Blood tests for herpes do have a place in specific clinical situations, but that’s for another post.

But say you did get a herpes blood test (even though it’s not recommended many people seem to get it done) and it’s positive for something called IgM antibodies. Armed with these results your doctor proceeds to tell you that these results mean you caught herpes recently, so you start to freak out….

Stop right there.

A positive herpes IgM test means nothing. I’ve posted about this before but enough people continue to leave comments on my herpes posts asking about their positive IgM test that it bears repeating…

A herpes IgM test is never, ever, ever indicated. Not ever, because it doesn’t mean much of anything. 

“Impossible,” you say. “My doctor ordered it, so it must be a valid test.”

Well, no.

Let’s review antibodies. When we are exposed to infections we make antibodies. Antibodies are proteins produced by the immune system that fight bacteria and viruses, hopefully containing these infections. IgM antibodies are made first, within weeks, but they don’t hang around. Think of them as first responders. IgG antibodies take longer to produce, but once present you typically have them for life.

However, with herpes this response system is a little different. The herpes virus is never cleared by the immune system. Once you stop shedding the virus it takes up shop in the nerves (the dorsal root ganglia to be specific). From time to time the virus is reactivated, either producing ulcers or just asymptomatic shedding of the virus. How often the virus is reactivated and how much virus is shed depends on many factors (a topic for another post).

It is this ability to stay dormant and then reactivate that is a defining characteristic of herpes viruses, but this also affects IgM production. When herpes is reactivated, even though it is not a brand new infection, the body often produces IgM. So, the presence of IgM antibodies against herpes don’t tell you if this is a recent infection or a reactivation and so is of no use clinically. In addition, the IgM tests offered by commercial labs have not been well vetted as type specific, meaning they may not reliably distinguish between IgM for herpes type 1 and type 2 (and remember, by the age of 30 almost everyone is positive for heroes type 1).

Just because a lab offers a test doesn’t mean that the test is A) useful for your medical care and B) reliable.

Despite this, many people get tested for herpes IgM.

If you are getting a blood test for herpes, ask your doctor specifically what test that means. If your doctor is ordering an IgM test then go somewhere else, because it means they don’t know enough about herpes to be testing you in the first place.

Remember, this post is not direct medical advice.

Government should not interfere with the patient-physician relationship without a substantial public health justification.

The full Statement of Policy was approved by ACOG’s Executive Board. Some recent examples of government interference include mandatory age requirements for Plan B, transvaginal ultrasounds before abortion, prohibiting doctors from asking about firearms, and laws that force doctors to lie to women about a link between suicide, breast cancer, and abortion. These laws are in direct violation of evidence based medicine and are therefore, quite simply, public health hazards. Yes, mandated public health hazards.

According to ACOG President Jeanne A. Conry, MD, PhD, “Given the relentless legislative assault on the patient-physician relationship that we’ve seen in the past few years—and unfortunately continue to see—we were compelled to issue a formal Statement of Policy.”

“We are speaking out not just on behalf of ob-gyns, but for all physicians and patients,” said Dr. Conry. “Many of these laws are dangerous to patients’ health and safety. As physicians, we are obligated to offer the best evidence-based care to our patients. Government should stay out of imposing its political agenda on medical practice.”

But legislative interference is not limited to reproductive health as now we see parents suing about age discrimination and lung transplants. These recent cases involve two children in desperate need of lungs and parents who are beyond desperate. I’ve lost a child and have a son with severe lung disease who has been in and out of the intensive care unit multiple times so I know a little about that kind of visceral desperation. My heart aches for these families.

A judge agreed has already intervened in the first case ordering that then 10-year-old girl (in the first suit) be placed on the adult list.

But here’s the thing. I’m fairly well-educated person from a medical standpoint, but I don’t know the first thing about how to allocate organs. I know there is a complicated matching process that involves blood type, antigens, a severity score, organ size and probably hundreds of other factors that I can’t know and frankly a judge can’t either. That’s why doctors do fellowships in transplant medicine. It’s very, very complex.

