Kevin Drum

Arkansas Will Force Doctors to Tell Women Abortions Can Be "Reversed"

| Tue Apr. 7, 2015 4:37 PM EDT

As conservative lawmakers pass a record number of anti-abortion laws, it is staggering to consider how many require doctors to tell patients information that has no basis in science. Five states now require abortion providers to inform women about a bogus link between abortion and breast cancer. Several states mandate that doctors say ending a pregnancy can lead to mental health conditions like clinical depression—another falsehood, in the eyes of most mainstream medical groups.

Now there's a new crop of legislation to add this list: laws forcing doctors to tell women planning to take abortion-inducing drugs that they may be able to change their minds mid-treatment.

On Monday, Arkansas became the second state to pass such a law, just over a week after Arizona's Republican governor signed a similar measure. A spokeswoman for Americans United for Life, the legal arm of the anti-abortion movement, confirmed that both laws are based on the group's model legislation.

Critics have slammed these bills as propagating a lie based on "junk science." According to the American College of Obstetricians and Gynecologists (ACOG), "Claims of medication abortion reversal are not supported by the body of scientific evidence."

Americans United for Life has not only backed the bills, but has enthusiastically endorsed a new procedure pioneered by George Delgado, a pro-life doctor who claims to have reversed abortions.

Most drug-induced abortions require two pills taken a few days apart. The initial dose, of mifepristone, blocks the progesterone hormones that help sustain the pregnancy. The second dose, of misopristol, causes contractions that flush out the pregnancy. Delgado says he's stopped abortions by injecting supplemental progesterone between the two rounds of medicine. The evidence backing his discovery, however, is incredibly thin. As Olga Khazan writes for The Atlantic:

Women who only take the first pill already have a 30 to 50 percent chance of continuing their pregnancy normally, according to ACOG. The progesterone advice is based on a study by Delgado in which he analyzed six case studies of patients who regretted their abortions and were given progesterone. Four out of the six patients went on to deliver healthy infants. In other words, the limited evidence we have suggests that taking progesterone does not appear to improve the odds of fetal survival by much. The abortion pill binds more tightly to progesterone receptors than progesterone itself does, one reproductive researcher told Iowa Public Radio, and thus the hormone surge is unlikely to do much of anything.

As Cheryl Chastine, an abortion provider at South Wind Women's Center in Kansas, put it recently, "Even if these doctors were to offer a large dose of purple Skittles, they'd appear to have 'worked' to 'save' the pregnancy about half the time."

That's why, on the small chance that a woman does regret her abortion midway through, ACOG-affiliated doctors say they would simply tell her not to take the second pill.

The injections might not only be useless—large doses of progesterone can actually be dangerous: "There can be cardiovascular side effects, glucose tolerance issues, it can cause problems with depression in people who already had it," Ilana Addis, a gynecologist who opposed the Arizona measure, told The Atlantic. "And there are more annoying things, like bloating, fatigue, that kind of stuff. It's an unpleasant drug to take."

The new Arkansas law requires the state's health department to write up information on abortion reversal for doctors to make available to patients, and it's not yet clear if the health department will promote Delgado's specific method. Meanwhile, Arkansas Right to Life is already promoting the services of doctors who are "trained to effectively reverse" abortions, and more than 200 physicians around the country have told pro-life groups that they are willing to conduct the procedure.

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More Fabulous Health News

| Tue Apr. 7, 2015 2:22 PM EDT

I continue to be a star patient. Final results from yesterday clocked in at 5.2 million stem cells. Apparently I only need two million for the transplant, but they like to get a double sample in case I need another transplant a few years down the road. So four million is the goal.

So why am I still here? Good question. I don't really have a good answer, though. Just in case? More is always better? This is actually a SPECTRE front and they use excess stem cells to breed an undefeatable clone army that will take over the world?

Not sure. In any case, stem cell collection has gone swimmingly and I'll soon be out of here. Now there's only one step left: the actual second round chemo itself followed by transplanting my stem cells back into my body. That begins on April 20.

BY THE WAY: The folks here, who have much more experience with cancer meds than your standard ER facility, are quite certain that my excruciating back pain on Friday was a side effect of the Neupogen. So that's that. Today was my last shot of Neupogen, which means I can get off the pain meds in the next day or two.

