AAPLOG Conference

As I started to write this post, I had trouble labeling it. "Pro-life," obviously applies, as does "ob/gyn" and "research," but so does "ethics," "spirituality in medicine," "vocation," "advice," "surrender...." I had to stop myself from clicking almost all of them.

Today was the 2012 annual education meeting of the American Association for Pro-Life OB/GYNs. It was in Washington, D.C. (my first time in the capital); it snowed this morning, and the conference was great. I was impressed with the high and rigid standards for publications, recommendations, and protocols. I was fired up to start healing our culture, now!

The highlights:

• 8:45 Maureen Condic, PhD. “Defining the Beginning of Human Life”
• Dr. Condic was at the Vita Institute. She condensed several of her lectures into one (because the audience had a more uniform education) on when human life begins.
• Dr. Condic's white paper probably contains her arguments, although I freely confess I did not read it!



Credit: euthman

• 9:45 Theresa Deisher, Ph.D. “Current Ethical Issues in Drug Development”
• I had no idea that some cosmetics, several vaccines, and some drugs are made in cell lines derived from aborted fetuses (and they contain contaminants from those lines). I'm not advocating chucking all vaccines, but I agree with Dr. Deisher that we should make an effort to find ethical, economical, and technological superior alternatives. Check out some of these companies:
• AVM Biotechnology (website still under construction)
• CEVEC
• Transposagen
• Cellular Engineering Technologies
• 10:30 George Delgado, M.D. “Reversing Mifepristone: Case Reports”
• Repeated doses of 200mg IM progesterone in oil = stop a chemical abortion. He went through six cases (publication pending). Amazing.
• You know, it's impossible to reverse a surgical abortion, so I feel that the increasing use of RU-486 is almost a boon.
• 11:00 Paul Gray, M.D. “Medical and Surgical Naprotechnology”
• Naprotechnology is incredible. Mainstream gynecology treats menstrual disorders and infertility very quickly with birth control or IVF, without finding the cause; naprotechnology finds the cause of a woman's problems and addresses them to correct the symptoms or infertility (when possible). It corrects a cycle instead of suppressing it. Besides being a theoretically better approach, it also doesn't involve carcinogenic pills predisposing the patient to thromboembolism!
• If you want to learn more about naprotechnology, you can read up at naprotechnology.com or fertilitycare.org. Please note, I haven't explored these sites, and they weren't mentioned by Dr. Gray.
• 11:45 Priscilla Coleman, Ph.D. “The Psychology of Abortion: Addressing the Critical Questions to Maximize Patient Care in 2012”
• WECARE 
• Dr. Coleman carried out the largest meta-analysis to date on abortion after-effects. She's met with a lot of resistance, but she concluded that (yes; surprise) there is psychological morbidity following abortion, especially in high-risk groups (unsupportive relationship, hx of previous mental illness, ambivalence about the decision...).  
• 1:15 Frederick Dyer, Ph.D. “Horatio Robinson Storer, M.D. and the Physicians’ Crusade Against Abortion, with implications for the current practicing doctor’s responsibilities toward the abortion issue.”
• Interesting historical sketch of a gynecologist in the mid-1800s who advocated against clandestine abortion because of the harm it does. I didn't know there was abortion in the 1800s! 
• Dr. Storer was supported by the AMA and his work led to the laws against abortion that disappeared in 1973.
• 2:00 Michael New, Ph.D. ‘Analyzing How State Level Anti-Abortion Laws Impact Fertility Outcomes.”
• Dr. New was at the Vita Institute as well! Never hurts to hear it again.
• 2:45 George Mulcaire-Jones, M.D. “Safe Passages Program: Confronting Maternal Mortality in Rural Nigeria, Update.”

• Magnificat Maternal Health Project 
• Awesome teaching tool; reminds me of the Worth the Wait program, because it treats the disease, not the symptoms (it heals the culture and the family and doesn't just hand out contraceptives to African couples).
• My thoughts: it works in Africa? Good. Bring it here. I desire to touch the poor here.
• 3:30 Angela Lanfranchi, M.D.: “The Abortion Breast Cancer Link: The biologic basis and a review of the literature 1957-2011
• Breast Cancer Prevention Institute 
• There is a link all medical professionals already agree on: an abortion stops a full-term pregnancy, which has a protective effect.
• The link people debate about is the "independent" link: an abortion not only removes positive effect, but has negative effect on breast cancer risk. Just look at the physiology! Data supports this, too. (For instance, every time a study finds a statistically significant correlation, it's positive.)
• 4:15 Byron Calhoun. M.D. “Premature Labor: The At-Risk Patient”

• This presentation mostly went over my head. It was the only one that was purely clinical and all about management recommendations for patients, so there were lots of terms and acronyms that I didn't catch.... I learned what a cerclage is, but only because I looked it up on my phone in the middle of the session!
• The point of this talk was: 127 studies show that women with a previous abortion (surgical, medical, or spontaneous) show increased risk for preterm delivery. It's above a 300% increase for women with combined medical/surgical abortions (e.g. incomplete medical abortion requiring D&C) according to a study from China (Laoi).

