Monthly Archives: June 2013

Frontiers of Fertility

Reproductive Health

Frontiers of Fertility

2013-06-10

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Making babies ought to be the easiest thing you’ll ever do—indeed, it ought to be a hard thing not to do. The evolutionary game is rigged so that it’s fun, the kind of fun you want to have even when offspring aren’t on your mind. Our body cycles make parenthood a constant possibility: women are ready to conceive every month, and men are pretty much ready to go any second. And the product of all that happy activity—a chubby, cuddly, cooing baby—is something we’re hardwired to find irresistible.

But things, of course, aren’t always so simple. The human reproductive system may be a prolific thing, but it’s also a very fragile thing, and there is a lot that can go wrong with it. In the U.S. alone, more than 7 million women have received treatment for infertility, spending more than an estimated $5 billion per year. For the past 10 years, the average billed cost for a single in vitro fertilization (IVF) cycle is $12,400—something infertile couples must pony up on their own since most insurance companies don’t cover infertility treatments—and just one cycle is usually not enough. According to the U.S. Centers for Disease Control and Prevention, only 42% of assisted-reproduction cycles lead to a live birth when the woman is younger than 35. The figure drops to 22% by age 40, 12% by 42 and just 5% by 44. Outside the U.S., the odds are no better, and the number of people who need help is far greater: an estimated 48.5 million couples worldwide are unable to conceive after five years of trying, according to figures released last year by the World Health Organization.

Given the powerful, primal hold baby-making has on us, the inability to perform so straightforward a genetic job can be deeply painful. “My husband and I would look around, and everyone we knew was having kids,” says Cindy Flynn, 35, an IT worker at a Sacramento nonprofit. “We struggled so hard to get pregnant. Building a family should not be so difficult.”

For now, it still is, but the outlook is getting decidedly brighter. Scientists are steadily refining and improving assisted-reproduction techniques. They’re harvesting better eggs, using fewer drugs to do it and selecting more vigorous sperm that have a better chance of producing a baby. They’re monitoring embryos while they’re still in the lab in ways that were impossible before. Perhaps most tantalizing, they are working to engineer human stem cells so that eggs and sperm can be produced in the lab using raw cellular material taken from the parents. This would lead to a baby that was entirely, genetically theirs, the product of an ordinary union of egg and sperm—nothing short of a last-ditch miracle for people who, without this help, might have been unable to produce any healthy egg or sperm at all.

“Twenty years ago I would often tell a patient, ‘I am sorry. There is nothing we can do,’” says Dr. Craig Niederberger, head of the department of urology at the University of Illinois at Chicago College of Medicine. “Fifteen years ago I would have been saying, ‘There is something I can do, but it’s very experimental.’ Today I can often say, ‘There is at least a 2-out-of-3 chance you are going to have a baby out of this process.’ It is becoming the most exciting field, with the most gratifying outcomes you can imagine.”

Boosting the Odds
Improving the outlook for fertility patients starts with improving the art of IVF, which is not just expensive and less than reliable but a true physical grind. Women must first endure a month’s worth of hormonal dosings, including two or three shots a day in the final stretch, all of which can lead to headaches, restlessness, irritability and hot flushing. The dosing pushes the ovaries to hyperovulate, producing up to a dozen ova at once, which are retrieved via laparoscope through an incision in the pelvis. Even after all that, there’s no guarantee the eggs will be viable; many immature ones that the ovaries would never have released on their own are shoved out prematurely by the drugs.

“Every time a patient goes through conventional IVF, the number of eggs designated as waste is about 90%,” says Dr. John Zhang, founder and director of the New Hope Fertility Center in New York City.

Smoking Alcohol: The Dangerous Way People Are Getting Drunk

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Smoking Alcohol: The Dangerous Way People Are Getting Drunk

@acsifferlin

(Alcohol Without Liquid) de

Alexandra Sifferlin is a writer and producer for TIME Healthland. She is a graduate from the Northwestern University Medill School of Journalism.Vaportini

To get drunk, people are getting creative. But a new form of drinking, known as “smoking” alcohol, has doctors concerned.

Whatever happened to taking shots? Any sort of excessive drinking is dangerous, be it via beer bongs or pouring shots into the eye socket. But now some drinkers are taking it even further and “smoking” alcohol. The questionable practice, which has potentially scary consequences, has various permutations.

