Talk:Emergency contraception/Archive 3

message: "There is no evidence that direct access to ECPs without a prescription results in fewer unintended pregnancies than controlled access via prescription." Why not move this sentence to the section on efficacy or societal impact? It seems out of place in its current location (under "Legal/Ethical Controversies") as a summary of the political issues in the approval process. If the controversy is that the drug was approved in spite of an absence of efficacy data, that should probably get its own bullet point (i.e. separate from the political controversy) as well as a citation to someone raising that concern. MastCell 23:38, 7 November 2006 (UTC)
replies: text: Sure... If you have some of the relevant cites, go for it. Otherwise I'll get around to digging through my old NEJM's. It might make sense to split the political controversy and the medical issues into 2 separate bullet points. MastCell 06:12, 8 November 2006 (UTC)
thread_title:  "No direct evidence" 

message: "No formal studies have evaluated the effect of race. However, clinical trials demonstrated a higher pregnancy rate in the Chinese population with both Plan B and the Yuzpe regimen (another form of emergency contraception consisting of two doses of ethinyl estradiol 0.1 mg + levonorgestrel 0.5 mg). The reason for this apparent increase in the pregnancy rate of emergency contraceptives in Chinese women is unknown."
I'm confused--is this/the reason for stating this in the prescribing info explained more anywhere else?  A search of Cochrane database only reports that most of the efficacy trials took place in China, not a difference between progestin pharmokinetics in Asian/Chinese women and other women. (Most recent research on DMPA pharmokinetics and Asian women is that there is no difference between Asian/Caucasian...) But, I am not a progestin-pharmokinetics-by-race expert...
Cindery 01:57, 9 November 2006 (UTC)
thread_title: Plan B and race in prescribing info

message: ...epidemiological comparisons between EC use + abortion rate different from randomized controlled trial of individual users. 
Cindery 03:17, 10 November 2006 (UTC)
replies: text: Sure, but they both support the point Glasier was making. In general, it's most useful to have primary study data first, then an expert/editorialist summarizing "what it means". This improves readability for the general reader. MastCell 19:52, 10 November 2006 (UTC)
thread_title: differences among studies in abortion rates section

message: This section references many nonsci sources, and rightfully so--it's not strictly about the medical aspects of EC.  "Pop sources should be avoided" not "never used"--the important thing is to evaluate them/when and where they used. In this case, the source situates/contextualizes the significance of the study socially-what did people say about it? at what time did it occur in the history of events being discussed? what did the study researchers say about it?  It's an extremely useful source for the reader in this context.
Cindery 20:09, 10 November 2006 (UTC)
replies: text: The text writes "A study showed...", then a link to the study. Fine. Then there's also a link to the Wsh Times. There's nothing in the text about interpretations of the study (and the WA Times is hardly a non-partisan source). It's fine to include WA Times as a source, but it needs to be clear we're citing the WA Times, and not the study in question. The text doesn't make that clear, and the WA Times article added little to what was already there. Ideally, regardless of what's done elsewhere, we should "avoid citing the popular press" per WP:RS; since the WA Times article doesn't add to what's stated in the article text, it's a perfect time to avoid citing it. MastCell 20:20, 10 November 2006 (UTC)

text: I'm not arguing that the Wa Times article is misleading; I'm saying that it adds nothing in terms of verifiability to the sentence in question, and pushes the limits of WP:RS. If we approach this article with the goal of getting it to featured-article quality (which I think is a worthy goal for any article one works on), then the sources need to be tightened up to accord with WP:RS; that will be one of the first issues in the process. I have no problem citing newspapers on sociopolitical issues, or if there's no alternative when describing a study. However, if the sentence is a straight description of a study, and we've already referenced the study in question, then a popular-press source is both superfluous and discouraged by WP policy. MastCell 22:16, 10 November 2006 (UTC)
replies: text: Yes, but the other news sources are used for current events. The sentence in question is the only one in which a news source is quoted as the citation for a medical study. Leaving aside my comprehension of WP:RS, and some significant issues on this page with WP:OWN, the problem is simple: the paragraph discusses the political controversy (i.e. the role of a pro-life constituency on the approval process, testimony that the decision to reject was made before the scientific analysis was even performed). The sentence in question, about the Raine study, is out of place. There could well be another paragraph about scientific controversy related to OTC approval, where said study would fit right in. I agree readers won't understand why the study is mentioned there; we should either improve the prose of the article to make that clearer, or (my preference) move it to a new section (on scientific controversy over OTC status) where it would be more at home. MastCell 01:22, 11 November 2006 (UTC)

text: What's lacking is any indication, in the article paragraph, of how the study in question bears on the political approval controversy. MastCell 01:44, 11 November 2006 (UTC)
thread_title: Wash times

message: ...that's where i remember the 24% from: 24% is the per-month/per-cycle pregnancy rate for random acts of intercourse, per Barret and Marshall in 1969. (Still, as Lyrl pointed out, the comparison between EC use once with unknown number of acts of intercourse is difficult comparison to make to intercourse-all-month with unknown number of acts. But, if you have random unprotected sex all month, there's a 24% risk of pregnancy. If you have random unprotected sex all month and used EC after every time, the risk would be greater than 24%. If you had unprotected sex all month and only used EC once at midcycle, the risk is 25%.
The user directions/fertility calculations still need to be included /addressed somewhere, I'm just not sure where. I did find American Assn of Pediatricians article which gives what I am guessing is the argument Lyrl was referring to--it says, more or less, midcycle fertility should be calculated into decision to take EC, but if date of LMP is unknown --and because date of ovulation can vary from person to person and cycle to cycle--there can be a risk of pregnancy any day. (But there's a big diff between "take after unprotected intercourse" and that...)
Cindery 20:38, 10 November 2006 (UTC)
thread_title: barret and marshall

