Grey Kitty, in Memoriam

Seven years ago today I lost Grey Kitty, patron cat of this blog. She was 15 3/4 years old and had been sick with apparent lymphoma for several months. One unfortunate thing about adopting a stray is that her birthdate remains a secret (best guess: somewhere in early April 1985) and so the only solid date for commemoration is the day of her death. It makes me sad to think of those last weeks, so instead I'll just post a picture of her taken in her prime, circa 1997.

Grey Kitty was sweet, bitchy, affectionate, neurotic, snuggly, funny, clumsy, and very very prone to hairballs. In other words - a truly excellent cat.

Free Vi*agra and the Pursuit of Happiness

Happy LOLcat from I Can Has Cheezburger?

Never mind the Vi*agra spam in your junkmail box. Mexico City is about to make that obsolete, at least if you're an elderly man. Starting on December 1, the city will dispense free ED drugs to men over 70.

With this program, Mexico is putting its rich neighbor to shame. In many cases, even those Americans with decent health insurance don't have coverage for ED drugs or contraceptives. (Let's not pit them against each other; each can be crucial to sexual health.) Men recovering from prostate surgery, where ED drugs are a standard part of the rehab regimen, often end up mail ordering them from India because insurance won't pay. For the uninsured, ED drugs are often simply unaffordable. In a similar vein, birth control has actually gotten pricier in recent months as federal subsidies have been allowed to expire.

Mexico City's stated rationale is an interesting one, as CNN reports:

"Everyone has the right to be happy," said Marcelo Ebrard Casaubon, governor of the federal district that encompasses the Mexican capital.

I realize that a strict libertarian or conservative would surely see the Mexico City plan as out of bounds. These are the same people - like John McCain - who oppose funding for contraception. They'd be just as outraged at the idea of funding a bunch of old fellows' jollies.

And yet, as blogger Leah Cohen points out, our Declaration of Independence guarantees the pursuit of happiness. Of course, the pursuit of happiness is not the same as actual happiness. By the same token, the right to be a sexual creature doesn't guarantee we get to have sex with anyone at any time we desire.

Even so. Call me a socialist, but I think the Mexico City scheme is a wonderful idea. Sexuality is a major part of potential happiness, and major sexual dysfunction can so quickly torpedo it. This is not just about orgasms; it's about pleasure and connection and intimacy, which ED can seriously disrupt. As such, it can benefit these men's partners, too.

I'm aware not everyone will agree that the government has any role to play here. But even if you think that sexuality is trivial, what about health? Because the second, stealth aspect of the Mexico City initiative is to entice these guys to get a thorough medical checkup.

"We have to protect people -- senior citizens above all," [Governor Casaubon] said in a statement Thursday. "Many of them are abandoned and lack money. They don't have medical services, and a society that doesn't care for its senior citizens has no dignity." ...

To obtain the medicine, men must first undergo a "very, very detailed" medical check to screen for and possibly treat ailments such as hypertension and diabetes, the government said.

Centers in Mexico City also will offer a variety of treatment to elderly men and women.

(Source: CNN again.)

That last sentence gives away the agenda, which is apparently much broader than sexual health. (The article unfortunately doesn't spell out the scope of the other services, so I don't know anything about what women will be offered.) Some of these men who seek ED meds may not require them if their hypertension or diabetes is brought under control. In others, ED may be the visible signal of hidden underlying disease. Their clinic visit may result in a diagnosis that would've otherwise been missed. These are guys who currently receive little or no health care, so their checkups will likely reveal a host of other issues, too.

Unlike the United States, Mexico committed years ago to viewing health care as a right, not a privilege. Now it seems to be making a serious attempt to follow through on this promise. The provision of ED drugs thus needs to be viewed as one tactic to deliver basic care to a long underserved population.

Reframing health care as a right rather than a privilege is, of course, a truly radical proposition, especially for those of us north of the border. But is it so radical, after all, to view health care and adequate food and clean water and - yes - even sexual health as basic rights? Aren't they all essential to the pursuit of happiness?

We live in a culture where there's a lot of palaver about "staying positive" during even the most dire illnesses. If you've ever been seriously or chronically ill, you know that - while we may grow or learn from the experience - it rarely enhances our happiness. It's very hard indeed to be happy while suffering severe pain or nausea. It's harder yet to be chipper if you're no longer alive.

During the presidential debates, Barack Obama said he agrees that access to health care is a right. What do you think? Is it properly within the role of government to promote people's happiness? And would you draw the line at sexual happiness?

And I Thought Sex Bias in Medicine Was Waning ...

How wrong I was.

A recent study published in the Journal of Pain and Symptom Management found that female cancer patients get significantly less adequate relief of their pain than do men in a similar position. Via Reuters (and Medscape, free registration):

The researchers examined pain severity and the adequacy of pain management in 131 cancer patients newly referred to a multidisciplinary cancer pain clinic.

Men and women did not differ significantly in terms of worst pain scores, least pain scores, or pain interference. However, average pain in the last week and "pain right now" were significantly higher in females (p<0.05).

The mean total daily dose of analgesics was significantly greater for males (130 mg morphine equivalent value) than for females (66 mg). Females were significantly less likely than males to receive prescriptions for high potency opioids (32.9% vs 51.0%).

Women were significantly more likely than men to report inadequate pain control, as indicated by scores on the Pain Management Index.

Contrary to my usual practice, I haven't tracked down the original study. So I can't speak to its strength and weaknesses. It definitely dovetails with an existing body of work that shows race and class affect patients' access to adequate pain relief.

In any event, the gender-linked differences in dosages and the percentages of patients getting the strong stuff are striking. When you consider that women 1) seek medical assistance more often than men, and 2) have the reputation of being less stoic than men (never mind what we endure in giving birth!) you'd expect women would be more likely to request and receive the most potent pain relievers. Why is the opposite true?

If you can think of a reason more plausible than sexism, let me know.

More Musings on the Edwards Affair

The night before last, in a fit of curiosity, I cross-posted my essay Surviving Cancer, Surviving Affairs on Salon's new blogging/social-networking platform, Open Salon. I've been a long-time Salon reader, so I was curious to test-drive this new feature. My post somehow caught the eye of Salon's editor-in-chief, Joan Walsh, who quoted a lengthy excerpt in her column.

All of which was kind of cool, but since the excerpt didn't include the part where I said "that doesn't mean it was right" for John Edwards to cheat on his wife, a lot of letter-writers who responded to Joan Walsh's column felt that she and I were making excuses for him.