And then what if doctors follow the variety of rulings that are likely to be handed down? (because when one lawsuit is successful, more will follow). In one court a judge might rule one way and in another court the exact opposite might happen. How is that good medicine?

I don’t fault the parents for trying. Not at all. And maybe organ allocation for children does need to be addressed. Raising public awareness to assess the situation is only a good thing, because if guidelines are truly robust they can handle the scrutiny. However, that scrutiny should come from educated peers, not a judge. Deciding who gets an organ must be evidence based (like all medicine) although there is evidence that some who are more connected or with more money may manage to work the system to get to the top of the list and I’d love to see legislation against that type of maneuvering.

When we allow the legal system to contaminate evidence based guidelines we get bad medicine. That is fact. In five states doctors must lie to women about a link between abortion and an increase risk of breast cancer. The growing number of ill-conceived reproductive laws (and now firearm laws) in this country already tell us that the legal system is incapable of interpreting medical literature or listening to guidelines from medical societies.

Just think of the Pandora’s box that government interference opens when every well thought out medical guideline can be tossed aside or suspended by a judge or a politician whose last biology course was 20 or more years ago.

One great tool for prevention is the vaccine, which has the possibility to dramatically reduce (if not eliminate) infection with the major pathogenic types of HPV.

A question that I am often asked is, “Should I get the HPV vaccine if I’ve already had HPV?” The concern being, if you’ve already been infected (and thus have antibodies) how can the vaccine help? Having had HPV would be defined as a positive HPV DNA test, cervical dysplasia (pre-cancer or cancer), or genital warts.

To answer that question I turned to my good friend, and world-renowned HPV vaccine researcher, Dr. Kevin Ault. His answer:

“If someone is known to have an abnormal pap or genital warts,  it is unlikely they have been exposed to every HPV type in the quadrivalent HPV vaccine. So the recommendation is to give the vaccine.”

As a reminder, the vaccine is recommended for adolescents (both boys and girls). Giving the vaccine earlier in adolescence is recommended as the vaccine will be most protective before exposure to genital HPV strains (so age 11 or 12), but if it was missed women can be vaccinated up to the age of 26 and men up to the age of 21.

In addition, there is some (albeit limited, but definitely exciting) evidence to suggest that the HPV vaccine prevents recurrence of HPV related disease in women previously treated.

And consider these words of wisdom from Dr. Ault, “I think it is important not to over think the recommendations. Get vaccinated.  Most people have sex, most people who have sex are exposed to HPV.”

If you are in the right age group, get vaccinated. End of story.

Human Papilloma Virus (HPV)

To recap: some strains of Human Papilloma Virus (HPV) are oncogenic, meaning they induce changes in a cell’s DNA that can lead to cancer. The same strains of HPV that are oncogenic in the genital tract for women, causing both cervical cancer and anal cancer, can also wreak havoc on cells in the oral cavity. As an aside, HPV can also cause anal cancer for men.

The association between cervical cancer and HPV has been known for a while; in fact the Nobel prize in 2008 was given to the scientist who proved the link. However, even before we knew about HPV women were getting Pap smears to diagnose pre-cancers, dramatically reducing the risk of death from cervical cancer. Now that we know about HPV and have tests that can detect it, cervical cancer screening has become very refined and if every woman had access to health care HPV-related cervical cancer could become a disease that we “used to see.”

Keep in mind that Pap smears and HPV testing for women are after-the-exposure surveillance. These methods prevent cancer by catching the infection before it causes cancer, they don’t prevent acquiring the cancer causing HPV virus in the first place. So, cervical cancer prevention for women also includes HPV vaccination and safe sex practices. Condoms reduce the risk of HPV transmission, but they are far from 100% effective as HPV infection is not limited to the vagina or penis (HPV infection causes what is known as a field effect, meaning the virus is often multiple places in the reproductive tract, penis and scrotum for men and cervix, vagina, and vulva for women). Safe sex practices also include limiting partners. The more partners you have, the greater your risk of exposure.