message: "Dr. John Jenkins, head of the FDA's Office of New Drugs, testified under oath than FDA Commissioner Mark McClellan had decided to reject the OTC application before the scientific analysis had been completed."  
*we already have one example that makes the point that the center for reproductive rights/pro-choice side believes the FDA was influenced; one is enough
*there's mcclellan's rebuttal, which would make this way too long, but must be included (and inclusion would weaken/drown in wordiness a clear point about woodcock)--mclellan's rebuttal is a) that he did consider the scientific evidence b) that he left before the decision was made.
*this clutters the paragraph with names that aren't familiar to a lot of people, and it isn't a cross section of the most important names that could be mentioned (makes no sense to mention mclellan but not galson or eschenbach...)
* all depositions are sworn under oath--that's what a depostion is, and there's a wikilink to depostition already.
Cindery 01:57, 11 November 2006 (UTC)
replies: text: I've shortened it, removed names, etc. There are two separate but related issues: decisions made before the scientific review, and the basis for that decision being a specific political agenda, so I've tried to condense it. MastCell 02:14, 11 November 2006 (UTC)
thread_title: too much information

message: I'm not sure how to put this in a way so as not to offend, given our history, but I think there are significant ownership issues with this page, and it would be worthwhile to review WP:OWN. Specifically, characteristics of ownership include the following:
*Minor edits concerning layout, image use, and wording are disputed on a daily basis by one editor
*The owner may patronize other editors, claiming that their ideas are interesting but that they lack the deep understanding of the article necessary to edit it
The article will only benefit by being open to other editors besides myself and Cindery. Although we probably both have a vision for how the page "should" look, it would probably be helpful to encourage more input from other editors, and to be a little less defensive and more open to ways in which the article can be altered/improved. This will be a necessity if the article is ever to reach featured-article quality. MastCell 02:12, 11 November 2006 (UTC)
replies: text: I have no problem with putting in Janet Woodcock's response, nor have I ever removed it or any other content that states Janet Woodcock's side. I agree it improves and balances the section, and I thank you for adding it. As far as being "excessively argumentative", I've made a few relatively minor changes to the article recently (reorder Glasier quote, re-added info on approval controversy with an updated source, removed non-RS citation), all of which have been immediately reverted by you. I think this article needs more editors; articles edited as a back-and-forth between only two editors are suboptimal (and run the risk of becoming argumentative). Articles owned entirely by one editor, in which all other editors have been essentially driven off, are often even worse. That's all I'm getting at. MastCell 03:05, 11 November 2006 (UTC)
replies: text: I know Cindery doesn't want to hear this from me, but it is way too hard for me to keep track of all the changes with the history page blown up with dozens and dozens of minor and major changes mixed together over the past few days. I would suggest maybe using an external word processor to work up a new version, and makeonly a few edits at a time, not roughly 150 edits over the course of 10 days between basically 2 editors. My two cents on this issue generally. I haven't really been able to keep up with the specific conflicts because of this. Maybe that is my fault, but I know I am not alone in being a wikipedian-against-countless-edits-in-a-row.--Andrew c 03:30, 11 November 2006 (UTC)
replies: text: I'm waiting for Cindery to wind down on the edits.  I intend to continue to contribute to this article, but am not in a state of mind to maintain the level of energy necessary to co-edit with Cindery when she is on a mission.  I haven't even looked at the article in about a week (though I read this Talk page); I don't want to get myself wound up over any changes I might disagree with.  I kindof agree with MastCell on the ownership thing, and definitely with Andrew on how difficult it would be to try to follow the edits as they occur.  But from past experience with Cindery I believe this is a temporary phenomenon, and that over the next few weeks this article will become more welcoming to other editors. In the end, the article will be better off because of this intense editing episode. See also eventualism.  Lyrl    Talk     Contribs   03:39, 11 November 2006 (UTC)

text: Re the Glasier edit, I didn't add or delete a word, just switched the order of two parts... i.e. a "minor edit concerning layout", which was immediately reverted. I've repeatedly said I feel this article could use more input from others besides me & Cindery; I'm not sure how this equates to "making other editors want to stay away". There are clearly other interested editors (Lyrl, Andrew c, David Ruben for instance). About the FDA stuff, I'm not citing a "partisan lawsuit". I'm citing sworn testimony, as reported by Reuters. It doesn't get much more reliable than that, given the threat of perjury. About Woodcock's statement, you first said the paragraph was too long and mentioned too many names. So I boiled it down to remove names and shorten it, and now am being accused of pushing a POV. I'm happy to try to reinsert McClellan's/Woodcock's testimony, but casting its removal as me trying to push an anti-FDA POV is inaccurate. MastCell 17:10, 11 November 2006 (UTC)
replies: text: Sigh. Instead of addressing the accusations of slander, and the assertion that I don't know what I'm talking about (I'm used to that one by now), I'll just say that I think your version looks fine and I'm happy with it. MastCell 20:17, 11 November 2006 (UTC)

text: Sigh. Instead of addressing the repeated accusations of slander, libel, POV violations, "false light", etc, your condescending tone, or the assertion that I don't know what I'm talking about (I'm used to that one by now), I'll just say that I think your version looks fine and I'm happy with it. MastCell 01:14, 12 November 2006 (UTC)

text: Since we agree on the content of the section in question, and you've reinforced the ownership issues I mentioned, I was going to let you take your last condescending shot at me and move on, but since you've seen fit to raise the specter of legal action, let me say this: I wrote here that "In the depositions, senior FDA officials testified under oath that the decision to reject the OTC application was made even before the scientific analysis was complete, and that they were told the application had to be rejected "to appease the administration's constituents", but that it could be approved later." This is a true statement. I'm not a lawyer, but I'm not aware of any jurisdiction in the U.S. where a true statement can be grounds for defamation. Truth is generally an absolute defence against libel, "fair report" notwithstanding. Again, I'm not a lawyer, but I think you should really be more careful about slinging legal accusations against people you're having a conflict with. MastCell 18:27, 12 November 2006 (UTC)
thread_title:  Ownership 