So I'll just say it one more time, with feeling: He done her wrong. John did not have Elizabeth's blessing to go outside the marriage. Her statements make clear that she was deeply, deeply hurt.

At the same time, I'm still frustrated by the dominant but simplistic trope of "what kind of a monster cheats on a sick spouse?" For those who've never experienced cancer or other serious illness, it may be hard to imagine how illness and its aftermath can mess with people's heads and hearts. Otherwise decent people can make hurtful decisions when they're not thinking or feeling straight. This goes for patients and caretakers alike.

Moreover, sexual infidelity is only one possible form that failure and betrayal can take. I have not slept with anyone other than my husband since I married him, 14 years ago to this day. I believe he can truthfully say the same. And yet, we've both failed each other in a variety of ways, as long-term partners inevitably will. Most of these failures occurred in the aftermath of illness. By now, we're back in a pretty good place, but it took work. It took us recommitting to each other again and again.

In that light, John Edwards' behavior looks wrong but not incomprehensible. It's harder to see him as Evil, though we may still see him as weak. He's not inhuman. He's just human.

And if we acknowledge that, then we have to inject a little humility into the three-ring-circus of judgmentalism. We have to let his family and his higher power judge his private misdeeds.

As for his public misdeeds, I purposely didn't address them in my original post. I chose to "write what I know" because I thought I could shed a different light than most of the commentary I'd read, and because I wanted to engage a conversation on relationships and serious illness. That doesn't mean I believe the political questions are trivial. On the contrary! I just thought others were covering the political side much more thoroughly.

As more facts and questions have come to light, though, I'm becoming increasingly concerned that l'affair Edwards might dog the Democratic Party through the rest of this election cycle. So, for the record, here is how I think it genuinely affects the public interest.

First, there's the question of whether the affair began before Rielle Hunter was hired. Some sources suggest this was the case. If so, then Edwards can fairly be accused of misappropriating campaign funds in hiring her.

Second, we know that Hunter has received millions of dollars, ostensibly to help rebuild her life after harassment by the tabloids. To me, this goes a tad beyond the call of kindness. (We should all have such generous friends in our lives!) Again, if any of this money came from political contributions, whoever is responsible needs to be held accountable.

Third, it was unquestionably reckless for Edwards to run for president with a major skeleton in his closet. In an ideal world, voters could distinguish between private behavior and public competence. But in America, they don't. And so the philandering politician lies. And then he gets caught. And then half of America is shocked at his sexual activities, while the other, purportedly more liberal half, cries: "It's not the sex! It's the lying!" - never mind that the lies were about entirely private (albeit foolish) behavior. Yeah, it's politically immature of us. But that's how things work in America, and Edwards knows this; he's too savvy a politician to claim naivete. He knew full well that if his affair became public, his chances at the presidency would be toast. And so he not only wronged Elizabeth, he also deceived his supporters and put the future of his party at risk. Imagine if he were the presumptive candidate right now!

Fourth, I'm suspicious about why Rielle Hunter is refusing to allow a paternity test to be conducted. Could it be that she's being paid off on the condition that she continues to refuse testing? This would allow John Edwards to act innocent - he's agreed to be tested - without putting him at any risk.

All of these unanswered questions are at least a distraction from Obama's campaign efforts. At worst, they may become a drag on the Democratic party, including the down-ticket races. I assume Edwards went public now in hopes of averting a big blow-up closer to November 4, but if he has failed to come clean - or worse, appears to be harboring more secrets - his grand confession will have been for naught.

And then there's one other thing that's bugging me, which is in a totally different register. Why does so much of the commentary revolve around the question of "why men cheat"? Sure, very, very few female politicians have been caught out in sex scandals. But garden variety affairs normally require two partners, and very often both are married. The statistics on infidelity are not terribly reliable, but on average they seem to show about a ten percentage-point gap between married men and married women. So why do we cling to this narrative of faithless men getting it on with desperate/victimized/conniving single gals?

I guess that loops back to my original frustration with the simplistic stories we Americans want to tell ourselves about that complex and mysterious thing, marriage.

Surviving Cancer, Surviving Affairs

So I wasn't entirely shocked at John Edwards' admission that he'd had an affair in 2006. Mostly, I was relieved that Elizabeth Edwards wasn't standing by his side. Maybe everyone learned from the sad spectacle of Silda Spitzer that the straying mate only looks worse when the spouse appears beside him while he makes his confession.

While most of the non-tabloid media attention has focused on how Edwards' disclosure might affect the presidential race, I've been obsessing instead on the connections between cancer, survivorship, sexuality, and relationships.

Now, I don't know anything about the Edwards' marriage. I believe that all marriages are deep mysteries - often enough to the partners themselves, and certainly to the outside world. I do know something about surviving cancer, however, and the still-taboo topic of how it can affect a marriage or other committed relationship.

The facts, as we know them, are that John Edwards had an affair in 2006 with a video producer for his campaign, Rielle Hunter. He has specifically said it occurred at a time when Elizabeth's cancer was in remission. It ended well before she was diagnosed with a recurrence in March of 2007. Indeed, he confessed to her back in 2006 and asked her for her forgiveness. She decided to stay in the marriage.

What follows is informed speculation. It's based on a mixture of my own experiences as a spouse of a two-time cancer survivor (a term my husband and I both dislike, because it falsely implies the experience is finite) and those of other couples who've dealt with cancer. In the interest of everyone's privacy, I've blurred some of my experiences with those of others.

For most couples going through cancer, the diagnosis and immediate treatment are a time of solidarity. The healthy partner supports and cares for his or her partner during chemo or radiation or recovery from surgery - or some combination of the above. The sick partner rallies to the extent physically possible and is grateful for support from every quarter, but especially from the caretaking spouse. You each marvel at the others' strength, and you're grateful that you have each other. (I realize a few spouses totally freak out, but I'm pretty confident that most react by drawing on their better angels.)

Then, abruptly, treatment ends. And you have to figure out how to rebuild your lives, and how to be a "normal" couple again. Nobody warns you about this. There's no roadmap. You might not even realize you're still on a major journey until you're already lost deep in the woods. No wonder lots of people's relationships founder.

Here are some of the ways the survivor can react. He or she can pretend everything is okay, which is right in line with the cultural script, but is bound to fail. He or she might fall into deep depression. Or act positively manic. Or be paralyzed with anxiety. Or try to make up for lost time by acting like a teenager. Or dwell obsessively on every bodily twinge. Or go on a fitness kick. Or any combination of the above, plus a whole kaleidescope of other possible reactions.