So what about preventing HPV related oral cancer? Well, here are some strategies…

1) Don’t smoke. It doubles the risk of head and neck cancer.

2) Think of oral sex as sex. Because it is. Many people think they are being safer if they “just” have oral sex, but the reality is oral sex is an effective way to transmit sexually transmitted infections. Also, many people who use condoms for penetrative sex don’t for oral sex, so in many ways it has become and even riskier behavior. Six heterosexual oral sex partners increases a mans risk of oral cancer 8 fold.

3) Consider using a dental dam for oral sex if you are not in a long-term relationship. If you would use a condom with that partner for disease protection, then you should be considering what you can catch from other orifices as well. Although keep in mind no one knows how well a dental dam actually works in reducing exposures.

4) Go to a dentist regularly. Studies show this reduces the risk of invasive cancer as your dentist can often identify a lesion when it is small and hopefully pre-cancerous. There is no oral Pap yet or HPV test, but I wouldn’t be surprised if we started seeing some kind of screening test down the road.

5) Maintain good oral health. In one study bad dentition was an additional risk factor (distinct from dental visits). This could be that chronic inflammation from gum disease or missing teeth may increase the risk of catching the virus if exposed.

6) If you are in the right age group, get the HPV vaccine. While there are no studies that show it reduces oral cancer for men (we won’t know that for 10-20 more years at least), it does reduce the burden of HPV related genital tract diseases. The vaccine could possibly help men in two ways: reduce their risk of exposure if their partners have been vaccinated (a vaccinated woman is less likely to shed the virus) and reduce the risk of a man catching the HPV virus if exposed through oral contact.

Douglas revealed his tumor was HPV positive while doing his press tour for Behind the Candelabra (which is great, by the way, and Douglas is appropriately both creepy and predatory as Liberace).

Palatal papilloma

Some strains of the human papilloma virus (HPV) are benign and simply cause warts (papilloma), but others are oncogenic and cause cancer. Cervical and anal cancers are the most common, but HPV-related head and neck cancers are on the rise, specifically head and neck squamous cells carcinoma (HNSCC).

HPV is detected in about 25% of all HNSCC. It is most commonly identified in oropharyngeal cancers (tonsils and base of tongue), 45–90% of these cancers are HPV positive. Douglas apparently had an oropharyngeal cancer (he reported his tumor was on the base of his tongue). However, HPV is also implicated as a co factor in 25% of cancers of the larynx and 23% of oral cavity cancers.

Studies are conflicting as to the role of kissing in oral HPV acquisition. The clearest link between oral HPV and thus oral HPV related cancers is, as Douglas states, via cunnilingus (possibly explaining why this disease is more common among men, although it would be interesting to know if the incidence of HPV related head and neck cancers among women who have sex with women is the same as heterosexual men).

However, there are a few things that Douglas left out (or perhaps were left out by the press, to give him the benefit of the doubt of course). First of all, typically it requires more than one oral sex partner to increase the risk of HPV related head and neck cancers. For example, oral sex with 6 or more partners increases the risk of HPV associated head and neck cancers 8-fold. It’s simply math…almost everyone has been exposed to HPV, but only a small percentage are actively shedding the virus and thus contagious. So, the more people you have oral sex with, the more likely you are to be exposed to someone shedding HPV.

While there is no denying that exposure to oncogenic (high-risk) HPV is a co factor, smoking should not be dismissed. Smoking more than doubles the risk of head and neck squamous cell cancers and alcohol is also a risk factor. Douglas is an ex-smoker and admitted in his biography to having a problem with alcohol (and other drugs).

This was a great opportunity to reinforce the important fact that oral sex is sex and carries with is the risk of both STDs and cancer. But Michael Douglas’s claim that “Oral sex caused my cancer” seems to gloss over the fact that he probably had oral sex with at least 6 partners, smoked a lot, and drank enough alcohol to need rehab.

