May 10th, 2005

Ah, chemistry

I have a little trouble with chemistry. For one thing, I didn't take any chem (or bio) after high school. I felt that labs were time consuming and dangerous and worked hard to avoid them. A while back I subscribed to Nature for a year, and read it cover to cover assiduously. I spent a lot of the time on the phone to a friend who had taken relevant courses asking what various words meant. These days, of course, I would use google, but it's a very different world now.

After having read an appalling number of books which abstract medical studies on Stuff Done to Pregnant Women and Their Babies, I have noticed a trend: Prostaglandins. They seem to be involved in absolutely everything, and some of the Stuff has the effect of increasing production (or supplying synthetic, analog or precursors to prostaglandins) and other Stuff has the opposite effect. I have a well-developed set of beliefs about polypharmacy and medical treatments that require other treatments to deal with the less-desirable effects of the initial treatments. They can be summarized as Stay Away If At All Possible.

However, when my newborn niece's patent ductus arteriosus did not immediately close (and contributed to her non-standard respiratory distress) and I read up on drug treatment for that (which worked, yay, no surgery in the offing for the wee one), my trend sat up and became a full-blown Paranoid Conspiracy Theory. An aspirin a day. Why does it work? Prostaglandins. Cox-2 inhibitors were developed to have a more specific effect on some, rather than several, prostaglandins, with the unfortunate side effect of death. Want to make the cervix ripen or activate uterine contractions (whether to induce labor or an abortion)? Prostaglandins (or analogs, or precursors). And again, the more specific and effective the treatment, the more likely it is to have the unfortunate side effect of death (or disability. Reading about uterine hyperstimulation is creepy. Reading about uterine rupture with no history of C-section rendered me speechless.).

Okay, that's all weird. But then it turns out that inflammation is mediated by prostaglandins. Bone resorption, ditto. Essential fatty acids, either the wrong balance or not enough, are a component of this complicated control system. See what I mean? They're everywhere. Everything interesting in the way of drug development or nutritional news in the last ten years seems to involve prostaglandins. And sure enough, they've only relatively recently tracked down a lot of the details, and many are still being studied.

Last night, after asking Roland a few more questions about what he remembered from his AP, but high school, chem class about prostaglandins, we sat ourselves down in front of google and spent an hour or so digging for a nice diagram or summary of the current state of understanding. This is when we found out about the bone resorption (does that mean someone taking aspirin for arthritis, or heart protection, is setting themselves up for osteoporosis? It sure sounds like it.) thing. Oh, and the asthma thing. No useful diagram (a lot of interesting ones that showed one PG getting turned into another, but never showing the control system with the inhibitors and precursors, which is what we really want). As near as we can tell, people who go to medical school have to learn this stuff before (or during). They ought to be able to predict a lot of these side effects by understanding how a treatment or drug acts. But they (collectively even, so whoever is doing formulary or protocol design is missing it, too) do not appear to be anticipating these things -- just tossing in more drugs and treatments to deal with the effects as they appear. Couple of theories spring to mind. They don't want to alarm the patients, so they don't really talk about it. They don't want to admit they don't understand how this shit works, so they don't really talk about it. Or they're in a flaming hurry to try something, anything, and they blow right through any considered discussion as to whether this is really a good idea (hurrying to save lives, make money, whatever. Possibly just institutionalized hurry).

Consider this an open call for a reasonably accessible introduction to prostaglandins as a major control system in the (human) body. That means in a pinch, I'll take a college textbook, but I'd prefer to avoid reading an entire endocrinology text. Which is currently what it sounds like I'm signed up for, if I really want to understand what the hell is going on here.

Honestly, by comparison, knowing what sub-arachnoid space is and being able to point to it in a diagram is straightforward.

Never let it be said I can keep my mouth shut about my politics

Check out the cover on this standard text on obstetrics. One positive review, from a midwife. I am not commenting on the contents of this book, which may well be excellent (dunno -- I haven't looked at it myself). I am talking _only_ about the cover design.

http://www.amazon.com/exec/obidos/ASIN/0838576656/

(1) Why is it human? Men don't give birth. Before you say, well, they had to distinguish the species, think hard about what _that_ says.

(2) Notice that while there is a baby on the cover, there is no mother. Whoa. They _erased_ mom from the picture entirely. Spooky.

(3) While mom has been erased, the time lapsed drawing/diagram tells you exactly what position she is giving birth in. Take a good look -- it's almost certainly semi-sitting. (Either that, or lithotomy.)

Title does get points for saying labor and birth, not labor and delivery, hence it does actually describe work done by mom, rather than focussing primarily on the birth attendants activities (which would be delivery).

Yikes.

I think I'm going to get Robbie Davis-Floyd's book. She may be crazy, but it is increasingly difficult for me to think she's wrong.