Through all of this, the overwhelming cultural message is very simple: You should be deeply grateful to be alive.

The post-treatment process of coping and rebuilding and grieving is more complicated, of course, if treatment has affected the person's sexuality. That's perhaps obvious for breast or uterine or prostate cancers. But chemotherapy often has medium-to-long-term effects on hormone levels and libido. Surgery and scars can lead to feelings of unattractiveness. I've heard anecdotally of prostate cancer survivors who became so depressed about their sexual losses that they took their own lives. So much for survivorship.

What's more, any form of cancer can result in profound alienation from one's own body. If your cells have risen up against you, how can you trust your own flesh? How can you revel in it again? And if you do find a way back to pleasure, will you still include your partner in it?

(That last question goes back to a woman I knew who'd had surgery for breast cancer, then got reconstructive surgery several years later. She was thrilled with her new shape. Soon thereafter she divorced her husband of 20 years. I don't know exactly what happened between them - they'd also spent years living in a trailer while building a house with their own hands - but clearly her "new" body played some role as a catalyst.)

The "healthy" partner, too, has to readjust, though he or she may not even realize this. Speaking for myself, I was so invested in the idea that I couldn't burden my husband with mundane frustrations that I bottled up a lot of resentments, and I had to learn again that he was strong enough to be an equal partner - that I didn't have to "protect" him constantly. I'm pretty sure there are lots of variations on these themes, too.

Both partners may be just sick to death of sickness. And that's the first thing my husband said when I mentioned John Edwards' confession. He said, maybe Edwards had an affair because he just wanted things to be normal again. Maybe he was tired of cancer and treatment.

My first thought was that maybe one or both of them just couldn't see a way to reconnect erotically after breast cancer. Speaking only for myself again, when I had a scare with an unclear mammogram - one that took months to clear up - I felt profoundly alienated from my body as a source of pleasure. And I didn't even have cancer, just a bad case of paranoia!

Maybe having an affair when your spouse has just faced down mortality is a way of affirming your own survival. Maybe it's a form of denial about your partner's mortality, and your own. This might be just an extension of the stereotypical mid-life crisis - but cranked up to eleven.

And maybe, with the pressures of raising two young kids and running for president (which I'd bet are only one notch tougher than raising two young kids and teaching at a university!) the Edwards just hadn't yet figured out how to be a couple together again.

In the end, why John Edwards strayed will remain a mystery to everyone outside his family, and that's only right. They deserve their privacy. A marriage should remain a mystery to everyone outside it.

And yet, while he publicly said he had an affair because he'd grown selfish while campaigning, I think his motivations must be more complex. No one comes through cancer treatment unscathed. Not the patient, and not his or her partner.

With this in mind, I don't think you have to approve of his actions to acknowledge that both he and Elizabeth were under tremendous pressure, and that his affair might be at least partly a reaction to their cancer crisis. That doesn't mean it was right. It's even possible he's just a horndog on the Bill Clinton model - though my gut feeling is that he's not.

I just think there's way more room here for compassion than for judgment.

Finally, I think this news may illuminate why Elizabeth Edwards decided to stay on the campaign trail after her recurrence was diagnosed, and why she seemed to arrive at her decision so quickly. As the AP reports:

In a statement last night, Elizabeth Edwards said that after a "long and painful process" she decided to stand by her husband. Mrs. Edwards called the affair a "terrible mistake" but said the healing process was "oddly made somewhat easier" after her diagnosis of a reoccurrence of breast cancer in March 2007.

First, it sounds to me very much as though the new diagnosis put the Edwards back into the "let's fight this beast together" mode. And secondly, Elizabeth had already decided to stick with John after he'd disappointed her. Cancer, at least, is impersonal in its cruelty. Having forgiven her husband for his deliberate actions, Elizabeth had already cast her lot with him. I can totally understand why she wouldn't let cruel but impersonal fate affect her loyalty.

Healed It on the Grapevine

Photo by Flickr user Greg_e, used under a Creative Commons license.

Following up on yesterday's gambling post, I'll admit there's one vice (other than coffee) that I do occasionally indulge. But science is increasingly casting doubt on how much of a vice wine actually is, and there's more good news about the red stuff this week. Note, though, that this is only preliminary research that hasn’t yet been tested out in actual female wine lovers:

New research from the University of Nebraska Medical Center shows that resveratrol, a natural substance found in red wine and red grapes, can suppress the formation of estrogen DNA adducts.

Although breast cancer formation involves a multitude of steps, most are fueled by increased estrogen. It collects and reacts with DNA molecules. Resveratrol, which is also sold in extract as a dietary supplement, prevents the formation of the adducts. It also suppressed two other known risk factors for breast cancer.

“We believe this could stop the whole progression that leads to breast cancer down the road,” said the study’s lead author Eleanor G. Rogan, Ph.D.

The amount of resveratrol found in one glass of red wine is enough to suppress the DNA adducts. The study was conduced in laboratory cultures and will need to be confirmed in larger human trials.

(Source: Ivanhoe)

Now, I’m sure the media will cloak this study in the usual caveats: The researchers said one glass, not one bottle. They only found helpful effects from red wine – not white wine, not martinis (more’s the pity). If you burn out your liver, avoiding cancer is kind of a moot point. I think most of us get that - and those who don't, generally aren't very susceptible to reasoned arguments anyway.

But these findings are interesting – and surprising – in light of recent research that showed even moderate drinkers to be at higher risk for breast cancer, regardless of the type of alcohol consumed. This effect appeared only for those cancers that feed off of estrogen - the same types that resveratrol promises to possibly interrupt. I’d like to know whether the beneficial effect of resveratrol outweighs the deleterious effect of the wine’s alcohol – a question that can only be answered in human trials.

The study that implicated alcohol as possibly promoting breast cancer did look at actual human beings, but it doesn't seem to have analyzed red wine separately. An earlier study that did so found that red wine offered no advantages. But adding to the confusion, red wine consumption has consistently been found to correlate with lower cardiovascular risks. A problem for all such studies is that it's hard to separate out other lifestyle factors, though it's reasonable to assume that a moderate wine drinker may have other habits that are healthier than someone who prefers mostly hard alcohol. Also, most of these studies can only prove correlation, not causation.