Whether Douglas simply wanted to forget his other risk factors, was looking for the best headline to promote his Liberace biopic, or is truly invested in his cancer being simply a-bad-luck-you-went-down-on-the-wrong-woman kind of thing, I don’t know. Regardless, Douglas seems to have has missed the irony in blaming his cancer on the act of oral sex while promoting a movie about a man who died because of risky sexual behavior. It wasn’t anal sex that gave Liberace HIV, it was unprotected anal sex with multiple partners. There’s a big difference.

Douglas had a great opportunity to discuss several risky behaviors for oral cancer, both sexual and lifestyle, and it was sadly squandered.

Years later when I was in medical school and then residency I marveled at this confidence, but of course I was looking at his case with the eyes of someone who, as Morgentaler himself said, had “the knowledge and experience that women no longer die of abortion.”

I had never seen an amateur abortion in Canada (though sadly, I have seen the ramifications of them in the United States). My only experience at the time was skilled surgeons in clean settings with sterilized equipment. So one night in residency when I happened to be on call with a more senior OB/GYN I asked.

“Oh Jen,” he said taking off his glasses and rubbing his eyes. “It was horrible. You have no idea. Every night we would admit two or three from the emergency department. That’s one hospital in one city. Every night, two or three.”

He continued.

“They were septic…perforated bowels and bellies full of pus and we couldn’t do a damn thing but take out their mangled organs, give them penicillin, and hope for the best. You have to remember, this is before we had the fancy antibiotics that we have now and we didn’t have CT scans or ultrasounds to help make a diagnosis.”

“Every night two or three, can you imagine?” He repeated himself to drive the point home. Appropriately done abortions by skilled providers have such a low complication rate he knew that I had seen few complications from legal abortions, never mind a complication from a back alley procedure.

“And they were almost always alone,” he added. “Boyfriend or husband didn’t know or worse, didn’t care. Often they were too ashamed to tell their families, but a few lucky ones had girlfriends with them.”

I didn’t know what to say.

“The worst, God, I’ll never forget. She was one of our gynecology floor nurses. She’d cared for these girls before and she knew what could happen. She was beautiful, and smart, and kind. One of our best nurses. I was on call when she arrived. She was grey, had a low blood pressure, and a rigid belly. She must have known what that meant as we wheeled her back to the operating room. She was full of pus and so we cleaned her out as best we could. I was the one who called her family. Her father hung up on me.”

He paused and wiped his eyes. “You know Jen, we all took turns sitting with her as she died.”

Most jury members would have known, or at least heard of, a woman who had sought out an illegal abortion. Some would have known a woman who was maimed or even died from an illegal abortion. A few would have known more than one. It was possible that one or more jury members herself had even had an illegal abortion, safe or otherwise. The jury would also know that while abortion was technically legal in Canada at the time that it required approval by a three member panel and so actually accessing an abortion was another thing. Many women were still forced to go elsewhere and suffer the consequences.

Henry Morgentaler was tried and acquitted three times in Quebec between 1973 and 1975. In 1976 the Quebec government announced it would not longer prosecute appropriately trained physicians who offered safe office procedures.

Knowing what I know now, it doesn’t surprise me at all.

Sydney Gunter, my grandfather, June 24, 1918

“Tell me about grandpa and World War 1,” I asked my dad.

“Well, he didn’t talk about it much,” he replied. “He said it was hell. He was in France, for three years I think, first in the cavalry and then he was a sniper. I believe he was quite a good shot.” And so ended my father’s knowledge, whether time had faded his memory (my dad is 84) or he never really knew is hard to say.

I remember asking my grandfather about his war experience myself. This was on one of our trips to England when I was growing up. My parents, who emigrated to Canada in the 1950′s, took the family back to England every three years for the summer. I spent a lot of time with my grandfather the summer I turned twelve. He was 88. We spent hours pouring over his stamp collection, his collection of cigarette cards, and his photograph albums. I remember clearly a sepia photo of him in uniform. Fueled by that lack of censorship that accompanies youth I asked him about the war.

He was an enlisted man, he told me. He was offered a commission several times, but did his best to turn it down. He had no intention of being an officer. “They led the charges,” he said, “And that’s who got shot first. I was happy to hang out in the back with the enlisted men.”