I also enjoyed briefly meeting with someone from Students for Life, and also talking with some old OB/GYNs about being countercultural, not being afraid of lawsuits, and doing God's will. It's late and I've got to get up at 4:30am tomorrow to fly back home, so good night!

Loooooong hiatus

Whew! I'm posting in the eye of a hurricane*. I was told February is the med student's lowest month. If I had time to focus on my grades, I'm sure that would be true (yeah), but since there's so much more to life I haven't been uber depressed (which is healthy, I guess). Here are the highlights:

• HHS mandate. Ex.haust.ing. I was checking news and reading stuff and talking with people eight times a day, HOPING that the administration wouldn't do what it has, in fact done. I'm still in shock, I can't believe this happened, and I don't know what this means for my future. (Same can be said of Obamacare.)
• The CMA is slowly taking off. It's hard: there are people who are just returning to the sacraments, and there are others who I don't get along with well. 
• Exam 2 for Introduction to Disease = baseball bat to the face. BUT, like I said, there's been so much else going on that I haven't really noticed.
• Made octopus soup! Week after that, parasitology block began. Learned about GI worms. Looked at frozen seafood bag, which read "product of China." I'm not quite hypochondriac about this, but I am now looking at my Lenten supplies with serious doubt.
• Retreat. The same week that I had my exam and the week before I went out of town for three days, I went on a Busy Person Retreat. It was such a grace. I didn't think having a non-habit-wearing Ursuline nun as a spiritual director for four days of directed prayer could be helpful. Boy, was I wrong!
• I applied for a research program this summer to work with the designer of the Worth the Wait sex education program. I think good, preventative, wholesome education is SO important. Please pray God's will be done and if at all possible, that I be accepted. I'm (kind of) putting all my eggs in this basket (oops).
• I applied for the National Student Research Program at UTMB. (Why all this research? I've never done bench research because it doesn't sound engaging, but I like clinical research and public health, as long as the research is meaningful, not forgetful of the patient, and doesn't stifle compassion.)

---

*Did you know the eyes of hurricanes can be polygonal?? Check out the pentagon in the upper right part of this picture.

It does matter what you believe

This article is about EXACTLY what I felt during Spirituality in Medicine class: If You Want to be a Good Person, It Does Matter What You Believe. DARN KANT!

A team of sociologists, led by Catholic University professor William D’Antonio, recently published a survey that has gotten quite a bit of media attention, for it shows that many Catholics disagree with core doctrines of their church and yet still consider themselves “good Catholics.” For instance, 40% of the respondents said that belief in the real presence of Jesus in the eucharist is not essential to being a faithful Catholic. Perhaps the most startling statistic is this: fully 88% of those surveyed said “how a person lives is more important than whether he or she is a Catholic.” In a follow up piece in the Chicago Sun-Times, a reporter asked a number of people on the street for their reaction to these findings. One man said, “I’m a very good Catholic because I follow what’s in my heart, more than what the church tells me to do…”

As even the most casual student of societal trends knows, this sort of cavalier attitude toward doctrine is rampant, at least in the West. I dare say that most people in Europe or North America would hold some version of the following: as long as, deep down, you are a good person, it doesn’t much matter what you believe. The intellectual pedigree of this popular idea can be traced back at least to the 18th century German philosopher Immanuel Kant, who held that religion is fundamentally reducible to ethics. All other forms of religious life and practice—dogmas, rituals, liturgies, sacraments, etc.—are meant, Kant thought, simply to contribute to upright moral behavior. In the measure that they fulfill this purpose, they are acceptable, but in the measure that they contribute nothing to ethics, they become irrelevant, even dangerous.

I would argue that what is truly dangerous is precisely the bifurcation between doctrine and ethics that Kant inaugurated and that has become so ingrained in the contemporary imagination.

Read more here!

Emptiness and Medicine

I have been meaning to post about how this Spirituality in Medicine class has been sucking the life out of me. The last assignment for this five-week class includes a survey, and here are a two of the questions and my answers.