Such questions are hard for us laypeople to sort out because the American media still tilt puritan when it comes to drinking, especially where women are concerned. Reports on the health benefits of red wine are always spiked with warnings, as if the reader might otherwise proceed directly to the nearest liquor store – article in hand – and thence to the gutter. Similar research findings are treated more even-handedly in the German media, for instance – but that’s a culture where women aren't presumptively sluts and bad mothers if they have a drink, and where even obstetricians allow an occasional glass of wine in late pregnancy.

Until the implications of this latest study are clarified, I think the take-home message is the same as it’s been for quite a while: Moderate drinking – especially of red wine – has some benefits. It also carries some risks. If you don’t enjoy red wine, you shouldn’t choke it down. If you do, then here’s to your health. After all, pleasure is a huge part of living a healthy and good life.

Breast and Prostate Cancer: Build the Pie Higher

Photo by Flickr user ILoveButter, used under a Creative Commons license.

I've previously lamented the tendency for prostate cancer and breast cancer to be pitted against each other. It's understandable - and completely appropriate - that prostate cancer sufferers would resent the miserly treatment of their disease when it comes to both research and treatment. Considering that one in five American men will get the disease and that current treatments typically leave men with an unacceptable side effect - permanent erectile dysfunction - it's disgracefully underfunded.

The solution, though, is not for the two diseases to compete for the same scarce resources. We shouldn't view this as a zero-sum game. Men afflicted by prostate cancer, and their partners who lives are also deeply affected, need to build a strong lobby. There are millions of prostate cancer survivors in the United States alone, yet the petition to increase government spending on it has not even gathered 10,000 signatures. (So go here and sign it!)

Another possible tactic is for the prostate and breast cancer lobbies to join hands. They're natural allies. While I don't want to deny the obvious differences between them, the similarities between these two cancers are also pretty striking. Both diseases were once too taboo to discuss (and to a great extent, that's still true for prostate cancer). Both are extremely common diseases. Both strike mostly older people but also a very significant number of people in midlife. And both intrude cruelly on people's sexuality, albeit in substantially different ways.

Now comes a small but significant scientific breakthrough that shows there's even an affinity on the biological level, as well:

A faulty gene closely associated with breast cancer is also responsible for a particularly dangerous form of prostate cancer, research has confirmed.

A University of Toronto team found prostate cancer patients carrying the BRCA2 gene lived on average for four years after diagnosis.

The average survival time for a man with prostate cancer is 12 years. ...

The latest study - based on 301 patients - examined two closely related faulty genes, BRCA1 and BRCA2, both of which greatly increase a woman's risk of breast cancer, and are linked to ovarian cancer.

Both genes cut average survival times in men with prostate cancer who carried them - for men carrying BRCA1 the average survival time was eight years after diagnosis.

BRCA2 has already been linked to deadly prostate cancer, with an Icelandic study recording an average survival time among prostate cancer patients carrying the gene of just 2.1 years. ...

Lead researcher Dr Steven Narod said: "We know that carrying a faulty BRCA2 gene increases a man's risk of getting prostate cancer, and our study shows that it also affects how long he will survive a diagnosis of the disease."

(Source: BBC News)

I don't know why this would be so; I'm not an expert, and it seems like even the real experts don't understand the mechanisms. It's intriguing that the BRCA2 mutation is the nastier of the two in prostate cancer, while BRCA1 is worse when it comes to breast cancer.

But on the policy level, there might be some real synergies in funding further research into these mutations. One of the fascinating trends in cancer research is that we're beginning to recognize how many different flavors a "single" disease such as breast cancer can have, depending on whether it's estrogen-sensitive, HER-positive, etc. At the same time, scientists are finding cross-linkages between apparently disparate forms of cancer, as this BRCA study shows.

So instead of fighting over an ostensibly limited pie, I'd love to see the boys and girls together and lobby jointly to "build the pie higher," to quote one of the best Bushisms ever.

And Walking Isn't a Medical Necessity, Either

According to Nate Jenkins at the AP, the state of Nebraska has decided that there's no need to help men who are struggling with erectile dysfunction. It already stopped Medicaid payments for Viagra and related drugs when the federal government did the same in 2006. Now it's excluding penile implants from Medicaid coverage as well.

I realize that the very term "penile implant" may have put you into a cringe. But before you close this window on your browser, consider that many men who suffer from erectile dysfunction after treatment for prostate cancer (including radiation as well as surgery) may not get much help from the drugs for erectile dysfunction. The Austin Powers vacuum pump works only for a minority. Their most effective remaining options are to try injections (yes, the needle goes where you think it does) or to undergo penile implant surgery.

These days, implants are inflatable. They're no longer a rigid rod that produces a permanent adolescent erection. The only outwardly visible sign of the implant is a fluid reservoir that apparently resembles a third testicle from close up.

From patient accounts that I've read, the erection resulting from the implant feels natural and pleasurable to both partners. Most of the men who have an implant wonder why they didn't get the surgery sooner. And while I'm not suggesting this should be anything other than a last resort, these guys sometimes brag just a little about how long they can go. Given what they've been through, I'd say they've earned bragging rights.

But apart from the cringe factor, this is what they're up against:

State Medicaid director Vivianne Chaumont said the change is consistent with a federal rule, approved in 2006, that barred the federal government from spending Medicaid dollars on erectile dysfunction drugs including Viagra. Nebraska followed suit a few months later and changed its rules to keep state Medicaid money from being spent on the drugs.

The federal government will still help pay for penile implants in states that choose to continue covering the procedure under their Medicaid plans.

“The decision was made not to cover the drugs, so it’s ... a good idea to have particular procedures for prosthesis not covered as well,” Chaumont said.

Medicaid is meant to pay for the medical necessities of needy people and “sex is not medically necessary,” she said.

(Associated Press via the Lincoln Journal-Star)

Do I even need to enumerate what's wrong with this? For one thing, it'll save small change. Jenkins reports that since 2003, a whopping three Nebraskans on Medicaid have had the surgery and the state's share for all three totaled $11,705.

The ruling is also blatantly sexist. The state Medicaid program covers breast reconstruction, as most private insurers are required to do in accordance with federal law. Where's the difference? Again, from the AP:

Chaumont, who moved to Nebraska about a year ago to take her current position, said she didn’t know why the decision was made to cover breast reconstruction under Nebraska Medicaid but added that it didn’t strike her as unreasonable.

“I don’t think breast cancer has anything to do with sexual dysfunction or sexual impotence,” she said.

