Tag Archives: evidence-based medicine

Reproductive Health-Care Providers Challenge Arizona Laws That Put Women’s Health at Risk

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On Thursday, April 11, women’s reproductive health-care providers filed a federal lawsuit seeking to remove Arizona TRAP (Targeted Regulation of Abortion Providers) laws that prevent and delay many women from accessing abortion. The lawsuit was filed by reproductive health-care provider Planned Parenthood Arizona and individual clinicians represented by O’Melveny & Myers, Planned Parenthood Federation of America, the Center for Reproductive Rights, and Squire Patton Boggs.

Arizona’s extreme, medically unnecessary TRAP laws violate Arizona women’s constitutional right to access legal abortion. Their effect has been dramatic: a 40 percent decline in abortion clinics, leaving 80 percent of Arizona counties with no access to abortion clinics, and weeks-long waiting times for services. There is only one abortion provider in the northern part of the state, and that health center only provides medication abortion one day per week.

“Arizona lawmakers have made it difficult or even impossible for women to access safe, legal abortion,” said Bryan Howard, president and CEO of Planned Parenthood Arizona. “Medically unnecessary laws that only serve to attack women’s rights and put women’s health at risk should be overturned to protect women’s health and rights.” Continue reading →

Sexual Health Made Simple(-Minded)

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OK, here’s all you need to know if you want to be completely safe. Don’t engage in sex with anyone (or anything) except yourself. Come to think of it, do you really know where yourself has been lately? Better be safe than sorry.

Who would you rather believe? Movie stars or scientists and doctors?

Admittedly, this is a tad extreme. Fortunately, all you need do is go on Facebook or Google and you’ll find a plethora of cool-sounding, stylish, and evidence-based strategies to keep you safe. Well, maybe not the latter. But who needs evidence? Who’s got time to read dry, long-winded articles written by doctors and scientists about prissy, painstaking experiments taking years or decades when you could be out having fun? Besides, if something is on Facebook or Google then it must be true, right?

Condom Alternatives for Guys Who Hate Condoms

Need a sexual health tip fast? Just pull one off the ’net. Oh, here’s one for you guys who don’t like using condoms. Not to worry. There’s a little adhesive sticker called a Jiftip that you merely affix to the tip of your penis before sex. “Nothing gets in or out until you remove” it, the company claims on its website, which means that just before climax you must abruptly pull out of your partner as gracefully as possible under the circumstances so you can ejaculate wherever.

In all fairness to the company, which simply wishes to offer an alternative product for people who don’t like condoms, their website warns against using it to prevent pregnancy or sexually transmitted diseases.

Which does bring up a HUGE question: So why use it? Their answer? First, it’s cheap — only $6 a pack. So hey, what’s stopping you? Maybe, despite all biological facts to the contrary, the product just might work for you. “How can anyone know — until they try?” Best of all, “Jiftip has no side-effects” … that is, aside from getting pregnant or catching an STD. Continue reading →

Telling the Truth About Abortion Politics

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Sens. Yee and Barto asked. We answered. It’s Our Turn to share the truth behind abortion politics. We have submitted the following op-ed to the Arizona Republic, but they have not (yet?) published it.

Thank You PP croppedAs a medical professional, I am dismayed at the recent “Our Turn” published in the Arizona Republic titled, “Make doctors tell the truth on abortion drug.” I would like to do just that — tell the truth and correct the record, because the opinion by legislators Barto and Yee was laden with revisionist history, misstatements of legal fact, and most important, non-medical junk science.

Doctors practice up-to-date, evidence-based medicine. I appreciate lawmakers repealing their intrusive foray into the practice of medicine, SB 1324. This law attempted to mandate how doctors dispense abortion medication according to an outdated, 16-year-old protocol contained in the original drug label. SB 1324 was an attempt to re-start a legal case that Arizona was losing. Despite the FDA’s update of the drug label to reflect current medical practice, policymakers and the governor stubbornly insisted on enacting SB 1324. Why, I cannot imagine. The repeal of this legislation was certainly welcome.