An individual can pour alcohol over dry ice and inhale it directly or with a straw, or make a DIY vaporizing kit using bike pumps. The alcohol of choice is poured into a bottle, the bottle is corked, and the bicycle pump needle is poked through the top of the cork. Air is pumped into the bottle to vaporize the alcohol, and the user inhales.

In 2004, the U.S. saw a brief (Alcohol Without Liquid) device, but the product was quickly banned in the U.S. and lost its following.

Nearly a decade later, clinicians are seeing evidence that the practice is gaining some traction — and not just among college kids and adolescent risk takers. It’s popular among people who want to lose weight and don’t want the calories that come from consuming alcohol. “People think it is a great way to get the effects of alcohol without gaining the weight because alcohol has an enormous amount of empty calories. You can’t be ingesting a lot of alcohol if you’re on a diet and want to lose weight,” says Dr. Deni Carise, the deputy chief clinical officer at CRC Health Group, a treatment- and educational-program provider for individuals struggling with behavioral issues, chemical dependency and eating disorders. “I think adolescents are also particularly susceptible to this because it is novel and exciting.”

In a North Texas man, Broderic Allen, says he stopped drinking to lose 80 lb. (36 kg) and started smoking alcohol to avoid calories:

When alcohol vapor is inhaled, it goes straight from the lungs to the brain and bloodstream, getting the individual drunk very quickly. Because the alcohol bypasses the stomach and liver, it isn’t metabolized, and the alcohol doesn’t lose any of its potency.

Drinkers feel the effects almost instantly, but the risks are also much higher. People who smoke their alcohol are at a much greater risk of getting alcohol poisoning and potentially overdosing. When people drink too much alcohol, they tend to vomit. Getting sick is one of the ways that prevents an alcohol overdose, but when alcohol circumvents the stomach and liver, the body can’t expel it.

It’s also much harder to know just how much alcohol you’re consuming in one sitting if you’re not stringently measuring. If a cup of alcohol is poured into a bottle and then vaporized, the drinker cannot tell if they are inhaling a few sips or the whole cup, since the liquid remains in the bottle.

“It’s also terrible for your lungs and nasal passages,” says Carise. “Your lungs are not meant to inhale something that can turn back into a liquid. When you think of liquid in the lungs, you think of drowning.”

The prevalence of the trend is unclear, since there are no current studies tracking the cases, says Carise. But like other drinking fads, YouTube videos of drinkers inhaling and smoking alcohol have increasingly popped up online.

The trend is also picking up in the bar scene, with vaporizing methods like the which is legally sold in all 50 states. The site boasts: “This has the advantage of no calories; no carbs, no impurities and the effects of consuming alcohol are immediately felt, making it easier to responsibly imbibe.”

Fortunately, these beverages are usually consumed in a wide glass, so the effect is not as concentrated, says Carise. Still, she finds the concept disturbing. “It is amazing what our culture will do to get drunk,” she says.

Obsessive Compulsive Personality Disorder: A Philosophy of Perfection

Psycological Health

Obsessive Compulsive Personality Disorder: A Philosophy of Perfection

2013-06-07

Television has entertained us for decades with their more than extreme characterization of people who have obsessive compulsive personality disorder. First, there was Felix Unger, the anxious, perfectionistic, and above-board neurotic character played by Tony Randall who drove his messier roommate Oscar Madison (played by Jack Klugman) crazy with his OCPD behavior (The Odd Couple). Next, we had TV’s lovable, neurotic detective Tony Shalhoub as Adrian Monk and also TV psychiatrist Dr. Niles Crane (played by David Hyde Pierce) of Frazier. And, today, we have Bravo reality star  Jeff Lewis of Flipping Out; the OCPD real-estate developer who will not let his employees use the bathroom in his home office if they have to make a bowel movement.

These highly intelligent, neurotic and very lovable characters wipe seats with napkins before sitting, neurotically honk their noses without cause, and also possess dogged will when it comes to living up to their standards. They have an obsessive-compulsive personality disorder that like all disorders of personality has both its strengths and weaknesses.

But, don’t think just because I’m mentioning television’s famously fussy who seem to be primarily men does not mean that women are immune to this disorder. The rates of OCPD appear to be the same for men as they are for women. About 1 in 100 people in the United States is estimated to have OCPD with a lifetime prevalence rate of 7.8% (National Center for Biotechnology Information; and OCFoundation.org).