message: Perhaps what is/was confusing for you is that you don't understand/I haven't adequately explained that Reuters' defense to publishing accusations made in depositions is not "truth"--they do not investigate the truth or falsehood of accusations; the exemption to the truth defense required for libel defense newspapers claim is the fair/neutral report exemption. So if you reproduce deposition accusations from a newspaper source, in order to piggyback on their neutral report exemption, you have to adopt it/reproduce that as well. The fair/neutral report exemption can exempt sources from liability for the truth or falsehood of accusations, which allows them to report that accusations were made without liability for whether or not the accusations are true, as long as the reports are unbiased, complete, do nothing to assert the accusations as true, but merely report on them, etc. If the report is not "fair and balanced," the exemption can be challenged/denied and the source then becomes liable for proving that the accusations are true/the source can be liable for defamation. In ongoing litigation, it would be impossible for Reuter's to prove that any accusations were true, as the courts have not ruled on the case yet, so reports can only be made under the fair/neutral report exemption/there is no possible "truth" exemption to be made. In short, the fair/neutral report exemption is specifically an exemption to the truth requirement viz libel defense. As long as reports are neutral/balanced, unproven accusations can be repeated and the source is not likely to be sued. If the report does not meet the standards of fair/neutral, it is no longer exempted from the requirement that it must be be true in order not to be libelous. Below are layman's descriptions of the requirements a report must meet in order to claim the truth exemption (not a libel exemption--the order would go, truth is a defense to libel, and fair report is an exemption to truth). (Note that "accurate" does not equal "true"--accurate would apply to attribution of a quote to a speaker and no other party, etc. Attributed to the "official record" means in the text of a deposition or the recorded minutes of a meeting, etc.)
Fair report or reporter’s privilege 
Fair report or reporter’s privilege protects reports of official government proceedings & records if the reports are:
          1. accurate
          2. fair or balanced
          3. substantially complete
          4. not motivated by malice
Courts in some states have said the report must be attributed to the official record or meeting for privilege to apply. 
 
First Amendment protection for neutral reportage of controversial charges 
The charges must be:
    1. newsworthy and related to a public controversy,
    2. made by a responsible person or organization,
    3. made against a public official or public figure,
    4. accurately reported with opposing views, AND
    5. reported impartially. 
Cindery 03:17, 13 November 2006 (UTC)
thread_title: fair/neutral report privilege

message: In the US, it seems clear that EC was used primarily for rape victims, and that EC equalled DES.
This tell us that a physician advisory was sent in late 70s, informing physicians that "Use of DES as postcoital contraception should be limited to situations where the fully informed patient or her physician deems that there is no alternative."   Meaning, it was in use as EC after it was banned in 1975.
This tell us that "DES is still approved for post-coital contraception in rape" as of 1985.   Meaning, in spite of the known existence of Yuzpe, DES was the standard treatment. Likely because it was believed to be more effective than Yuzpe. (Although inflated Yuzpe stats were believed then also, though DES was still believed more effective--it still doesn't completely make sense...unless "no alternative" was judged to mean "no slighly less effective alternative.")
This German study tells us that mid-80s, DES was believed to have failure rate of .07, consistent with the pre-Silvestre stats/belief  
Cindery 22:02, 14 November 2006 (UTC)
thread_title: DES and rape

message: ...and the obvious answer to why would Lilly continue to manufacture it until 1997 if it was banned in 1975? --is that Clinton passed resolution regarding pharmacy-compounding of banned drugs in 1997:   That would mean use of DES as EC after 1975 wasn't off-label, as the drug wasn't approved for any use and couldn't therefore be used off-label for another. Pharmacy compunding was the loophole. If a smaller manufacturer(s) is still making it, that would explain why it might still be available (but is still not approved for use, or even for pharmacy-compound use).
Cindery 22:18, 14 November 2006 (UTC)
thread_title: mysteries of compounding

message: I have corrected the erroneous assertion that DES was only used in cases of rape or incest--we already have a source which says it was used on college campuses, and the Pediatrics source which does not specify rape/incest only.  
Also: DES was not withdrawn in 1971--1971 is when it became well-known that it was carcinogenic. It was not removed from the market until 1975 (source--FDA--is included above--the 1997 docket lists DES, and the year it was withdrawn: 1975). 
More research should be done to get exact dates/frequency of use, but it is clear per the 1985 pediatrics source that it was a first line treatment, believed to be more effective than combined hormones, and that should be indicated in article. The rape victim source is RS, and American. (As I mentioned, the source names the morning after pill as DES, not the case.)  Further research needs to be done on this, and re Europe and the rest of the world for dates/use as first line treatment...
I'm not sure what POV issues you see here--I didn't know much about DES as EC except that it was the first, in 1973.  You seem to have a POV issue in that you believed it was not used after it was known to be carcinogenic (and clearly it was). The original statement "DES use gradually decreased long after it was known to be carcinogenic"--per the source I cited--is in fact the case: use as first-line treatment in 1985 is 14 years after it was known to be carcinogenic...that Lilly stopped making it in 1997--same year that Yuzpe was endorsed by the FDA, and banned drugs like DES were prohibited from pharmacy compounds-- appears to be not at all a misleading cap year for gradual use decline.
Cindery 07:14, 15 November 2006 (UTC)
replies: text: Actually, what I wrote was that DES was withdrawn for use in pregnant women by the FDA in 1971, which is correct. Use as EC was considered separately - clearly a mistake in hindsight. I see the FDA source you're referring to ("NDA withdrawn 1975"), but I'm not clear at all that the FDA actually withdrew the drug. If that had happened, it would no longer be available at all (except through compounding pharmacies), whereas it seems it was still widely used after 1975 and produced by a major pharmaceutical firm -- these things would not be the case if the drug was actually withdrawn from market by the FDA. I'm not clear on what the implications of rescinding the NDA are, but it seems clear that DES was still on the market after 1975 - and the DeMarco article (), from 1992, clearly states that "The FDA had not withdrawn its approval of DES for this purpose [EC]." MastCell 20:57, 15 November 2006 (UTC)

text: Also, it might be worth double-checking the references you've added - some of them appear broken (probably just a minor typo). I fix them myself when I can, but given how quickly this page changes it's probably best that you do it. MastCell 21:01, 15 November 2006 (UTC)
thread_title: factual errors

