The current issue of the journal Obstetrics & Gynecology includes an article on the risk of bone mineral density loss in users of contraceptive shots (DPMA, or brand name Depo Provera). As we mentioned in a previous post, the drug comes with a box warning that “Women who use Depo-Provera Contraceptive Injection may lose significant bone mineral density. Bone loss is greater with increasing duration of use and may not be completely reversible.”

The current study compared women who used DMPA for at least 24 months and had less than 5% vs. at least 5% bone loss to attempt to identify any characteristics that might be associated with a higher risk of bone loss.

The authors report that being a current smoker was associated with higher bone loss, while higher calcium intake (at least 600 mg/day) and having ever delivered a child were associated with lower levels of bone loss. Age, race or ethnicity, previous contraceptive use, and body mass index did not appear to be associated with higher bone mineral density loss.

Although only the abstract of the article is freely available, ScienceDaily provides an additional summary.

In other bone-related news, NPR published a piece this week, “How A Bone Disease Grew To Fit The Prescription,” which describes Merck’s approach to marketing the drug Fosamax, including its efforts to push smaller, cheaper machines to perform bone density scans (and for Medicare payment for the scans) and to expand the “osteopenia” diagnosis.

However, as the piece notes, “There are no long-term studies that look at what happens to women with osteopenia who start Fosamax in their 50s and continue treatment long-term in the hopes of preventing old-age fractures. And none are planned.”

The story and accompanying transcript provide a fascinating look at the marketing of a drug, from the perspective of a former Merck rep who believed he was helping save women from fractures through his marketing efforts, to criticisms of that work as “a plot to misdiagnose American women,” and the debate over whether women with slightly decreased bone density should be medicated at all.

Boston’s NPR news station, WBUR, recently featured a program on midwives, “Midwifery in Massachusetts” (archived online).

The almost hour-long segment, which aired on the program “Radio Boston,” addresses why some people choose home births and/or midwifery care; the ongoing discussion in Massachusetts about the regulation of midwives; and related birth issues such as malpractice insurance, c-section rates, cost and birthing centers.

A bill pending in the Massachusetts state Senate calls for the creation of a state board that would regulate and license Certified Nurse Midwives (CNMs), Certified Midwives (CMs) and Certified Professional Midwives (CPMs).

The program also features two Massachusetts commenters: Dr. Angela Aslami, an OB/GYN who does not support home births and does not believe CPMs should do deliveries, and Dr. Gene Declerq — Boston University School of Public Health professor and a technical adviser on the documentary film “The Business of Being Born” — who believes home births can be an acceptable option. Peggy Garland, a CNM who helped draft the licensing board legislation, was also a guest. The program includes listener comments and questions.

Our own Judy Norsigian, OBOS executive director, commented on the program’s website in support of expanding access to midwifery care.

“The key issues here have to do with preserving safe, optimal choices in childbirth for women and their families,” wrote Norsigian, pointing to this Choices in Childbirth statement signed by hundreds of physicians, midwives and other maternity care experts.

Norsigian also notes that OBOS is collaborating with Massachusetts Friends of Midwives (MFOM) and other groups to produce an 11-minute film  to educate Massachusetts legislators about the benefits of the proposed midwifery legislation. The DVD will be available through OBOS’s website by mid-January 2010. She concludes:

After OBOS produced our latest book (“Our Bodies, Ourselves: Pregnancy and Birth”) in March 2008, I had the unique opportunity to speak with hundreds of doctors, midwives, and community members in more than 50 cities across the country. It is exciting to see greater community activism trying to expand access to midwives in all settings. This will reduce the obscenely high cesarean section rate in this country, improve outcomes for both mothers and babies, and could also save millions of dollars now spent on inappropriate obstetrical interventions that actually worsen rather than improve outcomes.

The November issue of the journal Fertility & Sterility includes an article that attempts to determine whether assisted reproductive technology (ART, or AHR for “assisted human reproduction”) may be associated with a higher risk of birth impairments.

