maradydd: (Default)
First, the OMGWTFBBQ. Via Pharyngula, the Hastings Center Bioethics Forum, and TIME Magazine: pediatric endocrinologists Maria New and Saroj Nimkarn are advocating prenatal treatment with the glucocorticoid dexamethasone to "reduce behavioral masculinization" of female children.

Yes, you read that right: they want to expose pregnant mothers to one of the most potent, adverse-effect-prone steroids out there in the hopes of molding unborn girls into models of femininity.

I'll give you a few minutes to find where your lower jaw rolled off to and get a glass of water -- throwing up in your mouth a little is bad for your teeth. When you get back, I'll expand a little on the current standards of practice, and then we're going to go over some organic chemistry.

Back now? Great. First, PZ got one important fact wrong: the American Academy of Pediatrics and other noteworthy medical organizations have absolutely not condoned or endorsed this practice. The "consensus" to which PZ refers is an agreement that the study of dexamethasone as a preventative for congenital adrenal hyperplasia due to 21-hydroxylase deficiency should be conducted "via IRB-approved clinical trials through research centers large enough to obtain meaningful data" and with follow-up studies. This is, in my opinion, a reasonable position. CAH gets press because one of its effects can be ambiguous genitalia, sometimes aka "intersex", but its effects on aldosterone (one of the steroids your body produces) can lead to dehydration, hyponatremia, hyperkalemia, metabolic acidosis and death, in infancy. "Ambiguous" is also used, erm, ambiguously; it doesn't only mean "large clitoris", it also includes things like the urethra and vagina opening into a common cavity and causing severe urinary tract problems.

If there is sufficient reason to believe that prenatal dexamethasone can keep children whose genes prevent them from producing 21-hydroxylase alive, or make it possible for them to avoid difficult, expensive and painful surgery to restore urinary function, that is a valid avenue for research conducted under the auspices of an institutional review board. Attempting to tweak girls' personalities to make them more girly is way, way out of bounds, and New and Nimkarn should be censured for even suggesting the idea.

But what I really want to talk about is steroids, and what you, dear reader, do and don't already know about them.

"Steroid" is a really, really broad term. It's as broad as "sugar" or "alcohol". (The categories also overlap, which can be confusing; there are sugar alcohols and steroid alcohols.) When you think of "sugar" you probably think of that grainy white stuff you put in your coffee, and when you think of alcohol you probably think of booze -- but the picture is actually much bigger. All monosaccharides and disaccharides are sugars, including the ribose and deoxyribose that form the backbone of your RNA and DNA. Ethanol is the alcohol we drink, but it's just one of the aliphatic alcohols, which also include isopropanol (rubbing alcohol), methanol (can blind or kill you if you drink it!), xylitol (used to sweeten chewing gum), mannitol (baby laxative), ethylene glycol (antifreeze!), and glycerol (aka glycerin). I won't bore you with all the various non-aliphatic alcohol families, but there are a lot of them. So, also, with steroids.

Steroids are emphatically not just what dumb jocks inject to get really ripped really fast. (Those are certain anabolic steroids.) Just as "alcohol" refers to organic molecules with an -OH bound to a carbon atom and "sugar" refers to a particular type of carbohydrate building block, "steroid" specifically means "molecule with three six-carbon rings and one five-carbon ring in a particular arrangement". (That four-ring core is called a sterane, if you were curious.) And, wow, are there ever a lot of them. Cholesterol is a steroid. So are androgens (including testosterone), estrogens (there's more than one), and progestagens (humans only have the one, progesterone). But unless you're on hormonal birth control, taking estrogen or testosterone replacements, taking progesterone as part of fertility treatment, or otherwise tweaking your own sex hormones, if your doctor prescribes you a "steroid" it is almost certainly going to be one of the corticosteroids.

Dexamethasone is, as I said above, a glucocorticoid -- a member of the family of corticosteroids that can affect immune function. (In the interest of space, I'm going to skip the other family, the mineralocorticoids.) It is, not to put too fine a point on it, the nuclear option of corticosteroids. Long-term use -- which, for glucocorticoids, means more than a week -- causes the adrenal glands to start shutting down; stopping glucocorticoids abruptly after this has happened can cause an Addisonian crisis, which can be fatal. Even long-term use as directed frequently causes Cushing's syndrome, which has a whole raft of nasty symptoms including rapid weight gain, high blood pressure, insulin resistance, severe anxiety, and psychosis. As if that weren't enough already, long-term use also causes osteopenia, a lowering of bone density that is the precursor to osteoporosis.

