Know your steroids. Especially if you're pregnant.

[maradydd]

First, the OMGWTFBBQ. Via Pharyngula, the Hastings Center Bioethics Forum, and TIME Magazine: pediatric endocrinologists Maria New and Saroj Nimkarn are advocating prenatal treatment with the glucocorticoid dexamethasone to "reduce behavioral masculinization" of female children

Comments

[electricalgwen]

THANK YOU. This is, as ever from you, clear, concise, and has its head screwed on straight. Mind if I refer people?

I deal with dexamethasone all the time. "Nuclear option" about sums it up. I hadn't seen this particular controversy yet though; WTFBBQ about sums that up.

[maradydd]

Feel free.

I don't have any personal experience with dexamethasone, though I have two friends who've had to use it for various reasons (cancer, freaky brain infection), and I wouldn't wish its side effects on anyone. I've lived through eight weeks of being in the same apartment as a patient on prednisone, and that was horrible enough.

[nibor]

This is always good advice, and especially true when pregnant. It's shocking to discover how many doctors, even those specializing in pre-natal care, aren't up on the latest recommendations on what medications are safe or not to take while pregnant or nursing. Since testing on pregnant and nursing mothers is Generally Frowned Upon, the reliable data is somewhat sparse but it's worth learning where the reliable sources are and using them.

I spent a hell of a lot of time reading up on diabetes and what my options are. Sadly, Cyborg Pancreas isn't ready yet.

[maradydd]

A couple of years ago I might have been surprised, but not any more. Just as infuriating is medical "professionals" who can't be bothered to read a patient's chart before coming after them with a needle. Back in 2007, I had to rush enochsmiles to the ER with a 105-degree fever and crippling gut pain during a Crohn's flare. After triage and a quick visit from the ER doc, a nurse came in with a syringe; he was too out of it from pain to talk, so I said "What's that?"

"It's his medication," she said.

"What kind of medication?"

"Pain medication." She reached for his arm.

I got in the way, ready to grab her hand if I had to. "What kind of pain medication?"

She sighed and tried to move around me. "Toradol."

"What class of drug is that?"

"It's a non-steroidal anti-inflammatory."

I don't remember exactly what I said after that, but I'm reasonably certain it included "HE'S A CROHN'S PATIENT, HE'S ALREADY BLEEDING INTERNALLY, WHAT ARE YOU FUCKING TRYING TO DO, KILL HIM?"

Turns out Toradol causes GI bleeding even in patients with normal gut

[anaisdjuna]

I read this elsewhere and was going to post it as a comment to your steroids entry.

Unbelievably jacked up eugenic shit. Wonder if New realizes she'd have chemotherapied herself out of going into the traditionally male arena of science.

[mouser]

So, reading about this, the entire usage of Dexamethasone in all this is "off-label" - NOTHING here is what it is meant for, not even the partial treatment of the actual birth defect they want to study - and that it's been used for over the last two decades.

[maradydd]

Yup. Off-label usage is increasingly being used as an end-run around institutional review boards; if a doctor doesn't want to go to the trouble of IRB review, s/he can still build up a small body of test subjects by prescribing medications off-label, and apparently it's enough to write a paper on.

I'd like to see the medical journals take a stand against off-label investigative uses of pharmaceuticals. The journals can and should refuse to publish human-subjects research that hasn't been before an IRB.

[shingkhor]

I had a 16 day course of prednisone recently and my doctor was more than forthcoming about it - "it's the same thing my colleagues prescribe for organ transplant patients. take it exactly the way i tell you to or your adrenal glands will stop working".

behaviour molding of an unborn fetus is appalling in general - using steroids elevates it completely to evil.

[maradydd]

Good for your doctor, and I'm glad you've got a good one. I hope the anxiety/hypomania wasn't too bad.

Corticosteroids definitely have their place, particularly in emergencies (e.g. anaphylaxis, or premature babies' lungs), but they're such a hack -- they're basically an artificially-induced crisis mode, and the body just can't take that kind of stress for long. They won't even use them for acute (i.e., "my intestines are bleeding") IBD flareups here.

[vanbeast]

I had a 16 day course of prednisone recently and my doctor was more than forthcoming about it - "it's the same thing my colleagues prescribe for organ transplant patients. take it exactly the way i tell you to or your adrenal glands will stop working".

Yep, me too. Then I went and read up on the side effects and was scared out of my fucking mind. I was lucky, aside from developing the worst cold I've ever had I didn't get hit with anything else. Hope you had the same experience.

[fanlain]

Without dexamethasone, my sister would have died sooner than she did. It reduced the brain edema in her metastatic breast cancer. The dexamethasone basically bought her a month and a half longer of life. While that might not sound like much, I'm sure it was everything to her 4-year-old son and to her.

[maradydd]

Dexamethasone was absolutely indicated in your sister's case. When the choice is between high-octane steroids -- especially short-term high-octane steroids -- and death, then without question the steroids are the correct choice. That one is a no-brainer

[maradydd]

I don't know enough about the other effects of dexamethasone on fetuses. From animal studies it looks pretty bad, but the literature on humans is inconclusive. The unethical part is all about the children, though.