The authors reviewed data from records in an Ontario birth database for which information about reproductive assistance was reported, and compared outcomes for the 790 infants conceived via assisted means (including ovulation induction, intra-uterine insemination, in vitro fertilization, and intracytoplasmic sperm injection) to the outcomes of 43,462 infants conceived without assisted methods.

After adjusting for factors such as maternal age and smoking, the authors found that 2.91% of infants conceived by ART were diagnosed with a major birth impairment compared with 1.86% in the control group, with significantly greater odds of all anomalies and cardiovascular and gastrointestinal impairments; risks were highest for the IVF group as compared with other methods examined.

The authors explain that some other research has shown various levels of increased risk, but that it is not clear what might explain the findings. They speculate that “Elements that may contribute to increasing birth defects include the advanced age of one or both partners of the infertile couple, the essential cause of infertility, or the medications used to induce ovulation or to maintain the luteal phase.” They suggest that “The potential risk of anomalies associated with AHR may be considered in the counseling that is offered to infertile couples.”

In November of last year, the CDC released a study on the same topic and concluded, “Infants conceived with Assisted Reproductive Technology (ART) are two to four times more likely to have certain types of birth defects than children conceived naturally, according to a study by the CDC.”

The study found higher risks of some heart defects, cleft lip, and some gastrointestinal impairments associated with ART in singleton births as compared to babies conceived without fertility treatments.

The agency explained, however, that the absolute risk of any birth impairment is low, and provided the following example for context: “In the United States, cleft lip with or without palate affects approximately 1 in every 950 births; doubling the risk among infants conceived by ART would result in approximately 1 in every 425 infants being affected by cleft lip with or without palate.”

Reaching a similar conclusion as the current article, the authors of the CDC study state that “Although the mechanism is not clear, couples considering ART should be informed of all potential risks and benefits.”

A number of other studies have investigated this issue, although the body of literature on the topic has been criticized as being inadequate due to methodologic problems such as “inadequate population sizes, inappropriate control groups, missing adjustments, and unclear descriptions of the methods used to screen malformation,” according to one author.

However, most reviews of the topic seem to come to a similar conclusion: that further research is needed, and what is known should be discussed with those seeking ART so they may make informed choices about potential risks.

That’s the topic of this live, interactive webcast, scheduled for today – Wednesday, Dec. 16 — at 1 p.m. ET.

Sponsored by the Kaiser Family Foundation, the webcast will examine aspects of the current Senate and House health reform bills that particularly affect women of color, who face additional health and access challenges.

You can join the live webcast here. An archived version, as well as a podcast and transcript, will be available later today.

Today’s panel will also address provisions in the bills that would affect access to and coverage of abortions, and recent findings from the U.S. Preventive Services Task Force.

Cara James, KFF senior policy analyst on race, ethnicity and health care, will moderate the discussion with:

• Alina Salganicoff, Ph.D., vice president, director, Women’s Health Policy, Kaiser Family Foundation
• Judy Waxman, J.D., vice president of Health and Reproductive Rights at the National Women’s Law Center
• Paula Johnson, M.D., M.P.H., executive director of the Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital and associate professor of Medicine, Harvard Medical School

Panelists will take questions before or during the live program. Send questions to ask [at] kff.org.

The webcast is part of KFF’s series examining current issues in health disparities.

The College of Physicians and Surgeons of British Columbia (Canada) is the licensing and regulatory body for all physicians and surgeons in the province. As such, its mission involves establishing and enforcing standards for medical practice in the region, and the College publishes resource manuals with policies and guidelines to inform and direct providers.

The College recently approved a new resource manual on planned home birth [PDF] in British Columbia. It begins:

The College supports a woman’s right to personal autonomy and decision making in obstetrical care. When a woman is considering planned home birth, physicians play an important role in providing advice and information so that it is an informed choice, considering all the benefits and potential adverse outcomes. [emphasis added]

The manual goes on to explain factors to consider, such as previous cesareans, unpredictable complications, and the availability of emergency services.  Canada requires that midwives be licensed, and the manual includes the advice that “Physicians involved in planned home births need to ensure that they have appropriate knowledge, training, equipment and understanding of the assessments necessary in planned home delivery.”

