Friday Five: withdrawal, Amanda Bynes, gluten-free labels, vaccine rates, urgentrx

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Pulling out is surprisingly popular

A study that will be published in the September issue of Obstetrics & Gynecology shows that 31% of women aged 15-24 used withdrawal as the primary form of contraceptive at least once. The study also found that 21% of those women became pregnant, compared to 13% of women who used other methods. I was pretty outraged to learn that so many young women rely on their partners to pull out, so I consulted the Kinsey Institute site Kinsey Confidential to compare different forms of contraceptives:

Method Typical Effectiveness Theoretical Effectiveness
Withdrawal 81% 94%
Male condoms 85% 98%
Oral contraceptives 92% 99.9%
Intrauterine Device (IUD) 99% 99%
Implant 99.01% 99.01%

Whelp, turns out the much-touted condoms don’t fare much better in preventing pregnancy than withdrawal, but IUDs and implants are far better. Advocating for more extensive use of IUDs and implants would help more women learn about their effectiveness and safety, and could play a major role in reducing the number of unplanned pregnancies. (FYI: condoms protect against some STIs, so keep using them, okay?)

Now we know what’s ailing Amanda Bynes

After publicly unraveling, actress Amanda Bynes has been placed on psychiatric hold and reportedly diagnosed with schizophrenia. Schizophrenia is a debilitating yet treatable disease that can lead to delusions, hallucinations (including hearing voices and smelling odors that don’t exist), and cognitive issues, among other symptoms. I sincerely hope that her family and doctors help her find the right treatment so she can find relief from her suffering. This story is playing out all over the gossip mills, and we can learn from this: erratic behavior requires intervention. In an open letter, her former co-star Nick Cannon also taught us an important lesson about how provide compassion:

So I say to my sister Amanda Bynes you’re not alone. I’m here for you. I understand. I care and I appreciate you, because that’s what family does and that’s what family is for. I also extend this to anyone else in my life, past or present that may find themselves in hard times. I’m here! Call me! Because I truly believe, the hand you’re helping up today may be the one you’re reaching for tomorrow.

Side note: take a look at this fantastic Atlantic article with Dr. Christine Montross titled “How well do we really understand mental illness?” for more insight into the hows and whys of treating severe mental illness.

Gluten-free labels, now with accuracy!

People with celiac disease, those with gluten sensitivity/intolerance, and dieters can all rejoice because this week, the FDA standardized the label “gluten-free.” The limit is 20 ppm, the lowest amount of gluten detectable in a food product. Foods such as fresh fruit and eggs can carry the label “gluten free” because they naturally contain no gluten. Regulations like this help consumers make informed choices. Considering more than two million Americans cannot digest gluten, having consistent, effective labels is the right thing to do for their health.

State-by-state vaccine rates tell us about exemptions

Each year, the CDC analyzes vaccine rates among the 50 states, Washington DC, five cities, and eight other US jurisdictions that receive federal funding for immunizations. This year, Mississippi topped the list, with 99.9% of kindergarteners receiving full doses of MMR, DTaP, and varicella (chicken pox). Overall, median exemption rate for the country was 1.8%; Oregon had the highest, with 6.5% of kindergarteners not meeting the vaccine standards. Interestingly, Mississippi does not allow religious or philosophical exemptions for immunizations. Removing religious and philosophical exemptions altogether wouldn’t be appropriate, but perhaps the success Mississippi has with getting children vaccinated will spark a conversation about strengthening the requirements for getting an exemption.

UrgentRx: alleviating upset stomachs, potentially saving lives

Forbes just published its list of what it deems the 25 most innovative consumer and retail brands of the year. An over-the-counter medication company, UrgentRx, made the cut. The company produces powders of common treatments for headaches, allergies, and digestive issues, along with plain aspirin intended for use during a heart attack. UrgentRx powders can be taken without water, meaning that you can give yourself a hit of heartburn medicines whenever you need it. The implication for potentially life-saving doses of aspirin are immense: a study in the American Journal of Cardiology, as reported by Harvard Medical School, showed that chewed aspirin worked faster against heart attacks than swallowing it whole or taking a liquid version. For a person with heart disease, carrying around a powdered dose eliminates the need to chew and provides the benefits of aspirin as quickly as possible.