OCD or OCPD?

People often mistake Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) as the same conditions. But, they are very different disorders in cause, symptoms, and treatment (National Institute of Mental Health).

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that is a dysfunction of brain chemistry rather than personality development. Unreasonable thoughts and fears lead to intrusive ideas (obsessions) and repetitive behaviors (compulsions), like chronic hand washing or door checking that are unrealistic, irrational, and foreign to the person’s sense of who he or she would be normally. These symptoms cause them disabling anxiety and stress. They obsessively worry about harm coming to them or loved ones, and have unreasonable fears of contamination, and unwanted religious, violent, or sexual thoughts randomly popping into their heads. These symptoms disrupt their ability to function normally at home, work, or school. And, if their symptoms are severe enough or left untreated, the risk for suicide increases  (MayoClinic.com).

In contrast, OCPD is primarily a disorder of personality development that has no single cause. But, it is generally considered to be a disorder brought about by the effects of childrearing. The parent’s childrearing style squelches their children’s spontaneous self-expression. Either personality conflicts from their own past or social and economic pressures cause the parents to be intolerant of less than perfect behavior in their children. They may withdraw approval and affection or even punish the child, when the child’s behavior doesn’t live up to their standards.

In contrast, some OCPD persons were labeled the family savior by their parents. The child takes on the oppressive burden of either having to raise the family out of some adverse social or economic situation or having to bring happiness to a narcissistic, depressed parent who is using the child to fulfill unrealized desires of his or her own. OCPD traits arise in the child’s attempt to accomplish this formidable task.

No matter the particular relationship dynamics between parent and child, OCPD children learn that there is little room for imperfection, so that they begin to obsessively calculate every thought, feeling, and action to minimize the risk of falling below the  impossible standards they set for themselves.

But, what is this risk really all about? At its heart, it is the risk of disappointing themselves by falling below a standard of behavior that is really a consolidation of their parents’ hopes, fears, and expectations. This is what drives OCPD character traits. OCPD persons are trying to avoid disapproval, withholding of affection and love, or punishment, even more so than achieving perfection. They take on superhuman characteristics to assure that they feel good about themselves. All of their traits are meant to support a rigid ego that has only one way of dealing with the world. That is perfection. Anything that gets in their way of fulfilling this goal makes them highly anxious and fearful.

Because OCPD people run a tight ship on themselves, they usually excel at their professions and often become leaders of society. But, they also put impossible standards on family, coworkers, and friends. Thus, intimate relating can be problematic for them. They don’t know there is anything unusual or wrong about their behavior until lovers, family, and friends begin to point it out to them. But, intimate relating can actually become their greatest vehicle for emotional growth. They are fiercely loyal and want to do the right thing, so that it is possible to get them to negotiate needs, although they may kick and scream along the way.

Treatment of OCPD

The treatment of OCPD can be lengthy because their difficulties have become part of their general life philosophy. Their character traits are deeply entrenched in ego-behaviors that have brought them considerable reward in life. Research shows that one of the best treatment approaches for OCPD is cognitive-behavioral therapy. This therapy treats symptoms that disable the person rather than deep psychological complexes. Cognitive therapy needs to help these patients to identify distorted thinking that reinforces their philosophy of perfection, undermines relationships, and leads to a rigidity that actually thwarts their relationships and goals. Also, stress management can help them to deal with anxiety that results from their fears of letting go of OCPD ways.

But, I also recommend psychodynamic exploration so that the person can bring into full awareness the developmental contributions to their belief system and character traits. The goal of therapy is to help these persons to cope with change and unpredictability better, manage anxiety and stress, and become more spontaneous and comfortable with feeling. The aim is to get their character traits to loosen up enough to allow for new learning and emotional growth.

Remember, there’s usually an upside to our weaknesses and emotional problems. And, this is true of OCPD. These persons have an uncompromising standard of excellence, an unshakable commitment to their beliefs that helps them to endure suffering and opposition. Their nose to the grindstone mentality, integrity, and high intellect can be used as a treatment tool for personal change. OCPD people love to understand, so that a treatment that increases their awareness and ability to be in the world in new, more functional ways will hold their interest. Therapy can become a powerful vehicle for becoming better—only, now, in a healthy way.

