On Birth Control

Lately the standard response to any argument against enabling easy access to birth control for American women seems to be telling anecdotal stories about women who have health problems for which birth control is the therapy of choice, or women who have health problems that make their ability to access birth control problematic.

I feel especially situated to offer up yet another case study of sorts, because I have a rare condition that prevents me from being able to digest birth control (or any hormonal therapy). It induces acute pancreatitis (excruciatingly painful, let me tell you) and I end up in the hospital. As such, I have to take a name-brand that enables absorbing the hormone in another way, such as Ortho Evra (the patch) or Nuvaring (the ring) or Implanon (the implant), etc. And these technologies are still under patent, so they're all extremely expensive, even with phenomenal insurance. If I were in any other socioeconomic situation, they may actually be prohibitively expensive.
I also have a friend who has severe endometriosis and has been on birth control since she was 13. She can't go off of it, it's extremely dangerous for her. She has scar tissue throughout her peritoneal cavity and her chances of ever getting pregnant - safely, at least - are very low. This is a girl who actually needs birth control to stay alive.

But I digress, because these anecdotes, at this point, aren't adding anything to the conversation. They're too easy to ignore. Why? Because they're anecdotes. As much as we would love for it to be possible for every law written by every lawmaker to solve every problem for every person, it can't. All they can offer are blanket solutions that help the majority of people. And this is exactly where we should start the conversation: restricting access to birth control hurts everyone, not just the few women - like my friend and me - with rare genetic disorders that make obtaining birth control problematic, expensive or dangerous.

By everyone, you should note, I don't just mean women. I mean everyone. Men, women, families, married folks, single folks, college students, high school students, everyone. Allow me to explain.

Let's start by breaking down any argument about any drug or therapy into two halves: the scientific half and the social half. All drugs are, at their core, just chemical compounds that we put into our bodies, either by ingestion or some other form of delivery. These chemical compounds have a variety of effects, some are desirable and some are not. Often, the same chemical will be marketed for two very different purposes. In one instance, effect A is the desired effect and effect B is called a "side effect" and is written on a little warning label on the side of the package. In the other case, effect B is the desired effect, and as such, effect A becomes a "side effect."

But when we package these chemical compounds, we market them and give them a brand; an identity that we can, well, identify with. And then the drug becomes something more. Hormone treatments are no longer just pills containing measured doses of either estrogen or progesterone, they become Birth Control. And Birth Control has a very strong social presence, it represents very different things to different people. This, I think, is where we run into issues.

Let's examine what the construct of "family planning" represents, whether it's accomplished by hormonal birth control for women, which prevents ovulation, or by abstinence, or by the use of condoms, or by some futuristic space technology that prevents ejaculation of sperm in men. Whatever the method, the goal is to control just when and how and with whom you choose to create life.

The ability to plan the births of your children, to have them at the appropriate times in your life represents a massive safety net, especially for economically vulnerable families. This means fewer teen pregnancies, fewer unplanned pregnancies, it means healthier, safer pregnancies that are appropriately spaced apart, it means fewer abortions and it means happier, healthier families. This is good for families, it's good for the economy, it's good for this country. Women are only the subject of attack lately because the most effective form of birth control that allows you to remain sexually active is hormonal birth control, and has to be taken by the woman. If birth control were taken by men, I highly doubt we would be having this conversation at all.

If we must analyze the sexist element in this conversation, then let's get one thing clear. Anyone who says that women have been successfully managing this business of pregnancy and birth for millions of years without the help of modern medicine is ignoring the staggering history of death-during-childbirth, birth defects, stillbirths, back-alley abortions, infanticide (actual infanticide, not the political rhetoric used by Newt Gingrich), life-threatening health complications in women, pregnancy as the result of rape and more. Pregnancy wreaks havoc on a woman's body, it shifts her organs, pushes her cells toward insulin resistance (that's a mild - or in some cases not so mild - diabetic state) and attacks every system in her body with massive quantities of steroid hormones. To ensure that she will have healthy, safe, planned pregnancies a woman requires the assistance of - and constant monitoring by - a qualified doctor. So let's not trivialize the difficulties that pregnancy can bring for a woman, especially if the pregnancy was not her choice (as in cases of rape).

 But while the hormone pills used for birth control are chemically acting on the woman's body alone and for the purpose of preventing ovulation, that's just not the point. The point is about broader social consequences of not providing people with the tools they need to plan their families carefully, safely and responsibly. It's about saving women's lives and preventing abortions. It's about building families in the safest context possible.

