Consumer Alert: Aspartame

Aspartame (also known to you as Nutrasweet and little blue packets of Equal) is an artificial sweetener used in a variety of products. Most people associate it with diet soft drinks and the little packets for coffee and tea. In fact, it's in a lot of products you might not even think about (certain cereals, yogurt, etc.).

Depending on who you ask, aspartame is either perfectly safe or very dangerous. I will be upfront (as I sit here and type this while drinking a Diet Coke) and say that I don't think it is dangerous per se, although probably there are people who are sensitive to it and may react. And it's probably not good in excess, like pretty much anything else. There's even some evidence that using artificial sweeteners can actually lead to weight gain. But that's not what I'm blogging about today.

A producer of aspartame, Ajinomoto, has rebranded its product as AminoSweet. According to the website, "AminoSweet is made from two amino acids, the building blocks of protein found in many of the foods and drinks we eat every day, such as fish, meat, eggs, cheese and cereals."

I have a problem with the marketing approach here. It's misleading to imply that AminoSweet is somehow a "natural" sweetener because it's "made from two building blocks of protein just like those found naturally in many everyday foods." Is Ajinomoto trying to pull the wool over our eyes? Or do they think we are stupid? We've known for years that aspartame (or Nutrasweet or Equal) is an artificial sweetener. Key word: Artificial. As in, not found in nature.

If you avoid artificial sweeteners for any reason, be sure to read labels carefully. Shady marketing practices like this are sure to multiply as the trend of "natural" products increases.

Congenital Heart Defect Awareness Week: Feb. 7-14

Did you know that heart abnormalities are the most common birth defect? I didn't, until a few weeks ago. A Facebook friend posted a link to the Cora's Story blog and I casually clicked over to see what it was about. Cora died suddenly in her mama's arms at just 5 days old from an undetected congenital heart defect (CHD). I can't imagine suffering such a devastating loss, and I thank my lucky stars for my kids' healthy hearts. But Cora's mother Kristine has turned her pain into a wonderful mission in her daughter's name: to raise awareness about CHD and how easily it can be detected. With Kristine and Cora's help, hopefully more CHDs will be caught and treated early, saving babies' and children's lives.

Another fact I learned from Cora is how easily many CHDs can be detected. A simple pulse oximetry test (aka "pulse ox") done 24-48 hours after birth in conjunction with a newborn exam can detect a large proportion of CHDs, with a low false-positive rate. A pulse ox test is noninvasive and very simple: the reader is typically attached to the baby's toe and determines the oxygen saturation of the blood. An abnormal reading (typically below 95) is indicative of a problem. The research on pulse ox screening bears out the effectiveness of pulse ox screening tests for newborns.*

So why hasn't pulse ox testing become routine for all newborns? As I mentioned, the test is completely non-invasive and hospitals already have the equipment. Portable pulse ox readers are also available, which means both birth center and homebirth midwives could also easily carry them. Kristine is working on Cora's behalf to get laws passed nationwide mandating a pulse ox to be done on every newborn. I applaud her efforts and admire her strength at turning her pain into an effort to save lives.

What can YOU do? Request this test for your own babies and tell the pregnant moms in your life to request it when their babies are born. Pass this information on, and tell others to pass it on too. Write your Congressman and your state representatives and tell them you want pulse ox testing to be mandatory for all newborns. You might just save a baby's life.

*More information and research:
Medscape Medical News
British Medical Journal
University of Michigan
Medical News Today
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You're Doing It All Wrong

Confession: I cringe when I see your back drooping down in a plank pose. I die a little bit inside when you do a lat pulldown behind your neck. I get a shiver up my spine as you fling your legs forward on the leg extension machine.

I see people performing ineffective exercises and executing exercises with poor form all. the. time. And every time, I am seized by the same dilemma: Do I say something, or shut my mouth and pretend I didn't notice?

I don't want anyone to get injured, that's for sure. And I want people to see the results of their efforts. Performing an exercise improperly increases the likelihood of the former and decreases the likelihood of the latter. But....

I am a trainer, but I am not your trainer. If a member hasn't asked my advice, why should I offer it unsolicited? And by barging in on someone's workout, I might make him or her uncomfortable, and in fact LESS likely to seek advice or assistance from me in the future.

Not to mention, it galls me to no end to see trainers walking up to members and telling them they "should" be doing this exercise or that one. I find that highly irresponsible. Before recommending any exercise, I need to know at least a basic exercise and health history. Otherwise, how would I know about that torn rotator cuff back in '07 or those arthritic knees? I don't want to recommend any movement that is contraindicated for a person's health condition. I also don't want to recommend something that is far beyond a person's current level of ability, leaving open the possibility of injury. As a consumer, I would be suspicious of any trainer who tries to "recruit" new clients in this manner.

What do you think? Do you want someone to correct you if you're doing something incorrectly? Or would you prefer to just do your own thing without interruption?

My Worst Cycle Class Ever

On Friday morning I got a desperate call from the group ex director at a gym where I'm on their instructor sub list. Could I please sub a cycle class at 10:30? I reluctantly said yes... 10:30 is Rebecca's morning nap time and I had never subbed at this particular location. The director gave me some helpful information, such as the entry code for the cycle room and how to plug my iPod into the boombox being used while the stereo is being fixed.

Right away I thought, iPod? Though I have one, I am a relic who prefers to use CDs. I know, I know, I need to step into the 21st century. But I gamely charged up my iPod and got myself and the kids ready to go.

I left myself plenty of time, so I thought, to get the kids into the childcare area and get myself set up for class. I brought the kids in and was confronted with a barrage of paperwork to fill out. I hadn't done this at the other club in the chain so I didn't realize it would be necessary. I apologized to the girl and told her the copy of my driver's license (!) would have to wait until after class.

Then I headed down the steps in search of the cycle room. I successfully used the keypad to open the little lockbox containing the key to the door. But then I had a hard time using the key in the lock, while about 10 members waited around looking at me. It didn't get better once I got inside the cycle room. There was no boombox in sight and I couldn't get the microphone to work. I ran back up the steps in search of someone, anyone, at the club who could help me. The girl at the front desk pointed me to the manager and he followed me down the stairs.

The boombox, as it turns out, was in a little locked closet nowhere near the cycle room. He got that working with my iPod, thankfully, and then started tinkering with the microphone. He couldn't get it to work either. (At least it wasn't user error!) By now we were more than 5 minutes past the start time if the class, and I'm pretty sure the members were convinced I'm an idiot.