Real doctors reject junk science. More disturbing than the FDA label issue is Sens. Yee and Barto’s assertion that “at least 170 healthy babies have been born when medication abortions were reversed.” There is no scientific support for this assertion, just as there is no peer-reviewed medical evidence for the whole notion of “abortion reversal.” A handful of doctors with a moral agenda have attempted to use progesterone to “stop” a medication abortion. However, there is nothing in the literature to justify this practice, save for one report of six informal clinical anecdotes. No significant sample size, no control group, no oversight, no peer review. Regardless, last year these same legislators passed SB 1318, violating physicians’ and patients’ constitutional rights by forcing physicians to inform their patients that it is possible to reverse a medication abortion, which is untrue. Continue reading →

STD Awareness: Can I Use Plastic Wrap as a Dental Dam During Oral Sex?

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plastic wrapIf you read this blog — or any sexual health website, really — you’ll probably see dental dams getting a lot of props. A dental dam (not to be confused with a female condom) is a square piece of latex that can cover the vaginal opening or the anus. Anyone wishing to avoid the oral transmission of STDs like herpes, gonorrhea, HPV, syphilis, chlamydia, and intestinal parasites, dental-dam advocates say, should use a latex barrier. Most people, however, have probably never even seen a dental dam, and they are not widely used. Perhaps their unpopularity is related to myths about oral sex being safe sex (it’s not!); perhaps it’s due to dental dams being expensive or difficult to find.

Plastic wrap hasn’t been evaluated by the FDA for STD prevention, and no studies have assessed its effectiveness in reducing disease risk during oral sex.

Some safer-sex aficionados have found ways around that, though. They might cut the tips off of condoms and make incisions along the sides, creating little latex rectangles. An even easier and cheaper option lies in plastic wrap, which many people use as a barrier while performing cunnilingus (oral contact with the female genitalia) or rimming (oral contact with the anus). It is inexpensive, easy to find, odorless, and tasteless, and can be purchased without even a hint of embarrassment (unless perhaps your other purchases include duct tape, cucumbers, and clothes pins). And it can be pulled off the roll in sheets as long as your heart desires!

Planned Parenthood endorses the use of plastic wrap for oral sex when dental dams aren’t available. The Centers for Disease Control and Prevention and AIDS.gov both recommend plastic wrap for use during rimming. Health authorities, such as AIDS.gov and the Idaho Department of Health & Welfare, recommend non-microwavable Saran Wrap, because microwave-safe Saran Wrap has tiny pores to let out steam — which might also let viruses and bacteria through. Continue reading →

Can Herpes Be Cured Naturally?

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Many of us are infected with herpes simplex virus, which can be transmitted sexually to cause genital herpes. Although herpes is incurable, there are antivirals that can help reduce symptoms. But, because not everyone wants to take pharmaceuticals, a lot of us might seek alternatives in an attempt to treat or even cure our herpes infections.

“Natural” doesn’t necessarily mean safe or effective, so be critical.

For centuries, we have treated herpes in many ways — though not necessarily successfully! In the early 1800s, a British treatment involved placing lint between the tip of the penis and the foreskin. It was claimed that this would cause herpes lesions to heal within 14 days — not coincidentally, this is about how long it takes for them to heal on their own, untreated. Later that century, a London surgeon promoted an arsenic-based solution as a cure for recurrent herpes outbreaks. He presented the cases of a couple of patients. One had been suffering from outbreaks for six years, and after a course of this treatment he allegedly never experienced them again. Another patient had been experiencing recurring outbreaks for four years, and after taking this treatment for a year, his outbreaks “became less and finally cleared altogether.”

We now know that, even without treatment, herpes outbreaks generally become less severe over time, and often stop flaring up completely. When outbreaks do occur, they clear on their own, without treatment. This phenomenon is called “regression to the mean,” and many promoters of bogus remedies rely on it for the appearance that their products work. Because we often think that two things that happen at the same time are related, and that one causes the other, we might attribute the clearing of our herpes lesions to whatever “treatment” we were taking, regardless of whether or not it actually benefited us.

