£2000 bounty - contraceptives (and UTI) literature review

by Chi Nguyen3 min read15th Sep 202113 comments

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I would like if there was a well-researched LessWrong post on the pros and cons of different contraceptives. - Same deal with a good post on how to treat or prevent urinary tract infection, although I'm less excited about that.

  • I and a friend would be willing to pay some of our private money for this to get done. Up to £1000 each. Open to considering higher amounts, but depending on the post, it might also end up (much) lower.
    • Depending on your track record, this could be paid in advance as a commission or as a bounty or a mix. The amount would depend on the quality.
    • Before you put serious time and effort into this, please reach out to me, so we can set expecations for the payment.
  • I'm also looking for people to chip in (either to offer more money or just to take some of the monetary burden off me!)
  • £40 bounty if you refer someone who ends up doing this and does it well. If you include some information that spares me a lot of work figuring out whether the person is likely to do a good job, that's highly appreciated!


Examples of the type of content that I would like to see included:

  • Clarity on the contraception and depression question. e.g. apparently theory says that hormonal IUDs should give you less depression risk than pills, but in empirical studies, it looks like it's the other way around? Can I trust the studies?
  • Some perspective on the trade-offs involved. E.g. maybe I can choose between a 5% increased chance of depression vs. a 100% increased chance of blood clots. But maybe basically no one gets blood clots anyway, and then I'd rather take the increased blood clot risk! But because the medical system cares more about death than me, my doctor will never recommend me the blood clot one, or something like that.
  • If there wasn't already a post on this (but I think there is), info on that it's totally fine to not take 7 day pill breaks every months, but that you can just take the pill all the time. (Although I think it might be recommended to take a short break every X months)
  • Some realistic outlook on how much pain and effects on menstruation I should expect
  • Various potential benefits from contraceptives aside from contraception
  • Conditional advice of the form "if you have a history of [depression/painful periods/irregular sleep rhythm...], you might want to try out X first. If X has adverse effect Y for Z number of months, my next best recommendation is A"
  • Interactions with other drugs and diseases, e.g. modafinil, selegiline, endometriosis
  • How long to try out a particular contraceptive before switching if it initially causes pain/depression
  • 1-year discontinuation rate with most commonly cited reasons for discontinuation
  • Some information on vasectomies and sterilization, including reversibility (and whether to get endometrial ablation while getting sterilized: What's the productivity-risk of chronic pain trade-off?)
  • Comparison of subtypes of different types of contraceptives, e.g. the longer-lasting IUD vs. the IUD for people who haven't had children, yet. What's the convenience vs. pain/period trade-off here?
  • Any weird, experimental male contraceptives that you can get your hands on if you really try - and how
  • On the UTI side: Is the cranberry stuff a myth or is it a myth that it's a myth or is it a myth that it's a myth that it's a myth?

I don't think a good post would have to cover all of these, and I admit some of these are weird details, but those are the type of things I'd be interested in.

Alternatively: If there actually already are really good resources on this topic out there, please let me know!
 

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Helpful resource for whoever ends up doing this: Contraceptive Technology. It's a huge book that summarises almost all effectiveness studies that have been done on contraceptives, including the definitions of perfect and typical use (very important when comparing contraceptives). It also has detailed summaries of side effects, medical interactions, description of method of action and well researched "advantages" and "disadvantages" sections — it's basically what doctors use to decide how to prescribe birth control. 

Source: I have used this book myself in research, I work for a birth control app company.

Looks like £2000 is currently ~2800USD.

Hi, MD here.
The collection of questions feels pretty random personalized (EDIT) - even if I would wanted to I could not really see where I should start and where I should stop. I believe that most of these questions should be answered like a good obstetrician/gynecologist who knows you and not by someone without rigorous medical training who volunteers to comb through google scholar.  Some prompts:

Here are some links for non-medicine trained people:
Oral contraception: https://jamanetwork.com/journals/jama/fullarticle/1814214?resultClick=1

Long acting contraception: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2519616?resultClick=1

Endometriosis (if you have severe pain during menstruation go to a special clinic for that): https://jamanetwork.com/journals/jama/fullarticle/2719310?resultClick=1

Vasectomy: https://jamanetwork.com/journals/jama/fullarticle/2685157?resultClick=1

Many women do not make a break. But this should be discussed with your obstetrician/gynecologist.

Nothing "relevant" new in the contraception space available for males to my knowledge.

For the UTI issue: shower your genital area before and after sex (seems more important for the female), both wash your hands depending on what you are doing with them and (as female) drink a glass of water with a tablespoon of D-Mannose ideally before each intercourse and on a regular basis (every other day). I spent a non trivial amount of time researching this a 2-3 years ago and it is definitively superior to Cranberry (but I am too lazy to look up the literature now and link it here).