Given the degree of side effects involved with long-term dexamethasone usage -- and the several weeks of treatment involved in the New and Nimkarn study constitutes "long-term" -- the "behavioral masculinization" paper rolls over from "horrible" to "sheer, unrestrained evil". They are literally advocating putting pregnant women through multiple weeks of chemical torture -- not to save lives, but in pursuit of a behavioral "ideal".

If you think this is anything even remotely resembling right, I invite you to spend a month on dexamethasone -- without medication to mitigate side effects, remember we can't give benzos to pregnant mothers because they might adversely affect the fetus! -- and find out what it does to you. The stretch marks alone -- which look more like "I lost a fight with a cage full of tigers" than "boo, cellulite" -- will last a lifetime; the psychological damage from finding out just how deep your capacity for violence and self-hatred can run may fade, eventually.

All that said, there is one extremely valid prenatal use for dexamethasone. If you're about to give birth to a premature baby younger than 34 weeks, one injection of dexamethasone 24-48 hours prior to birth will help the baby's lungs produce the surfactant which it needs to be able to breathe. (Multiple doses used to be the standard, but -- big surprise -- it turns out that the beneficial effects of multiple doses are no higher, in any statistically significant sense, than of a single dose, and the adverse effects on both mother and fetus with multiple doses are worse.) Consider the difference, though: one injection versus several weeks of dosing, sharp increase in likelihood of survival versus reinforcing social norms. It's like day and night.

What it all comes down to, in the end, is this: be an informed patient. Ask questions. When you're prescribed a medication, the minimum you need to know is:
  1. What exact medication is this? Don't accept a category as an answer. You wouldn't hire a contractor who told you she was going to build your cabinets out of "wood"; you wouldn't hire a florist who told you he would make your anniversary bouquet out of "plants".
  2. How long will you be on it?
  3. What is the intended benefit of taking this medication?
  4. What are the potential or likely adverse effects for the timeframe in which you'll be on it?
  5. (if applicable) What are the potential interactions with any other prescription medications, over-the-counter medications, supplements, herbs, &c you take?


Doctors have a lot of training, and they do learn how to perform risk analysis, but at the end of the day, you are the one who gets to decide whether the potential benefits of any medication are worth the risks involved. You can't know the benefits or the risks unless you know exactly what you're putting in your body. Ask, and don't put up with bullshit non-answers.
maradydd: (Default)
Dear advertisers who use 400px high Javascript banners that slide up from the bottom of the page I'm reading:

I am using a netbook. So are several million other people. Your ads cover literally half of our screens' real estate. This does not endear me to your product, whatever it is. You could be offering free kittens dunked in marshmallow creme with 500-euro notes tied to their tails and I would miss out on your offer, because your ads are so annoying that I close them before even looking at what you're selling. As you probably learned in Marketing 101, if your target audience does not look at your ad, sales will not improve. I recommend you go back to the drawing board.

Dear content providers who use such ads, such as newscientist.com:

This means you too.

No love,
Meredith
maradydd: (Default)
I recently learned that a disabled friend of mine, who has a connective tissue disorder and gets around with the help of various assistive devices and a service dog, has been getting hassled by neighbours who want everyone to park at one end of the street and walk home during the day when kids are playing (and have gotten a city street permit to this effect, though they're using it inappropriately -- they can't legally block residents from driving to their own homes, but they're doing it anyway.)

That alone is plenty out of line, but when my friend went to talk to her neighbours about why this wasn't going to work for her, they blew her off -- one of the reasons being "well, Mr. So-and-so is 92 and he doesn't mind."

News flash, people: being old and being disabled are not the same thing. Some old people are ridiculously healthy and spry -- my granddad was still climbing ladders to fix stuff in the garage when he was 90, and the first indication that nature wanted him to slow down was stage 4 lung cancer. (He died two months later.) Certainly there are disabilities that are more common among the elderly -- you don't see a lot of young people with Alzheimer's apart from that one poor family in Holland -- and many chronic conditions, such as polycystic kidney disease, tend to worsen over time, but being old does not mean ipso facto being disabled.

