Diamond, Eugene F.

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The Linacre QuarterlyVolume 33 | Number 2 Article 19May 1966Oral Progestins and the Catholic PhysicianEugene F. DiamondFollow this and additional works at: https://epublications.marquette.edu/lnqRecommended CitationDiamond, Eugene F. (1966) "Oral Progestins and the Catholic Physician," The Linacre Quarterly: Vol. 33 : No. 2 , Article 19.Available at: https://epublications.marquette.edu/lnq/vol33/iss2/19volves both Blue Shield and Blue Cross. DR. SHERIDAN: Your point is very well taken, Sister. I can assure you that at least the head of the Catholic Board of Education is urging this. He wants this. How far it has gone beyond there I do not know. We had a meetling wirth Cardinal Meyer on this very subject, but discussions were concluded by his untimely de­mise. Now we will have to begin again in this same direction. J.t may be as a central Archdiocesan proj­eot because there are parishes that just can't carry the burden. There will have to ,. for them. Perhaps, would like t FATHER JC mighty God. by the effor1 We ask Y r We ask You ing works consoling ar of Your gco beg tha,t Y ilies, and al· end to etern ,. Amen. ome compensation-··.2r Marren, youe with a prayer.w. MARREN: Al­·vish to glorify Youput forth each day.;sing on all we do.. 'company the heal· ,r hands with the rengthening graces j and mercy. We g us, all our lam­work with in the - &ppiness with You.Many of our subscribers send their used copi{;s o: LINACRE QuAR· TERLY and other med1ical journals to missionaries abroad. If you wish to help in this work of spreading the Fai th, w,ite for the name of a missionary to: ·Kenrick Remailing Service, Kenrick Seminary,7800 Kenrick Rd., St. Louis, Missouri 63119. A name and complete information will be forwarded to you. 192 LINACRE QUARTERLYProgestins and the Catholic Ph 'r,ician EUGENE F. DIAMOND, M.D. Wendell Holmes has wisely "A medicine should always eel to be hurtful. It is al­ly hurtful; it may some-indireotly beneficial." It is , laid down originally by that a drug given to a· y person cannot augment but only diminish it. What drugs are the oral progestfos? pacl<!age inserts suggest that many contraindications - . indi­. e risks in their use. They to healthy persons and withowt contraindkation. As how are we to evaluate against time-honored ther­principles? I tecenrt: editorial on bias in ew England f ournal of Medi-ls alleged that no participant apeutic trial is ever totally eel in the outcome of this t but rather brings to if I positive or negative enthusi­One great source of bias is the "Zeitgeist." This accepted the majority, or an elite , about a drug may influ­investigator and make him about an observed result. tgeist surrounding "the pill" only medical but sociologioal, ical, theological, political omic as well. Almost all of Agencies bring to bear upon 'ns a positive enthusiasm. d is associate professor of clin­. , Stritch School of Medicine, University, Chicago. It is against ·a background of posi­tive bias, then, that the pill must be evaluated. SIDE EFFECTS AND CONTRAINDICATIONS In pregnancy, there is a hyperco­agul,able s<tate related to augmented levels of intrinsic thromboplastin, S·tuart £actor, plasma thromboplastin component, and fibrinogen. When this hypercoagulable state is furth�r complicated in pregnancy by s·tas1s or slowing of blood flow, an ominous setting for thrombosis occurs. Indeed, thrombophlebinis and throm­boembolism are well recogn,ized com­plications of pregnancy. It has  been shown that the hypercoagu1able state of pregnancy is reproducible, at least in part,. bythe administration of ora'l progestms. As a matter of fact, hematologists at two centers have reported the use of oral progestins in the therapy of hemorrhagic disorders - notably those due to Factor VII and Factor· X deficiency. In addition, it has been shown that the oral progestins produce pelvic vasodiHtatio� which in tum could produce slowmg and stasis of venous circulation. Such an ominous combination of circum­�ances would make the association between oral progestins and throm­botic compHcations highly plausible, if not proven. As a matter of fact, recent publications fairly uniformly admit the associa tfon b etween oral progestins and thrombophlehitis 193 while denying an association with thromboemboiism. The oral progestins profoundly affect the individuals endocrine ho­meostasis, probably by way of their effect on the pitui!tary-hypothal,amic complex. The protein-bound iodine and serum corticoids are elevated during progesitin therapy, while ald­esterone secretion is increased, uri­nary corticoids are diminished. and the glucose tolerance curve is -a,litered. Considering the rudimentary state of medical k nowledge in the area of endocrinology (particularly the del­icate interaction and reciprocal in­hibition