Call to action on breastfeeding

The HHS has a call to action on breastfeeding that is currently open for comments. (h/t to Our Bodies, Our Blog.)

I commented on Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care, and Paid Maternity Leave so far, but could easily comment on all of the topics. I hope they get lots of good feedback. Please comment!

Vaccinations – dipping my toes in the waters

I have wanted to talk about vaccinations for a while, but I have been afraid to broach the subject. I am definitely at a clash between two cultures when it comes to vaccinations. I know how ugly the language can get coming from both sides of the issue. I want to discuss some nuance here. Let’s see if it works.

I got an email from a faculty member at my medical school asking us to make phone calls against Florida SB 242 relating to immunizations, which is on the agenda of the Policy and Steering Committee on Ways and Means April 21st. I am not taking a stand on whether this sort of email is appropriate. I do encourage political discourse. I wish the email had a link to the full text (pdf) of the bill (which is actually hard to pin down. I think there are a lot of proposed amendments, too) or used the original language of the bill. I would like to exercise my same freedom to discuss the issue that my faculty member took, and examine some aspects of the proposed legislation.

The proposal wants to start a registry of vaccines by lot number. Why is this a problem? I know many people swear there is no link between autism and vaccines. Vaccine reactions are supposed to be rare. Why can’t we support this by tracking lot numbers? Autism was not under any form of surveillance in Florida when I wanted to research it five years ago in an epidemiology class. There are supposed pockets of autism here. What’s wrong with a little old fashioned public health research here? Nothing wrong with data. The lot number is an easy enough thing to note. When I administer an HIV screen I note the lot number (with a sticker) in no less than eight places. Parents can refuse to be part of the registry. So, this doesn’t have to be a burden if parents are resistant to having that sort of information recorded. I am a big fan of opt out options. (Although I tend to think there will be some overlap between the parents who don’t want their kids’ vaccines tracked by big brother and the parents who don’t want to vaccinate, period.)

The second recommendation (one of the links above) is to prohibit:

The sale, purchase, manufacture, delivery, importation, administration, or distribution of any human vaccine used for children under age 6 or pregnant women which contains any organic or inorganic mercury compound in excess of 0.1 microgram per milliliter.

There is an exception made for epidemics. I always hear vaccine advocates saying that thimerosal is no longer an issue, it has been removed from virtually all vaccines. So, again, what is the problem. Why defend the mercury? I know some people say dental types who want to defend the mercury in silver fillings are just trying to prevent lawsuits. Is this the same sort of issue? Mercury was in most vaccines up until very recently, and is still present in some, namely the flu vaccine.

Finally, it allows for a modified schedule for vaccine administration. Again, what is the problem? Why the utter inflexibility? It does not say it allows for any new exemptions. Some diseases do not cause outbreaks generally (bacterial meningitis, hepatitis B), at least not in young children. I can still see how a pediatrician can inform the parents, allay fears, and try to set up a schedule that works for everyone. Is the child not going to be in daycare (which may not accept the adjusted schedule) and not exposed to many people? What’s wrong with waiting on a few?

I think my professor is afraid that making accommodations about vaccines in any way gives credence to vaccine critics. I think the opposite. Making sure vaccines are as toxin free as possible and allowing for some parent autonomy, within reason, actually takes fuel away from the extreme anti vaccine crowd.

OK, have at it. Try to be civil or you may get a square on the bingo card.

If I was in charge of the FDA…

I may not teach at Harvard Medical School like the author of this interesting op-ed in the Boston Globe, but I also have some opinions on what the new FDA should do. I am right with the people who have many complaints about our foreign policy under the past administration, but medicine and health were also gutted and ruined, and the FDA was at the rotten core.

I agree with every recommendation she makes, especially the ones about comparing new drugs with existing drugs in the same category for efficacy, and using clinical endpoints like heart attack and stroke instead of biomarkers like cholesterol. (H/t Our Bodies, Our Blog)

I would go one step further and recommend that all pharmaceutical companies do the preliminary research themselves on new drugs, but contribute to a general fund for advanced trials. Independent scientists would do blinded research, including older drugs for comparison. All results would be published. These companies would have to be damn sure all the kinks were out by the time it got to that stage.