To learn more about OCPD, you may want to explore the links in today’s post. There’s a wealth of information on OCPD on the internet, today. Some of these websites include Psychcentral.com; MentalHealth.com; OCFoundation.org; and The Gift of OCPD.

I hope you liked today’s post and gained some new understanding into OCPD and the making of a personality disorder. If you did, please let me know by selecting the Like icon that immediately follows. You can also Tweet or Google+1 to let your friends know about it. Take good care friends. Warmly Deborah.

How Vinegar Could Save 73,000 Women A Year From Cancer

featured, Sexual Health

How Vinegar Could Save 73,000 Women A Year From Cancer

Almost two decades ago, a doctor named Surendra S. Shastri was put in charge of preventative oncology at Tata Memorial Hospital in Mumbai, India. One of his biggest jobs: to figure out how to cut the toll from cervical cancer, which kills 200,000 women a year in the developing world but is rare in developed countries.

In the United States, that death toll is just 4,000, the result of the most successful story of early detection preventing cancer death. Unlike most other cancers, cervical cancer starts as a pre-cancerous lesion that accumulates mutations. The Pap smear, a technique invented in the 1920s by George Papanicolau, a Greek pathologist at Cornell University, involves a doctor taking cells from the lining of the cervix and sending them to a lab to be analyzed under a microscope. Annual pap smears mean most cases of cervical cancer that would happen in the U.S. are caught before they become deadly tumors. In India, which has the world’s worst cervical cancer burden, the introduction of annual Pap smears for all women seems impossible.

“We don’t have the kind of laboratories or the kind of trained manpower needed for having a Pap smear. The Pap smear has succeeded in the countries where it has because of good quality control and frequency of screening,” Shastri says. He needed something far cheaper. The idea that he and others hit upon was to steal a step from from the procedure that follows a suspicious Pap smear. Doctors pour acetic acid – basically a sterile vinegar solution – onto the cervix and look at it under a magnifier. Cancer and precancer cells have less of the gooey cytoplasm than healthy cervix, and the acetic acid makes them actually turn white after just a minute. The normal cells remain a healthy pink.

Shastri skipped the magnifier and the doctor, and decided to train the same health care workers who give immunizations and other basic preventative measures to apply an acetic acid solution in the field. In 1998, he obtained funding from the National Cancer Institute, one of the U.S. National Institutes of Health, to conduct a fifteen-year clinical trial comparing using the vinegar screen once every two years to not screening in 150,000 women. The results are being presented today here at the annual meeting of the American Society for Clinical Oncology. The vinegar test reduced the rate of cervical cancer death from 16.2 women per 100,000 to 11.1 women per 100,000, a 31% reduction.

“It’s amazing,” says Carol Aghajanian, chief of gynecologic oncology at Memorial Sloan-Kettering Cancer Center in New York. “Thousands of lives could be saved by this inexpensive technique.”

Shastri and his co-authors estimate that in India alone, the introduction of acetic acid screening could prevent 22,000 cervical cancer deaths annually. If it could be instituted across the developing world, that would save 73,000 lives.

Based on those results, the national government in India and the state government of Maharashtra, the state of which Mumbai is the capital, are instituting screening programs for all women. But translating this procedure from Tata Memorial Hospital to the rest of India or from India to the rest of the world does pose challenges.

Ted Trimble, the Director of the Center for Global Health at the NCI, notes that the health care workers did more than just use tests. They made innovative use of new technology – using digital cameras to record exams so they could be reviewed later and geomapping of the slums of Mumbai so women could be found – and of super-organized records. More than that, he says, the workers did a great job of making sure women who were screened as potentially having cancer did get to Tata Memorial for their exams. Will other hospitals in other countries be as diligent outside of a controlled clinical trial? It’s impossible to know.

Still, this is a striking example of how a low-tech, low-cost intervention can sometimes take the place of a more high-tech innovation. In 2009, Shastri co-authored a paper in the New England Journal of Medicine showing that a single round of acetic acid screening was about the same as a single pap smear for detecting cervical cancer, but neither were as good as a newer invention, which tests for the viral DNA of the strains of the human papilloma virus that are the main cause of cervical cancer.

But the viral DNA test is expensive. Even in the U.S., it is so costly that it has not replaced Pap smears. The Bill & Melinda Gates Foundation has partnered with Qiagen QGEN -0.38%, the Dutch diagnostics company, to create a cheaper version that might be useful in the developing world. Irma Alfaro-Beitz, a senior director of global health at Qiagen, says that Qiagen worries about introducing the test in countries that lack the equipment and processes to perform it or the ability to make sure women are helped once cervical cancer is found. “It is very important that when we introduce a test into a country that country is ready for the test,” she says.