“Did you get shot?” I remember asking.

“Yes, twice,” was his reply. I also asked if it hurt, and yes, apparently it hurt a lot. And then we moved on to something else and I never asked him about the war again.

I’ve always wanted to know more, and thanks to the British Archives I do. Many service records from World War 1 were apparently lost, but my grandfather’s records, like the man himself, survived. Faded documents written in fountain pen, now microfilmed but not before the ink on many had simply disappeared with time.

Great Britain declared war on Germany on August 4, 1914. My grandfather, Sydney Gunter, enlisted one month later on September 4, 1914. He was 24 years old.

He signed up for Three Years with The Colours, also known as Short Service, meaning he committed to three years with His Majesty. If the war were to end sooner he would be discharged “with all convenient speed.” However, if it were not over in three years, well, he was enlisted until it ended.

His medical records say that he was 5 feet 9 inches and 154 lbs. Grey eyes, just like my father. He was a Private assigned to the 3rd Battalion of the Suffolk Regiment. He entered the Theatre of War on July 14, 1915. My birthday is July 14. I now wonder how that made him feel. I can’t imagine he ever forget his first day in France.

It appears as if he was on a base in England between enlisting in September of 1914 and heading the France the following year. The only proof I have of that is he was disciplined for being off base on January 15, 2015. I suspect he was out having, “a bit of fun.” The penalty was a formal admonishment and docking 1 day of pay. Apparently he had quite the sense of humor and enjoyed a party.

On Feb. 28 1916 he suffered a gunshot wound to the face and left arm as well as injury from grenade shrapnel. He was back “in the field” nine days later. I was not surprised to read that arm wounds carried a 25% mortality. Blood loss, lack of antibiotics, starvation, and constant stress all in a background of filth. How does a man survive a wound at all in that situation, never mind get back in the dysentery and rat infested trenches nine days later?

Along the way he was promoted to Lance Corporal and then Corporal. He was wounded again on July 22, 1917 and as my father said, “I guess they felt he’d done his time,” so he after spending more than two years in the trenches of France he was transferred to the reserves back in England. He married my grandmother in 1918 and was formally discharged from the service in 1919. He lived to be 98 years old.

Everyone in the family used to be annoyed that he never wore his hearing aids. He said they never worked. Yes, he was stubborn. I’m sure that was a requirement for survival. However, as I read more and more about life in the trenches I now know the noise was deafening from gunfire, bomb blasts, and grenades. Of course he needed hearing aids later in life and what a tragedy that it was viewed as an inconvenience instead of a sacrifice.

I remember my grandfather as an old man with white hair and a sense of mischief mismatched to his years. He was perpetually covered in cigarette ash (two packs a day, starting with Woodbines at the age of eight), who liked two heaping teaspoons of sugar in his tea, ate bran everyday, and watched cricket with the volume turned way up. However, this Memorial Day I learned a little more and I am in awe of what he survived and wish with all my heart that I had known how to ask him more and to thank him.

I told my children about their great-grandfather and how it is our duty to preserve as much of this part of his legacy as possible. I don’t know how one qualifies one war as “just” and worth preserving and another as criminal action, however, if we are going to ask men and women to fight for us the least we can do is respect them, help them, acknowledge the horrors, and preserve their experiences. Lest we forget really does say it all.

“Now remember,” I said to Oliver and Victor, “Remember that when things are hard that you are a Gunter. The same thing that kept your great-grandfather going in France is the same thing that burns inside of you. It got you through months in the neonatal intensive care unit, surgeries, and infections. Your great-grandfather was shot twice and probably gassed and still made it to 98. You have that in you.” I point at their chests for emphasis. My boys were not expected to survive, and yet here they are a pair of mischievous nine-year-olds who love a party.

I’m not exactly sure how best to honor my grandfather’s legacy and his gift, but I figure this is a good place to start.