Everyone reading this will either get old or die young. Some of you will get old and never slow down; some of you will end up with osteoporosis, or arthritis, or diabetes. Perhaps the correlation between age and disability makes some people uneasy around young people who walk with canes or have motorized chairs -- perhaps it makes them think of their own inevitable mortality someday. But people who are young and disabled are disabled now, and it's inhumane to pretend that their problems don't exist.

Perhaps if we can get people to realise that disability and age aren't as causally linked as people seem to think they are, both the elderly and people like my friend won't have to put up with this kind of rudeness any more.
maradydd: (Default)
By way of Pharyngula, apparently the creationists are starting to abuse information theory, not just physics, in their tortured attempts to justify their doctrine.

Of course, you understand, this means war.

ETA: /me reads the comments. Oh. Apparently creationists reject Claude Shannon's work on information theory. Infidels. They shall be first against the wall when the revolution comes.

One thing that I will never understand is why creationists believe that an omniscient God is bad at math.
maradydd: (Default)
Dear everyone,

If you are planning on committing suicide via overdose, for fuck's sake do not do it with anticholinergics. Anticholinergics are otherwise known as "deliriants" for very, very good reason. If you want to die confused and terrified while your blood pressure pingpongs around out of control, anticholinergics are an extremely effective way of accomplishing that. If you're lucky, the rapid swings in blood pressure will trigger a heart attack (which is also not a lot of fun, especially when you can't tell what's real and what isn't); if not, you're likely to end up in a coma with a failing liver.

Seriously, just don't. It will suck for you, it will suck for whoever finds you while you are still alive and it will suck for the medical professionals who end up treating you. Do yourself a favour: call a friend, call a suicide hotline. You can even call me if you can deal with someone talking you out of it with logic and being pretty much entirely unemotional about the situation.

But yeah, fuck anticholinergics in the ear.

ETA: thanks [livejournal.com profile] ephermata for just generally being awesome
maradydd: (fail)
[livejournal.com profile] joedecker points out that Obama has asked SCOTUS not to hear a DADT case currently being considered for certiorari.

This annoys me, but Joe, as usual, has accurately captured my annoyance, so go read his post if you want that. Here's my thing. This is only one of several times in the last few weeks that I've read an article about Obama asking SCOTUS not to hear a case. We've got the administration asking SCOTUS not to hear appeals from Valerie Plame and her husband vs. several Bush II officials, families of people killed during 9/11 vs. Saudi Arabia and several Saudi princes (yes, that's a forum, but go read the brief), and some Uighur Muslim Gitmo detainees who want to be released into the US. He's also asked for an overturn of Michigan v. Jackson, which would allow police to interrogate a defendant who has a lawyer (or who has asked for one) without that lawyer being present, which of course opens up all kinds of nightsticky opportunities. (Yeah, [livejournal.com profile] txtriffidranch, I know -- use a length of garden hose filled with lead shot and that nun won't have a mark on her. It's the principle of the thing.)

And, of course, despite having promised that, if elected, he would end warrantless wiretapping, he's already broken that promise (though, to be fair, we did see this one coming last summer when he was still a senator.)

What. The hell. Is up. With that? Historically, I know Presidents have clashed with SCOTUS before -- FDR, Nixon -- but since when does the President run around telling the court what to hear and not to hear? Was this just something that didn't get a lot of coverage the last few presidencies, or is Obama actively continuing the monstrous power grabs that eight years of Bush softened us up for?

(Yes, yes, I know the articles all say he's "asking", but really, grow up -- they're putting it nicely.)
maradydd: (bad post!)
(SCENE: [livejournal.com profile] maradydd, just having finished making a batch of Rice Krispie treats, settles in on the couch to get some evening coding done.)

[livejournal.com profile] maradydd's PHONE: ring ring

([livejournal.com profile] maradydd notes that the call is coming from an unknown caller, but answers anyway.)

PRE-RECORDED FEMALE VOICE: This is your final notification that the warranty on your vehicle is about to expire! Don't take the risk of driving without a warranty -- please press 1 to speak with one of our representatives about extended warranty coverage on your vehicle.

([livejournal.com profile] maradydd calmly presses 1. Some HOLD MUSIC plays. A few seconds later, a MAN picks up.)

MAN: Good afternoon, can I get some information from you?

[livejournal.com profile] maradydd: Which vehicle of mine has a warranty that's about to expire?

(Long pause.)

MAN: Excuse me?

