Researchers are working to better treat and monitor the high-risk pregnancy condition preeclampsia.
This week’s New Yorker features a fascinating piece on preeclampsia, a fairly common but little understood complication of pregnancy.
Preeclampsia, for those fortunate enough to have been spared it, is marked by high blood pressure and protein in the urine (swelling, weight gain, problems with vision and dizziness are also common symptoms). Women who suffer from it are often prescribed bed rest, but the only real cure is delivering the baby. It affects about 5 percent of pregnant women, and though most women in the United States and Europe receive appropriate treatment, contributing writer Jerome Groopman notes that the disorder “is among the most common causes of premature birth in the U.S.” and “is one of the leading causes of maternal death in the developing world.”
In the piece, Groopman, who’s a professor of medicine at Harvard, follows medical researcher Ananth Karumanchi’s quest to determine what causes preeclampsia. (Preeclampsia is known as “the disease of theories,” a prominent OB-GYN tells Groopman, because its cause is unknown.) Karumanchi discovers that women suffering from preeclampsia have elevated levels of the proteins soluble FLT and endolgin in their bloodstreams. These proteins bind to other proteins and prevent nourishment from reaching the endothelial cells that line the mother’s blood vessels. Bad for the mother, but good for the fetus; researchers theorize that “the fetus, by releasing soluble FLT into the mother’s bloodstream, causes her vessels to constrict, diverting blood to the placenta at the expense of her organs.” Karumanchi’s reasearch seems to indicate that an influx of certain other proteins can repair the damage done by soluble FLT and endolgin, and a commercial drug to treat preeclampsia using this method is in development.
That’s the quick and dirty version, and the full article is well worth reading. But some of Groopman’s and Karumanchi’s side observations about maternity and the medical industry deserve special note. Groopman observes that “among medical researchers, obstetrics is often regarded as a dead end,” because “when a pregnant woman takes a drug or undergoes a medical procedure, her fetus may be affected in ways that are difficult to measure or to predict … [and] a fetus cannot consent to participate in a study.” He notes that “pregnant women are understandably reluctant to volunteer to test new drugs and therapies,” and the medical community can also be reluctant. Karumanchi had trouble getting his research funded by the National Institutes of Health when his proposals dealt with pregnancy, but when he described his work as “focused on the effects of hypertension on the kidneys and made no mention of placentas or pregnant women,” he immediately got funding from the National Institute of Diabetes and Digestive and Kidney Diseases. It’s a knotty problem; no one wants to risk damaging fetuses, but that understandable reluctance may wind up compromising maternal health.
A similar conflict of interests plays out during pregnancy. If Karumanchi’s theory is correct, preeclampsia may be viewed as “an extreme version of maternal-fetal conflict,” Groopman writes. Evolutionary biology professor David Haig has written that “an infant’s prospects may be bleak if a mother dies, but children have survived without mothers. Thus, if childbirth threatens the lives of the baby and its mother, the baby may struggle for its own survival, even if that increases risk to the mother.” All the more reason for women to be able to choose whether to carry their pregnancies to term, I say.
Particularly since all pregnancies aren’t created equal. Research like Karumanchi’s will probably help doctors diagnose, monitor and treat preeclampsia, and that’s great news. But though doctors still aren’t entirely sure why some mothers get preeclampsia and some don’t, Karumanchi believes that “the underlying health of the mother’s blood vessels” likely plays a role. Women with diabetes, hypertension, kidney disease or abnormal clotting proteins, as well as women with genetic predispositions, may be more likely to get preeclampsia, and as of now, there’s no cure beyond bed rest. Here’s hoping researchers heed Karumanchi’s call for more testing: “Now is the moment; we’ve got to grab it and run with it,” he told Groopman. “My feeling is that it would be almost a crime not to try it.”
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Page Rockwell is Salon's editorial project manager. More Page Rockwell
Some thank the economy for a decline in teenagers giving birth, but contraception is the likelier savior
Teen births hit a record low last year, according to a CDC report released Tuesday, and the narrative quickly taking hold in the media is that we have the recession to thank. It’s a surprising idea, that teenagers are keeping it in their pants because a baby isn’t a prudent choice in the current economic environment. Foresight isn’t what we expect from those creatures of impulse — and, indeed, when is a baby a practical economic choice for a teen? It also struck me that the teen birth rate isn’t the same as the teen pregnancy rate, if you catch my drift (my drift being … abortion). I took my questions to a couple of experts in hopes of some clarity.
