The STAR Trial

Three days ago, in a media blitz reminiscent of the Women’s Health Initiative, the National Cancer Institute released preliminary findings of the STAR trial in the most prestigious, rigourously peer-reviewed scientific (not) journal in existance – The American Media. For those of you who haven’t heard, the STAR Trial is a head-to-head comparison of Tamoxifen and Raloxifene (Evista) in preventing breast cancers in high risk post-menopausal women. Everyone has been waiting to see if Evista would prove to be as effective as Tamoxifen in preventing breast cancers without the same risks of uterine cancer and blood clotting.

I had intially intended this post to be a summary of the STAR Trial findings, and why I am thrilled to hear them. But when I went to find the journal article where the results were published, I discovered that there is no paper. There is not even a meeting abstract. Just a press release that tells us the “results are being submitted for publication”.

This appears to be yet another in a new and, in my opinion, disturbing trend among medical scientists – the announcement of study data by press release rather than by publication in a peer review journal.

Look, you want to hold a press conference on your cloned sheep? Be my guest. If your data sucks, you’ll get caught at publication, and no one gets hurt (except the sheep). But when you study involves humans, and expecially when it also deals with the incredibly sensitive and inflammatory topic of breast cancer, your data should be released in the forum best-designed to allow physicians and patients to responsibly and reliably assess the study findings – the peer reviewed medical journal. To do otherwise is unfair to the American public and their physicians.

Don’t tell me your data is too important to wait for the peer review process. Most journals have a fast track for important timely studies. But the study results are always embargoed from the press until publication.

Don’t get me wrong. If the STAR trial results stand up to peer review, I’ll be the first to cheer. But you tell me – How am I supposed to counsel my patients about this data when it is being presented without the oversight of peer review, and with no discussion of study methods, statistical analysis or data interpretation?

Trust me, my patients want to talk to me about this study. I’ve had five phone calls abut it so far, and more, I know, in the coming weeks.

What am I to say? “Sorry, Mrs. Daughter of a Mother with Breast Cancer who lies awake at night worried that she’s next in the cancer line. Call me back in June. That ‘s when the abstract is being presented at the American Society for Clinical Oncology in Atlanta. Better yet, let’s wait for the paper. An abstract really is not something on which to base medical care.”

When will the paper be published? Gee, I don’t know because it hasn’t even been submitted yet!

I pity the poor person who has to review that paper. Judge the data to be wrong, and you set off shockwaves among the public, who already think they know the trial results. Criticize the statistical methods, and you’ll just confuse everyone. Rubber stamp it, and you lose your credibility. I’m telling you, the researchers had better be right on this study. Because the American female public, still staggering from the roller coaster ride of the Women’s Health Initiative, can’t take another one.

The Roller Coaster at Coney Island
And one more thing. I find it fascinating that the STAR data were released just 3 days prior to Evista manufacturer Eli Lily’s quarterly results, and 1 week prior to the stockholder’s annual meeting.

Oh, I’m sorry. I’ll stop…

Meditteranean Appetizers

Here’s a little plate of some of the appetizers leftover from last night’s dinner party.

Here’s what to do – take a shaving of the Capricho de Cabre (mild pepper crusted goat cheese). Lay it on a pita triangle that you’ve toasted yourself, then top it with a little slice of that Spanish fig cake in the back. Pop it in your mouth, and wash it down with a few sips of a nice white pinot. Then, have a bite of the feta apricot triangle you made yourself.

A few more sips of Pinot, and you’re in heaven.
____________________________________________________
Pita Toasts (Sorry, no photo – we ate them all.)

1 bag of fresh Pita (or make some yourself)
a little olive oil in a tiny bowl
Kosher salt
Pepper

Cut the pita into small triangles (about 12 per piece). Lay out on a baking sheet and brush with olive oil. Sprinkle with salt and pepper. Bake at 400 degress fahrenheit for 10 minutes. Serve with hummus and cheeses.

Feta in Phyllo

You can put almost anything in phyllo, and it is so easy to work with. Keep a box in your freezer for last minute inspiration. I was inspired to make this by a nice box of gorgeous apricots and some delicious honey I found at Fairway yesterday.

3 sheets frozen phyllo dough
6 oz (or so) Feta cheese
12 Dried apricots
Honey
Coarsely ground pepper

Thaw phyllo dough. Cut 6 sheets lengthwise into 4 equal columns.

