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Double Standards – Contraceptives and Medicines

Imagine a woman warned by her doctor to refrain from having a fifth pregnancy for medical reasons. She decides to use natural family planning (NFP). Will the bishops of CBCP and their allies question her decision?

Certainly not. As early as 1951, Pope Pius XII in his Allocution to Midwives specifically accepted medical reasons as a justification for birth control. He said:

Serious motives, such as those which not rarely arise from medical, eugenic, economic and social so-called “indications,” may exempt husband and wife from the obligatory, positive debt for a long period or even for the entire period of matrimonial life. From this it follows that the observance of the natural sterile periods may be lawful, from the moral viewpoint: and it is lawful in the conditions mentioned.

Now imagine another woman with exactly the same medical reasons who chooses contraceptive pills. To be consistent with their own teachings, one would expect the bishops to simply say: right reason, wrong method. But no, they are now on a war path and have branded the use of contraceptives as treating pregnancy like a disease. In their desire to destroy the status of contraceptives as medicines and its value to public health, it seems they are willing to stigmatize pregnancy prevention as inherently immoral.

In his “contraception is corruption” speech, Archbishop Villegas said: “A contraceptive pill is to be considered an essential medicine. If it is a medicine, what sickness is it curing? Is pregnancy a sickness?” Weeks later, Senator Enrile echoed the same line: “In the case of a contraceptive pill, is pregnancy a disease that needs to be cured? Why do we need to prevent it?”

Sure, pregnancy is not a disease. But pregnancy and childbirth can lead to diseases or injuries. Even bishops must be aware of this fact, which makes their argument sound so contrived. The World Health Organization has a whole chapter listing such diseases and injuries in its International Statistical Classification of Diseases and Related Health Problems. Obstetricians exist to prevent or treat these conditions.

If the bishops of CBCP and the anti-RH camp are not yet convinced that they are stirring up double standards in morality, they should try asking this to any user of NFP: “Is pregnancy a disease to be cured? Why do you need to prevent it?”

A double standard in law is also being pushed by the anti-RH camp. The claim that medicines must cure a disease, or must not prevent normal bodily functions like pregnancy is not supported by our laws.

Anti-coagulants and contraception

As far back as the Food, Drug and Cosmetic Act of 1963, drugs have been defined as articles intended “for use in the diagnosis, cure, mitigation, treatment, or prevention of disease,” or “to affect the structure or any function of the body.” The above phrases are retained in the latest version of that law, the Food and Drug Administration (FDA) Act of 2009. And in case the anti-RH camp will try to claim that medicines are different from drugs, they should read the Universally Accessible Cheaper and Quality Medicines Act of 2008 which defined drugs and medicines the same way, and included “drugs and medicines indicated for prevention of pregnancy, e.g., oral contraceptives” as part of the “List of Drugs and Medicines that are Subject to Price Regulation.”

Many substances classified as medicines without any controversy expose the hollowness of the “pregnancy is not a disease” argument. Blood clotting or coagulation is not a disease. Yet we have anticoagulant medicines, commonly used to reduce the risk of heart attacks and strokes. A functioning immune system is not a disease, yet we have medicines that suppress the immune system, a standard fare to prevent organ transplant rejection. Having gastric acid is not a disease, yet we have antacids to manage indigestion.

People do choose to avoid normal or even desirable activities to prevent possible future harm. I’m pretty sure even bishops and anti-RH campaigners do it. We avoid too much sun; avoid too much food; avoid too much reading; avoid crossing streets when overpasses are available. When the path towards harm is clear enough, stigmatizing people who steer away violates plain common sense. Unless the bishops have another brand new standard of common sense.

Double standard in action is my final beef with the “pregnancy is not a disease” argument. In that memorable August 16 Headstart episode [1], TV host Karen Davila asked Senator Tito Sotto if his wife has had a tubal ligation, and this in part is what he said:

She has to be ligated. Because, yes, because she had, how many pregnancies. … She had four cesarean operations. … So, pagkatapos noon, sinabi ng [obstetrician], “You have to be ligated.”

A few minutes before in that same interview, when asked why he was against the RH Bill, Sotto’s first response was to attack the status of contraceptives as medicines. This is what he said:

Medicine is supposed to be, must cure something. What does a condom cure? What does an injectable cure? What does an IUD cure? So they’re not medicines, they’re not essential medicines.

