, upright position in the pushing stage. Neither of those practices are standard of care.

However, some practices with weaker support of even recommendations against their use, such as denying food and water to laboring women and episiotomy, respectively, are routine and common during birth in the United States.

So, my wonderful mentors, who I am loving more and more every day, said that it sound to me like I would be working hard to contribute data that was already abundant. What I want to know is why there is a disconnect between evidence based clinical research and practice. Also, it seems that the same practices that are proven in literature but ignored in practice are the woman centered, autonomy encouraging practices, and the practices that disfigure and deprive women are the ones that persevere.

So, now I am going to do a study on attitudes on and barriers to incorporating certain practices into clinical obstetrics. I think I am going to compare those four practices: episiotomy, denial of food and water, continuous labor support by a doula, and upright positions in second stage. I want to examine perceptions of their evidence, confidence in the support of their effect on outcomes, and general attitudes toward each of the practices and evidence based medicine in general. I am going to write a questionnaire andsend it out to ob/gyns, probably ones in Florida, but we’ll see.

Cool? I think so.
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

What the HELL???

I was blessed with being selected for the high-larious series on Shakesville,What the hell??, in which people send in embarrassing pictures from their youth. I sent in this art school self portrait.

Seriously, what the hell?

Check out the whole series. It’s a great stress release.

Good-bye, Cort

I found out that one of my neighbors from college died, apparently from a drug-induced overdose of some kind. It was self-inflicted and maybe intentional.
ETA: Well, I heard wrong. I have heard since he shot himself, quite intentionally.

Cortland was my neighbor and my friend. He was a drinker, which was pretty standard for my college friends. He was an artist, too, which was also pretty standard. Well, I was in the art program.

He was fun and sarcastic and cynical. He had a unique, emphatic way of speaking. He would come over almost every night and drink his first quart of beer (Florida had some strange beer import laws at the time. We didn’t have 40′s. We had quarts. Which were synonymous with his nickname.) He would never finish his second quart, which he would inevitably kick over at some point, along with anything else his combat boots could catch. We kept a “shit towel” specifically for Cort to clean up his almost nightly spills.

Our friends all got lousy tattoos together in his apartment, which was a mirror image of ours, from a wandering hippie tattooing friend of his. He got R. Crumb’s Fritz the Cat on his leg. I found the exact picture he used for the tattoo, strangely enough on the cover of a Spanish printing of it but whatever. That was on the side of his lower leg. He used to call me “a bowl and a half kind of a girl,” which was a private joke.

He was always a tortured, sensitive artist type. I always suspected he would have trouble adapting to being a responsible grown up in society. I never knew him to do any hard drugs, one that would lead to a lonely overdose, but more than 15 years have passed since I sat across my living room from him.

His passing reminds me of Don McLean’s Vincent.

Good-bye Cort. This world was never meant for one as beautiful as you. Love, the bowl and a half kind of a girl

Almost Healthy

I am praying my zucchini, which has languished in my fridge for a week while I started my new fellowship, is still good. I am making chocolate zucchini muffins. This recipe is fantastic and I have used it before. I am so happy I found it again! I think it’s almost healthy, since it has equal amounts of zucchini and sugar.

In fact, if I ever had a food business or a cooking show, I would call it “Almost Healthy.” Somehow, I don’t think that name would work for a medical practice.

Cross posted at my food blog. (Did you know I had a food blog? I guess I compartmentalize.)

Mommy Wars Bingo

New Improved Mommy Wars Bingo is on shelves now in the community issue of hip Mama zine.

My friend happened to buy a copy and have it in her bag when she came over! I haven’t gotten one in my mailbox yet.

What a great day!

I started my fellowship today.

I was about an hour early. My fellow fellow (ha!) told me the main mentor for the fellowship, Dr. F, said to come in at 10 a.m. I was too excited and insecure to come in that late, so I got to wander around by myself for a while. My “bosses”, the three researchers we will be working with, came in at 10 a.m.

Dr. F told us that she wanted us to come up with a plan, and she didn’t expect us to have anything concrete yet. I already have a lot of stuff put together. She also told us she wants some help right away putting together a grant proposal. She wants us to help with a literature search on control groups and ethics. Um, YAY!!! I am such a dork.

We got to sit in on a meeting about on the project on gay Latino men and HIV transmission prevention that is the subject of the grant. Our opinions were taken seriously. I mentioned transgender issues and the researchers and their project developer actually considered them. Part of the project involves a job application workshop, and we discussed if the training could include information on legal names versus transitioned names on job applications, if the gender assigned on the identification does not match the gender of the person interviewing for the position, gender discrimination, community resources and inappropriate interview questions.

The head researcher did say that only MTF transgender subjects would be considered, which indicated to me what her views were on gender identification. At the end of the discussion, she also joked around that no one would want to transition from assigned female gender to a male gender anyway, so it didn’t matter. She elbowed the other researcher, also a cisgender female we’ll call Dr. R, and they both giggled. I think it is more of a “girls rule, guys drool” humor they engage in often, at the expense of the third head researcher, her husband Dr. B, than a commentary on transitioning. But still. Transgender males and their health needs do exist, and could be the subjects of research, not just a joke. But I was happy we did have a legitimate discussion about trans issues for a good five minutes before anyone made any crude or disparaging remarks, and what was said was relatively mild.

Speaking of gender and sex, it was so strange to keep hearing everyone using male pronouns when referring to research and disease transmission. I am usually immersed in reading about birth and women’s issues.

The project manager Dr. R mentioned working at a nonprofit gay and lesbian association for several years, and said she worked at an abortion clinic in the 1970′s! Dr. B talks about health care reform and universal health care in glowing terms, and is a diehard idealist who has worked in the public health corps for years. I told them that I wanted to train them on the bibliographic software I used at my former job, and they sound genuinely interested.

We went out to lunch at the fancy faculty club that I didn’t know existed. It’s like a secret bunker with a pretty restaurant inside. They all left at 2 p.m. The main person in charge, Dr. F, will be gone until Monday. They are all very friendly and obviously like each other a great deal.

The other fellow and I hung out for another two hours or so. Before I left, I checked hipmama and saw that my Mommy Wars Bingo has arrived in mailboxes, in print in the hip Mama zine.

I swam with the family when I got home. I made a kick ass South Carolina Shrimp Boil for dinner tonight.

Life is good.