The National Institute for Mental Health is abandoning the DSM, for what appears to be psychiatry’s pipe-dream of proving that mental illness is biological and genetic, but at least it’s not taking the piece of garbage that is the DSM-5 seriously.
The soon to be released movie Pray the Devil Back to Hell— part of the Women, War, and Peace series on PBS— tells the story of the women who united to help bring an end to the Liberian Civil War. Leymah Gbowee, an activist who helped to bring Christian and Muslim women together to wage a silent protest outside of the Presidential Palace in Liberia, is a Nobel Peace Laureate for her leadership in the Liberia Mass Action for Peace featured in the film.
A press release from Doctors Without Borders
For an in-depth story, read The fight for global immunisation. Can funding keep pace with the will to vaccinate every child worldwide? by Adel Mahmoud at Al Jazeera
Ectopic pregnancies occur when an embryo implants in the fallopian tubes, ovary, cervix, or abdomen. I covered fallopian pregnancies in Part 1 of this series. Part 2 is about pregnancies in the cervix. They are rare, only occurring in 0.1% of ectopic pregnancies, and most of them occur after in vitro fertilization.
It’s most typical for a cervical pregnancy to abort spontaneously in the first trimester, but those that don’t are problematic and dangerous, especially those that are implanted in the isthmus— between the cervix and the fundus (see diagram above)— which are the most common types of cervical pregnancies. The first symptom of a cervical pregnancy is abnormal vaginal bleeding, but unlike ectopic pregnancies in the fallopian tubes or ovaries— roughly 2/3rds of cervical pregnancies do not cause cramping or pain. For this, and other reasons, cervical pregnancies can be hard to identify. Women who don’t go to the emergency room at the onset of bleeding are especially at risk, so it’s recommended that women do go to the emergency room as soon as abnormal vaginal bleeding begins. A woman who has no medical insurance and no pain, may wait until she is clearly in crisis and the consequences of that can be frightening— it can threaten her fertility and her life.
Before imaging technology advances like ultrasound, cervical pregnancies that didn’t spontaneously abort couldn’t be identified until after the woman had been given a hysterectomy to stop the bleeding. It was confirmed after an examination of the hysterectomized uterus. Now, a cervical pregnancy can be discovered even before the woman has symptoms. If her cervix has a bluish discoloration, for instance, imaging can be ordered so that the medical team can identify the problem and treat it.
Cervical pregnancies before twelve weeks that don’t spontaneously abort and are identified early are the easiest to treat and present less of a threat to a woman’s fertility and life than those detected and treated later. Imaging helps to determine where the pregnancy is in a woman’s uterus, but it can also be missed. Even with ultrasound, it can be difficult for a medical team to distinguish between a failed or threatened miscarriage and a cervical pregnancy, especially when the fetus is located a bit higher in the uterus and only partially in the cervix.
There are a lot of options for early cervical pregnancies that lean toward a conservative* approach. For those that continue longer there are many options for treating them. A hysterectomy may be required to stop the bleeding when the placenta is removed. To understand some of the risk of these pregnancies, it’s important to understand that the placenta is not just a sack that develops in the uterus— that’s the amniotic sac that develops inside the placenta— the placenta is a venous organ that can develop outside of the uterus. Removing it can cause significant and life-threatening hemorrhaging. Not removing all of it can cause infection. There is not a specific protocol for treating cervical pregnancies after the first trimester. Treating one can be challenging even for experienced surgeons.
If the woman’s pregnancy is misdiagnosed as a threatened or failed spontaneous abortion, and the woman is sent home to watch and wait, then the woman is at risk of hemorrhage. If a woman finds herself in a Catholic hospital that does not allow the use of methotrexate or any procedure that threatens the fetus, she may need to go to another hospital for treatment, if her future fertility is important to her.
As an aside, I found this recommendation in this article
“CAUTION ! In some societies a woman who does not menstruate is not acceptable as a wife, and if this is so in your community, don’t sacrifice her uterus unless her life is in danger.”
A society that primarily values women according to their ability to produce children, doesn’t value infertile women enough for their partner to remain loyal to them. If you think that that doesn’t have anything to do with the beliefs at the root of the “personhood” movement, then maybe you’re not paying attention to their implicit message. We’re getting into serious A Handmaid’s Tale territory with “personhood” legislation that defines “personhood” as beginning at conception and women as incubators who are of less value than a life-threatening mass of cells that has no or astronomically low chances of ever becoming viable.
“The Effects of a Hearty Dinner after Visiting the Antediluvian Department at the Crystal Palace”, a cartoon published in the magazine Punch in 1855 (image in public domain). An unsuspecting visitor of the Crystal Palace exhibition is haunted in his nightmares by the monstrosities emerging from the distant (and not so distant) past.