A tubal ligation is of course a contraceptive medical procedure, not a medicine. But women fearful of the health consequences of another pregnancy, whether using condoms, injectables, IUDs or tubal ligations to prevent the next one, would surely be hurt by the senator’s loaded questions. Sotto attacked the health benefits of contraceptives and admitted to using the health benefits of a contraceptive procedure. The double standard  is simply stunning. Perhaps Sotto should answer Enrile’s core concerns: “Is pregnancy a disease that needs to be cured? Why do we need to prevent it?”

[1] All quotes taken by the author from the video.


Images by Alex Brown and anqa, used under the Creative Commons license.

Posted in RH BillComments (49)

Alternative (to) Medicine

The Silver Bullet. The Magic Pill. The Cure For What Ails Ya. Wouldn’t it be nice if we had a miracle drug that could instantly cure us of whatever illness we might have? “Colds? Muscle pain? TB? Gonorrhea? Cancer? Pop this pill and call me in the morning.”

Sadly, no such thing exists (yet). The human body is an extremely complicated piece of machinery (Needlessly complicated in fact, that’s why it’s improbable that we’re intelligently designed, ok creationists?), and drugs that have a beneficial effect on one part of your body will likely have a detrimental effect on another part of your body. No single drug will have a beneficial effect on your ENTIRE body, unless you consider death to be beneficial.

However, there are many people who swear by such miracle cures. Pretty much all of them fall into the category known as “Alternative Medicine”.

Alternative medicine has always existed, in one form or another, throughout human history. The principles have roughly stayed the same: “All maladies are caused by some sort of imbalance in our *insert magical, unmeasureable, undetectable energy/life force here*, and the cure is *insert modality here*.”

The thing is, they only became “alternative” after the dawn of science-based medicine. Our ancestors used all sorts of “treatments” and “remedies” for every ailment, from the mundane (leaves, flowers, ground up animal parts, etc) to the outright bizarre (spells, incantations, faith healing, etc).

But we can’t really blame our ancestors because back then, our knowledge base was pretty limited. In fact, as recently as the 1860’s, bloodletting was a pretty common treatment for a lot of ailments. Even something as simple as handwashing was seen as “ungentlemanly” by doctors and surgeons, no less.

But in this day and age of advanced scientific knowledge, near instant communications, fast transport and travel,  fantastic technologies, and the incredible exchange of ideas afforded to us by the internet, there really isn’t much of an excuse to believe in Supplements, Complementary and Alternative Medicine (or SCAM, for short)…

…or is there?

Let’s try to analyze this question:

“If SCAM is bunk, then why is it so popular?”

I think it boils down to a few factors:

1. Confirmation bias:

Most people who use SCAM fall under one of two categories:

a. Those who already believe in them;

b. and those who are willing to try them either because of lack of finances, or because conventional medicine didn’t work for them.

Both these types almost always fall victim to confirmation bias. So what is confirmation bias?

Confirmation bias (also called confirmatory bias or myside bias) is a tendency for people to favor information that confirms their preconceptions or hypotheses regardless of whether the information is true. As a result, people gather evidence and recall information from memory selectively, and interpret it in a biased way.

The first type already expects the SCAM modality to work, so they feel better after using it. The second type is desperate for something to work, and is therefore primed to believe that it is actually working.

2. The body heals itself (most of the time):

If you’re like the vast majority of people in the civilized world, you won’t go see your doctor until your fever/cold/cough/ache is at it’s worst. Also, a significant portion of that population goes to a SCAM practitioner, instead of a real doctor.

The thing is, if we are reasonably healthy, our bodies are quite capable of fighting off most illnesses. And since we go see these SCAM practitioners at the peak of our illness, any treatment they perform (or don’t perform) is almost guaranteed to “cure” you. Thus, giving the illusion that the homeopath, naturopath, reiki master, acupuncturist, chiropractor, touch therapist, etc. is the real deal.

Now I’m sure some SCAM proponent is saying ” AHA! So you’re admitting that those who go to real doctors also have this phenomenon going for them!”

Well yes, to a certain degree. You see, the placebo effect applies even to real medicine. So you get an actual benefit, PLUS the placebo effect. This is also the reason why in science, we have this thing called the “randomized, double blinded, controlled clinical trials” to separate the placebo effect from true efficacy, something no SCAM practitioner does.