I had to conduct class with 16 attendees by shouting at them over the music. Not the first time I've ever had to do that, mind you, but still. Then for some reason my iPod was not playing the songs in the playlist in order. The playlist was ordered correctly on the menu, but the songs came out randomly (I guess I had some kind of "shuffle" setting on?) and I had to keep flicking through the songs to do them in the right order. Not easy when I was out of breath and had sweaty fingers. The class just didn't flow.

From start to finish it was pretty much a catastrophe. I wish I could say I had some sort of "lesson" in all this, but I thought I was pretty well prepared to go into a new situation. I don't know if I'll be too anxious to go back there anytime soon though.

What Happened to Informed Consent?

I guess for some people this is old news, but this morning I read this article about medical students doing pelvic and rectal exams on patients who are under general anesthesia for surgery. These patients, in many cases, did not consent to such exams, and may not ever even know it was done to them. Apparently this issue has come up a few times over the years (see the references section of this article) without ever really being resolved. And men, this includes you too... Imagine going in for a routine knee surgery and having 4 or 5 med students practice rectal exams on you while you're out cold.

If a woman goes out to a bar and a man spikes her drink with roofies and then has sex with her while she's unconscious, is it not rape if she can't remember it? Of course it is. How is this significantly different?

Any procedure performed on a patient requires informed consent. It is a legal right and an ethical obligation. The fact that this continues to go on is abhorrent. Of course med students need to learn somehow, but this is not the way.

Studies and surveys have shown that people will, when asked, consent to med students performing such exams. There are also some programs in place that pay volunteers for undergoing examinations in order to teach med students. Both are better alternatives than simply probing people's orifices without their knowledge or consent. More importantly, performing pelvic and rectal exams with a conscious patient have the advantage of allowing the patient to give feedback (as in, "Hey that HURTS!"). The student can better learn to conduct such exams so as not to hurt the patient.

If you are having surgery or any other treatment at a university or teaching hospital, ASK if they have med students learning pelvic and rectal exams on anesthetized patients. If you are ok with simply knowing in advance, you can feel free to consent at that time. Or you can tell your attending physician you do not consent, as well as write it on your consent form that you specifically do not consent to such exams.

If you are a student doctor or nurse, please refuse to check your ethics at the hospital door. Just because "this is the way it's always been done" doesn't mean it has to continue to be done that way. Tell your resident, your attending, your supervisor, or your preceptor that you won't participate in exams of anyone who hasn't given explicit consent.


Hat tip to The Unnecesarean for the topic of this post.
Further reading here

In Florida, A Pregnant Woman is Nothing But A Womb Pod

I encourage people to follow this case in Florida, where a woman was court-ordered to be held against her will on hospital bedrest. She was 25 weeks pregnant and having some issues in her pregnancy, so it was recommended she remain on bedrest. However, with a job and two other young children at home, she did not feel that would be possible. So the hospital sought a court order to keep her hospitalized, claiming it was in the "best interests of the fetus." Never mind what might be in the best interests of her other two children! The court order required her to submit to any and all treatments during her stay. Three days later, she had no choice but to undergo a c-section, and during the surgery it was determined that the fetus had already died. (Which, as an aside, could have easily been determined by an ultrasound rather than major abdominal surgery.)

In the past, courts have always upheld patient autonomy in making medical decisions, even for pregnant women, even when it might endanger a fetus. The Florida courts, however, have summarily stripped this woman of her constitutional rights. Fortunately, a lawyer has agreed to appeal her case pro bono, and the ACLU has (rightfully) stepped in as well.

Let this case be a warning to women everywhere: The Pregnancy Police are watching. You think it's bad that people give you the stinkeye in Starbucks when you don't order a decaf latte? Just wait til they imprison you in the hospital until delivery for it.

Are You a Disaster Waiting to Happen?

A couple of weeks ago, I came across a blog post that combines two of my main interests: Teaching group ex and birthin' babies. The analogy quoted from Mother's Intention: How Belief Shapes Birth by Kim Wildner is great:

"Heart disease is the leading cause of death in the US. 873 per 100,000 die of heart disease (CDC). (Remember, natural birth is between 6 and 14 per 100,000 in the US, depending on the population.)... Using the logic of obstetrics, all health clubs should be in hospitals and all fitness trainers should be cardiac surgeons. Any independent health club with 'lay' trainers would be 'practicing medicine without a license,' subject to prosecution. It's for your own good."

Exercise is dangerous business! Go for a workout and it could end in catastrophe! Let's not forget that Pheidippides DIED running the first marathon. But don't worry, Wildner has the solution for all of us exercisers out there:

"...in order to know if a problem is developing, close monitoring and 'management' is required. We will need to place straps on the muscles to measure the intensity of the workout. of course, it will be restrictive, but we need to know how hard the muscles are working to know if the heart can take it. We'll need to monitor heart rate, blood pressure, fluid output. We'll need to give an IV because with sweat excreted, you could dehydrate, and of course, we simply can't take the risk of letting you drink anything lest you need emergency surgery..."

Does any of this sound faintly ridiculous? Is your health, your life, so precarious that a workout could kill you? Is your body so defective it can't handle a natural function like physical exertion? Unless you're in a risk category- such as a heart problem, an autoimmune disease, or chronic illness- the answer is no.

So why are we so quick to believe that a mother's body can't birth her baby without all the monitoring and the technology and the machine that goes ping? Why do I keep meeting women who were told their baby was too big, their pelvis too small, their bodies just "not able to do it on its own"? I think that's just sad. It can't be true that so many women's bodies function normally in every other way... except this one. Having a baby is not an emergency or a condition from which women need to be rescued. Pregnancy and birth are not a disaster waiting to happen. But unfortunately that doesn't seem to be the prevailing attitude, least of all among most obstetricians.

I leave you with one of my favorite quotes, from midwife Ina May Gaskin:

"Remember this, for it is as true and true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic... Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body."

Resolution Time

For a lot of people, the new year is a time to pledge change. Some people try to break old habits and some try to create new (healthier) habits. One of the most common resolutions is to get in better shape, whether that means losing weight, exercising more, or both. Maybe you've made that resolution in the past. Maybe you made it this year.

It should come as no surprise then, that January is the busiest month of the year at gyms and health clubs. (Second is September- when kids go back to school and routines that petered out over the summer start anew.) I've watched each January as the gym fills with "New Year's Resolution People" who are gone by the time Valentine's Day rolls around. And you should know, that we as instructors and trainers, are talking about you. We love to see new faces in class, really we do. But when you start out during the month of January, we are skeptical. And truthfully, though I can't speak for all instructors, there are some of us guilty of complaining about our gym regulars getting shut out of classes by overexuberant newbies during the month of January. Sorry.