message: No, DES was approved for EC after it was known to be carcinogenic in humans. The rodent studies were in the 30s--DES was approved for use in humans in 1949, when it was known to be carcinogenic in rodents. In 1971, the Boston doctors discovered the cluster of cancer cases in DES daughters and made the connection--a generation later. Cancer in humans=1971. DES approved as EC=1973. Here is a reader-friendly timeline, from ITVS, which is part of PBS:  Part of ongoing confusion is that it is not well known that DES was used as EC at all, and it was used by far fewer women for Ec than it was used by women to "prevent miscarriage" for 20+ years.  When it was discovered to be completely ineffective for preventing miscarriages--a separate discovery from the fact that it is carcinogenic--it was promoted as EC.)  The FDA remains the ultimate reliable source on when it withdrew DES: 1975. It just says, all doses of 25mg. Unless you can show that the FDA withdrew it for one purpose only, it was withdrawn by FDA in 1975. An advisorywas sent re cancer in 1971, but it wasn't withdrawn. I'm saying: yes, it appears pharmacy compounding was the loophole; Lilly dumped it when that loophole was closed. I think it merits more research, and probably contacting NIH/NCI, which received fed funding in 1992 to study/follow up on DES (a fact we can thank Ted Kennedy for; it was his legislation :-), and the two main DES action centers--one in Toronto, one in CA, as they may know where to find more sources.
Cindery 21:10, 15 November 2006 (UTC)
replies: text: This is not so much a "factual error"; as a misunderstanding. You wrote, "DES was approved in spite of its known carcinogenic effects". I took this to mean approved by the FDA in general, while you meant approved specifically as EC. Easy enough to clarify. I'll look into the NDA issue more; it doesn't compute that on one hand, we're saying the drug was "withdrawn by the FDA" in 1975, while it was also "widely used" into the 1980's. MastCell 22:19, 15 November 2006 (UTC)

text: OK. I'm not sure if your incivility is an attempt to provoke a reaction, or simply a personality trait, but please... I read the source carefully and I'm familiar with the use of DES in pregnancy vs. as EC. I explained where this misunderstanding came from, and how it could potentially be addressed, in what I presumed was a reasonably civil manner. You apparently refuse to see this as a misunderstanding and insist on accusing me of willful ignorance, failure to read sources, failure to understand something you've "repeatedly explained" to me, and "hasty editing". Hasty edits? I make a few edits/day, at most, to this page, and my edits have the lifespan of a sickly mayfly before they're reverted. I'm all for discussing controversial issues here, but I'm also not required to get the Cindery stamp of approval on the talk page prior to each edit. Such a presumption is a further indication of the significant ownership issues that affect this page. MastCell 23:05, 15 November 2006 (UTC)

text: Suggesting that I run around adding "factually incorrect" edits is not only incorrect but uncivil. What you're calling "factually incorrect" has to do with our different interpretations of sources, a misunderstanding based on the text (explained above), and a misreading on your part ("withdrawn for use in pregnant women", see above). These things all happen when people edit; the problem here is that they're being cast as willful ignorance on my part. If you consider your comments to exemplify "constructive criticism", we must have very different understandings of the concept. I've learned a lot from the sources you've cited, and this article is immeasurably better as a result of your edits. However, it's exhausting to try to edit with someone while constantly fending off accusations of inserting factually incorrect material every time we disagree about content. I won't even get into the issue of your massive expansion of the DES section, only to have my half-sentence sourced addition reverted as violating "summary style". I think this article needs more editors, but it's hard to make that happen when every content issue blows up into this kind of thing. MastCell 23:57, 15 November 2006 (UTC)
replies: text: OK. First of all, I wrote that DES was withdrawn for use in pregnant women (not as EC) in 1971, which is factually 100% correct; the fact that you misread this doesn't mean I made a factual error. Second, you wrote DES "was approved in spite of its known carcinogenicity". I explained at length that I took this to mean approved by the FDA, whereas you meant approved as EC - this is a misunderstanding, not a factual error. Finally, some sources say DES was to be used only in cases of rape or incest, others suggest it was "widely used"... again, a bit of a gray area. I say this not to score points, but because you persistently jump to the conclusion that I'm making "factual errors" left and right, and that I'm sloppy and ignorant. We're trying to edit this article together, and misinterpreting these kind of things as "factual errors" and attacking me for them is totally unproductive. If you find yourself busy cataloging what you believe to be "factual errors", and unable to assume good faith and discuss these differences without resorting to incivility and condescension, then perhaps it's time to disengage for awhile. MastCell 18:07, 16 November 2006 (UTC)

text: I agree that this talk page isn't really the place for this discussion. I initially responded to your "Factually incorrect" heading in the interest of explaining that it was a misunderstanding, so that you didn't think I was trying to be difficult. I then raised the other issue (miscasting my edits as based on sloppiness/ignorance, and then repeating this bad-faith interpretation to justify your actions) because it contributes to the difficulty in getting more editors involved on this page. I'm not sure exactly what you mean by "involving an admin", but outside scrutiny/input would probably help break the cycle we're in here. I'll be the first to admit that this isn't my finest hour, but then I think both of our records on Wikipedia speak for themselves. MastCell 23:06, 16 November 2006 (UTC)

text: OK. I'm not sure if your incivility is an attempt to provoke a reaction, or simply a personality trait, but please... I read the source carefully and I'm familiar with the use of DES in pregnancy vs. as EC. I explained where this misunderstanding came from, and how it could potentially be addressed, in what I presumed was a reasonably civil manner. You apparently refuse to see this as a misunderstanding and insist on accusing me of willful ignorance, failure to read sources, failure to understand something you've "repeatedly explained" to me, and "hasty editing". Hasty edits? I make a few edits/day, at most, to this page, and my edits have the lifespan of a sickly mayfly before they're reverted. I'm all for discussing controversial issues here, but I'm also not required to get the Cindery stamp of approval on the talk page prior to each edit. Such a presumption is a further indication of the significant ownership issues that affect this page. MastCell 23:05, 15 November 2006 (UTC)
replies: text: You're right, it's time to let this non-productive thread die. As far as what you consider my "harrassing" comments on your talk page, personal attacks, etc, as I said, I think both of our records on Wikipedia speak for themselves. MastCell 18:15, 17 November 2006 (UTC)
thread_title: another factual error

