Wednesday, 20 February 2008

Daily Mail journalist in sterilise-the-promiscuous-bastards shocker

Posted by: Dr. Thunder
So my medical license to practise in Australia still isn't ready.

Therefore, I have nothing to blog about on the coalface.

But, this extended holiday does mean I'm spending alot more time online. One of my favourite websites to hang out is

It's the message-board where this blog got started.

In the "ladies lounge" of boards (which, despite the name, is not a virtual pole dancing club. It's a forum where ladies' issues are discussed) the following Daily mail article has provoked a heated debate.

It's a bit long, so I've cut and pasted what i thought were the salient points, but you should read the whole article by following the link above.

"Last week, an intriguing proposition was mooted by Government minister Dawn Primarolo.
Teenage girls, she said, could be steered towards what is described as "long-term contraception".
This is now possible thanks to the development of contraceptive jabs and implants which can last up to five years.
In other words, there is a way of effectively sterilising girls for a lengthy period of time.
In 2005, there were 39,804 conceptions by under-18s in England - a rate of 41.3 per thousand.
The trouble for those who would tackle the pregnancy problem is that the very act of warning against pregnancy can be unproductive. "

"A certain proportion of teenagers like to defy fate - and the more you warn them not to smoke, drink, have sex, stay up late, join gangs, the more they will.
Defying authority, not doing what you're told, is, for many, part of growing up - the search for your own identity, a necessary preparation for leaving the nest. Persuasion doesn't work. The instinct to rebel goes too deep. "

"It seems that many of today's girls just like being pregnant, and emotionally and physically - not just practically - have more to gain than lose if they are. Sex education hasn't helped, and may indeed have harmed. "

"The Government says it has tried everything to stop pregnancy rates rising - from school matrons to a blizzard of sex education, to free condoms and morning-after pills.
But it's not working. That's why I think sterilising girls for a few years isn't such a bad idea after all - and, when you think about it, it's a tempting solution for the State, too.
Once you stop your under-20s having babies, there's no end to the social improvements you could make. "

"If girls go on to college instead of minding babies, fewer children overall will be born. The more educated a girl, the fewer babies she is likely to have - education and fertility rates being in inverse proportion.
The maternity services, now so very over-stretched, would be better able to cope. Young mothers would not have the priority they now do when it comes to housing, and accommodation would be set free for those unfortunates clamouring on the waiting lists.
Education would benefit, too. Classrooms would be less plagued by fatherless lads whose ambition it is to cause nothing but trouble.
So the children of teenage mothers can suffer, too. "

"Not having babies takes intelligence, planning, prudence and boring appointments with doctors. So what do we do? Deprive potential children of life by sterilising a few hundred thousand girls society has decided are "too young" to breed, regardless of their biological capabilities?
Go for the quality of child they might produce in their 20s or 30s, rather than the quantity they could create if they start at 14? That, let's face it, is what's up for discussion. "

"There is, I admit, a dreadful gender unfairness in the suggestion that teenage girls should be sterilised. Shouldn't boys under 17 have their tubes tied, too? It takes two to make a baby.
What's sauce for the goose should be sauce for the gander. Perhaps the Government should start thinking about how that would work.
Since science has now devised a way of stopping girls getting pregnant without damaging their longterm reproductive health, the idea of enforcing sterility on girls under 17 seems to me a least worst option

So, I thought I'd see what the blogoratti think of this proposal.

The minister in question, Dawn primarolo, is a Labour party minister in the UK, and minister of State for Public Health.

She has not advocated compulsory sterilisation of the UK's female teenager population. However, this journalist, Fay Weldon, has.

As a paediatrician, I have issues with both of their stances.

Firstly, the issue of compulsory sterilisation. This to me is one of the most outrageous suggestions I have ever heard in my life. I'm no lawyer, but I'd imagine it contravenes human rights legislation?

What would the reaction be if we proposed "tying the tubes" of teenage boys, I wonder?

What makes it worse is that our journalist friend wants us to give an implant, which last 5 years. Considering we (as far as I'm aware) don't have any solid data on the long term side effect profile of these implants in children of this age, I find the suggestion doubly galling.

Dawn primarolo is more restrained in her calls for teenagers to use long term implants, with their consent.

I'm all for greater access to contraception, in the quest to reduce the number of teenage pregnancies.

But I wonder at what age a girl is mature enough to give informed consent for an implant that will make her sterile for 5 years. We have the concept of "Gillick competency", whereby if we deem a teenager competent to make an informed decision about their treatment, then they can make that decision. But this will add a whole new edge to assessing this capability.

At what age can a girl assess the risks of an unknown side effect profile?

Would over zealous parents push their kids into having a 5 year implant, to put their own minds at ease?