The only way we can know if treatments actually work is to compare them with standard medications or placebos (such as identical-looking sugar pills) in well-designed clinical trials. In such studies, patients are assigned to either medication or placebo at random, which is called “randomization” and is like flipping a coin. And, to protect against introducing bias into the study’s outcomes, trials should be “double-blinded,” meaning that neither researchers nor patients know whether the placebo or the medication under study is being administered. The “miracle cures” you hear about usually haven’t been subjected to such scientific rigor — if they have, the results usually aren’t promising. Continue reading →

How Often Do I Need a Pap Test?

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Editor’s Note: In August 2018, the U.S. Preventive Services Task Force updated their recommendations to allow patients 30 to 65 years of age to receive HPV testing alone every five years — without an additional Pap test.

Almost 80 years ago, Dr. George Papanicolaou developed a simple test, the Pap test (also called the Pap smear), done in a doctor’s office to check for cervical cancer. During a pelvic exam, a doctor swabs a small sample of cervical tissue and looks for abnormal cells. If these precancerous cells are detected, it will lead to more tests or other more invasive treatments such as a colposcopy (in which actual tissue may be removed). In the 1930s, when Papanicolaou was developing his test, cervical cancer was more lethal than breast cancer. But since the development of this test, the number of women dying from cervical cancer has dropped dramatically. In 2009, of the 4,000 women in the United States who died of cervical cancer, most had never been screened or had not been screened in the 10 years before their diagnosis.

This year, the U.S. Preventive Services Task Force recommended less frequent Pap testing.

Cervical cancer is most common in women between ages 35 and 55, and usually develops from a human papillomavirus or HPV infection. Not all HPV infections lead to cervical cancer, and it can take decades for a persistent infection with a high-risk type of HPV to become cancer. High-risk HPV types are sexually transmitted and can lead to cervical cancer and also anal, penile, and oral cancers.

There are two types of screening: Pap tests and HPV tests. While they both require a pelvic exam in which cells are taken from the cervix, Pap tests look for abnormal or precancerous cells, and HPV tests look for DNA or RNA from high-risk HPV types in cervical cells. Both tests are used to try to catch cervical cancer in its earliest stages so that it can be successfully treated. Continue reading →

How to Find Accurate Health Information Online

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Does conflicting information on the Internet leave you scratching your head? Image: David Castillo Dominici / FreeDigitalPhotos.net

Does conflicting information on the Internet leave you scratching your head? Image: David Castillo Dominici / FreeDigitalPhotos.net

Did you know only 13 states require that sex education in public schools be medically accurate? This leaves a lot of people in the dark when it comes to making decisions that could have a lasting impact on their lives. Luckily, the Internet can make accurate information about sex accessible. It can also be a dangerous tool if wielded incorrectly, so it’s important to differentiate sources of good information from unreliable sources. An article in the New York Times suggests that the No. 1 way teenagers get their information about sex is through the Internet. Whether or not they receive medically accurate information depends on their search results.

You can’t assume that a product’s legality is evidence of its efficacy.

The Internet is a maze of conflicting information. Most reputable authors will cite their sources, and it’s important that you check them. Online message boards can be filled with anonymous commenters offering opinions, anecdotes, falsehoods, or facts — unless these commenters back their statements up with sources, it may be difficult for you to evaluate their claims. A message board dealing with sexually transmitted diseases (STDs) might seem like an ideal outlet for someone who is concerned about having an STD; other message boards dealing with sex or contraception offer a similar refuge. Users might appreciate the anonymity afforded by such online communities, but it’s important to remember that the people there are also anonymous. The Internet “hive mind” cannot substitute for a professional diagnosis, scientific consensus, or medically sound advice.

Other dubious sources of information might include “alternative health” websites. Many of these practitioners give good advice, like to quit smoking, start exercising, and eat fresh fruits and vegetables. We can’t argue with that. Sometimes, though, these communities can encourage the use of unproven remedies in place of effective treatments. A quick Google search for “natural contraception” can lead you to websites promoting mixtures of herbs for preventing pregnancy, and a search for “herpes cures” might leave you thinking that earwax or homeopathy can stop an outbreak in its tracks. Nonscientific ideas about the immune system also give rise to medically inaccurate statements about vaccines, such as the idea that “natural” HPV infections are preferable to being vaccinated with Gardasil — despite the facts that natural HPV infections might not confer effective immunity against re-infection and can lead to cancer. Continue reading →