message: I put in the exact wording, because that is the exact wording used in abstract. Abstract doesn't specifically say, "stilbestrol no longer used as EC in US," it says "stilbestrol no longer in use in US."  The whole article is mostly reliable only as a relic of erroneous beliefs held about EC in 1990--that DES was more than 99% effective, that Yuzpe was 98% effective, that Danazol was effective at all...and since it is full of what we now know to be errors, and until more exact dates can be located, the two sources, one American and one European, should reflect what they actually say. (Personally, I think saying anything other than it was first line treatment as of 1985 in US, and use gradually declined after that; efficacy was recalculated for Yuzpe and Yuzpe was approved in 1997, when Lilly also dumped DES, is probably a bad idea--it is not necessarily true that the date is not known, it is only true that we don't know it. What we have is two sources, one full of errors, the other referring to "the morning after pill" as DES in a 1990 article--neither is conclusive evidence, which may exist. Also, both are pubmed abstracts, not necessarily the wording used by original authors. If both are wrong, it would not be the first time a pubmed abstract didn't use wording used/peer-reviewed by authors. (The pubmed summary of the Silvestre meta-analysis is particlarly misleading--one must read the whole study to "get it," and the pubmed "conclusion" is so misleading as to be completely wrong; give the opposite conclusion of the study.) Your impatience to contradict the source which implies it was in use to some degree in US until 1997 may not really be serving the article; and it may have been in last legs of it use after 1997 (though it seems unlikely, since Lilly stopped making it in 1997; Yuzpe was approved in 1997.)
Cindery 21:49, 15 November 2006 (UTC)
replies: text: Poor Glasier. Saying her paper is "full of errors" is misleading; in reality, it accurately represented the state of knowledge in 1990. We now know more, and the paper's stats on efficacy have been superceded by more up-to-date and robust information; that's how science works. However, simply because the scientific conclusions of the study, while reasonable in 1990, are now out of date, does not logically imply that a statement such as "DES is no longer used in the U.S." is inaccurate. That's not something that will change with more research. Implying that everything in the paper is de facto suspect simply because the state of knowledge has advanced since 1990 is a legalistic fallacy. In fact, her paper remains the only source to definitively address the issue of when DES stopped being used. Attempts to undermine its credibility in that respect, based on the fact that newer studies have superceded Glasier's efficacy calculations, don't seem relevant. If your argument is that the PubMed citation for Glasier is factually incorrect, please provide more details... but in the absence of such details, PubMed's citation is a reliable source. MastCell 22:53, 15 November 2006 (UTC)
replies: text: I'm sorry... why is "stilbestrol" in quotes? What point are we trying to make? It's a Briticism for DES. Putting in quotes serves only to confuse the meaning of the sentence. MastCell 00:00, 16 November 2006 (UTC)

text: Yes, but we summarize the content of articles all the time. Putting quotes around the term implies there's something different about it, and it simply confuses any reader who's not intimately familiar with the naming system of DES. We don't use pick-and-choose terms elsewhere when quoting studies. It's a matter of clarity, and I'm not clear why this study is any different, although I realize you disagree with its conclusions about time period of DES use. MastCell 00:11, 16 November 2006 (UTC)
replies: text: I've never heard of an unequivocal statement ("DES... no longer used in the U.S.") in a peer-reviewed journal, as cited on PubMed, being declared an "unreliable" source for Wikipedia purposes out of hand. If you really believe that the paper doesn't meet WP:RS criteria, I think we should get a 3rd opinion. I'm happy to pull the actual paper next time I make it to the library, but it might be a while. Until then, I don't see how a blanket impeachment of the PubMed indexing system, or the fact that the state of medical knowledge has evolved since 1990, can override what is a very explicit Wikipedia policy. MastCell 00:44, 16 November 2006 (UTC)

text: I agree more research is needed, and I will pull the paper next time I'm at the university library (my current locale doesn't carry the journal in question). I'm also fine with removing the entire speculation until we get the actual article text. As far as paternalistically "protecting" the reader from the out-of-date info in Glasier's paper, I don't think that's a reasonable justification for excluding it as a source. If a reader manages to slog through the article and is browsing the footnotes, they'll have had ample information about the state of knowledge on EC effectiveness, and how it has evolved. Of course a 3rd opinion is non-binding, but since it's just the 2 of us going back and forth on a policy point (WP:RS), the perspective might be helpful. We can table that until we retrieve Glasier's actual article text, though. MastCell 19:54, 16 November 2006 (UTC)
thread_title: "stilbestrol"

message: I am going to begin a comparative cancer section, beginning with what is known (and not known) about levonorgestrel and breast cancer. All info positive/negative about levo, and combined synthetic hormones used in EC should go in section, I think; as well as belief that because use of EC is such limited exposure, exposure not considered as risky as long-term exposure (or, presumably, as beneficial). This is also where fact of no studies of long term impact of high doses or repeat high doses should go...?
Cindery 21:50, 15 November 2006 (UTC)
replies: text: Don't you think that information should go in the articles about the individual drugs? Remember we had the huge list of side effects over at hormonal contraception because that term is an umbrella term? I believe the same reasoning should apply here. This article is not about a specific drug, but a number of drugs used for a similar end result.--Andrew c 22:02, 15 November 2006 (UTC)

text: We've covered a similar conflict like this in the past. I think it is original research to dig through journals and publish "what risks may exist in spite of..." If this information isn't mentioned on the product label, and hasn't raised flags from the FDA or any other regulatory group, I do not believe it is our place to suggest that these possible, hypothetical, and otherwise unknown (to the FDA and drug companies) risks still exist. But maybe I am assuming things about exactly what you want in the article (if that is the case, I apologize). I agree that a bit of the information you suggested could be included. I just think it is also important to make it concise and to the point, and allow the more detailed information to exist in the specific drug articles.--Andrew c 22:39, 15 November 2006 (UTC)
thread_title: Cancer

message: Now might be a good time for you to read up on the Wiki guidelines regarding systemic bias. One of the biggest systemic biases is US-centricity. The history of the availability of DES in the US is not the same as the history of DES in the world/history in general. The FDA and the NIH do not apply to any other country. (As I mentioned before, more research needs to be done re Europe and the rest of the world re DES. My research so far indicates that DES is still being used as EC in St. Croix, and that it was used less in parts of Europe in the mid-80s than it was in US, because Denmark, for example. approved PC4 in mid-80s, along with UK...) Long before an article can be considered for "featured" status, a simple "request for feedback" will address basic errors like systemic bias/US-centricity...
Cindery 00:45, 16 November 2006 (UTC)
replies: text: Those are all valid points. However, as Lyrl pointed out, moving the DES stuff to the history section doesn't mean the section is complete. It's a start; at least it will be in the appropriate section. The History section can be expanded and sub-categorized as we accumulate more info about other countries. The question isn't so much whether the DES paragraph, as currently written, is the final word on "History". It's a question of where this type of information belongs, and I agree with Lyrl that the "History" section seems most appropriate. MastCell 01:05, 16 November 2006 (UTC)