So go ahead and visit (or spend the money on private calls with) good physicians (if you mistrust your healthcare system you could for instance look up those people who where involved in writing up the medical guidelines in your country on the topics that itch you the most). It will be more adjusted to your needs and the professional will help you to separate the relevant from the mere interesting.
 

I believe that most of these questions should be answered like a good obstetrician/gynecologist who knows you and not by someone without rigorous medical training who volunteers to comb through google scholar

People without conventional credentials combing through google scholar is a mainstay of LessWrong (this includes me). If you object to that practice or think people are doing a bad job then I think you should make a top-level post laying out your case, where it can be debated without hijacking someone else's request. Criticizing just one post feels both unfair to that one post and shortchanging the argument, since only people interested in this particular question will see it.

Interpreted charitably, I believe that mschons' comment is claiming that for this situation in particular, combing through Google Scholar isn't the best approach, not that it is inappropriate in general.

Hi, thanks for this comment and the links.

I agree that it's a pretty vast topic. I agree that the questions are personalized in the sense that there are many different personal factors to this question, although the bullets I listed weren't actually really personalized to me. One hope I had with posting to LessWrong was that I trust people here to be able to do some of the "what's most relevant to include" thinking, (e.g.: everything that affects ≥10% of women between 20 and 40 + everything that's of more interest on LessWrong than elsewhere (e.g. irreversible contraception)) I agree it's a tall order though.

For talking to my doctor: I found my experience of talking to doctors pretty frustrating to be honest. I think I've learned much more about contraception (including about where my doctors were misinformed) via the internet or friends than doctors. I don't doubt that there are excellent doctors out there, but it's difficult to find them. The advice with looking up people who wrote up medical guidelines seems solid.

That being said, while I'm interested in the topic myself, I was mostly thinking that it would be good for the LessWrong/EA community to have a reliable source. (I'm mostly constrained to hormonal contraception and have already tried out a couple, so my remaining search space is relatively small.) I think it could save lots of women many hours of research into which contraception to take + productivity loss from trying out or permanently choosing suboptimal contraception.

You prompted me to try out the D-Mannose, thanks! I've had it lying around, but was always to inert to research whether it actually works, so never bothered to take it.

I'd be interested, but you say that the payment "depending on the post, it might also end up (much) lower". Also, I haven't done any research into this before, and would have a lot of reading to do, and so someone else would probably do it first.

Have you already had volunteers, and could you elaborate on the payment?

Sorry for replying so late! I was quite busy this week.

  • I initially wanted to commission someone and expected that I'd have to pay 4 digits. Someone suggested I put down a bounty. I'm not familiar with putting bounties on things and I wanted to avoid getting myself in a situation where I feel like I have to pay the full amount for
    • work that's poor
    • work that's decent but much less detailed than I had envisioned
    • multiple reports each
  • I think I'm happy to pay the full amount for a report that is
    • transparent in its reasoning, so I can trust it,
    • tells me how much to trust study results, e.g., describes potential flaws and caveats for the studies they looked at,
    • roughly on the level of detail that's indicated by what I wrote under "the type of content I would like to see included". Ideally, the person writing wouldn't treat my list as a shopping list, but use their common sense to include the things I'd be interested in
    • the only report of this type that claims the bounty
  • The first two are the most important ones. (And the last one is weird) If It's much less detailed, but fulfills the other criteria, I'd still be happy to pay triple digit.
  • As you're later comment says, I think this is a pretty complex topic, and I can imagine that £2000 wouldn't actually cover the work needed to do such a report well.

I think before someone seriously puts time into this, they should probably just contact me. Both to spare awkward double work + submissions. And to set expectations on the payment. I'll edit my post to be clearer on this.

actually never mind. I don't have a university or anything that gives access to journals, sci-hub doesn't have a convenient search tool, and arxiv doesn't have enough articles about this topic

You can search on scholar.google.com (if normal google isn't good enough) and get them from scihub/libgen.

woah, birth control is way more complicated than I thought. I started looking and it turns out I can't just read a bunch of studies about each method and say what the side effect risks are. There are quite a lot of birth control methods and chemicals, each with tons of complicated chemical interactions, tons of complicated hormonal interactions, side effects, etc. Each article talks about lots of fancy biological terms like "venous thrombosis" that I have to keep looking up. I also don't really have the medical knowledge to really put things in scale: for example, one medication treatment is said to raise a hormone level to a peak of something ng/mL, and I don't know how much of a change that is.

Thanks for the help finding sources, everyone, but this bounty won't be claimed until a doctor looks at it.