Talk:Issues in Interdisciplinarity 2020-21/Evidence in Hormonal Contraception

=  Division of group work:  = Since the three of us live in the same accommodation we had the chance to meet several times in person to discuss the Wikibooks chapter. Even after 2 of us went back home for Christmas we continued meeting once or twice every week to work on the project via Zoom. This led us to do many things collaboratively, producing sections which have been written and extensively edited by the entire group and not any individual member. The fact that we met so frequently allowed us to better discuss topics face to face and reach better conclusions as the different perspective of each member in the group were better understood and heard. We also had a final call where we all went over the different sections in the book and did our final edits communally as well as reduced words.

Here is a general outline of what each group member did individually:

Ethan.dawson101:
 * Wrote “Evidence in Biology”
 * Wrote the introduction based on first draft written by Edgeofdawn
 * Wrote second paragraph in the Tensions section
 * Edited and restructures both Conclusion and Tensions sections with Edgeofdawn

Edgeofdawn:
 * Wrote the first outline of the introduction
 * Wrote main bulk of Tensions and conclusion section
 * Cut down words so that chapter fit max. wordcount of the assignment

Ocinweg
 * Wrote "Evidence in Psychology"
 * Reviewed the introduction written by Ethan.Dawson, and the conclusion written by EdgeOfDawn.
 * Finalised the conclusion, editing and adding a final paragraph.

= ''' Meeting 1: 23/11/2020, (15:00-16:00) Attended by Ocinweg, EdgeofDawn and Ethan.Dawson1010. ''' =

1) Discussed topics for the chapter.

2) Suggested ideas: Extra-terrestrials, over-population, sterilization, evidence in contraception.

- Evidence in contraception: Safety in contraception?

a) Biological evidence- Quantitative evidence, analysis via physical impact on the body.

b) Sociological evidence- Theological interpretations (qualitative evidence, case by case bases and dogma based analysis.)

c) Political evidence- Review of economic impacts, cultural deviations and feminist based interpretations/ qualitative evidence.

d) Feminist approach regarding the evidence for contraceptives - Discussed if Feminism is considered as a discipline and if we could use it as one.

e) https://books.google.co.uk/books?id=DImlYJ7NQycC&printsec=frontcover&dq=papers+on+the+safety+of+contraception&hl=en&sa=X&ved=2ahUKEwjV1rbdgJntAhWRilwKHaY3AbIQ6AEwAHoECAUQAg#v=onepage&q=papers%20on%20the%20safety%20of%20contraception&f=false

f) https://www.nber.org/papers/w19493

More potential sources:
Higgins JA, Smith NK. The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept. J Sex Res. 2016;53(4-5):417-456. doi:10.1080/00224499.2015.113442 https://doi.org/10.1080/00224499.2015.113442

''' Work for next session : Research initial tensions within the topic, forms of evidence regarding safety, define safety in forms of contraception. Add information to discussion. '''

https://books.google.co.uk/books?hl=en&lr=&id=AHNsBAAAQBAJ&oi=fnd&pg=PP1&dq=interdisciplinary+tensions+contraception&ots=FO-wokKZI_&sig=RPJHsBdf41DXZH3DruliJbfNxao&redir_esc=y#v=onepage&q=interdisciplinary%20tensions%20contraception&f=false

= Meeting 2:26/11/2020 (13:00-14:00) Attended by Ocinweg, Ethan.Dawson1010 and EdgeofDawn. =

1) Further discussion of topics.

2) Reconsidering Over population (Power)- Discussing (biological) the power in the availability of contraceptives (indirect power), vs political bans (direct power).

3) Return to contraception- Biological perspective vs psychological perspective (hormonal impact) - Look at the concept from the place of a policy maker. Control trials vs course experimental methods. (Differences in the available forms of evidence)

4) Beginning to research biological perspectives vs psychological perspectives.

= Meeting 3: 27/11/2020 (15:00-16:30) Attended by Ocinweg, Ethan.Dawson101 and EdgeofDawn. =

1) Discussion on the scientific content within the biology header.

2) Discussion of division of labour between topics.

3) Clarification of our arguments.