text: There is nothing preventing us from putting country specific subsections in the history section.  I have never before heard the argument that something titled "history" is mistitled if it goes into depth on the subject it covers.  I thought history was anything - specific or broad - that happened in the past?  If so, history of ECP availability is a perfectly appropriate either as a subtopic or integrated into ECP development history. I still believe it is misleading to talk about drugs that are not actually available in the "availability" section, and oppose that use of the section. Lyrl    Talk     Contribs   22:57, 16 November 2006 (UTC)
thread_title: systemic bias

message: According to Thompson/Micromedex, the AMA recommended DES "only for emergencies such as rape or incest" in 1990, which is certainly some indication taht it was still used in US in 1990. 
Cindery 02:27, 16 November 2006 (UTC)
thread_title: AMA/1990

message: Actually, maybe it shouldn't be abbreviated--it does a good job of explaining the current estrogen-progestin hypothesis, and why 1) futher study is needed--there's not much data on progestins 2)e-p viz breast cancer is a speculative hypothesis and what that means/hormonal interplay complex 3) it provides info that applies to levo and yuzpe.  It should probably be modified to reflect more than one source, though.
Cindery 02:00, 17 November 2006 (UTC)
replies: text: I still think the Emergency contraception article is not the place for the debate to take up space. Go to the individual drug articles, or at the very least the parent article, hormonal contraception. --Andrew c 02:12, 17 November 2006 (UTC)

text: There is not reason to even suspect EC as a leading cause of breast cancer.  Or other hormonal contraceptives, for that matter, despite the known risk increse caused by ongoing combined hormonal contraception.  Lifestyle choices play a huge role - having a first child after the age of 30 increases breast cancer risk 431% over having a first child before the age of 20 (). Other chemicals also are leading suspects: phthalates are a much more pervasive and (in large part because of that pervasiveness) more damaging class of chemicals than EC or even ongoing hormonal contraceptives.  Because of the extremely minor role EC might - or might not - play in breast cancer, it is unwarranted to have such a large section discussing theories of breast cancer.  Especially since they are only tangentially related to EC. Lyrl    Talk     Contribs   02:40, 17 November 2006 (UTC)

text: I think the issues here are relatively straightforward. I agree with Lyrl and Andrew c. This article is not the place to debate basic-science hypotheses about androgenic or estrogenic crossover of levonorgestrel. These are hypotheses, and their clinical relevance in this context is unknown. Placing them in a section entitled "Levonorgestrel and breast cancer", which goes on to imply that levo-only EC increases the risk of breast cancer (not supported by the citation), raises fears that are not supported by the literature. Not to mention that we're blurring the lines between levo being contraindicated in women with known breast cancer to imply that levo raises the risk of developing breast cancer - again, not supported by our citations. It's important that medical/health-related articles are presented evenly and informatively, without minimizing known risks, but also without engaging in scare tactics or making implications that aren't supported by the available data. Not only is it OR (joining A and B to advance position C, which is not argued by the authors), Lyrl is right that it also gives undue weight (per WP:NPOV) to an association that has not been shown to exist. MastCell 17:57, 17 November 2006 (UTC)
replies: text: Also, Cindery wrote above that the increased risk with levo was seen in a combined group of levo/estrogen plus levo-only users. That's not the case - in fact, Tables VI and VII of the Norwegian article (those in which the authors note the increased risk with levo) both say specifically, in the Table headers, "Progestagen-only Users Excluded". In other words, another reason why this study does not say anything about an increased risk of breast cancer with levo-only EC; it just says that they didn't find an increased risk with progestin-only contraception - if anything, evidence (albeit somewhat weak) that levo-only EC would not increase the risk of breast cancer. MastCell 18:33, 17 November 2006 (UTC)
thread_title: long version of breast cancer study

message: In keeping with the above thread, I'd propose the following section in the interest of keeping things brief, summarized, relevant to the topic at hand, and in line with the relevant published data:
----
====Breast cancer, levonorgestrel, and estrogen====
The WHO advises that current breast cancer is an absolute contraindication to high-dose progestin-only contraception. In a large cohort study, users of combined estrogen-levonorgestrel contraceptive pills had an increased risk of breast cancer which paralleled the increasing dose of levonorgestrel. However, the exposure to estrogen was felt to be the most important factor in this increased risk. In women who used progestin-only contraception, there was no increase in the risk of breast cancer.
----
I've left the remainder of the previous section in the article and just commented it out with tags, so it's not gone for good. Input on the above? MastCell 18:40, 17 November 2006 (UTC)
replies: text: And I've added the following sentence: "The study authors encouraged further research on the effect of progestin-only contraception on breast cancer risk." ... to point out that more research would be useful. MastCell 18:44, 17 November 2006 (UTC)

text: I think your current edit of the breast cancer/levo paragraph looks good. I'd still favor removing the in-vitro stuff and focusing on the clinical studies, for clarity and relevance, and obviously the paragraph can be expanded to address Yuzpe, but I think the summary of the two levo-related clinical studies (as it exists in the above edit that you made) looks reasonable. MastCell 21:58, 17 November 2006 (UTC)
thread_title:  Levo/breast cancer 

message: The WHO advises that current breast cancer is an absolute contraindication to high-dose progestin-only contraception. In a large cohort study, users of combined estrogen-levonorgestrel contraceptive pills had an increased risk of breast cancer which paralleled the increasing dose of levonorgestrel. However, the exposure to estrogen was felt to be the most important factor in this increased risk. In women who used progestin-only contraception, there was no increase in the risk of breast cancer.
----
I've left the remainder of the previous section in the article and just commented it out with tags, so it's not gone for good. Input on the above? MastCell 18:40, 17 November 2006 (UTC)
replies: text: And I've added the following sentence: "The study authors encouraged further research on the effect of progestin-only contraception on breast cancer risk." ... to point out that more research would be useful. MastCell 18:44, 17 November 2006 (UTC)