Preventing early removal of the Mirena is important for the following reasons:

• Contain costs. IUDs themselves are expensive and there is often a co-payment for insertion as well.
• Prevent unplanned pregnancies. Long acting reversible contraception (LARC) is the most effective form of contraception because there is no user error, and so with the IUD out the next method chosen is likely to be less effective when considering real world experience. Not everyone has a plan for their post IUD contraception and that time of considering what to use next is very high risk for an unplanned pregnancy.
• Reduce the burden of complications. While significant complications with IUD insertion are very low (less than 1%), they are all associated with the insertion. If you have an IUD inserted and pulled out 3 months later you have assumed that risk for nothing.

The best way to prevent dissatisfaction related to a known side effect (irregular bleeding) is to be adequately counseled about that side effect. So how common is irregular bleeding after a Mirena IUS?

There are a couple of high quality studies to consider. These studies followed women after the insertion and they completed daily diaries to record bleeding, so the data is prospective (these were typically studies looking at ways to reduce post Mirena insertion irregular bleeding).

The average number of days with any bleeding in the first 90 days after Mirena insertion was 35 in one study (May 2013), but it ranged from 18-55. In another study (Sept 2011) the average number of bleeding days that required a pad or tampon in the first 84 days after insertion was 22-32 days, but 25% of women bled for 33-55 days (the longest was 64 days).

While the studies aren’t perfect (they varied slightly in how they quantified the bleeding) and the diaries were not collected by investigators daily, but rather batched and collected later, they do confirm that in the first 3 months after a Mirena is inserted there is a fair bit of spotting or bleeding. If you add the days together it totals about a month, but 50% of women will bleed more than that.

Bleeding for the equivalent or at least (and possibly more) than 1 month out of the first 3 in a random way is a nuisance. Studies tell us that overall its much less blood that a period, it’s just smaller amounts with an unpredictable pattern. However, this nuisance bleeding decreases significantly over time and is important to put in the big picture. If you look at all methods of reversible contraception (Mirena, copper IUD, pill, patch, depo-provera shot. ring, and implant) women with the Mirena IUS have the highest satisfaction scores at 1 year. Also, looking at all methods of birth control, women who chose a Mirena are more likely to be using that method at a year compared to women who chose a different method.

While you should be prepared for a fair bit of irregular bleeding in the first 3 months after your Mirena IUS is inserted (and if you are in the 50% who bleed for fewer than 30 days, then great!) you should also know that if you stick with it by 1 year you are more likely to be highly satisfied with your Mirena (and less likely to be pregnant) than if you had chosen a different method.

Adapted from Peipert et al. Data from Contraceptive CHOICE Project published in Obstetrics and Gynecology May 2011

Kangaroo care (KC) is the practice of skin-to-skin contact with a premature baby and parent. In low and middle-income countries, where there are fewer medical resources, Kangaroo Care has been shown to reduce mortality among premature babies and shorten the length of hospital stay.

Kangaroo Care is also very beneficial in high-income countries even in the midst of extremely high-tech care. Holding a premature baby skin-to-skin:

• Improves breast milk production and breastfeeding (when mothers do the KC). Remember, breast milk is the best medicine for preemies.
• Reorganizes the nervous system. A premature baby is meant to be in the warm, dark, dampened environment of a uterus filled with amniotic fluid. The stress of our noisy, harsh, cold environment can negatively affect a premature nervous system. KC promotes healthier sleep patterns for a premature baby and reduces stress on the nervous system. Premature babies who experience Kangaroo Care tend to have better neurological outcomes. My children were born at 26 weeks, which in 2003 meant a 85% chance of survival and, if they survived, a 25% risk of severe or moderate disability and a 25% risk of a minor disability. The more premature the baby, the greater the negative impact on the nervous system.
• Improves parent-child bonding. The universal first experience of a parent is touching and holding their baby. It is a primitive need and evolutionarily was probably essential for survival as a mother’s embrace at birth provides warmth, helps with bonding, and improves breastfeeding. Many parents of premature children don’t even get to touch their babies at birth, never mind hold them. My son Oliver was too sick for his resuscitation team to even stop for me to have a look. The neonatal intensive care unit is a very disorienting and traumatic experience for parents, and so the time when you can mentally step out of that environment and hold your baby helps the healing go both ways. I feel I got as much out of holding my boys as they did being held.
• Provides pain control for your baby. There is such a positive effect on the nervous system that a baby a young as 28 weeks can have a reduced pain response to a procedure with KC.