Discuss the impact of the movie Patch Adams.

I enjoyed the movie because Patch reminded me that I want to help people by being an ordinary person, not a computer full of facts. But as I watched the movie, I realized that this class would not be what I was expecting. In this class, “spirituality” meant compassion, gentleness, humanity, and respect for others. These are all good qualities of human nature, but I thought “spirituality” always implied something above nature (not unnatural, but supernatural).

Discuss any insights or new ideas you have gained through this course- anything that you didn’t like or that struck you as particularly meaningful.

I appreciated the forthright manner that the course director took, acknowledging that talking with patients comfortably about things beyond medicine is vital to good care.

But throughout the course I felt that no presenter believed their religion was the only true one. Perhaps because I strongly believe this about my religion, the class began to drain me and I started to dread going. I am glad I took this class, but am also glad it is only five weeks long.

I am also wondering why Dr. C gives a presentation. We asked her if she used spirituality, and her answer was “not really.” In fact, I was hurt by her statement about the Catholic Church “thinking the world [would] end” if she didn’t go to Mass on Sunday (a serious obligation, a precept of the Church), which mocks the Faith that I love.

I am grateful, though, to have learned how to confidently speak with patients about their beliefs, as in the spiritual history.

Similarly draining was the annual College of Medicine Faith Panel, held to give medical students information on what patients of different faiths need and want. The panelists included:

1. A sikh M4
2. A buddhist undergrad
3. A Lutheran vicar (in training to be a pastor)
4. The pastor of my parish
5. A Jehovah's Witness elder
6. A rabbi
7. A Muslim student
8. An atheist (whom you've met before; I went home crying.)

Jesus, Mary, Joseph; save souls!

Planned Parenthood and Trafficking

Mature viewing only.

You can't believe every video you see. But PP fired this manager after changing its statements from 'we called the cops' to 'this was unprofessional and unethical,' so I believe this is unadulterated footage.

http://liveaction.org/traffick 

The darkness of the world feels so overpowering. We must have confidence in God; the more our wills and desires are his, the abler we are to allow him into the turbulence of our own souls and of the world around us. As I googled for this (by the way, it is very hard to find: PP pays for the top result to be "PP exposes sex ring...") I found an article from TIME magazine, and was floored to see it attempt to brush off the footage.

The video released Tuesday by Live Action appears to be edited, and it is not possible to know the full context of Woodruff’s comments. One could argue that much of her behavior was in keeping with Planned Parenthood protocol: she suggested, for instance, that the girls should receive full gynecological exams and follow-up care, rather than just STD testing, and reiterated that any woman who comes through Planned Parenthood’s doors deserves access to care.

This is a stretch of the phrase "much of." The author states the only appropriate thing Woodruff did.

Of course, if in fact she believed [what she was told], her response was clearly lax. But [perhaps] Woodruff’s seeming encouragement of the [actors] was an attempt to coax the victims of abuse into her care....

To do this would also be inappropriate. A healthcare worker is less qualified than the police (or other specialist) to take care of these victims.

Aside from the fact that such video “exposés” prevent workers like those at Planned Parenthood from delivering care — presumably, they are not attending to real clients in need during the activists’ sting operations — they also result in exorbitant costs to the government to fund unnecessary investigations.

Exorbitant? Ten minutes of an MA's time?

It also seems that the $125,000 grant that Lila Rose reportedly received from an anonymous donor to carry out the investigation of Planned Parenthood might have better served the effort to eradicate sex trafficking if it had been given to the Polaris Project or any other organization that actually fights sex trafficking.

Two things: $125,000 is pennies in the life/choice funding fight; and the purpose of the videos was not to eradicate sex trafficking, it was to defame and expose PP for what it is.

Spiritual history

As a part of Spirituality in Medicine, I took a spiritual history from a volunteer patient. A spiritual history is added to a clinical history of a new patient. It asks:

1. Does the patient uses religion or spirituality to help cope with illness, or is it a stressor--and how?
2. Is the patient a member of a supportive spiritual community?
3. Does the patient have any troubling spiritual questions or concerns?
4. Does the patient have any spiritual beliefs that might influence medical care?

The patient I interviewed considers himself a non-denominational Christian, although he has not been to church in ten years. He told me he can't see how religion or spirituality influences bodily illness or coping with it. He can't imagine any spiritual beliefs that would influence medical care. He told me religion means spirituality with a schedule, a man-made concept and corruptible. He cast some aspersion on wealthy churches.