Hey, a girl can dream, can’t she?

Reply turned post, I’ve heard this song before style

Pretty soon I may actually come up with an original post, and stop doing only replies-turned-posts. I have recently added more sites to my feeder. I deleted some, too, so that may be a moot point. I also just finished classes and S’s birthday party, and am looking forward to a week “off”. I have a lot planned for this week, including a trip to a Medical Students for Choice convention on Friday. I also have to catch up on a lot of business I let slide until this week off. Not to mention, I have a written final in Osteopathic Principles and Practice, and a cumulative practical, on Tuesday after spring break. That includes license and car registration renewals, quizzes for my public health class, plans for my research project, my FAFSA, exercising and gardening…and catching up on hundreds of updates in my blog feeder. This catching up process explains a lot of replies. Some turn into posts. I like doing these because it shares other sites with people who have similar interests, and at least half of my ranting occurs on other sites.

So, this was a reply on a post about the resistance to the increased Medicaid contraception coverage in the stimulus package on RH Reality Check. I am not sure why this was being discussed now, since it happened in January, even though I welcome this kind of an article anytime. I swear, even thought I am backlogged, the post on RH Reality Check and the original article from FAIR were both published yesterday. It may be timely, since this provision as supposed to be added to the budget that just got passed.

Anyway, the reply:

Not only is the corporate media guilty of not challenging talking points or critical attacks by politicians, but this case was even more egregious. The mainstream media, even liberal sources, tend to treat women’s reproductive health, especially contraception and abortion, as a political third rail. It’s automatically “controversial”, so everyone’s outrageous statements are accepted under the umbrella of controversy.

By including women who would qualify for Medicaid if they got pregnant to Medicaid’s contraception program, women would have more control over their reproductive autonomy, not less.

It didn’t even matter that this provision would PREVENT abortions, not increase them, so it could not fund the nonexistent “abortion industry”. It most certainly would not impose them on pregnant citizens like the Chinese government.

I really wonder why Rep. Boehner and his ilk are opposed to contraception if they are supposedly interested in decreasing abortions. They need to add “anti contraception” to their platform. I would be interested in seeing the reaction to that.

Good news

I guess this is what my research methods professor meant when he was talking about regression toward the mean. There is so much back-asswardness left over, health and science wise, from the last administration that it seems like Obama is really churning out a lot of liberal policies when, in actuality, his policies are just righting some wrongs and supporting evidence and better outcomes.

Here is a good example: A federal court ruled the FDA was wrong when it dragged its feet over approving OTC (over the counter) availability of Emergency Contraception (EC). It will now be available to 17 year olds (good!). This was something that was recommended by the FDA’s own panel of doctors advised that it be available OTC for all ages way back in 2003. We are getting there. Slowly.

My conscience clause comment

My comment to the Department of Health regarding the proposed rescission of the Bush era conscience rule. For information on making your own comment, please visit Rachel at Women’s Health News.

This comment is in regards to the rescission proposal.
I am a medical student, a future ob/gyn, a mother, and a concerned citizen. I think there was no current need for the new conscience clause ruling. The former HHS secretary, Mike Leavitt, purposefully mischaracterized the state of licensing for ob/gyns in order to forward a political ideology. The American Board of Obstetrics and Gynecology publicly demanded that the HHS show even one case of discrimination against a practitioner who exercised his or her right to refuse to participate in an abortion, and Secretary Leavitt was unable to produce even a single example.

The Obama administration states that it is committed to changing the unfortunate recent history of overlooking science and truth in order to advance political ideology in health policy. In fact, most of these decisions have been based on opinions that only represent a minority ideological belief of the citizenry. The rescission of this ruling is imperative to reestablish faith in our national health policy.