May 1, 1851: The First Dinomania (and Dinosaur Nightmares) at the Scientific American
The life sized models of Crystal Palace inspired the very first “Dinomania“- hundreds of thousands of people visited the Crystal Palace creatures, dinosaurs were discussed in popular magazines and models, posters, poems and novels of prehistoric beasts were widely distributed and appreciated – to the great delight of cartoonists…
This experiment looks to be starting out with some sensible approaches. It’s money well spent. Oregon is smart with money, OHSU is an excellent research hospital, and Oregon is the first state in the U.S. to have in-home caregiving, which saves money and allows thousands of disabled people to live in comfort and dignity.
I would like to see all HMOs encouraged to operate as well and as efficiently as Kaiser Permanente. As an in-home caregiver who has had four clients in Oregon, I must say that the clients who chose Kaiser got great care and personal attention. I enjoyed working with Kaiser staff and felt like part of the care team, because they made me part of it, they truly get team work. The other HMO I know of requires patients to play phone tag for a week to get anything done; and the other— for those on MEDICARE/MEDICAID— I call “the place where patients go to die.”
Since the SEIU has organized caregivers, they’ve provided plenty of different kinds of training, so that the caregivers can learn what they need to to take care of their patients individually, and caregivers who work enough hours to qualify can get very affordable health insurance through Kaiser Permanente— caregivers not having health care is a BAD idea, for obvious reasons. I’ve no doubt that caregivers and the SEIU will have a lot of good input in this process of looking for ways to improve our health care system in meaningful ways. It would not surprise me if Oregon managed to lead the way for the U.S. on quality health care that our nation can afford and be proud of.
There are two services I’d like to see added for home-care in Oregon— wheelchair repair/pick-up, and occasional help with deep cleaning, re-organizing, and hauling things off. The latter would help to reduce falling hazards and make homes more livable and spacious. At this time, caregivers only get paid for light housekeeping as far as the portion of their hours that are dedicated to housework.
And, of course, I’d like to see all states implement home-care for their disabled population. It’s smart. It’s humanizing. It’s personalized. And it’s nice.
Thanks for the 2 billion dollars, Mr. President!
The Obama Administration’s 2013 National Drug Control Strategy by drug monkey at Scientopia
Drug Donations are great, but should Big Pharma be setting the agenda? by Jack at Pharmagossip
The European Emergency Medicines Agency Ordered Not to Release Trial Data, For Now by Ed Silverman at Pharmalot
In the article Kathleen Frydl on the drug war: ‘Here we have total and complete failure.’ by Dylan Matthews in the Washington Post, he interviews Kathleen Frydl, who has just published a book The Drug Wars in America, 1940 – 1973. In the book, and in the interview, she sketches the history of drug addiction in the U.S. following the development of new narcotics and wars in which many soldiers became addicted to narcotics that were used to manage pain. She also traces the evolution of U.S. drug policies from the Harrison Narcotic Act which regulated the distribution and use of narcotics used for medicinal purposes, to a focus on illicit drug use and prosecution, to the failure of Congress to regulate and tax prescription drugs like amphetamines and barbiturates in the fifties (though they were known at the time to be extremely addictive), to “the war on drugs” that was started by Nixon.
As an example of how ineffective the drug war has been, she gives this example
It’s time to step back and look at the forest. In 1968, a dime bag of heroin cost $5 and was about 15 – 40 percent pure. Today, without adjusting for inflation, it costs $5 and it’s 15 – 40 percent pure. That’s a crude measure, but that’s the definition of failure, right there.
and after giving additional insight concludes
The thing I have been suggesting, at the top of my list, is some kind of National Academy of Sciences study to formally model different approaches to the regulation of illicit drugs, including the way that we used to do it under Harrison, and also to address how costly the transition between one regime and another would be. We’re at the point where we want the hard social science and formal modeling to come in.
For example, if you’re negotiating trade agreements, as we are doing right now, what would it mean to include illicit narcotics reduction in those talks rather than requiring crop dusting for eradication? Which is more effective? There’s a lot of things I suggest that are traditional tactics of agriculture and trade policy, that I’d like to see assessed by neutral scholars.
from Opiniatrety: Missed Opportunity
If I had known about the Twitter-length philosophy contest, I would’ve entered “All conversational implicatures are cancelable, and I am the Queen of Romania. I mean it literally.” Only 99 characters, and not only is it an original argument I actually got it published (with some additions). Oh well.
comment: Was Dorothy Parker the original source of “and I am the Queen of Romania (if memory serves, I think actually “and I am Marie of Romania”) or was she quoting?
blog host’s response: I had thought of it as something of a ready-made phrase but maybe she originated it. I actually changed it from “Marie” so it wouldn’t be a ready-made phrase or idiom, because those mess up implicatures — in this case you actually do have to do the calculation that I’m obviously not the queen of Romania, and so I’m flouting a maxim of quality, and so I’m trying to say that “all conversational implicatures are cancelable” isn’t true either.
Huh. Don’t know what he said, but now I’m kind of worried about using a ready-made phrase or idiom and messing up an implicature somewhere.