among glands), the use of such a disiturbing drug is poteniti,ally explosive. It has been suggested that t�e fact t�·at the pill might provoke d�a�tes m certain susceptible in­dt\l'lduals should be considered a "blessing in disguise since it enables early treatment." Most of us would be surprised to know that it is a blessing to get diabetes at 30, rather than a,t 60. With regard to the hepatic effects of the drug, the report of the Puerto Rican field t11ials discloses fairly fre­quent abnormalrities of bromsulfaHen excretion and transaminase levels among those on oral progestins. This caused some anxiety as to the effect of long-term use of the pill on he­patic function and, as a matter of faot, reports of jaundice during ther­apy are now be1ng published with regularity. Most of the oral progestins now on the market are 19-nor-steroid derivatives. Since they have the 17-0H group in the beta position, 194 they have an a. lar to that of ! When given il women durin•· twelrve weeks' can and do p1 of the fetus. cates that £· women will l:. the time the,.­plraces a sigr. · male fetuses whei;e millior the pill. DOCTOR-CL[ .Jgenic effect simi­,1 eth y !testosterone. · e usual dosage to: he first eight topregnancy, they '. ce masculinization :e experience indi­, t 1. 5 percent of . ,1e pregnant during on progestins, th� :nt number of fe. risk in a nation , women are taking Y COLLABORATION Because th: 's a potent drug, it would seem ir, rative that it always be given und. · 'he careful supervi· sion of a phyi.. ,n. The impetus for the dispensinr; " such a drug should never come frc the patient or from a clergyman. o priest, in or outof the confessi' .,al, should ever rec· ommend the J. :J. To say that the priest does n0, n•commend the pill but only "refer, the patient to .herphysician" trul r begs the question. Agarinst ,the background of what lll�Y seem a poignant and urgent fannly sirtuation, medical arguments for re· fusing the pill may seem specious and pedantic. Irt is certainly to be ex· pected -that a priest might see an in�ricatfon for family pl_anning ��chdd spacing, through hts counse ing, but he should leave the meansfor achieving this end up to thefamily physician who, alone, kno� which method would be safe an successful for what patient. · Priests as well as doctors encoun·ter many unhappy wome�. �; are single, some are married WI LIN ACRE QUARTERLY · ies, some are married with"lies. The pill may seemsolution to some situations·ve of unhappiness, particu­ng mothers of large fam­en such a temptation exists, portant to remember the report from the American tric · Association convention indicated that, using the Mu1tiphasic Survey, SO of women taking the pill ptoms of depress·ion. IN FAMILY PLANNING women say they do not other child, what they usu­is that they do not wish pregnant for awhile, or that not want another noisy pre­around the house. They do that they wish to he and they certainly do not they want time to save neiat chHd's college educa­this day of "buy now, pay Ind even "Hy now, pay later," lous to •assume that a t percentage of our popu-their next child on rthe economic considerations to eighteen years hence. and physidans must help eouples reaHze that it is pos­grow apart as well as to­iln marriage. The -last twenty their lives wHI be just as the middle twenty years. average American woman letes her childbearing by 1V'hich means ,tha t by 45 or will be mistress of an empty and a relatively empty life. I am told of the great oh11os 866 and anguish being caused by super­numerary and unwanted children, I must say that I cannot verify such a situation in the last fifteen years of treating parent-child relation­ships. In a family constellation in which the father's job is dehuman­ized by auromartion and the mother's work s,tripped of creativity by mod­em gadgets and mixes, the children are frequently the only access par­ents have to a vitaUty and a vicari­ous meaning in their lives. OVER-POPULATION CHALLENGE I was raised in the era of apolo­getics and I will admit to some di.ffi­culties in adjustment in this age of the search for a consensus. I am particularly anguished by those who say that the only diifference between the Catholic position and the mod­ernist position is a matter of means to a common end. I doubt this very much. I doubt that the average Catholic is ready to adopt the con­traceptive mentality. We. are sep­arated from the modernist view by formidable obstacles. First of all, we are separated by a reverence for life which prevents our accepting . their views on abortion - therapeutic or otherwise. Secondly, we are separated by a reverence for the human body which prevents our accepting their views on sterilization -voluntary or otherwise. Thirdly, we are separated by a reverence· for sex which makes their tasteless and mechanistic methods of sex