This Iconic California Drought Photo Is Pretty Personal for Me

| Tue Apr. 7, 2015 7:00 AM EDT

If you've seen any photos of the current California drought, you've probably seen some variation on these striking before-and-after images of this bridge near Lake Oroville:

California Department of Water Resources

Seeing those images popping up everywhere has been a little weird for me since that bridge used to be named after my grandfather. 

My grandfather, B. Abbott Goldberg, was the deputy director of California's Department of Water Resources from 1961 to 1966. He was one of the legal architects of Gov. Pat Brown's California Water Project, the massive, contentious undertaking that built the infrastructure that currently supplies 25 million people and 1 million acres of farmland. He argued and won two Supreme Court cases, the details of which are mind-numbingly arcane. But they were essential to realizing Brown's vision for mastering the natural resource that he saw as essential to the state's survival.

Winning the West's water, my grandfather explained in a University of California oral history project, was almost a religious mission. His colleagues, he said, "had come up and they had transmitted to me, certainly, the tradition of the Old West, that water is the limiting resource and that by bringing water to the thirsty land, you were in effect doing the Lord's work and that there was nothing more important for the people of California than providing an adequate water supply."

He was proud of his work, whose effectiveness was evident in Californians' unquestioning expectation of plentiful, cheap water. When the state went through the big drought of 1976-77, he noted, "There wasn't a murmur about a shortage of domestic water in Southern California…I didn't find anybody beating the doors down to thank us for what had been done. The fact that it took some forty years to achieve it was just forgotten." Later in his life, he read Cadillac Desert, Marc Reisner's critique of the growth-at-all-costs mentality embodied in the Water Project. He wasn't a fan.

Not that he couldn't see the other side. In his oral history interview, conducted in 1979, my grandfather admitted to some conflicted views about California's relationship with water. Sounding like a good Northern Californian, he mused, "Someplace along the line, the idea began to dawn on me that really Southern California was an environment essentially hostile to human occupation…[B]ut what are you going to do about the millions of people already down there?" And: "I do remember saying to someone that really, the only solution to the water problem was birth control."

He even indulged the what-if question that every thinking Californian asks once they've been here long enough: "I sometimes wonder, maybe it would have been better to let California dry up and blow away, and keep it the way we used to know it."

Which brings us back to the bridge, another symbol of Californians' ambition and ambivalence. After the state named it after my grandfather in the late '60s, local lawmakers objected, insisting it be renamed the Enterprise Bridge, after a town of the same name that had been inundated by Oroville Dam—one of the signature features of the California Water Project.

The Link Between Fracking and Oklahoma's Quakes Keeps Getting Stronger

| Mon Apr. 6, 2015 3:30 PM EDT
A man in Sparks, Oklahoma, picks through rubble from his home following an earthquake in 2011.

Over the last few years, Oklahoma has experienced an insane uptick in earthquakes. As we reported in 2013, the count exploded from just a couple per year back in the mid-2000s to over a thousand in 2010, growing alongside a boom in the state's natural gas drilling industry.

There is now a heap of peer-reviewed research finding that Oklahoma's earthquake "swarm" is directly linked to fracking—not the gas drilling itself, but a follow-up step where brackish wastewater is re-injected into disposal wells deep underground. It's a troubling trend in an industry that thrives under notoriously lax regulations, especially when the risk to property and public safety is so obvious.

If those numbers weren't dramatic enough, here's another: This year, Oklahoma has experienced an average of two quakes per day of magnitude 3.0—enough to be felt and inflict damage to structures—or greater. That's according to a deep, comprehensive report on the subject out in this week's New Yorker.

But even freakier than the earthquakes themselves, according to the story, is the pervasive denial of science coming from state agencies like the Oklahoma Geological Survey, whose job it is to oversee the oil and gas industry:

The official position of the O.G.S. is that the Prague [Oklahoma] earthquakes were likely a natural event and that there is insufficient evidence to say that most earthquakes in Oklahoma are the result of disposal wells. That position, however, has no published research to support it, and there are at least twenty-three peer-reviewed, published papers that conclude otherwise.

The story goes on to detail super-cozy relationships between top regulators and drilling company executives; the state's ongoing and systemic habit of dismissing or ignoring the rapidly accumulating pile of evidence about the quakes; and a failure by regulators and the state legislature to take any meaningful steps to address the crisis. It's really quite damning.

