Bioethics and Politics

What happened to the Blog?I

2010-04-19T04:27:00.000-07:00

I spend a lot of time on Facebook. The "Notes" on that site work pretty well for a blog. Come see, sometimes.

Abstinence study: it works!

2010-02-03T12:03:00.000-08:00

I've been reading about the Jemmotts' work with inner city kids for a while. There's an article in this month's Archives of Pediatrics and Adolescent Medicine - one of the American Medical Association journals - about a randomized trial of abstinence-only vs. "safer sex" with encouragement to use a condom. The results were a significant difference in first intercourse and intercourse in the previous 3 months, during the 24 months of follow up. There was no difference in condom use between the two groups, when the kids did have sex. A repeat intervention decreased the likelihood of multiple sexual partners.

Here's the abstract:

Objective To evaluate the efficacy of an abstinence-only intervention in preventing sexual involvement in young adolescents.

Design Randomized controlled trial.

Setting Urban public schools.

Participants A total of 662 African American students in grades 6 and 7.

Interventions An 8-hour abstinence-only intervention targeted reduced sexual intercourse; an 8-hour safer sex–only intervention targeted increased condom use; 8-hour and 12-hour comprehensive interventions targeted sexual intercourse and condom use; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior. Participants also were randomized to receive or not receive an intervention maintenance program to extend intervention efficacy.

Outcome Measures The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up. Secondary outcomes were other sexual behaviors.

Results The participants' mean age was 12.2 years; 53.5% were girls; and 84.4% were still enrolled at 24 months. Abstinence-only intervention reduced sexual initiation (risk ratio [RR], 0.67; 95% confidence interval [CI], 0.48-0.96). The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29.0%) reported having coitus in the previous 3 months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99). Abstinence-only intervention did not affect condom use. The 8-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.

Conclusion Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement.

Trial Registration clinicaltrials.gov Identifier: NCT00640653

Sudden Infant Death Syndrome associated with lower serotonin levels

2010-02-03T07:40:00.000-08:00

Nature News has an article on a study published in the Journal of the American Medical Association that ties lower levels of serotonin to an increased risk of sudden infant death syndrome (also called "cot deaths," "crib deaths, or "SIDS"). The authors are not sure what causes the low levels or whether the low serotonin levels are the cause or an effect of the deaths and don't make any sort of recommendations for treatment or changes in care of children.

I'm still surprised at the decrease in crib deaths that happened when we all started telling moms to lay their babies on their backs in the crib. All of my life (and when my kids were babies) we had been taught to lay them on their tummies or sides. However, the more I thought about it, babies are on their backs when nursing from the breast, and so putting them in bed this way probably brings about some protective effect of mimicks one.

Don't forget: Back to Bed!

Tebow Super Bowl Ad Controversy Proves "Pro-abortion," not "Pro-choice"

2010-01-27T03:09:00.000-08:00

Sarah Palin has written a note on her Facebook page on the move to oppose an ad that's scheduled to be run during the Super Bowl. The active opposition to the ad by the National Organization for Women (incorrectly named, btw) and other groups, shows just how pro-abortion, rather than pro-choice, they are.

The 30 second segment is sponsored by - and paid for by - Focus on the Family. It tells the story of Pam Tebow, mother of Heisman Trophy winner, Tim Tebow. Tebow's mother was encouraged to abort him due to medical problems.

Colorado Springs, Colo (Friday, Jan. 15, 2010) – Focus on the Family will broadcast the first Super Bowl ad in its history February 7 during CBS Sports' coverage of the game at Dolphin Stadium in South Florida.

The 30-second spot from the international family-help organization will feature college football star Tim Tebow and his mother, Pam. They will share a personal story centered on the theme of "Celebrate Family, Celebrate Life."

Jim Daly, president and CEO of Focus on the Family, said the chance to partner with the Tebows and lift up a meaningful message about family and life comes at the right moment in the culture, because "families need to be inspired."

"Tim and Pam share our respect for life and our passion for helping families thrive," Daly said. "They live what we see every day – that the desire for family closeness is written on the hearts of every generation. Focus on the Family is about nurturing that desire and strengthening families by empowering them with the tools they need to live lives rooted in morals and values."

Daly added that all the funds to air the ad came from a handful of "very generous and committed friends" who donated specifically to support the project. No money from the ministry's general fund was used.

The Tebows said they agreed to appear in the commercial because the issue of life is one they feel very strongly about.

The Washington Post reports that there has been opposition to the airing of the ad:

After learning of the ad late Monday, Women's Media Center (speaking on behalf of the National Organization for Women, the Feminist Majority Foundation and other organizations) asked CBS to pull the ad. It also questioned how and why the network, which used to forbid "advocacy" advertising, agreed to air Focus on the Family's spot, which is valued at $2.5 million to $3 million.

"An ad that uses sports to divide rather than to unite has no place in the biggest national sports event of the year -- an event designed to bring Americans together," Jehmu Greene, president of the Women's Media Center, said in a statement.

The pressure on CBS proves my earlier assertion that as a society, we in the US have moved from the 1960's slogan "Our Bodies, Our Choice," to "Our Bodies, Our Choice, and You Don’t Have Choice."

Qualify for government subsidy: become a(n involuntary) unionized government employee

2009-12-26T06:11:00.000-08:00

Next up: doctors, section 8 housing owners, ????? Grocery stores, drug stores???

A year ago in December, Ms. Berry and more than 40,000 other home-based day care providers statewide were suddenly informed they were members of Child Care Providers Together Michigan—a union created in 2006 by the United Auto Workers and the American Federation of State, County and Municipal Employees. The union had won a certification election conducted by mail under the auspices of the Michigan Employment Relations Commission. In that election only 6,000 day-care providers voted. The pro-labor vote turned out.

Many of the state's other 34,000 day-care providers never even realized what was going on. Ms. Berry tells us she was "shocked" to find out she was suddenly in a union. The real dirty work, however, had been done when the state created an "employer" for the union to "organize" against.
Of course, Michigan's independent day-care providers don't work for anybody except the parents who were their customers. Nevertheless, because some of these parents qualified for public subsidies, the Child Care Providers "union" claimed the providers were "public employees."
Michigan's Department of Human Services then teamed with Flint-based Mott Community College to sign an "interlocal agreement" in 2006 establishing a separate government agency called the Michigan Home Based Child Care Council. This council was directed to recommend good child-care practices—and not coincidentally, to serve as a "public employer." Although the council had almost no staff, no control over the state subsidies and no supervision of the providers' daily activities, it became the shell corporation against which the union could organize.
Thus the state created an ersatz employer and an ersatz "bargaining unit" against which what was essentially an ersatz union could organize.
Today the Department of Human Services siphons about $3.7 million in annual dues to the union—from the child-care subsidies. The money should be going to home-based day-care providers—themselves not on the high end of the income scale. Ms. Berry now sees money once paid to her go to a union that does little for her. She says she is "self employed and wants nothing to do with the union."

Open Letter to AMA: I quit

2009-12-24T04:44:00.000-08:00

Emailed to the AMA Board:
I paid my Texas Medical Association dues for 2010 but will not renew my American Medical Association membership. I do not want to be counted as an AMA member.

I dropped my membership once before due to political moves by the leadership of the AMA. I rejoined hoping to work within the House of Medicine to influence policies of the AMA. I became more active in my TMA, the Texas Academy of Family Physicians, national meetings of the AMA and the American Academy of Family Physicians and accepted the Chairmanship of the Family Medicine Section of the Christian Medical Association.

This weekend, AMA President-Elect Wilson announced support for the Reid substitute and manager’s amendment, which dropped the effort to correct the “Sustainable Growth Rate” and does not even mention (much less achieve) tort reform. Instead, current language provides billions of dollars in special deals for Democrat Senators, support for payment for elective interventional abortion in healthy mothers and on healthy babies, and an expansion of Medicaid that threatens to bankrupt my State of Texas.

The AMA leadership have told us that they hoped to protect our patients and the practice of medicine in the final legislation, just as I had hoped to influence AMA policies by lending my name and paying my dues to them. I will no longer give the AMA my name or my money, since neither of us has achieved our goal.

Beverly B. Nuckols, MD
New Braunfels, Texas

Open Letter to AMA

2009-12-24T04:41:00.000-08:00

No Connection - Hasting Center Essays Miss the Mark

2009-12-16T04:54:00.000-08:00

The Hasting Center has published an online collection of essays called"The Values and Health Care Reform Connection" allowing the public to comment on health care and "American Values." You have to admire the awareness of the academics - not only have they noticed that the conservative, pro-life, religious “American” is concerned with values, but they are trying very, very hard to appeal to those of us with a Judeo-Christian background. I’ve only skimmed a couple of the essays so farm but I have found a glaring inability to stay on task or a basic lack of understanding of the world view of the intended target, uh, audience.

For example, in “Stewardship: What Kind of Society Do We Want?,” Len M. Nichols misses the mark in spite of peppering the essay with terms like “stewardship,” “abundant life” and “covenant” and appeals to the writings of John Locke and Thomas Jefferson.

(Skip over the use of a faulty, biased 2009 Institute of Medicine report on the consequences of lack of universal health care insurance in the U.S., already thoroughly debunked by Steven Malloy’s “Junk Science” blog.)

In his appeal to “American Values,” Nichols attempts to define “stewardship” to include a “covenant” as a duty of property owners to ensure that the poor have food to eat. He refers to the book of Leviticus and Jewish Law that land owners leave “the corners” of their fields for the poor to glean, rather than going back to harvest all that is there. While noting that the rule was propagated the “other books that Moses wrote,” Nichols explains that only adult males could own land "in ancient Palestine." He would have been better off referring to the “Torah” or “the Law,” which was given by G_d, not Moses, and to the Nation of Israel, since there was no “Palestine” at that time.

Nichols almost persuades me that he “gets it” in his discussion of the basis for rights: the belief that humans are created in the image of G_d. However, he asks what good is the right to life or the pursuit of happiness without access to essential health care and quotes Jefferson’s comparison of liberty with health. He does not seem to understand that both Locke and Jefferson described these as negative rights: the right not to be killed, and the right not to be enslaved or have ‘the fruit of one’s labor” forcibly taken. In other words, no one has the right to cause another to be sick, but there is no right to medicine or medical care.

Nichols does not resort to the usual call for Christians to remember the Good Samaritan. In fact, he turns to an argument that might be more appealing to Libertarians, whom he calls “a tiny group of argumentative people.” His discussion of rights and stewardship by is converted to support for the rationing of health care, noting that Leviticus does not require the landowner to bring the poor person home and cook him a meal. In this, too, he demonstrates his lack of understanding of the Judeo-Christian world view. The covenant to care for the sick and poor is between individual believers and G_d. Government hasn’t proven itself to be trustworthy enough for me to assign my duty to G_d over to its stewardship.

LifeEthics quoted about Doctors for America posts

2009-12-13T08:05:00.000-08:00

I've been a little distracted, getting my house ready for the New Braunfels Republican Women's Christmas Tour of Homes, but I should be blogging more in the future.

Found a post at "RBO," (RealBarackObama) that quoted my reports (here and here) on the conference call with "Doctors for America," back in September. I like being known as someone capable of "serious sleuthing."

?No self breast exams?

2009-11-19T00:54:00.000-08:00

The recommendation *not* to teach exams throws the whole report into question for me. If we are changing the frequency of mammograms, should we also change the recommendation to do self exams? Won't the first change the effectiveness of the second?

In the news, the report by the Agency for Health Care Research and Quality. The "conventional wisdom" about breast cancer screening was turned on its head - or, at least tweaked, this week.

I think we might have been over doing the mammograms ("MMG"), but the old recommendation to do a "baseline" MMG between 35 and 40, with self exams each month and MMG each 2 years from 40 to 55 and then one a year or each 2 years according to risk, made sense to me.

What I absolutely don't get is the recommendation to stop teaching self exams. Teaching self breast exams received a "Grade D" recommendation - meaning there's no empirical evidence that the procedure is "effective." In other words, it has "moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits." The practice would be "discouraged" -- considered bad medicine, and actually put the doctor at risk for criticism. It most certainly won't be paid for.

There's a reason to find masses: it will change what we do, we have treatment that we can and should do for positive changes. Any mass that's fast growing and lasts over a month is highly suspicious and any mass we can feel should be biopsied. Even though the sensitivity may be low (compared to MMG), patients who do regular exams have been proven to be more likely to find masses earlier and smaller than the doc would at an annual exam, and it's non-invasive, cheap, and accessible. Teaching the self exam gives me something to talk about while I'm doing my own exam of the patient and is an opportunity to explain what I've written, above.

It looks like the fuss over the recommendation will be the first test of the realities of "Comparative Effectiveness Panels" which was funded by $1 Billion allocated in the 2009 "Stimulus Package." Emotions and reactions are high, with Health and Human Services Secretary Sebelius, Medicare and most insurance companies already reporting that their policies (paying for annual MMG and recommending teaching at doctors' exams) won't change. The Mayo Clinic has absolutely renounced the recommendations.

For more information on the policies of other nations, see this article.

AMA opposes marriage and "Don't Ask, Don't Tell"

2009-11-11T09:07:00.000-08:00

November 10, 2009, delegates to the AMA interim session approved resolutions recommending that the AMA oppose same sex marriage bans, urge redefinition of marriage under federal and state laws. They also recommend the ending of the "Don't Ask, Don't Tell" policy in the military. "Report 1" - "REPORT 1 OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH (I-09), Health Care Disparities in Same-Sex Households," is only published in the "members only" access, in advance of publication in a "peer reviewed journal." There is a specific request *not* to publish the report. However, for those of you who would like to review the report, let me know and I'll forward the pdf. Report 1 tells us that, according to census data, approximately one third of people living in same sex relationships are uninsured, while also noting that slightly less than 1% of the US population lives in same sex households. The Reference Committee report states that "Adoption of this report further strengthens AMA policy in support of issues impacting same-sex households." The AMA currently recommends that members be aware of and work to prevent possible health care disparities among men and women who live in same sex partnerships. However, by adopting this report, the delegates have now apparently voted to encourage a wide-spread untried and potentially unhealthy social experimentation by calling for the redefinition of marriage on behalf of 0.33% of our population in order to "support measures providing same-sex households with the same rights and privileges to health care, health insurance, and survivor benefits, as afforded opposite-sex households."

Surely, the same goal can be achieved without demanding that all States and the Federal Government change their definition of marriage. It appears that even the State of Washington, which just voted to afford the same rights of marriage to same-sex couples, did not go far enough to make the radicals happy.

The resolution concerning "Don't Ask, Don't Tell" originally asked that the AMA oppose using any disclosure to a health care professional for dismissal. However, the reference committee recommended and the HOD approved, a substitute resolution that goes far beyond support for patient confidentiality in health care: "HOD ACTION: Substitute Resolution 917 adopted. "REPEAL OF “DON’T ASK, DON’T TELL” "RESOLVED, That our American Medical Association advocate for repeal of “Don't Ask, Don't Tell,” the common term for the policy regarding gay and lesbian individuals serving openly in the U.S. military as mandated by federal law Pub.L. 103-160 and codified at 10 U.S.C. § 654, the title of which is "Policy concerning homosexuality in the armed forces."" It's getting harder and harder to tell myself that I must continue my AMA membership in order to make a difference with in the organization. I'm beginning to be afraid that by adding to their numbers, I'm part of the problem, rather than a help.

Judge denies lawsuit to stop embryo destruction

2009-11-10T04:10:00.000-08:00

Citing other legal rulings that embryos aren't "persons" under the law, a Federal judge (report, here ) denied the right of others to sue on their behalf or to sue to save them from being destroyed under new rules at the National Institutes of Health.

I've said it before: "law" does not a person make. "Person" is an artificial designation, made up by people who want to decrease the numbers of humans who have the right to live and by lawyers who want to control which entities (such as corporations) have "rights" bequeathed by law. Females are not "persons" in Arab nations like Saudi Arabia.

HPV vaccine adverse reports (prep for further posts)

2009-10-28T04:49:00.000-07:00

Hwang convicted of fraud in cloning ruse

2009-10-26T01:43:00.000-07:00

A South Korean court has convicted the perpetrator of the 2005 cloning fraud. Information here.

Doctors pressured by scheduled Medicare pay cut

2009-10-20T08:02:00.000-07:00

Here's confirmation from The Hill.com that planned cuts in Medicare payments to doctors are being used by Senate and White House leaders to secure support for the current health care reform bills, without tort reform.

The White House and Democratic leaders are offering doctors a deal: They’ll freeze cuts in Medicare payments to doctors in exchange for doctors’ support of healthcare reform.
At a meeting on Capitol Hill last week with nearly a dozen doctors groups, Senate Majority Leader Harry Reid (D-Nev.) said the Senate would take up separate legislation to halt scheduled Medicare cuts in doctor payments over the next 10 years. In return, Reid made it clear that he expected their support for the broader healthcare bill, according to four sources in the meeting.

and,

Reid also asked that doctors ease up on demands for medical malpractice reform during the upcoming healthcare debate. Democrats have traditionally resisted calls for tort reform, which trial attorneys — a reliable base group — staunchly oppose.

The problem with fines (mandatory health insurance)

2009-10-18T08:04:00.000-07:00

The Washington Post notes that manufacturers of medical devices are being accused - they haven't offered "to give something back" to pay for health care insurance for all. Because they won't play the game that President Obama's been playing with the pharmaceutical industry and hospitals, their devices will be taxed like luxuries -- and the Administration will be able to say they've saved $40 Billion dollars.

Again, how much can they save by allowing Medicare docs' 21% cut to go through at the beginning of the year? (and they'll blame the Republicans for writing the original law in 1997)

Sarah Palin writes on the problem with mandatory health insurance at her Facebook page, here.

Americans want health care reform because we want affordable health care. We don’t need subsidies or a public option. We don’t need a nationalized health care industry. We need to reduce health care costs. But the Senate Finance plan will dramatically increase those costs, all the while ignoring common sense cost-saving measures like tort reform. Though a Congressional Budget Office report confirmed that reforming medical malpractice and liability laws could save as much as $54 billion over the next ten years, tort reform is nowhere to be found in the Senate Finance bill. [17]

Here’s a novel idea. Instead of working contrary to the free market, let’s embrace the free market. Instead of going to war with certain private sector companies, let’s embrace real private-sector competition and allow consumers to purchase plans across state lines. Instead of taxing the so-called “Cadillac” plans that people get through their employers, let’s give individuals who purchase their own health care the same tax benefits we currently give employer-provided health care recipients. Instead of crippling Medicare, let’s reform it by providing recipients with vouchers so that they can purchase their own coverage.

Aristotle ethics, RFK, and health care reform

2009-10-17T03:20:00.000-07:00

The Wall Street Journal's daily newsletter by James Taranto, The Best of the Web Today, debunks a quote floating around the Internet to support the "right" to health care paid for by government. The blurb has been attributed to a translation from the writings of Aristotle, a translation from the original Greek by Robert F. Kennedy.

Unfortunately, the first reference to the quote is from 10 years after Senator Kennedy died, is credited to someone else, and the original cannot be found in the existing works of Aristotle.

From an article by Edmond Pellegrino, the last chairman of President Bush's President's Bioethics Council, written in 2008:

In attempts to establish the provenance of the text in question we have conducted an extensive search for its source and original wording. We have not been able to locate it. Our initial curiosity was aroused by several things, including that rights language did not seem to have the Aristotelian context, and health care, as such, was not included in Aristotle's works. We searched Nicomachean Ethics and Eudemian Ethics, and the Magna Moralia without successfully locating the quote. Nor could we find it in other of works of Aristotle: On Length and Shortness of Life, De Anima, Economics or the Fragments. "Rights" language certainly would stick out in Aristotle's virtue-based ethics.

That article by Dr. Pellegrino is available in pdf, here, thanks to the WSJ and Georgetown Bioethics.

Intentionally Skewed Cancer Survival Rates

2009-10-08T05:25:00.000-07:00

From Ann Coulter's latest report on Health Care Reform Myths:

European women are only 55.8 percent likely to live five years after contracting any kind of cancer, compared to 62.9 percent for American women.
In five cancers -- breast, prostate, thyroid, testicular and skin melanoma -- American survival rates are higher than 90 percent. Europeans hit a 90 percent survival rate for only one of those -- testicular cancer.
Most disturbingly, many cancers in Europe are discovered only upon the victim's death -- twice as many as in the U.S. Consequently, the European study simply excluded cancers that were first noted on the death certificate, so as not to give the U.S. too great an advantage.

I didn't know about that last manipulation of the cancer survival rates.

Don't laugh: Nanoparticle rub for impotence

2009-09-25T03:00:00.000-07:00

The next addiction? The next big scare? Most definitely the next big joke.

What about the man's sperm? And what about the female partner? How much of a dose will she and her DNA receive.

What are nano particles, anyway? (Don't answer that, I know the text-book answer.)

There is a report of a new topical cream that delivers medication by using nanoparticles to deliver the drug - such as nitrous oxide, in the case of impotence - through the skin.

Just think about the marketing technology: beauty, sex and the latest nanomedicine. And it doesn't hurt (that we know of).

Get ready to mute your TV if the kids are in the room. The jokes will be risque,' to say the least.

Science Knowledge Quiz

2009-09-22T01:43:00.000-07:00

The Pew Research Center for the People and the Press has a 12 question quiz on general science knowledge.

Take the test, here, and tell me how you did.

(I got them all right.)

(Did I mention that doctors are current or former nerds who "aced" every class - at least until med school? In med school, a few of us took an ego hit. I learned to study that first fall.) (And, now, I'm learning to deal with not being a "swift" as I used to be: ADHD mind in a 50-something body.)

Politics bites science

2009-09-20T18:29:00.000-07:00

For a clear outline as to why you shouldn't believe that 45,000 people die each year because they don't have insurance, read the blog entry by John Milloy, publisher of "Junk Science" on last week's report in the American Journal of Public Health.

Forget that the authors are blatantly biased members of the "Physicians for a National Health Plan."

All you need to know is:
# Among the many problems with the study, here are four of the most glaring; all of which will likely be missed by the media:

* The researchers assumed that study subjects lacking health insurance at the time of the interviews did not subsequently gain or regain insurance coverage. In fact, a study subject could have received health coverage the very next day after the interview and this would not have been considered by the researchers.
* The researchers essentially assume that lack of health insurance at the time of interview is the causal factor in the deaths that occurred. No data was gathered to back up this assumption.
* None of the data collected during the interviews, including insurance status, was validated by the researchers.
* The study result is statistically weak. Combined with the peculiar date-of-death cutoff (the year 2000 as opposed to any other year), it raises questions as to whether the study result was produced by “data dredging” – essentially cherry-picking data that provides the desired result.

Obamacare-Point and Counterpoint

2009-09-20T17:49:00.000-07:00

One of the best reviews of "Obamacare" I've seen.

Obamacare-Point and Counterpoint

Shared via AddThis

Follow up from Doctors for America

2009-09-18T13:50:00.000-07:00

Received this message a few minutes ago.