Titian, Christ and the Good Thief

I pressed him. I asked him to imagine he had a serious diagnosis, like terminal cancer. He speculated that he might become more active in his church. Would he be more scheduled? Yes, he guessed so. And when he thought about death, he expressed a desire for pastoral care.

A few weeks ago, a video went viral on YouTube about loving Christ without religion. My parish priest had an excellent homily that week about why this makes no sense. Religion (L. religare "to re-tie") is a human virtue born of a response to God's grace. Christ calls us to Himself; we imperfectly attempt to answer. Because we keep failing, we re-tie ourselves and regulate ourselves so that we can become perfect. Religion, briefly, is the sign of love of Christ. How can we hate it? It is our cross and discipline, so that we can "run so as to win."

Physician-Assisted Suicide

Today I attended a Medical Bioethics Club meeting. We watched the first part of Mademoiselle and the Doctor, a documentary made about an Australian man who helps people commit suicide. He states he wants to "help to end their suffering," admitting "it's very difficult to [do this] legally...." I was internally weeping and praying through the entire twenty-minutes. It was rather horrifying, especially to see patients with no depression or terminal illness desire to end their lives. (Parenthetically: I have known women like Lisette Nigot, who do not want to age or whose bodies are deteriorating far before their minds. They are beautiful people and I want them to live!)

However, this post is not about rebutting the documentary or physician-assisted suicide (PAS). That is accomplished very elegantly elsewhere. This post is a report on the attitude of medical students toward PAS. I took notes of my peers' discussion, so everything in quotes is verbatim. I place the quotes in the form of an interview. The quotes are drawn from four second-years interested in bioethics; one is interested in OB/GYN and at least two others in internal medicine.  

What is PAS?

It's "providing them assistance."

In the documentary, Ms. Nigot has no depression, terminal illness, or lack of support group in life. Nevertheless, she desires to end her life. What do you think of this?

"[I just kept thinking] 'I want to scan your brain!' "
"It's not natural." (Ironically, the student with the most liberal viewpoint said this.)

Ms. Nigot said she first thought about putting a bag over her head. What do you think of this?

It's "degrading."

Why?

She hasn't been given the options for how she could die. [?!]

Is PAS different from giving other medicine?

"[G]iving them a clot-buster for their stroke and giving them barbituates for their death...I think that's the same thing."
"[Y]ou want that [the options] to be available...it's a personal decision...it's the same with abortion...you'd want the best for them." You'd have to refer to a pro-PAS doctor.
"[D]eath is a part of life, and as physicians we want to improve their quality of life, so...." This student trailed off, assuming his point was obvious.

Some people think there are things physicians shouldn't do, regardless of people's beliefs. What do you think of this?

"I think every doctor is entitiled to their own opinion and their advice is based on their core beliefs..." but they have to be able to refer patients to someone who can do what the patient wants.
"[Y]ou can't approve or disapprove of suicide, that's an individual's choice..."
"Right."

How should we deal with patient requests for PAS?

The student who had been the most conservative and even agreed when I said "life is valuable" said that we should have "guidelines," like 'the patient have to have a terminal illness, etc.'
The liberal student: "yeah, give someone an inch, and they take a yard."

I did not speak much. I played the role of the TAC tutor, clarifying points (when I said "life is valuable" it was to make the conservative student a little more coherent) and disagreements. The discussion only lasted about forty minutes, and careened off-topic into how little information physicians have about medication toxicities (the second years take a lot more pharmacology than M1s).

But oh my goodness. Can you believe the things they said? Death by bag-over-the-head is degrading because we haven't presented the options?! Death that way is degrading because we are rational animals and it is unfitting to die in a way that dishonors a person with a social, creative, intelligent soul! Forget PAS; we say someone dies a "horrible" or "violent" or "shocking" or "tragic" death whenever this happens in all the various ways it can.

What do you make of the lack of logic on "death is a part of life"? The sameness they see between healing and PAS/abortion/contraception/etc? The remnants of sound thinking ("that's not natural" and the need for "guidelines")?

I have to go study antibiotics (we're learning all of them for an exam in two weeks, and I'm totally overwhelmed), so the post is sadly truncated. As I said: it's just a report. Discuss in the comments!

---

Note: here are two sources I found for the Church on PAS, but I didn't read them all the way through, so I can't recommend them. (Generally, however, the NCBC is awesome.)

1. A Bishop writing on AmericanCatholic.org
2. End of life page of the National Catholic Bioethics Center