As a reporter covering the fracking industry, I've found that a lot of the problems associated with the technique aren't necessarily inherent to it, and could be resolved with more pressure on companies to behave responsibly, or laws requiring them to. Better zoning regulations could keep wells out of neighborhoods. Stricter well construction standards could cut down on the leakage of methane, a potent greenhouse gas, and help ensure that gas or chemicals don't contaminate groundwater. In other words, while industry may resist them, there are ready solutions at hand to many of the most cited drawbacks. And the same could be true in the case of earthquakes: while many geologists have now found that drilling wells into deep "basement" rock can set off temblors, there still isn't a law in Oklahoma that simply requires locating disposal wells elsewhere.

Their state's lack of basic engagement on the fracking-and-earthquakes issue is, understandably, a source of great frustration to Oklahomans, including those who are otherwise totally supportive the drilling industry. They're worried not only about above-ground damage, but about how quakes might effect the state's vast network of oil pipelines and underground aquifers. It's hard to imagine the nightmare that would result if a serious earthquake ruptured these pipelines and caused a major spill. That sentiment was nicely captured in the New Yorker by a quote from the town manager of Medford, a hamlet outside the oil center of Cushing:

"We want to be a good partner for the oil companies—it's exciting for us that they're here. But if they can move the disposal well even just three miles, what a difference that would make."

Fabulous Health News

| Mon Apr. 6, 2015 3:20 PM EDT

I am blogging direct from the Apheresis Center at the City of Hope in Duarte, California. There's a large machine to my left that makes ticking noises and—hopefully—is drawing blood from one of the catheters in my Hickman Port. The stem cells are then removed and the remaining blood is returned through the other catheter in the Hickman Port.

There was some question about whether this would happen today. You see, my daily Neupogen injections are supposed to stimulate my white blood cell production and therefore my plasma stem cell production. The goal is for my stem cell production to be above 10, and if it's lower than that, there's no point in doing the collection.

So earlier this morning they drew some blood to test my CD34 level. It was....

102.00.

This is superheroic performance, though the nurse declined to tell me if I had set a new world record. In any case, this is great news for two reasons. First, it means no more Neupogen shots. Second, it means that I'm likely to be finished here in two or three days. Yippee!

And this surely demands a treat for everyone. So here's some bonus catblogging. As you can see, Hilbert has cleverly used staircase access to perch himself on the top of Karen's bookcase, where he is lord of all he surveys. As usual.

Science Is Ignoring its "Publication Pollution" Problem

| Mon Apr. 6, 2015 11:05 AM EDT

In a damning op-ed published Friday, Arthur Caplan, a medical ethicist at NYU's Langone Medical Center, called out scientists who are turning a blind eye to the scientific publishing industry's "publication pollution problem." At the root of the matter: pay-to-publish journals with weak or nonexistent pre-publication review standards that are "corroding the reliability of research." As he wrote in the Mayo Clinic Proceedings, "neither the leadership nor those who rely on the truth of science and medicine are sounding the alarm loudly or moving to fix the problem with appropriate energy." 

Consider this recent experiment, as described in the commentary:

Harvard researcher Mark Shrime recently wrote an article entitled "Cuckoo for Cocoa Puffs?: The Surgical and Neoplastic Role of Cacao Extract in Breakfast Cereals." The fake authors he chose for the piece were Pinkerton A. LeBrain and Orson Welles. Shrime submitted this fake article to 37 journals. At last count, 17 had accepted the obviously phony, nonsensical paper. John Bohannon did the same thing with a completely phony paper, with even more depressing results in terms of peer reviewed acceptance to journals. The journals that took these gibberish-laden, concocted articles were scam, author-must-pay, profit driven entities that nevertheless have every appearance of being legitimate journals.

"Predatory publishers" create a seeming win-win situation: the publisher makes money and the author gets a journal article published—currency in the world of science and academia. The result?

Predatory, pay-to-publish, non-peer-reviewed journals flood disciplines with bad or fake science, making it hard, much as light pollution does, to see the real stars. Worse, publication pollution lessons the impact of legitimate science in the formation of public policy, undermining public health, weakening the overall value of legitimate publications in influencing policy, and creating opportunities for the continued power of crackpot views that corrode many areas of public life, such as vaccination, fluoridation, and the prevention and treatment of diseases, such as autism, AIDS, and cancer.