Take a strip of phyllo and brush with olive oil. Lay a second sheet on top of the first and brush with oil. Place a bit of feta cheese at the end of the strip. Top with an apricot and top with a tiny drizzle of honey and a quick grate of pepper. Fold phyllo like a flag (photos here)

Lay out onto baking sheet seam side down and bake at 350 degrees for about 12 -15 minutes till golden. Serve warm.

There is No Conspiracy…

Ever so gradually, but undeniably, my blog has been disappearing from the net.

It all started on Super Bowl Sunday, when I noticed that the number of visits to my blog were lower than usual. I shrugged it off, figuring that everyone was watching the game. But the next day was no better – in fact, it was worse. And every day after that, fewer and fewer visitors. Posts that usually netted a hundred or more hits a day from Google searches became lost altogether, gathering dust on Blogger’s server somewhere.

Then finally, the day came when I had not a single visit from a search. Just the usual suspects coming to visit directly. (You know who you are, and I love you each and every one…)

Suspicious, I googled my blog. Nothing. I tried unique combinations of words from my busier pages. Nada. I could occasionally get a link to other blogs that linked to me, but no direct links. And no cached pages.

There was no question about it. Someone, or something was locking me out of the net.

But why? What had I done? Was Merck really that powerful? Does someone at Google or Yahoo hate me? Was it a conspiracy? Were my credit cards and bank cards suddenly going to become unusable? Was I going to disappear altogether without a trace? …

I shook off my suspicions and began to search the net for an answer. It took me a whole week, but curiosity finally won out over paranoia. And thanks in no small part to the Blogger help group and geeks such as Dave Davies and Ron Southern and Kevin Gibbons, I discovered the answer.

The Blogger Metatag Glitche

There was no conspiracy. And it was not Google’s fault. It was Blogger. It seems that my switch over to the new Blogger had caused this meta tag to be inserted into my blog’s template: $BlogMetaData$

A meta tag is a name for a list of commands, all pre-packaged by Blogger to do all sorts of nice things like name your blog and tag you blog, etc. But, hidden within the source code of my meta tag was this line: metaname=”ROBOTS”content=”NOINDEX,NOFOLLOW”

Now this command is a good way to hide your blog from the public, or disappear an embarrassing post before too many people read it. But if, like me, you want folks to find your blog and read it, it’s not a good thing. Sort of like saying to Yahoo and Google: “You can look but don’t tell anyone what you saw”.

Thanks to help from some other bloggers, I learned how to remove the offending code from my template. (It’s not too complicated, email me if you want to know, or check the sites referenced above)

Now I just have to be patient while Google’s robots crawl over my blog (I keep envisioning those spider robots from Minority Report…). And hopefully, one day soon, my blog will begin to make it’s way back from oblivion.

Apologies

For those of you who came here for food or medicine, I apologize for the techno-babble. I wrote this post so that it might help some other blogger out there who is having the same problem I did. My little pay it forward, so to speak.

And now, if you’ll excuse me, I’ve got more work to do. I need to figure out how to remove the GPS device that the CIA has implanted in my scalp….

Merck Suspends Lobbying for Mandatory HPV Vaccination

Merck today reported that they are suspending their lobbying efforts for mandatory HPV vaccination. (Thanks to Main Mama for pointing this out to me.)

“Our goal is about cervical cancer prevention, and we want to reach as many females as possible with Gardasil,” Dr. Richard M. Haupt, Merck’s medical director for vaccines, told The Associated Press.

“We’re concerned that our role in supporting school requirements is a distraction from that goal, and as such have suspended our lobbying efforts,” Haupt said, adding the company will continue providing information about the vaccine if requested by government officials.

I’m not sure what exactly suspending lobbying means. Merck has been funneling funds through Women in Government, whose members have been the driving force behind mandatory HPV legislation. Both Merck and the WIG have declined to say just how much money has changed hands between them.

If the WIG’s members are the “government officials” Haupt is referring to, then I assume it means the relationship with the WIG remains in place. From what I can see, the majority of Merck’s work with the WIG has been done – boilerplate legislation has been crafted and the WIG members trained to introduce the legislation. At this point, Merck can sit back and let the WIG do it’s job for them, and deny that they are lobbying. (I know, I know. I’m just so cynical…I think I’m just getting really good at reading between the lines of these corporate press releases disguised as news.)