Asked why it is important to cover breast reconstruction, she said that doing so “is in line with other insurers.”

I'm always uncomfortable when breast cancer and prostate cancer get pitted against each other. Both deserve adequate - no, generous - funding. It should never be a zero-sum game. And in this case, there's no conceivable reason to cover one but not the other. Breast cancer has effective advocates. Prostate cancer remains largely in the shadows. That's the only real difference.

Note also Chaumont's wholly bureaucratic justification. She has no idea why breast reconstruction is reimbursed! Maybe she implicitly sees breast reconstruction in terms of the politics of appearance and normative femininity. If you're missing a boob, you can't be a real woman. What's worse, if people have to look at your asymmetry, they might be reminded of the artificiality of the beauty ideal, the toll disease can take, and our shared mortality. Not that Chaumont is reflective enough to say any of this.

Of course, men with ED often say they no longer feel like real men. But their losses can be kept safely hidden from the public eye. Everyone else gets to pretend there's nothing wrong.

At bottom, Chaumont is enforcing the idea that sex is optional and probably downright icky or evil. That sex is not for people who are aging or ill (even if an increasing number of prostate cancer patients are in their 40s and 50s). That sex is not a part of mental health. She doesn't give a shit that their partners suffer nearly as much from the loss of marital "delight." But what gave her the right to impose her own anti-sex views on Nebraskans who've had the double bad luck to be both poor and seriously ill?

What's next? Will the state of Nebraska refuse to subsidize walkers or canes on the theory that walking is not a medical necessity? You can stay alive without walking, chewing, seeing, or fucking. And you can survive for decades without using your higher brain functions, including logic and empathy, as Chaumont's decision proves. It seems that even thinking is not a medical necessity.

Cancer, "Positive Thinking," and the War Metaphor

Toy soldier image by Flickr user atomicShed, used under a Creative Commons license.

Ted Kennedy underwent surgery today for a brain tumor. The press coverage of his illness has stressed two major themes so far: He has a particularly bad type of brain tumor, a glioma. And even in the face of his grim prognosis, Senator Kennedy is displaying courage. A fighting spirit.

Yesterday's New York Times finally tackled the obvious collision between these two themes with a wonderfully insightful article by Jan Hoffman. Now, I don't know anything about how Senator Kennedy is handling this. And really, it's not my business. (Of course, I do sincerely wish him well. Nobody should have to face such a tough diagnosis.)

But I do have a very personal stake in how popular culture portrays the "fight" against cancer. Far too often, the media and ordinary people employ metaphors that just violate the experiences I've had with my loved ones who've been stricken by it.** So I'm grateful that the NYT devoted some space to deconstructing them.

First, there's the relentless pressure to "think positive." An AP article posted after successful completion of Kennedy's surgery today quoted him as saying, "I feel like a million bucks. I think I'll do that again tomorrow." Obviously he's being flip about it. I'm genuinely glad for him that he can crack a joke while in recovery; black humor is one of the better coping mechanisms, in my experience. But boy, this sort of media chatter sets the bar high for the rest of us who might come out of surgery groggy, scared, shaking with cold, and - believe it or not - humorless.

If you get a cancer diagnosis, dozens of people will tell you to stay positive. Some of these will be people you barely know. Of course, if your remaining time on this earth turns out to be rather short, it's a wonderful gift if you can find pleasure in it. But it's just not so simple. You don't hear people exhorting hostages to "think positive" while a gun is being held to their heads, do you?

Hoffman's NYT article accurately describes the pressure patients come under to put a positive spin on their illness:

“Whether you’re a celebrity or an ordinary person, it’s obligatory, no matter how badly you’re feeling about it, to display optimism publicly,” said Dr. Barron H. Lerner, the author of “When Illness Goes Public.” [Dr. Lerner is a physician at Columbia who's also an expert on the history of breast cancer.]

That optimism reassures anxious relatives, the public and doctors, regardless of whether it accurately reflects the patient’s emotional state. “If Ted Kennedy wanted to stick up his middle finger,” Dr. Lerner added, “that would be the more appropriate finger, but he’s doing what he is supposed to.”

Whether such images inspire patients, or reinforce unrealistic expectations that they, too, should maintain a game face, remains an open question, say doctors, social workers, family members and patients themselves.

That middle finger would be such a relief! It would take a lot of pressure off patients to act brave for other people's sake. Sure, sometimes it's adaptive and helpful to act brave for your own sake; acting brave can help you feel brave. Sometimes you have to shield your young children from the whole truth, since it doesn't help a preschooler to hear that a parent might die when in fact that parent might live.

The problem arises when the patient feels unable ever to let her guard down - when platitudes take the place of real support and encouragement. Hoffman collected a few of the real prizewinners:

Uneasy well-wishers, steeped in near-superstitious belief about positive mental attitude, can exacerbate anxiety. On Cancerblog.com and ChemoChick’s “Excuse Me?” sites, lists of tone-deaf remarks include, “If anyone can beat it, it’s you,” “You gotta think positively” and “Just look at Lance,” a reference to Lance Armstrong, the champion cyclist and a cancer survivor.

What the NYT can't say, because it's a respectable publication, but I can, since Kittywampus is not: These platitudes are just bullshit. The superstition, of course, stems from the idea that positive thinking is not just a way to make the most of our remaining days but our best weapon in defeating the disease itself. Having had a birds-eye view of chemo at work, I can assure you that a resolute attitude might get you out of bed in the morning; it is not likely to make the difference between life and death.

The second load of bullshit that Hoffman exposes is what she felicitously calls the "stirring martial language" that we employ in discussing cancer.

Dr. Gary M. Reisfield, a palliative care specialist at the University of Florida, Jacksonville, believes that the language used by cancer patients and their supporters can galvanize or constrain them. Over the last 40 years, war has become the most common metaphor, with patients girding themselves against the enemy, doctors as generals, medicines as weapons. When the news broke about Senator Kennedy, he was ubiquitously described as a fighter. While the metaphor may be apt for some, said Dr. Reisfield, who has written about cancer metaphors, it may be a poor choice for others.

“Metaphors don’t just describe reality, they create reality,” he said. “You think you have to fight this war, and people expect you to fight.” But many patients must balance arduous, often ineffective therapy with quality-of-life issues. The war metaphor, he said, places them in retreat, or as losing a battle, when, in fact, they may have made peace with their decisions.

To describe a patient’s process through illness, he prefers the more richly ambiguous metaphor of a journey: its byways, crossroads, U-turns; its changing destinations; its absence of win, lose or fail.