3. Personal anecdotes trump impersonal data every single time:

We love hearing stories, especially stories delivered with conviction by a satisfied SCAM victim customer. Let’s face it: Hearing a feelgood story about how some miracle product cured a person of his/her cancer is far more compelling than some boring study written on a piece of paper by anonymous scientists from thousand of miles away. This is one of the big reasons why practically every form of SCAM relies on testimonials from satisfied victims customers.

4. It feels good and is easy to understand:

Every successful SCAM modality is also very simple to understand. No technical knowledge is required. There’s no scary sounding drugs or hyper-complicated machinery to intimidate you. From vague and simple explanations of adjusting/restoring the balance of chi in your body to replenishing vibrational energy/bioenergy/life energy, just about anyone can understand it. Many SCAM modalities also incorporate soothing music, comfortable couches or beds, massages, and dim lighting to help a victim customer relax. As you might guess, a relaxed victim customer is more likely to report positive results.

And because of all of the above, many of us are quite eager to accept that these SCAM modalities work, despite the low quality of evidence that supports them. As I have mentioned before, most SCAM practitioners rely on testimonials and anecdotal evidence. They also love to cite poorly made studies, many of which are performed by themselves, and published in “pee-reviewed” (that’s not a typo) medical journals, which were made just to promote SCAMs.

5. Conspiracy theorists vs “Big Pharma”:

There is a general notion among the public that “Big Pharma” is out to get them and that Big Pharma is in bed with Big Bad Government to keep us sick in order to keep selling drugs. Many SCAM practitioners love to incite this particular fear and paranoia into potential victims customers. It’s easy to target “Big Pharma” as evil, because it’s seen as one single entity. Few people realize that in order for this “Big Pharma Conspiracy” to exist, everyone from the pharmaceutical companies’ top management to government officials, to doctors, to nurses, med techs, researchers, down to the clerks and support staff HAVE to be involved in the conspiracy. Few people stop to think that these people are human too, with their own friends and loved ones that they would like to keep free from illness.

Now, do I think pharmaceutical companies are benevolent and have only our wellbeing and best interests at heart? Of course not. As with any other business, the three main objectives of pharmaceutical companies are 1.) profit, 2.) Profit, and 3.) PROFIT. Given the choice of cutting costs and saving money vs spending a fortune on efficacy and safety trials, I’m pretty sure which path the pharmaceutical executives would rather take.

But this is why the pharmaceutical industry is one of the most heavily regulated industries in the world. The FDA keeps a close eye on them. These companies spend billions upon billions of dollars on R&D, efficacy trials, and safety trials. They have to, otherwise they won’t have a product to sell. This is also why most real medicine costs a lot.  In fact, the rules and regulations are so stringent that roughly 85% to 90% of the drugs being tested never get past the first and second phase of clinical trials. It is also interesting to note that Big Pharma actually PREFERS these super stringent rules and regulations that cost a lot of money, because it discourages startup competition, leaving only the big boys with fat wallets.

And no, the FDA is not perfect. Many defective products have still passed through it’s screening process. Some would say that this is unacceptable and the FDA sucks, but that would be like saying that Kobe Bryant is bad at free throw shooting because he only makes 84% of them. Also, once a defect is discovered (even relatively minor ones), it is immediately pulled out.

Compare and contrast with SCAM, which few people realize is ALSO a multi-billion dollar industry. The SCAM industry has a ridiculous reputation for being “all natural” (as if that means anything) and somehow “more caring and more personal”. We need to realize that these people also have profit as their primary motive. Otherwise, they wouldn’t charge for their treatments. The worst part is, this industry is NOT regulated at all. For an industry that frequently promises to “wash away the toxins”, many of their products have been found to contain hazardous materials.

We, as consumers, need to be more skeptical of fantastic claims. This is the only way we can weed out bad products from the good ones. As with almost every thing we encounter in life, it’s useful to always remember this adage:

“If it sounds too good to be true, it probably is.”

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Why I’m Happy to be on Anti-Depressants

I saw my psychiatrist the other day. I hadn’t seen him in 10 months. Not because I didn’t want to, but because I hadn’t felt the need to see him all throughout that period. For the first time in a long, long time, I felt that my head was screwed on right, and there wasn’t much to report to him except that my life was just fine. Pretty good, even. In fact, that was exactly why I came to see him the other day — in the hopes of tapering myself off of the anti-depressants he prescribed for me, because I was pretty sure they had done their job.