But what about all those tubes and wires? And some of the preemies are so small!

That’s what I thought. My children were 26 weeks and weighed 1 lb 11 ounces and 1 lb 13 ounces. They had breathing tubes, intravenous lines, oxygen monitors, and EKG electrodes. It seemed that almost every square inch of them (and there weren’t that many square inches) was covered with some kind of medical equipment. And they were so small. And fragile. I was terrified that I would either: A) dislodge some really, really important piece of medical equipment and/or B) break them.

But that’s where the neonatal intensive care nurses come into play. They are so used to handling the tiniest babies they make it look easy, and the thing is, once you do it a few times it’s not so hard. And you manage to get skin to skin, even with all those tubes and wires.

If a preemie is critically ill, and some are, it may take a few days or even longer until they are stable enough to be held. Sometimes even touching them is just too much for their nervous system and they will drop their heart rate or lower their oxygen levels in response. However, the nurses are trained to look for the subtle signs that means a baby is ready to try KC.

Getting to hold your baby the first time is an amazing thing. For me, it happened 8 days after my children were born. They were each able to tolerate about 30 minutes, but within another week they were up to an hour. I held them each for an hour twice a day until they came home. It is the most amazing thing to see your baby’s heart rate lower and oxygen levels rise in response to your touch.

Kangaroo Care is a simple, intuitive, and free therapy that has been proven effective by high quality medical research. What a wonderful thing indeed.

Plan B is one type of morning after pill. It is the hormone levonorgestrel. The brand is Plan B but there are generics as well. It does not cause abortion. It does not affect implantation. It works by inhibiting ovulation.

The American Congress of Obstetrics and Gynecology and The American Academy of Pediatrics feel that Plan B should be available over-the-counter to anyone who wants to buy it without a prescription or identification. This is because

• The sooner the product is taken, the more effective it is (i.e. if you have already ovulated, it won’t work)
• There is no known medical contraindication to taking levonorgestrel. And one could take it every day, but since the generic is $25 (at least) the chance that would actually happen is 0%.
• Levonorgestrel is very safe. Far safer than many drugs already available without a prescription of identification. Acetaminophen (Tylenol) is far more dangerous than levonorgestrel.
• Identification is a big barrier. Not everyone has their ID with them at all times and not everyone has a driver’s license. Especially young people.

Initially, the Obama administration stepped in and went against the Food and Drug Administration who voted in 2011 to make Plan B available to all ages without a prescription. We were left with the over-the-counter for ages 17 and up ruling.

Various groups sued the department of Health and Human Services about this decision, but in the meantime the FDA decided to to approve an application from Teva (the manufacturer of the brand name product, Plan B) to sell their Plan B product on the shelf to those ages 15 and up, albeit with identification.

Judge Edward Korman of the 2nd U.S. Court of Appeals called bullshit on everyone. The Obama administration, the FDA, and Teva and sided with (gasp) science. Korman agreed that the science says that Plan B is safe and not an abortifacent, but rather contraception (remembers, it interferes with ovulation) just like a condom, so it should not have an age restriction nor an ID requirement.

From a science perspective this should have been the end of the story. But it’s America and the government is cowardly and science is often viewed as witchcraft.

There has never been a levonorgestrel related death, but almost 200 children under the age of 12 die every year in the United States from gun violence, but I don’t see any federal legislation banning children from touching firearms. Every day in the United State 7 people between the ages of 1 and 19 die from gun violence, but the government is concerned about Plan B affecting the safety of the youth of America?!

Mr. President and Ms. Sebelius if you really cared about protecting young people you wouldn’t be wasting tax dollars appealing Plan B.

No one aged 19 and under will die today from Plan B, but 7 will die from gun violence.