Hoffman then describes a patient who's nearly ten years out from pancreatic cancer. He became angry once treatment was over and realized "Oh my God, I have nothing left to fight with." It's not at all uncommon to become depressed after treatment, and this sense of having run out of "ammunition," as Hoffman puts it, can be one contributor to depression. I've seen exactly this occur in someone near and dear to me. Studies have shown major depression to be common after breast cancer, as has lots of anecdotal evidence. I'm not aware of much research on other cancers but it stands to reason that breast cancer would not be unique in this respect.

One reason for post-treatment depression - and for its lack of recognition - is the idea that you should just get back to normal right away, especially if your disease was caught early and your prognosis is reasonably good. Everyone from employers to family members want this and expect it. (I'm sure that as a family member, I've had moments where I've let this desire show, too, as much as I've tried not to expect the "new normal" to look like the "old normal.") It's not that simple, of course. Even with a "good prognosis" you're still waiting for the ax to fall. And you're constantly reminded of this by the fact that your body is not the same anymore; maybe you've lost your hair, maybe your energy is permanently depleted, maybe you've lost a part of yourself to surgery.

Another contributor to post-treatment depression is personality and temperament. Those of us who are biased toward doing something - anything - will inevitably feel some let-down when there's nothing left to be done. And if this is how you're already wired, the ethos of modern Western medicine, which is similarly slanted toward action instead of watchful waiting, does nothing to counteract this tendency.

But surely the metaphors we use feed these post-treatment problems, too. We've been waging a "war against cancer" ever since President Nixon declared it in 1971. Since then, we're lost two real wars (counting the present one as unwinnable). The war metaphor might have provided some reassurance to Americans with a clear memory of sacrifice and triumph in World War II. I don't see it as reassuring at all today, and I don't think that's just due to my own pacifist leanings.

We speak of "survivors" in a well-intentioned attempt to remove the stigma and victimhood from cancer. It's good that we no longer treat the disease as taboo, speaking of it in hushed tones (if at all). But what does it mean when the word "survivor" comes to denote anyone with cancer from the moment of diagnosis up to the moment of death, whether from cancer or other causes? And even if you're lucky enough to die much later of something wholly unrelated, what do you gain from the implicit pressure in "survivor" to put the disease behind you as soon as treatment ends, never mind that the gun is still at your temple?

There are exceptions to the triumphalist military narrative. A recent memoir by Kathlyn Conway, who has struggled through both Hodgkins lymphoma and breast cancer, is refreshingly honest, though often bleak. In Ordinary Life: A Memoir of Illness she describes how her illness was just something she had to get through. It did not transform her. It did not make her a better person, nor did it lead her to deep religious faith. But stories like hers are still the exception that proves the rule.

Finally, it's worth asking what it means to have war metaphors mixed promiscuously and unthinkingly with all this talk about "positive thinking." It's not just that war-talk shapes how we think about cancer; the reverse is likely to be true, too. Isn't it likely that valorizing military language in our cancer discourse helps recast war as brave and noble even in times where it's clear that it's simply a lost cause? Certainly there's a long history of seeing "the enemy" in terms that evoke tumors and metastases. But that would be a whole 'nother post.

** I'm basing my reflections on experiences of several people close to me, including some immediate family members, but they're a composite because I want to respect everyone's privacy.

Waking Dreams of the Perfect Breast Cancer Prevention Drug

Photo of a lilac-breasted roller by Flickr users Arno & Louise, used under a Creative Commons license. If you came here for a lovely photo of black-and-white breasts set off by orange Sungold tomatoes, too bad; I got annoyed at too many late-night hits from visitors seeking boobie pictures, which is not what Kittywampus is about, and so I took down the original breast photo. However, this fella's lilac breast is quite gorgeous in its own right.

So the other night I woke up in the wee hours and started thinking about breast cancer and how to prevent it. Now, the obvious rational approach is right living, on the individual side, and a much cleaner environment, when it comes to collective strategies. On the first score, I eat my veggies and I'm no lush (though also not the teetotaler that the latest study suggests all women should be). As for tidying up the environment? Unlikely in my lifetime, especially when it comes to those persistent estrogen-like plastic and pesticide compounds that are a likely driver of rising breast cancer rates.

But the great thing about half-delirious insomniac thoughts at 4 a.m. is that you don't have to be rational. And so I started fantasizing about an ideal drug to prevent breast cancer. Clearly, Tamoxifen and its cousins that induce menopause-from-hell symptoms don't come close to fitting the bill; they're harsh enough that they're only used in women at high risk. But if you only intervene after cancer is diagnosed, the current slash/burn/poison approach leaves women maimed, debilitated, and in constant fear of recurrence.

My vision was a substance that every woman could take, at least once she was pretty sure she was done with childbearing and thus wouldn't be using her breasts to feed anyone. It goes without saying that the ideal drug would be free of side effects. (I know, I know, but it was 4 a.m., so humor me.)

You'd want a drug that would stop mutations in their tracks before the rogue cells had a chance to replicate. And you'd need to deliver it to the location where those mutations are most likely to arise: the milk factory. Since virtually all breast cancers start either in the milk-transporting ducts or the milk-producing lobules, that's where you'd want to intervene. (I'm not discounting a third variant, inflammatory breast cancer, but that seems like a biologically different beast.)

You'd want a substance that would penetrate through the first layers of cells and selectively knock out any abnormal ones. Maybe it would induce apotosis; maybe it would stop such cells from reproducing; maybe it would just smother the bad guys. Whatever its mechanism, the key thing is that it would travel straight to the ducts and lobules and then act locally rather than systemically.

As anyone who's nursed a child knows, the milk factory has an amazing capacity to ramp up and, well, expand. And this is where such a drug could satisfy the prerogatives of vanity as well as health: If it acts locally by permeating the ducts and lobules, why couldn't it simultaneously cause them to inflate prettily? I'm not talking about mimicking the porn-star silicon look. I'm just suggesting that this ideal drug could cause a little bit of non-milk fluid to be retained. You'd get a little of the size and perkiness that pregnancy produces - but now without a belly eclipsing the boobs.

The great thing about this two-in-one function is that the drug would sell itself. Its developers would be reap wealth and good karma. Women would stick religiously to the dosage schedule.

The only downside? Plastic surgeons would be hanging around soup kitchens.

And It Won't Make You Blind, Either

Photo of a geyser in Iceland by Flickr user Benzpics63, used under a Creative Commons license.