I’m still stuck on that one explicit statement, “supports a woman’s right to personal autonomy…” For contrast, see our previous discussion on the AMA’s homebirth resolution and birth choices.

Last week, TPMMuckraker ran a story by Zachary Roth, “Drug-Makers Paying Off Competitors To Keep Cheap Generics Off Market,” about the deals (sometimes called “reverse payment settlements” or “reverse settlements”) made between drug companies in order to keep generic drugs off the shelves after the original patents protecting the brand name drugs have expired.

As Roth explains:

When a generic drug is approved to come to market, the maker of the more expensive name-brand drug sues the generic for patent infringement. But instead of a conventional settlement, in which the generic pays the patent-holder to settle the claim that it infringed the patent, the payment goes the other way: the patent-holder pays the maker of the generic, in exchange for a pledge to delay bringing the generic to market.

As a result of these “pay-for-delay” deals, cheaper generic drugs are often kept off the market for a longer period than they otherwise would be.

While the TPM story doesn’t mention any drugs specific only to women’s health, Prescription Access Litigation provides at least one relevant example — a patent litigation/generic case from the late 1990s over the breast cancer drug Tamoxifen. The Centers for Disease Control and Prevention estimates that 46 percent of Americans used at least one prescription drug in the past month, so many consumers (male and female) are affected by drug prices on a regular basis.

There’s been little action in recent years on proposed legislation to prevent such deals. The “Protecting Consumer Access to Generic Drugs Act of 2009″ — HR 1706 — was introduced earlier this year by Rep. Bobby Rush (D-Ill.), and so far, like similar bills introduced the past, it has not made it past the committee stage.

The House Subcommittee on Commerce, Trade and Consumer Protection held a hearing on the proposed legislation in March and apparently referred the bill on to the full Committee on Energy and Commerce, which does not seem to have considered it.

The Federal Trade Commission has also come out against the practice. FTC Chairman Jon Leibowitz said during a talk at the Center for American Progress in June that ”American consumers would save $35 billion dollars over the next decade if these deals were banned.”

This past summer, the Department of Justice weighed in on one such case and concluded: “a settlement involving a payment to the alleged drug patent infringer in exchange for its agreement to withdraw its challenge to the patent and delay bringing its generic drug to market is presumptively unlawful and requires the defendant to offer justifications in order to avoid antitrust liability.”

Ever wish you could meet Cyndi Lauper — or Tegan and Sara or Margaret Cho? Or ask Katha Pollitt or Kate Harding or Rebecca Traister to edit your manuscript? Or wear the iconic blazer Princeton Professor Melissa Harris Lacewell appears in on “The Rachel Maddow Show”?

You’ll have your chance today — but only today — to make these and other dreams come true.

Head on over to the Women, Action & Media auction, where you’ll find 53 amazing items, including:

* dinner with Jessica Valenti

* autographed guitars from Ani DiFranco, Aimee Mann, Emmylou Harris and Patty Griffin

* an original DTWOF comic strip by Alison Bechdel

* a customized recipe by Lisa Jervis

* lunch with Baratunde Thurston and a tour of the offices of “The Onion”

* Sarah Haskins records your outgoing voicemail message

* signed books and posters by the likes of bell hooks, Marjane Satrapi, Jane Hamilton, Suzan-Lori Parks, Jennifer Weiner and Venus and Serena Williams

* much, much more

WAM! — the annual conference turned national organization that is fighting for gender justice in media — is raising for money for its launch as a national organization, with WAM! chapters in all 50 states and beyond.

It’s a great cause — and you can do your holiday shopping. Seriously, there are great deals to be had. And no one else will give (or get) the same gift!

Bidding ends at 9 p.m. EST. Good luck!

Make yourself comfortable. You’re not going to want to move for the next 15 minutes.

Rachel Maddow invited Richard Cohen, who claims he can “cure” homosexuals, on her show Tuesday night. Passages of his book “Coming Out Straight” — unscientific, debunked, ridiculously accusatory passages — are being used to justify proposed legislation in Uganda  that calls for executing gay men and women either living with HIV or who are “serial offenders” (whatever that means).