Will, as the right-wing always argue, there be an extra level of complaceny amongst teenagers if they're "sterilised". Will this lead to a lack of condom usage, and higher rates of STIs?

Are the type of teenagers who are responsible enough to think about their reproductive health 5 years in advance the ones we should be aiming new initiatives at? Are these not the girls who are already using the shorter-term depot contraceptives, the pill, or condoms?

My take on the issue is that forcibly medicating teenagers is a huge no-no. I don't imagine you would find many doctors willing to do it, either. I would refuse to forcibly medicate most people who are ill, so I sure as hell wouldn't do it to someone who's well!

As for giving the option of 5 -year implants, I'm less sure. I'm not convinced of their benefits when compared to shorter-term injections, and I'm unsure about their safety profile. If I'm not sure about it, with my medical degree, is it fair for me to ask girls in their teens to evaluate the risks Vs the benefits?

I know it's just the ramblings of the usual marginalised Daily Mail types, but it's a topic that interested me a lot.

The original (and best) discussion, from the ladies lounge at can be found at

Drop in if you fancy a chat and a pole-dance :P

So, has anyone else got an opinon on this? Is this the way forward in tackling spiralling teenage pregnancy rates? Or is the whole thing ethically and medically questionable?

On the Australia front:

1) It's way too hot here for a pasty paddy like me.

2) People are all very friendly here so far

3) Beware any docs coming out to this neck of the woods..medical registration is taking much longer than before for overseas docs. I've been here on a holiday visa for 2 weeks, and my license still hasn't been processed. I applied in november!

4) For the women: There are a lot of really nice parks and nature reserves here

5) For the blokes: Australian women are HAWT :P

Sunday, 17 February 2008

Ask your doctor about starbursts for male pattern baldness

So, I've only been in Australia a couple of days, and feel unqualified to comment on their healthcare system as of yet.
However, enroute here from Ireland, I passed though the USA. Thankfully, I had no need to make use of their healthcare service either.
But, I did have ample opportunity to make use of the cable TV in my hotel during a 48 hour stopover in LA.
What amazed me was the amount of adverts for prescription drugs on television. All paid for by the drug companies, extoling the virtues of their particular drug, and usually rolling out some actors who claim to have used these medications.
After the actor (or sometimes genuine patient) tells you how their depression was cured by Sad-Gone, they urge viewers to "ask your doctor" about this wonder drug.
Almost invariably, this is followed by a guy speed-reading a disclaimer "drug X is not suitable for everyone. Side effects include liver failure, kidney failure, yellow teeth, arse falling off, cardiac failure, blindness and spontaneous gingerness".
I was flabbergasted. Evidence? Who gives a flying fuck about evidence when you have a happy post-coital elderly couple lying on a bed thanking humanity for viagra or cialis. They're right there in front of you, ON THE TV FOR GODSSAKE, so it must work.
So, what does the panel think? Is this fundamentally ethically wrong? Or are drug companies empowering patients?
I personally find the concept of a pharmaceutical company peddling drugs to people who usually have no access to data about the drug, or do not have the tools to interpret this data, pretty uncomfortable.
Also, are GPs in the states over-run by patients demanding a drug they saw on FOX TV?
I'd be very interested in peoples' thoughts.

Dr. Thunder

Saturday, 16 February 2008

The sorryness

I would like to take a leaf out of the Australian Prime minister's book, and make an apology. I apologise for neglecting this blog for the last 2 months or so.

My (lame) excuse consists of a combination of being in hospital for a while, and being on an extended holiday.

I just didn't want to think about work, while I was hiking the length and breadth of New Zealand.

But I'm back.

I'm no longer in New Zealand though. For the next year I'm working in sunny Australia. It's really cool over here, and that's not a comment on the heat! My pasty paddy skin was never designed for 30 degree temperatures and high humidity. This has to be the first time in my life that I've gone IN to a neonatal unit to cool down.

Anyway, it's a little soon to be blogging about the Oz healthcare system, as I'm only in the door. I'll be very interested in seeing how it compares tot he New Zealand, UK and Irish systems.

So far it's looking good. But, for starters, the labour ward, the neonatal unit and the adult intensive care dept are all in the one location. This is something you don't always see in Ireland and the UK. All maternity departments will have a baby unit of some sort attached. But many won't have somewhere to put mothers if they become seriously unwell during their labour. We're heading in the right direction back home, but I'm glad to see the Aussies have it sorted,

I also noticed that I get paid by the hour here!! Like I have a timesheet. Getting paid for overtime will be a new experience for me. Not sure if I'll cope.

Anyway, more posts will follow as I settle into the job. I start with 3 months of neonatology in an enormous unit, so much fun and frolics are sure to follow!

Watch this space..............