What I Am Reading: OCP

(by whizbang) Oct 21 2014

Click to Amazon

Click to Amazon

Stop what you are doing. Right now. We all should read this book, The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution. Jonathan Eig tells us the story of the intersecting lives of Margaret Sanger, Katharine McCormick, Goody Pincus, and John Rock. Their individual motivations differed, but ultimately their efforts combined to bring about the oral contraceptive pill (OCP), Enovid.

Sanger wanted to make sex as free and pleasurable for women as for men; McCormick wanted women to have more opportunities without being a slave to their uterus. Goody Pincus wanted to be recognized as a great scientist; Rock wanted women to be able to space pregnancies. All were influenced by the health effects of uncontrolled fertility on women, particularly those who were poor.

Their discoveries collided with changing social attitudes around 1960, leading to a revolution in women's rights and attitudes toward sex. The book details the perfect storm that led to the current state of women and sex. When they first began testing the OCP, contraception was illegal in a majority of the United States. They worked around that little problem by testing an initial indication for menstrual disorders! Many previously infertile women in Rock's practice also became pregnant after a few months of regulation with Enovid, so even though it inhibited fertility, it had a possible infertility indication!

Perhaps most importantly, this work reminds us how important the OCP and control of fertility are for women. Women with fewer pregnancies experienced better health. In the years after the OCP became available, women's wages began to catch up to men's; a woman employee was not merely killing time till the stork came! Women also began entering higher education in greater numbers, including professional schools. Women continued their decades-long quest for real equality.

We have other contraceptive options today, but the OCP remains the gold standard. Read this book; you will learn something, and the stories are quite entertaining!

No responses yet

Disappointment @Fitbit

(by whizbang) Oct 18 2014

FitBitOneFor several years I have been wearing a Fitbit of one sort or another. Currently I have a One clipped to my bra, measuring various activity parameters. I love my One and the Fitbit dashboard, enough that when my scale went bad I bought the Aria wifi scale. Having my weight and activity data in the same database has been interesting and helpful.

I prefer Lose It! for diet tracking, but it can interface with the Fitbit dashboard. I can see interrelated health data all in one place!

Earlier this year I found out that my blood pressure was sky high. Fitbit does not make a blood pressure cuff, nor do any on the market automatically record to their dashboard. It has a place to record blood pressure, but I would have to manually enter it. I explored a couple of "fitness dashboards" that said they could accomplish this feat, but none worked.

When Apple announced the Health module in iOS8, it thrilled me. Given the popularity of Apple and Fitbit, I assumed that my problem had been solved. Then Fitbit announced that they would not pursue Health integration for now, and Apple will no longer be selling Fitbit devices.

Damn.

Like it or not, a single health dashboard that can collect information automatically will give people the best information to track their health habits and results. Manual entry can be performed, but really should be unacceptable in this day and age. Also, there are other devices out there that could be linked up (CPAP machines, etc).

If these corporations were really people, we could put them in "time-out" or "peace chairs*" until they work this out. Unfortunately, disciplining and/or modulating behavior of corporations is proof that they are not really people (is the Supreme Court paying attention to this blog?).

So come on, Fitbit. Play nice with Apple. Please, for me!?!


* "Peace chairs" came to our attention when our daughter was in first or second grade. Children with disagreements were to sit side-by-side in these chairs and work out their differences with words. This concept did not really get our attention until the day that another child would not do the "peace chair" thing with our daughter. She wielded a pair of safety scissors and told him to get in the "peace chairs" or she would cut him. This led to an interesting discussion with her teacher. Thus, I really do not have any data to support the use of "peace chairs" in practice. 

 

No responses yet

Commitment or Insanity? #nanowrimo

(by whizbang) Oct 17 2014

During my residency in pediatrics, I had an idea for a story. As I pondered various twists and turns in the tale, I realized that telling the world would result in a novel.

Needless to say, life intervened. A couple of kids, a lab to start, a career to develop; somehow these all kept me from getting around to putting my words on record.

A couple of years ago I told my son about my idea. He was pretty amazed at the level of detail I had already incorporated into the general plot. Every time he came home from college, he asked about my progress. I finally started a Scrivener file for the work and began creating character sheets and some scene outlines. At least I could say it was a work in progress, and not just a dream in my soul.