Ben Harder, science journalist at U.S. News and World Report, is calling out the major news services for recycling a five-year-old study on prostate cancer as if it were fresh news. He's right to criticize their sloppy reporting, of course. He was wrong, however, to suggest that the study is dubious just because it's not brand-new. Given the study's content, I hope that the screw-up in reporting will give it more exposure than it might otherwise get. When I read about it a few months ago, my reaction was: Wow, this is news that helps men take their health into their own hands, if you'll forgive a bad pun. So why isn't it already common knowledge?

What a group of Australian scientists found is this: Masturbation may offer protection against prostate cancer. And actually, not just masturbation but any sexual activity resulting in ejaculation. The group, headed by Dr. Graham Giles, found that men in their twenties who ejaculated at least seven times per week reduced their risk of prostate cancer by one-third compared to those who ejaculated fewer than three times per week. That's a remarkable figure.

The explanation Dr. Giles offered when the study was published in 2003 makes intuitive sense to me, even if it's still somewhat speculative. Basically, to use a rather unfortunate plumbing metaphor, he suggested that the pipes stay cleaner and healthier when flushed out regularly:

Our research indicates that there is no association between prostate cancer and the number of sexual partners, which argues against infection as a cause of prostate cancer in the Australian population.

We also found no association between maximum number of ejaculations in a 24 hour period and prostate cancer. Therefore, it is not men's ability to ejaculate that seems to be important.

While it is generally accepted that prostate cancer is a hormone dependent cancer, apart from age and family history, its causes are poorly understood.

For this reason, our explanations are fairly speculative - one possible reason for the protective effects of ejaculation may be that frequent ejaculation prevents carcinogens building up in the prostatic ducts.

If the ducts are flushed out, there may be less build up and damage to the cells that line them.

Ben Harder did find one subsequent study, published in 2004, that strikingly corroborated the Australians' findings. That study found:

Each increment of 3 ejaculations per week across a lifetime was associated with a 19% (95% CI, 7%-30%) decrease in risk of organ-confined prostate cancer.

Its lead author, Dr. Michael Leitzmann, told Harder he's certain no further work has been done on this topic. Why???

These studies found a free, simple, and fun way a man can protect himself against a cancer that strikes one in five men. Yet I'll bet more adult men are aware of other habits that protect against prostate cancer, such as drinking tea and eating tomatoes. As a gal who calls herself Sungold, I'm unabashedly pro-tomato; but why should tomatoes get all the press while the benefits of ejaculation are ignored?

I can only think our deep cultural ambivalence about sex is to blame. That would explain why this news failed to make a splash five years ago. And that also accounts for the dearth of follow-up studies, which mirrors the shameful underfunding of research on prostate cancer in general. This anti-sex mindset is also deeply anti-scientific, preoccupied with ideas about purity that date all the way back to Leviticus.

Artwork by Flickr user adamrice, used under a Creative Commons license.

(In case you can't read the quotation from Leviticus 15:16-17 in the image above: "And if any man's seed of copulation go out from him, then he shall wash all his flesh in water, and be unclean until the even. And every garment, and every skin, whereon is the seed of copulation, shall be washed with water, and be unclean until the even.")

If it seems like I'm making too much of this, check out this comment, copied verbatim from Harder's blog:

how can anyone condone masterbation? in the Bible it is widely and worldly known as a sin! you will be sending people straight to hell.

Unfortunately, it's also "widely and worldly known" that this is the brand of thinking that brought anti-condom AIDS education to Africa, sees cervical cancer as the just wages of sin, and believes comprehensive sex education causes teenage pregnancy. In this worldview, a few million excess cases of prostate cancer might seem like a cheap sacrifice in creating a moral dystopia where the only pleasure is feeling holier-than-thou.

Petitioning against Prostate Cancer

Most Americans probably know that the women among them face a 1 in 6 lifetime risk for breast cancer. What's less well-known is that men's corresponding risk for prostate cancer is 1 in 5. Even as awareness and funding have risen for breast cancer, prostate cancer languishes somewhere between Viagra jokes and vague memories of Bob Dole going public.

The reasons for this have a lot to do with masculinity. Both of these cancers affect people's sexuality profoundly and irrevocably. Since the 1970s, women have become adept at body talk, even on such uncomfortable issues, while the rules of masculinity demand men maintain a tough front and keep silent, especially when it comes to sexual performance.

I've heard prostate cancer patients grouse about how much better-funded breast cancer is, as if funding was showered upon them because everyone wants to protect the ladies. Truth is, that funding materialized only after breast cancer survivors cast off the taboos around the disease, went public, got organized, and lobbied stubbornly until it was easier for lawmakers to say yes than no. Prostate cancer survivors will have to do something similar. Both diseases need and deserve more funding, and it ought not to be a zero-sum game where the two causes get played against each other.

Now there's a petition circulating that aims to put the issue on our next administration's policy agenda. The nonprofit group behind it, Malecare, hopes to gather over 100,000 signatures and present it to our next president the day after inauguration. Among other things, it states:

Breast and Prostate Cancer scientists should not be made to compete for limited research funding. Scientists must feel encouraged to develop prostate cancer research. Both Breast Cancer and Prostate Cancer research funding must continue to grow. Breast Cancer and Prostate Cancer patients, equal in number, should receive equal and adequate funding and promotion for research.

If you're moved to sign, the petition is here. Yeah, it's just a petition. But it's a start.

A Test for Ovarian Cancer?

Researchers report that a new blood test combining six different biomarkers can detect early-stage ovarian cancer with 99.4% accuracy. (For the scientifically inclined, the six markers are leptin, prolactin, osteopontin, insulin-like growth factor II, macrophage inhibitory factor, and CA-125.)

This matters to me because I had a big ovarian cancer scare when I was 26. I'd been feeling fatigued and vaguely sick for months when an ultrasound picked up a mass on my right ovary. A subsequent CT scan indicated it was solid. Everyone got good and scared; my usually calm mom was so freaked, she ran a couple of red lights while driving me to the doctor. I confronted the possibility of never having kids even if I didn't die from it.

I went into surgery, only to wake up with all my parts intact. The doctors were all so red-faced they wouldn't say anything except that the laparoscopy showed no signs of a cyst, much less cancer. Another doctor who wasn't involved in the snafu later theorized that I'd had a cyst that looked solid on the CT because it contained blood, and that had burst during a rough exam. That was a good enough answer for me. I was still left with the first real intimation of my own mortality.

