August 26th, 2008

more Bright Ideas from the medical community

Once upon a time (according to women who were having babies forty years ago) there was this idea circulating that the placenta completely blocked all the nasties from getting from mama to fetus and therefore smokin' and drinkin' and pretty much any kind of (prescription) drug was A-OK because after all it Couldn't Get to The Baby.

Yeah, we know _that_ didn't turn out to be true.

Still, even after we realized that all kinds of stuff made it through the placenta, there was still this whacky idea out there that the amniotic sac was somehow "sterile", which is part of what enabled the medical community to claim they needed to shave and "sterilize" the mother to prevent her from giving some Nasty Disease to the baby. (a) Did not turn out to be possible to sterilize the mother (even with a c-section delivery) and (b) attempts to do so interfered with normal colonization of the infant with comparatively benign stuff, with the result that when they inevitably were colonized, it was with much nsatier stuff.

Which isn't necessarily relevant to this particular rant.

We've known (well, _I_'ve known and I must have read it somewhere) for a while that infection that had crossed into the womb in the course of a pregnancy dramatically increased the odds of preterm birth (and not the relatively uneventful kind of preemie -- no, the in the NICU for a month or more kind of preemie with all kinds of follow-on problems). For reasons best known to the medical community, this was believed to be fairly unusual (even in cases of pre-term birth).

http://health.usnews.com/articles/health/healthday/2008/08/26/preterm-births-linked-to-infection-of-amniotic.html

They're rethinking that now, too.

And what do they think is a reasonable next step? Hey, let's just do screening amnio on every pregnant woman at 20 weeks to see if she's got an infection.

What could go wrong with _that_, after all?

Well, there is the fact that, even with good technique, but especially with sloppy technique, there's a risk of _introducing_ an infection that way. Dunno how many would be reduced in practice to detected, but that'd be something to worry about.

Then there's the question of exactly what would you _do_ if you detected an infection at 20 weeks? Abort? _That's_ gonna go over really well. Treat? Presumably with antibiotics, but delivered how? And who knows what kind of effects that could have. If group B strep is anything to go by, you'd just wind up with increased resistance and nastier bugs in the remaining group of infected uteri -- and that group might only not be smaller, it might have gotten bigger (see issue above of introducing an infection).

I'd bring up what they used to do to "sterilize" or "clean" the uterus post c-section and sometimes post vaginal birth (just pull it out after the baby and scrub it up good. Yeah. That'll only help.). But that would be gross.

Altho it would be relevant. (And goes a long ways to explaining why prolapsed uteri are so common in women who had babies during a certain time period. No, Virginia, those are _not_ complications of "vaginal birth". Those are complications of having a really evil birth attendant do bad, bad things to your body.)

*sigh*

Around this point with T., I quit reading about pregnancy and birth. But I've actually not been reading that much this time around. And this particular item came from my daily news skim -- not from any pointed googling.

ETA: Just to avoid looking like a complete idiot: a lot of the infections were not bacterial, but rather fungal therefore obviously antibiotics would be a complete non-starter as an idea. The good aspect of the screening amnio is that, presumably, you'd have a cultured (ETA2: er, sequenced; they used PCR because a lot of these little guys don't survive attempts to culture) version of whatever the bug in question was so you'd have a good idea what might reasonably counter it. OTOH, are there any "safe" antifungals for during pregnancy? And what, precisely, would be a safe and effective delivery mechanism (because ya gotta wonder if oral or even IV would get through the placenta in appropriate amounts)? And if you went back into the sac directly, how are you planning on testing this for safety and efficacy before you start treating pregnant women this way?

Does this strike anyone else as ethically really dodgy?

ETA3: and apparently _one_ organism found via PCR appears to be New to Us. Hey! The Womb, the Final Frontier.

more kindle commentary

I did not go looking for this; R. sent me the link:

http://www.businessweek.com/the_thread/techbeat/archives/2008/08/here_comes_kind.html

I completely disagree with the fawning comments that this is good commentary. This is the same-old same-old tech-geek-writes-about-kindle-when-who-knows-when-he-last-read-a-book. Right down to the reading a physical book is very satisfying piece of nonsense. He thinks:

"The most revolutionary thing about the product is the ability to wirelessly get almost any book and many newspaper and other subscriptions in a matter of seconds."

That may or may not be revolutionary; it certainly _is not true_ and that's my biggest complaint about the kindle -- the sheer inadequacy of what is available for it, particularly on day-of-release (there's an unpredictable lag time for nearly everything I want to buy on the kindle and as a person with Prime shipping, it makes me cranky).

I do agree that the textbook route is a great way to go, and have been hoping Bezos would do this if only to save the backs of our children from total destruction. I'm not so much worried about the college "kids" (who are mostly legal adults anyway); I'm worried about the tweeners and teens laden down with backpacks that weigh 20-50% what they do. Evil.

You can really tell this guy is not the target audience for the kindle.

"I don’t see Kindles around in the real world, and I’ve never heard anyone express the desire to own one"

LibraryThings users are buying these suckers at good clip. At least one of the smart bitches has one. I have one. M. in my book group bought one. L. in my book group is lusting after one. And only about 7-8 people _show up_ to that book group reliably.

I've said it before and I'll say it again, and writers like this will keep failing to hear it. Books are NOT like music. The universe of CDs is comparatively small (even with the ramping up of the small/one-off labels). The universe of books is massive by comparison -- a few orders of magnitude bigger. While most CDs are sold to a small fraction of the total number of people who buy CDs in the course of a year, the difference is way more dramatic with books -- a tiny fraction of the people-who-buy-at-least-one-book-a-year buy (and read) the vast majority of books bought in the course of a year. The kindle is aimed squarely at that population. IMO. I haven't worked for Amazon in almost 10 years so I have no inside track any more.

The interesting difference is that several months ago, people like this author were openly mocking the kindle and predicting its imminent demise. Not so much any more.

how many e-books in circulation

Of course, I have no mortal clue what these people _mean_ by an e-book, but if it's a copy of a book in electronic format, then this article:

http://www.theregister.co.uk/2008/08/26/kindle_no_firestarter/

Quotes someone who is clearly loony. Does it make _sense_ that of the 50K estimated e-books in circulation, almost 3K would be listed at LibraryThing?

I mean, I know there's some overlap there there, but come on.