Getting medicated for mental conditions remains a touchy topic in our touchy tropical nation, but there really shouldn’t be a stigma surrounding it. The human body is a staggeringly complex system, and getting wounds, tumors or other more physical glitches is not the only thing that can go wrong with it. Biochemical imbalances can affect the way a person processes the world around him, sometimes to the point of it being debilitating. It’s an illness like any other.

Nega and Chaka

Prior to medication, each day filled me with worry, dread, anger, and sorrow. There were flashes of okay-ness and even rarer blips of actual joy, but for the most part I was preoccupied with negative emotions. (And no, I did not affix Emily the Strange or Jack Skellington all over my trappings and listen to Dashboard bleary-eyed. That’s not depression; that’s just sad.) On the outside, I looked decidedly normal, even functional, and maybe just a bit too quiet, but little did others know that each move I made — choosing what to wear, walking down a sidewalk, buying a snack, talking to someone — required intense personal deliberation, as if one wrong move could ruin the day. And the moments following each act were flooded with all sorts of self-criticism, second guessing, and bad memories only loosely related to the current situation.

Did I say the right thing? Are my shoes too casual? Will this burn enough calories? Did I spend too much? Was this the right color? Should I have smiled? Could I have done it better? Are they sick of me? Did I forget anything? How hard will it be to commute later? Do I have to go to that employee thing? Do they hate me? Why is my hair like this? Why do I work here? Do I deserve him? Why is my family this way? Why can’t I say how I feel? Remember when your uncle told you you brought grief to the family? Remember when you did this and she said this so he did this and now they hate you? Remember when you were a better person and things were looking up? What happened to you? Why are you like this? Can you see yourself like this for the rest of your life?

I had to slog through each day this way. Suffice it to say that it took a toll on my work and my relationships. I found it hard to be with people, much less befriend them; every new assignment at work felt like a huge bag of sand against my gut; I picked ridiculous fights with my boyfriend which led not only to me screeching and bawling ’til dawn, but me clawing at my face and arms ’til they bled and even running away in hysterics. This was normal for me at the time.

Psyching Myself Up

Fortunately, my boyfriend is both incredibly supportive and fiercely logical, and he eventually convinced me that seeing a psychiatrist would do me some good. He was well aware of my none too rosy family history, my anorexia, my frequent run-ins with thieves and other unsavory types, my instantaneous apprehension towards authority figures, etcetera etcetera etcetera, and how all of these were connected one way or another to my difficult personality. Something was not right me. He wasn’t holding it against me. It was just a blatant fact that needed to be addressed.

So I went to a psychiatrist and told him as much as I could about how I thought and felt. (A psychiatrist, by the by, is different from a counselor or psychotherapist, the proverbial shrink who listens to you talk about your childhood and whatnot. Psychiatrists simply diagnose your condition, prescribe medication, and monitor your treatment.) This was the beginning of a slightly tedious process, stretched over several months, of ascertaining what I should do. It was fairly easy for my psychiatrist to conclude that I had major depressive disorder with a touch of social anxiety; what was harder was finding the right pill and dosage for what I had.

I started off with half a pill of escitalopram daily. Escitalopram is an SSRI, or Selective Serotonin Reuptake Inhibitor, the most common form of anti-depressant prescribed today. Serotonin is a chemical neurotransmitter whose presence is linked to feelings of peace and well-being, and what SSRIs do is keep this serotonin from being reabsorbed, letting it stay in the brain longer to better boost one’s mood. This is obviously the layman’s explanation, but that is basically what SSRIs do, because depressed people can’t seem to get the right balance of serotonin in their brain.

Alive, Alert, Awake, Enthusiastic

At the beginning, half a pill packed a punch. I could sense the difference in me immediately: I felt awake and alert — my eyes literally opened wider (they’d apparently been extra droopy and I never noticed), and my movements felt sharper, more precise. More importantly, my thoughts were no longer flooded by unnecessary negativity. When before my thoughts would immediately link themselves to something bad or worrisome, they now stood on their own, guilt- or problem-free. The medication worked so well that I even tried playing tricks with myself, thinking bad thoughts deliberately, only to feel them slip off of my consciousness like pats of butter. I know you think I sound high or something,  but that’s how it felt. I felt fine because things really were fine. If I had a legitimate problem in my midst, such as difficulty getting a ride home in the pouring rain, or my big boss sending my work back with endless edits, I didn’t blow it out of proportion and conclude it was the end of the world and I might as well jump out a window or into speeding traffic. I understood what was wrong and did what I had to do to address it, like a normal person.