The only people who kept bringing up "what physicians can be doing now to ensure that Congress pushes forward to create meaningful health reform" were the same guys who made sure that the rest of us were on "listen-in" mode only.

Still no mention about the close connections with Senator Max Baucus, the Obama election and transition teams, the Center for American Progress and John Podesta, or (specifically) Dr. Murthy's own role on the transition team.

If y'all would like to send your comments on to the WH Office of Public Engagement or D4A, here's the information:

-------- Original Message --------
Subject: Follow up on last night's White House call
Date: Fri, 18 Sep 2009 16:19:57 -0400
From: Vivek Murthy MD MBA, Doctors for America
To: hocndoc@flash.net

Dear Beverly,

Thank you for participating in last night's White House Physician's call. In particular we want to thank you for all of the thoughtful and substantive questions that you brought us. We hope those of you who didn't get an opportunity to ask a question during the call will still do so.

For those who didn't catch it last night, the e-mail given for the speakers on the call is: public@who.eop.gov

In recognition of the fact that the White House may not be able to reply to all e-mails expeditiously, we welcome you to cc us as well, and we will do our best to get you up-to-date information.

One of the topics that came up a few times last night is what physicians can be doing now to ensure that Congress pushes forward to create meaningful health reform. At Doctors for America, direct involvement of physicians is exactly what we do. If you haven't done so already, we welcome you to become more involved by filling out our volunteer form.

Sign up to volunteer: www.drsforamerica.org/volunteer.php.

In addition, we've created a video on our Action Center to highlight some of the things that you can do today to help ensure we take critical steps towards a better health system this year.

Watch the video to learn what you can do: www.drsforamerica.org/action_center.php.

Thank you again, for your participation and for your ongoing commitment to health reform.

Sincerely,

Vivek Murthy, MD MBA
Doctors for America

Playing doctor with the White House

2009-09-18T07:50:00.000-07:00

Who’s playing doctor with the White House: Another example of the lack of openness in the dealings of the Obama Administration

(Informed consent blurb: Organizing for America, etc., along with all the White House websites, are collecting data including email and other information from everyone who visits or contacts their sites. I got a couple of those emails from David Axelrod last month.

Don't worry - they already have my data. I used to email President Bill Clinton at least once a month and ask him to resign for the sake of our daughters – they are about the same age - because he'd set the women's movement back 50 years. He never answered. However, it occurs to me now that maybe that's why I was named to the Bush Administration's National Advisory Committee on Violence Against Women.)

On Thursday, September 17, 2009, I was web-surfing and searching Google news hits on the September 12th March on Washington and health care reform when I found information about a conference call between "Doctors for America," the White House "Office of Public Engagement" and doctors like me who somehow found out about the conference call.

I called in, but wasn't called on to ask my questions, so I re-wrote them as an essay (see below) and emailed it to info@drsforamerica.org I'm also sending the essay to the White House OPE.

When I started writing up my notes from the call, it finally occurred to me that – even though there was no attempt at disclosure - there might be a connection between "Drs for America," "Organizing for America" (whose website address is still "http://www.barackobama.com/ ," the same url once used by - and the remains of - “Obama for America,” the Barack Obama campaign machine.

I was slow to catch on, but I was right: The leadership at Doctors for America is made up of nearly the same roster of men and women who, in 2008, were the leadership of “Doctors for Obama” in 2008. Common names are Vivek Murthy, MD MBA, Mandy Krauthamer, MD MPH, Nikhil Wagle, MD, Alex Blum, MD, and Jay Bhatt, DO MPH

And, I was wrong: there’s a disclaimer at the bottom of the “Doctors for Obama” leadership page that says “Not affiliated with Obama for America.” (Yeah, right.)

In fact, former Obama Administration transition chief John Podesta's “Center for American Progress” funds the group :

May 04, 2009
'Doctors for America' launches

This may not wind up being decisive in the health care fight, but the organizing gap between the two sides continues to widen.
Sen. Max Baucus and the Center for American Progress Action Fund are announcing a new group on a conference call later this morning: Doctors for America, which is a reincarnation of Doctors for Obama, an arm of the Obama campaign that boasted more than 10,000 members.
The question of patients' relationships with their doctors is always a flashpoint in debating changes to the health care system, so doctors are often particularly credible messengers.
Today they'll "release new reports detailing the depth and breadth of America's health care crisis and announce a new effort to amplify physicians' voices in support of health care reform," according to the advisory.
By Ben Smith 11:07 AM

Here's the bio on the President and Co-founder, Vivek Murthy, MD MBA, at the Center for American Progress website:

Vivek Murthy is an internal medicine physician at Brigham and Women’s Hospital and an Instructor at Harvard Medical School. He received his undergraduate degree in Biochemical Sciences from Harvard University, his MD from the Yale School of Medicine, and his MBA from the Yale School of Management. He completed his residency training in Internal Medicine at Brigham and Women’s Hospital. Vivek is the co-founder of VISIONS and the Swasthya Project, international health non-profit organizations focused on HIV/AIDS education and women’s health, respectively. He is also the co-founder and chairman of Epernicus, LLC a web-based professional networking service for individual researchers and scientific institutions. Vivek’s past research has focused on the participation of women and minorities in cancer clinical trials; his current research interests include physician satisfaction and burnout. During the 2008 presidential campaign, Vivek served as a member of the Obama Health Policy Advisory Committee and the Obama New England Steering Committee.

Notes on the Conference Call

I couldn't catch all the names and I am not very good at telling who was speaking, but did try to take some notes from the opening statements. The quotations are the actual words of the speakers, the rest is my own interpretation and from memory.

The moderators talked about the "public option" as though it's a done deal and strongly pitched it as just a way to provide health care for people who have lost their insurance.

We were told that everyone will be required to have insurance, and that businesses will be asked to "chip in their part."

The White House has a plan to fix the SGR that has been pushed off over and over. In fact, there are plans for a “complete reform of the physician payment system.” without incentives for doing more procedures.

The President has given instructions to begin the medical liability demonstration projects to find a way to decrease defensive medicine while "mitigating risks to patients."

We were told that we are closer than we've ever been to health care reform this year.

The moderators were surprised by the second doctor who said he was from the former Soviet Union and that the public option would soon become the only option. They were adamant that the public option is not a pathway to single payer. (And besides, we all know that being paid by and regulated to the teeth by the government is not at all like working for the government.)

Later, one of the docs who called in asked specifically about the news stories that the public option was finished and the White House representative reminded us that the legislation is not written, yet. He was adamant that we shouldn't rule the public option out and that we should advocate with our patients and fellow doctors for that option.

One doctor asked about the effect on doctors with concierge or boutique practices and the other doctors who "opted out." The answer from one of the men was that these practices were just a reaction to cash pay patients who couldn't afford insurance.

There was a lot of excitement about one doctor's suggestion that doctors be required to give two years to a sort of National Healthcare Workforce. And huffy about the shortage of doctors that a Massachusetts doc reminded them that they'd have if all the uninsured were suddenly looking for primary care.

The woman naturopath was reassured that naturopathic primary care doctors would be evaluated by the same evidence based medicine that the traditional docs were judged by.

My letter to Doctors for America and the White House Office for Public Engagement

I’m Beverly B Nuckols, MD, the National chair of the Family Medicine Section of the Christian Medical Association as well as a member of the AMA, the Texas Medical Association and the American Academy of Family Physicians. I'm not officially representing the above, but I believe that my opinions are shared by a large number of doctors.

Many of my colleagues and I see the Patient Centered Medical Home plans, the protocols at Mayo and other medical centers that have been praised are attempts to model a bureaucratic form of practice for large practices so that they can do what the family doctor does every day.

My experience is that government bureaucracy is not only more restrictive and punitive than private insurers, the clout of the Federal government results in undesired UNINTENDED consequences all across the board. Doctors used to be the good guys, but now we feel as though we are assumed to be guilty of abuse of the system, largely due to Federal legislation and regulation.

These result in time and money spent on our futile attempt to keep up with Medicare regulations in order to avoid charges of fraud, abuse and waste. For instance: HIPPA, National Provider Identification numbers, bullet points and check boxes, E & M’s, procedure and diagnosis codes and qualifiers that change each year, and a whole alphabet soup of regulators.

In addition, government cost control attempts in the '90's actually limited the numbers of graduate medical slots, while encouraging sub specialty growth in relation to numbers of primary care doctors.

Making it all worse is the fact that under current Medicare payment schemes, Family Doctors who provide the same services as sub-specialists are paid less by Medicare.

Like the laws and regulations in the past, this year's “reform bills” and proposals are overly complicated and try to guarantee too much: school based clinics, nutrition data on menus and buffet lines, an overhaul of the federal income tax code, new lists of “enhanced penalties,” taxes, fines and the mixing of all of the above abuses with an overhaul of the Federal Income Tax.

Today’s announcement about the study of liability makes me worry that our Texas laws concerning tort reform will be over come by Federal inertia and interference.

1. Why not just look at Texas’ experience with tort reform rather than wasting time and money on new studies?

2. Is it possible to make the legislation smaller in scope so that it is focused on providing help for those patients and families who cannot afford or access medical care?

3. What plans are there to ensure training and sufficient payment for family physicians and other primary care doctors who are in the best position to coordinate care for our patients in the "Medical Home?"

Edit: added this 4th question that I believe I sent to Doctors for America:

4. Could the fines and mandates be replaced with tax incentives, removal of restrictions on Health Savings accounts, return of the major medical plans and the removal of the barriers preventing patients from owning their own health care insurance?

Comments on President's 9-9-9 speech

2009-09-10T06:56:00.000-07:00

You can read the speech, here.

As of 8:30 AM on September 10, there's not much comment from the AMA or other powerful, interested observers. I wonder if, like me, they're waiting to see the actions that result from the speech?

Here are my own(Beverly Nuckols) thoughts after the speech:

Quality, timely, or cheap medicine: Pick two. If you think you can have all three, please, tell Walmart how to do it.

The President is still talking about mandating that everyone buy insurance. He still ties it to employers and there is no mention of tax breaks for individuals who buy their own insurance. (Will companies still be forced to ensure dependents, and will "children" include adults to the age of 26?)

Instead, we hear about fines and new taxes, and more negative comments about profit-seeking companies and "the wealthiest Americans."

First, show me the wording in the actual proposed Bill, give me time to read and understand it and reassure me that you’ve read it. Will that wording be clear on the various promises?

Second, let’s get this straight: tax cuts don’t cost the government, taxes cost the taxpayers. If the government wants more money, give incentives to those who earn money that you tax. Don’t punish them by taxing them at higher rates! If the government has less, the government should do what the rest of us do: cut what you spend!

It seems illogical to me to tax insurance companies for offering "the most expensive plans." These are plans that people decide to buy for themselves. The only result of such a tax would be to kill the "expensive plans."

If the government mandates well care for everyone, there will not be enough manpower or other resources for sick care. If you mandate the addition of both numbers of people and services to the health care that is paid for not only by private funds but public funds, you will increase costs and demand.

Show me the “patient safety trials” that will decrease defensive medicine. As to the tort reform and "trials" to allow doctors to practice with less concern about lawsuits, I suggest that the President simply look at Texas since our own tort reform passed in 2005.

President Obama promised that abortion will not be funded by federal funds and that the current conscience laws will remain in place. Does this mean that no mandates for private insurance to cover abortion will be allowed? Does this mean that he will enforce the conscience laws that exist?

We must remember that the President signed an Executive Order in his first week to fund organizations that pay for abortions and referral for abortion overseas and who overturned the last Administration’s ruling to affirm the enforcement of conscience laws. What will he do in the face of the House’s passage of a Bill that will fund abortions in Washington, DC?

Cross-posted at Comal GOP blog.

Global Warming Ate the Science

2009-08-16T02:23:00.000-07:00

The next time you hear about anthropogenic global warming or global climate change, demand to see the data. It no longer exists.

I've been a skeptic all along, because I remember the warnings about the "coming ice age," that I read in my "Weekly Reader," back in grade school. (In the dark ages of the 60's and 70's.)

This is not science, people. The proper scientific method involves the reporting of detailed, open, and reproducible modes of collecting data. Little black boxes - in which numbers are cooked without access to the raw data by colleagues and even rivals - are not allowed.

The United Nations organization that oversees climate change or global warming is the UN's Intergovernmental Panel on Climate Change (IPCC). The IPCC uses data (if you can call it that) from the Climate Research Unit, or CRU. In fact, the CRU apparently only releases numbers that have been collated and "adjusted."

After years of refusing to turn over the raw data and releasing only modified numbers, Phil Jones of the CRU reports that the organization has lost all the old data that was used to prove global warming.

From the UK's Register, "Global Warming Ate My Data":

The world's source for global temperature record admits it's lost or destroyed all the original data that would allow a third party to construct a global temperature record. The destruction (or loss) of the data comes at a convenient time for the Climatic Research Unit (CRU) in East Anglia - permitting it to snub FoIA requests to see the data.

The CRU has refused to release the raw weather station data and its processing methods for inspection - except to hand-picked academics - for several years. Instead, it releases a processed version, in gridded form. NASA maintains its own (GISSTEMP), but the CRU Global Climate Dataset, is the most cited surface temperature record by the UN IPCC. So any errors in CRU cascade around the world, and become part of "the science".

Professor Phil Jones, the activist-scientist who maintains the data set, has cited various reasons for refusing to release the raw data.

Forget conscience - go straight to mandate

2009-08-10T19:33:00.000-07:00

Human Events has an editorial from Christian Medical And Dental Association's Jonathan Imbody.

Here's an excerpt:

A national poll showed that Americans favored the “conscience clause” regulation and the civil rights laws it enforced by a two-to-one margin. During a 30-day public comment period, an astounding 340,000 comments and petitions poured in favoring the regulation.

The White House and Congress ignored public opposition, and instead moved even more aggressively to evolve abortion from a choice into a mandate.

Besides the House bill opening the door to mandated abortion coverage in all health insurance plans, the House of Representatives in July voted to force taxpayers to fund abortions in the District of Columbia. The Senate is now eyeing publicly funded abortions under the eight million-member Federal Employee Health Benefits Program.

In each of these actions, the President and Congress tacitly assert that abortion ideology trumps the conscience rights of taxpayers, patients and health professionals like Katrina Belova.

"I became very concerned when I learned about President Obama’s plan to rescind the conscience clause," Katrina said. "It made me uneasy to think that my adopted country, which was always proud of its democratic heritage, had begun to remind me of a communist country my family fled ten years ago.

"If the conscience rule is rescinded and I am obligated to choose between performing an abortion or losing my job, I will choose the latter. And then where will I flee next?"[vii]

Former Senator Explains Consequences of Bill Language

2009-08-06T07:30:00.000-07:00

Former Senator from Tennessee, Fred Thompson, explains the consequences of the language concerning end of life care that is included in the current version of House Bill 3200.

I do read the language as making the counseling mandatory, although not necessarily a demand that doctors (or nurses, if they are the "primary care providers") tell a patient that they must refuse or be willing to withdraw medical intervention at the end of life.

Of course, there's the pesky problem that no one has written the approved counseling language or produced the approved documents, yet. That will be done by "the Secretary," if and when the Bill passes with this provision still in place.

Here's what I think happened: the Committee or staffer who wrote that section thought that offering payment for what was mandated in the "Stimulus bill" earlier this year would be a politically advantageous move.

However, since no one knows what will actually be required by the Secretary of Health and Human Services, and there is no note as to which doctors will be responsible to counsel patients, I forsee a repeat of the confidentiality snafus and stumbling blocks that happened after the "HIPAA" became law. Remember when every single doctor and pharmacy had each patient sign a disclaimer, no one knew who could talk to whom, and a whole lot of money, time and energy was wasted making sure that you knew that the provider knew that the government wanted us to keep your medical information private - at least from everyone except the government agencies who demanded documentation, ICD-9 and CPT codes and qualifiers?

Here's Senator Thompson's essay:

FRED THOMPSON: Phantom pains at The Post

Fred D. Thompson

A Page One article in Saturday's Washington Post blaring the headline "Talk Radio Campaign Frightening Seniors" states, "A campaign on conservative talk radio ... has sparked fear among senior citizens that the health care bill moving through Congress will lead to end-of-life 'rationing' and even 'euthanasia,' " and that the bill has been described as "guiding you in how to die."

The story's continuation inside -- under the headline "Conservatives Have Seniors Fearing 'Euthanasia' as Part of Reform" says that, like arguments about abortion coverage, this has become a distraction to the president's broader health care agenda.

The reader looking for examples of this "talk show" campaign will be disappointed. Not one talk-radio host is quoted, and no specific radio show is mentioned (though The Post does quote an interview done on my radio show, without telling the reader the interview was done on a radio show). However, the article does make use of information supplied by off-the-record "Democratic strategists." One is free to conclude for oneself who has launched a "campaign."

It does seem that the words attributed to unnamed conservative culprits are fairly mild compared to the hysteria coming out of left-wing Web sites and blogs. My favorite is the one found on the Huffington Post, where Republicans are accused of saying that granny would be shot in her wheelchair under a provision in the Obama-Pelosi-Waxman health care bill.

Let's discuss whether these deranged seniors are being misled by people who actually may have read the bill. (Presumably this offense cannot be laid at the feet of their representatives of Congress.) Although I have never said anything like the things attributed to radio talk hosts, the article states that "the attacks on talk radio began when Betsy McCaughey ... told former senator Fred D. Thompson (R-Tenn.) that mandatory counseling sessions with Medicare beneficiaries would 'tell them how to end their life sooner' and would teach the elderly 'how to decline nutrition -- and cut your life short.' "

The basic position of the bill's proponents seems to be that these consultations are totally voluntary, that seniors should have the benefit of such end-of-life consultations and that the consultation provision is nothing more than to get doctors reimbursed when a consultation occurs at the patient's request. The "let's get the doctor paid" rationale was swallowed whole by The Post's writer, Ceci Connolly.

Those concerned by this provision believe it to be mandatory and wonder why the government is involving itself in the doctor-patient relationship and with end-of-life decisions.

Section 1233 of the bill, having to do with Medicare, describes the "advanced care planning consultation" as between the individual (a spouse and next of kin are not mentioned) and a "practitioner," described as a physician, a nurse practitioner or a physician's assistant. (It does not appear that it is a requirement that the physician in question be the patient's physician of record.)

In legislation, an issue as to whether an action is mandatory or not can be resolved quickly by a glance at the statute, which will state that (in this case) the consultation either "shall" be taken or "may" be taken. Remarkably, neither phrase is used in the statute in question.

Rather, the statute just describes what a consultation is and then strictly prescribes in mandatory language what must be included in the consultation as well as what may be included. For example, in Paragraph 4, a consultation "may include the formulation of an order regarding life-sustaining treatment" and may include an order for "the use of artificially administered nutrition and hydration."

The drafters of the provision were either sloppy, befitting a situation in which a complicated, 1,000-plus-page bill, controlling one-sixth of the economy, is rushed through the legislative process. Or it might be that the drafters desired an intentionally vague statute, knowing administration officials would be drafting regulations for the implementation of the bill after it passed.

As it stands, there is more than ample reason to believe the provision was meant to be mandatory with regard to the practitioners. Otherwise, why have the provision in the bill at all? If getting the doctors paid for a voluntary consultation really was the provision's intent, an amendment of two or three lines would have fixed it. As it is, it is two lines in a five-page provision full of specific instructions about what doctors, nurses or doctor's aides must explain to the patients.

Seniors are reminded daily by the media that Medicare is going broke, that the country must cut Medicare costs and that the last days of life are by far the most expensive. Now they are being told by the administration -- one that has been less than transparent on this bill and a host of other issues -- that this bill will cut Medicare costs. They are learning that they are "coincidentally" being asked about end-of-life issues at the government's behest, perhaps by a stranger who is receiving Medicare reimbursement payments. How long do you think it will take a Medicare patient to figure out which decisions will cost the government money and which will save the government money?

This is no reflection on medical professionals. They clearly are being put in a position they neither have asked for nor are completely qualified for. However, I am gratified that a president who can matter-of-factly accuse doctors of routinely removing a child's tonsils solely for financial gain has newfound trust in a doctor's or some hospital employee's ability to consult and even help draw up legal documents regarding end-of-life issues.

If this is all just a misunderstanding about whether this provision is mandatory or not, it can be resolved readily. Let's see if the supporters of the provision are willing to add language to the bill making it clear that there is no requirement that these consultations take place. Better still, they should drop this provision from the bill and let patients discuss these matters with their families, their clergy, lawyers who have expertise in living wills and powers of attorney, or whomever else they desire.

So is this a conspiracy to kill off granny? No. Will seniors be forced to make decisions they don't want to make? No. But will "practitioners" be encouraged to have end-of-life discussions that include when it might be best for patients to allow their life to end earlier than it has to? Of course. And seniors have a right to be satisfied that there is not, at the heart of this process, undo consideration given to cost-cutting.

In the end, it depends on how comfortable one is with having the government in the middle of this process. That is what this discussion is really all about.

Fred D. Thompson, a former Tennessee Republican senator, hosts a nationally syndicated radio show (www.fredthompsonshow.com).

Robin Alta Charo named FDA advisor

2009-08-03T20:33:00.000-07:00

The University of Wisconsin at Madison has announced that Robin Alta Charo has been named senior adviser to the Commissioner of the Food and Drug Administration.

You'll remember lawyer/ethicist-for-sale Charo. She's the one who sees no problem with sex-selection abortion and who called President Bush's Council on Ethics the "endarkenment." She protests anyone following their consciences, especially religious physicians.

Page 425 (end of life counseling)

2009-07-30T06:39:00.000-07:00

I received several emails over the last few days concerning page 425 of the House Bill on Health Reform, HR 3200, which outlines mandatory end of life "options" counseling.

Technically, it appears on the surface to allow doctors (and other "providers") to charge for the counseling. But, yes, it's mandated counseling and in the wrong hands, it might encourage withholding of care more than some of us would like -- and certainly more that others might like.

Can you imagine a more personal and private subject? The subject should be broached by your family doctor. But it appears that every doctor who sees Medicare patients will be responsible. I can imagine the emotional undertones of different doctors as they recite the standardized language and present the forms to be signed! And then, the counseling will be reported to the Center for Medicare and Medicaid Services, with the appropriate modifying code.

I object to the mandated repeat counseling when someone gets sick, the inclusion in the "Medicare and Me" handbook with language to be formalized by the Secretary and forms for the counseling. I've mentioned before how "hot" an issue this could be, even with my limited exposure to the debate.

I hope that someone with sensitivity is in the Secretary's office, assisting with decisions on the literature and forms.

ABC explains the Obama Administration

2009-07-29T02:44:00.000-07:00

ABC News Senior White House Correspondent Jake Tapper has written an article, "When Academic Words Become Political Ammunition," that gives an anonymous "White House official's" rebuttal to the many concerns expressed about President Obama's choices for advisers and "czars" who will affect the shape of health care policies. He attempts to debunk criticisms of the philosophies of Ezekial Emanuel, MD (a bioethicist who is heading the push for control of health care finance and delivery in order to provide universal insurance) and John Holdren, director of the White House's Office of Science and Technology Policy.