The Gates Foundation still says that the new test should cost about $5, and that it has received regulatory approval from the European Union and been granted marketing authorization in many emerging markets, including India. But approval from the World Health Organization is still pending, and that will be necessary to allow agencies of the United Nations to procure the test.

Shastri says that even if the test becomes available, he is likely to use it only as a second step after the acetic acid screen. The current cost of screening one woman is about 30 Indian rupees, about half a U.S. dollar. Even if the cost of HPV viral testing can drop to $2, it will still best be used to make sure that cancer is detected in women whose cervixes show white areas after being exposed to acetic acid.

Other methods are also being used to help to reduce the number of cervical cancer deaths, too. Last month, Merck and GlaxoSmithKline dropped the prices of the two vaccines against HPV, Gardasil and Cervarix, to $4.50 and $4.60 per dose for use in the developing world. That’s less than one-twentieth the price in the developed world.

There is also some good news on the treatment front: researchers at the ASCO meeting announced that Roche’s Avastin can extend the life of an average woman with late-stage cervical cancer by four months to 17 months. It is not yet clear what can be done to get Avastin, which costs tens of thousands per year, available to rural women in the developing world.

Yes, oral sex can lead to cancer

Sexual Health

Yes, oral sex can lead to cancer

Actor Michael Douglas made headlines on Monday after telling The Guardian that his throat cancer may have been caused by the human papillomavirus transmitted through oral sex.

The link between oral sex, HPV and cancer has been receiving more attention in recent years.

HPV is a virus that’s transmitted through sexual contact — genital or oral. There are more than 40 types, according to the Centers for Disease Control and Prevention, and approximately 79 million Americans are currently infected. Most people have no symptoms.

“HPV is so common that nearly all sexually active men and women will get at least one type of HPV at some point in their lives,” the CDC’s website states. “In most cases, the virus goes away and it does not lead to any health problems. There is no certain way to know which people infected with HPV will go on to develop cancer.”

Douglas’ publicist told CNN that the actor did not intend to point to HPV as the sole cause of his throat cancer, but was suggesting it as one possible cause.

HPV is thought to cause 1,700 oropharyngeal, or throat, cancers in women and 6,700 oropharyngeal cancers in men each year, according to the CDC. Tobacco and alcohol use may play a role in who develops cancer from the virus, the government agency notes.

A 2011 study found that the proportion of oropharyngeal cancers related to HPV increased from 16.3% to 71.7% between 1984 and 2004. Data presented that same year at the American Association for the Advancement of Science annual meeting suggested HPV was overtaking tobacco as the leading cause of oral cancers in Americans under the age of 50.

The virus is transmissible regardless of whether the sexual contact is heterosexual or homosexual.

Approximately 42,000 people in the United States will be newly diagnosed with oral cancer in 2013, according to the Oral Cancer Foundation. This includes neck, mouth and throat cancers. When they’re found early, oral cancers have an 80 to 90% survival rate, the foundation says.

“Patients with HPV-positive cancers have better survival rates,” Dr. Anil Chaturvedi of the National Cancer Institute told CNN in 2011. “The precise reasons for the survival benefits are not clear, but tumors in HPV-positive patients tend to have less genetic damage. Because of that, they are more responsive to cancer therapies like radiation treatment.”

The CDC and the American Academy of Pediatrics recommend both boys and girls get the HPV vaccine between the ages of 11 and 12. Doctors say the vaccine is most effective if administered before a child becomes sexually active.

HPV has also been linked to cervical cancer, penile cancer and anal cancer, according to the CDC. The HPV vaccine prevents the most common types of the virus. There are two approved for use in the United States: Gardasil and Cervarix.

Of course, HPV is not the only danger of having unprotected oral sex. Sexually transmitted diseases like herpes, syphilis, gonorrhea and HIV can be also be spread through the act.

To stay safe, the CDC recommends always using a condom and getting tested regularly.

“The good news is that all STIs are preventable and most are curable,” writes Gail Bolan, the CDC’s director of STD prevention division. “But, because most STIs have no symptoms, testing is the necessary first step to treatment.”