text: I think your current edit of the breast cancer/levo paragraph looks good. I'd still favor removing the in-vitro stuff and focusing on the clinical studies, for clarity and relevance, and obviously the paragraph can be expanded to address Yuzpe, but I think the summary of the two levo-related clinical studies (as it exists in the above edit that you made) looks reasonable. MastCell 21:58, 17 November 2006 (UTC)
thread_title: Breast cancer, levonorgestrel, and estrogen

message: The point you are trying to make--that doctors informed patients of the carcnogenic/teratogenic effects and/or there was follow-up for treatment failures--is not reflected in the literature. The Detroit hospital case clearly illustrated terrible follow-up, and the pediatrics source says nothing about warnings or informed consent. You could say, FDA warned that therapeutic abortion should be seriously considered, but literature doesn't show evidence that patients were warned, advised, or follow-ed up with to determine if they were pregnant. There isn't good evidence that informed consent was followed at all or even advised--"patient or her doctor deems that there is no alternative"--and "no alternative" turned out to be "no slightly less effective or more expensive alternative."  Keep in mind that PPIs didn't even exist until late/mid-70s for the birth control pill, after the National Women's Health Network staged the first protest at the FDA, specifically regarding the dangers of high dose estrogens. The concept/practice of informed consent has evolved a great deal (and was still not considered adequate in 1996)--what doctors were warned about wasn't necessarily passed on to patients--the opposite was the case. It's an interesting discussion/matter to explain in article, but it isn't particularly relevant to availability. (What the Med Lett source reiterates is already in the JAMA article used in "history.")
Cindery 23:08, 20 November 2006 (UTC)
replies: text: The source (Med Lett) says "Early therapeutic abortion is recommended when this use of DES fails." I agree it says nothing about issues of informed consent, whether women were actually advised to abort, etc - only that the recommendation in the medical literature was to consider abortion in such cases. (I'm not sure it was the FDA themselves who made the recommendation, or I'd attribute it to them as you suggested). I'm not trying to make the point that doctors were informing pts of the effects; I agree that the informed consent process has come a long way since the 1970s and is still a work in progress. I'm adding it because it seems relevant that the risk was seen as high enough that abortion was (theoretically) encouraged if DES failed. MastCell 23:51, 20 November 2006 (UTC)

text: I think the fact that the most widely available/used form of EC was dangerous enough that abortion was recommended is relevant, or at least as relevant as the rest of the DES stuff in the paragraph; it adds to the first half of the sentence, which describes DES' effects on the fetus. I'm happy to work on making the sentence less "misleading", although as it currently stands it seems fairly straightforward. MastCell 00:35, 21 November 2006 (UTC)
thread_title: DES/abortion

message: This tells us that DES was still used as EC in 2000, but not where--Europe? Turkey? Should probably go in general history. 
Cindery 01:51, 21 November 2006 (UTC)
thread_title: DES/2000

message: Regarding the section on the ICEC: does it belong under "Controversy"? As currently written, the section makes no mention of any controversy. Also, in the interest of summary style, it could probably be shortened dramatically; most of the section is a verbatim quote from the website source. Why not shorten the quote to just say that the ICEC focuses on "Manufacturing an EC Product, Facilitating Product Registration, and Negotiating a Public-Sector Price", perhaps with a (very) brief expansion of each point? MastCell 23:19, 21 November 2006 (UTC)
replies: text: I didn't even notice that it was under controversy; I thought I put it just before International Availability. It should probably be part of or after history--it's an extremely significant historical development, and explains why suddenly EC is on everyone's radar/was ever considered as a "public health measure."  The very difference in what the term "emergency" means has changed viz postcoital contraception since ICEC/1995-98. I envisioned it as raw material needing to be summarized (and info re marketing and "social marketing" needs to be added; so it's incomplete). The fact that Postinor-2 is the most commonly used brand of EC--not Plan B--should be emphasized somewhere, and it should be emphasized in ICEC summary that ICEC was conceived of/functions as a means to bring Postinor-2 to developing countries with first world money. (Emergency contraception!--brought to you by the World Bank...and Frank Carlucci. Ok, not "you," but the third world by way of "you," because USAID isn't allowed to put money into contraceptives that aren't approved in US anymore...since that's my take on it, it's probably better if someone else summarizes it first--but the implication that they helped create a market where none existed shouldn't be 86'ed entirely--they admit as much. And the fact that the consortium exists to bring Postinor-2 to the 3rd world, and that Postinor-2 is used in more countries than any other brand should be given due weight.
Cindery 23:41, 21 November 2006 (UTC)
replies: text: It's always hard/impossible to separate the profit motive from more altruistic concerns in the pharmaceutical industry, but to keep things from veering into "Constant Gardener" territory, we should probably also state or summarize the ICEC's purpose in its own words (as the section currently does) - after all, many people think that expanding the range and availability of contraceptive options in the developing world is a laudable goal, and one of the Consortium's stated aims is to improve the affordability of EC. MastCell 19:18, 22 November 2006 (UTC)

text: I see what you're saying; however, I think expanding contraceptive options/access in the 3rd world doesn't solely benefit Western economic interests - reproductive freedom/access to contraception could conceivably be helpful to the interests of those developing nations and their citizens as well, and some would go so far as to consider these items to be human rights. I don't know about "any means necessary"; the ICEC and friends are talking about expanding access and availability, not forcing anyone to do anything against their will. And I don't know about contraception serving "Western economic interests"; one could argue the opposite, that having a large supply of desperate, overcrowded people ensures these interests easy access to cheap and pliable labor in the era of outsourcing. Sure, economic interests undoubtedly play a role in what the ICEC does, and I wish that wasn't the case. But it doesn't seem like the worst thing in the world to expand access to contraception in developing countries either. MastCell 04:34, 23 November 2006 (UTC)

