Women’s Health and the Media: Where do we find trustworthy information?

1. Women’s Health and the Media: Where do we find trustworthy information?

2. What are the key challenges? • Media portrayals of new medical research often inaccurate • A societal embracing of the “quick fix” or “pill for every ill” approach

3. Key Challenges…. • Increasing influence of the pharmaceutical industry over physician prescribing practices as well as the educational and advertising materials aimed at the consumer or patient

4. Amidst the plethora of websites, ads and other sources, how does one find trustworthy information?

5. Know the source of your information and look out for conflicts of interest • Utilize non-commercial websites prepared by those who know how to evaluate the quality of the research that they cite • Use more than one source

6. EXAMPLE OF CHILDBIRTH AND THE RISING CESAREAN SECTION RATES IN THE UNITED STATES

7. Reasons for Rising Cesarean Rates(IOM 1989 report) • 30% of the rise due to diagnosis of dystocia (abnormal or difficult labor) • 25-30% due to repeat cesarean section • 10-25% due to breech presentation • 10-15% due to fetal distress

8. Current reasons for rising cesarean rates Primarily changes in obstetrical practice, such as: - More repeat cesareans - More refusals to allow VBACs - Concerns about malpractice - More advocates of medically- unnecessary cesareans

9. NCHS TRACKING IN 2004 • “Cesarean delivery rate rose 6 percent in 2004 to 29.1 percent of all births, the highest rate ever reported in the United States” From: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths04/prelimbirths04health.htm

10. TRACKING in 2004 (cont.):“The rate has increased by over 40 percent since 1996. For 2003–04 the primary cesarean rate rose 8 percent, and the rate of vaginal birth after cesarean delivery (VBAC) dropped 13 percent. The primary rate has climbed 41 percent and the VBAC rate has fallen 67 percent since 1996.”

11. NIH Meetingon Cesareans by “Maternal Request” (March 27-29, 2006)Will media coverage of this meeting and its report result in more cesareans with no medical indication (elective surgery)?

12. QUESTIONS ADDRESSED AT THE NIH MEETING: • What is the trend and incidence of cesarean delivery in the US and other countries? • What are the benefits and harms of cesarean “by request” vs. attempted vaginal birth (both short-term and long-term)? (Cont.)

13. QUESTIONS (cont.) • What factors influence benefits and harms? • What research should be done to get better evidence for making decisions regarding cesarean delivery “on request” vs. attempted vaginal delivery?

14. Panel’s RecommendationsFinal report atwww.consensus.nih.gov/2006 • Insufficient evidence, so more research needed on benefits and risks of cesarean delivery on maternal request vs. planned vaginal delivery • Until better evidence is available, any decision to do cesareans upon “maternal request” should be carefully considered

15. Recommendations (cont.) • Not recommended for women desiring several children given rising risks of placenta previa and accreta with each cesarean delivery • No cesareans upon “maternal request” prior to 39 weeks or without verification of lung maturity (because of significant risks of neonatal respiratory complications)

16. Recommendations (cont.) • Effective pain management services should be available for all women so that fear of pain is not a motivating factor for an elective cesarean • NIH (or other appropriate Federal agency) establish a website with up-to-date information

17. The final report did not adequately consider many recognized long-term adverse outcomes associated with cesarean surgery and did not take into account the impact that avoidable obstetric practices can cause during vaginal birth.

18. From the national Listening to Mothers II Survey of the Childbirth Connection in NYC (http://www.childbirthconnection.org/article.asp?ck=10401): • 56% of women who wanted a vaginal birth after having had a cesarean said a doctor denied them that option. • 1 out of every 4 women polled who had caesarean said they felt pushed into having the surgery.

19. Excellent discussions of this meeting: • Diony Young’s editorial in the September 2006 issue of BIRTH –’ “Cesarean Delivery on Maternal Request”: Was the NIH Conference Based on a Faulty Premise?’ • Henci Goer’s piece in Lamaze e-news (June 2006) • Rona McCandlish’s article in MIDWIFERY (v.22, 2006): “Meeting maternal request for Cesarean section – paving the road to hell?”