Here is where I have seen a lot of people go wrong. Let's take a hypothetical woman named Jane. Jane has made a resolution to lose weight through diet and exercise. So on January 2, she signs up at the gym and vows to go every day. I would bet my last dollar that Jane will fail.

Why?

Well, for a couple of reasons. First, Jane is likely to burn herself out quickly. I see this more with men, but women do it too. Jane literally hits the ground running, going 4, 5, 6 days in a row to the gym and pushing herself hard. And then she is overtaken by fatigue and muscle soreness... And then she thinks, "Ugh, this is why working out sucks. It makes me tired and sore." And pretty soon that gym membership is nothing more than an automatic monthly charge on her credit card. Second, Jane set herself up for failure before she even began by setting a vague goal of "losing weight" through diet and exercise.

But Jane doesn't have to be one of the New Year's Resolution People that instructors and trainers sigh about. She can do one simple thing to help herself succeed. She can set a SMART goal. SMART stands for Specific, Measurable, Attainable, Relevant, and Time-bound.

Specific- "Losing weight" or "getting in shape" are not specific goals. Losing 20 lbs. or being able to run for 30 minutes without stopping is specific.
Measurable- There should be no doubt about whether a goal has been achieved. Progress towards a goal can be measured- losing 5 lbs. out of 20, or running 10 out of 30 minutes without stopping.
Attainable- Losing 20 lbs. or training for a marathon in 2 weeks is not attainable (and even if it were, it certainly wouldn't be healthy). Be realistic when setting a goal.
Relevant- It may seem obvious, but it doesn't make sense to train for a 5k run by riding a bike. And "training" for a competitive eating event is probably not a good method of weight loss. (That's a joke people!)
Time-bound- Assigning a deadline keeps goals on track. Set both short-term or interim goals to mark progress towards a long-term goal.

For Jane, a SMART goal might be: Fit into her size 6 jeans (specific) by losing 20 lbs. (measurable) in the next 4 months (time-bound). To do this she will count calories and go to the gym 3 days a week (attainable and relevant).

Finally, my personal opinion for people who haven't been working out regularly is to start off slow. Yes, we should all work out about 5 days a week, but for those just starting out, 2-3 days a week is enough. Carve out that time and cement it into a weekly schedule, the same way meetings or appointments are scheduled. Once those couple of days become a habit, add another day, and eventually another. Trying to do it all at once can be too overwhelming and discouraging, and I think that's why a lot of people can't stick with a routine for more than a few weeks.

Have you made a resolution to get in better shape in the past? How did it work out for you? Are you resolving that this is the year you'll get fit?

A Bit of History That Gives Me Chills

Yesterday one of my favorite bloggers, The Unnecesarean, posted an excerpt from a history text about birth in the early 20th century. The excerpt presents the practice of putting women under "twilight sleep" for labor and delivery as a way to convince WASP women to have more babies because "modern" birth practices render it painless-- or at least without the memory of pain. I had never heard of this racist/classist perspective of twilight sleep before. But it got me thinking, especially since I recently read that the tv show Mad Men featured a character giving birth within the haze of twilight sleep.

I can't remember the first time I heard about women being "put under" to have their babies- it was probably as a child or teen. Until a few years ago, I guess I thought it was a benign but clumsy attempt to spare women the pain of birth. No big deal. But then I happened to see "The Business of Being Born, " a documentary by Ricki Lake that covers a little bit of the history of birth in the US. The historical aspect was eye-opening, to say the least. When you start to think about the fact that this is the way many of our parents came into the world (and maybe even some of us, considering twilight sleep was prevalent well into the 60s and even the 70s in some hospitals), it can be downright scary.

Beginning in the 1900s, a combination of scopolamine and morphine was administered to all women entering the hospital for birth. Women had no recollection of the birth, and certainly no recollection of any pain. Feminists heralded this as a fantastic medical breakthrough, and demanded its widespread availability for birthing women. As word spread of this wonderful new pain-free way to give birth, women across the country chose to deliver in hospitals offering twilight sleep. In fact, there are reports of women being put under for delivery whether they wanted it or not, even against their own explicit refusal. But since women had no recollection what actually happened during their births, and husbands at that time were not part of the birth process, it was years before the true horror of twilight sleep was exposed.

Since the women were not fully sedated, and not fully relieved of the pain of labor, they had to be placed in restraints in their hospital beds so as not to thrash themselves onto the floor. When husbands started questioning the marks on their wives' wrists and ankles left behind by the leather restraints, the practice of restraining was not abandoned. Instead new restraints made of lambswool were designed so as not to leave any marks. Women were left, tied down, to writhe through their labors until the doctor arrived with forceps to extract the baby. (See photo at top.)

When the effects of the medicine wore off, women were presented with a freshly bathed, blanketed bundle of baby. Some women complained of feeling detached from their babies, like they weren't even sure it was their own child. The drugs also crossed the placenta and often sedated the baby, resulting in breathing problems. Over time the method was eventually abandoned, as a result of the negative side effects and the second wave of feminism. As women reclaimed control of their reproductive lives, including access to birth control pills, they also began increasingly demanding unmedicated births and fathers' involvement in births. The development of epidural anesthesia also played a role in the demise of twilight sleep.

Maybe it's my own personal bias against hospitals, but the thought of literally being dropped at the door of the maternity ward by my husband and literally having no recollection of anything else until being handed a baby two days later utterly horrifies me. I don't think the method would have taken off if husbands had been allowed in- I cannot imagine any man permitting such barbaric practices to be visited upon his wife. But they didn't know, so they couldn't help.

There was (and I think there still is) a certain mystique around birth: We don't know exactly how labor starts, and can't predict when it will happen. Regardless of a mother's weight gain or belly size, we don't know the size of the baby until it's born-- even ultrasound measurement can be off by a pound or more in either direction. This mystique allowed generations past, and still allows many people today, to maintain a certain degree of ignorance about birth. It's very easy to assume that the doctor has all the knowledge, the hospital has all the equipment, so all the expectant parents need to do is show up when it's time. I think that is a dangerous attitude. The same people who wouldn't hesitate to seek a second opinion from a doctor who said they need a heart transplant... the same people who would consult with three different orthopedic surgeons about a knee replacement... don't think twice about their choice of care provider, birth place, or pain management options. I could write a whole other post on the topic of informed birth choices... But suffice to say for now, If you don't know your options, you don't have any.