education unacceptable and repugnant. Finally, we are separated by a reverence for God which makes us entuely unable to accept their "new morality," woven out of the fabric of the old immorality and made 195 t relevant in what they like to call "the post-Christian era." · The problem of the pill is largelyan American problem. Pl1anned Par­enthood International now places itsemphasis largely on intrauterine de­vices. We are not an under-indus­trialized economy. We are not anover-populated country. We haveadded firfity million people to ourpopu1'ation since 1945, ,a 25 percentincrease. During the same period,we have ,added $400 billion to ourgross national produot, our per­capit,a income has doubled and ourunemployment has dropped to be-low 5 percent. acres of land i and only 6 pe; residential pU! We have s our value sys a devaluatior: over-valuatio· have lost the a reward fo· view of the sex. We are, ulati on explc, about the cc all levels of we have a cru ADVICE TO AUTHORS : have two billion '1e United States, · r of it is used fores.a breakdown in .s. We have seen the child, and an }1is education. We se of the child as {. in favor of the l. as a p enalty for ous about the pop· 1 but unconcerned ation explosion at na-turity. In short. ; moral dilemma. Art icles on topics of potential interest to the Catholic p · · . s;cian as a Catholic and as a physician are earnestly solicited. A goodly poi· ·.·n of THE LINACRE QuARTERLY readers are not members of the medical profe3sion but are engaged inallied health fields, teach moral theology, or serve in hospitals, and material fortheir benefit would also be welcome. The subject matter may be predominantlyphilosophical, religious, or _medico-moral in nature. Malcrial should be type· written, double-spaced, with good margins and on one �idc uf the paper only.Manuscripts (original and one copy) should be submitted to the Editorial Officeof THE LINACRE QUARTERLY, 1438 &rnth Grand Blvd., St. Louis, Missouri, 63]04. One additional copy should be retained by the author. Full editor ial privileges are reserved. Ref�rences if used should appear at the end of the article and shouldconform to the usage of the Index Medicus. (This format is that employed in theAbstract Section of THE LINACRE QuARTEllLY.) A brief but pertinent curriculumvitae of the author(s) should accompany the manuscript. The Thomas LinacreAward is .made annually to the author(s) �f the original article adjudged to bethe best to appear in THE LINACRE QUARTERLY during each calendar year. 196 LINACRE QUARTERLY .-The Conference of Health Service Personnel For Peru and Bolivia BROTHER FRANCISCO TAN EGA, FMSI, M.D. rformance of the spiritual r,al works of mercy is as as the Church Itself, dating our Lord's lifetime when He ut doing good and healing · Lord has sa:id that at the ent we shall be held ac­not for our knowledge and but according to whether we have performed all the « mercy toward our neigh-1hat neighbor with whom He · ed Himself.aries in fur-flung areas of-bring home the messageever so effectively bymanrifestaitions of mercy., the theology of ,the Headthe theology of the hand -· ring hands of mercy inof the Church.1'ho else can best typify these g hands but medical mis­In response to ,the late n XXIIl's earnest cry to Amerioa, medical mis-- religious and Jay - werethe first to respond to thechaUenge. From all over the world they have �ome to Latin America bringing with them their intelli­gence, experience, spirit of abnega­tion, and Christian creativity, and ready to help overcome the woeful problems of ignorance ·and dise_ase and to spread the joyful Christian good news of faith, hope, and love. To speak ahout one prominent segment of this vast armada, there are English-speaking groups from the United States, Canada, Ire­land, and the Philippines - doctors, nurses, hospiual administrators, mid­wives, practical nurses, and medical technidans - religious and lay, male and female - lahoring in Peru and Bolivia. Their work ranges from the barren Pacific coast of Peru to the frigid zones of the Andes Moun­tains at elevations close to 14,000 feet ahove sea level, down to the teeming, humid jungles of the Ama­zon, days away from civilization. T h e s e  s turdy peo ple o p erate  Church and government sponsored clinics, dispensaries, and hospitials -from one-room outposts to a 1000-bed modem complex with residents, interns, nursing school, and com­plete lia:borartory facilities and staff. Drawn rtogether by the bond of common problems, a group of 20 of these ,heal,th workers, representing IO religious communities, met for the first time in f963 in Cocha -bamba, Bolivia to share their mutual 197 

Oral Progestins and the Catholic Physician

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Oral Progestins and the Catholic Physician

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