The problem is that with Medicare and Medicaid, about half of medical care in this country is already paid for using tax dollars, and we are currently considering expanding tax dollar payment for nearly all health care in the Nation. I disagree with Ezekial Emanuel's position, referenced in the Hastings journal article, "Where Civic Republicanism and Deliberative Democracy Meet," which is linked (in pdf) at Tapper's essay:

Americans fear that if society guarantees certain services as "basic," the range of services guaranteed will expand to include all - or almost all - available services (except for cosmetic surgery and therapies not yet proven effective or proven ineffective). So rather than risk the bankruptcy of having nearly every medical service socially guaranteed to all citizens, Americans have been willing to tolerate a system in which the well insured receive a wide range of medical services with some apparently basic services un- covered; Medicare beneficiaries receive fewer services with some discretionary services covered and some services that intuitively seem basic uncovered; Medicaid beneficiaries and uninsured persons receive far fewer services.

In fact, while we are concerned about the amount of taxes that will be imposed, the Tapper essay points out that we are very much afraid that government interference in health care will result in more limitations, so that none of us will be allowed, much less "guaranteed," to seek medical care that will prolong our lives and make us feel better, unless we are seen as members of a group that is more valuable than others. The examples that Dr. Emanuel gives and our observation of the government pre-paid medical care schemes around the world lead us to believe that, the more health care is financed by tax dollars, the more expensive and rationed it becomes.

Academic mind experiments that do not draw a line between what is acceptable and what is condemned by the authors understandably will be interpreted by others as at best, neutral, at worst, in support of condemnable acts.

Congressman Henry Cuellar on Planned Parenthood

2009-07-25T10:48:00.000-07:00

Went to this morning’s McQueeney, Texas meeting where Henry Cuellar was met with an overwhelming group of constituents upset over what's happening in Washington, DC.

Rep. Cuellar told us that he voted in favor of Planned Parenthood funding yesterday because they give care to “mothers” and he does everything he can do to support mothers. (I suggested that we go to any PP office today and that I bet no mothers come out of the building.)

The people of Guadalupe County- maybe 100 to 150? - turned out to protest the health bill and tax and cap. There were some tough questions about gas prices and about whether private insurance will survive.

People laughed when Cuellar said the bill is “revenue neutral.”

Believe it or not, the man was adamant that he has good private insurance and that he wants to keep *his* private insurance! Why not put all the government employees on Medicare or the VA (depending on their background). Why do we give and give so that our employees can have better benefits than we can afford?

He constantly talked about organizations and corporations that supported the bills, ignoring that the constituents in front of him do not. He handed out paper after paper (how green is that?) supporting the health bill and tax and cap.

He talked against the Blue Dogs, but did say that he wouldn’t allow Pelosi to bring the bill to a vote by bypassing the Committees.

Myth: doctors take out tonsils needlessly

2009-07-22T22:13:00.000-07:00

Then, there's the charge that doctors will needlessly take tonsils out. First, it's unlikely that your Family Physician or Pediatrician does surgery. Second, I don't think the ENT's are getting paid for these anymore, unless they jump through hoops to prove that they're not over-doing it.

AP: In trying to rally support for health care overhaul, Obama described a patient who sees a physician for a sore throat, or a parent who brings in a child with a sore throat.

"Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there. ... The doctor may look at the reimbursement system and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out,'" Obama told a prime-time news conference.

The president added: "Now, that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change — maybe they have allergies. Maybe they have something else that would make a difference."

Video and here.

Obama Press Conference Transcript

2009-07-22T22:06:00.000-07:00

The transcript of the press conference is on line at the Washington Post.

However, if you want an annotated version, try this blog.

Thoughts on Obama's health speech July 22, 2009

2009-07-22T17:41:00.000-07:00

Why doesn't the President just say that the Executive branch employees in his Administration will get rid of their insurance and go on Medicare???

Not a doggone thing that the President is talking about tonight - except for the taxes, the increased bureaucracies and the requirements that Pharmacy companies discount meds - is in the Bills that are being proposed by the House or the Senate.

The government is not paying for those private insurance costs -- the tax cuts for insurance is not the burden that will break the federal budget.

(And by the way - the White House is the people's house. It's only being used by this man.)

Ann Coulter on government Health Care finance

2009-07-22T17:30:00.000-07:00

On the other hand, there's Ann Coulter's take.

Give Ann a chance, here. She makes some very good points.

Addendum -- Including this one:

Now the Democrats want to force us all into one gigantic national health insurance plan that will cover every real and mythical ailment that has a powerful lobby. But if you have a rare medical condition without a lobbying arm, you'll be out of luck.

What works and what doesn't

2009-07-22T17:13:00.000-07:00

Art Caplan has written his two cents worth about the health care reform push. Dr. Caplan needs to read the current bills being hashed out in the Senate and the House. The House bill is over 1000 pages. (The expectation is that, like the last 3 Big Bills, the actual final version will appear in the wee hours of the morning, hours before the final vote.)

First, what President Obama is talking about is prepaid chronic care and catastrophic care. These should be addressed separately. Most people can pay for their own physical and for their own blood pressure medicine -- just ask the majority of the Medicare "covered" who saw their deductible go up this year and who hit the "donut hole."

Or ask the veteran who has a job that offers private insurance.

In the '90's, when I was in med school and doing my residency in Family Medicine, the VA was not the stellar government medicine that Art thinks it is today. And the requirements for coverage - who was "service connected" - were constantly being tightened. Men who should have been covered because of their service in WWII and Korea found that the only way to get care was to show up at the ER and wait their turn.

All of the paper work and regulatory hassles - especially the risk of "fraud and abuse," now "fraud, waste and abuse" - that I've faced in practice are the result of Federal laws interfering in normal practice: 1968 then 1974, on through the amendments to the Social Security Act in 1997.

I certainly hope that the powers that be will offer a "basic plan" that is really a basic plan. I know that it cost much less to insure and care for my family back when we had major medical insurance. However, I doubt that the various special interest groups will allow that. The bills mandate that pap smears, mammograms and "preventive services" will be provided at no cost to the patients. No copay, no coinsurance. No deductibles.

This means that we docs will be under pressure to do everything at "preventive visits." However, the House bill mandates qualifiers and diagnostic codes for all services.

Didn't that complicated chart originate from one of the Democratic proponents of health reform?

If you do ask your doctor about the paperwork and hassles, ask them whether they'd rather fight Medicare or United Health.

If Medicare truly has a lower administration cost, it's because laws and regulations shift the burden to your doctor and the hospital social services and patient advocates.

When I run up against a Blue Cross or Humana requirement that I disagree with, I can argue with the Medical Director or even drop their plan and see their patients outside of the plan for cash. However, if I disagree with a Medicare ruling that I can't admit my 82 year old who's falling, has a low potassium level, is running a fever, and has a bladder infection unless he's septic as defined by Medicare, there's no doctor to talk to. There's thousands of pages of regulations each year and that risk of "fraud and abuse."

Another difference - the government is not paying for those private insurance costs. If they will leave us alone, the insurance costs will either cut their growth or price themselves out of business. If the government increases its payment by the plans proposed in the House and the Senate, the costs will simply grow as they have.

These costs will be added to the 23 Trillion dollars our grandkids already owe.

Mayo Clinic calls health care plans bad medicine

2009-07-22T15:33:00.000-07:00

I've always said that if the Mayo Clinic docs were so smart, they'd come to Texas where it's warm and they can golf year around (like their patients who visit us from October to April).

Nevertheless, doctors at Minnesota's Mayo Clinic have come out against the current plans for health "reform." They are joined by the US Chamber of Commerce.

And then, of interest to those of us who are pro-life, there's the President's assertion that he will leave the decision to pay for abortion up to the "experts."

The President's history of overturning restrictions on federal funding of abortion and of regulations strengthening the conscience rights of medical professionals does not back up his assertion that his administration will not support abortion by federal health care funding.

How many pro-life doctors will he put on the MedPAC???

Governor Jindal reminds us how FEMA helped flood insurance

2009-07-22T15:10:00.000-07:00

You may not be aware that the only way to buy flood insurance is through FEMA, the Federal Emergency Management Agency. In fact, the Agency draws the lines for the Flood Plains and so, decides whether you need flood insurance.

Executive Order 12127

President Carter's 1979 executive order merged many of the separate disaster-related responsibilities into the Federal Emergency Management Agency (FEMA). Among other agencies, FEMA absorbed: the Federal Insurance Administration, the National Fire Prevention and Control Administration, the National Weather Service Community Preparedness Program, the Federal Preparedness Agency of the General Services Administration and the Federal Disaster Assistance Administration activities from HUD. Civil defense responsibilities were also transferred to the new agency from the Defense Department's Defense Civil Preparedness Agency.
John Macy was named as FEMA's first director. Macy emphasized the similarities between natural hazards preparedness and the civil defense activities. FEMA began development of an Integrated Emergency Management System with an all-hazards approach that included "direction, control and warning systems which are common to the full range of emergencies from small isolated events to the ultimate emergency - war."

As we learned in 2005, the centralized bureaucracy is not the most efficient method of responding to the disasters of flooding. (It might have helped if the former Governor had allowed earlier response.)

Governor Jindal discusses possible "bipartisan" health care reform measures, here.

Redefining, Reducing and Rationing Health Care

2009-07-20T13:23:00.000-07:00

Peter Singer, in his op-ed for the New York Times this weekend, seems to be unaware of the difference that our mobility in the United States - both in geography and society - can make. We have choices, can call on friends and family and/or gain sympathy of the wider community (as demonstrated by the pink ribbons on so many cars and products) to obtain what we need and sometimes what we want. (Hear those Rolling Stones in the background? )

I don't expect perfect this year, but I'd sure like to have more options than Pelosi, Rangel, Waxman and Kennedy seem to allow. And, like many other Americans, I'd be more reassured if the Speaker and the House Ways and Means Committee would agree to sign up for the "public option" and if Ted Kennedy would accept the same rationing he's proposing for the rest of us. (No Chappaquiddick health care jokes, please - but isn't he aware that he's going to need readmission to the hospital soon? And don't you think the anecdotes he tells are ironic?)

Or, if the President could get his budget report out on time.

However, the AMA has endorsed the House Bill (no number, yet) as unveiled last week, in spite of the fact that the definition of "primary care provider" includes nurse practitioners. The White House immediately began pushing for cuts in physician payments to ensure that there's no deficit. Orszag hinted on TV yesterday that the 20% cut due next year would work just fine.

My letter to the Board of Trustees of the AMA resulted in a reply from Dr. Rohack:
"As noted, there are elements in the bill that will help you as a family physician in Texas. And as fellow Texan {sic}, you know as well as I that leading the nation in the number of uninsured patients is not a proud statistic and having some federal help will be needed for our patients since our Texas legislature continues to pass on opportunities to help them."

(And Texas' economy is relatively stable as our State government is solvent, too, Dr. Rohack.)

I'm not sure how many of you remember the retroactive tax increases passed by Congress and even instituted by IRS rules. But I'm sure that you remember this Congress' threat this year to retroactively tax the bonuses given to AIG employees.

The House "Reform" Bill allows the Secretary of Health and Human Services not only to set what we are paid, but to set the Nation's mandated insurance coverage, premium rates and then the taxes and penalties that are supposed to pay for half the cost of the Bill, all coordinated with the IRS.

The other half will come from proposed savings. That 20% cut in Physician payments from Medicare is going to look awfully attractive to the bureaucrats.

Everyone's income is no safer than the payment your Family Nurse, uh, Doctor may receive under this Bill.

Health Care Reform: Tax and Spend (and abortion on tax dollars)

2009-07-18T05:03:00.000-07:00

(Editorial correction: Sermo was not begun by the AMA. It is a private group, possibly funded originally by pharmaceutical companies. But, no one there knew the funding source.)
(The vote is now nearly 11,000, and still against the new plan.)

How about a simple solution to the rising government expenditures for health care: don't "force Congress" (See President Obama's press statement video, here. At 6 minutes 40 seconds, he says "force Congress.") to spend more money!

Or, we could try Biden's plan to spend more so we won't go bankrupt as we bankrupt the insurance companies and increase the numbers of people on government-paid health care and increasing mandates that health care funding cover more and more "benefits."

The AMA started a blog-type website that can only be accessed by licensed physicians in the US. 94% of the 2949 docs who have responded to the poll on that site, Sermo, oppose the AMA's endorsement of the current House plan. 96% say that the AMA does not speak for them. The top concerns that the doctors have include interference in the doctor-patient relationship (34%) and malpractice/tort reform (32%).

I've already sent my request to the AMA Board of Trustees to rescind their endorsement. CBS news reports that

"Separately, the White House urged Speaker Nancy Pelosi to toughen the emerging bill so it will hold down the future increases in Medicare payments to doctors, hospitals and other providers. The request, in a letter from Budget Director Peter Orszag, came one day after Congress' top budget official warned that as drafted, the legislation fails to slow the growth in health care costs nationally."

The House Bill still doesn't have a bill number. It's gone from 300 pages to 600 pages, to the current 1018 pages. It's here http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf

All of the Democrat-controlled committees in the House and the Senate have blocked amendment after amendment that would have limited or blocked taxpayer funding of abortion. This is at the same time that the House Finance Services legislation passed, which will allow tax money to pay for abortions in the District of Columbia!

The House's plan will make it impossible to have private insurance if you don't have it at the time the plan passes and those plans will be restricted from changing, except for adding costly benefits that the House mandates. They won't be able to charge anyone any copays for "preventive services" - well child care, physicals and colonoscopies, etc. These requirements will bankrupt the insurance companies.

Everyone who does not have a plan at the time the House "reform" goes into effect will be forced onto the public plan on day one. If they don't sign up, they pay a fine of 2% of their income - this is in addition to the new employer tax and the new "surcharge" tax on the rich - or as Speaker Pelosi says, "a very few people will help with the revenue stream."

(Cross posted to Comal County GOP blog)

Will you pay for abortions?

2009-07-08T08:27:00.000-07:00

One more problem with federal interference in the payment for health care is whether or not Federal tax money will be used to pay for abortions. I've been worrying about what I'd do about my taxes if the law makes me complicit to this extent.

From the Kaiser Foundation:

An ultimatum against using federal money for abortion procedures could reopen the politically treacherous rift over the issue, creating yet another obstacle for congressional Democrats to overcome if they are to achieve their health reform goals, Time reports. "While current versions of the [health reform] legislation do not address the abortion issue at all, late last month 19 anti-abortion Democrats in the House sent a letter to Speaker Nancy Pelosi, warning 'we cannot support any health care reform proposal unless it explicitly excludes abortion from the scope of any government-defined or subsidized health insurance plan.'"

Congress banned spending federal Medicaid dollars on abortions in 1976, and all but 17 states banned paying for the procedures with state Medicaid funds, too. However, as many as 90 percent of private insurers do pay for abortions and the restrictions the legislators are demanding could compromise those benefits. Under one proposal, individuals earning up to $43,000 a year who get subsidies to buy insurance could not purchase a policy that has abortion coverage. "And it would raise all sorts of other questions if insurers were allowed to discriminate among their customers based on whether or not they are using federal dollars to pay for their policies," Time reports.

"Abortion rights advocacy groups are pushing back. On Monday, the National Women's Law Center released a poll of 1,000 likely voters conducted by the Mellman Group indicating that 71% favor including reproductive services such as birth control and abortion as part of health reform," Time reports. "The poll also found that 75% believe an independent commission should determine what medical services are covered among the basic benefits offered under health reform" (Tumulty, 7/8).

Obama cancels meeting of President's Council Bioethics

2009-06-18T06:44:00.000-07:00

I wonder whether the new commission/committee/council will have even one pro-life member? Will Robert P. George (one of only 3 or 4 conservative bioethicist with tenure at a major university), for example, have a spot?

And remember the fuss and bother when some of the members of President Bush's Council were replaced in March, 2004? Bet there's none, now!

Obama Plans to Replace Bush’s Bioethics Panel
By NICHOLAS WADE

Members of the President’s Council on Bioethics were told by the White House last week that their services were no longer needed and were asked to cancel a planned meeting, a council staff member said Wednesday.

The council was disbanded because it was designed by the Bush administration to be “a philosophically leaning advisory group” that favored discussion over developing a shared consensus, said Reid Cherlin, a White House press officer.

President Obama will appoint a new bioethics commission, one with a new mandate and that “offers practical policy options,” Mr. Cherlin said.

$1 Trillion to cover 11 Million people

2009-06-17T18:26:00.000-07:00

According to the Associated Press, 37 Million people would remain uninsured under the legislation discussed in Kennedy's Senate Health, Education, Labor and Pensions Committee. If there are 48 million uninsured, now (not, more below), then one trillion dollars to cover an additional 11 million people.

Can you imagine? There's no coverage at all for people who aren't eligible for Medicaid, but who make less than 150 percent of the Federal poverty level ($33,000 for a family of four.)

Of course, some of this cost comes from subsidizing families of four who make $110,000 a year. In fact, 60% of the cost will be in the subsidies for people who make 150% to 500% of the Federal poverty level.

(We won't mention the cost of regulating restaurant menues and forcing the placement of nutrition information on those menues and on notices next to each item on a buffet line. Or the as-yet uncounted costs to the chefs who must calculate and document their recipes in order to know those nutrition facts.)

Daschle/Dole/Baker! Health care on the fast track -along with the entire Nation's finance

2009-06-17T14:53:00.000-07:00

Right after this Yellow Brick Award ceremony, I'm thinking that it may save my life for me to learn to use Twitter and Facebook. Now.

While President Obama is planning to take over the entire finance world ASAP, ABC is planning their all-day infomercial for Obama and his push - there is no "plan," yet - for health care "reform" by July 4. No opposing or alternate viewpoints will be allowed. They're even refusing to take a paid-for program in rebuttal, according to the Drudge Report.

ABC REFUSES PAID ADS OFFERING ALTERNATIVE VIEWPOINT FOR WHITE HOUSE HEALTH CARE PROGRAM
ABC is refusing paid ads for its health care program at the White House. Thus they're refusing even a paid-for alternative viewpoint.

Conservatives for Patients Rights requested the rates to buy a 60 second network spot immediately preceding the broadcast of the Town Hall meeting.

While looking for verification of this story, I came across several that report that former Senators Tom Daschle, Bob Dole and Howard Baker are working on a health care "compromise." (Come on! there's a reason they aren't Senators any more!)

See their report, "Crossing the ~~Streams~~ Lines" here.

So, we'll have a Secretary of the Treasury (who claims to be unable to do his own taxes using Turbo Tax) running Wall Street and all the banks. We'll have a known plagiarist and serial failed Presidential candidate (who also can't figure out that gifts and services are taxable) working with another serial failed presidential candidate (who took money for telling the world that he needs a little pharmaceutical help in the bed room) working to reign in the cost of doctors, hospitals, and those pharmaceutical companies. (The third player in the health care waters is Baker, another serial failed presidential candidate. It's just that no one's ever heard of him.)

But don't worry -- even if you are able to vote for a completely new House and a turnover of a good portion of the Senate in 2010, Obama will still run the Census out of his Committee to Reelect the President.

In the meantime, Obama is planning to cut Medicare fees to Hospice, hospitals and doctors while instituting a new tax on health care insurance benefits from employers, according to the Washington Post.

Why not? After all, Daschle had to pay taxes on his limo and driver and Geithner had to pay them on his kids' summer camp!

Addendum after skimming the report:
The "Crossing the Lines" report is full of calls for more regulation with a sprinkling of pablum.

First, they demand that everyone have health insurance. (Could be acceptable if we were allowed to chose between Major Medical and From-First-Dollar. And if it weren’t for the rest of the trash.)

They believe - or at least claim to believe - that it will pay for itself. (Who knew old white haired men could be so funny?)

How will the money be raised?

By a “trigger” to enforce cuts when costs reach a certain point and by not paying for those treatments that are considered less effective.

What are they going to do with all the men and women who insist on antibiotics, today, for their bronchitis? Will they protect the doc when the patient develops bacterial pneumonia?

How about my man in his mid-80’s with a 102 fever in the ER, a bladder infection, multiple falls that resulted in bruises and skin tears, and potassium at 2 (normal is 4)? Medicare would not allow me to actually admit him because he turned out not to be septic by their criteria. He ended up on “Observation” for 3 days while his wife and I tried to find some safe place for him to go after discharge and I tried to get a handle on his potassium. He left for the rehab hospital with a potassium of 2.6. On a heart monitor. Because Medicare rules threaten us with charges of “fraud and abuse.”

How about our local hospice? Obama has announced his intention to cut funding to hospice. I guess there’s not much efficacy in hospice. After all, the hospice patient is, by definition, expected to die within 6 months. However, hospice patients are less likely to present at the ER, with the costs of their care much less than hospitalization.

Force Medicare "reform" without proof that it will work?

2009-06-16T02:43:00.000-07:00

The Washington Post reports on the latest findings of the "Medicare Payment Advisory Commission" (MedPAC) today. According to the WaPo, this is a "commission that advises Congress on the federal medical program for older Americans."

In other reports, there is mention that President Obama plans - at the same time - to cut Medicare and Medicaid funding by over $900 Billion dollars, to somehow expand the numbers of Americans who are given "guaranteed health care" under some government "public plan," and to pay for any expansion by taxing insurance benefits given by employers.

And it all has to be done in the next two weeks:

For months, Obama remained on the sidelines of the health-care debate because "he felt it was important to not be too proscriptive," Axelrod said in an interview. "Now we're into a different phase, where decisions are being made very quickly, so it's time to weigh in to a greater degree."

The Obama strategy, articulated in the speech here and in a series of private meetings, is to present each major stakeholder with an enticement in return for a bit of sacrifice.

Again, there's mention of "accountable care organizations," and how to force doctors into them. This time, we do learn that coercion will be necessary to form these organizations and that there's evidence that these sort of interventions don't save money or improve the health care of patients caught up in the schemes. In fact, some of these interventions are now considered wasteful and the first place to cut:

To illustrate what it might take to save Medicare, the commission describes how primary-care doctors, specialists and hospitals could be reorganized into "accountable care organizations" whose members would receive bonuses if the organizations met quality and cost targets. To ratchet up the incentives, health-care providers that fail to meet cost and quality targets could be penalized, the report says.

Even then, any projected savings would be highly uncertain, the report says. What is certain is that Medicare cannot maintain its current trajectory, it adds:

"If current spending and utilization trends continue, the Medicare program is fiscally unsustainable. . . . Part of the problem is that Medicare's fee-for-service payment systems reward more care -- and more complex care -- without regard to the quality or value of that care."

The report underscores the challenges facing President Obama and Congress as they seek to overhaul the health-care economy. The administration has put a spotlight on what it considers wasteful spending, but it has offered sparse details as to how it would change the incentives that produce the waste.

The report identifies some areas that are ripe for savings. MedPAC estimates that the government is paying private Medicare health plans -- which were supposed to save the government money -- much more than it should. In addition, the government could save money by adopting a more streamlined approval process for "follow-on biologics" -- products that imitate biotech treatments already on the market.