“The recession is everyone’s favorite causal explanation for things happening right now,” said Rachel Jones of the Guttmacher Institute. “Other than people conjecturing, there is no evidence that the recession has had a direct impact on teen sexual behaviors.” What we do know, however, is that contraceptive use increased among teens between 2007 and 2009. “We don’t know the reason for that increase,” she explains, and, in fact, it could be the recession — but, again, the truth is we just don’t know. Her no-nonsense take: “It seems if we want to look for reasons for patterns in teen birth rates, [birth control use] is the one indicator that offers us practical insights.”
Bill Albert of the National Campaign to Prevent Teen Pregnancy shared my initial skepticism about the economic explanation: “I just simply do not know many 16-year-olds who are thinking about bank statements when they hop in the sack.” But he pointed out that while roughly eight out of 10 teen pregnancies are unplanned, “there is a mushy middle ground [of teens who] say, ‘Well, yeah, I wouldn’t want to get pregnant, but it wouldn’t be the worst thing that happened.’” Call it the “mush” factor: Perhaps those ambivalent teens were swayed by firsthand experience of the economic meltdown: “Their parents might be struggling to make house payments,” he said. “They might know neighbors who have lost jobs and can’t find jobs.”
As for the question of whether a decrease in teen births might be linked to an increase in teen abortions, there is a bummer of a data lag: Guttmacher isn’t releasing 2008 stats on pregnancy terminations until early next year. However, says Albert, “if the past is prologue, the answer is probably no. What we have seen over the past two decades is that teen birth rates have gone down because the underlying pregnancy rate has gone down. Put another way, all three — pregnancy, abortion, birth — all tended to be going down at the same time.” Jones agrees: “Teen births and abortions seem to follow the same trajectory,” she said. “We haven’t seen any indicators that abortions have gone a different direction than births.”
You might recall that there was a troubling and unexplained rise in the teen birth rate in 2006 and 2007. Albert says the 2009 finding — which followed a 2008 decrease — suggests the uptick was “an abnormal blip” and that we’re now “resuming a nearly two decade trend toward fewer teen pregnancies and fewer births.” Inexplicably, some abstinence advocates think this report has “exonerated their approach,” reports the Washington Post. Valerie Huber of the National Abstinence Education Association told the paper, “This latest evidence shows that teen behaviors increasingly mirror the skills they are taught in a successful abstinence education program.” Except that … it doesn’t. Says Guttmacher’s Rachel Jones, “The levels of teen sexual activity haven’t changed, which would suggest that there isn’t more abstinence out there — but there was a change in contraceptive use.”
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Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory
The MSNBC host is back on Twitter with a response to his critics -- but he ignores their key complaint
Update: Olbermann has responded on Twitter by blocking me and tweeting, “Your article embarrasses you and your site.”
Back from his self-imposed Twitter timeout, Keith Olbermann is lashing out at his feminist critics. As Sady Doyle explained last week in Salon, the online protest was started in response to Michael Moore’s mischaracterization of the allegations against Julian Assange. Olbermann became a target after retweeting a link from Bianca Jagger that incorrectly claimed “the term ‘rape’ in Sweden includes consensual sex without a condom,” and that named Assange’s accuser (which is generally a journalistic no-no). Overwhelmed by the Twitter campaign, which was waged with the hashtag “mooreandme,” Olbermann quit the microblogging site in a huff. This afternoon, after a few days of calm reflection, he tweeted a link to his thoughts on the matter:
I endorse, sympathize with, and empathize with, the rape consciousness goals of #mooreandme, and have already apologized accordingly. But I cannot defend and will not accept their tactics which mirror so many of the attitudes and threats they fight. I do not know of what Julian Assange is guilty, if anything, and neither does anybody else. But given the extraordinary efforts by Sweden to extradite him, to say he is benefiting from some form of rape apologism is not fact-based. It is also unfair to condemn as anti-feminist those who merely address the juxtaposition of this prosecution to the fact that Assange threatens the secret and nefarious activities of dozens of governments.
But, of course, his antagonists are not condemning him for “merely address[ing] the juxtaposition” (a point Kate Harding made clear in her Salon piece about “the rush to smear Assange’s accuser”). They allege that he spread misinformation about the accusations against Assange. As Doyle wrote, “People trust journalists: If a journalist says something, like ‘the term “rape” in Sweden includes consensual sex without a condom’ (Olbermann’s own, demonstrably false, as-yet-unredacted words), most people will believe that what he has said is true, and act as if it is true, without doing further research.” The protest has consisted of frequent calls for Olbermann to issue a simple correction, to set the record straight for his many followers.