To take such a powerful medical tool, one that affords people some control over the most important aspects of their lives, and turn it into a political pawn by which to acquire more votes is morally and socially inexcusable. It is, at its core, politicizing peoples' dignity and freedom. And hiding behind the excuse of personal religious morals is a useless defense. My parents never told me that sex is only for marriage, they told me sex is for a committed adult relationship, and left it at that. I see nothing wrong with this particular moral compass, and I plan to pass it along to my children. The government wasn't formed to legislate peoples' personal philosophies on life. It was formed to protect our rights to lead our lives as we see fit, and restricting access to birth control is a direct violation of that goal.

So, let's not mince words on the moral here: birth control is good. No matter your religious objections, you cannot deny the evidence that everyone benefits from the ability to practice responsible family planning.

The "Safe" Answer

As much as it concerns me that starting this blog with a political topic might turn people off, I'm going to go with my instinct to write what's on my mind. Let's talk about Michelle Bachmann and vaccines.

There have been many articles lately on the remarks the congresswoman made - and later defended - at the Republican debate. In case you haven't been following, I'll summarize: She has spoken out against Gardasil, the HPV vaccine that can help lower a woman's chances of contracting cervical cancer. But she didn't just speak out against the vaccine, she created a rumor that it can cause mental retardation in children.

I'd like to focus on one aspect of this story that I feel has some relevance to science education. Here's the article that got me started thinking about it, for your reference. There's a lot going on in that article, especially about Rick Perry, but I'm not here to talk about politics, so I'm going to skip over all that and focus on one remark made by Ms. Bachmann: “This is the very real concern and people have to draw their own conclusions.”

I find this argument both fascinating and disturbing, and I'm certain I've seen it before, specifically in a video that made the rounds a while ago from the Miss USA pageant. The contestants were asked whether evolution should be taught in schools. The overwhelming majority said no, because they 'don't believe in evolution.' But a precious few gave what was clearly considered to be the "safe" answer: teach the debate. This stance is so common it has become something of a catch phrase within the evolution vs. creationism conversation.

I really think the Miss USA contestants and Ms. Bachmann are saying the same thing: tell people that there is a controversy. Don't represent the facts, don't educate them about science or even mention that conclusive scientific data exists on the subject... No, just tell them "There is a debate going on. You should pay attention, and form your own opinions."

It sounds innocent enough. After all, we want people to think for themselves. So they should look at the debate themselves, right? They should gather the facts and come to a conclusion on their own. But don't be fooled. This argument is already biased toward an anti-science conclusion. It sends people off running in the wrong direction, while veiling itself behind a guise of neutrality.

What Bachmann is really doing here is putting on a show. She starts a rumor that casts her opponent in a negative light and makes her look like a hero for drawing attention to some flaw of her own invention. Then, when she is confronted with real, scientific evidence that her claims are completely fabricated, she throws her hands up and says "That's just what I heard! I'll let people make up their own minds." It sets the stage for anti-science rhetoric, because any retort automatically sounds like an implication that people shouldn't be allowed to make up their own minds, when in reality the public has been handicapped in their ability to approach the subject neutrally. Bachmann creates controversy where there is none, then walks away and lets the scientists talk in circles trying to repair the damage.

The same goes for the "teach the debate" attitude toward evolution. At the end of the day, a science classroom is a science classroom, and it is the responsibility of a teacher only to teach science. Not politics, and certainly not religion. But this idea has somehow become what is considered the "safe" answer. Why do people hear this, and think it's neutral? Or innocent? This is the most politically charged sentiment I've ever heard on the subject of science education. What these people are really saying - both Bachmann and the "teach the debaters" - is that it's okay to make up false rumors about science and medicine, misrepresent or even completely silence the facts, then tell people to come to conclusions based on incomplete and falsified evidence. It's okay to handicap people when their health and education is concerned. Because ignorance endows us with political and social power, and let's be honest, that was really the point all along.

I think if you sat Michelle Bachmann down and asked her if she thinks that science education is important, she would say yes. And she'd mean it, emphatically. But she clearly doesn't fully understand the underlying principle of skepticism or the importance of the scientific process. She is actively crippling the science education of the public when she spreads lies for her own gain.

Given that, know this: when you say "wouldn't it be better to teach the debate?" and I say "No," I'm not trying to keep the truth from you. I'm trying to keep you from allowing the truth to be poisoned for you, before you have a chance to study it for yourself. This isn't a safe answer. It's a highly political answer; a mean trick. And it does tangible harm; don't forget that we're talking about medicine here. The HPV vaccine prevents cancer. It actually prevents cancer. Michelle Bachmann is scaring people into avoiding a vaccine that could save their lives. Why? So she can gain more votes.

So, the next time someone says "You should investigate this debate and draw your own conclusions," start your investigation by asking the question: is there even really a debate going on? I think you'll be surprised how often you'll find the answer is 'No.'