[livejournal.com profile] maradydd: I said, which vehicle of mine has a warranty that's about to expire?

MAN: I'm afraid I don't have access to that information, that's why I'll need to --

[livejournal.com profile] maradydd: So what's the point in calling me, if you don't actually know whether I have a vehicle with a warranty that's about to expire or not?

(Another long pause.)

MAN: Ma'am, is your number [REDACTED]?

[livejournal.com profile] maradydd: That's right.

MAN: I'll place your number on our do-not-call list, sorry to bother you.

[livejournal.com profile] maradydd: You have a nice day now. [hangs up]
maradydd: (Default)
The following is a response to this post about California's Proposition 8. I left it as a comment there, but comments are moderated, and somehow I don't think it will get posted. Thus, y'all get to read it here.

Amy writes:
"After legalizing same-sex marriage 5 short years ago HIV/AIDS has increased in Massachusetts with more than 40,000 being infected each year."
I don't know what Amy's source on this figure is, but I did some research, and this claim is not only wrong, it's wrong on several orders. The first same-sex marriage in Massachusetts was performed on May 17, 2004. Since then, the prevalence of HIV/AIDS -- "prevalence" meaning "how many people have it" -- has increased, but the rate of increase has fallen off sharply.

First of all, according to the Massachusetts Office of Health and Human Services' epidemiology department, whose 2007 report you can read for free, as of November 1, 2007 there were only 16,866 people known to be living with HIV/AIDS in Massachusetts.

How could there be 40,000 new cases a year if the total number of cases in the state is less than half that?

The report also examines the trends in HIV infection. As you can see in the chart (the right-hand one on the first page), the number of newly diagnosed HIV infections dropped sharply between 2004 and 2005 and again in 2006. If you look at the first page of the data tables, you'll see that in 2003 the total number of cases was 14,992 and in 2004 it was 15,633. That's an increase of 641 cases. In 2005 the number was 16,217 -- an increase of 584 cases. In 2006 the number was 16,621 -- an increase of 404 cases. For the first ten months of 2007 it was 16,866 -- an increase of 245 cases.

What we can see from this is that the rate of new infections in Massachusetts has not only fallen since the introduction of gay marriage, it has fallen more quickly. 57 fewer people got infected in 2004 than in 2003. 180 fewer people got infected in 2005 than in 2004. And 159 fewer people got infected in the first ten months of 2007 than in all of 2005. If we project that trend out to the end of 2007, that would be 190 fewer new infections.

I'm sorry, Amy, but your argument doesn't hold up.
maradydd: (Default)
Man, you take apart a monitor at a party and everyone wants to know what the hell you're doing.

I mean, L. and I had a perfectly good reason for it: it was a hacker party, we were working on hacking together a high-voltage power supply from a CFL and the flyback transformer from an elderly CRT, the setting and the task at hand seemed to go well together. Within a few minutes of arriving, we met a guy who had taken apart many, many CRTs before, and who was quite happy to hang back and give helpful tips. That was great, and I was equally happy to give the twenty or so people who wandered by in the next hour and a half a quick explanation of what we were up to. ("We're making a Jacob's Ladder, so we need a flyback transformer. Later we're going to use the power supply for another project, but a Jacob's Ladder seemed like a great way to test it.")

Where it got annoying, though was the couple or five people who basically demanded we justify our right to plunge our hands into the guts of a sacrificial monitor. "Isn't that going to release dangerous gases?" No, that's only if we break the tube, and we're not going to do that. "Those transformers can hold a lot of charge even after the monitor's off." Yes, and not only has this monitor not been turned on in two years, L. held a screwdriver across the leads to discharge any remaining charge. "But what do you need that strong of a power supply for?" A Jacob's Ladder sounded like fun, dammit.

The absolute best exchange, though, went something like this:

WELL-MEANING BUT ANNOYING PERSON: Does anyone here actually study electrical engineering?
[livejournal.com profile] maradydd, grinning: Not me!
L, grinning even larger: Why yes, in fact I do.

The irony, of course, is that L. is getting his PhD in electrical engineering because that's where they decided to put the cryptographers. Me? I build radios and do the odd bit of electrical work on cars.

I'm half tempted, if I do a hardware project at one of these things again, to print out a sign that reads YES, I KNOW WHAT I AM DOING, PLEASE DO NOT INTERRUPT ME.

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