4) Discussion of available sources and citations for the economics section.

= '''Meeting 4: 02/12/2020 (11:30-12:30) Attended by Ethan.Dawson101, EdgeofDawn, Ocinweg. ''' =

1) Recap of individual work done since last meeting.

2) Discussion of the relationship between our differing subjects within the topic.

3) Discussion of how best to redraft and address evidence within our subjects.

4) Psychology as filling in the gaps in research left by biology- Sexual disfunction and menstrual cycles for example.

5) Interest in the tendency for biological research to drop participants who abandoned the trial vs the tendency in psychology to ask why that individual did so.

= Meeting 5: 12/12/2020 (16:00-17:00) Attended by Ethan.Dawson1010 and EdgeofDawn. = In this meeting we discussed basically the Tensions and Conclusion. EdgeOfDawn had written a base first draft of both these sections and during the meeting discussed edits and new ideas the other members had thought of such as:
 * Moving section about the privilege of biology has as policy makers put it at a higher priority that psychology from tensions to conclusion.
 * Make the focus that biology has on only physical effects the "cause" of its privilege, thus link the two ideas better
 * Introduce more mentions of Interdisciplinarity and its benefits to the field
 * Introduce new argument on self rapport and the idea of quantitative vs qualitative evaluation of this self rapport as a way of producing evidence.
 * Talk about recent importance and focus in mental health
 * Bring back idea of meta-analysis and the argument we originally had but then had gotten rid of

= '''Meeting 6: 13/12/2020 (14:00-15:30) Attended by Ethan.Dawson1010, EdgeOfDawn, Ocinweg. ''' =

1) Review and group edit of the wikibook. 2) Review of Introduction and Conclusion. (most recent additions) 3) Discussion of submittal times and pdf format.

= '''Meeting 7: 14/12/2020 (11:30-12:30) Attended by Ethan.Dawson1010, EdgeOfDawn, Ocinweg. ''' = Final meeting on the Wikibooks chapter
 * 1) Reduce word count
 * 2) Add to discussion how the group work was divided
 * 3) Export Wikibooks as PDF and upload

= '''Initial planning: Evidence in Contraception. Wiki-books article by Ehan.Dawson1010, Ocinweg and EdgeOfDawn.''' -=

Introduction:
A definition of hormonal contraception, its uses, its general importance etc.

Define its separation from physical contraceptives such as condoms.

Should we focus on hormonal contraception used for preventing pregnancy or also its use in treating dysmenorrhea or mental health problems caused by female reproductive hormones?

Potential Introduction Draft (EdgeOfDawn)

Hormonal contraception works by… Contraceptive pills are not only for preventing pregnancies, but are widely used by young women for treating heavy flow and period associated pain and cramping (dysmenorrhea). Due to such a broad usage, it is imperative that several aspects, across multiple disciplines, are considered in regards to the development and improvement of new or currently available hormonal contraception. However, tensions between disciplines such as biology and psychology show…

Introduction Draft (Ethan.Dawson101)

Hormonal contraception nowadays exists in a variety of forms: birth control pills, vaginal ring, hormone-releasing contraceptive coils or contraceptive skin patch. However they all work on the same basis, they all alter and influence female hormone levels, with most of them stopping the ovaries from ovulating and releasing mature eggs.

Due to such it’s broad usage, research in the field considers several aspects regarding the development and improvement of new or currently available hormonal contraception. Thus, we see research on them in multiple disciplines such as Biology and Psychology. This multidisciplinary range of studies shows a variety in evidence which in itself presents many interdisciplinary tensions. Therefore, an insight into tensions between disciplines like Biology and Psychology will better the understanding of hormonal contraception by policy makers and the general populus, improving their everyday use and effectiveness.

Evidence in biology
Most of the biological research relating to hormonal contraceptives use randomized control trials (RCT) nowadays using computer-generated randomization schemes. Another main group of studies regarding hormonal contraceptives is composed of large non-comparative multi-center registration studies. Nonetheless, an important problem in the field is that both these designs (RCT’s less) run the risk of being biased due to the fact the companies that manufacture the contraceptive being tested fund, undertake, analyze and write up the results of such studies.

In terms of the population of these studies we find large variety with samples ranging from 40 up to 237,242, but with clinical trials of around 600. We also see how these populations are mostly European or American, limiting the applicability of the data. Simultaneously, most studies limit themselves to 365 days, and generally don’t document the long-term health effects of hormonal contraceptives.

Within the discipline of Biology we can generally evaluate evidence for hormonal contraceptives as being quite varied. This is due to the fact that exogenous administration of synthetic hormones can alter the hormonal secretions elsewhere in the body leading to modifications in multiple organ systems and physiologic processes. Thus, we see how Biology uses an large array of specialized methodologies to measure this plethora of non-contraceptive effects.

One of the most problematic methodological assumption in Biology affecting it’s production of evidence is it’s reliance on self-report measures as a valid quantitative measurement method. Biological research on hormonal contraceptives focuses greatly on participant adherence and compliance, evaluation of menstrual-associated symptoms and contraceptive use. Thereofore research relies greatly on interviewer-administered questionnaires, self-administered surveys and daily diaries. We find more of this vagueness of biological evidence in lack of well and consistently defined terminology. Researchers rarely use consistent terminology of words such as “continuation,” “compliance,” and “adherence,” or “misuse”, “nonuse,” and “correct use”. This variable terminology causes conflicting and equivocal data and limits to any related negative outcomes.

Furthermore, as a discipline biology fails to capture the full complexity of contraceptives due to the general lack of research towards non-physiological more qualitative non-contraceptive effects of hormonal contraceptives. There is a lack of attention directed towards menstruation-associated symptoms, participant satisfaction, and long-term health effects of continuous administration such as sexual disfunction. We can clearly note a preference within the discipline to look at physical conditions as evidence, due to is quantitative nature. We can find many epidemiologic studies showing an increased risk of venous thromboembolism, ischemic stroke, and myocardial infarction or even increased prothrombotic and cardiovascular risk, all of which are easily tested and subjectively quantifiable conditions. The same goes for the benefits of hormonal contraceptives such as reduced risk of ovarian and endometrial cancers, more favorable bleeding patterns, and improvement in menstruation-related symptoms

Version two
Most of the biological evidence relating to hormonal contraceptives is produced through randomized control trials (RCT) using computer-generated randomization schemes,[3] or we also find many large non-comparative multi-center registration studies.[4] Nonetheless, an important problem in the field is that both these designs, although regarding RCT’s this is less so, run the risk of being biased as the companies that manufacture the contraceptive being studied fund, undertake, analyze and write up the results of these studies.[4]

In terms of populations, we find a large variety of samples ranging from 40 [5] up to 237,242 [6], but with clinical trials not going above 600 participants, and with a mostly European or American demographic.[7][8] Generally, research doesn’t last more than 365 days with studies evaluating between 4 to 8 menstrual cycles. Hence the more long-term health effects of hormonal contraceptives are undocumented in biological studies.[3]

Within the discipline of biology, evidence for hormonal contraceptives is quite varied. This is due to the fact that synthetic hormones can effect the body’s own hormone production, potentially leading to several different physiological changes.[9] This forces biological research to use multiple specialized methodologies to measure this range of effects.

However, one problematic assumption in the biological study of hormonal contraceptives is in the application of self-reports as a valid quantitative measurement method. The reliance of biological research on interviewer-administered questionnaires, self-administered surveys and daily diaries is due to the field’s focus on participant adherence and compliance and evaluation of menstrual-associated symptoms.[8] Another major problem with this biological evidence is in the lack of well and consistently defined terminology such as “continuation,” “compliance”, “adherence,” “misuse”, “nonuse,” and “correct use”,[8] producing conflicting or equivocal data and limiting the observation of negative outcomes.

Most importantly, as a discipline, biology fails to capture the full complexity of contraceptives due to the general lack of research towards non-physiological, non-contraceptive effects of hormonal treatments. There is a lack of attention directed towards menstruation-associated symptoms, participant satisfaction, and long-term health effects like sexual disfunction of continuous administration of hormonal contraceptives.[3][10] There is a preference within biology to state physical conditions as evidence, due to it’s quantitative nature. Many epidemiologic case studies exist showing an increased risk of venous thromboembolism, ischemic stroke, and myocardial infarction,[9] all of which are easily tested and objectively quantifiable conditions.

Intial Plan:
A qualitative analysis of short-term risks and benefits of hormonal contraception.

Examples of studies: clinical biological trials, give an indication of the types of evidence that is used. Evidence is quantitative with an impersonal approach to participants.

http://apps.webofknowledge.com.libproxy.ucl.ac.uk/full_record.do?product=WOS&search_mode=GeneralSearch&qid=2&SID=E6ql38buHr6naWzXTiI&page=1&doc=9

http://apps.webofknowledge.com.libproxy.ucl.ac.uk/full_record.do?product=WOS&search_mode=GeneralSearch&qid=2&SID=E6ql38buHr6naWzXTiI&page=1&doc=8

These are randomised controlled trials - often used in studies to gain quantitative data of effectiveness. Not usually any scope or study of individual experiences as with psychology.

Evidence in psychology
“Literature testing psychological implications of commencing oral contraceptives has lagged behind research investigating physical risks.” Despite this, the field continues to push for a greater understanding of the long-term consequences of hormone use in contraception. It is because of this comparative lack of interest that we may identify a heavier use of meta-analysis (see  ) as the field takes advantage of previous research as opposed to the in-depth, case by case studies conducted by the traditional biological perspective.

The research conducted to review the possible effects of hormonal contraception, having been conducted over a larger time scale than its biological counterparts, identifies and analyses the impact that hormonal contraception has on both a neurological/hormonal level (I.e., its influence on natural female cycles and their level of attraction toward a possible mate) but also a purely behavioural level, helping to diagnose the source of certain mental illness and the differing hormones within contraception that serve to worsen/aggravate them.

Research methods, in the cases often utilized by meta-analyses of the topic, include discussions on second wave feminism and the impact of contraception on the workforce, qualitative observation of the impact of hormones within primates in accordance with the changes in their behaviour, and lastly in qualitative studies of the impact upon women in which the impact upon behavioural patterns was analysed as well as the mental health repercussions/consequences of the use of these contraceptives.

These studies carried out first on primates and then women, show a relevant impact not only upon the physical health of the individual, though it is noted that these specifications fall more in line with biological research, but also upon levels of both aggression and in some cases, depression. Revealing an increased tendency in women toward BPD (borderline personality disorder) and both an increased and decreased level of aggression in primates varying depending on species. This tendency within primates to vary in aggression levels speaks to the impact on human women and yet sufficiently distant to yield yet uncertain results and is for now too draw human consequences from.

Version two

“Literature testing psychological implications of commencing oral contraceptives has lagged behind research investigating physical risks.” [9] - Kobey and Bunnk, 2012.

Despite this, the field pushes for a greater understanding of long-term consequences in hormonal contraception use. There is a heavier use of meta-analyses as the field takes advantage of previous psychological research.[10] Alongside these meta-analyses the psychological evidence also focuses on the use of in-person interviews and population based studies; these aid in giving a longer-term perspective with a more qualitative approach.[11]

The research conducted to review effects of hormonal contraception, formed over a larger time scale than biological research, not only analyses the impact at both a neurological or hormonal level,[12] but also a behavioural level. This helps to diagnose sources of certain mental illnesses and the hormones used in contraception which serve to aggravate them.[13]

Research methods also include subjective discussions on second wave feminism and the impact of contraception on the workforce due to a relation to women’s health and psychology.[14] There exists further qualitative observation of the impact of hormones on primates,[13] and qualitative studies relating to behavioural patterns in women.[15] These studies carried out on primates and then women show an impact not only upon the physical health of the individual, though it is noted that these specifications fall more in line with biological research, but also upon levels of aggression and depression. However, primates may be considered sufficiently distant to humans that they yield uncertain evidence regarding possible human consequences.

Tensions
Differences in evidence type between biology and psychology present one avenue in which tensions arise. Many biological studies are clinical, randomised trials with a control group. (See ) They study and numerically ‘score’ effects of hormonal contraception on a large group of people, and run statistical analysis on their results; this produces primary evidence which is largely quantitative and removes the aspect of personal experience in regards to contraception use. On the other hand, a wider range of meta-analyses can be found in psychology, which is therefore secondary evidence. In addition, there is a focus on using reports and interviews from women about their personal experiences with contraception use and its impacts on their own mental well-being and sexual activity. Evidence such is this is gathered from more situational studies as opposed to the randomised, double-blind and statistical biological experiments.

In the development of hormonal contraceptives, there is greater focus on biological research – does the drug adequately effect the target, how much should a dosage be – when first considering if the drug is viable. Psychological studies testing the effects of hormonal contraception usage are usually carried out following this clinical testing. For example, while hormonal contraception has been in wide use for over 50 years, suggesting high levels of biological research into viable drugs, the effect of contraception on stress responses and emotional memory remains unexplored; it is only in recent years that such things are being considered. Furthermore, while there is increasing attention in the literature towards studying psychological effects (including sexual experience), the drugs studied are branded products already in use. In the case of studying long-term effects, longer research time periods also mean that psychological studies ‘lag’ significantly behind biological ones. Here, tension arises as biological evidence is considered a ‘priority’, while psychological evidence may be considered an afterthought.

When considering the viability of a contraceptive drug, there are of course ethical concerns when testing for psychological effects in a substance that has not yet been clinically trialled. However, the amount of time required for long-term psychological study of contraceptives may mean that drug companies prefer to develop drugs after completing only clinical trials; also a concern considering the importance of mental health is equally important as physical. As such it is difficult to consider both forms of evidence in a multidisciplinary approach to contraception development; instead, an interdisciplinary approach that brings together different aspects of each discipline’s evidence to reach a holistic judgement could be considered.

Tensions version 2
Differences in evidence type between biology and psychology present one avenue in which tensions arise. Many biological studies are clinical, randomised trials with a control group, such as Osuga, Hayashi and Kanda’s 2020 study. Effects of hormonal contraception on a large group of people are studied and numerically ‘scored’, and results are statistically analysed; this produces primary evidence which is largely quantitative and removes the aspect of personal experience in regards to contraception use. In psychology however, there is a focus on using reports and interviews from women to generate evidence; the emphasis is on their personal experiences with contraception use and its impacts on their own mental well-being and sexual activity. Evidence such is this is gathered from more situational studies as opposed to the randomised, double-blind and statistical biological experiments.

In the development of hormonal contraceptives, there is greater focus on biological research – does the drug adequately effect the target, how much should a dosage be – when first considering if the drug is viable. Psychological studies testing the effects of hormonal contraception usage are usually carried out following this clinical testing. For example, while hormonal contraception has been in wide use for over 50 years, suggesting high levels of biological research into viable drugs, the effect of contraception on stress responses and emotional memory remains unexplored; it is only in recent years that such things are being considered. Furthermore, while there is increasing attention in the literature towards studying psychological effects (including sexual experience), the drugs studied are branded products already in use. In the case of studying long-term effects, longer research time periods also mean that psychological studies ‘lag’ significantly behind biological ones. Here, tension arises as biological evidence is considered a ‘priority’, while psychological evidence may be considered an afterthought.

Furthermore, biological studies considering the safety of contraception may focus more on physical side effects of usage, such as bleeding.(Use one of Eric’s references here) The mental side effects considered in psychological studies are less apparent and may take longer to manifest themselves. Since the evidence gathered in biology is written about more physical and perhaps more tangible side-effects, this could mean that biological evidence is seen as more viable/valid than its psychological counterpart.

Conclusion:
When considering the viability of a contraceptive drug, there are of course ethical concerns when testing for psychological effects in a substance that has not yet been clinically trialled. However, the amount of time required for long-term psychological study of contraceptives may mean that drug companies prefer to develop drugs after completing only clinical trials; also a concern considering the importance of mental health is equally important as physical. As such it is difficult to consider both forms of evidence in a multidisciplinary approach to contraception development; instead, an interdisciplinary approach that brings together different aspects of each discipline’s evidence to reach a holistic judgement could be considered.

= References =