text: I'm sorry, when I wrote that "I see what you're saying", I was talking about the arguments you chose to highlight on the talk page. I agree the talk page isn't the place to debate this issue. I do think it's worth considering that I've thought and read on the topic beyond the "propaganda" I was presumably fed in high school/college, but have come to a different conclusion than you have, as reasonable and educated people sometimes do on complex issues - this isn't always a mark of deficient knowledge on one party's side. I do agree with you that it's unnecessary to include a lengthy pro/con debate about ICEC on this page, and that people can reach their own conclusions. MastCell 17:18, 23 November 2006 (UTC)
replies: text: OK. I don't have the energy right now to respond to another 4 paragraphs, but as you seem to believe I single-handedly drew this thread off-topic into a non-productive realm of arguing personal beliefs, it might be worth re-reading it from the top. Fortunately, I think we agree that arguing the pros/cons of the ICEC and World Bank's societal impacts is outside the scope of this article. MastCell 04:51, 24 November 2006 (UTC)

text: Sure - Margaret Sanger made such an argument as long ago as 1920, and it's a (probably over-)simplistic application of the principles of supply/demand to the labor market. But before we get into eugenics and the evils of Planned Parenthood, it does seem like, for now at least, this thread can be closed - after all, Lyrl was kind enough to address the initial issue by moving the ICEC paragraphs, and I need to get back to consuming my disproportionate First-World share of the world's turkey and stuffing resources. MastCell 20:25, 24 November 2006 (UTC)

text: I'm not making an argument for including anything, at the moment. That's why I felt this thread could die off for now. Sanger's argument was that huge families provide a ready source of labor, and the increased availability of labor drives down wages, hence the economic interest of "capital" is not necessarily population control. Also, overcrowding is not a simple matter of population divided by continental land area. "None of Africa is overcrowded"... Really? Lagos? MastCell 19:20, 25 November 2006 (UTC)
replies: text: Criticism of population organizations should go in the article of that specific organization, or in an article dedicated to the subject such as population control.  Such information is not appropriate for the EC article. Lyrl    Talk     Contribs   22:25, 25 November 2006 (UTC)
replies: text: I agree. <restored deleted comment> MastCell 19:55, 26 November 2006 (UTC)

text: You said "no part of Africa is overcrowded", and I said that Lagos (for example) is overcrowded whether one looks at population density, resource availability, development, or any other rational measure. Maybe ICEC deserves its own page, I dunno... but I strongly agree with Lyrl that criticism of population organziations, the evils of the World Bank, etc etc, should not be in this particular article. Sure, I believe in those other human rights you listed as well, but this is the emergency contraception page... let's stay focused. MastCell 19:59, 26 November 2006 (UTC)

text: I'm still not sure why we're arguing. There's no content issue at stake, and I've suggested we close this thread a few times now. Yet you seem to be twisting my very simple statement about an overcrowded part of Africa, and then claiming I'm the one who can't admit to being wrong. I also have no interest in defending what you describe as the "status quo", nor do I uncritically accept that the ICEC and friends have only the developing world's best interests at heart. It's just that you went off-topic on the World Bank, "no part" of Africa being overcrowded, etc and I (perhaps foolishly) took the bait, thus encouraging you to paint me as a naive dupe of my high-school social studies textbook. I do feel I should ask, on behalf of the country's social studies teachers, for a source for your now thrice-repeated statements that high-school social studies indoctrinates students into a false view of "population control". I don't remember learning anything about population control in social studies, and we read a standard textbook as well as Howard Zinn. If you need the last word, go ahead, and then let's close this thread unless there's a concrete content issue to be discussed. MastCell 19:22, 27 November 2006 (UTC)

text: I can't distinguish between Cindery's purely conversational writings vs. her suggestions for changing the ICEC section.  Would a sample paragraph be too much to ask? It would sure help me decide whether I agreed with the proposed changes or not. Lyrl    Talk     Contribs   00:47, 28 November 2006 (UTC)
replies: text: The fact that this thread had become a two-way conversation about off-topic issues was the very reason I've repeatedly suggested we close it - I think we agree that nobody has the authority to unilaterally close threads. That said, I'm with Lyrl again, as I mentioned in my last few posts - can we have a concrete content issue to discuss, so the soapboxing can cease? MastCell 04:47, 28 November 2006 (UTC)

text: You may want to re-read the IPPPH source on the Concept Foundation that's cited in the article. Sure, the World Bank is one of the funders of the Concept Foundation, but its contribution is dwarfed by that of the Rockefeller Foundation (and that of the UNFPA) - by that rationale, the Rockefeller Foundation is even more "relevant" to EC. More significantly, the source also states that "The grant from the World Bank and UNFPA facilitated the licensee selections process and technology transfer of Cyclofem. While the grant from Rockefeller and Packard Foundations, assisted in the clinical development of emergency contraception (EC) with various dedicated EC pills." Poor grammar aside, it seems explicitly clear that the World Bank funded Cyclofem, while the Concept Foundation's EC activities were funded primarily by the Rockefeller Foundation. We all have axes to grind, but making the case that the World Bank is "acutely relevant" to the topic of EC seems a stretch. The Rock Foundation is way more financially involved in the distribution of EC, but even so, it has its own article and shouldn't merit more than a passing mention and Wikilink here. MastCell 17:53, 28 November 2006 (UTC)

text: Given your level of involvement with the page, it's impossible to edit without interacting with you. I thought I was commenting on a content issue - namely, I don't think the Rockefeller Foundation's "protection" of oil interests is relevant enough to include on the EC page, whereas you feel that it's one of the "primary issues that need clarity" here. That's a content issue. It seems that the Rockefeller Foundation, rather than the World Bank, financed the development of the Concept Foundation's EC product - that has implications for the content as well. Obviously, I don't speak for the other editors, and I'd like to know what they think as well. About my previous comments: Wikipedia functions by consensus. It's hard to build consensus when you assume that differing opinions are based on youthful ignorance, obstinacy, or malice, rather than thoughtful consideration of a complex issue. My comments were a request that you respect views that differ from your own as possibly being equally well-founded, even if you disagree with them. MastCell 00:26, 29 November 2006 (UTC)
thread_title:  ICEC 

message: Did some minor cleanup of grammar, fixed a few awkward phrases. I tried to maintain the original sense and content and left anything that made me semantically nervous strictly alone. If I have changed any meaning unintentionally please let me know on my talk page, I would appreciate any feedback if I've messed up. 
Resonanteye 16:48, 27 November 2006 (UTC)
thread_title: grammar