Vitamin D Confusion

Until recently, I'd never given vitamin D much thought. I mean, rickets? Isn't that a disease that pirates and other seafarers got, along with scurvy and beriberi? It seems like every time I turn on the news lately, vitamin D deficiency is linked with other health conditions, such as cardiovascular disease, prostate cancer, diabetes, depression, even H1N1 influenza. The problem isn't limited to adults, either. New research has indicated that children are vitamin D deficient as well.

It's possible we've taken the "safe sun" message too much to heart. We've become so accustomed to slathering on sunscreen every time we step outside that we're blocking our bodies' natural vitamin D production from the UV light of the sun. Ironic that by trying to prevent one disease, skin cancer, we've potentially put ourselves in the path of other diseases.

The NIH recommends 400 IU of vitamin D supplementation for adults, assuming an individual is not synthesizing any vitamin D from sunlight. But is that enough? Recent evidence makes the case for higher amounts, up to 5000 IU per day. There is also a case for modest sun exposure, 5-10 minutes of full sun (without sunscreen) on the arms/legs/face, 2-3 times per week. But the amount each individual needs varies based on age, race, time of year, and latitude. So how to know if you're getting enough?

I was surprised to learn recently that a simple blood test can tell you if you're getting enough vitamin D. (And with my annual physical coming up in a couple of weeks, I'm definitely asking for my D to be tested as part of my labs.) If you'd like to ask for it too, it's the 25-hydroxyvitamin D test, also known as the 25(OH)D test. Note: This is different from the 1,25-dihydroxyvitamin D test [1,25(OH)2 D], which will not give an accurate portrayal of vitamin D status. According to the Vitamin D Council, a healthy level is 50-80 ng/ml, which should be maintained year-round.

Another bit of information of note: Athletes may need more vitamin D than the general population. This is an area of research that needs more study, but initial recommendations are on the upper end of the intake range. One writer chronicled her experience with D deficiency and its effects on her athletic performance. If your performance has been lagging for no apparent reason, it might be time to check your D level.

I think this is as good a reason as any for me to pack it in and move to the Caribbean. "Sunshine Vitamin" anyone?

Exercise and Breastfeeding

A new study from the University of North Carolina-Greensboro concludes that breastfeeding mothers who exercise lose less bone density and less lean body mass than non-exercising women. Although the study is small and the topic warrants further exploration, the results are promising. Bone loss is normal during pregnancy and lactation, as the baby depletes some of the mother's calcium stores for skeletal development. Bone density generally rebounds, at least partially, after a woman ceases breastfeeding. But concern over osteoporosis could lead some women to decide (or be convinced) to wean prematurely.

The UNC study demonstrates that moderate exercise, in addition to its many other benefits, can mitigate the effects of breastfeeding on a mother's bone density. It is important to note that the women in the study did not have a gym membership or attend group exercise classes- they performed a combination aerobic/strength-training routine 3 times a week in their own homes. In other words, the benefits of exercise are not out of reach to women unable to join a health club. For women who worry that exercise will affect their milk supply, there is no research that supports this myth. Furthermore, the additional caloric expenditure associated with both exercise and lactation (along with healthy eating habits) may help mothers shed their pregnancy pounds more easily.

Are Motherhood and Feminism Incompatible?

I have never considered myself a feminist. I'm not "anti-feminist." I support many of the aims of feminism, such as gender equality in the workplace and advocacy for victims of discrimination, violence, and sexism. But I just haven't felt like I fully identified with the socio-political group of "feminists."

What comes to mind when you think of the feminist movement? Maybe it's women like Gloria Steinem and Betty Friedan. Maybe it's politics, like the Equal Rights Amendment and Roe v. Wade. Perhaps it's social issues, such as sexual harassment, domestic violence, or rape. Or maybe it's just Girl!!! Power!!! I'd say all of those are pretty valid answers.

But when you think of feminism, do you think of moms? Probably not. Do you know why? Because the feminist movement doesn't think about moms either.

In the United States, something like 80% of women will have at least one child. That's more than the number of women who obtain bachelor's degrees (26%) and more than the number of women participating in the workforce (60%). But where is the feminist activism on behalf of mothers?

I started with perhaps the most well-known feminist group, the National Organization for Women (NOW). The "Top Priority" issues that NOW works with are listed on the front page of their site: Abortion and Reproductive Rights, Economic Justice, Ending Sex Discrimination, Lesbian Rights, Promoting Diversity and Ending Racism, and Stopping Violence Against Women. Worthy causes, all. When I clicked on "Many more" at the bottom of the list, I found, way down on the list of "Other Important Issues" a link to the Mothers [sic] and Caregivers [sic] Economic Rights page. The issue as NOW sees it is paid parental leave. Their action plan on this issue consists of.... a petition. Oh, and encouragement for women to contact their Senators. Wow, great plan. Things weren't any more promising on the Abortion and Reproductive Rights page. Apparently, the only reproductive rights that NOW supports are the ones that assist women who DON'T want to be mothers. The agenda is abortion, emergency contraception, and birth control access for all women. These are important issues, but do nothing for the women who choose to carry a pregnancy to term.

I next decided to head over to NARAL Pro Choice America. This was another bust, as their platform of issues encompasses only abortion rights, birth control access, sex education, and "Women of Color." Nothing about being pro-choice for women's childbearing options as opposed to pregnancy prevention and termination options.

Surely the ACLU must be working on behalf of mother's rights, right? Wrong. While they have a Women's Rights Project (started by Ruth Bader Ginsburg), the project only focuses on four areas: Employment, Violence Against Women, Criminal Justice, and Education. Again, all important issues, but nothing that directly advances the position of mothers.

I wandered over to the Obama Administration site, Change.org. There is a Women's Rights page, but it looks like news stories, blog entries, and job postings. Nothing resembling any kind of national movement of any type.

This is getting discouraging.

Isn't anyone fighting for better maternity leave policies? For breastfeeding women who are returning to work and need time and a place to pump breastmilk? For women who want to be attended by a homebirth midwife (still illegal in 10 states)? For women who want options other than a court-ordered cesarean section?

Well, how about the National Advocates for Pregnant Women (NAPW)? Now we're getting somewhere! The NAPW includes the following in its mission:

• By focusing on the rights of pregnant women, including those who are continuing their pregnancies to term, we hope to broaden and strengthen the women’s rights and progressive movements in America today... While it is generally recognized that people have a right to bodily integrity and the right to procreate, women face an array of restrictions on their reproductive decision-making, from restriction on access to abortion services, to restrictions on alternative birthing practices to a wide variety of health and welfare polices that devalue and undermine motherhood for some women, including low income and women of color. Although it is generally accepted that adults can decide what medical treatment they will or will not have - once a woman becomes pregnant others may be able to make that decision for her.