Anyone convicted of a homosexual act faces life in prison under the Uganda bill, and anyone who ”aids, abets, counsels or procures another to engage of acts of homosexuality” faces seven years in prison.

Cohen insists that he is not a proponent of the legislation, but Maddow doesn’t let him off the hook:

“I realize I was taking the risk of helping promote you and the way that you think about these things by putting you on the air,” says Maddow, “but I do think that you’ve actually got blood on your hands.”

For more background on what’s going on in Uganda and the connection to influential right-wing members of Congress, read the transcript of this “Fresh Air” (NPR) interview with Jeff Sharlet,  author of “The Family: The Secret Fundamentalism at the Heart of American Power.”

Visit msnbc.com for breaking news, world news, and news about the economy

Healthy People is a program of the U.S. Department of Health and Human Services that sets health objectives for the nation for a ten-year period. The current set of objectives is referred to as Healthy People 2010, but as 2010 is fast approaching, the department is considering a new set of health priorities to target through 2020.

The objectives typically cover preventable disease, increasing quality and length of life, and the elimination of health disparities across a range of focus areas. For example, Healthy People 2010 included an objective to “Reduce cesarean births among low-risk (full term, singleton, vertex presentation) women” and provided a 15% target c-section rate for first births, and 63% for births after previous cesarean. This target has not been met, with the CDC data from 19 states indicating that in 2006 – the most recent year of finalized data currently available – 23.5 of every 100 first, live births was by cesarean, and repeat cesarean rates were about 92%. It has been included again as-is for the 2020 objectives.

The agency is now accepting public comments on the proposed 2020 objectives. For each focus area (such as access to health services, maternal, infant, and child health, cancer, etc.), you can review objectives retained as-is, modified or dropped from the HP2010 goals, as well as clearly seeing objectives new to HP2020. You can then comment directly on an individual objective, and review comments already submitted.

A few examples of new objectives that may be of interest to readers:

• Decrease incidence of late-stage disease breast cancer.
• Increase the percentage of women in need of publicly supported contraceptive services and supplies who receive those services and supplies.
• Increase the percentage of employers who have worksite lactation programs.

There are many, many others which Our Bodies Our Blog readers may want to review and comment on, in focus areas such as maternal health, disability, cancer, older adults, sexually transmitted infections, adolescent health, family planning, violence prevention, and environmental health. You can create a profile on the site, or choose to view objectives and comment anonymously. Comments are being accepted through December 31, 2009.

Today pro-choice folks are converging on D.C. for a National Day of Action to support health care reform that includes a full range of reproductive health services for women and to oppose the Stupak Amendment, which prohibits abortion coverage in any public option and creates bureaucratic hurdles that could make it difficult for women to pay for abortion coverage with their own money.

Christine has written about the amendment several times on this blog, and the NPR pieces linked above also provide good background info.

Supporters include Planned Parenthood, NOW, YWCA, Choice USA, the Religious Action Center of Reform Judaism, NARAL Pro-Choice America, the Center for Reproductive Rights, the American Association of University Women, the Religious Coalition for Reproductive Choice, the ACLU, and others. Each of these organization websites has information on the basic schedule for the day, background materials on the issue, and tips for/ways of taking action for those not in D.C., including petitions, draft emails, and guidance for making phone calls to Senators/Representatives.

Tweets from the event can be followed at #stopstupak. Have photos or reports from the scene? Let us know in the comments!

Somewhat lost in the recent debate over mammography recommendations were the updated cervical cancer screening guidelines from the American College of Obstetricians and Gynecologists. Although the Practice Bulletin itself is limited to subscription access, ACOG issued a press release that outlines two important changes:

• Cervical cancer screening should begin at age 21 years (regardless of sexual history). Screening before age 21 should be avoided because women less than 21 years old are at very low risk of cancer. Screening these women may lead to unnecessary and harmful evaluation and treatment.
• Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years. Evidence shows that screening women every year has little benefit over screening every other year.