The vaccine, which costs about $360, has been projected to have the potential to generate $3 billion a year in sales. According to that pie up there, that’s almost $2 billion in profit for Merck. Gardasil revenue in 2006 totaled $155 million (The vaccine was approved in June 2006).

Pie Data from Baltimore Sun.

Only in New York

TBTAM: Any new sexual partners?

Patient: Yes. Well, not really a partner, more like a one night stand.

TBTAM: I hope you used a condom.

Patient: Well, I didn’t have any, and it was around 5 am…

TBTAM (interrupting): So you didn’t have intercourse?

Patient: No, we had intercourse.

TBTAM: Without a condom?

Patient: No, we used a condom.

TBTAM: I though you said you didn’t have any…

Patient: We didn’t. But we ordered some in.

TBTAM: Ordered in condoms? From where?

Patient: The Deli. I called down to the doorman in his building and asked him where he orders in for coffee. He gave me the number of a deli on the corner. So we ordered in a box of condoms….Well, also some bottled water.

Happy Valentine’s Day!

TBTAM, MD
New York, NY

Name: Your Name Here__________________________________
Address: Your Address Here_______________________________

Rx
HUGS & KISSES
Disp: 1 million
Sig: Give and take as many possible

Refill: As Needed

The HPV Vaccine Controversy

Should HPV vaccination be mandatory for young girls? And, more pointedly, is it appropriate for the governor of Texas to bypass the legislature by using an executive order to mandate the vaccine in Texas?

Very interesting discussions on this issue over at DB’s Medical Rants. And in Dinosaur Musings. And on NPR. And in the letters section of the New York Times.

My thinking on this issue is colored by what I have come to know about Merck’s funding of the group called Women in Government (WIG), whose members have introduced most of the HPV legislation around the country. As you may recall, I wrote in December about the financial relationship between Digene, Merck and WIG. The Baltimore Sun broke the story in January, and then the AP picked it up, as did Fox News, Forbes and others.

In their reporting on the Texas mandate, the NY Times pretty much glossed over the flow of lobbying dollars from Merck into Texas. Merck declined to tell the Times how much they actually donated to Women in Government, which, by the way, carries a non-profit status.

Since then, Merck has been mysteriously removed from list of Business Council members at Women in Government. (Don’t worry – the old cached pages are still around).

“Members also play an integral role in planning for future growth, have the ability to attend our regional conferences, and support the financial stability of the organization.”

to this:

“Business Council members support the overall mission of Women In Government.

Fascinating.

Much of the opposition to mandatory HPV vaccination is coming from the usual anti-vaccine groups and the religious right. That’s unfortunate, because it is distracting the media from seeing the real story, which is the unprecendented influence of Big Pharma in legislating healthcare. And the use of Pharma-funded consumer “advocacy” groups to push Pharma’s agenda when the healthcare community does not respond fast enough for the shareholders. The push for mandatory HPV vaccination is not coming from any organized medical lobby that I have seen – it is coming from Merck.

Right now, because the HPV vaccine does more good than harm, the healthcare community and the media seem to be willing to let Merck slide on this one. But I believe it is a very slippery slope upon which we are allowing them to ride. They still need to get better at covering their tracks, but their recent absence from the WIG website proves they are fast learners in this regard. If they get any better, then a day will come when we will no longer know from where the influences are coming. And if the product being pushed is not the HPV vaccine but another Vioxx, I don’t want to imagine the outcome…

I will state again that I believe the HPV vaccine to be a good thing. And so far, I have trusted the CDC and the professional organizations who have recommended for use of this vaccine. I have even begun giving my patients the vaccine.

But in lobbying for making Gardasil mandatory less than one year since its FDA approval, I think Merck has gone too far in trying to assure the market for their vaccine. And when I see them covering up their relationship with the WIG and declining to say how much money they have given this group which is lobbying all over America for mandatory HPV vaccination, I find myself wondering what else they are hiding.

And that’s not a good way to feel about a company whose vaccine you are administering to your patients.
___________________________________________

Update: The American Academy of Family Physicians and the Texas Medical Association have both issued statments against mandatory HPV vaccination.

Nap…or Die

Midday napping is associated with lower cardiac mortality, according to this recent study in the Achives of Internal Medicine.