Now that's what I'm talking about. While the NAPW doesn't address issues beyond pregnancy (such as maternity leave and breastfeeding rights), it's still a great agenda. However, they do not specifically bill themselves specifically as a "feminist" or "women's rights" organization. They consider themselves a reproductive and human rights organization.

The National Partnership of Women and Families works toward family-friendly employment policies, such as flexibility in the workplace and paid sick leave. In fact, the National Partnership helped draft the Family Medical Leave Act legislation. Their agenda is great for working mothers, though I would like to see them go even further by adding support for breastfeeding/pumping moms. And in the reproductive health arena, they only scratch the surface, by supporting general ideas of affordability, quality, evidence-based and patient-centered care. It would be good to see

The other problem: Have you ever heard of the National Partnership and/or NAPW? Most people probably have not. They don't have the prominence of (and the political weight that goes along with) larger organizations like NOW and the ACLU. Women (and men too!) need to know about the NAPW and the National Partnership in order to give the organization a broader base of support and more political sway.

To be fair, there is a patchwork of different groups that support specific mothers' rights issues. For example, The MAMA Campaign and The Big Push for Midwives support choices for birthing mothers and pro-midwifery laws. First Right works to end breastfeeding discrimination. Over the past few decades the feminist agenda has not adequately included the rights of mothers. As it stands now, there isn't one umbrella organization to encompass ALL of the personal, political, social, and economic issues mothers face. Maybe some would say it's not necessary, that the other groups, small and large, that have a piece of the "mommy agenda" will be able to get the job done. I wonder, though, if it's an idea whose time has come.

Health Care: Why It Will Still Suck After They "Fix" It

I admit I am getting annoyed. I tried to be patient with this process, but as the days and the weeks and the months tick by, it becomes more and more clear that 300 million Americans are about to get a giant Congressional rectal exam.

I'm not one to join the Teabaggers (and really, with a name like that, how can you take yourself seriously?), and I'm certainly not one to take my AR-15 to an angry town hall meeting. But I think I have read enough on the subject of the health care reform fiasco to realize that we're not going to get the change we've been promised. What we will get is a piece of crap legislation that protects the interests of Big Insurance and Big Pharma and does nothing to improve access to and the quality of our healthcare.

We know that what we have now isn't working. The oft-quoted figure is 47 million Americans are uninsured, and the truth is that millions more are underinsured. In this country, we provide more "care" at greater expense and at worse outcomes than any other industrialized nation. The insurance industry and Medicare have a whole lot of influence how physicians practice. Insurers and Medicare set reimbursement rates for procedures. Basic care has a low reimbursement rate. But the more tests and procedures a doctor orders, the higher the reimbursement. As a result, they often provide more, often unnecessary care. I don't blame doctors for trying to make a living. They go through years of study and rigorous training to practice medicine. But we've created a system that incentivizes quantity over quality.

In the endless, exceedingly tedious debate about healthcare, a few major items have been discussed.

1) A single-payer system. Often compared to Canada and the UK, opponents argue that it will "ration" healthcare. And send your grandparents to the death panel. Certainly those systems have their drawbacks. It is true that some people have long waits for treatment, though my understanding is that those are "nonemergency" cases. If you're having a heart attack, it's not like they send you to wait in line. I also just want to point out that WE ALREADY RATION HEALTHCARE IN THE U.S.. Every time an insurance company denies a claim or refuses to cover a test, treatment, or procedure, they are RATIONING. And if they deny someone a treatment that could or would be lifesaving, well, that sounds an awful lot like a death panel to me. A uniquely American single-payer system (with salaried doctors and coverage for everyone) could be made workable if anyone cared to try. But try getting that past the insurance companies who have bought off Congress. This option is completely off the table at the moment, maybe forevermore.

2) "Universal mandates." Everyone has to be covered, no ifs, ands, or buts. Employers must offer coverage to employees. Those who are unemployed or otherwise don't have coverage through an employer are required to buy into insurance cooperatives (see #3) and/or a government-run plan (see #4). Sure, sounds great in theory. But small businesses will be hard-pressed to provide insurance to their employees, even if there are cooperatives to buy into. And large businesses could choose to cut costs by scaling back their plans- and if employees opt-out, so be it, they'll save even more money. So there is no reason for companies to provide anything but a bare-bones plan with minimal coverage. Employees can choose the lousy plan their employer offers, or pay more to the government plan or a cooperative. Which means we'd be in no better position than we are now. Furthermore, without underwriting reform (see #5) to ensure that no one can be denied insurance or be required to pay astronomical premiums due to pre-existing conditions, requiring everyone to be covered could put a lot of strain on a lot of family budgets.

3) Insurance cooperatives. This is an idea with some potential, but also with some pitfalls. The basic idea is that doctors, hospitals, and businesses band together to offer services to members. The model would likely be Group Health of Seattle, which covers about half a million members. The benefit is that co-ops are non-profit and member-run, with the goal of keeping costs low. In theory, such co-ops would compete directly with private insurers and force insurers to lower their own prices. However, co-ops have a less than stellar history, and there is no guarantee that they would be successful in significantly reducing premium costs to members. (Just for kicks, I went to Group Health's site and got quotes based on my own family of 5... They don't have a plan that matches our current health insurance. The co-pays are higher, they all have some kind of deductible, and all have at least 10% coinsurance. The closest plan to ours is $888 a month, which is more than what we currently pay out of our pocket, but my husband's employer picks up part of the tab. My guess is that the total cost is fairly similar, but Group Health's plan covers less.)

4) Government-run plan, aka "the public option." Sort of a third alternative to Medicare and Medicaid. The government obviously has the negotiating power to keep costs low. But would it just be Medicrap? Hard to say. The insurance lobby has been crying like a bunch of little girls whose kitten died about this one. They complain that they couldn't compete with the government keeping prices low. Well, they could start by not paying gazillion-dollar salaries and bonuses to their company officers. There are questions to be answered about any public option, such as who would be eligible and what kind of financial assistance would be provided to those at lower income levels. But what once was a mainstay of Obama's call for reform has been all but ditched.