Getting doctors to join accountable care organizations may require pressure, MedPAC Executive Director Mark E. Miller told reporters: "If you want people to voluntarily organize, you may want to make sure that the current system isn't as pleasant a place to be."

The model for accountable care organizations resembles that of large, tightly managed physician groups, practices that have been the subject of demonstration projects, and Medicare's experience with those offers limited encouragement, according to the report. Measurable quality improved in the areas of care monitored, such as for diabetes and congestive heart failure. But "whether the demonstration has actually generated savings for the Medicare program is debatable," the report says.

Policymakers hope that money can be saved by better coordinating care. But, according to the MedPAC report, Medicare pilot programs intended to coordinate care for patients with chronic diseases -- programs that involved insurance companies and other private groups -- generally achieved modest quality improvements. Most of the programs cost Medicare more money than it would have spent without them, the report says.

Public Funding for Health Care in Real Life

2009-06-15T04:41:00.000-07:00

I don't see how this will cut costs to the government for Medicare and Medicaid.

The group Physicians for a National Health Plan, published a link to an April, 2009 report from the Lewin group by Sheils and Haught outlines the expected effects on insured, employers, doctors and hospitals under various types of public plan financing. At Medicare rates, doctors would see their income go down if everyone is covered, and go down slightly if only the self-insured and small businesses were covered. In the long run, if the public option is offered to everyone, 119 million people would switch over from private insurance.

The numbers in the news say that the Kennedy-Dodd Bill before the Senate Finance Committee will offer Medicare plus 10% to doctors and hospitals - so those decreases are not quite accurate.

Here's a report on one example of just such an effect.

Real world experience comes from Hawaii's short attempt to cover all uninsured children. It also describes the increased Medicaid coverage in Hawaii in the last few years, and the Federally Qualified Health Clinics that give care to uninsured and underinsured.

Texas Medical Association Health Care Principles

2009-06-14T07:24:00.000-07:00

Available for members on the TMA website, but looks okay to post here.

The TMA House of Delegates adopted the principles as official TMA policy in May. They include:

* Promote portable and continuous health care coverage for all Americans using an affordable mix of public and private payer systems.
* Promote patient safety as a top priority for reform, recognizing an effective mix of initiatives that combine evidence-based accountability standards, committed financial resources, and rewards for performance that incent and ensure patient safety.
* Adopt physician-developed, evidence-based tools for use in scientifically valid quality/patient safety initiatives that incentivize and reward the physician-led health care delivery team, and include comparative effectiveness research used only to help patient-physician relationships choose the best care for patients.
* Preserve patient and physician choice and the integrity of the patient-physician relationship.
* Incorporate physician-developed, evidence-based measures and preventive health and wellness initiatives into any new or expanded health benefit package to promote a healthier citizenry.
* Recognize and support the role of safety net and public health systems in delivering essential health care services within our communities to include essential prevention and health promotion public health services.
* Support the development of a well-funded, nationwide emergency and trauma care system that provides appropriate emergency and trauma care for all Americans.
* Support public policy that fosters ethical and effective end-of-life care decisions, to include requiring all Medicare patients to have an advance directive that a Medicare enrollee can discuss as part of a covered Medicare visit with a physician.
* Provide sustainable financing mechanisms that ensure the aforementioned affordable mix of services and create personal responsibility among all stakeholders for financing and appropriate utilization of the system.
* Invest needed resources to expand the physician-led workforce to meet the health care needs of a growing and increasingly diverse and aging population.
* Provide financial and technological support to implement physician-led, patient-centered medical homes for all Americans, including increased funding and compensation for services provided by primary care physicians and the services provided by non-primary care, specialist physicians as part of the patient-centered medical home.
* Through public policy enactments, require accountability and transparency among health insurers to disclose how their premium dollars are spent, eliminate preexisting condition exclusions, simplify administrative processes, and observe fair and competitive market practices.
* Reform the national tort system to prevent nonmeritorious lawsuits, keeping Texas reforms in place.
* Abolish the Medicare SGR annual update system and initiate a true cost-of-practice methodology that provides for annual updates in the Medicare Fee Schedule as determined by a credible, practice expense-based, medical economic index.
* Support the implementation of an interoperable National Electronic Medical Records System, financed and implemented through federal funding.
* Require payers to have a standard, transparent contract with providers that cannot be sold or leased for any other payer purposes without the express, written consent of the contracted physician. This principle, in effect, calls for a prohibition against so-called silent PPOs.
* Support efforts to make health care financing and delivery decision-making more of a professionally advised function, with appropriate standard setting, payment policy, and delivery system decisions fashioned by physician-led deliberative bodies as authorized legislatively.

AMA offers public plan compromise

2009-06-12T06:35:00.000-07:00

One more post before I have to work, from the American Medical Association morning newsletter.

Unfortunately, I can't access most of the links:

AMA offers public plan compromise.

The AP (6/12, Tanner) reports that the American Medical Association "has long opposed government intrusion into healthcare and believes reform can be achieved by revamping private health insurance plans." Now, AMA President Dr. Nancy Nielsen "says the group wants details on Obama's proposal for a public health insurance plan to compete with private plans." She noted that the AMA "opposes any public plan that forces physicians to participate, expands the fiscally challenged Medicare program, or pays Medicare rates."

But, she explained that the group "remains open to the idea of a government-run health insurance plan, as long as doctors are not required to participate and the plan pays doctors more than Medicare does," CQ Today (6/12, Wayne) reports. Dr. Nielsen said that "doctors would accept a public plan that competes on a 'level playing field' with private insurers." She claimed that "at a minimum...the government should not require doctors to participate as a condition of retaining their Medicare billing privileges, and the plan must pay higher rates than Medicare does." Among "other variations of a public plan" that "the AMA 'is willing to consider,'" include Senate Budget Chairman Kent Conrad's (D-ND) proposal to "create a system of publicly owned insurance cooperatives in place of a government-run public plan."

AMA said to be open to considering Sen. Conrad's co-op proposal. CongressDaily (6/12) reports, "The American Medical Association wants to see details of Senate Budget Chairman Kent Conrad's (D-ND) compromise proposal for a public health insurance plan, the group told senators Thursday." The group's statement "could help an already promising compromise gain more traction." AMA Trustee Samantha Rosman told the Senate Health, Education, Labor and Pensions Committee at a roundtable meeting that "the AMA is open to consideration of a new health insurance option that is market based." She added that although "no legislative details have yet been put forth," the group is looking "forward to reviewing those ideas." Sen. Conrad's proposal includes that creation of "a nonprofit co-op that would serve as a public plan alternative to private insurance."

Chamber Of Commerce, insurance industry join AMA in push against public plan. In a follow-up to Wednesday's New York Times (6/10, Pear) article about the American Medical Association's (AMA) push to eliminate the public plan from the health reform legislation, Shirley S. Wang observed in the Wall Street Journal (6/11, Wang) Health Blog that the AMA is arguing that a public plan "threatens to restrict patient choice" by crowding out the private insurers. In this effort, they are joined by the US Chamber of Commerce, which "says it is concerned that the proposed mandate that employers help pay for insurance would add new costs to already struggling businesses." Finally, "private insurers also are pushing back against the idea of government-run exchanges where consumers could buy policies." In an update to the blog entry, Wang added, "The AMA later issued a statement saying it might be able to support some version of public plans being discussed."

Public plan debate sparks Democratic "civil war." The Politico (6/12, Brown) reports that President Obama's calls for a public health plan "has touched off an increasingly fierce Democratic civil war on Capitol Hill, as liberals fearful about squandering the chance to achieve that goal are taking aggressive steps to keep moderates in line." The Politico notes that Democratic strategist Joe Trippi "launched a campaign" accusing Nebraska Sen. Ben Nelson (D) of "being a 'sellout' for special interests" when he spoke out against the concept. Meanwhile, bloggers on the Daily Kos "went on the attack" after the centrist Democratic think tank Third Way "cautioned Democrats on overreaching on a public plan." Louisiana Sen. Mary Landrieu (D) "is the next target," the Politico reports.

In the Washington Post (6/12) 44 blog, Ben Pershing notes "the increasingly heated debate over healthcare reform...within the Democratic party," adding that the formation of a public plan option is a major point of contention.
From the AMA

Obama to address AMA House of Delegates. President Barack Obama will speak at the Annual Meeting of the AMA House of Delegates on June 15 in Chicago about the nation's need for health system reform. "President Obama has made health reform a top domestic priority, as has the AMA," AMA President Nancy H. Nielsen, MD, PhD, said. "[His] speech to AMA physicians shows that he values the input of those who dedicate their lives to caring for patients." The House of Delegates opens tomorrow, June 13, during which physicians and medical students from around the country will debate and set policy on health system reform and a variety of other matters that affect physicians and patients. The meeting runs through June 17.

HELP (the whole government prepaid health plan)

2009-06-12T05:56:00.000-07:00

Appropriate (on several levels), the proposed plan for government mandated and government financed health care is called the "HELP" plan. The current draft (I think)in .pdf can be accessed, here.

The Kennedy "draft of a draft" was 167 pages long. This thing is over 600 pages and I've gotten through about 150 pages, so far.

You may hear about the Hawaii Prepaid Health Care Plan, or Hawaii's mandated employer-provided insurance plan instituted in 1974.

Here's an article that covers the problems with Hawaii PHCP, according to one author from that State. Please note that the uninsured in that State is still 10% and that many employers attempt to use employees for less than 20 hours a week, so that they don't come under the mandate.

Please see the part near the end that I've highlighted, concerning the mandated services (including in vitro fertilization, etc.) that increase the cost of health care and insurance in Hawaii.

Due to Hawaii's low uninsured rate of 9.6 percent, policymakers have been looking at our unique employer-mandated health insurance as a model to be followed at the state and even national level. Since 1974, Hawaii has implemented the Prepaid Health Care Act (PHCA), which contains two major directives: 1) That employers provide employees working 20 or more hours a week with health insurance; and 2) That any plan offered by insurers provide equal or better benefits offered by the plan with the most subscribers in the state.

For several reasons, expanding PHCA beyond Hawaii's borders would be a catastrophic mistake.

Fact: From a low of only 5 percent of uninsured residents in the 1980s, the number has nearly doubled to 10 percent today. According to the US Census Bureau, Hawaii's current uninsured rate is not statistically different from states like Minnesota, Wisconsin, Iowa, and Maine, none of which implement employer-mandated insurance.

Conclusion: A low uninsured rate cannot be solely attributed to employer-mandated insurance. Mandating that employers provide coverage does not tackle the underlying problem of skyrocketing health care costs.

Fact: Employers find ways to save on costs by manipulating employee work hours. Following PHCA, the number of employees in the state working between 20 and 35 hours per week decreased while utilization of both employees working less than 20 hours and employees working over 36 hours increased. Evidence supports the claim that employers also drop employees altogether to avoid providing coverage, thereby increasing the rate of unemployment as well.

Conclusion: Requiring employers to cover employees working 20 or more hours has not eliminated, but merely shifted, the burden of health insurance costs to businesses while contributing to the growing uninsured rate.

Fact: Hawaii Medical Service Association (HMSA) is by far the largest provider in the state with 68 percent of the private market and 701,527 members as of May 2008. Kaiser is the second largest with a 20 percent share — thus, HMSA and Kaiser control nearly 90 percent of the state's insurance marketplace.

Conclusion: By requiring insurers' health plans to provide equal or better benefits offered by the plan with the most subscribers, PHCA protects HMSA's and Kaiser's majority control of the market, leaving little room for other insurers to enter the market. Lifting this restriction would introduce badly needed competition, which would go a long way in driving down expenses.

Fact: The state government mandates a wide range of benefits, including expensive and questionably necessary services such as in vitro fertilization and drug and alcohol addiction treatment, which highly inflate the cost of coverage.

Conclusion: Granting consumers the freedom to customize their own plans free of costly state requirements would allow them to prioritize cheaper, preventive services such as cancer screening. This would lower the price of coverage, leading to a larger number of both covered and healthier residents.

PHCA has effectively eliminated health insurance competition in the state, beleaguering citizens with growing expenses and lack of freedom in choosing the health plan that best fits their needs. Opening up the market within and outside the state (much like how consumers can already shop for auto insurance across state lines), in addition to eliminating expensive mandated benefits, would go a long way in restoring the purchasing power and choices of Hawaii's residents regarding the most important aspect of their lives — their health.

Pearl Hahn is a policy analyst at the Grassroot Institute of Hawaii.

TriCommittee Health Care Bill Summarized

2009-06-11T21:59:00.000-07:00

I'm still looking for the actual Bill(s), with the names of sponsors. Evidently the Kennedy Bill is going to be voted on next week.

In the meantime, the "Tri-Committee plan" is summarized, here.

Eliminates cost sharing, creates "accountable care organizations," allows employers to chose between offering coverage and "contributing funds on behalf of their uncovered workers," includes individual mandates (people must have one of the approved plans, except in "hardship"), Expands the National Health Service Corps, Expands Medicaid, and (according to the AMA) will force doctors who take Medicare to participate in the "Public Option."

UNITED STATES CONGRESS

Key Features of the Tri-Committee Health Reform Draft Proposal
in the U.S. House of Representatives
June 9, 2009

President Obama’s Commitment: The Tri-Committee bill fulfills the President’s commitment to health care reform via legislation that:

•
Reduces costs;
•
Protects current coverage and preserves choice of doctors, hospitals and health plans; and
•
Ensures affordable, quality health care for all.
Plan Overview:

•
Maintains the ability for people to keep what they have and minimizes disruption;
•
Invests in health care workforce to improve access to primary care;
•
Invests in prevention and public health programs;
•
Creates a new national health Exchange that permits States the option of developing a State or regional exchange in lieu of the national Exchange;
•
Establishes shared responsibility among individuals, employers, and government;
•
Offers sliding scale credits to ensure affordability for low and middle-income individuals and families;
•
Jump starts health care delivery system reforms to reduce costs, maintain fiscal sustainability, and improve quality; and
•
Expands authority to prevent waste, fraud and abuse.

Workforce Investments:

• Expands the National Health Service Corps;
• Boosts training of primary care doctors and expands pipeline of individuals going into health professions, including primary care, nursing and public health;
• Supports workforce diversity efforts; and
• Expands scholarships and loans for individuals in needed professions and shortage areas.

Prevention and Wellness:

• Expands Community Health Centers;
• Waives cost-sharing for preventive services in benefit packages;
• Creates community-based programs to deliver prevention and wellness services;
• Targets community-based programs and new data collection efforts to better identify and address racial, ethnic and other health disparities; and
• Strengthens state, local, tribal and territorial public health departments and programs.

Insurance Market Reforms:

• Ensures availability of coverage by prohibiting insurers from excluding pre-existing conditions or engaging in other discriminatory practices;
• Prohibits rating based on gender, health status, or occupation and strictly limits premium variation based on age;
• Establishes a new Health Insurance Exchange to create a transparent marketplace for individuals and small employers to comparison shop among private insurers and a new public health insurance option; and
• Introduces administrative simplification and standardization to reduce administrative costs across all plans and providers.
Ensuring Affordability and Access:

• Includes sliding scale affordability credits in the Exchange to support individuals and families with incomes between Medicaid eligibility levels and 400% of the federal poverty level (FPL); (NOTE: The average cost of family coverage today is 14% of a
family’s income at 400% of poverty.)
• Expands Medicaid for the most vulnerable, low-income populations and improves payment rates to enhance access to primary care under Medicaid; and
• Caps total out-of-pocket spending in all new policies to prevent bankruptcies from medical expenses.

Public Health Insurance Option:

• Enhances transparency and accountability by creating a new public health insurance option within the Exchange to offer choice and ensure competition;
• The public health insurance option is self-sustaining and competes on “level field” with private insurers in the Exchange; and
• When individuals “enter” the Exchange, whether on their own or as employees of a business that is purchasing in the Exchange, they are free to choose among available public and private options.
Benefits:

• Independent public/private advisory committee recommends benefit packages based on standards set in statute;
• Guarantees choice and fair, transparent competition by creating various levels of standardized benefits and cost-sharing arrangements, with additional benefits available in higher-cost plans; and
• Phases-in requirements relating to benefit and quality standards for employer plans.

Shared Responsibility:

• Once market reforms and affordability credits are in effect to ensure access and affordability, individuals are responsible for having health insurance with an exception in cases of hardship;
• Employers choose between providing coverage for their workers or contributing funds on behalf of their uncovered workers;
• Government is responsible for ensuring affordability of insurance through new affordability credits, insurance market and delivery system reforms and oversight of insurance companies; and
• Protects small businesses by exempting small low-wage firms and providing a new small business tax credit for firms providing health coverage.

Reforming the Health Care Delivery System and Ensuring Sustainability:

• Uses federal health programs (Medicare, Medicaid and the new public health insurance option) to reward high quality, efficient care, and reduce disparities;
• Adopts innovative payment approaches and promotes better coordinated care in Medicare and the new public option through programs such as accountable care organizations; and
• Attacks the high rate of cost growth to generate savings for reform and fiscal sustainability, including a program in Medicare to reduce preventable hospital readmissions.

Modernizing, Improving and Preserving Medicare:

• Replaces the currently flawed Sustainable Growth Rate (SGR) formula that determines physician pay rates in Medicare;
• Increases reimbursement for primary care providers, improves the Part D program, and implements many other MedPAC recommendations;
•
Extends solvency by eliminating overpayments to Medicare Advantage plans, and refining payment rates for certain services;
•
Creates new consumer protections for Medicare Advantage beneficiaries;
• Improves low-income subsidy programs to ensure Medicare is truly affordable and accessible for those with lower incomes; and
• Eliminates cost-sharing for all preventive services.

Downgrading American Medical Care

2009-06-11T16:57:00.000-07:00

That image above is from a report in the American Spectator by Betsy McCaughey (the former Lieutenant Governor of New York State) on the true cost of medical care in the United States. It demonstrates that Americans still pay approximately the same for combined food and medical care expenses. As food costs less of the family budget, more is spent on medical care. The reason is that food is less expensive, not that people don't buy food because they have to pay for medical bills.

She also points out that our US survival rates for cancer are much better than those in countries that have longer waiting periods and that spend less on health care.

Obama to push public health plan, forced physician participation

2009-06-10T20:31:00.000-07:00

The New York Times is covering the opposition to a public health plan (government pre-paid health care) by the American Medical Association.

Within that article is the news that the Democrat leadership intends to not only implement a government insurance plan that would compete with private insurance companies, but the legislation would force doctors who already accept Medicare to accept this new plan, also.

America’s Health Insurance Plans, a lobby for insurers, said Tuesday that the government plan proposed by some Senate Democrats could “dismantle employer-based coverage and significantly increase costs for those who remain in private coverage.”

Under a proposal favored by many Democrats, doctors who take Medicare patients would also have to participate in the new public plan. Democrats say that requirement is needed to make sure the public plan can go into business right away with a large network of doctors.

The medical association said it “cannot support any plan design that mandates physician participation.” For one thing, it said, “many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate.”

“In addition,” the A.M.A. said, “federal programs traditionally have never required physician or other provider participation, but rather such participation has been on a voluntary basis.”

Those who had Medicare supplements that paid for their drugs before the Medicare Part D plan was implemented will remember their surprise when they were forced out of their old plan and onto the new one. The big surprise came when they hit the "donut hole," or the level when they had to pay for all of their own prescriptions.

Imagine your boss has the choice between buying insurance, or (as in Massachusetts) paying a fine that is less and allowing you to be absorbed by the government plan.

Now, imagine that you can't find a doctor that is taking new patients. Or a doctor that can see those patients within a reasonable time frame.

Here in Texas, some Medicaid patients are assigned to clinics, not doctors. Their "primary care providers" are not doctors, but groups that hire nurse practitioners to see them, to take call, and to manage their care.

In fact, Rural Health Clinics are required by Federal law to hire Physician Assistants or Nurse Practitioners who *must* do a certain percentage of the visits and patient care - I believe it's 50%. In other words, the government forbids the doctor who owns the clinic from seeing all his own patients and keeping the patient load at a reasonable level. Just another example of unintended consequences of government interference.

Obama/Kennedy Health Care Reform in the works

2009-06-06T22:03:00.000-07:00

(This is a cross post from the Comal County GOP blog. I believe the report is relevant to LifeEthics.org.)

(As you read this, remember that this is the same group who gave us No Child Left Behind and "accidentally" released a nearly-300 page report on the "site, location, facility, and activity" of all the civilian nuclear sites that the Obama Administration plans to report to the International oversite agency, with pretty little tables. That's the picture above.

And note that no one seemed to blink an eye at the claim that Germany has had government single payer health insurance "since the '20's. The President toured one of the medical facilities from the 30's just before D-day.)

Today, across the US, the Democratic National Committee sponsored small group meetings on Health Care Reform, called "Organizing for America." See this news report and this one, that shows the Daily Kos group is not happy.

Here in New Braunfels (at the public library, as announced in the News), our host and an "advocate planner" - see this definition here and this usage here - Dona Evans, told us that the purpose of the meeting was to support President Obama's "plan" - she passed out copies of this outline and showed us video from this press conference - or maybe it was the three principles of health care reform.

The meeting was very tightly planned. The paperwork and agenda were available to the hosts before the meeting, on line.

It also appears that our little meeting in New Braunfels, Comal County, Texas was worthy of one man who told us he met with Obama planners on the health care reform last November and December, and another man who said he was trained by Saul Alinski himself in Chicago in the '60's. I believe I identified a core of about 7 people who were DNC/OfA plants and who remained behind for over 30 minutes after the meeting broke up.

BTW, as I said at the beginning of the meeting, I'm not an opponent of "reform." As I said, I believe that every problem we mentioned today is a result of government interference. The President said that we've talked about the problem but haven't had reform for 60 years. I say that we had government interference that increased costs and hurt our chances of meeting the President's goals. Medicare in the 60's, HMO's in the '70's, HIPPA, DRG's, and now, the cover-from-first-penny drug benefit that caused many retirees to lose good private subsidies and leaves them responsible for the whole bill for much of the year.

Although no one at the meeting today seemed aware, Senator Edward Kennedy's staff released a "draft of a draft" of his Bill, a 177 page piece to be called "America Health Choices Act." The pdf is here.

Addendum (June 7, at 1:20 PM) - Actually, our agreement was that we do not believe that this is an emergency, that we do not want Congress to pass any bill before they go home for recess at the end of July, and we do not want to send our Health Care money to Washington or have our Health Care decisions made in Washington, at all. While some mentioned the fear of government (one young man quoted Jefferson), most spoke of experience and the history of Government interference.

Below, find the report that Ms. Evans sent out to all of us who attended the meeting, along with a few more - among them are the names of local docs who I assume is her daughter and son-in-law. (All of our email addresses were visible - I sometimes forget the "blind copy to" function, also, so I won't copy all the email addresses, here.)

26 people at our event plus an unknown number of protestors outside marching with signs.
0# of calls made at your event
3 service projects planned for Saturday, June 27th, again at 2:00 p.m. in the library: individual volunteers, blood drive and food drive

We had excellent support and publicity from the local newspaper.
An account of our event follows:

WOW! Democracy in action!

First let me express my appreciation to everyone who attended the Organizing for America kickoff meeting Saturday, June 6th, at the New Braunfels library. Also, thank you for the lively discussion and sometimes heated debate. We even appreciate those who showed up to march in protest of our meeting – that’s what free speech is all about.

When I volunteered to host the meeting, it is because I support what President Obama is attempting to do for our country, and because of my background and experience, I know firsthand that the current health care system is broken and needs to be fixed. I am not a Republican or a Democrat, I am an American who is a concerned citizen, mother of four, grandmother of two.

When I signed up to host the kickoff to organize support for President Obama’s plan, I naively thought everyone would want to improve the current system. What’s not to like about “improvement”?

Surprise! Surprise! Some folks are downright passionate about not supporting President Obama’s proposed health care reform. It’s a good thing that I truly believe, “The shining spark of truth cometh forth only after the clash of differing opinions.”

It is my job to talk to patients everyday about their medical bills, because I am a medical billing and coding clerk in a busy doctor’s office who services both newborns and seniors, and all those ages in between. And I know, many people who live in the Comal Area cannot afford health care insurance, doctor’s visits, hospital care, and prescription drugs; and those who do have insurance are being impacted by increased premiums, co-pays, coinsurance, and deductibles and reduced coverage and benefits. I know that what President Obama says about the current system is true – it needs to be fixed.

We had twenty-six concerned citizens show up to talk about health care reform at the meeting. I don’t how many protesters were outside the library. But, I am told that as we consulted, they marched carrying signs of protest.

About the only thing everyone at the meeting agreed on is that we – those who were present -- don’t want an inefficient government health care system that lacks prudent oversight and necessary regulations and ends up costing taxpayers more than it should and delivering substandard services. More than once, the TARP bailout and lack of oversight, lax regulations, and abuse were mentioned.

Despite the fact that not everyone agreed on what should be done, or how it should be done, everyone had constructive and thoughtful comments and most shared their story about how the present health care system has impacted their lives.

The big question is how can we structure change around the three basic principles put forth by President Obama and his Vice President Joe Biden: 1) reduce costs, 2) guarantee choice, and 3) make sure quality health care is affordable and available to all Americans.

But how? That is the big question. I am an optimist; I truly believe that there is a solution for every problem. And I firmly believe that the American people, if informed, can make good decisions. I know that when informed passionate Americans unite around a cause they can make miracles happen.

Interestingly, I discovered, that most of the attendees who oppose President’s Obama’s health care proposal, have never read it. Their opposition seems to be based on one of two things: 1) what they heard on talk radio or network tv; and 2) their general fear of a nationalized health system. (Because everyone has heard that Canada’s system doesn’t work right either.)

Most of those who attended and voiced their opposition were unwilling to actually sit through a reading of the proposed plan – which we offered to do. Based on their reactions, I would say, their mind is made up; don’t confuse them with the facts. It was my hope that they would at least listen/read to what the plan actually contains, rather than what a radical radio talk show host claims it contains. I have listened to some of the radio talk shows and realized that they are more motivated by ratings than telling the truth.

What I got from those who were the most negative about health care reform is their fear. Many attendees agreed they fear governmental bureaucracy. Many are afraid that big government programs would waste money on inefficient administration and would end up providing substandard services. One lady said, “I love my country, but I fear my government.” Another man said he feared a dictatorship. Others just expressed concern that centralized services tend to be inefficient and wasteful.

Some attendees expressed fear of electronic medical records, where ones medical history would be accessible over the internet. Everyone agreed, that safeguards should be built into any national EMR system to ensure privacy. Some noted that an efficient, properly operating EMR system could save the government and private companies millions by eliminating the need for duplicate services, such as MRI’s, X-rays, and labs, being performed each time someone moves to a new locality and sees a new doctor or changes doctors.

Many of those who attended praised the U.S. Military health care service. One lady who was born in Germany touted the many benefits of its program (including dental care), which has successfully operated since the 1920’s, and where co-pays were recently raised to $10. I mentioned my own positive experience with the universal health care system operated in Hawaii. There was a consensus that it would be good to look at the countries and states that successfully insure all their residents and use those as an example on which the U.S. could model a new health care system for Americans.

One gentleman, who is a private contractor with a minority-owned company that bids on government contracts, suggested that insurance contracts be awarded to those companies that can provide the best services for the least amount of money on a regional basis – similar to construction contracts.

Several people shared stories of how their lives and the lives of their family had been negatively impacted as the result of a catastrophic illness or major surgery. They came to the meeting to genuinely see how they can support President Obama so that health care wouldn’t bankrupt families and cause them to have to choose between paying exorbitant doctors and hospitals bills or pay for food and rent.

However, most of the attendees had either had good experiences with U. S Medicare or the U.S. Military or reported they had received excellent services from both.

Almost everyone agreed, that instituting a regional system based on contracts, similar to the present contracted administration of Medicare Jurisdiction 4 system by Trailblazer Health, of which Texas is part of along with Oklahoma, Colorado, New Mexico, Arkansas and Indian Health, might be a way to avoid an inefficient centralized system.

Many attendees expressed concern over what the future might hold for their children and grandchildren. From a personal standpoint, I am now concerned because my youngest daughter who is the mother of a five year old is going to enter the military, not only because she loves her country and feels passionately about its defense, but also because she will get health care for her daughter as one of the benefits. Despite working for twenty years, she is unable to afford health care insurance through her employer.

Many attendees advocated a “single payer system”. I have to admit, I didn’t know what a single payer system is, so I looked it up. “Single-payer health care is a term used in the United States to describe the payment of doctors, hospitals, and other health care providers from a single fund. It is often mentioned as one way to deliver universal health care. The administrator of the fund is usually the government, but may be privately subcontracted similar to Medicare, the existing US system that is nearly a single-payer. Australia's Medicare, Canada's Medicare, and healthcare in Taiwan are examples of single-payer universal health care systems.”

Given the overwhelming positive comments about U.S. Medicare and the Military, that might be something to explore further.

One concern that came up more than once was the Medicare donut hole, which I recently experienced first hand. Here’s what Wikipedia says about that subject, The term "donut hole" (or "doughnut hole") refers to a coverage gap within the defined standard benefit under the Medicare Part D prescription drug program. Under the defined standard benefit package, there is a gap in coverage between the initial coverage limit and the catastrophic coverage threshold. Within this gap, the beneficiary pays 100% of the cost of prescription drugs before catastrophic coverage kicks in. The term "coverage gap" is preferred by Centers for Medicare and Medicaid Services (CMS) and prescription drug plans, but "donut hole" has been more widely adopted in the popular media.[citation needed]

On a more personal note, one of medications costs over $500 a month. So, when combined with my other medications, I had reached the coverage gap – the donut hole -- by May of this year. What that means very simply is, that those who are the most needy medically receive the least amount of help with their medicine.

On another topic, volunteerism, it was suggested and agreed that among other things, American volunteers are what make our nation great.

Organizing for America, a project of the Democratic National Committee, urged today’s attenders to return for a National Day of Community Service. Everyone was asked to take part in at least one of the following activities: 1) volunteer at some kind of health-related center, such as a clinic, hospital, or nursing home; 2) organize a blood drive; and/or 3) take part in a food drive, in support of the health care reform initiative.

It was agreed that we will meet again: Saturday, June 27th, at the New Braunfels public library to report in individual acts of volunteering in health-related centers. One opponent of healthcare reform suggested, involvement in Options for Women, the Pregnancy Assistance Center, or participation in the Texas Alliance for Life Walk in Seguin, June 20th.

Organizing for America will hold both a blood drive and food drive to be held at the New Braunfels library on June 27th, the National Day of Community Service, at 2:00 pm. Folks are urged to donate blood at that time, and to bring nutritious foods such as canned fruits and vegetables, juices, rice, beans, powdered milk, baby food, and diapers as a way of showing the group’s interest in and concern for the health of the local community.

During the coming weeks, everyone who supports President Obama’s health care reform plan is urged to share their personal story with their friends, neighbors, and coworkers as a way of increasing awareness and garnering support for change. That is what got President Obama elected, the promise of change. The status quo is not acceptable. The group unanimously recommends careful well thought out

If you haven’t read the plan put forth by President Obama and Vice President Biden, then please go to: http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf download the entire nine page document, read it, and then decide for yourself. What do agree with? What do you disagree with? Would you like to hold an event that is expressly for debating the issues? We have well-informed advocates that are willing to do just that – advocate for President Obama’s proposed plan by going over the plan point by point to see where/if we can come to an agreement.

I have to confess, I am an Advocate Planner. I believe that the clash of differing opinions is not only healthy, it is imperative to generate the spark of truth. If you would like to attend the next meeting, or perhaps meet with members of OFA to discuss the merits of President Obama’s proposed plan for health care reform and support this initiative, please let me know: (email and phone at the link, above. BBN).

Prayers for Tillers and pro-life Kansas

2009-05-31T20:44:00.000-07:00

Killing is not pro-life, although I remember the Sanctuary cities in Jerusalem under Mosaic law.

However, it's more important to remember that the prolife community in Kansas city has supported "Choices," a clinic next door to George Tiller's abortion facility that offers crisis pregnancy assistance and has helped to pioneer perinatal hospice in the United States. Here's a National Right to Life article on perinatal hospice.

I pray for peace and a quelling of the bitterness in Wichita, Kansas.

!Safe! Induced Pluripotent Stem Cells

2009-05-29T07:15:00.000-07:00

Robert Lanza is now reporting that his research group has produced induced Pluripotent Stem Cells (iPS) that are safe for use in humans. The website, Red Orbit, has provided a link to the original (.pdf)article. See the Time magazine news article, here.

Lanza gives credit to the pioneering work of Shinya Yamanaka:

Dr. Robert Lanza, chief scientific officer at Advanced Cell Technology (ACT), reported today in the journal Cell that his team has created stem cells using human skin cells and four proteins. The innovation builds on the breakthrough discovery in 2006 by Shinya Yamanaka, who similarly coaxed human skin cells to revert to a pristine, embryonic state by introducing four key genes into the cells, piggybacked on viruses.

The technique relies on proteins that induce reprogramming of the cells, rather than genes or viruses. These appear to function in a manner analogous to the stimulating factors that are currently the standard of care for low blood cell counts: The body - in this case, the cell - begins to function the way it's wanted when certain proteins are introduced.

In this study, patients' own skin cells were harvested by a small biopsy. Approximately one in 10,000 of those cells were induced to revert to the embryonic stage. While this 0.001% seems a minute fraction, it's much more significant and achieveable than the production of patient-specific cells from cloned embryos, where each cell line would require multiple donor oocytes - "eggs" - harvested from women. Obtaining those oocytes has not proven very easy, even without the ethical problem of creating and destroying a human embryo that is the twin of the cell nucleus donor.

Fasten your seat belts - things will move fast, now.

Rumor: Francis Collins to head NIH

2009-05-26T11:15:00.000-07:00

The Scientist reports that the name being circulated as most likely to head the National Institutes of Health is Francis Collins.

Dr. Collins spearheaded the US government efforts to document the human genome. However, he's just as well known for being not only a believer, but a Christian. He has told the story of his conversion in the face of the beauty of nature, in his book,The Language of God; A Scientist Presents Evidence for Belief.

Dr. Collins believes that the evidence is strong that the Earth is more than 6000 or so years old and that it looks as though the Creator used evolution to do His work. (You can imagine the shock when he gave his talk outlining his evidence at the Center for Humanity and Bioethics a few years ago.) He's started an organization called "BioLogos.org," to explore the interface of science and religion.

Study of iPS cells draws nearer to finding cures

2009-04-17T07:38:00.000-07:00

Research in stem cells and the origin and treatment of disease is definitely moving away from destructive embryonic stem cell research toward induced pluripotent stem cells (iPS).

A fantastic review that connects Japan's Dr. Yamanaka, San Francisco's Srivastava, the University of Texas Southwestern Medical Center in Dallas, and the Burnetts of Sulphur Springs, Texas, is published in the Japan Times. (Written by Rob Waters for Bloomberg news.)

Yamanaka, a professor at Kyoto University, developed a technology that may make the argument moot. Yamanaka, who has two daughters, started his effort 10 years ago, after peering at a tiny embryo through a microscope and reflecting that it might form a child if it wasn't used to make stem cells, he said in an interview.

"That's the moment I thought about this project," he said. "I saw that if we could make pluripotent stem cells without using human embryos, that would be ideal."

In 2006, he scored his first success. Using a virus to insert four genes into the skin cells of mice, he started a process that returned the cells to a primordial state able to form any other cell in the body. Yamanaka named them induced pluripotent stem, or iPS, cells. The next year, he repeated the feat with human cells.

Yamanaka and researchers elsewhere are now racing to find better ways to achieve the same effect. They would like to get rid of the virus, which can cause the genes to lodge permanently in the structure of the cell and may trigger the growth of tumors.

Yamanaka's technique exploits a basic fact of human biology — that every cell in a person contains the genetic instructions that set that person's traits, from hair color to inherited disease. By taking skin cells from a person with a disease and turning them into cells in the heart, brain or pancreas that are affected by a genetic disease, researchers can experiment with disorders at their earliest stages, Harvard's Melton said.

Labs are now creating iPS cells because making them is far simpler than getting cells from embryos, said Jeanne Loring, founding director of the Center for Regenerative Medicine, part of the Scripps Research Institute in La Jolla, Calif.

"Every stem-cell researcher I know has made about a dozen," Loring said.

She estimates that researchers have made 300 different so-called lines of iPS cells, a number that may double this year. Each line is a colony of cells descended from the first ones made. Scientists keep them alive in culture and the cells keep replicating.

Grants of $23 million awarded last June by the California Institute for Regenerative Medicine, the state's stem-cell funding agency, show that researchers are embracing iPS cells. Of 16 grants awarded, eight went to teams developing new iPS cells and five to groups comparing iPS and embryonic cell types. Just three went to scientists proposing to work solely with embryonic cells, according to the San Francisco-based agency.(Emphasis mine.)

And actual treatments are coming soon:

In 2004, Srivastava, then working at the University of Texas Southwestern Medical Center in Dallas, went with colleagues to Sulphur Springs, Texas, to collect blood samples and perform ultrasound scans on members of the Burnett family.

The researchers analyzed the genes of family members and found that 11 had heart-valve defects linked to mutations in a gene called Notch1, which plays a role in the formation of many organs, including the heart.

People with this mutation make half as much of the Notch1 protein as they should and their heart valves develop abnormally. The protein shortage primes their valves to take on extra calcium, which, over time, makes them stiffen, malfunction and require replacement.

Four years after his Notch1 discovery, Srivastava, now the director of the J. David Gladstone Institute of Cardiovascular Disease, supervised as the Burnetts had a pencil-shaped skin punch pushed into their calves to extract a bit of skin. When the boy's turn came, his 12-year-old brother, Ryan, laid a comforting hand on his back.

The iPS cells made from the Burnett's skin will be coaxed to become heart cells that carry the Notch1 mutation, Srivastava said. He plans to use the cells to test for drugs that boost levels of the Notch1 protein. This, he reasons, should make the hearts of people like the Burnetts more resistant to the entry of calcium and reduce the mineral's buildup on the valves.

A drug that could do this may essentially prevent the disease, Srivastava said. That is because the condition is present at birth, yet symptoms usually take decades to develop, giving a medicine ample time to work.

Within five years, Srivastava predicts, he will have found the right drug and be ready to start human clinical tests. A closely held company named iZumi Bio Inc., in California, will collaborate with Srivastava on this and other research involving iPS cells, Seidenberg of Kleiner Perkins said.

Texas Medical Association doesn't support conscience

2009-04-16T01:40:00.000-07:00

This TMA press release/"Alert" is a shallow statement which ignores the history and facts behind the ruling and addresses the right to conscience as though it is dependent on circumstances and can be "rescinded."

The individual right not to act is called "Liberty." As an inalienable right, liberty cannot be given away or taken. It cannot be "balanced" by actions of the State or by organized medicine, only infringed.

The ruling does cover emergencies and is only a clarification of the many laws in place at this time to protect the right not to act of health care professionals.

Was there any attempt to balance this opinion by contacting those in support of the ruling?

For more information on the Ruling and the (4 year or more) history behind it, see the many "conscience" articles at this blog and the information at Freedom2Care.

From the Texas Medical Association:

TMA Backs Rescinding 'Conscience' Rule

TMA, AMA, and state medical societies across the country support the Obama administration's plan to rescind a federal rule that prohibits recipients of federal funds from forcing physicians and other health care professionals to participate in actions they find religiously or morally objectionable.

In a letter to Acting Health and Human Services (HHS) Administrator Charles E. Johnson, the groups said the Conscience Rights of Health Care Providers regulation, adopted by the Bush administration in December, is unnecessary and could have far-reaching implications. They said it "could undermine patients' access to vital medical care and information, impede advances in biomedical research, and create confusion and uncertainty among physicians, other health care professionals, and health care institutions about their legal and ethical obligations to treat patients."

They wrote that they support "strong conscience protections" for physicians, residents, and medical students and other health professionals, especially when it comes to abortion. No physician, hospital, or hospital employee should be required to perform an act that violates good medical judgment or personally held moral principles. "However, while we support the legitimate conscience rights of individual health care professionals, the exercise of these rights must be balanced against the fundamental obligations of the medical profession and physicians' paramount responsibility and commitment to serving the needs of their patients. As advocates for our patients, we strongly support patients' access to comprehensive reproductive health care and freedom of communication between physicians and their patients, and oppose government interference in the practice of medicine or the use of health care funding mechanisms to deny established and accepted medical care to any segment of the population."

Other points in the letter include:

* Abortion education should be encouraged "so medical students receive a satisfactory knowledge of the medical, ethical, legal, and psychological principles associated with termination of pregnancy …" The letter adds that "the observation of, attendance at, or any direct or indirect participation in abortion should not be required." Resident training should include "specific educational standards for the knowledge and skills associated with pregnancy termination that allow an exclusion for individuals or residency programs with religious/moral objections or legal restrictions."
* Several provisions and definitions in the rule "are ambiguous, overly broad, and could lead to differing interpretations causing unnecessary confusion among health care institutions and professionals, thereby potentially impeding patients' access to needed health care services and information." The rule, for example, defines "health service program" as "any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded, in whole or in part" by HHS. "This definition inappropriately expands the scope of the conscience provisions beyond family planning and abortion services to include virtually any medical treatment or service, or biomedical and behavioral research," the letter says.
* The rule does not address how conscience rights of individuals and institutions apply in emergencies.

Austin, Tx., Judge allows mother to harvest dead son's sperm

2009-04-08T06:32:00.000-07:00

This story illustrates the outcome of autonomy and "because we can."

How awful for this woman to lose her son in this way. However, I'm not sure that a child should be born - conceived - in such a way. Certainly not as a "grand child," rather than a child born for his or her own being. I hope the mother takes a while to consider her actions, her ability to raise this child and to love him or her for himself/herself, rather than as a memorial to her dead son.

(On the other hand, humans are pretty adaptable, maybe this child won't suffer at all. How many of us felt that we were "means to an end" for our parents at some time?)

From the Austin American Statesman (where stories tend to disappear after a time), :

TRAVIS COUNTY COURTS
Judge OKs collecting of dead son's sperm
Mother of man who died after Sixth Street attack wants to try to have grandchildren.

By Tony Plohetski
AMERICAN-STATESMAN STAFF
Wednesday, April 08, 2009

The mother of a 21-year-old assault victim who died of his injuries received permission Tuesday for his sperm to be collected post-mortem, giving her the chance to have a grandchild through a surrogate mother.

Travis County Probate Judge Guy Herman ordered the medical examiner's office to maintain the body of Nikolas Colton Evans until his sperm can be taken.

Herman also said officials at the office must provide access so an expert can take the specimen.

Herman issued the orders after an emergency hearing at the request of Marissa Evans, whose son died Sunday after being punched and falling during a March 27 assault on East Sixth Street.

"I want him to live on," Evans said. "I want to keep a piece of him."

She said that her son had frequently talked about his desire to have three sons and had chosen their names: Hunter, Tod and Van.

Marissa Evans and her attorneys were trying Tuesday to find a urologist or other medical expert willing to collect the sperm. According to medical experts and published reports, whether such sperm is useful often depends on how quickly it is collected after death.

University of Texas law professor John Robertson, who specializes in bioethics, said that state law gives parents control over a child's body for donation of organs and tissues but that "this use is very unclear."

"There are no strong precedents in favor of a parent being able to request post-mortem sperm retrieval," he said.

Police have said Nikolas Evans was leaving a bar with a friend about 2 a.m. last month when they got into an argument with several men.

After that argument, police have said, another group approached Evans and his friend, and one of the men in that group hit both of them. Evans hit his head on the ground after he was punched, according to investigators.

No arrests have been made in the case.

Evans was taken to University Medical Center at Brackenridge, where he remained until his death.

Marissa Evans, who donated her son's organs, said she repeatedly asked whether his sperm could be taken during the donation process Monday but was told it was not possible.

Michelle Segovia, spokeswoman for the Texas Organ Sharing Alliance, said the organization deals in procuring major life-saving organs but provides families with information about a company that performs sperm collections.

She said the organization has gotten three or four such requests in recent years.

Evans said she was unable to find someone to collect the sperm Monday. Early Tuesday, she contacted Austin attorney Mark Mueller and asked whether he could help her file court papers to seek her son's sperm.

"I can understand her situation," Mueller said. "She has just lost her son, and she knew her son wanted to have children."

Mueller said he asked Herman for an emergency hearing, after which the judge granted the request.

"His mother wanted it done," Herman said. "There were other body harvesting that was going to take place, and I didn't see why this additional body harvesting shouldn't take place."

According to court documents, donation workers began taking Nikolas Evans' organs at noon Monday and continued until 9 p.m., at which time he was removed from life support.

Court documents said that it was essential for Evans' sperm be collected within 24 hours of him being removed from life support unless his body were cooled to no more than 39.2 degrees. Herman said the body is being kept at the appropriate temperature.

"Irreparable harm will be caused by the failure to harvest the sperm prior to that time," documents said.

Attorneys representing Marissa Evans had initially asked that the medical examiner's office collect the specimen, but Herman said the agency wasn't equipped to do so.

Dr. Elizabeth Houser, a urologist for the Urology Team in Austin, said she is familiar with a case in which a man's sperm was collected 30 hours after his death and stored for 15 months before a woman was inseminated.

Evans, who also has a 22-year-old son, described Nikolas Evans as a quick-witted aspiring filmmaker who recently had been accepted into film school at the University of California at Los Angeles.

A memorial service is set for 2 p.m. Saturday at Shepherd of Life Lutheran Church in Arlington.

"He was just a pleasure to know," Marissa Evans said. "It was evident in the fact that at any given time, there were 15 to 20 kids at the hospital waiting to see if he was OK.