Older guidelines from ACOG and other groups varied but tended to suggest that women start screening at age 18 or 21, or at the onset or within 3 years of the onset of sexual activity, whichever came first, and often recommended yearly screening.

The new guidelines also suggest that women women 30 and older should be screened for cervical cancer whether by conventional or liquid PAP test once every 2 years, instead of annually, and after 3 consecutive negative tests be screened once every 3 years. Women with certain risk factors such as a history of cervical dysplasia or cancer, HIV, other causes of immunosuppression, or exposure to the drug DES may need more frequent screening.

Unchanged in the guideline is that women who have undergone total hysterectomy no longer need a Pap test, and that women ages 65 and older can discontinue cervical cancer screening if they have three consecutive negative Pap tests and no abnormal tests in the previous 10 years.

The American Cancer Society issued a statement that the revised ACOG guidelines “aren’t very different than the guidelines currently outlined by ACS, which were last updated in 2002;” they’re also very similar to the recommendations issued in 2003 by the USPSTF. Medical News Today provides a freely available summary of the guideline.

We interrupt this blog to bring you an urgent message: Our Bodies Ourselves needs your help.

This is not your ordinary holiday fundraising campaign. We need to raise $50,000 by Dec. 31 to maintain staffing and continue our program work at current levels.

Here’s the deal. OBOS has a big name but a tiny budget. Book sales account for only 6 percent of our budget (yes: 6 percent!). We’re a nonprofit that depends on donors and grants to make up the other lean 94 percent. And this year has been hard.

If you’re a regular Our Bodies Our Blog reader, you know we do our best to evaluate the latest medical research and studies (and provide tips so you can, too), explain ongoing political negotiations over women’s health and women’s bodies, and keep you informed on everything from the new, improved female condom to the benefits and harms of osteoporosis medications. And we provide a venue for guest writers to share their organization’s work and personal stories.

What you might not know is that OBOS is a tiny organization with a full-time staff of only six (and a few part-timers like us) that works in partnership with other organizations to create change around the world. Here’s what we’ve been up to lately:

- We are in the midst of writing the 9th edition of “Our Bodies, Ourselves,” scheduled for publication in the fall of 2011.

- We work with women’s groups around the world who translate and adapt “Our Bodies, Ourselves.” The book is currently in 24 languages! 24!

- A group we work with in Japan coined new, positive words for female reproductive organs because there weren’t any. These words are now in the Japanese dictionary.

- Another group in Nepal worked to get women’s reproductive rights included in the country’s new constitution. We influenced a constitution!

- We’re creating a 15-minute documentary to send to law makers in Massachusetts to promote the creation of a board of registration in midwifery.

- We’re working to promote the health care reform public option and to ensure that abortion is covered as a medical procedure.

- OBOS staff, especially its tireless co-founder Judy Norsigian, speaks to dozens of groups every year and testifies at political hearings on issues such as the safety of breast implants, problems with direct-to-consumer advertising of prescription drugs, the well-documented efforts of midwifery care and more.

- We provide an unbiased, independent, feminist perspective that is all to often missing from healthcare debates.

- We created the Women’s Health Heroes awards in 2009, inducting 20 women nominated by readers like you. And we’re gearing up to honor more heroes in 2010.

Our Bodies Ourselves has always been there when you needed us most. And now we need you.

We can continue this work with your support. If we can get 1,000 people to make donations of $50 each, we’ll reach our goal faster than you can say, “Women rock!”

So please make a donation today (it’s tax deductible!). Share this news with your friends and networks. And enjoy the warm fuzzies you get from knowing you did a good thing — and from knowing that OBOS will be there to answer your health questions and to be an advocate for you and your family.

Thank you for your support!

- Rachel & Christine

Courts in Philadephia recently ruled in favor of two plaintiffs who sued Pfizer because they believed their breast cancer was caused by taking Prempro, an estrogen plus progestin combined hormone replacement therapy (formerly sold by Wyeth).