5) Medical underwriting reform. At present, insurance companies can refuse coverage to, or cancel coverage for, anyone with a "pre-existing condition" or a condition that becomes too expensive to treat. Depending on the insurance company, a pre-existing condition can be almost anything, from seasonal allergies to cancer, from a being beaten by one's spouse to a prior c-section.* And watch out if you get sick: Your insurance company may drop you like a hot potato. This denial of coverage definitely needs to change. In 2007, nearly 2/3 of all bankruptcies were due to medical bills- in 80% of those cases, the folks who filed had health insurance. (Himmelstein, D, E., et al, “Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, May 2009.)

6) Tort reform. Supposedly our legal climate forces doctors to practice defensive medicine. I say supposedly because it appears that doctors are acting more as a result of the fear of lawsuits than actual litigation. A new report in Business Week asserts that malpractice suits do not add appreciably to the costs of health care. According to the New York Times, frivolous lawsuits and huge jury awards are not burdening the system. Those who favor tort reform point to Texas as a successful model. While it's true that malpractice lawsuits, malpractice judgments, and liability insurance costs have all been lowered in Texas since the reforms were implemented (all good things), Texas still has some of the highest healthcare costs in the nation.

Will any meaningful change actually be made in this reform process? I somehow doubt it. The smoke and mirrors thrown at us so far fail to impress me. I don't pretend to have the answers myself, but I can clearly see that the House and the Senate have done nothing but kill trees with their 1000+ page bill. I am disappointed that Obama has taken a weak and waffling standpoint on the whole issue. He has backpedaled on the public option. And he didn't give any real direction to Congress- a group of folks who have probably the best health care plan in the country and therefore could care less about anything but the campaign contributions they get from Big Insurance and Big Pharma. The bottom line is that as long as healthcare has a profit motive, we will never see any meaningful improvement in costs or in quality. Since there doesn't seem to be any likelihood of making insurance companies non-profit entities, I'm betting that real reform is nothing but an illusion.


*The c-section issue is a double-whammy, because those women who can't get insurance due to a prior c-section also face hospital and physician policies "prohibiting" VBAC . Which means that many of those women will not only essentially be forced to undergo major surgery, but they'll also have to foot the entire bill, to the tune of $15,000 or more.

NYTimes Article: Froot Loops Are Health Food

Link to article

You may soon be seeing the new "Smart Choices" labels on products at your grocery store. Several manufacturers- such as Kellogg's, Kraft, and PepsiCo- have banded together to label certain products as "better for you" options. They formed a committee, including the dean of Tufts University school of nutrition and representatives of each the cooperating corporations, in order to decide which foods would meet their criteria to receive the Smart Choices green checkmark logo.

Now here's the problem. Can we honestly think that giant processed-food manufacturing companies are going to put consumers' best interests ahead of their own financial interests? I'm going to go with, "Uh, no."

So what foods have made the list? You can do a search online for products by brand or by category. It's rather amusing to look at the contradictions. All-Bran and Corn Pops are both Smart Choices? Or as the article points out, both regular AND "light" mayonnaise are Smart Choices too? So, according to the Smart Choices program, it seems there is no substantial nutritional difference between those products. Also included as a Smart Choice: Fruit Roll-Ups. Never mind that in a 14g serving, 7g is pure sugar. A Smart Choice can be made of 50% sugar? Seriously, did a group of 7 year olds put this list together?

By artificially enhancing a food with little to no nutritional value, manufacturers can slap a Smart Choice label on a product. (Coming soon to a store near you: Bacon! Now with added calcium!) And by doing this, they can still claim they are following federal nutrition guidelines. This is a complete scam on the American public and an insult to our intelligence. There's hope though: The FDA has written a letter to the Smart Choices program to put the committee on notice that they'll be facing regulatory scrutiny. Let's hope they're willing to put some muscle behind the criticism. No, it's not easy to altogether avoid processed foods. But as consumers we can learn to read nutrition labels and make better choices without some silly checkmark contrivance.

Medicated Moms

Today I read this article about a mother who decided antidepressants were the answer to her parenting stress. Her anecdote about the kids bickering in the backseat of the car is a story all too familiar- Been there, done that, got the t-shirt.

But... Since when is getting angry and yelling at your kids a condition requiring medication?

I absolutely believe that there are legitimate uses for antidepressant and antianxiety medications. There are people who wouldn't be able to get out of bed in the morning without them. But by all indications, use of these medicines has greatly increased. Some would say they are overprescribed- even the author acknowledges it:

"My doctor said he prescribes mood-enhancing medications about 10 times a week... My friend called her doctor to make an appointment and talk about going on Paxil. The nurse said she would just call the script into the pharmacy. No appointment necessary."

No appointment necessary? Are you kidding me? I had to make 3 calls to my doctor, begging her to call in a prescription for antibiotic eyedrops for pinkeye without seeing me first. Why are there doctors handing out powerful psychotropic medications like they are candy?

Here is my biggest problem with the author:

"Maybe moms like me should do more yoga, cut back our responsibilities, see a therapist, exercise more, put duct tape over our mouths every day after 5 p.m. Maybe we should do anything to avoid relying on drugs to become calmer, happier people."

She outright acknowledges that there may have been other (non-pharmacological) ways to handle her stress and anxiety, but did she bother to try them? No, she didn't. It's easier just to pop a pill. Antidepressants have well-documented side effects. As far as I know, yoga and therapy do not.

I reiterate the fact that there are many people for whom antidepressants are nothing short of a godsend. Yet I have to wonder if we, as a society, have come to view any negative emotion as a sign of a mood disorder. Or maybe it's that we think we can use a pill to cure just about anything. Or maybe [conspiratorial whisper] the pharmaceutical companies' marketing tactics have convinced us we are broken and need to be fixed.

And I Didn't Come In Last!

Aflac IronGirl Columbia Women’s Triathlon

Race Report

August 23, 2009

I have Cortney to blame or to thank for this race. She was the one who, fresh off her own first triathlon, said I could “totally do one.” I was in the first trimester of my pregnancy, so maybe it was pregnancy brain that made me think it would be a good idea to do a triathlon at three months postpartum. I registered and then basically forgot all about it for about 3 months. In January, I began taking a lap-swim class at the rec center. I built a lot of confidence in my swimming technique and endurance that way, even though I was the only pregnant woman in the pool. I was also able to continue teaching spin classes up until a few days before Becca was born. And that left only running.

Ah, running. The bane of my existence. I've tried to like running, truly I have. I have made several attempts to become a better runner, starting in high school when I thought I would die doing 10 laps around the courts at tennis practice. The thought of taking it up again with a baby bump was too much to bear, so I put off training for that until Becca was a few weeks old. And it was just as lousy as ever. I have friends who are Runners, yes, with a capital R. I just don’t know how they do it.