Instead of doing that, though, Olbermann continues: “And I will not engage those who suggest that those who do not prioritize one issue to the exclusion of all others should succumb to forced financial contributions, or should ‘kill themselves.’” He followed up by retweeting one of the messages in question, which read in part, “Seriously, kill yourself.” Then he retweeted a call for him to donate $20,000 to the anti-rape organization RAINN as atonement. His antagonists have been quick to point out that he cherry-picked the “kill yourself” tweet, which is an exception in the thread, and that the call for “financial contributions” is simply in the interest of rape victims. One user wrote, “we WILL NOT be satisfied UNTIL you retract the false information you publicized re: Assange allegations.” Olbermann responded, “you’ll have to accept a block instead.”
It seems Olbermann’s Twitter vacation didn’t help him to raise the level of discourse or realize that, as Doyle put it, his “style of old-media authority doesn’t hold up” online.
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Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory
NOW calls on the breast-obsessed chain to stop serving kids
The National Organization for Women is protesting Hooters. I know: Yawn. Next I’ll be interrupting major sporting events with breaking news that Gloria Steinem isn’t a fan of the “Girls Gone Wild” franchise. But, seriously, the argument at play here is more interesting than it at first seems. It isn’t the breast-obsessed chain’s existence that is being challenged, but rather the fact that Hooters serves children. Clearly, there is abundant evidence that Hooters is guilty of poor taste (see: restaurant name) — but should the chain be forced to card customers at the door and turn away anyone younger than 18? Several California chapters of NOW have filed official complaints alleging just that.
Hooters is described in official business filings as a provider of “vicarious sexual entertainment.” NOW points out that the chain has “used this designation as a way to avoid compliance with regulations against sexual discrimination in the workplace.” The official employment manual warns that a waitress is, as NOW paraphrases, “employed as a sexual entertainer and as part of her employment can expect to be subjected to various sexual jokes by customers and such potential contacts as buttocks slaps.” At the same time, however, Hooters is marketed as a family-friendly restaurant. It offers a kid’s menu, high chairs, booster seats and all sorts of merchandise for little tykes — like a “Life begins at Hooters” T-shirt, an “I’m a boob man” onesie and a “Your crib or mine?” bib.
We could argue over whether Hooters has a healthy impact on a kid’s developing view of women and sex, but I tend to think entertainment and dining decisions should be left up to individual parents. More important, that isn’t the issue at hand. In this case, NOW (which hasn’t always been a model of moderate thinking) has taken the exceedingly reasonable position that Hooters shouldn’t be allowed to have the best of both worlds: Either it functions exclusively as an adult venue, and continues to protect itself (somewhat) from sexual discrimination claims, or it’s held to the same standards as any ol’ family restaurant and gets to keep on serving the kiddies tater tots and creepy onesies.
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Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory
The question is raised after four female bodies are found on a Long Island beach
As New York confronts the possibility that there’s a serial killer on the loose, many have taken note that this case looks a lot like what we see in the movies: The victims are all women, and at least one is suspected to be a sex worker. When it comes to serial murder, it turns out fiction really does reflect reality. A report was released last month finding that 70 percent of known victims of serial killers are women (consider that only 22 percent of homicide victims in general are female); and it turns out sex workers are 18 times more likely than “normal” women to be murdered. Why might this be? Well, in the words of the Green River Killer, who targeted prostitutes:
I picked prostitutes as victims because they were easy to pick up without being noticed. I knew they would not be reported missing right away and might never be reported missing. I picked prostitutes because I thought I could kill as many of them as I wanted without getting caught.
Since they’re doing illegal work, sex workers have to be secretive and discreet. They often work in isolated and industrial areas. They get in cars with strangers. There are rarely detailed records of transactions. Many are drug addicts and estranged from their families, so they are less likely to be reported missing. Anyone who knows anything about a girl’s whereabouts is likely involved in the trade themselves, so they aren’t super eager to speak with police. What’s more, as we saw with the Robert Pickton case in Vancouver, police sometimes discount tips from working girls (all the more reason to not risk talking to them in the first place).
It just so happens that Friday is International Day to End Violence Against Sex Workers, which was created in memory of the victims of Gary Ridgeway, a.k.a the Green River Killer. Similar to the Pickton case, local sex workers knew Ridgeway’s identity, but, as prostitute-turned-performance artist Annie Sprinkle puts it, they “were afraid to come forward for fear of getting arrested, or the police didn’t believe those that did come forward, or the police didn’t seem to care.”
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Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory