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Lacroix studies

I've noticed that the two "LaCroix" studies (probably more accurately Scholes studies, as Scholes is the lead author) are billed as being essentially one study on the talk page and in the article. I'm not clear why this is. Looking at the studies, they describe two different patient populations. One study looked at a group of 170 women aged 14-18, enrolled in 1999-2000 (PMID 15699307). The other study looked at 457 women aged 18-39 (PMID 12192229), enrolled 1994-1999. There's no overlap in the cohorts (see their ages), and they were enrolled separately (not as part of the same project). So these would appear to be two separate studies, which reached similar conclusions. I think the confusion may arise from a third study (PMID 14759613), in which Scholes et al. "pre-published" their results from the adolescent cohort, but that study is not referenced in the article. The bottom line is that there appear to be two separate studies (one in adolescents, one in adult women) which reached similar conclusions about reversibility of BMD after discontinuation of Depo (in addition to the small New Zealand study). I'll make an adjustment to the text to reflect this. MastCell 03:29, 5 November 2006 (UTC)

Pfizer consultant

Thank you, David. Points taken. Apologies to Cindery for being unnecessarily argumentative. To refocus on content issues, I'm curious to hear other opinions about labeling Lacroix a "Pfizer consultant" in the context of this article, as I notice I'm not the only editor to raise this concern. My own feeling is that it represents OR, as I mentioned above, again in needlessly incivil language for which I apologize. MastCell 03:35, 5 November 2006 (UTC)

suggestion: cancer section

I suggest that this article have a section just for evidence about cancer risks. Why is item #9 in the "Footnotes" section blank? --JWSchmidt 04:24, 5 November 2006 (UTC)

Content Deleted

• Use of Depo may offer more privacy to some users than other forms of contraception, such as pills, condoms, and diaphragms, as there are no material objects which must be kept at home to continuously provide contraceptive protection.

• Depo is not immediately reversible. Because Depo Provera is administered once every 3 months, treatment can only be stopped 3 months after the last injection.

i can only assume the following claim is nonsense:

• Infants born to women exposed to Depo during pregnancy in one study had an 80% greater chance of dying in the first year of life. —The preceding unsigned comment was added by 202.0.106.130 (talk • contribs).

inaccurate inoformation

"The majority of this article has been written by a single editor who persistently and blatantly violates WP:NPOV, WP:NOR, and restores inaccurate information, using Misplaced Pages as a soapbox to push their POV that Depo-Provera (and most other contraceptives) are dangerous products foisted on women by a conspiracy of greedy and malevolent corporations, public health organizations and physicians. 68.255.20.88 08:05, 3 November 2006 (UTC)"

actually i would like to see that 'inaccurate inoformation' - at least in the discussion section - as well as Pfizers' completely accurate and neutral information —The preceding unsigned comment was added by 202.0.106.130 (talk • contribs).

Depo during pregnancy

'Infants born to women exposed to Depo during pregnancy in one study had an 80% greater chance of dying in the first year of life'

does this mean something along the lines of: "while Depo is not injected during pregnancy, if it WERE injected due to error the consequences would be............"

or does it mean something else entirely????????? also the citataion does not re-direct to an actual article —The preceding unsigned comment was added by 202.0.106.130 (talk • contribs).

effectiveness of Depo

is it reasonable to suggest in the article that while other contraceptives are only partially effective Depo is near 100% effective or is that not accurate? —The preceding unsigned comment was added by 202.0.106.130 (talk • contribs).

deliberate misinformation?

'Infants born to women exposed to Depo during pregnancy in one study had an 80% greater chance of dying in the first year of life' and here is the citation:

Exposure to DMPA in pregnancy may cause low birth weight.

PIP: A study sponsored by the Special Program of Research, Development and Research Training in Human Reproduction of the World Health Organization was carried out in Thailand involving groups of women with 1573 accidental pregnancies. There were 830 accidental pregnancies while using the injectable contraceptive depot-medroxyprogesterone acetate (DMPA), while 743 women had become pregnant before use. There were also 601 accidental pregnancies in oral contraceptive (OC) users. The comparison group of a total of 2587 controls comprised women whose pregnancies were planned as opposed to the exposed group. Women using DMPA had more pregnancy risk factors compared to other groups owing to low socioeconomic status, lower maternal weight and height, smoking and alcohol use during pregnancy, and unplanned pregnancy. However, even after adjusting for these factors, DMPA users had a 50% higher than normal risk of having a low-birth-weight child. The same level of statistically not significant risk was also found among the OC users. Among those who had had accidental pregnancies during DMPA use, and in whom conception was estimated to have occurred within 4 weeks of a DMPA injection, the risk of low birth weight was 90% higher than that in the control group. The increase in risk appeared to decline to 50% when the interval between conception and DMPA injection was 5-8 weeks, and to 20% when the interval between conception and DMPA injection was 5-8 weeks, and to 20% when the interval was or= 9 weeks. This trend was highly significant. Early, high-dose exposure in utero to DMPA seemed to affect fetal growth. There was no increase in the risk of mortality in the 1st year of life for infants exposed to OCs as compared to infants not exposed. However, infants from DMPA-exposed pregnancies had an 80% higher than normal risk of dying during the 1st year of life. Therefore, some infants born out of accidental pregnancies that occur during DMPA use may be at an increased risk of infant death.

—The preceding unsigned comment was added by 202.0.106.130 (talk • contribs).

content deleted

according to Pfizers' site, which the section on Warnings and precautions is purportedly referfing to:

'You should use Depo-Provera Contraceptive Injection long term (for example, more than 2 years) only if other methods of birth control are not right for you.'

i have deleted those items which appear to be either gibberish or deliberate misinformation —The preceding unsigned comment was added by 202.0.106.130 (talk • contribs).

gibberish?

how is the following NOT gibberish? 'Use of Depo may offer more privacy to some users than other forms of contraception, such as pills, condoms, and diaphragms, as there are no material objects which must be kept at home to continuously provide contraceptive protection.' —The preceding unsigned comment was added by 202.0.106.130 (talk • contribs).

content deleted

• 'This loss of BMD is of particular concern during adolescence and early adulthood, a critical period of bone accretion.'

sounds good however what is BMD and what is 'bone accretion'...... and who is the target audience?

• Long-term studies of users of Depo-Provera have found slight or no increased overall risk of breast cancer. However, one subset of the study population did show an increased risk of breast cancer in recent users (Depo use in the last four years) under age 35. ........... the reference appears to be about Pfizers' disclaimers RE loss of bone calcium —The preceding unsigned comment was added by 202.0.106.130 (talk • contribs).

WOAH!

Many parts of this article are good and NPOV, but other parts of it read like a scathing review. I'm sorry I don't have any better critcism at this time, but wow... this article seems to be highly POVed against use of Depo. I don't want to start disputing facts, or quotes, like where there's that quote that (paraphrased) Depo is by far the most dangerous drug on the market (/paraphrased). But it would be nice if the content outside of facts and quotes were more straight forward, honest, and neutral. I mean, the dangers that are inherent in use of Depo are pretty clear given the facts, I don't think we need to bolster that with our own personal opinions. --Puellanivis 22:16, 4 December 2006 (UTC)

You've probably seen on the talk page that issues of POV have been debated pretty heavily. I tend to agree with you. If you have some suggestions on how the page can be improved, please go for it. Don't worry - if others disagree with your edits, you'll hear about it. MastCell 00:36, 5 December 2006 (UTC)

I completely agree. Mifepristone is in a similar state. -Severa (!!!) 11:55, 19 December 2006 (UTC)

I also agree (except few not many parts of this article are accurate and NPOV). Mifepristone (and Emergency contraception) are in similar states. All three articles should be flagged to warn readers that the neutrality and factual accuracy of the articles are disputed.68.255.23.152 18:10, 20 December 2006 (UTC)

In general, I think the {{totally-disputed}} template and its ilk should be reserved for instances where no agreement or consensus can be reached on NPOV, despite the efforts of a number of editors. I don't think we're at that point yet - I'd suggest, instead, editing the three articles to try to remove what appears to be POV. It may be possible to do so and maintain a reasonable consensus. If not, and an impasse is reached, then the NPOV tags would be more appropriate - I just don't like to use them first-line, before we've made efforts to address the POV issues. So I guess what I'm saying is, be bold and edit the articles (or propose edits on the talk page) to address the POV issues. MastCell 18:21, 20 December 2006 (UTC)

I think it is perfectly appropriate to flag articles that have been made extensively and pervasively biased and factually inaccurate as a result of hundreds and hundreds of edits by a single editor in a short period of time.68.255.23.152 20:20, 20 December 2006 (UTC)

Well, I guess whether you add the tag is up to you. I would say that if you add the tag, it would be best to list here on the talk page specific areas/issues which you believe are factually inaccurate or POV. Best of all is to also propose edits to resolve those issues). My experience has been that just tagging an article as POV, without specifying the reasons and particulars, is not as constructive. MastCell 21:57, 20 December 2006 (UTC)

Recent edits

I've removed the following from "Warnings and Precautions":

Some women may prefer amenorrhea. According to Jerilynn Prior, M.D., professor of endocrinology and metabolism at the University of British Columbia in Vancouver, and board member for the Society for Menstrual Cycle Research,"the most important thing to emphasize about menstrual suppression is that the long-term effects are simply unknown," and "allowing the one vital sign unique to women to go unmonitored...could ultimately lead to an enormous uncontrolled experiment with a woman's health."

The "some women may prefer..." sentence is unsourced, and the quote on the importance of a menstrual cycle and the possbile risks of amenorrhea is in no way specific to Depo (it would apply equally to all forms of hormonal contraception) and is more appropriate for the hormonal contraception or amenorrhea articles. MastCell 18:32, 20 December 2006 (UTC)

Also removed, from "Black Box Warning", the clause about WHO distribution vs. FDA approval. This has little to do with the black box warning on bone loss, and the controversy is already covered under the "Controversies" section, which is the more appropriate place for it. The removed source is here for archival purposes: . MastCell 18:43, 20 December 2006 (UTC)

I know we've gone back and forth about LaCroix being a consultant to Pfizer, but to recap: in the studies cited here, a) no conflicts of interest are disclosed, and b) LaCroix is neither the lead nor senior author. The Pfizer consultancy thing is apparently based on a separate, unrelated article authored by LaCroix in 2003 in which she notes receiving consultancy fees from Pfizer. There are several issues here: a) the papers cited here do not disclose a conflict of interest; b) the potential conflict noted in the 2003 paper comes after one of the studies cited here - there's no indication whether LaCroix had received fees at the time of the relevant article's publication; c) joining fact A (LaCroix wrote a paper on Depo) with Fact B (LaCroix elsewhere disclosed a Pfizer consultancy fee in a different article) to advance Position C (that LaCroix had an undisclosed conflict relevant to the Depo paper) is the defintion of original research. Finally, the way it's phrased now, it seems to totally discount the results of two peer-reviewed studies based on an OR assertion of an undisclosed conflict of interest which no citable source seems to be alleging. Therefore I've removed it. MastCell 18:58, 20 December 2006 (UTC)

1. "Exposure to DMPA in pregnancy may cause low birth weight". Prog Hum Reprod Res (23): 2–3. 1992. PMID 12286194.
2. Cite error: The named reference Patient labeling was invoked but never defined (see the help page).
3. "Health experts define menstrual cycle as critical indicator of women's overall health". Medical News Today. September 22, 2004.