"He was just an all-around good kid."

HPV Vaccine works for males

2009-04-01T22:33:00.000-07:00

Good news from the Family Practice News:

ATLANTA — The human papillomavirus vaccine was efficacious in preventing persistent infections and genital warts caused by HPV strains 6, 11, 16, and 18 in a Merck-sponsored study of 4,065 males aged 16-26 years.

The findings were presented by Dr. Richard M. Haupt at a meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. Merck had previously reported immunogenicity and safety data for its HPV vaccine (Gardasil) in younger males aged 9-15 years, but these are the first data on efficacy in males and the first findings in older adolescent and adult males.

The rationale for use of Gardasil in males is twofold. There is intrinsic benefit to males themselves since HPV strain 18 causes penile, anal, and oropharyngeal cancer and HPV 6 and 11 are associated with genital warts. There is also a public health benefit to vaccinating males against HPV since coverage among girls is likely to be incomplete, transition of HPV occurs efficiently between sexual partners, and “gender-neutral” vaccination would be expected to reduce overall viral transmission in the entire population, noted Dr. Haupt of Merck Research Laboratories, Whitehouse Station, N.J.

ACIP is expected to recommend the vaccine for use in males aged 11-12 at the adolescent visit, just as it is now given to girls. This should simplify implementation, Dr. Doug Campos-Outcalt of the University of Arizona, Phoenix, said in an interview.

Since, besides cervical cancer and those mentioned above, the Human Papilloma Virus is also implicated as the cause of half of lung cancers in non-smokers, many oral and throat cancers, and some prostate cancers, the universal vaccination of boys and girls will most likely save lives and prevent millions of people from disfiguring disease.

I've never seen a case of bacterial meningitis since I left med school, thanks to the vaccine against Hemophilis influenza or Hib. Perhaps the future doctors will never see cervical cancer and will be surprised when and if they see lung cancers.

Texas Legislators Seek to Limit Funds for Human Embryo Destruction

2009-03-30T02:59:00.000-07:00

Senator Steve Ogden is a Texas Hero!

Sen. Steve Ogden, R-Bryan, though, said critics exaggerate what his 24-word "budget rider" would do. He said it simply assures that the budget's $700 million for research doesn't underwrite destruction of embryos.

"There is a significant moral concern amongst many Texans that a human embryo really meets every scientific definition of human life that's out there and that we shouldn't be using human embryos for scientific experiments," Ogden said.

The dispute flared early last week. The Senate Finance Committee, which Ogden heads, took only two minutes late Monday to consider his rider. It says, "No funds appropriated under this act shall be used in conjunction with or to support research which involves the destruction of a human embryo."

The provision was adopted, 6-5, with Sen. Robert Duncan, R-Lubbock, joining four Democrats against.

The Dallas Morning News reports (free registration required) that some Texas embryonic research advocates claim this move will "embarrass" Texas. Of course, they also claim that embryonic stem cell research only involves "embryos that would be discarded, any way" Since we know that much of the research involves specially created, "disease specific" embryos, the latter is false.

And so is the first objection. Every week, we are reading about new ways to reprogram adult cells to achieve the stem cells that are needed to study and treat disease without ever going near an embryo. Former proponents of embryonic research and producers of new embryos for stem cell research like George Daley are switching their focus toward non-embryonic research. Texas researchers have been early stars in this research, among the first to using umbilical cord blood for stem cell research.

Texas doesn't need to waste our money following the false trail of embryonic stem cell research when there is so much promise in more treatments, sooner, from non-destructive and non-embryonic research.

Why the medical home sounds good but won't work

2009-03-29T18:24:00.000-07:00

A sister Family Physician says in her blog, "Musings of a Dinosaur,"

It is the source of endless angst among family doctors in solo and small group practice, because the structure of the PCMH excludes us by definition. The PCMH is advertised to work best in large group practices like Kaiser and the Mayo Clinic. All I can say is "DUH!"You know what the PCMH really is? Nothing more than this:

IT'S A WAY TO MAKE LARGE GROUP PRACTICES WORK MORE LIKE A SOLO DOC!!!

I am already performing every meaningful function of the PCMH. So is virtually every physician in solo and small group practice. There is absolutely nothing to be gained -- and a significant amount of money to be lost; this thing is expensive! -- by adopting any of this PCMH shit. Somehow that doesn't seem to stop our Academy from tossing us to the wolves by simply ignoring us.

New England Journal of Medicine plays conscience politics ("Trust me, I will act against my conscience," cont'd)

2009-03-29T01:40:00.000-07:00

The New England Journal of Medicine has published a "Commentary" by a lawyer who has worked for Planned Parenthood, concerning the practice of medicine and conscience.

I don't like to publish entire articles from subscription-only sources (especially one written by a lawyer), but this serious breach of ethics on the part of the NEJM should be documented.

The NEJM published this in advance of the dead-tree version because the last day for comments is the same day the paper Journal comes out.

This most definitely should have been in the "Free Content" form, and it is. We should thank the editors for this favor. Physicians and others who do not subscribe (to the tune of several hundred dollars a year) are able to read and answer this lawyer's viewpoint of the practice of medicine.

There is no opposing view offered. Yep, let's talk about "choice" and "consent." but only give their choice and their consent.

The essay contains more of the ridiculous examples that we should be used to by now: the author asks about a doctor who refuses to care for diabetics because his religion counts gluttony as a sin.

She calls abortion - all abortions, without making the distinction between elective abortion and those necessary to save the life of the mother - "standard of care."

More in a bit:

From the online version of the New England Journal of Medicine, published in advance of printing in the April 9, 2009 issue of the Journal:

The regulation, as explained in its text (see the Supplementary Appendix, available with the full text of this article at NEJM.org), aims to raise awareness of and ensure compliance with federal health care conscience protection statutes. Existing laws, which are tied to the receipt of federal funds, address moral or religious objections to sterilization and abortion. They protect physicians, other health care personnel, hospitals, and insurance plans from discrimination for failing to provide, offer training for, fund, participate in, or refer patients for abortions. Among other things, the laws ensure that these persons cannot be required to participate in sterilizations or abortions and that entities cannot be required to make facilities or personnel available for them. And they note that decisions on admissions and accreditation must be divorced from beliefs and behaviors related to abortion. On their face, these laws are quite broad.

But the Bush administration's rule is broader still. It restates existing laws and exploits ambiguities in them. For example, one statute says, "No individual shall be required to perform or assist in the performance of any part of a health service program or research activity funded" by DHHS if it "would be contrary to his religious beliefs or moral convictions."1 Here the rule sidesteps courts, which interpret statutory ambiguities and discern congressional intent, and offers sweeping definitions. It defines "individual" as physicians, other health care providers, hospitals, laboratories, and insurance companies, as well as "employees, volunteers, trainees, contractors, and other persons" who work for an entity that receives DHHS funds. It defines "assist in the performance" as "any activity with a reasonable connection" to a procedure or health service, including counseling and making "other arrangements" for the activity. Although the rule states that patients' ability to obtain health care services is unchanged, its expansive definitions suggest otherwise. Now everyone connected to health care may opt out of a wide range of activities, from discussions about birth control to referrals for vaccinations. As the rule explains, "an employee whose task it is to clean the instruments used in a particular procedure would also be considered to assist in the performance of the particular procedure" and would therefore be protected. Taken to its logical extreme, the rule could cause health care to grind to a halt.

It also raises other concerns. In terms of employment law, Title VII of the Civil Rights Act, which applies to organizations with 15 or more employees, requires balancing reasonable accommodations for employees who have religious, ethical, or moral objections to certain aspects of their jobs with undue hardship for employers. But the new rule suggests that if an employee objects, for example, to being a scrub nurse during operative treatment for an ectopic pregnancy, subsequently reassigning that employee to a different department may constitute unlawful discrimination — a characterization that may be at odds with Title VII jurisprudence.2 As officials of the Equal Employment Opportunity Commission remarked when it was proposed, the rule could "throw this entire body of law into question."3

Furthermore, although the rule purports to address intolerance toward "individual objections to abortion or other individual religious beliefs or moral convictions," it cites no evidence of such intolerance — nor would it directly address such intolerance if it existed. Constitutional concerns about the rule, including violations of state autonomy and rights to contraception, also lurk. And the stated goals of the rule — to foster a "more inclusive, tolerant environment" and promote DHHS's "mission of expanding patient access to necessary health services" — conflict with the reality of extensive objection rights. Protection for the silence of providers who object to care is at odds with the rule's call for "open communication" between patients and physicians. Moreover, there is no emergency exception for patient care. In states that require health care workers to provide rape victims with information about emergency contraception, the rule may allow them to refuse to do so.

Recently, the DHHS, now answering to President Barack Obama, took steps to rescind the rule (see the Supplementary Appendix). March 10 marked the beginning of a 30-day period for public comment on the need for the rule and its potential effects. Analysis of the comments (www.regulations.gov) and subsequent action could take some months. If remnants of the rule remain, litigation will follow. Lawsuits have already been filed in federal court, and Connecticut Attorney General Richard Blumenthal, who led one of the cases, has vowed to continue the fight until the regulation is "finally and safely stopped."4

This state of flux presents an opportunity to reconsider the scope of conscience in health care. When broadly defined, conscience is a poor touchstone; it can result in a rule that knows no bounds. Indeed, it seems that our problem is not insufficient tolerance, but too much. We have created a state of "conscience creep" in which all behavior becomes acceptable — like that of judges who, despite having promised to uphold all laws, recuse themselves from cases in which minors seek a judicial bypass for an abortion in states requiring parental consent.5

The debate is not really about moral or religious freedom writ large. If it were, then the medical profession would allow a broad range of beliefs to hinder patient care. Would we tolerate a surgeon who holds moral objections to transfusions and refuses to order them? An internist who refuses to discuss treatment for diabetes in overweight patients because of moral opposition to gluttony? If the overriding consideration were individual conscience, then these objections should be valid. They are not (although they might well be permitted under the new rule). We allow the current conscience-based exceptions because abortion remains controversial in the United States. As is often the case with laws touching on reproductive freedom, the debate is polarized and shrill. But there comes a point at which tolerance breaches the standard of care.

Medicine needs to embrace a brand of professionalism that demands less self-interest, not more. Conscientious objection makes sense with conscription, but it is worrisome when professionals who freely chose their field parse care and withhold information that patients need. As the gatekeepers to medicine, physicians and other health care providers have an obligation to choose specialties that are not moral minefields for them. Qualms about abortion, sterilization, and birth control? Do not practice women's health. Believe that the human body should be buried intact? Do not become a transplant surgeon. Morally opposed to pain medication because your religious beliefs demand suffering at the end of life? Do not train to be an intensivist. Conscience is a burden that belongs to the individual professional; patients should not have to shoulder it.

Patients need information, referrals, and treatment. They need all legal choices presented to them in a way that is true to the evidence, not the randomness of individual morality. They need predictability. Conscientious objections may vary from person to person, place to place, and procedure to procedure. Patients need assurance that the standard of care is unwavering. They need to know that the decision to consent to care is theirs and that they will not be presented with half-truths and shades of gray when life and health are in the balance.

Patients rely on health care professionals for their expertise; they should be able expect those professionals to be neutral arbiters of medical care. Although some scholars advocate discussing conflicting values before problems arise, realistically, the power dynamics between patients and providers are so skewed, and the time pressure often so great, that there is little opportunity to negotiate. And there is little recourse when care is obstructed — patients have no notice, no process, and no advocate to whom they can turn.

Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. Instead, patients deserve a law that limits objections and puts their interests first. Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients' needs demand it. Because the Bush administration's rule moves us in the opposite direction, it should be rescinded.

Dr. Cantor reports representing an affiliate of Planned Parenthood in a legal matter unrelated to conscientious objection. No other potential conflict of interest relevant to this article was reported.

Source Information

Dr. Cantor is an adjunct professor at the UCLA School of Law, Los Angeles.

This article (10.1056/NEJMp0902019) was published at NEJM.org on March 25, 2009. It will appear in the April 9 issue of the Journal.

References

1. 42 U.S.C.A. § 300a-7(d).
2. Shelton v. Univ. of Medicine & Dentistry of New Jersey, 223 F.3d 220 (3d Cir. 2000).
3. Pear R. Protests over a rule to protect health providers. New York Times. November 17, 2008:A14.
4. Press release of the State of Connecticut Attorney General's Office, Hartford, February 27, 2009. (Accessed March 20, 2009, at http://www.ct.gov/ag/cwp/view.asp?A=3673&Q=434882.)
5. Liptak A. On moral grounds, some judges are opting out of abortion cases. New York Times. September 4, 2005.

Clues to how blood stem cells become activated (adult stem cells)

2009-03-26T02:02:00.000-07:00

The National Institute of Health has a news release about research done with NIH funding. The researchers explored how hematopoietic or blood cell producing adult stem cells are activated. The NIH article is very detailed, but easy to read and understand. An adaptation of the press release is at Science Daily.

The research article was published in Nature Cell Biology. (The abstract is free, the article can be purchased by non subscribers, for $18. I think this will be one of the articles that will eventually be published for free, since the research was Federally funded.)

From the NIH Press release:

For Immediate Release
Wednesday, March 25, 2009

E-mail this page
Subscribe Contact:
Robert Bock or Marianne Glass Miller
301-496-5133

Researchers Decipher Blood Stem Cell Attachment, Communication
Finding Has Implications for Leukemia Treatment, Artificially Culturing Blood Cells

Researchers at the National Institutes of Health have deciphered a key sequence of events governing whether the stem cells that produce red and white blood cells remain anchored to the bone marrow, or migrate into the circulatory system.

An understanding of the factors that govern migration of blood stem cells might lead to improved treatment of leukemia, a cancer that affects circulating white blood cells. The findings also have implications for culturing infection-fighting immune cells outside the body, where they could be temporarily held in storage during chemotherapy and other treatments which suppress the immune system. Moreover, the findings could contribute to a strategy for growing large quantities of red blood cells in laboratory dishes outside the body, to reduce the need for blood donations.

Previously, researchers thought that the cellular environment in which the stem cells reside produced the chemical signals that determined whether the cells would be stationary or free–floating. The current study provides evidence that the stem cells produce chemical signals of their own that may, in turn, influence the chemical signals they receive from their environment.

"This important discovery will advance our understanding of how blood cells and immune cells are generated," said Duane Alexander, M.D., director of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The findings were published on line in Nature Cell Biology. The study was conducted in the laboratory of Jennifer Lippincott-Schwartz, Chief of the NICHD Section on Organelle Biology. The study’s first author was Jennifer Gillette, also of the Section on Organelle Biology. Other authors were Andre Larochelle and Cynthia E. Dunbar of the Hematology Branch of NIH's National Heart, Lung, and Blood Institute.

Dr. Gillette explained that hematopoetic progenitor stem cells — the cells which give rise to red blood cells and immune cells — travel between the bloodstream and the bone marrow. Within the bone marrow, they anchor themselves in place by attaching to bone marrow cells called osteoblasts.

Other studies have shown that osteoblasts secrete a substance that acts as a chemical signal that regulates the attachment of the stem cells. Large amounts of the chemical, which is known as SDF-1 (stromal cell derived factor-1), cause the stem cells to leave the bone marrow and enter the bloodstream. A small, continuous pulse of SDF-1, however, attracts the stem cells and results in their attachment to the osteoblasts.

In laboratory cultures, Dr. Gillette and her coworkers incubated unattached stem cells with osteoblasts. As the stem cells approached the osteoblasts, they developed long, tentacle-like projections, called uropods. The uropods attached to the surface of the osteoblasts. Then, a small portion of a uropod was absorbed inside an osteoblast. The uropod material was eventually sealed inside an endosome — a tiny balloon–like structure within the cell. After the osteoblasts absorbed the uropod material, they began producing SDF-1.

Dr. Gillette noted it appeared to be the stem cell material that stimulated the osteoblast to produce SDF-1, the substance that causes the stem cell to remain attached to the osteoblast or migrate into the blood.

"Our study indicates that stem cells may actually be able to manipulate the signals that they receive from their environment," Dr. Gillette said. "Stem cells seem to have a little more control than we thought."

2009-03-16T00:50:00.000-07:00

The "Rescission of the Regulation Entitled 'Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law'” was posted on the Federal Register on March 10th, with the announcement of a 30 day period in which to comment. The full announcement can be read here. (PDF Acrobat document) Comments must be made by April 9th.

Please consider taking a look at the website Freedom2Care to learn more about the problem of restricting conscience. You can use one of their forms online to let the Administration and Health and Human Services Secretary Sebelius know how you feel or to tell your story.

To send a comment directly to the HHS, go to the website, http://www.Regulations.gov and fill in the form there or send an email to proposedrescission@hhs.gov.

Obama will fund more losing embryonic stem cell research (New Yellow Brick Award to the President)

2009-03-07T14:11:00.000-08:00

Just days after we hear about functioning induced Pluripotent stem cells from adult skin cells, cells that can produce dopamine, the proteins missing in Parkinson's disease, we read that President Obama is going to overturn the limits on funding for embryonic stem cell research. Despite the fact that these cells match the patient because they come from the patient, that they will be cheaper, more accessible and we believe have less risk of causing cancer, this Monday morning, the 9th of March, 2009, the White House plans a quiet ceremony to sign the Executive Order.

Follow the Yellow Brick Road, Mr. President. The great embryonic Oz will get you home. Do not look behind the curtain, ignore that little man.

"Stroke of the pen, law of the land. Kinda cool!" (Thank you, Paul Begala.) We've been trying to spend a Trillion dollars every 10 days in the Obama administration. Let's just throw more good money after bad.

Typical of the news articles, is this one, from the US News and World Report, entitled (sigh)"Obama to End Stem Cell Ban Monday
Researchers applaud his action, which is expected to kick-start efforts to unlock therapeutic potential."

I recommend that you read that link above, in order to compare reality with what the proponents of destructive embryonic stem cell research believe.

The article is so full of holes. The title and first paragraph say "ban." There never was a ban. Ask Daley and Melton of Harvard who have been creating embryos for destruction to harvest the parts.

And then, there's this gem of an emotional non sequitor, I'm afraid from my State of Texas:

"It's going to remove an embarrassment for American science," said Dr. Darwin Prockop, director of the Texas A&M Health Science Center College of Medicine Institute for Regenerative Medicine at Scott & White Hospital in Temple, said in February. "It's a statement that we're going to again believe in science."

Prockup must have been teased too much about his name as a child. Seriously, who among us stopped and now started to believe in science again?

We are not behind, we are not embarrassed, unless it's in imposing regulations. Even the "Progressives" are calling for more restrictions. The UK has more regulations on regenerative medicine and embryonic research than the US. France, Germany and Israel have similar limits on funding. Germany, at one time had criminal charges and fines attached to their ban.

CIRM has $3 Billion which must be spent on cloning and embryonic stem cell research. Their "Strategic Plan?" (This is a pdf, for a review, read this article at the CIRM website.) One cure and 2 trials in ten years. Who thinks the US is going to top their billions in embryonic research, when results with induced Stem Cells are bounding ahead?

Oh, I know, CIRM thinks the NIH should buy their $400 Million in bonds, this year. No one else wants the losing proposition.

Non-embryonic stem cells to cure Parkinson's?

2009-03-06T07:41:00.000-08:00

The journal, Cell, has published an article (free abstract, full article and supplements for purchase) on patient-derived induced Pleuripotent Stem Cells (iPSC's) that appear to be brain neurons that produce dopamine, which is lacking in Parkinson's patients.

Besides being derived from the patient's own skin cells (they won't be rejected and are cheaper and more accessible to more of us than embryonic), and being non-destructive (no embryos destroyed - and, did I say, cheaper and more accessible?), these iPSC's were derived using viruses that can be purposefully, and apparently, fully removed from the culture.

The plans apparently are to use the cells to study the disease. However, with the history of the debate over this disease, I wouldn't be surprised to see them used to treat the donors' Parkinson's disease very soon. Parkinson's is so devastating to patients and their families that several attempts to use brain transplants of aborted embryonic and fetal tissues have been used on real patients, with disastrous results. These iPSC's should be safer than fetal tissues.

Trust me, I have no conscience (Again and again, and again)

2009-03-06T06:51:00.000-08:00

Siricou Raven, that gadfly of the prolife blogger, says I'm using scare tactics, that the NHS pays for dialysis, and that we pro-conscience doctors are afraid that 'THE GAYS WILL DESTROY MEDICINE!!!!' Oh, and Bush did it!

Well, what do you expect of people who don't have consciences and who are told by the Powers that be that we must violate any oaths we've taken for money and law?

It's not Gays and Lesbians we're trying to protect ourselves and our consciences from - its their lawyers. Beginning in 2005 and through last month, ACOG broke one of the strongest tenets of modern medicine: Thou shalt not put thy colleagues in greater malpractice risk.

The conscience protection ruling is a synthesis of current laws. The synthesis was only necessary because in 2005, the American College of Obstetricians and the American Board of OBGyn turned their quiet attack on pro-life residency candidates (few programs will accept pro-life doctors) into an effort to change laws (lobbying the US Senate) and amended their own ethics policies to put not only ACOG members, but all doctors at risk of losing their certification, their licenses, and increased our lawsuit risk.

Obama, what's-her-name, and Daschle are bought and paid for by Planned Parenthood and NARAL. (Daschle sent out letters against George Bush in '04, on NARAL's letter head. After the SCOTUS allowed the Partial Birth Abortion Ban, Sebelius vetoed 3 separate bills due to their limits on abortion. And Obama made his famous "first thing I do is sign FOCA" speech to PP)

Most people have access to the $4 Walmart drugs. Our little town has 2 low cost clinics, one is free of charge, one has a cost of less than $5. Everyone who can raise the money can have the latest and greatest -- not so in the NHS. A few years ago, it was illegal to sell Tamiflu in Great Britain, because NICE said it was.

Years before that, Dialysis was limited to those under 55 years old. Echoing that, this year, a man in his 50's was told he would not get surgery to stabilize his ankle until he kicked his nicotine habit.
http://www.dailymail.co.uk/news/article-481617/Doctors-refuse-fix-builders-broken-ankle-unless-quits-smoking.html

Our hospital has indigent care, as does our County. We doctors see patients for cash and are aware when their costs are out of pocket. (My phone has a program that has formularies for local insurance plans. The patient and I discuss whether they want the once a day Tier 4 drug, the twice a day Tier 3 or the 4 times a day generic.)

This is your future on Government Medicine

2009-03-04T05:31:00.000-08:00

Imagine that it is 2016, and you are a 65 year old boomer. You have been admitted to your local community hospital with malaise, fatigue, vomiting and cloudy mental status. You have had blood pressure problems and diabetes for a few years, and have just been diagnosed with renal failure. As you drift in and out of consciousness, you are vaguely aware your old family practice physician, who had taken care of you for 20 years, is not around. A religious man, he quietly retired from medical practice in 2014, after the full force of the Obama administration‘s removal of conscience protection for physicians in February, 2009, came into effect.

Read the whole article for a chilling look at the future and a concise review of how we got to this point.

Bravo, Dr. Davenport!

Goodbye Medicare, hello County Clinic

2009-03-03T02:05:00.000-08:00

Where is the outrage over the destruction of (what is left of) Medicare and the debt we owe to veterans? I'm afraid that we're not talking about "Medicare for all," or even "Medicaid for all." We're talking about County Clinic for all.

For a look at the proposed cuts in cost for Medicare, take a look a this table.

Consider that "reduce costs for re-admissions" and the "bundling" of hospital and outpatient costs after a hospitalization.

That means that Medicare will only pay a flat fee to the hospital for any hospitalization and follow up care after the hospitalization and will not pay if the patient has to be readmitted for complications or a new illness within a certain period of time. Patients would not be able to return to their family doctor for follow up care, unless the doctor works for the hospital. And there would be a lot of pressure to keep patients out of the hospital.

People who "cost" Medicare the most money would be encouraged to forgo care. I predict a huge push for hospice care for anyone with complicated, chronic diseases. (Or, possibly, a back-alley, underground medical care system for cash and barter. Wonder how long that will be legal?)

The AMANews reports that coordination of care doesn't lower costs to Medicare, only 2 out of 15 of the model centers cut patients' days in the hospital, and that the coordination is burdensome for small and solo practices. For every 100 patients, we interact with 99 other doctors in other practices. (I knew it was a lot.) (I don't think any of these links require subscription, let me know if there's a problem.)

This is my favorite part from that article:

"It doesn't matter if you back up a truck to their offices and drop off bundles of money," Dr. Norman said. "They don't have the time, resources or expertise right now to put this all in place."

Speaking of "bundles of money," the stimulus has a chunk to support Community Health Centers, as reported by Reuters' Maggie Fox. Will these centers really be open longer hours, as advertised, and will they continue to mandate the hiring of mid-levels (Nurse Practitioners or Physician Assistants), rather than allowing the hiring of physicians with the grants, as currently the case for other Federally funded clinics?

The budget includes plans to pay for the 667 Billion dollar health care for all by cutting payments to “providers” (including doctors and hospitals, pharmacists and wheel chair companies), according to the Wall Street Journal. We're already scheduled to have that automatic “Sustainable Growth Rate” 20% cut in Medicare payments to doctors, next year. Want to bet that the cut won't go through and/or won't be considered part of the "savings"? (And mesh with the President’s plans to cut the deficit.)

That WSJ and the LATimes articles also mention a “public” health care plan, and possible new taxes (on the employer’s portion of insurance payments or a new income tax).

Speaking of which, the Massachusetts mandatory health insurance trial isn’t working - even to make sure that people have insurance or are able to see their doctor in a timely manner - according to the Boston Globe The solution? That old United States National Health Insurance Act, paid for by "a modest progressive tax."

AMA: "People aren't going to waste time on Embryonic Stem Cells, anymore"

2009-03-02T04:12:00.000-08:00

A member of the "lobby group Comment on Reproductive Ethics" maintains that there are "some scientists who like to hold on to what they've got, but" she doesn't "think people are going to waste time on embryonic stem cells any more."

(Josephine Quintanelle, quoted in the Guardian, 3/1/09)

The American Medical Association sends its members a "Morning Rounds" email with the latest headlines on science and medicine. The articles have more links than my posts and the editors seem to choose that days' big story.

Today's big story is that the Washington Post (free registration required) reports on a from a Letter to the journal, Nature. Two groups of scientists, one from Toronto (Andras Nagy, from the University of Toronto) and another from Edinburgh (Dr Keisuke Kaji, at the Medical Research Council Centre for Regenerative Medicine at the University of Edinburgh) have found a way to make skin cells transform into embryonic-like stem cells without using viruses.

This should lead to a cheaper way for people to have their own cells transformed into therapies. Farther down the line, it could help us treat disease and injury -and aging - in place, by inducing repair where it's needed and without transplants. On the other hand, if we use embryonic stem cells, it would be necessary to make a clone of each person or find some sort of universal donor cell that would not be rejected. The previous way of reprogramming cells to an embryonic stage used viruses that could not be removed and which have the potential to cause cancer if left in the DNA of the cells.

The scientists used human fibroblasts - a type of skin cell - which were treated with a "jumping gene" from a cabbage looper moth, that inserts itself into chromosomes along with the genes that "reprogram" the fibroblast -- then, the extra gene can be removed.

From the Post, a very clear description.

The alternative cells, known as induced pluripotent stem cells, or iPS cells, appear to have many of the same characteristics as embryonic stem cells but are produced by activating genes in adult cells to "reprogram" them into a more primitive state, bypassing the moral, political and ethical issues surrounding embryonic cells. Until now, however, their use has been limited because the genetic manipulation required the use of viruses, raising concerns the cells could cause cancer if placed in a patient. That has triggered a race to develop alternative approaches.

"These viral insertions are quite dangerous," Nagy said.

In the new work, Nagy and his colleagues in Toronto and at the University of Edinburgh in Scotland instead used a sequence of DNA known as a transposon, which can insert itself into the genetic machinery of a cell. In this case, the researchers used a transposon called "piggyBac" to carry four genes that can transform mouse and human embryonic skin cells into iPS cells. After the conversion took place, the moth gene, called "piggybac" lost its ability to insert itself into the chromosomes of the cells and "disappear" or can be removed.

"PiggyBac carries the four genes into the cells and reprograms the cells into stem cells. After they have reprogrammed the cells, they are no longer required, and in fact they are dangerous," Nagy said. "After they do their job they can be removed seamlessly, with no trace left behind. The ability for seamless removal opens up a huge possibility."

Unfortunately, for some reason the scientists used (non-stem) fibroblast cells from embyros as the cells that are reprogrammed, so the research is being repeated in cells from non-embryonic sources.

Other news articles on the breakthrough are at BBC News, Nature News,
AFP, Financial Times, the Candian Press, the Guardian and the Globe and Mail.

Obama moves to overturn Conscience rules

2009-02-27T07:24:00.000-08:00

For a couple of years, LifeEthics has covered the conscience of physicians and what it would mean if a doctor, nurse or hospital were to be forced to go against their consciences. My review is here.

From the LA Times, we learn that President Obama plans to rescind the ruling clarifying conscience laws in force in the US today:

Conscience' rule on abortions may be overturned
The Obama administration wants to clarify a Bush policy that lets healthcare workers deny services because of moral beliefs.
By Noam N. Levey
February 27, 2009
Reporting from Washington -- Taking another step into the abortion debate, the Obama administration today will move to rescind a controversial rule that allows healthcare workers to deny abortion counseling or other family planning services if doing so would violate their moral beliefs, according to administration officials.

The rollback of the so-called conscience rule comes just two months after the Bush administration announced it late last year in one of its final policy initiatives.

Inevitably, no matter what they say, the outcome will be to further politicize abortion and to force doctors to perform abortions and assisted suicide, force Catholic hospitals to allow abortions and sterilizations and - inevitably - physician assisted suicide.

Last month without official ceremony, Obama overturned a controversial ban on U.S. funding for international aid groups that provide abortion services.

The move by the Department of Health and Human Services to throw out the conscience rule is being made equally quietly as most of Washington focuses on the president's blockbuster budget plan.

On Thursday officials stressed that before the administration finalizes the rollback, a standard 30-day comment period seeks input from people across the ideological spectrum.

"We believe that this is a complex issue that requires a thoughtful process where all voices can be heard," said one official, who was not authorized to speak on the record about the policy change.

The officials said the administration would consider drafting a new rule to clarify what healthcare workers could reasonably refuse to do for their patients.

For more than 30 years, federal law has allowed doctors and nurses to decline to provide abortion services as a matter of conscience, a protection that is not subject to rule making.

In promulgating the rule last year, then-Health and Human Services Secretary Mike Leavitt said it was necessary to address discrimination in the medical field.

Whose life is it, anyway?

2009-02-26T09:09:00.000-08:00

Trait selection in babies "is a service," says Dr. Steinberg. "We intend to offer it soon."

Whoops, someone noticed that some of this reproductive technology stuff might not be ethical.

Talk about controlling parents!

Eugenics is a done deal. The cat's out of the bag. There's no going back. (Don't think about the 14th Amendment that overturned Dred Scot and took the slaves from their "owners.")

Of course, the "Progressives" and human-plus groups only commit *good* eugenics. All they want is control and more money.

The "Progressives" started raising the alarm a couple of years ago, when they were pushing for a change in the Bush embryonic stem cell policy. The logic was that the reason there is no regulation is that the government isn't paying for enough research.

At the same meetings, they were adamant that their group must ~~have the power~~ maintain control. (Alta Charo, Laurie Zoloth, Jonathan Moreno, Insoo Hyun and the rest of the "Ethicists for Hire" crowd.)

Funny, in all these links, I didn't find a single comment about the doctors who lost a discrimination suit in California for refusing to fulfill a patient's request for IVF -- even in the midst of the hulabaloo about the mother of octuplets.

HT to Vox Popoli

US behind on regulation of reproductive technology

2009-02-21T04:25:00.000-08:00

After hearing/reading for the last 8 years that there is too much regulation of research, there's now a call from the Jonathan Moreno and the "Progressives"(at the website that grew out the Center for American Progress, originally founded by John Podesta, Obama's advisor) for regulation of reproductive technology. See this post at the "Science Progress" blog.

Scroll down to the middle of the blog post on regulation to see a fantastic interactive map of regulation across the world.

Unfortunately, the regulation may not be easy to come by, or what those of us who are pro-life might wish for. The progressives mock those of us who believe that even embryonic humans have the right not to be intentionally killed or enslaved. See the comments in this review of Yuval Levine's book, Imagining the Future.

Human cloned embryos

2009-02-04T02:46:00.000-08:00

Oddly, there is very little notice of the confirmation that Advance Cell Technology has created cloned human embryos. Current bioethics and science reporting evidently takes the creation and destruction of human embryos for granted. In fact, the embryonic humans were created with the intention of destroying them.

No one - or almost no one - seems to notice.

Wired Science has one of the few reports that narrows in on what should be the headline:"Research Breakthrough: Human Clones May Be Genetically Viable."

It is significant that (as reported earlier) human-animal hybrid embryos do not appear to be a practical source for human embryonic stem cells. However, after reading the article itself, it appears that the story with in the story may be - I believe should be - even more significant.

The article, "Reprogramming of Human Somatic Cells Using Human and Animal Oocytes," is available online and free, here, in pdf form. Supplemental information is available here.

Lanza and his colleagues report that they used human eggs and human donor DNA to create about 50 cloned human embryos, all females. They also write that they used a human embryo started by in vitro fertilization as a "control," or material to test the validity of their other results.

Cells were removed for testing from some of the cloned human embryos and the IVF human embryo. Other than that, we do not know the fate of these embryonic human girls.

Edited January 27, 2010 to correct a "Label" typo

Human-animal embryos don't work for stem cell production

2009-02-04T01:25:00.000-08:00

The New Scientist has a good review article that explains a new research report from Robert Lanza of Advanced Cell Technology, that attempts with "thousands" of embryos created by placing human DNA into the oocytes or eggs of animals have failed to produce stem cells. NatureNews, the news arm of the journal, Nature discusses the report, here.

The abstract of the article, "Reprogramming of Human Somatic Cells Using Human and Animal Oocytes" published in Cloning and Stem Cells, is available here. The list of researchers is very long and they are from several different laboratories.

Each of the news articles above includes statements from researchers who do not believe that human-animal cloned embryos are a dead-end for stem cell researchers. However, the confirmation of the outcome from several labs, with different researchers, is strong evidence that it is unlikely that this technique is a reasonable way to produce "patient specific" stem cells - those that are an exact match for the donor of the DNA.

I have not read the actual article, yet, but from the news articles and the abstract, it appears that the "cybrids" do express the genes of the donor DNA and are clones of the donor. However, while enucleated human oocytes are able to reprogram the DNA of the donor to result in embryos that divide to the stage at which it is possible to harvest embryonic stem cells, the emptied eggs of cows and rabbits do not. The cybrids only divide to about the 16 cell stage and do not turn on the genes responsible for pleuripotency, or "stem-cell-ness."

See my Update, written after I read the report.

Adult stem cells in MS for reversal

2009-01-30T01:21:00.000-08:00

In Multiple Sclerosis (MS), the immune system of a patient turns on his or her nervous system, destroying the myelin sheaths that serve as insulation around nerves, disrupting the transmission of nerve signals. The myelin damage often occurs in a patchy manner, at first. See the Medline Plus page from the National Institutes for Health for more information, including a patient tutorial in English and in Spanish. The Journal of the American Medical Association has a similar patient education page in pdf.

There have been trials using adult stem cell treatments in the form of bone marrow transplants and injection of adult stem cells in different manners for several years. (See ClinicalTrial.gov for some of these - if my search lapses, search "stem cell multiple sclerosis.)

The March issue of Lancet Neurobiology reports (Free access to the abstract) success from research at Northwestern University using the patients' own bone marrow stem cells, after harvesting those cells, preserving them, and then using chemotherapy to destroy the immune system before replacing the patient's stem cells. A review of the study is at the Science Daily and at this blog, Science Codex.

Here's the information on this trial from Clinical Trials.gov.

Any sort of bone marrow transplant is dangerous due to the lost red blood cells, platelets (to make blood clots), and the white blood cells that function as the immune system. This trial was set up to preserve all but the immune system. While it's still not a procedure to take lightly, it appears that the researchers at Northwestern have made it safer.

Senate defeats Republican SCHIP pro-life measure

2009-01-28T17:20:00.000-08:00

Senator Martinez from Florida introduced an amendment to the Senate Bill concerning the children's health insurance bill that would have prohibited tex money going to non-government organizations in other countries and used to promote abortion, lobbying foreign governments to change their laws to accept abortion, and which would give those organizations more money to perform abortions.

This amendment would have placed into law the "Mexico City Policy" that President Obama overturned on Friday, January 23, 2009.

The vote went pretty much along party lines, with the exceptions of Republican Senators Collins and Snowe of Maine, Senator Spectre of Pennsylvania and Senator Mulkowski of Alaska. One Democrat, Senator Nelson of Nebraska, voted in favor of the prolife amendment. (Thanks to LifeNews for reporting the votes.)

The Senate version will allow families that exceed 400 times the Federal poverty limit t0 $88,000 and, in some cases, with incomes over $100,000, per year.

For more on the SCHIP Bill, see the Associated Press' "GOP fails to limit children's health program."

Democrats want to more than double spending on SCHIP. President Barack Obama has urged Congress to quickly send him a children's health bill that he can sign into law. The House has already passed a bill comparable to the one before the Senate.
Republicans offered an alternative approach through an amendment sponsored by Sen. Mitch McConnell, R-Ky. McConnell argued that his amendment focused more on helping low-income families and did not rely on tax increases to pay for the additional health spending. His amendment also would not allow federal funding to extend health coverage to children of newly arrived legal immigrants, as the Democratic bill allows.

Coffee, again

2009-01-27T19:48:00.000-08:00

In June, LifeEthics reported that coffee drinkers are likely to live longer - or are at least less likely to die of heart disease.

Today, a new study on Swedes and Finns reports that 3 to 5 cups of coffee (I drink nearly a quart a day) when middle aged (I am) decreased the chances of Alzheimer's dementia by 60 to 65%.

Not only will I live forever, I'll know it!

Elections have consequences (abortion, contraceptives, committees)

2009-01-27T10:03:00.000-08:00

ABC's This Week with George Stephanopolis ran an interview with Speaker of the House Nancy Pelosi on Sunday, January 25, 2009. The transcript is here.

Stephanopolis allowed the Speaker to gloss over her policy that does not allow debate or amendments from the House floor, or that no Republicans were allowed to see or vote in Committee on last week's SCHIP Bill ("H.R. 2 is rushed legislation by the Democrat Majority that did not hold a single committee hearing or allow amendments to be offered on the bill."), and were only given a summary at 5:30 AM on the day of the vote.

STEPHANOPOULOS: The president has made it pretty clear he wants this to be a real bipartisan effort. Yet House Republicans have said they have been shut out of this process. There were no Republican votes in the appropriations Committee, no Republican votes in the Ways and Means Committee.
PELOSI: Well, because the Republicans don't vote for it doesn't mean they didn't have an opportunity to.

While I believe that true contraception, as in prevention of the union of sperm and oocyte, is ethical, I had planned to move strait to the Speaker's comments about Family Planning funds. However, it appears that the President was listening to the voters, even if the Speaker hadn't.

Posted: Tuesday, January 27, 2009 11:41 AM by Domenico Montanaro
Filed Under: White House, Congress

From NBC’s Mike Viqueira
The provision within the stimulus that would allocate money for contraceptive programs through Medicaid will be pulled out of the package.

NBC News confirms that the president called Henry Waxman, the chairman of the committee that inserted the contraception provision into the stimulus during the mark up last week, to ask him to remove the measure from the bill, according to a Democratic leadership source.

In short, the idea has simply become too controversial. Speaker Nancy Pelosi's defense of the program over the weekend, where she indicated that it would be a money saver, was not well received.

So that provision is out.

Complicating matters, both Minority Leader John Boehner and No. 2 Eric Cantor have told House Republicans that "all Republicans should vote against the stimulus" if it remains "in its current form," according to a GOP leadership aide.

They spoke inside their weekly conference meeting, behind closed doors. Afterward, both men came to the on camera stake out. The House will begin debate on the stimulus package late today, with no votes expected until tomorrow. Debate is expected to begin somewhere close to 5 p.m. ET.

The way your U.S. House works is that anyone who wants to offer an amendment to be considered on the floor has to go to a committee, the Rules Committee, beforehand.

The Rules Committee is a complete and utter tool of the majority leadership. (Emphasis mine, BBN.) It decides which amendments will be allowed on the floor for consideration. The minority is habitually unhappy with the result, as their measures, especially the ones that have a chance of passage or contain some political mischief or "poison pill" language, are barred. The Rules committee meets this afternoon to make its decisions.

So, besides politics, what's all the fuss about?

Part of the problem is the $50 million for the National Endowment for the Arts, ACORN, $200 million for sod for Washington, DC parks, $20 Billion for electronic medical records, and the emphasis on global warming research (with its increased costs for housing, transportation, food production and all aspects of our daily life).

One day after the 36th Anniversary of Roe vs. Wade and as the number of electively aborted children in the United States alone (non-medically necessary, not associated with "rape, incest, or the life of the mother") approaches 50 Million, President Obama overturned the so-called "Mexico City Policy" or "global gag rule." US tax dollars will once again be allocated to organizations that advocate abortion as birth control, and even those that lobby to change the laws of other nations to allow abortion where it is not currently legal. Every news article I've seen conflates the gag rule with limiting non-abortifacient contraception. However, the only restriction is that on abortion.

Another Bill now in the House and Senate, would wipe out abstinence-based sex ed and mandate emergency contraception according to the Rochester, NY newspaper:

* House member Louise Slaughter submitted the Prevention First Act of 2009 (H.R. 463/S.21). In the Senate it was introduced by Democratic Senate Majority Leader Harry Reid.

The legislation focuses on reproductive and sexual health issues, and in some cases reverses Bush administration policies. It provides funding for comprehensive sex education programs, and none for abstinence-only sex ed. Other provisions include mandatory access to emergency contraception for rape survivors, and a requirement that hospital staff provide factual, science-based information on EC, including instructions that it doesn't cause abortions.

The bill would also force health insurers to offer equitable coverage for prescription contraceptives.

And then, finally (from the first link above), Speaker Pelosi on Federally funded contraception for the poor:

STEPHANOPOULOS: Hundreds of millions of dollars to expand family planning services. How is that stimulus?
PELOSI: Well, the family planning services reduce cost. They reduce cost. The states are in terrible fiscal budget crises now and part of what we do for children's health, education and some of those elements are to help the states meet their financial needs. One of those - one of the initiatives you mentioned, the contraception, will reduce costs to the states and to the federal government.

More pictures from the March for Life in Washington DC

2009-01-26T02:11:00.000-08:00

These pictures are from our camera, my phone and my husband's phone.

I wore my white coat to the Rally, with extra layers underneath, but had to keep the heavy coat over it most of the time. We Texans still got pretty cold over the three hours we were at the Mall.

I'm wearing a "Texas Alliance for Life" cap.

The handsome bearded guy in the long coat on the far left is my husband.

The crowd was slow to gather due to its size. As I said in my earlier post, it took over 1 1/2 hours for us to clear the Mall. (I tried to sneak out the side. It took 30 minutes to weave across the crowd, and I ended up surrounded by the same group of people I'd begun with, as I walked out of the street onto the sidewalk of the art museum!)

There was no way that we were going to make it to the Supreme Court Building while the speeches were still going on, much less get near the speakers.

So, our group decided to visit the Newseum, the museum of news journalism that recently opened. (It's done well, but I'm not sure it's worth $20 a visit.) The pictures that seem to be from above the crowd were taken on the 4th floor balcony of the Newseum.

National March for Life Washington, DC, January 22, 2009

2009-01-25T21:02:00.000-08:00

Several hundred thousand people gathered for the National March for Life on the Mall in Washington, DC on January 22, 2009 to mourn the 36th Anniversary of Roe vs. Wade. My husband and I were among them, along with two friends.

It took 1 1/2 hours for all of the Marchers to pass onto Constitution Avenue as they left the Mall on the way to the Supreme Court. That first picture above shows the last of them as they wound their way around the Capitol.

We saw pro-life activists everywhere we looked in DC throughout the week. There were groups of teens and some of the women wearing buttons declaring "I regret my abortion" at our hotel. We shared an elevator with Father Frank Pavonne of Priests for Life on Thursday night.

Conscience: more than abortion

2009-01-20T03:04:00.000-08:00

Last month, a judge in Montana ruled that patients have the right to a doctor's assistance in their intentional death by suicide. Baroness Warnock argues that doctors who will not kill their patients on demand are "wicked." The States of Washington and Oregon already have legalized "Aide in Dying." Is it now my duty to inform my patients on Hospice that they have a "right" to "safe(?) and legal" death by prescription?

Here is part of a poignant Letter to the Editor from an Internal Medicine doc in Oregon:

I was caring for a 76-year-old man who came in with a sore on his arm.

The sore was ultimately diagnosed as a malignant melanoma, and I referred him to two cancer specialists for evaluation and therapy.

I had known this patient and his wife for more than a decade. He was an avid hiker, a popular hobby here in Oregon. As he went through his therapy, he became less able to do this activity, becoming depressed, which was documented in his chart.

During this time, my patient expressed a wish for doctor-assisted suicide to one of the cancer specialists.

Rather than taking the time and effort to address the question of depression, or ask me to talk with him as his primary care physician and as someone who knew him, the specialist called me and asked me to be the "second opinion" for his suicide.

She told me that barbiturate overdoses "work very well" for patients like this, and that she had done this many times before.

I told her that assisted suicide was not appropriate for this patient and that I did NOT concur.