Today I saw a link to the National Novel Writing Month site. I signed up, agreeing to write 50,000 words during November.

I will likely fail to write this many words.

Even if I only grind out 20,000 words, that’s a lot more than I have done to date. Having that bit of competition and encouragement may make it happen, and may get me to produce more than I anticipate.

Any of you have dreams of authorship? Not scientific papers, but novels, collections of stories, or even memoirs? I challenge you to sign up for #nanowrimo as it is called on Twitter. Let’s make each other write!

2 responses so far

Farewell #Sciox

(by whizbang) Oct 10 2014

Science Online announced its dissolution yesterday. This makes me sad; I learned a lot from this conference. However, I am not surprised at this outcome.

Science Online 2014 failed to attract a number of professional writers that attended earlier versions of the unconference. I learned a lot from these people, especially about the craft and tools of writing. As a physician-scientist, I had reasonable writing skills, but little knowledge of the nuts and bolts of publishing.

  • The response of the organization to the scandal of 2013 was tone-deaf at best. Many of us at the 2014 conference were disturbed by this response.
  • I was disappointed in 2014 that no sessions featured medical or health related topics; for 2015, they selected no topics in advance. I was not willing to send in the bucks when it was not clear what was on the program.
  • Frankly, they lost my participation when they announced Atlanta as the 2015 location. I had just been to a meeting in that city, and I had no interest in returning anytime soon. I really, really hate that airport as well.
  • The writing was on the wall when the conference failed to fill this fall. In the past, slots were gone within minutes of opening. When I read the list of participants a month ago, I saw none of the regulars who might have convinced me to go, including the writers I had met and learned from at earlier events. The group always needed to include new blood, but a cadre of prior participants with institutional memory really made things flow.

These events are bittersweet; one could argue that the book I published this week would not have happened with the information and insights gleaned at Science Online. I will miss the people I met along the way.

One response so far

My New Baby

(by whizbang) Oct 09 2014

What do you call 100 babies in a single litter?

What do you call 100 babies in a single litter?

Hard copies arrived! My new book, The Promotion Game, arrived in a big box.

I never realized how proud I would feel to see my work in print and hold it in my hands.

It's almost like giving birth to something, except without the blood.

If you are interested in succeeding in academic medicine, this book may be for you. You can get more information here.

Ebooks are expected to be available soon on Amazon and the other usual venues.

One response so far

High Stakes Games

(by whizbang) Oct 08 2014

Too many new faculty in academic medicine get lost.

They sign on with academic medical centers with the best intentions. They want to inspire the next generation of providers. They want to solve healthcare problems. They hope to make the world a better place.

Unfortunately, academic medicine provides many distractions.

Unlike our PhD colleagues*, we MDs often fail to teach our trainees anything about academic life. I came from an academic family. I knew about ranks and tenure and other issues, but I still didn't really know how to succeed in The Ivory Tower. Someone gave me the Faculty Handbook, including promotion and tenure (P&T) guidelines, when I showed up at my first job.

Yes, I wrote it all down!

Yes, I wrote it all down!

Have you ever read a faculty handbook? Have you ever tried to read a faculty handbook? These documents tend to be written with stilted dry language. The handbook for an entire campus also keeps things vague enough that it applies to all departments and sections; this provides little guidance for a new assistant professor. You have to find contacts who can give you the real dirt. How many papers are considered "a significant number?" What sort of funding counts toward the tally? Will case reports be held against you? How do you document your educational efforts?

Mentorship helps (those contacts described above). P&T workshops with department-specific information can help. Unfortunately, none of these can be used as a lasting reference. Clinician faculty, in particular, often lose sight of their goal. Patient care responsibilities and other tasks can distract them from achieving and documenting the things that matter for academia. They get a few years into their first appointment and discover that they are behind the eight ball. Many leave academic medicine at this point.

That's why I have written down wisdom collected from multiple institutions and many colleagues. I have tried to keep this brief guide chatty and useful, rather than an academic tome. Yes, it is vague in that it gives no specifics for any institution; however, it does help faculty members know what to ask their colleagues and mentors.

When you get down to it, P&T is really a game. You have rules, you reach milestones, you keep score, and eventually you can win.

Yes, this is my Big Surprise. The book is debuting soon, both in print and as an ebook. Learn more at the website, ThePromotionGame.com.