The current conscience legislation is already too overreaching. I am concerned that requiring health care entities to pre-certify that they do not discriminate in hiring, specific to conscience refusal, will hamper the ability of certain organizations to fulfill their mission statements. For example, in my high risk area, South Florida, the Department of Health has family planning clinics established and funded for the sole purpose of providing birth control to the underserved. With the climate encouraged by this recent legislation, it is entirely plausible that these facilities would be forced to hire employees that are opposed to birth control.

In fact, some sections of the rule do not refer to abortion at all, and could be construed to apply to any practice that a potential employee finds unethical. Birth control is not abortion according to medical definitions of pregnancy and the methods of action of birth control, but many extremists see forms of birth control as abortion, and the law caters to such a worldview. How long until observant Christian Scientists are applying for jobs at surgery centers with the intent of obstructing surgical procedures? It seems like this rule is likely to increase costly lawsuits. It also seems like health care entities will be almost forced to hire employees that will expressly NOT fulfill their job duties in order to avoid such lawsuits. Where is the pressing need to increase such lawsuits? In actuality, there is a pressing need for more abortion providers and more contraception access, not less. There is a pressing need to reduce health costs, not increase them. There is a need to increase common ground, not accentuate difference and encourage uncooperation when there is already more than adequate provisions protecting conscientious objection in health care.

Rescission

Well, I thought I was only going to be learning new words in medical school. But, here comes the proposal for the “rescission” (I guess that is the act of rescinding?) of the so-called conscience rule that was passed at the end of the Bush administration. The new Department of Health and Human Services (HHS) has released the text of the proposal to rescind the rule.

The recommendation for rescission will be released officially on Tuesday, and the 30 day comment period will begin at that point. I know misinformation is already being spread that this proposal will lead to health care practitioners being fired for refusing to perform abortions. The Christian Medical and Dental Association (CMDA) at my medical school sent out a letter saying just that to its members, and urged them to comment.

I will be posting a link for comment when it is available.

I have to be honest, it is hard to get worked up after reading the proposed rescission or the original rule. It is really a bunch of posturing about multiple previous laws and statutes. The main issue I have with the recently adopted rule is the requirement of health care entities that receive department funds to provide written certification that they will and do not discriminate in employment against people who would exercise a conscience objection to a procedure. It also mentions posting information at these workplaces, much like you see posters describing worker’s compensation rules by time clocks. The biggest danger I can see is in its excessive and vague repetition of what is objectionable. At several points it does not even mention abortion specifically, and these sections of the rule could easily be taken out of context and be used to support costly lawsuits by people who are opposed to many other aspects of health care, from contraception (very plausible) to surgery (not as likely, but still entirely possible).

What I see this doing is further polarizing the two sides of the debate. Eight years of radical anti choice policies by the Bush administration has pushed the conversation about a myriad of reproductive health issues to the far right. The significant need claimed in the Bush HHS rule is nonexistent, but it has succeeded in making a bunch of anti-choice advocates think there is a significant need for this legislation. The American Board of Obstetrics and Gynecology (ABOG), the licensing group for ob/gyns in the United States, was supposedly the reason why former HHS Secretary Leavitt felt the need to create this new legislation. In a released letter (pdf) to Leavitt late last year, ABOG states:

In none of our various communications with you and your Department have you provided the American Board of Obstetrics and Gynecology with “even one” instance of the discrimination of which you have publically (sic) accused it in your Press Release, let alone any supporting documentation. My careful and comprehensive review of the ABOG files does not disclose “even one” instance of a physician who was denied certification or recertification, or whose certification was revoked, because the ABOG allegedly required that physician, as you have charged, to violate his or her conscience by referring patients for abortions.

So, what is left is a group of radical anti-choicers who have been emboldened to fight new fronts in reproductive health as the lines move farther to the right, regardless of the actual need or ethics of such actions. Simultaneous to the origination of the new rule last year was the Pill Kills campaign. The fight for anti-choicers to try to justify to preserve this legislation fuels the fire, especially as Obama is is planning on signing an executive order on Monday to resume funding more lines of stem cell research. I am waiting for an even further shift to the right by anti-choicers. Since all of the various conscience clause laws will still be in effect, even if this latest rule is rescinded, I am predicting the next great front will be vaccines. I would love to see some of these activists who object to vaccines that are made with embryonic tissue start getting their hardline approach to “rabies, some mumps, rubella, chickenpox, hepatitis a, smallpox (some), ipv” more popularized. Imagine if they sue because they want to be hired to work in a pediatric clinic and refuse to administer, discuss, or refer for any of these vaccines. What if they want to work in a school office but want to refuse to handle any health forms certifying that children are up to date on these vaccines?