And the best thing about the pill working? It was a signal that something really was wrong with me. I was told that SSRIs only worked if something was wrong to begin with (it’s not the kind of pill you can abuse), so the fact that there was a staggering difference in me the moment I popped just half of one in meant I was doing something right.

Sex Bomb

But of course, like any other kind of medication, there was the risk of side effects. This was one of the main reasons why getting medicated is a trial-and-error process; every individual reacts to each pill in their own unique way, so you really have to whittle all the options down to the one most suited to your body’s chemistry and to your lifestyle. And unfortunately, I hit a particularly annoying snag with escitalopram: my sex drive sputtered out. I felt literally numb down there, and while my boyfriend was very understanding about it, it still really frustrated me. Sex is a normal thing people do and to be denied it felt frustrating and, in the end, depressing.

Thus, my psychiatrist prescribed citalopram, escitalopram’s older, less sophisticated version (a.k.a. fewer side effects), and upped my dosage to a whole pill a day to make up for this pill’s lack of fine-tuning. And it did solve my little quibble. I had to take a larger dose, and citalopram was slightly more expensive than escitalopram, but the fact that it could fight my depression and save me from sexual drought was worth it. My psychiatrist then advised me to take it for an entire year (six months for the actual treatment of my serotonin levels, and then another six months to really bolster the treatment and make sure the effects stay put), and to check in with him every now and then, especially if something was up.

On the Mend

But I didn’t check in with him for the next 10 months. (I would not recommend forgoing the psychiatrist to anyone; I was just being hardheaded and I am not a good example.) It was just that, as I’ve mentioned, I was lucky enough to have everything good since we nailed down the pill and dosage right for me. Long story short, it got to the point where I couldn’t tell the difference between feeling normal and feeling medicated. In fact, here’s a list of personal improvements I’ve achieved, off the top of my head:

  • I can hold a conversation and not loathe myself afterwards.
  • I am more capable of telling people what I want instead of being meek and doormatty.
  • I don’t throw a fit when my boyfriend isn’t home by 6:30 PM.
  • I eat what I want and only when I’m hungry, and don’t spend hours staring at my love handles in an awful mixture of sorrow and horror.
  • I can forge and maintain friendships with people I sincerely like.
  • I am more active about the things I believe in.
  • I am more willing to try new things, no matter how far they are from my comfort zone.
  • I care far less about what others think of me, my writing, my anything.
  • I don’t beat myself up over the way I write.
  • I no longer feel the need to pander to people I don’t like, and ultimately don’t crave for others’ approval anymore.
  • When I feel upset, it doesn’t stretch on and escalate over the next 12 hours.
  • I don’t care about my past, and neither do I worry too much about the future. I’m just fine where I am and I figure myself out from day to day.

I am still the same person I was before, in the sense that I still believe in the same principles, strive for the same goals, enjoy the same things, and swear like the same old sailor. The only significant change is that I’m actually happy to be this person, that I don’t unwittingly pile a whole lot of metaphysical shit on to bring myself down for no reason. I don’t feel different. I feel better. What moron doesn’t want to feel better?

Get Happy

So there. Thanks to my most recent conversation with my psychiatrist, which could possibly be my last, at least for a long while, I am now on a program to taper off my medication. Next month, I will take half a pill each day for the first two weeks, and then take half a pill every other day for the last two weeks. I will then stop taking medication after that, and will monitor how I feel over the next two months. If I feel just fine, that means I’m in remission. If not, that means I’ll have to go back to medication on a higher dosage for another length of time. But I’m pretty confident I’ll be in remission, because everything’s gone pretty well thus far. Unlike before, I now hope for the best.

I’d like to stress again, of course, that medication affects people in different ways, and that my case just happened to be fairly clean-cut. Others have a more difficult time with their treatment, so I cannot really speak for people on meds in general. What I do want to relay, however, is that getting medicated shouldn’t be frowned upon and, in fact, is a perfectly normal option for people with conditions similar to mine. Depression, bi-polar disorder and their ilk are more common than people think, and their methods of treatment are also more mundane than many would like to believe. Medication can be a difficult process, sure, but that doesn’t make it strange or wrong. In fact, I’m happy to be on medication. Wasn’t that why I signed up in the first place?

Posted in Featured, Personal, ScienceComments (28)