The Healthy Contraceptive?

By Jim McVeagh 21/12/2011 2


The MacDoctor sees that the Lancet is up to its old tricks again – publishing controversial comments and papers with poor scientific reasoning behind them. You would have thought that almost single-handedly producing the anti-vaccine movement with a poorly researched, bogus article would have taught them some caution, but apparently not.

Not yet published in print, but available online, there is this commentary: Britt K, Short R. The plight of nuns: hazards of nulliparity Lancet online DOI:10.1016/S0140- 6736(11)61746-7. It is subscription only but here is the main premise:

The Catholic Church condemns all forms of contraception except abstinence, as outlined by Pope Paul VI in Humanae Vitae in 1968.13 Although Humanae Vitae never mentions nuns, they should be free to use the contraceptive pill to protect against the hazards of nulliparity since the document states that ’the Church in no way regards as unlawful therapeutic means considered necessary to cure organic diseases, even though they also have a contraceptive effect’. If the Catholic Church could make the oral contraceptive pill freely available to all its nuns, it would reduce the risk of those accursed pests, cancer of the ovary and uterus, and give nuns’ plight the recognition it deserves.

The argument in a nutshell is based on the well-attested fact that nulliparity (not having any children) increases your overall risk of breast, uterine and ovarian cancer. The combined oral contraceptive pill has some protective effect against the latter two. Therefore nuns should be allowed to take the pill to protect them from cancer.

This argument falls in a number of areas. Firstly, in the graph that the authors publish to “prove” their point (shown below), it can be seen that nuns are only at risk from increased rates of uterine and ovarian cancer in their 80s. As these two cancers are rare diseases anyway, it would seem that their relative risk of dying from these diseases is still likely to be very small. There is an appreciable risk from the far more common breast cancer, but the oral contraceptive has not been shown to protect against breast cancer and may, in fact, increase the risk slightly.

Secondly, these graphs make no effort to determine the other risks of the pill relative to nuns, notably thromboembolism (clots in the legs and the lungs) and high blood pressure. We know that the pill reduces mortality for women overall, but that is because taking the pill is much safer than having babies. This factor is not a consideration for nuns. It may well be (in fact I would consider it likely) that the risks of the oral contraceptive will outweigh any gains. Particularly as the authors are essentially proposing that nuns take the pill continually, unlike most women. We have no idea whether this imposes additional risks to the taker.

Finally, the fact is that nuns live, on average, 5 years longer than women in general (I do not recollect the name of the paper I saw this in, but the study involved 70+ thousand nuns and seems quite robust). This is probably due to a number of factors such as reduced stress, reduced likelihood of accident and healthier lifestyles. Their choice to dedicate their lives wholly to God does them no harm and provides them with long, often very healthy lives. It is absurd to take a single aspect of an otherwise healthy lifestyle and blow in out of all proportion. Indeed, it seems that the only purpose of the authors is to castigate the Pope for his decree against contraception because there appears to be no valid medical or clinical purpose evident. This kind of nonsense is best left to the tabloids and does not belong in a reputable medical journal.

Hat Tip: ScrubOne at Halfdone and Catholic Mom

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2 Responses to “The Healthy Contraceptive?”

  • For those wanting the article, the URL is: http://dx.doi.org/10.1016/S0140-6736(11)61746-7

    As you noted this is from a Comment, not a full research article. Comments can be speculative, ruminative, etc., and are not peer-reviewed.

    My (initial, late at night) reading of your post is that your religious leanings have encouraged a defensive response with your ‘old tricks’ of over-exaggerated protest, etc. 😉 (I’m just being even-handed in tongue-in-cheek fashion to make a point via humour.)

    I’m not interested in defending what was written and in any event even I did want to I couldn’t as I haven’t access to the full Comment at present. (And am unlikely to get it when I do! I do have my own gripes about the presentation of the graphs – without error margins, etc., it’s difficult to know what to read from them; it’s possible this is covered in the text.)

    I’m guessing that the paragraph you cite is the only one referring to the Catholic church? You perhaps might want to try read it again, with a view that they are (just) trying to point out that the church’s ruling may not block the use of the contraceptive pill as therapy rather than “castigat[ing] the Pope for his decree against contraception”. (In particular, try reading their ‘If’ and ‘could’ as tentative and cautious.)

    On a wider note it it seems to me that it is unrealistic for publications to avoid every thing that might ‘excite’ individuals from every ideological or advocacy group out there. Groups do have to recognise and accept that their practices will face criticism from others, after all, and raising the elements of the matter in discussion isn’t being negative in itself.* By way of example, titles of other Comments coming up for publication suggest that they, too, deal with issues that might offend some individuals:

    “Moral science and the Presidential Commission for the Study of Bioethical Issues”

    “How to solve the crisis behind Bribegate for Chinese doctors”

    “XMRV and CFS—the sad end of a story”

    Should these also not be published because some people will get excitable about their subject matter? (I haven’t read them; I’m just drawing on the titles – it’s what subject matter that they cover is my point.) For myself, I’ll be interested to read the latter, the Preview for which notes, “Scientific papers on chronic fatigue syndrome (CFS) often evoke much debate and emotional reaction”.

    * I’m also reminded here of a few members of an anti-vaccine group who currently trying to ‘shout down’ my politely pointing to a source of information that one of their number asked for.

  • I am no stranger to controversial comment and hyperbole, Grant, so I don’t have an issue with using controversy to kick off a discussion. What irritated me about this article, though, is that its only reason for being was to excite controversy over the Catholic rejection of contraception on very flimsy a spurious grounds. If you read the article, there is nothing else worthy of discussion. The authors, for example, do not address the “plight” of the nulliparous business executive or the nulliparous woman with Down’s syndrome. Just nuns.

    I am not Catholic, nor do I agree with the Pope’s stance on contraception. I have no feelings one way or the other on this matter. It strikes me that the Pope would probably not object to nuns using contraceptive for medical reasons as this does not actually interfere with his decree. My post was entirely motivated by the poor medical reasoning behind the comment.

    If one is going to be controversial, one should at least ensure that your starting point is not laughably stupid.