More than $100 million was awarded by juries between those two cases, although news reports indicate that Pfizer will appeal and damages awarded are likely to be reduced; a Pfizer spokesperson said the company does not believe the verdicts “were supported by the evidence or the law.” About 10,000 similar cases are apparently pending at this time.

In 2002, the Women’s Health Initiative study was released results indicating that women taking estrogen plus progestin hormone replacement (such as Prempro) were more likely to develop breast cancer than women taking placebo, and their cancers were more likely to be more advanced. The trial was stopped early that year after it became clear to investigators that the risks of combination hormone therapy outweighed the reported benefits.

As a result of WHI findings, in 2003 the FDA required the addition of a black box warning to the drug’s label to state that estrogen and estrogen plus progestin therapies should not be used for the prevention of cardiovascular disease, and to warn of increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women taking the estrogen/progestin combo.

A recent Time magazine story looks at the decade-long search for a drug to cure women with low sexual desire — a so-called female Viagra. A German pharmaceutical company thinks it’s on the right track with flibanserin, a drug originally developed as an antidepressant (it didn’t work for its intended purpose). Filbanserin is undergoing clinical trials to treat hypoactive sexual desire disorder (HSDD).

Our own Judy Norsigian is quoted in Time, expressing caution:

Certainly, there may be women who will do better after taking flibanserin, says Judy Norsigian, executive director of the women’s health advocacy Our Bodies Ourselves, based in Cambridge, Mass. But she thinks the diagnosis of HSDD unnecessarily medicalizes women’s sexual lives. Attempting to treat low libido with a pill ignores the fact that many women’s level of desire is deeply affected by everyday life stress and interpersonal relationships. Add to that a cultural milieu that at once promotes shame and ignorance about women’s sexuality while wildly inflating their expectations for sex.

In many cases, says Norsigian, the proper solution to a lack of sexual desire would involve a number of non-drug approaches, such as therapy, mind-body techniques and getting partners involved in the solution. “That could be equally successful while at the same time not exposing women to the [potential] long-term adverse effects of drugs,” says Norsigian, who suggests testing drugs like flibanserin against drug-free therapies. “Moreover, the non-medication approaches often address root causes for lack of libido and thus reflect a prevention approach that is usually much wiser.”

During a recent event hosted by the Vanderbilt University School of Nursing’s Midwifery Program, Norsigian raised similar questions about whether women are receiving the best and safest treatments. She also discussed examples of how mixed, inaccurate or incomplete media coverage can make it difficult for women to navigate their health options and to understand the risks involved with some procedures. The Reporter, Vanderbilt Medical Center’s weekly newspaper, covered Norsigian’s talk.

The current issue of the journal “Clinical Risk” has of a series of articles commenting on risk and cosmetic surgery, from reputation and regulatory risks to physicians to clinical outcome risks for patients.

Because the journal is based in the UK, much of the discussion of the regulatory environment is focused there, but the articles also address the trend of cosmetic surgery tourism between nations and general perceptions of and risks to patients seeking cosmetic surgery.

In the editorial for the issue, plastic surgeon Nigel Mercer writes that “We have reached a stage where public expectation, driven by media hype and, dare one say, professional greed, has brought us to a ‘perfect storm’ in the cosmetic surgical market.”

He also describes a “massive increase in ‘marketing’, including discount vouchers, 2-for-1 offers and holidays with surgery! In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a ‘2-for-1’ advert for general surgery?”

Another author, Khoo, notes the “grey area between advice and advertising” when surgeons provide information to prospective customers (patients). Similarly, Bradbury writes that cosmetic surgeons should be prepared to decline to do procedures, to say “no” or “not now,” and should avoid pushing extra procedures on a client.

The idea that cosmetic surgery carries minimal risk is also criticized. Mercer writes that “the media and both published and broadcast ‘marketing’ have wittingly or unwittingly given the public the impression that cosmetic surgery procedures are quick fixes and carry no risk of downtime or complications. Nothing could be further from the truth and it defies common sense to think otherwise.”

The BBC has additional coverage of the issue. On a related note, The Guardian published a story last Friday on labiaplasty and the increase in the number of these procedures in the UK in recent years.