Jeffrey Beall, a University of Colorado librarian who wrote a similar op-ed in Nature in 2012, estimates these publishers make up a whopping 25 percent of all open-source journals. Beall maintains an ongoing list of "potential, possible, and probable" predatory publishers on his website, Scholarly Open Access. He's identified over 1,300 such publishers and journals to date.

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Housekeeping Note

| Mon Apr. 6, 2015 12:00 AM EDT

My second stage treatment for multiple myeloma starts in earnest on Monday. I'll be at City of Hope the entire week while they collect stem cells and then process and freeze them. Then I have a week off, and then on April 20 I go back for the second stage chemo. That will last three weeks.

Which is to say that I'll be more or less away from blogging for the next six weeks or so. But don't worry! MoJo will keep things going with regular posts from staff members and periodic guest posts from all the bloggers who have been part of the linkfests back and forth with me over the years. It should be fun.

As far as I know, I'll have the technical capability to blog during this entire period. So I'll probably pop in now and again when I have something to say and the energy to say it with. With any luck, I'll be back completely by June. See you on the other side.

Happy Easter

| Sun Apr. 5, 2015 11:18 AM EDT

I slept 7 hours last night! That's the first time this has happened in months. And that was even in addition to an hour or two of napping that I did yesterday afternoon.

This is my Easter present to myself.

Answer Key for Friday's Flowers

| Sun Apr. 5, 2015 12:21 AM EDT

Wondering what all those flowers were that I posted photos of on Friday? Here's the official answer key, starting with the top row:

  1. Calla lily
  2. "Easy Does It" rose
  3. Variegated climbing rose (no tag)
  4. "Julia Child" rose
  5. White floribunda rose
  6. Nasturtium
  7. Daisy
  8. "Cecile Brunner" climbing rose

If you got them all right, congratulations! You're a master botanist

Health Interlude

| Sun Apr. 5, 2015 12:06 AM EDT

"Flu-like symptoms" my ass.

The last couple of days have been a horror story. On Thursday afternoon, out of the blue, I started having intense lower back pain. Then it got worse. By late evening it was bad enough that I took some morphine, which had very little effect. It got worse through my sleepless night. More morphine at 2 am, then more again at 7 am on Friday morning. At that point, the pain was so excruciating that I wanted to head over to our local ER, but unfortunately Friday was the day we were scheduled to go to LA to have my Hickman port installed for the stem cell transplant. Marian, thank God, insisted on us doing the right thing: driving to LA regardless and getting help there. (On the bright side, Good Friday traffic was light.)

I was practically writhing on the floor for the hour after we got there. Eventually I was taken back to prep, and the doctor tried IV morphine. It had only a minor effect. Then he gave me several IV infusions of Dilaudid, and that did the trick. I was still in pain, but it was tolerable.

Unfortunately, our timing was bad. The Dilaudid was wearing off just as the surgery to install the port began, and they could give me only a limited additional amount until it was over. So the surgery was a horror story too, even though the placement of the port is basically pretty painless.

Long story short, all of this might have been the result of my Neupogen injections, which make my bones work overtime. But my doctors all agreed that although back pain is a common effect of Neupogen, pain of my level was very unusual. Alternatively, all of this could have been due to a pathological fracture in my lower back. A CAT scan ruled that out, thank goodness. So we still don't know for sure what was going on. But after a very bad day and night, apparently the Dilaudid was the right painkiller, and I woke up in the hospital Saturday morning feeling surprisingly good. I would have given long odds against that Friday night.

So....very mysterious. And for me personally, a whole new definition of pain. Hopefully it won't return.

Need a silver lining? As bad as it all was, it was apparently a sign that the Neupogen is working. Routine bloodwork shows that my white cell count is high and getting higher. Hooray! That's what we're hoping for.

On Monday we start putting the Hickman port to use. I will be up at City of Hope for 2-5 days while they extract stem cells and then process them and freeze them. If I'm producing lots of stem cells, they'll finish up in a couple of days. If I'm producing a weak stream of stem cells, it may take as long as five days. Cross your fingers.