Among men and women, when controlling for potential confounders and using those not taking siesta as a referent category, those taking a siesta of any frequency or duration had a coronary mortality ratio (MR) of 0.66 (95% confidence interval [CI], 0.45-0.97). Specifically, those occasionally napping had a 12% lower coronary mortality (MR, 0.88; 95% CI, 0.48-1.60), whereas those systematically napping had a 37% lower coronary mortality (MR, 0.63; 95% CI, 0.42-0.93). Among men, the inverse association was stronger when the analysis was restricted to those who were currently working at enrollment, whereas among women, a similar analysis was not possible because of the small number of deaths.

Now if you’ll excuse me, I’m going to go lie down…
Van Gogh. Noon: Rest From Work (After Millet) 1889-90; Musée d’Orsay, Paris . From WebMuseum, Paris.

The One-Meal-at-a-Time, No-Diet Diet

In my determination to lose weight without dieting, I’ve decided to tackle my eating habits one meal at a time. Starting with breakfast.

I blow every diet with the first thing I put in my mouth – my coffee. I happen to like my coffee light with half and half and one sugar. And two cups of it, thank you very much. Without my coffee made that way, I feel deprived and miserable. So any diet I go on is destined to fail. Because if you start your day out feeling deprived, then it’s just a matter of time before you start to overeat.

The other problem with me and diet breakfasts is that they required a huge lifestyle change – getting up earlier to make breakfast and eat it at home. Oh, sure, I can get motivated, head to the store on Sunday night to stock in what I need for the week, set the alarm and do the right thing. I can even keep that up for a few days or a few weeks. But then throw in a 5 am migraine an early morning meeting, or a weekend too busy to shop for food and before you know it, I’m rushing to my friend Mark’s deli on the way to work, picking up my usual coffee and croissant or an egg and cheese on a roll and eating at my desk.

One of these days I hope to be one of those get up at 5 am, work out for an hour, eat a homemade smoothie and raw egg, pack a healthy lunch with 2 snacks and head off to work kinda’ gal. But I’ve finally come to terms with the fact that it’s just not gonna’ happen all at once.

After all, our eating habits are tied into our whole daily schedule. So going on a diet means changing everything. No wonder we fail. It’s just too much at once.

Now where was I? Oh, right – breakfast.

One day last month, my daughter was having what looked like a delicious breakfast – peanut butter with a tad of honey on bread. I tried it – delicious! Then I got bold and made myself a cup of coffee with a little low fat milk to go with it. And do you know what? Next to the peanut butter sandwich, that coffee was perfect! I didn’t miss my half and half and sugar at all! I think the peanut butter makes up for the cream and the teensy bit of honey for the sugar.

I’ve modified the sandwich a bit – I use 7 grain bread, less than a tbsp of peanut butter, just 2-3 teeny tiny drops of honey and skim milk in the coffee. Add a bit of fruit and bang – a great breakfast! Mark can make it for me at the deli (even deliver it to the office) if I don’t have time myself at home, so that part is solved too.

I’ve had this breakfast enough days now that it has the same homey, heart-warming feeling my old breakfasts had. I am convinced that for me, food has many psychological overtones. If it doesn’t have that warm cozy feeling, I don’t feel like I’ve eaten anything. So, instead of fighting those feelings, I think I need to find healthy foods that give them to me.

In the past two weeks, I’ve started working on lunch. Still haven’t found the sweet spot on that one yet, but I’m eating healthier in the searching process.

The result? I’m down 6 lbs. in less than a month.

I’m calling it the One-Meal-at-a-Time, No-Diet Diet. Think Oprah would go on it with me?

Week Night Warriors – Pasta w/ Shrimp & Artichokes

Last evening Mr TBTAM and I were debating whether to order in for the millionth time this month or try to put together a decent meal for ourselves and the kids on a busy week night when we were both dog-tired.

I am so proud of us that we didn’t give in to the stack of menus sitting in the drawer under the phone. Instead, armed with a glass of white wine each, we raided the larder to see what we could come up with that did not entail a trip to the store and could be on the table before 8 pm.

That’s it down there, and it was delicious. With a little side salad, it did the trick. Veni, Vedi, Comedi!