20. Possible consequences of these Recommendations • An increasing trend towards considering cesarean birth as a “normal” birth with benefits/harms on par with vaginal birth • Misleading coverage in the media • Continued distortion of the concept of “women’s right to choose”

21. “Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term” Liu et al. CMAJ Feb 2007 (This study used a breech group as a surrogate for an elective cesarean group)

22. Among healthy women in the study: 27.3 per 1,000 women in the planned cesarean group (breech births) had severe complications (such as major infections or blood clots) vs. 9 per 1,000 women in the planned vaginal group

23. From the CMAJ commentary: “This study provides additional support to a growing body of evidence suggesting that primary elective cesarean birth may place both mother and newborn at greater risk for adverse outcomes than planned vaginal birth”

24. COSMETIC SURGERY is the fastest growing medical specialty in the U.S.

25. Breast implants solely for cosmetic purposes are increasing in popularity despite substantial risks associated with both silicone and saline implants.

26. See the booklet prepared by the US Food and Drug Administration for photographs and descriptions of adverse implant outcomes such as disfigurement, capsular contracture (when the breast becomes hard and misshapen), and deflation: www.fda.gov/cdrh/breastimplants)

27. Sample Photo from Implant Maker’s Website

28. Photo of Capsular ContractureFrom FDA Booklet

29. This is the same 27-year old woman after her painful implants were removed

30. Necrosis in mastectomy patient with implants for one week

31. After removal of one woman’s leaking silicone implants

32. According to the American Society for Aesthetic Plastic Surgery, 364,610 women got breast implants in 2005. The number was up 9 percent from 2004.

33. “It's like being set free, from being trapped in a bad body, to being set free in a nice body.” From: ‘More women having ‘mommy makeovers’ by Kim BaerThe Free Lance-Star (Fredericksburg, VA) March 13, 2007

34. A survey by the American Society of Plastic Surgeons showed that nearly 40 percent of plastic surgery patients believe they should have been more proactive in learning about potential side effects and complications before surgery.

35. “There are over-the counter creams and lotions. And then there’s Botox Cosmetic. My doctor says they’re just not the same. She said only prescription Botox is approved by the FDA to treat the frown lines between your brows…”

36. A large coalition of groups: See www.safecosmetics.org “Skin Deep” a report of the Environmental Working Group, helps consumers and workers to better protect themselves from known or suspected carcinogens and reproductive toxins.

37. In October 2005, Governor Schwarzenegger signed the Safe Cosmetics Act into California law. As of January 1, 2007, cosmetics manufacturers in the state will be required to disclose any product ingredients that cause cancer or birth defects. 

38. Harmful Substances to Avoid • Para-phenylenediamine, a chemical found in some dark hair dyes (may increase risk for bladder cancer in humans) • Phthalates, typically used as a solvent and plastic softener and also found in many shampoos and other hair products, cosmetics, deodorants and nail polish (has been linked to cancer and to birth defects of the male reproductive system). To learn more, go to www.nottoopretty.org.

39. To avoid (continued): • Talc, in talcum powder (has been linked to a 60% increase in the risk for ovarian cancer in women who use it in the genital area). • Propylene glycol, an ingredient found in some moisturizing products and skin creams (may damage the kidneys and liver).

40. What to do to minimize risk Read labels carefully and choose all-natural alternatives, such as products made with olive oil, safflower oil or oatmeal, whenever possible.

41. Direct-to-Consumer Advertising of Prescription Drugs: Misleading Ads and How They Hurt Us

42. The Public Gets Misinformation • Benefits are often overstated, while risks are understated • FDA warning letters are issued after the ads run • Corrective ads are rarely required • Withdrawal of an ad is the only penalty

43. Ads are geared primarily to selling more drug product, not educating the user • The ads work: the most highly advertised drugs, accompanied by promotional campaigns geared to physicians, sell extremely well

44. Top selling drug in the world?

45. Lipitor (Pfizer) (with more than 13 billion dollars in sales in 2005)

46. Drugs can be quite useful, but “Pills for Prevention” may not be the best approach.

47. Important to promote a view of public health that stresses primary prevention – identifying and eliminating disease-causing agents in our food, water, and air.

48. Precautionary Principle of Public Health: When an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established. Science and Environmental Health Network: www.sehn.org

49. Consider the example of an ad for SARAFEM (Prozac repackaged as a pink and purple capsule) at www.sarafem.com (ad since removed):

50. ”Think it’s PMS? Think Again…it could be PMDD…” Picture of a young woman trying to zip her jeans (too bloated?); picture of another woman seemingly distressed… Then text follows: