Medicine

American Academy of Family Practice quotes me on Plan B without restrictions

Should all girls “of child bearing age” be able to walk into the corner pharmacy and buy Plan B without ID, age restrictions or parental supervision? I don’t think so!

However, my professional organization, the American Academy of Family Practice, issued a statement this week advocating for just that. Our online newsletter included my comments in an article published today:

On the other hand, family physician Beverly Nuckols, M.D., of New Braunfels, Texas, said she has issues with the Academy statement because it is inconsistent with its own Family Medicine, Scope and Philosophical Statement.

“Family physicians not only treat the patient within the context of her family, we also strive to treat the whole patient — ‘biological, behavioral (and) social,'” Nuckols said. “In this case, the ‘disease’ we are trying to prevent is the high-risk behavior of unprotected sex. Parental involvement is vital to the health of children and is the best prevention for high-risk behavior, including adolescent sexual activity.

“The AAFP normally and correctly advocates parental involvement and intervention to prevent other high-risk activity, such as driving without a license, the use of guns without adult supervision, smoking, or overeating, etc.,” she said. “What is the rationale for treating adolescent sexual activity any differently than we would treat other risky behavior or preventable risk factor?”

Nuckols, who serves as chair of the Christian Medical & Dental Association’s Family Medicine Section, said she also has concerns about OTC Plan B One-Step because there are few controlled, randomized studies that prove levonorgestrel to be medically safe and effective for adolescents at the dosage given.

“The published data on emergency contraception don’t break out the numbers of adolescent girls, but the numbers appear to be low,” she said. “The closest I’ve found are small studies for treatment of menstrual disorders and inherited bleeding disorders by chronic use of oral or intrauterine levonorgestrel, with the youngest age at 14.”

via AAFP Disagrees With Justice Department Blockade of OTC Access to Plan B One-Step — AAFP News Now — AAFP.

(BTW, The author quoted my written statement, exactly, so any errors are mine.  I goofed in identifying myself to the author: Much to my relief, our CMDA Family Medicine Section elected a new Chair and I’m now the Past-Chair. I didn’t realize we had passed the turn-over date. Oh, and “data” really is plural, so “data … don’t” is not terrible grammar, just awkward.)

Dying, Naturally, in the Emergency Department

Here’s an excellent professional article about end of life care for patients that’s relevant to our discussion about SB 303.

Two Roads to Death

Two major pathways to death have been described: The easy and the difficult road Figure 1. Depending on the road a patient takes, the intensity of ED management may vary significantly. For instance, some patients are highly symptomatic at the EOL, requiring intravenous medications and even continuous drips to maintain comfort while others can be managed by relatively simple oral regimens in the home setting, with the support of hospice services.For symptoms like pain, the EM skill set proves sufficient as the management of healthy patients and those at the EOL is similar. EM treatment algorithms are less relevant, however, for symptoms like dehydration, delirium and dyspnea in the dying patient. For this reason, we will focus our attention on the unique approach to these common and often troublesome EOL issues.

via Dying, Naturally, in the Emergency Department.

New brain research shows two parents may be better than one

More evidence that we shouldn’t treat our children of tomorrow like lab rats by redefining marriage:

A team of researchers at the University of Calgary’s Hotchkiss Brain Institute (HBI) have discovered that adult brain cell production might be determined, in part, by the early parental environment. The study suggests that dual parenting may be more beneficial than single parenting.

Scientists studied mouse pups that were raised by either dual or single parents and found that adult cell production in the brain might be triggered by early life experiences. The scientists also found that the increased adult brain cell production varied based on gender. Specifically, female pups raised by two parents had enhanced white matter production as adults, increasing motor coordination and sociability. Male pups raised by dual parents displayed more grey matter production as an adult, which improves learning and memory.

“Our new work adds to a growing body of knowledge, which indicates that early, supportive experiences have long lasting, positive impact on adult brain function,” says Samuel Weiss, PhD, senior author of the study and director of the HBI.

Surprisingly, the advantages of dual parenting were also passed along when these two groups reproduced, even if their offspring were raised by one female. The advantages of dual parenting were thus passed along to the next generation.

To conduct the study, scientists divided mice into three groups i) pups raised to adulthood by one female ii) pups raised to adulthood by one female and one male and iii) pups raised to adulthood by two females. Researchers then waited for the offspring to reach adulthood to find out if there was any impact on brain cell production.

Scientists say that this research provides evidence that, in the mouse model, parenting and the environment directly impact adult brain cell production. While it’s not known at this point, it is possible that similar effects could be seen in other mammals, such as humans. The study is published in the May 1 edition of PLOS ONE. It was funded by the Canadian Institutes of Health Research (CIHR).

The research paper can be read online: http://dx.plos.org/10.1371/journal.pone.0062701.

Vermont House passes aid-in-dying bill – News – Boston.com

The House rejected an amendment to allow the people of Vermont to vote on a referendum. The Vermont Senate has not passed the Bill.

MONTPELIER, Vt. (AP) — After a second long day of debate, the Vermont House gave final approval Wednesday to a bill that would allow terminally ill patients to ask their doctors for a lethal dose of medication.

via Vermont House passes aid-in-dying bill – News – Boston.com.

Hippocratic Oath and Lawyers at the End of Life

Doctors don’t swear oaths as part of our training anymore; and certainly not the Hippocratic Oath. After all, the Hippocratic doctor swears to follow his conscience, even when the patient disagrees. He must refuse to give women medicine or devices to cause abortion or to give poisons to kill patients, no matter who asks for it.

Neither doctors nor hospitals killed Terri Schiavo. Terri Schiavo was killed by her husband’s lawyers and the probate judge who forbade food and water by mouth and by IV or feeding tube.

Plan B, Minors, and the Obama FDA Appeal

Just after I hit “publish” on yesterday’s effort to explain the mechanism of Plan B and why we still shouldn’t allow minor girls to buy it over the counter, I found the news that the Obama Administration has decided that the FDA will appeal the ruling by a New York Federal Judge Edward Korman that gave the FDA 30 days to remove all age restrictions on Plan B, the “morning after pill.” This will not change this week’s decision to move the age requirement down to 15 years of age, it is a good, if minor, move.

USA Today has an article that’s typical for those who object to the appeal, written by Cecile Richards, the former National president of Planned Parenthood (and the daughter of the late Texas Governor Ann Richards).

The comments on CBS News’ coverage of the appeal point out one big problem that teens who have unplanned sex may also have: the “emergency” aspect of “emergency contraception.” One person suggests that Plan B should be available in vending machines and restrooms, as condoms often are. Several readers are concerned that teens who have unprotected sex plan won’t ahead or be able to find a pharmacy open when they need it..

Obviously, the writer of that comment doesn’t understand that the pill can be useful up to 5 days — and is still very effective (if it’s going to be) for at least a day or two. As I responded, there is a difference between a condom and Plan B: the latter is ingested and will have an effect, however small, on the hormonal balance of whoever takes it. Condoms don’t make people nauseous or throw up!

Plan B appeal angers W.H. allies – Kathryn Smith – POLITICO.com

I didn’t expect this!

President Barack Obama’s administration on Wednesday angered allies in women’s groups by appealing a judge’s ruling that the morning-after pill must be available over the counter to girls of all ages.

The administration has argued that the pill should not be readily available to young teens, so the appeal is consistent with that position.

via Plan B appeal angers W.H. allies – Kathryn Smith – POLITICO.com.

Plan B and Minors (Updated!)

Update 5/02/13: The Obama Administration has decided to appeal the judge’s ruling that the age restrictions must be removed completely from Plan B sales.

Because of a ruling by a Court in New York on April 5, 2013 and the April 30, 2013 announcement that the Obama Administration has published its intent to allow 15 year olds to buy Plan B over the counter without a prescription or adult supervision, the news is full of the controversy about whether or not Plan B is an abortifacient because it kills the embryo or blocks implantation.

(How about that: she’s old enough to buy over the counter emergency contraception, but she’s still young enough for her parents to buy her insurance until she’s 26!)

There is quite a lot of evidence that Plan B does not interfere with the embryo if fertilization occurs and none that it does. If, as the evidence supports,  it doesn’t cause the death of the human embryo, before or after implantation, Plan B is not an “abortion pill.”

But it still shouldn’t be sold over the counter to minors.

I don’t know anyone who thinks it’s healthy for 12, 14 or 15 years olds to have sex – whether boys or girls. While Texas does have the “Romeo and Juliet” defense ( when there’s no force, both are over 14 years old, opposite sex and within 3 years of the same age), 15 year olds can’t legally consent to sex. Texas law deems it a “crime of indecency” to have sex with a minor under 17.  Our State has also decided that 15 year olds can’t drink alcohol, can’t buy tobacco or Sudafed, and they usually can’t get a driver’s license.

We do this to protect them, because we know that they are not prepared to make good decisions. Their brains are not mature enough and they don’t have the experience and knowledge to adequately judge the difference between immediate gratification and future benefit. The fact is that most parents are their children’s best protectors and advocates. We are legally responsible for our children, but we are also morally responsible for them. We love them and don’t want them to hurt!

Parents need – and have the right – to know what our dependent children are doing and what medicines they are taking. By changing these regulations, the Federal government is moving between the parent and child — a much more sacred relationship than “a woman and her doctor.”

There is very strong evidence from good scientific experiments published in the last 10 years that Plan B does not interfere with the implantation or development of an embryo.

Plan B only works, when it works, by preventing fertilization for 4-5 days in the middle of the month – before ovulation – it delays ovulation so there is no egg to fertilize and by preventing the sperm from getting to the egg.

Plan B is a high dose of progesterone, the main hormone produced by the ovaries during the second half of a woman’s monthly cycle. Before ovulation, Progesterone or Plan B delays ovulation (the release of the egg from the ovary) and makes it difficult for the sperm to get to the egg.  At or after ovulation,   progesterone appears to slow the sperm’s travel to the egg (prevents fertilization) In nature, this prevents fertilization of an old egg – and its effect is one of the signs used by women who use “Natural Family Planning.”   Progesterone normally encourages the development of the lining of the womb after ovulation. In fact, doctors sometimes give Progesterone to women who have repeated miscarriages.

 It wouldn’t be ethical to conduct experiments on women who are ovulating and having sex, because those women might be carrying a human embryo that hasn’t implanted or who could be harmed. While it is true that there have been no experiments on women who might be pregnant, there are good studies which were done on ovulating women who have their tubes tied or who agree to abstain from sex during the experiment. Then, they were studied by checking repeat exams, blood work, ultrasounds and biopsies of the womb.  No evidence that Plan B interferes with implantation or damages the embryo has been found.

Current evidence is that Plan B decreases the risk of pregnancy for those women who take it properly, Plan B cuts the risk of pregnancy by 50- 70%. At the population level, it does not decrease either the pregnancy rate or the abortion rate. In fact, even women who have the pills in their medicine cabinet – who don’t have to pay $45 when they have unprotected sex – don’t use the pills consistently. This is true in countries like Scotland, the UK and Jamaica where teen girls can obtain the medication without a prescription or are provided the medication in advance of need.

I am a pro-life doctor who, like Texas law, believes that the individual begins at fertilization. I spend much of my time advocating for laws that protect the human right not to be killed and for traditional medical ethics. Yes, I am a Christian , but I prefer to make my arguments from the science side because I’m convinced that science will prove me right in the long run. After all, the “Nature’s Creator “ cited in the Declaration of Independence created science!

For the science, see these articles:

Added 8:00 PM 5/2/13 One of the best and oldest. I can email a copy of the entire article to anyone who needs it http://www.contraceptionjournal.org/article/S0010-7824%2805%2900045-4/abstract

• http://www.ncbi.nlm.nih.gov/pubmed/20670097
• http://humrep.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17537781
• http://linkinghub.elsevier.com/retrieve/pii/S0010-7824(12)00100-X
• http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1726-46342010000200010&lng=en&nrm=iso&tlng=en
• http://linkinghub.elsevier.com/retrieve/pii/S0010-7824(11)00106-5
• http://www.webmd.com/sex/birth-control/news/20070417/plan-b-doesnt-cut-pregnancy-rates
• http://jama.jamanetwork.com/article.aspx?articleid=200095

Update on the Texas Advance Directive Act (SB 303)

The Texas Advance Directive Act of 1999 (TADA) describes “Advance Directives to Physicians” (what most people would call a “Living Will”) and contains Section 166.046, an attempt to outline the procedure for resolving a disagreement between a doctor and patients or their surrogates about what is medically appropriate treatment.
The law currently in effect requires the doctor to notify the patient or the surrogate when he or she believes that their request is medically appropriate. If there is still a disagreement, the doctor asks the hospital to convene a meeting of their ethics committee. If the committee agree agrees with the doctor, and no other doctor is willing to take over the care of the patient, the treatment in question can be withheld or withdrawn. TADA doesn’t allow “Physician Assisted Suicide” and certainly doesn’t allow euthanasia, where the patient might be killed on purpose.