Pasta with Shrimp, Peas, Artichoke Hearts and Sun-dried Tomatoes

-1/2 bag frozen, uncooked shrimp from Fairway
-1/4 bag frozen artichoke hearts from Trader Joes (left by Irene on her last visit)
– A few sundried tomatoes that have been sitting in a little bag on the counter for the past three months, and that I was wondering if I would ever use.
-1/4 cup of frozen peas from an opened bag that’s been in the freezer forever (and that will remain there even longer because there is still 1/2 bag left)
-Half a lemon from the bottom of the drawer in the fridge that miraculously was still good
– 3-4 cloves garlic, sliced
-Olive oil
-Kosher Salt
-Fresh ground pepper
-1/4 cup white wine from my glass
-1 pound penne pasta

Put water on to boil for pasta, with a touch of salt. Put peas in a bowl with just enough water to cover; drain when thawed. Soften sun-dried tomatoes in some warm water for a few minutes. Drain and slice into slivers. Put artichoke hearts into a small saucepan, cover with water and a squeeze of lemon, and heat till boiling, then cook for 3-4 minutes till done. Drain and set aside. Thaw shrimp by running them under cold water, then peel, drain and pat dry. Season with salt and pepper.

Start pasta cooking.

Heat olive oil in saute pan will hot. Toss in shrimp and cook till pink. Remove shrimp to a bowl. Add a bit more oil to the pan, then saute garlic till aromatic (do not brown). Deglaze pan with a 1/4 cup white wine and remaining juice of the lemon. Add in the peas, artichoke hearts and sundried tomatoes and heat while wine cooks down a bit. Add shrimp back in, heat briefly

Drain pasta and put in bowl. Toss with shrimp mixture. Serve.

More on Merck and Women in Government

Apparently, I am not the only one to be a bit taken aback at the speed with which Merck’s HPV vaccine is being legislated into healthcare.

“A lot of us are worried it’s a little early to be pushing a mandated HPV vaccine,” said Dr. Martin Myers, director of the National Network for Immunization Information. “It’s not that I’m not wildly enthusiastic about this vaccine. I am. But many of us are concerned a mandate may be premature, and it’s important for people to realize that this isn’t as clear-cut as with some previous vaccines.”

He added, “It’s not the vaccine community pushing for this.”

Who is pushing it? Merck, of course. Via a group called Women in Government. More at the Baltimore Sun.

Update:
Mandatory HPV Vaccine legislation in Maryland has been pulled (Via Pharmalot) and The Associated Press has picked up on the connection between Merck and WIG.

Notes To Myself

What do you do with those little tidbits of information that you want to remember about a patient, but that you may not want to write in a chart for the whole world to see?

Case in point – A patient tells me her BRCA gene test results on the condition that I not put it in her chart. She paid for the test out of pocket, and is under no obligation to tell those results to anyone. I understand this, but if I don’t write it down somewhere, I won’t remember it the next time I see her.

In the past, this has not been a problem. I just put that information on a little stickie note in the chart. That way, it was right in front of my nose, but not shared if ever a copy of the record was requested.

The nature of my job means that I get told a lot of intimate stuff that relates to my patient’s gynecologic health. Perhaps there is a history of sexual abuse that impacts her ability to be examined. Or her husband is impotent, or has certain sexual needs that are affecting her. These details are important to our interaction both that day and on future occasions, but my patient’s insurer does not need to know then in such detail to confirm their medical necessity.

Simple. Just use a post-it! That way, if a colleague is seeing my patient for a related reason, I can pick up the phone and transmit the more sensitive information confidentially, sending over just the paperwork needed to care for the patient without blaring her personal life over the fax machine.

But now we have an electronic medical record, and my little post-it system is no more.

In the EMR, the only option I have is to make an entire encounter confidential, so that no other provider in our system can read it. I do use that option for the occasional celebrity patient or for the employees who wants their records uber-protected. But that does not work as well, in my opinion, for handling those little bits of personal information that count.

I wish so much that I were one of those doctors who remember every single detail about their patients, and rarely need to write anything down. Sadly, I am not. I can barely remember my wedding anniversary, let alone personal details about a patient I have not seen for months. I really do need these little notes to myself.

So, for now, it’s all going into the chart. (Or not, depending on just how sensitive the information is.) I’m trying to develop a little code system that will remind me, but that’s remains a work in progress.

If any of you out there using an EMR have tackled a similar problem, do tell me your solution.

Because if I don’t write it down, I will forget it. And that’s a promise.

Lunch from Russ and Daughter

Russ and Daughters is a New York institution – a smoked fish and gourmet specialty food shop on the Lower East Side. I’d say they have the best smoked fish in town. (Although Sables on the Upper East Side and Barney Greengrass on the Upper West are extremely close contenders, and I suspect if I were doing a post about either of them I would be calling them the best in town…)

There’s alway a line at Russ and Daughter, but it’s well worth the time spent in the queue. Or shop early, which is what we did, to avoid the crowds.