Why Won't Portland Fluoridate?

Portland, Oregon votes tomorrow on whether or not to fluoridate its water supply. I’m fascinated by the ways people adopt non-mainstream beliefs, so I jumped right into the anti-fluoridation activism vortex and found a culture motivated by fear and a desire for purity. I started with the Fluoride Action Network (FAN). My first thought: these people have money. The site is nicely designed and full of videos so the information is accessible to all. FAN focuses on the idea of “mass medication,” arguing that adding fluoride to the public water supply constitutes forcing drugs on unwilling people. According to FAN, people with kidney disease are at particular risk for fluoride toxicity.   They say, “it is unethical to compromise the health of some members in a population to obtain a purported benefit for another—particularly in the absence of these vulnerable members’ knowing consent.” FAN interprets fluoridation as an attack on personal liberty, a medical harm, and an informed consent issue. They allude to a government conspiracy to medicate and dull the intelligence of the public through fluoride.

Then I found Clean Water Portland, a group dedicated to keeping fluoride out of the city’s water supply. The first reason Clean Water Portland gives for voting no tomorrow is that “Industrial byproducts don’t belong in our water.” The chemical in question is fluorosilicic acid (FSA), a waste product from fertilizer manufacturing. Associating water and fertilizer is a great way to increase skepticism. Just the phrase “industrial byproducts” seems sinister and contaminated.

Clean Water Portland also invokes parents’ anxiety about harming their children by citing the conclusions of a Harvard meta-analysis of Chinese studies on the relationship between fluoride and IQ. The studies found an approximately 7 point drop in IQ when children lived in communities with fluoridated water. The researchers in the Harvard study note that this is a preliminary analysis and that there may be other issues contributing to the IQ drop.

Clean Water Portland frames the link between fluoridated water and IQ by asserting that “in a large population such as Portland, a shift of 5 IQ points would cut the number of geniuses in half and double the number of mentally handicapped.” Whoa! A vote for fluoridation is a vote for robbing your child of genius status. How could you? This shows Clean Water Portland’s inclination toward using parents’ natural desire to protect their children as a means to maintain the “purity” of Portland’s water.

Finally, I arrived at the Facebook page of Fluoride Free Portland. It has 415 likes, and appears to be a somewhat active community of Portlanders sharing links and encouraging people to promote the anti-fluoridation message. “Clean” and “natural” are their most important buzzwords. The posts show the true fear and disgust some Portlanders have for fluoride. The page is littered with photos of FSA tanks labeled “corrosive” and “caution.” Political cartoons, quotations placed over images of pristine lakes, and photos of kids holding anti-fluoride signs adorn the page. Supporters call for their perspective to be included on the Portland Water Board website but get their information about the dangers of fluoride from unreliable sources.

Like other fringe health activist groups—I’m looking at you, anti-vaxxers—the anti-fluoride coalition exists in a world where there is a pure, clean version of life that is endangered by deceptive medicine and industry. While I believe we must have a healthy amount of skepticism, particularly regarding the motivations of corporations, the anti-fluoride groups seem to have abandoned reason. They subvert their own cause by their radical opposition. I think there are plenty of people who would be willing to have a conversation about informed consent and the potential health effects fluoride can have on vulnerable populations. The alarmism and guilt used by these groups makes the rest of us tune out their potentially valuable contributions to the conversation.

Whether Portland starts fluoridating its water is up to the voters. But we should keep an eye on the anti-fluoride movement. Anti-vaccine groups were not taken seriously at first, and now we have outbreaks of pertussis and measles. With the easy communication afforded by the Internet, anti-fluoride could become the next big health movement, and our teeth will suffer.