Sigh.

Reversal of misfortune

I was happy to hear on NPR today that the Obama administration is finally getting around to reversing the Bush administration’s so called “conscience clause”. Unfortunately, it is hard to discuss the nuanced details of the HHS rule in soundbites. NPR failed to do this well when introducing the story and on their main page, by describing the rule by using this tag line: “The “conscience clause” allowed health care workers to decline to participate in abortions and other services.”

I have to give NPR credit, they did do a good job covering the issue in the full coverage. They pointed out that conscience exceptions have been protected for more than 30 years. They also pointed out (on the radio but not in this article) that the new rule permits people to anyone even tangentially related to the delivery of health care (including cashiers, receptionists and janitors) to refuse give information or referrals to care by someone who is not religiously opposed to whatever health care that person is opposed to, whether it be fertility treatment, contraception, abortion, blood transfusions, HIV drugs, you name it.

And, health care delivery systems have to certify that they are not discriminating against any people with religious objections to any medical treatment in hiring to receive any federal funds, like Medicare or Medicaid. So, theoretically, if Christian Scientists applied to work at a surgery center, they wouldn’t be able to discriminate against them in hiring. If they refused to do any sort of surgery, participate or facilitate any sort of surgery, and refused to refer to another staff member or another facility or even give any sort of information about surgery, they could not be fired or the facility would be discriminatory. In fact, if they were not hired, the surgery center would be open to loss of federal funds and reimbursement, and costly lawsuits. This certification of hiring people who would most certainly refuse to perform their job description was not mentioned in the NPR coverage, or most other coverage.

Rachel Maddow said this fails her “Amish bus driver” test today on her show. I was thrilled that she mentioned the words “contraception” and “abortion” in her coverage of the story. I love her to death, but I wrote her a letter recently complaining about her lack of coverage of reproductive rights issues. Glad she represented today.

Linky dinky doo

I haven’t had time to post recently, but I have been reading lots of great stuff on the interwebs.

Time magazine has published an article called The Trouble with Repeat Cesareans. (H/t Rixa at Stand and Deliver) The author also has a post up at Huffington Post entitled Childbirth Without Choice. Even better than these two wonderful articles, The International Cesarean Awareness Network (ICAN) has a new database of VBAC policies in US hospitals. What a fantastic resource.

Rachel at Women’s Health News spearheaded a lot of concern when she posted about a proposed bill in Tennessee to drug test women under a dizzying array of mom blaming reasons. I was very happy with the flurry of outrage and support on the feminist sites. I think pregnancy issues, especially ones that involve having a baby, not preventing one, don’t get adequate attention on many of these sites. The National Advocates for Pregnant Women generally have good information on the issue of drug testing and subsequent imprisonment of pregnant women.

Edited to add: Rachel has expanded on her discussion of this topic with a brilliant post examining the many troubling aspects of forced drug testing on select pregnant women.

The National Family Planning and Reproductive Health Association has a post up about a resolution being introduced to include *gasp* women’s reproductive health issues to the national debate on health care reform. It would be symbolic, but hey, it’s a symbol we need. I am sick of women’s reproductive issues being dropped like a hot potato any time someone points out that it is controversial. (I’m looking at you, Obama.) I had a discussion with the lobbying arm of the American Osteopathic Association during a presentation on grassroots activism at our school. She told me that they don’t advocate for women’s reproductive health issues because it is controversial. She pointed out to me there are lobbying groups specifically set up to oppose such legislation. I asked her why that wouldn’t make it more important for them to advocate for women’s issues? I also asked her who is going to defend women’s health care if groups representing physicians won’t. She also said they don’t really do anything regarding Medicaid. I was pretty disappointed with this presentation, to say the least. It should have been called “Grassroots activism for those where the grass is already greener.”