So I got a new bike, got some new running shoes, got a new swimsuit, and went about my business. I felt positive that I could tackle the swim, even though I’m not accustomed to open water swimming. I was consistently doing 1k in 23-24 minutes in the pool, without overly tiring myself. On the bike, I could tell that all the spin classes had actually paid off, giving me the endurance to take on longer rides. It was the run that plagued me. Even on “fresh” legs, I never did better than an 11 minute mile. And when I did my bike-run bricks, it was always a 12 minute mile. If you’re doing the math in your head, that is approximately a snail’s pace.

We arrived in Columbia, MD around 1 pm on Saturday. After getting the kids settled into naps, I went to pick up my race packet as well as some goodies from the expo and then over to the park to rack my bike. I didn’t realize how close together the bikes would be on the racks- only about 6 inches apart. Analyzing the space, I realized there wasn’t going to be much room to set up my gear. Luckily, I had a pretty decent spot, in one of the center rows and not far from the main aisle towards the T1 exit. I then walked down to the lake to see the swim course. The lake was as swampy and slimy as I’d imagined.

I also drove the bike course in the pouring rain, and realized it was very hilly, even more than the map had indicated. Up to that point, I was uncertain if I would race in my bike shoes, with feet clipped to the pedals, or in my running shoes. I am nervous riding with my feet attached to the pedals, especially since I’d fallen (twice) when I lost my balance and couldn’t unclip from the pedal in time to put my foot on the ground. But with the hilly terrain, I knew I’d need the added efficiency of the bike shoes, which allow me to pull upward on the pedal instead of just pressing down.

When I got back to the hotel, we all went out to dinner at Clyde’s, still in the pouring rain. I was concerned it would be raining during the race, or at least that the rain would go on long enough to leave the roads wet- and slippery- for the bike ride. Luckily, the rain stopped overnight and the pavement was nearly dry by 6 am on race day. I didn’t get much sleep on Saturday night, between thinking about the race, hotel staff moving trashcans around right outside our window at midnight, and multiple awakenings by Josh, who finally wound up sleeping in bed with Jordan.

My wake-up call was at 5:15. That gave me enough time to get dressed, eat breakfast, and pump a couple of bottles for Becca. Then I grabbed my transition bag and headed out to catch the shuttle bus. At the entrance to the park, I got my body marked and then headed down the muddy incline to the transition area. I arranged and rearranged my gear in the tiny patch of grass next to my bike, trying to figure out where to put it so it wouldn’t be in the way of someone else’s bike or gear. Soon they were calling out just a few minutes to the transition area closing, and I headed out to find Bob and Lauren while I waited for my swim wave to start.

After I met up with Bob and Lauren, we waited at the swim start for Jordan to arrive with the kids. I was in wave 10, so there was plenty of time to stand around and wait. Finally it was time to line up with my wave. I made small talk with a couple of the women standing nearby as we slowly waded into the green water. The bottom was sandy and slimy, and I could feel strings of some kind of seaweed brushing past my legs. “Ew!” I said to no one in particular, “I’m such a girl.” A couple of the women around me laughed. When the water became waist-deep, I decided to swim out closer to the starting line and tread water, rather than keep walking and risk finding out what other unpleasantries the murky depths had in store. I seeded myself near the back of the pack, not knowing how fast the others would be swimming. We counted down to the starting time, and at 1, I pushed the button to turn on my heart-rate monitor and then began my swim.

From land, the swim had seemed so long, much longer than 1k. I guess it’s hard to judge actual distance by doing laps in the pool. I told myself that it was no big deal, just keep moving forward. Though I had practiced sighting in the pool, doing it for real in water that literally didn’t allow me to see 6 inches in front of my face, was totally different. I had practiced primarily freestyle, knowing it would be the fastest stroke. That plan quickly got dumped for a mixture of freestyle and breaststroke in order to stay on course. I remembered to emphasize my arm strokes to save my legs from getting tired. As I rounded the first buoy, I saw a woman from a couple of waves ahead of me hanging on to it (allowed for resting). After the second buoy, I passed several women from the previous wave, which was encouraging. I kept going, drafting off a woman ahead of me for a little while, until she tired and slowed down. One buoy passed, and then another, and another, and suddenly a guy in a canoe said there was less than 300 yards left. Sweet! I plowed forward, rounded the final buoy, and headed for the swim exit. As I ran up the ramp, I glanced at my watch and saw I was in the 24 minute range. I happily ran up the hill to my bike, grabbing a cup of Gatorade on the way.

I got my helmet and shoes on pretty quickly, but fumbled around trying to get my bike off the rack. The bikes on either side of mine were still there, and I caught my handlebars on the front wheel of another bike. Frustrated, I ducked under the rack a couple of spots over where the rack was empty and dragged my bike out from the opposite side. Doing that ate up some time, unfortunately, but I hustled up the ramp out of the transition area and mounted my bike as fast as I could.

I felt good, if a little uncertain, as I pulled out on to the road. There weren’t too many people in front or back of me at that time. Soon a few riders came and passed me. As I started feeling more confident, I passed someone. And then someone else. As I sped up to pass someone at the crest of a small hill, another rider came up behind me and passed me, saying, “nice move!” as I passed the first rider. For awhile it seemed like I kept passing, and being passed by, the same handful of people. As we got to the first really big climb, I saw several women walking their bikes up the hill, some of them huffing pretty hard. I said a few words of encouragement as I rode past them. There were several other hills like that on the ride, with people walking their bikes, but I am proud that I didn’t dismount and walk even once- it was never so difficult that I was even tempted.

All along the way, women were talking to each other, cheering each other on, and cracking jokes. At the turnaround, I grabbed some Gatorade and kept going. I was surprised that I was not feeling tired. My legs would feel fatigued on the climbs, but as soon as I hit the downhills and the flats, they recovered quickly. Race volunteers and local residents were out on the course, clapping and cheering. As I sped along the home stretch, I felt fine, but started mentally preparing for the hardest part to come. Entering the park, I could see Jordan, Bob, Lauren, and the kids on the sidelines waving. I got off at the dismount area and jogged my bike back to the rack. It didn’t take me long to swap my helmet for my hat and my bike shoes for my sneakers, and I was off.