Plates of marinated artichoke hearts, smoked salmon tartare, sable, whitefish salad and herring in sour cream, served with warm bagel quarters and coffee made a delicious lunch on a recent Saturday. It’s salty fare, which made it the perfect prelude to a long afternoon spent wandering the stalls at the Union Square Green Market and St Mark’s Place in the East Village. There was no need for anyone to make a bathroom stop!

Grand Rounds Vol 3; No 18

Thanks to our favorite scut monkey, Signout, for hosting grand rounds this week. Signout is a first year medical resident with a wonderful blog.

For those of you not in medicine, the scut monkey is the lowest member of the team, and since it flows downhill, gets to do all the work. (Although medical students are technically lower, and can have tasks assigned to them by the scut monkey, it is ultimately the intern’s job to make sure the work gets done.)

Hopefully, she doesn’t think of grand rounds as scut work. Thanks, Signout.

Making Choices

I was in my third year of medical school working on the abortion service.

In those days, women were admitted to the hospital the night before their abortions in order for laminaria to be inserted. Overnight, these dried seaweed rods would moisten and swell, slowly stretching the cervical opening so that the procedure could be performed the next day without the need for dilating the cervix manually, thus decreasing the risks of tearing and bleeding.

It was a busy service, with upwards of twenty procedures a day, two days a week. We med students were assigned to do the admission histories.

I remember sitting with woman after woman while they told me their stories. A young teenager who had fallen for an older man, a man who had loved her, left her pregnant and was now nowhere to be found. Another, a haggard, tearful woman in her thirties, was adamant that her husband would never know that she had gotten pregnant the night that he came home drunk, beat and then raped her.

There was the newly recovered drug addict just getting her life together, still hoping to get her three children back from foster care. And the mother who had five children at home and was waiting to hear whether her sister would be able to stay with them tonight. Still another teenager, this one accompanied by her mother, who said nothing but never left her side.

Each decision to abort these pregnancies appeared to have been painfully made, and none was casual. Every one of these women had mixed emotions about what she was doing, and yet every one had a conviction that this was her only choice at this point in her life. The teenager seemed a bit less sure of herself, but she reiterated to me that this had been her own choice, and Mom was still hoping she would change her mind. It was her second abortion, and she would not tell me the circumstances of her becoming pregnant.

At one point, all the women were told to undress, put on their hospital gowns and meet in the patient lounge to hear about their procedure from the chief resident, who would then examine them one by one in the small exam room next door and insert their laminaria.

“Tell them to leave their underwear in their hospital rooms”, he told me.

“What?” I cried. “You mean they are all going to sit there completely naked under their gowns while you stand there in your white doctor’s coat and tell them as a group what to expect tomorrow? Can’t they at least wear their underwear?”

“I don’t have time to wait for them to take them off”, was his answer.

“But it demeans them…” I started.

In a tone of voice that told me I had already gone too far, he said simply “Just do it.”

So I did. I was, after all, just a medical student. And he was my chief.

But at that moment, I made my choice as to what I would do when I graduated. If this was how the men who worked in this field treated women, well, then we women needed to become gynecologists and start treating women as something other than cattle.

I also decided that day that I was pro choice. I wasn’t sure if I would do abortions, but I knew that if this was the world that women were living in, then this option had to be available to them until we had something better.

Later on, I would come to realize that the something better is safe and effective contraception, sex education, childcare, family-friendly work environments, healthy male-female relationships, child support and education. Of these, the one that I believe is most within our reach today is safe and effective contraception, and that is where I have concentrated my efforts. I subscribe to the belief that abortion should be safe and available, but rare. Unfortunately, those who most vehemently oppose abortion also oppose contraception, and seem to want to assure that abortion remains anything but rare.

In my career, as it turned out, I would butt heads more than once with the men who supervised me. But I would never again encounter such a blatant misogynistic attitude among any of the ob-gyn’s I was to meet. Sure, there were a few jerks, but also some not-so-nice women. And I will go on record as saying that many of the very best gynecologists I know are men, including those to whom I refer my friends and family.

I don’t know that we women gynecologists have changed this field as much as I thought we would. I think we are too busy just getting the work done. The field has changed most, I believe, in response to our patients and their advocates, who persistently raise the bar for all of us docs, men and women alike. And continue to demand reproductive choice.

So keep up the pressure, Ladies… We need your voice.