I loved this post on Shakesville with book recommendations for coming of age boys. Thanks! Again, impressed with the parenting style coverage from a site that normally caters more to the childless and gay men.

Finally, on a non health related item, there is the issue of horrific, racist political cartoon comparing Obama to a gunned down monkey. As usual, Ill Doctrine has a good analysis of the many problematic angles of this story. I am saddened by how non progressive some of his commenters are. It is very clear that the context of the rag, the New York Post, paints the stimulus as Obama’s stimulus. In fact, that same day, on the previous page, there was a huge picture of Obama’s face next to headlines criticizing the stimulus package. And, the same cartoonist has published previous cartoons with Obama standing at a pad presenting his stimulus bill. Racist apologists who try to nitpick that the author of the bill wasn’t literally Obama make me ill. (No offense, Jay Smooth, for the use of the word ill.)

Email and reply

From my uncle:

The financial crisis explained in simple terms:
Heidi is the proprietor of a bar in Berlin. In order to increase sales, she decides to allow her loyal customers – most of whom are unemployed alcoholics – to drink now but pay later. She keeps track of the drinks consumed on a ledger (thereby granting the customers loans).

Word gets around and as a result increasing numbers of customers flood into Heidi’s bar.

Taking advantage of her customers’ freedom from immediate payment constraints, Heidi increases her prices for wine and beer, the most-consumed beverages. Her sales volume increases massively.

A young and dynamic customer service consultant at the local bank recognizes these customer debts as valuable future assets and increases Heidi’s borrowing limit.

He sees no reason for undue concern since he has the debts of the alcoholics as collateral.

At the bank’s corporate headquarters, expert bankers transform these customer assets into DRINKBONDS, ALKBONDS and PUKEBONDS. These
securities are then traded on markets worldwide. No one really understands what these abbreviations mean and how the securities are guaranteed. Nevertheless, as their prices continuously climb, the securities become top-selling items.

One day, although the prices are still climbing, a risk manager (subsequently of course fired due his negativity) of the bank decides that slowly the time has come to demand payment of the debts incurred by the drinkers at Heidi’s bar.

However they cannot pay back the debts.

Heidi cannot fulfil her loan obligations and claims bankruptcy.

DRINKBOND and ALKBOND drop in price by 95 %. PUKEBOND performs better, stabilizing in price after dropping by 80%.

The suppliers of Heidi’s bar, having granted her generous payment due dates and having invested in the securities are faced with a new situation. Her wine supplier claims bankruptcy, her beer supplier is taken over by a competitor.

The bank is saved by the Government following dramatic round-the-clock consultations by leaders from the governing political parties.

The funds required for this purpose are obtained by a tax levied on the non-drinkers.

Finally an explanation I understand …

My reply:

This is the second email I have received comparing people who are having their homes foreclosed on to alcoholics. This is after 8 years of our country spending money like a drunken sailor. If my husband, a sober schoolteacher, gets laid off this year as threatened, we will most likely have to default on our home loan. The stimulus package is giving 8 billion to the school districts in our state, and his job may be saved. I am very grateful. Teachers have already been laid off at my mother’s school. My older brother worked for Lehman Brothers, and his position closing out that company will end soon. The stimulus package has provisions so he can get help paying COBRA payments to keep health insurance for his family, including his son with a health condition. This kind of hostile email is only serving to divide our nation even more. With unemployment rates rising to 10% and more, it’s getting pretty pathetic to continue pretending this is an us and them world. The unemployed alcoholics you non drinkers complain about may be your own family members.

Please take me off of your email list.

I also got an email from my cousin (from the other side of my entitled, privileged, conservative family) comparing income taxes to a rich guy coming and buying drinks for a bunch of unemployed drunks every night. The moral twist: What if he doesn’t show up to buy them drinks the next night? Then who will pay for them?

I wrote a similar reply.