I was very concerned about my patient's mental state, and I told her that addressing his underlying issues would be better than simply giving him a lethal prescription.

Unfortunately, my concerns were ignored, and approximately two weeks later my patient was dead from an overdose prescribed by this doctor.

His death certificate, filled out by this doctor, listed the cause of death as melanoma.

The public record is not accurate.

My patient did not die from his cancer, but at the hands of a once-trusted colleague.

This experience has affected me, my practice, and my understanding of what it means to be a physician.

ACOG: Abort or refer

2009-01-19T23:46:00.000-08:00

The American College of Obstetricians and Gynecologists (ACOG) have finalized and published their Ethics Statement # 385. It looks like they ignored the ruling from the Department of Human Services on Conscience -- or believe it will soon be overturned.

The ACOG pdf is set so that it is not possible to copy and paste - I have typed in the first bit, myself. Click here for the full document.

ABSTRACT: Health care providers occasionally may find that providing indicated, even standare, care would present for them a personal moral problem – a conflict of conscience – particularly in the field of reproductive medicine. Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient’s health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities. Conscientious refusals that conflict with patient well-being should be accommodated only if the primary duty to the patient can be fulfilled. All health care providers must provide accurate and unbiased information so that patients can make informed decisions. Where conscience implores physicians to deviate from standard practices, they must provide potential patients with accurate and prior notice of their personal moral commitments. Physicians and other health care providers have the duty to refer patients in atimely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. In resource-poor areas, access to safe and legal reproductive services should be maintained. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care.

____________________________________________________________

Physicians and other providers may not always agree with the decisions patients make about their own health and health care. Such differences are expected – and, indeed, underlie the American model of informed consent and respect for patient autonomy. Occasionally, however, providers anticipate that providing indicated, even standard, care would present for them a personal moral problem – a conflict of conscience. In such cases, some providers claim a right to refuse to provide certain services, refuse to refer patients to another provider for these services, or even decline to inform patients of their existing options.

Conscientious refusals have been particularly widespread in the arena of reproductive medicine, in which there are deep divisions regarding the moral acceptability of pregnancy termination and contraception.

For more on the controversy, here are my posts on Conscience, and here is a history of the ACOG and DHHS statements.

Texas teens form pro-life club

2009-01-18T05:09:00.000-08:00

And, it seems that the kids in Coppell, Texas (near Dallas) are only "anti-abortion" because of the undue influence of their families and churches. From the Dallas Morning News:

Abortion rights advocates say it's even harder for them to organize high school students because of the focus on abstinence.

"We're up against a movement that has federal dollars going into public schools," said Kierra Johnson, director of Choice USA. "You compound that with what they could be learning in church, and it sets us back in terms of outreach to young people under 18."

Of course, the Dallas Morning News calls the club "anti-abortion," not "pro-life." In spite of the fact that the kids call themselves "The Pro-Life Club." The author calls for tolerance on the part of the "anti-abortion crowd but can't even bring herself to use the term the teens would prefer.

I guess the DMN doesn't keep up with the latest research. Otherwise, they'd know that the study on abstinence that was in the news earlier this month informed us that teens - whether they sign a pledge or not - who come from religious, conservative backgrounds are more likely to delay their first intercourse for about 3 years longer than their peers. I nominate the author of the article,Katherine Leal Unruth, her editor, and Ms. Johnson for Twits of the Year and definitely award them my own Yellow Brick Road award. ("Do Not Look Behind the Curtain, Ignore That Little Man." Or small woman.)

Bravo Coppell teens, their parents, and their churches!

Baroness Warnock: doctors who won't kill are wicked.

2009-01-11T13:30:00.000-08:00

Baroness Warnock took part in a debate in Belfast, Ireland on January 5, 2008.

According to a Belfast news report, the Baroness said that doctors who will not kill their patients are "genuinely wicked."

Baroness Warnock, who last year caused worldwide controversy when she said that some dementia patients had a "duty" to seek death, said last night: "I think that people should be able to beseech their doctors, nurses to end their life when it is no longer worth living (in the patient's eyes]."

Speaking of terminally ill patients who, while in good health, have made a written request to be killed when they reach a certain point in their illness, she said: "There are doctors, we know, who don't pay any attention (to those wishes to die].

"But that seems to me a genuinely wicked thing to do – to disregard what somebody had quite explicitly said, that he wants to die – not to be resuscitated in certain circumstances and in certain circumstances to be helped to commit suicide.

"I believe that if someone is diagnosed as having the beginnings of Alzheimer's or dementia, at that stage it is a positive duty that doctors should talk to them about what will happen when the moment comes where they reach steep decline."

Speaking of the impact that medicine-prolonged life has had, she said: "The consequence (of living longer] is financial, but much more importantly, I think of the number of people who end their life demented, unable to recognise family, unable do anything for themselves.

"They can be kept alive and are kept alive, but the question has to be: What is the point of the life at the last stages of Alzheimer's or dementia?"

The point of any life is one of those big questions, isn't it?

Teen Pregnancy Rates Increase at Same Rate as Others

2009-01-11T11:51:00.000-08:00

It seems that everyone decided to have more babies in 2006, including teen girls from age 15 through 19.

The summary of the CDC report is available as a news release, here. A 100-page report is available pdf containing more numbers and breakdown of the data is at this link.

I don't believe that the information will answer any of the big political debates. The unmarried mother rate is too high, teens have too many babies too young, too few women begin prenatal care in the first 3 months, and too many had early births - both planned (scheduled C-sections) and unplanned.

We definitely need to discuss some of these numbers, however. 39% of children of white mothers, 50% of children of Hispanic mothers (who have half of all babies) and 70% of children of black mothers are born outside of marriage. The numbers of babies born to mothers under 15 years old should be a scandal (especially in the Black and Mexican and other Hispanic populations) and the focus of both public health and law enforcement. See pages 39 through 45) Note that the numbers of pregnancies under 15 have fallen precipitously since the 1980's, but the Hispanic community still

The biggest surprise to me? 494 women had babies after 50!

By the way, 2006 was the first year in quite a while that the US birth rate has reached replacement level.

Virginity pledges: the rest of the story

2009-01-02T19:24:00.000-08:00

The "kids" aren't "kids" and they aren't "teens." And they wait 3 years longer than their peers and no one knows if they even had a sex ed course in school.

Fox News reports on their interview with the author of a report on teens who take virginity pledges. She told them that religious teens wait 3 years longer than non-religious teens and (as reported here, last week), the background of those who take virginity pledges is more important than the pledge itself.

Click here to read the study in Pediatrics.

Note that there is no way to know whether any of the students took any type of abstinence-based sexuality education course, that the ages of the "pledgers" and "non-pledgers" evaluated and matched in the study were at least 15 in the first "wave," 22 or so at the end, and the average age of first intercourse for the group is 21 years old, three years older than the national average.

Rosenbaum, the author of the "new" study also removed all of the married participants in the study:

Her study also only looked at teens who were unmarried five years after taking virginity pledges, now ages 20 to 23. "The married are out of the picture, so they're not as interesting," she said.

Edited 1/3/09 at 6 AM.

New study on virginity pledges and behavior

2008-12-30T08:17:00.000-08:00

The article in question can be downloaded from Pediatrics, here.

The final "wave 3" data came from the group that the author calls "adolescents" -- who were 22 years old. Data from those who had married was treated as "missing."

We don't know anything about the actual sex ed courses that the students took, who paid for the course, or whether they actually took a course or just made a pledge.

From the article: “Virginity pledges are also now used to measure AOSE program effectiveness, which the US government considers successful if they produce many virginity pledgers, irrespective of participants’ sexual behavior.”

(Is it true that the pledge is considered a marker for the success of abstinence-only sex ed? I know that I’ve read several articles showing short term increase in the intention to remain abstinent, so that would not surprise me. However, I haven’t seen this “marker.”)

As far as I can tell, it appears that the author took data from a series of national questionnaires , matched kids for background and family, and found that they have similar outcomes after 5 years.

Oddly, a huge number - 80% - of the pledgers denied having pledged in follow up. The other number that seems to stick out is that the non-pledgers did pay for sex and/or get paid for sex more often.

Nevertheless, the only study that I’ve seen that measured pregnancy rates after a course that included teaching proper condom use did not show prevention of pregnancy, either. I posted a review of the pay-for-view article in the British Medical Journal.

Abstinence vs "plus"

2008-12-27T17:56:00.000-08:00

The Texas Legislature is about to reconvene and the sex ed debate in our State is already in the news. (Free subscription required.)

Unfortunately, the news article blurs the line between sex ed for all children in our schools and the problem that some of our girls have multiple pregnancies as teenagers. What little evidence we have about "abstinence-plus" vs "abstinence-only" sex ed (some of which is reviewed here and here) is never mentioned, while the fact that our State teen pregnancy rate has dropped is seen as a failure or completely ignored.

Along with many of our local physicians, I teach the doctor's portion of "Worth the Wait." The program is taught in all our county's schools. The classes begin in the 6th grader (the students are 11 and 12 years old) and continue into High School health classes (through grade 12, or 17 to 18 years old). The course consists of 16 or 17 classes, including one on STD's that is taught by local doctors and one on the legal consequences, taught by local lawyers.

The main contrast between "Worth the Wait" and "Big Decisions," the program mentioned in the article ( available for download, free, here), is that in each of the 10 to 12 lessons, the latter emphasizes condom use for those who do choose to have sex. There's even a supplemental lesson that teaches how to correctly use a male condom.

Many point out that since some teens will have sex before marriage, and that many will do so much earlier than expected, the earlier these lessons are taught, the better. However, in my experience, the kids who are having sex before 17 or 18 are the ones who are also engaged in other risky behavior, including drinking alcohol and smoking, or who are being abused. (See the story about the 18 year old young man, here.)

I'm uncomfortable with early discussions about "taking action" to buy condoms and how to use them because it seems to actually endorse the idea that there is a healthy way to have sex outside of a committed, monogamous relationship - one that 14, 15 and most 16 and 17 year-olds are not able to establish.

I believe that the best decision is the one that parents, teachers and our schools should teach. We do not talk about the safest way to drive a car before they are 16 and have passed several tests or that seat belts will protect them if they drive recklessly, we don't teach them which alcohol to drink when they are under the legal age limit, and we never tell them that if they are going to smoke, here's the way to do it.

In my "How to live a healthy life" talk that I give adolescents and teens (and sometimes adults) I talk about the physiological and medical reasons we encourage helmets for skaters, seat belts in cars, and why we discourage certain other behavior. I mention the job of the liver, the differences in the body as it matures, the risk of addiction, injury, and infections. Then, I talk about the psychological and social risks and consequences.

For instance, can you really trust someone selling an illegal drug to be honest about what he's selling you? If someone pressures you to have sex without a condom, knowing the risk of even deadly infections (yes, I talk about condoms in my office) does he even love himself, much less you?

It astonishes me how varied the apparent ages of these children are - even through the High School classes (up to age 18). Some still appear to be prepubescent and some look to be fully developed physical adults. While discussing sexual abuse, I remind the 11, 12, and 13 year-olds that in the State of Texas, that it is absolutely illegal to have sex under the age of 14.

And in every class of 6th graders, there's at least one girl who raises her hand and asks if she could go to jail.

Top 50 Medical Blogs list

2008-12-17T04:57:00.000-08:00

We made number 12, under Bioethics. The list appears to be a good resource - just come back here when you're done surfing the others!

Spelling corrected 1/6/09

Health care reform conversation

2008-12-17T04:37:00.000-08:00

There's a comment from a proponent of single payor health care payments on one of my November posts. A few points need to be clarified:

The numbers about infant mortality are skewed in the US because we count more infants as "live births" than other countries.

We use Medicaid money to finance special education and Medicare to finance medical education -- are those included in those numbers?

Also, that $7000 is an average - that includes all the expensive care for very ill patients. It would be more interesting to note per-capita bone marrow or other organ transplant.

I would like to see how much of our medical spending is actually elective - Botox and plastic surgery as well as contraceptives and abortions.

The majority of Family Physicians are against or conflicted about about single payer. We don't have a great history of changing policy to the benefit of our practices. Medicare, medicaid, and Workman's Comp pays better for procedures like surgery and invasive tests than they do for cognitive and preventive skills.The Family Doctor could do more if we weren't under pressure to see 4 to 5 patients per hour.

Health care outcomes are strengthened where primary care is strongest, according to research.

What I want to see is a public policy that allows patients to own their own health insurance and for doctors to work for the patient. Medicare still won't pay for tetanus shots when a covered patient needs one.

I just worry that what we have is not working because of regulations and laws. I don't want more of those.

Fox builds hen house

2008-12-13T02:54:00.000-08:00

In the same set of news alerts that notified me of the Vatican's condemnation of cloning and embryonic stem cell research, I read that Insoo Hyun is the lead author of the International Society for Stem Cell Research (ISSCR) Guidelines for the Clinical Translation of Stem Cells.

The Guidelines are also published on line at Cell Stem Cell and, along with a patient handbook and other supporting material, is available at the ISSCR website. Here is the link to the page containing links to pdf of the Guidelines, patient handbook, and other materials. That page also links to the Stem Cell Cell article.

The story in the Australian blurs the differences between destructive embryonic stem cell research and the non-destructive, ethical forms such as induced pluripotent stem cell research and adult stem cell research. The focus is on the former, detailing long anticipated (but not yet begun) phase 1 embryonic stem cell research, without mentioning on-going trials or previous achievements using the non-controversial cells.

The ISSCR in general and Dr. Hyun in particular, are very much advocates of embryonic stem cell research and cloning for research. Also on his task force were Laurie Zoloth and George Daley, both strong advocates of embryonic stem cell research. Daley has worked to create embryos slated for destruction in his own Harvard lab, although he has focused on non-destructive research, recently.

Dr. Hyun has a Ph.D. in bioethics and is on the faculty at Case Western University in Cleveland, Ohio. He has focused on cloning research, and his early work included assisting the Clinton Administration's National Bioethics Advisory Committee (that would have been along with Obama transition team members, Jonathan Moreno and Robin Alta Charo) on their "secular" article on cloning. He went to South Korea with Hu Suk Wu in order to study the effects of cloning research on the Koreans - before the Korean was exposed as a fraud.

I wonder whether there was even one member of the ISSCR team who considers embryonic stem cell destruction unethical? And how soon will Dr. Hyun join his former colleagues in DC?

Renewed fuss over conscience in medicine

2008-12-03T07:07:00.000-08:00

For some reason, the media has decided to focus on the proposed rule from the Health and Human Services Department on the right of conscience, even for doctors, and even for abortion. I guess they felt it was the right thing to do.

LifeEthics has been following the conscience issue as it unfolded over the last year and I wrote a review of the history of the rule in November. Here is the actual notice of the proposed rule, in pdf.

Kaisernet.org, the Kaiser Family Foundation's daily on line newsletter article recalls the report by the New York Times last month that 3 of 5 members of the Equal Employment Opportunity Commission (two Democrats and one man, the legal council appointed by President Bush) released a statement that the new regulation would "overturn" years of protection. In my opinion, that is ridiculous in light of the recent debate about the American College of Obstetricians and Gynecologist's Ethics Statement #385 requiring member physicians to provide abortion, practice in close proximity to an abortionist, and/or make prior arrangements with an abortionist. In practice, all physicians who provide health care to women, including Family Physicians, Internists and Pediatricians, are held to the ACOG standards.

For those physicians and other medical professionals who are employed, the regulation will merely underscore and clarify protections. For those of us who are self-employed but subject to Boards and ethics statements like that of ACOG, the new regulation will provide protection from new pressures to act against our consciences.

For the worst report that is not on a blatantly pro-abortion website, see the AHN ("AllheadlineNews") editor's incredibly biased contribution. Practice your skills at unravelling biased non-news statements on this excerpt:

The Equal Employment Opportunity Commission has advised the president that the rule would overturn four decades of civil rights laws in the nation. They also say that current law protects people who have religious objections from performing duties that conflict with their religion.

Many groups support the regulation, although about as many oppose it.

******

The new rules probably wouldn't stop people with money or those living in large cities, or metropolitan areas, from finding the care they needed.

However, critics worry that poor people, or those living in small towns, might not be able to afford to travel outside their area to find a medical facility or health care workers that would provide them with the medical care they needed.

Thus the new regulation would create a two-tier health care system for some in America, while being funded from taxpayer money.

Overthrow protections by protecting? And, "Many . . . about as many?"

Remember that ACOG would requirements doctors who do not perform abortions to only practice "in close proximity" to those who do.

I still say that the ethical solution would be to make sure that pro-abortion OB/Gyns spread out to cover any shortage areas, rather than force the rest of us to clump together or make some areas - and all the men, women, and children that will never need an abortion - do without a local doctor so that no one ever has to be exposed to a conscience.

"Tea-bag" Adult Stem Cell Treatment for Stroke

2008-12-03T02:37:00.000-08:00

British researchers report an amazing recovery for a 49 year old man who suffered a hemorrhagic stroke on October 15, 2008. The researchers at the company, "Biocompatibles," used adult stem cells from a healthy donor. The cells had been engineered to cause them to produce a protein that helps prevent "programmed" cell death (even after the bleeding stops and the pressure is removed) and embedded in tiny beads that had been sewn up in a cloth "tea-bag."

From the press release, published on the Medical News Today Neurology and Neuroscience website:

Stroke is one of the leading causes of death in the elderly population in the developed world. The incidence rate has been reported as 145 per 100,000. Hemorrhagic stroke is responsible for ~15 to 20% of all stroke and it is the least treatable form of stroke. It is associated with the highest morbidity and mortality rate of all stroke with only 44% of affected patients surviving the first 30 days. Only 20% of these survivors regain functional independence. The cascade of events starts with the sudden rupture of a blood vessel in the brain, causing haemorrhage and pressure inside the skull. Surgery may be used to relieve the pressure; but the haemorrhage causes a longer-term process of programmed cell death, or apoptosis, and it is this that causes the lasting neurological damage.

The CellBeads™ are delivered directly to the injury site during the surgery. They are programmed to deliver CM1, a proprietary version of a naturally occurring protein, GLP-1, which has been shown to have powerful anti-apoptotic effects. The delivery mechanism is a cluster of human adult mesenchymal stem cells obtained from a healthy donor and encapsulated in alginate beads. The cells are genetically engineered to produce the protein, which is delivered continuously, directly to the injury site. The alginate beads protect the stem cells from the body's immune system, which would otherwise destroy the foreign cells. CellBeads™ are transplanted within a retrievable mesh device and are removed completely after a treatment period of 14 days. Retrieval of the implant prevents possible long-term side effects from the transplanted cells.

The research is a "Phase I/II" trial, which means that the doctors and scientists are actually testing the safety of the treatment, and not the actual effectiveness of the treatment, itself. In other words, "does the treatment do more harm than good."

The CEO of Biocompatibles, Crispin Simon (that name is as British as tea bags), spoke to a Reuters reporter for a story published at Forbes online, stressing that the patient is young and other wise healthy, and had the standard of care for hemorrhagic strokes, surgery to relieve the pressure from the blood on the cells around the stroke. 10% to 20% of patients have similar recovery, without the Biocompatible beads.

Still, the report is a welcome source of hope for anyone who has watched and waited helplessly after a patient or a loved one had a hemorrhagic stroke.

Causal link between abortion mental illness claimed

2008-12-01T00:25:00.000-08:00

Fergusson of Australia has published more data on his birth cohort from ChristChurch, New Zealand. This time, he's claiming causal relationship between abortion and later mental illness. A 3 invited comments in the same journal seem to accept that his conclusion is true: Abortion responsible for depression, anxiety, and substance abuse, at least do some degree.

The articles are in the British Journal of Psychiatry.for pay, but here's the discussion:

(a) For both models there was consistent evidence that even after extensive covariate adjustment, exposure to abortion was associated with a modest but detectable increase in rates of mental disorder. The concurrent data suggested that after adjustment for confounding those exposed to abortion had
rates of mental health problems that were 1.37 (95% CI 1.16–1.62) times higher than for those who had not become pregnant (P50.001). The lagged model produced a slightly lower estimate of 1.32 (95% CI 1.05–1.67, P50.05).
(b) Pregnancy loss was associated with a modest increase in the rate of problems using the concurrent measures of pregnancy outcome, with those who experienced a pregnancy loss having a rate of mental health problems that was 1.25 (95% CI 1.01–1.53) times the rate for those who were never pregnant (P50.05). However, under the lagged model, pregnancy loss was not associated with later outcomes, with an adjusted RR of 1.06 (95% CI 0.79–1.43, P40.70).
(c) For both models, having a live birth, whether with or without
an unwanted/adverse reaction, was not associated with significant
increases in the overall rate of mental health problems when due allowance was made for confounding variables

Seed Magazine's Ethics and stem cells blog focus

2008-11-30T21:47:00.000-08:00

Seed Magazine runs a group of blogs on science, ethics, politics and opinion. Most of the bloggers are engaged in academic science.

There's a new blog sponsored by the site, What's New in Life Science Research?

The first subject of the blog is stem cells. I was surprised to read the narrow range of knowledge and assumptions in the posts, propagating the same old fallacies: only those frozen in vitro fertilization embryos will be used, embryonic stem cells show the most potential, Bush cut off funding for stem cells with his Executive Order of August 9, 2001.

No Patent on Human Embryonic Stem Cells: EU

2008-11-27T22:31:00.000-08:00

A Thanksgiving present from the European Union!

The Enlarged Board of Appeal of the European Patent Office (EPO) did not take the day off. Early on November 27, the EPO announced that they would not allow the development of human embryonic stem cells to be patented as filed by WARF in 1996, since that technique depended on the destruction of human embryos.

For background on WARF, see this post on the patents, here.

The EPO has upheld its previous ruling from earlier this year:

The EPC does not allow patenting inventions whose commercial exploitation would be contrary to public order ("ordre public") or morality. Furthermore, the Convention prohibits patenting on uses of human embryos for industrial or commercial purposes.

Needless to say, Geron is not happy.

UK Teens, Abortion Rights?

2008-11-26T19:48:00.000-08:00

The Family Planning Association in the United Kingdom is pushing a video called "Why Abortion" for use in schools teens, according to the Telegraph.co.uk website.

The laws in the United Kingdom differ in different regions. Abortion is still illegal in Northern Ireland, for instance. England and Wales, where abortion is legal and, like contraception and the morning after pill, paid for by the National Health System, has the second highest abortion rate is the second highest in Europe.

Nevertheless,

the Government announced that sex and relationships education will become compulsory in primary schools as part of a drive to cut teenage pregnancy rates. The National Children's Bureau also wants all secondary schools to have on-site sexual health clinics, while girls as young as 13 will be urged to have contraceptive injections and implants.

The FPA is offering schools the chance to buy a copy of the DVD for £25 together with a booklet that claims to explode the "myths" that having a surgical abortion can harm a woman's ability to conceive in the future, and that terminating a baby is always upsetting.

No mention that parents might not wish their daughters and sons to have sex at 13 -- and that the great majority do not. Or the risk that the 13 year old might be a victim of sexual abuse.