The new test, if it pans out in the phase III clinical trials already underway, will be a huge blessing for a whole host of reasons.

1. The biggie: Ovarian cancer won't so often amount to a death sentence. It might even do for ovarian cancer what the Pap smear did for cervical cancer: transform it into a scary but usually curable disease, instead of a major killer. Now, it's the fifth leading cause of cancer deaths among American women, accounting for an estimated 15,280 deaths in 2007 according to the American Cancer Society. When it's found early, still confined to the ovaries, the five-year survival rate is 93%, as compared to 45% for all cases. But fewer than 20% of all ovarian cancers are caught that early, again according to the ACS. It's hard to diagnose because its physical symptoms are quite unspecific: bloating and pelvic heaviness, indigestion, nausea, back or pelvic pain, vaginal bleeding or abnormal periods, and weight gain or loss.

2. The best test currently available gives 1 in 20 women a false positive result indicating cancer where none is present. The new test will mess with people's minds only 4 times out of 1000. If you're one of those women faced with fear of impending death, that's a huge difference – as I learned the hard way.

3. This improved accuracy will avoid unnecessary CT scans (which are costly and expose the patient to considerable radiation).

4. Better accuracy will avoid unnecessary surgeries – again, I can testify what a boon this will be.

5. Women who carry one of the BRCA genetic mutations, which predispose them to both breast and ovarian cancer, may be able to choose watchful waiting without quite so much worry. Currently, many women with the BRCA mutation choose elective removal of their ovaries, but that plunges them into instant menopause at a young age.

The big open question – assuming that the test proves itself in its final trials – is whether insurance companies will cover it, and if so, for whom.

To learn more about ovarian cancer, visit the National Ovarian Cancer Coalition or the National Cancer Institute. For the original study, go to the abstract; you can download the full article for free from there.

Photo by Flickr user herby fr used under a Creative Commons license.

Gardasil for Everyone!

When Gardasil, the vaccination against human papilloma virus (HPV), came on the market in late 2006, I figured it's about 30 years too late for me. HPV has been proven to cause cervical cancer (as well as genital warts). But Gardasil is approved only for girls and young women aged 9 to 26, on the assumption that they're less likely than older women to have already been exposed to all four strains of the virus covered by the shots.

So far, those of us over 26 don't have any way to prevent HPV infection and its potentially disastrous consequences (other than abstinence - not bloody likely!). Yet we're increasingly confronted with the knowledge of our HPV status, as testing for HPV gradually becomes routine. My ob/gyn offered it to me last spring, and my insurance covered it.

Luckily, the test showed I'm not currently infected with HPV. I'm pretty sure I had an active infection for several years in my twenties, when I kept getting moderately abnormal results on Pap smears. Most people eventually clear the virus spontaneously; I assume that's what I did.

One nasty feature of HPV, though, is that it can be reactivated, a trait it shares with a number of other particularly nasty viruses. Some of these just cause great misery - like the varicella zoster virus, which causes chicken pox in kids but shingles if it's reactivated later in life. But others, including Epstein-Barr (the mono virus), have been implicated in causing certain types of cancer.

I'm speculating a bit here, but it seems to me that reactivation is the most plausible explanation for at least some cases of cervical cancer in older women - those in their 50s or 60s and older who've been monogamous for decades, with a monogamous partner, and who probably weren't actively infected for all those decades.

But maybe it's not too late for me and my ilk, after all. A recent study by Merck, Gardasil's maker, found that it reduced the rate of HPV infection and pre-cancers in women aged 24 through 45. I'm wondering if the vaccine might help the body keep the virus in check at undetectable levels, even though Merck's press release on the study doesn't suggest this. To qualify for the study women had to be free of at least one of the flavors of HPV that Gardasil targets. But the vaccine's impact was so dramatic, it doesn't seem plausible to me that its only effect was to prevent fresh infections:

Also as a primary analysis, GARDASIL prevented 83 percent (95% CI: 51 to 96%) of persistent infection, low-grade cervical abnormalities and pre-cancers, and external genital lesions caused by HPV types 16 and 18 alone (23 cases in the placebo group and four cases in the vaccine group). In a secondary endpoint, GARDASIL prevented 100 percent of persistent infections, low-grade cervical abnormalities and pre-cancers, and external genital lesions caused by HPV types 6 and 11.

The press release doesn't say anything about the sexual habits of study participants - whether their sex lives were more like Samantha's in Sex and the City, or more like, well, mine. Obviously this information would help us understand whether Gardsasil mostly blocked new infections or mostly prevented reactivation of old ones.

This isn't just a theoretical question. It matters because if Gardasil hinders reactivation, then women of any age ought to consider getting the shots.

Gardasil might benefit men, as well. HPV has been pretty conclusively linked to oropharyngeal (mouth and throat) cancer, as well as cancer of the penis and anus. Having oral sex with six or more partners triples one's risk of oropharyngeal cancer. What's more, vaccinating men would contribute to herd immunity, thus reducing the risk to the entire population.

And no, I don't work for Merck. I realize this is a new vaccine and it might still turn out to have some untoward side effects. So far, though, its benefits seem to vastly outweigh its risks.

Unless, of course, you buy the wingnut idea that immunizing young girls will turn them all into sluts. Lynn Harris at Broadsheet has brilliantly put their objections into limerick form:

Why block a vaccine? Here's our answer.
Gardasil is no values-enhancer.
To prevent HPV
Causes sex, don't you see?
And quite frankly, we prefer cancer.

A Not-So-Bitter Pill

When I first went on the birth control pill in the early 1980s, its reputation was still clouded by the problems associated with the original, high-dosage pills of the 1960s. I worried about blood clots (my family has a history). I'm sure I wasn't the only person to suspect that any pill that allowed me so much fun with so little worry would eventually cause cancer.

Well, there's good news today. It turns out that taking the pill actually protects against ovarian cancer, and to quite a dramatic degree. The AP reports on a study published today in the Lancet that found a 20 percent decrease in risk for every five years a woman took the pill. This protective effect gradually declines over time once a woman stopped taking it. But even so, this is a massive effect, which could prevent as many as 30,000 new diagnoses of ovarian cancer each year, and which for most women vastly outweighs the pill's small increased risk of breast cancer. The Lancet is calling for the pill to be sold over the counter in Great Britain.

Whoever said that the wages of sin are death? :-)

Image from onlybirthcontrol.com