I jogged along the trail, oh so slowly, as other runners passed me. There were some people walking, but I didn’t want to give in. I made it about a mile and a half, forcing myself up the “Gatorade Hill,” but soon after had to walk a short stretch. I ran the turnaround and then had to make it back up Gatorade Hill. This second time I walked. I ran the downhill part, and then walked one more time for a couple of minutes before running it the rest of the way in. Although most of the course was fairly shady through the wooded areas of the park, the last half-mile or so of the trail was in full sun. I’d had plenty to drink, yet I could feel a little lightheadedness setting in. There was nothing to do but push myself through it. In the last stretch, I was able to use a final burst of energy to get myself into the finishing chute. I heard Jordan call my name and waved at him and Josh and Alex, then went on to cross the finish line.

My final time was 2:35:39, a little more than my goal of 2 ½ hours, but overall not a bad showing for a first-timer. (I did post a better time than the 79 year old woman at least!) Some great lessons learned… for next time? I have some clear ideas on what I could improve, so yes, I think there will be a next time.

What Color Is Your Pee?

Yes, that's right, I just asked you the color of your pee. Go ahead to the bathroom and check. I'll wait right here.

Done? Ok.

Urine color is a great indicator of your hydration, which is important even if your most strenuous activity is couch surfing. The U.S. Navy has a helpful chart to help you determine if you are sufficiently hydrated based on the color of your urine. How did you fare? As the chart notes, sometimes vitamin supplements can affect the color of your urine, particularly B vitamins, which tend to temporarily turn it neon yellow. If that's the case, you can check again in a couple of hours.

Severe dehydration is, of course, a serious condition, and can be fatal. Even mild dehydration can cause symptoms that many people would not associate with fluid loss, such as fatigue, headache, or irritability. Ever just feel "blah"? It could be mild dehydration!

How much fluid do we actually need? Well, the bad news is that it's probably more than you usually drink. The good news is that any liquid, not just water, counts towards your daily intake. Yes, even coffee. Even wine! In general, we need about two quarts of fluid a day- that's the legendary eight 8-0z. glasses of water. But that's just for starters. If you are spending time outside in hot weather, spending time at high altitude, ill, pregnant, or breastfeeding, you'll need to drink two to six cups more per day. And you'll definitely need to drink more during exercise.

The American College of Sports Medicine recommends a fluid replacement approach to hydration during exercise. If you weigh yourself before and after a workout, you can determine how much fluid you've lost. An ounce of water weighs 1 oz., so one pound of weight loss would be 16 oz. of fluid lost. Aim to consume at least that replacement amount during exercise, as well as taking in extra fluids before and after a workout. Unless you are exercising for upwards of an hour, plain water is sufficient for hydration. If you are training for more than an hour at a time, you should consider a sports drink for electrolyte and carbohydrate replacement.

It can be a PITA to make sure you're drinking enough each day. Hence the question, what color is your pee? If it is clear or pale yellow, you can be sure you are getting enough fluids. If not, think about carrying a water bottle with you or keeping a big cup on your desk at work. And the next time you're feeling "blah," reach for some water before you reach for some coffee or a snack-- You might just be dehydrated. Drink up and then go get your pee on!

"Duodecaplets" Are a Hoax

Fox News report

I, for one, am glad this turned out to be untrue.

"Dodecamom" Doesn't Have Quite The Same Ring To It

Tunisian Woman Poised to Give Birth to 12 Babies: Reports
(Also reported here.)

I guess we'll learn in the coming days if this is a true story or a hoax. Stories of "extreme fertility" really get under my skin. I understand wanting to have children. And I can certainly sympathize with those who are unable to get pregnant or stay pregnant. I know from friends who have suffered fertility problems and miscarriage that it is frustrating, heartbreaking, and overwhelming. But the higher the order of multiples, the higher the risk to both mother and babies. Why take chances with your own life, or the lives of the children you so desperately desire? And where are the medical ethics?

It is a known fact that multiple gestations are at greater risk for premature birth and the potential accompanying health problems. Does bleeding in the brain sound like a great start to life? Even with the availability of selective reduction, there are plenty of folks who object to such practice, and others who would reject it based on the fact that it potentially puts all the fetuses at risk. But let's go back even further, to the fertility doctors who create these high order multiples, because 12 spontaneously conceived babies would be so rare as to be impossible.

Several European countries already limit the number of embryos transferred during IVF. While I believe that the majority of fertility specialists practice ethically, perhaps it is time for the law to step in and keep everyone on the same page. Any thoughts?

Current Thoughts on H1N1 Influenza: "Swine Flu"

I've been following the news about the swine flu since it first started making headlines last spring. The media have repeatedly drawn our attention to the fact that the 1918 flu pandemic began much the same as the current one: With a mild version of the virus in spring and summer. And we all well know, by the fall of 1918, that strain turned suddenly deadly. It's difficult to escape drawing a very frightening parallel to the H1N1 strain making the rounds.

Although the government has been cautious about predicting the impact of swine flu this fall, the FDA is nonetheless putting the H1N1 vaccine on a fast track to approval. The call for the population to immunize may well happen before human clinical trials of the vaccine have been completed. And that, for me, is where things get very scary. Do I want to be in the position of being a guinea pig for a brand new vaccine? Do I want my children to be guinea pigs too?

The other concern I have with the H1N1 vaccine (aside from it being untested) is that it will be the first influenza vaccine to contain an adjuvant. A few other FDA-approved vaccines contain adjuvants, which help boost immune system response and allow less antigen to be included in the vaccine. That means the amount of antigen can be stretched to allow for more doses of the vaccine to be produced. And if you recall the flu vaccine shortage of 2004, this is a potentially fantastic development. But! The adjuvant in Glaxo's swine flu vaccine is not FDA approved, and while some clinical data exist from its use in Europe, it has not been studied here. More alarming: The government has made vaccinating pregnant women a priority, but the vaccine will go untested in pregnant women.

I am not anti-vaccination. I understand that vaccines are one of the most important medical developments of the modern era. My kids are fully vaccinated, with the exception of seasonal flu vaccines, mostly because those vaccines tend not to be highly effective due to strain mismatch. And (knock on wood) my kids have never had the flu despite being in daycare/preschool with dozens of other nose-picking little petri dishes like themselves. To my knowledge, I've only had the flu once, an unconfirmed case in 1999. I spent two days in bed, using copious amounts of NyQuil to maintain a semi-vegetative state until the worst had passed.

At present, H1N1 has not demonstrated itself to be any more virulent than any other strain of seasonal influenza. If the virus does not mutate into something more deadly, I have no plans to take part in what amounts to a mass clinical trial. If people start kicking the bucket left and right, however, I may be persuaded to get the vaccine. Let's not engage in mass hysteria and allow safety to fall by the wayside.