*Instead, our PhD colleagues prepare everyone for an academic career, even though we know there are not enough positions for every trainee and many will have to pursue careers outside of The Ivory Tower.

One response so far

The Next Step

(by whizbang) Sep 29 2014

So I have been working with my standing desk for some time now. I have gotten comfortable with upright posture for most of my office duties, so I thought I would up my game and add physical activity.

Turns out an under-the-desk treadmill is $600 minimum. I'm not that ready for commitment. One website showed a standard treadmill that you could detach the handrails from, but I am not up for that sort of project.

StepperInstead, I spent $50 for a stair-stepper. It requires no power source. You can buy them at a variety of price points with various bells and whistles, but I went low-tech here. I have it set on the lowest tension.

It does take some time to get used to the stepping while you do stuff. I usually take calls without stepping, but I am able to write this blog post while I'm working my butt.

Only disadvantage I can see is that I am climbing a staircase to heaven but my Fitbit registers it as steps, not stairs. Oh, well, I'm burning extra calories.

So far I'm pretty happy with this investment. For the first time since I moved to Oklahoma I can easily get inm 10,000 steps without setting foot in the gym.

No responses yet

Big Surprise Coming

(by whizbang) Sep 24 2014

In the next couple of weeks I have a big surprise coming. It will explain my relative lack of posts lately.

In the meantime, I have to go to a wedding and take care of my patients.

Try to pee without me...

One response so far

Screening Urinalysis in Practice

(by whizbang) Sep 18 2014

Guidelines based on evidence or expert opinion, even when available, seem to be followed only occasionally. What do pediatricians do in practice with screening UAs?

Pediatricians’ screening urinalysis practices. J Pediatr 147:362-5, 2005  doi:  10.1016/j.peds.2005.05.009

This survey study examined the self-reported practices of general pediatricians in the US at a time when UA was recommended at 2 ages: start of school, ~5 years old, and sexually active adolescents. They asked when all asymptomatic children seen in the practice were screened at least once with the following choices:

  • Infancy (<1 year of age)
  • Early childhood (1 to 5 years of age)
  • Late childhood (5 to 12 years of age)
  • Adolescence (12 to 20 years of age)

Yes, they included the only definitely recommended age in two choices in their survey (why didn’t someone see this ahead of time?). The majority of responders (78%) screened at least once, with 58% screening more than one age group, leading to the following results:

  • Infancy 9%
  • Early childhood 60%
  • Late childhood 55%
  • Adolescence 58%

Pediatricians reported that they felt this screening benefitted the children and their overall health. Beyond that, the survey did not attempt to elucidate the rationale for practices identified. Were physicians unaware of changes in guidelines?

What is the downside of screening so many, so often? Next up we will look at the costs of this practice.

No responses yet

Pediatric Screening Urinalysis in the US

(by whizbang) Sep 16 2014

A Brief History of Recommendations

Back in the 1980s when I trained, the American Academy of Pediatrics (AAP) recommended a screening urinalysis at four age points during childhood: infancy, early childhood, late childhood, and adolescence. Getting urine out of a child can be incredibly time consuming. Stick-on bags can be used in children not yet toilet trained, although results are often contaminated by skin flora. Bags can also leak, making the process a frustrating waiting game.

In 2000 the AAP published new guidelines with screening UA recommended only at 2 ages: 5 years old, the typical age of school entry, and in sexually active adolescents.

Hmm...UA doesn't seem to be a procedure...

Hmm...UA doesn't seem to be a procedure...

Today's well child preventive care guidelines are known as Bright Futures. The components of care are enlarged in the figure at the right; recommended lab studies are listed under Procedures, and no urinalysis can be found in this table or elsewhere in the document.

At present, it would appear that otherwise healthy, asymptomatic children do not need screening UAs.

What About Sports?

After exploring a number of professional sites, including the AAP, I found no recommendations for UAs prior to athletic participation. Blood pressure screening is included, with the recommendation that children with unexplained or uncontrolled hypertension should not participate in power lifting or body building. A urinalysis should be included in the work-up of hypertension in children, but that goes beyond the scope of the sports physical.

So the Answer is...?

Poll

None of the above wins!

None of the above. Currently, no UA is recommended at any age or before any activity for healthy, asymptomatic children.

So what are primary care providers actually doing? And why is this an issue? More fun to come, WhizBangers!

No responses yet

Older posts »