The Texas Senate passed Senator Bob Duell’s Senate Bill 303, which significantly improves current law.  SB 303

• Requires the doctor to notify the patient or his surrogate before writing a “Do Not Attempt Resuscitation” order,
• Prohibits the withdrawal of artificially administered hydration and nutrition except in extreme circumstances and
• Gives families 5 days instead of 2 to prepare for the ethics committee meeting and 21 days instead of 10 before the patient must transfer care to another doctor,
• Outlines the duties of the hospital to  treat all patients the same, regardless of age, disability, or ability to pay, to provide a trained liaison to assist the family, and requires timely copies of the medical records.

Because SB 303 still needs to pass in the House, Texas Alliance for Life asked me to help them make a video explaining how it reforms current law.

If you agree that SB 303 is a pro-life reform Bill please call your State Representative at 512-463-4630 and ask him or her to support SB 303.

My “Ethics 101” on the law: “Back to Basics on Texas Advance Directive Act”

Thank your Texas Senators for a Good Bill!

From Texas Alliance for Life:

 

Texas Senate Passes Pro-Life SB 303 to Help Families

Protect Loved Ones Near the End of Life

 

Lt. Governor David Dewhurst and Sen. Donna Campbell M.D. Deserve Thanks!

 

April 24, 2013

 

Dear Larry and Beverly:

 

Very good news! Last week the Texas Senate passed SB 303, a strong pro-life bill that will change current law to help families protect their loved ones near the end of life. Supported by pro-life Lt. Governor David Dewhurst and authored by Sen. Bob Deuell (R-Greenville), the full Senate passed SB 303 on a decisive 24-6 vote.

Your Texas state senator, Sen. Donna Campbell M.D., voted to support SB 303, a pro-life vote. Please thank Lt. Governor Dewhurst and Sen. Campbell for their support. See sample messages below.

SB 303 is strongly supported by broad coalition of pro-life and provider organizations including Texas Alliance for Life, the Texas Catholic Conference of Bishops, and the Texas Baptist Christian Life Commission. 

 

Voting for SB 303 were: Campbell, Carona, Davis, Deuell, Duncan, Ellis, Eltife, Estes, Fraser, Garcia, Hinojosa, Huffman, Lucio, Nelson, Nichols, Rodriguez, Schwertner, Seliger, Uresti, Van de Putte, Watson, West, Whitmire, and Zaffirini.Voting against SB 303 were: Hancock, Hegar, Patrick, Paxton, Taylor, and Williams. Senator Brian Birdwell was absent.

 

(snip)

Dems divided on congressional Obamacare changes – Jake Sherman – POLITICO.com

Democrats are seeking to exempt Congress and their staffers from Obamacare.

http://www.politico.com/story/2013/04/dems-divided-on-congressional-obamacare-changes-90648.html

Texas Catholic Bishops Conference Rebukes “Texas Right to Life”

Using words such as “egregious,” “cynical,” “outrageous,” and “deceive,” the Texas Catholic Bishops Conference have published the letter that they sent to Texas Legislators concerning the actions of Texas Right to Life concerning Senate Bill 303 and its companion, House Bill 1444 on April 15, 2013.

Since employees and representatives of TRL continue to “stoke fear through ridiculous claims,” (and to harass those who support the Bills)  here’s the letter (I’ve reproduced the emphasis is in the original):

The Texas Catholic Conference is compelled to publicly correct the misstatements and fabrications that continue to be perpetuated by the Texas Right to Life organization against legislation to improve end-of-life care by reforming the Texas Advance Directives Act.

It has been said that all is fair in love, war and Texas politics. However, the actions of Texas Right to Life have been so egregious and cynical, especially when comes to misrepresenting the moral and theological doctrine of the Catholic Church, that the TCC cannot stay silent.

Texas’ Advance Directives Act needs reform. Current law lacks clarity given the complexity of end-of-life care, contains definitions that could permit the withdrawal of care for patients – including food and water – and permits unilateral Do Not Resuscitate Orders without the permission of, or even consultation with, the family.

Senate Bill 303 and House Bill 1444 are based on Catholic moral principles and reasonable medical standards for defending human life and protecting the conscience of both families and physicians. Both billsprevent unilateral DNRs, improve communication between medical providers and families, ensure a clear and balanced process for resolving differences, and give families the right to challenge Do Not Resuscitate Orders before a medical ethics committee.

In both its materials and communications with legislative offices and staff, Texas Right to Life has tried to stoke fear through ridiculous claims of nonexistent “death panels” and assertions that doctors are “secretly trying to kill patients.” Both claims are absurd. The truth is, many factors are involved in the sausage-grinding process of public policymaking. Some have less to do with making good laws and more about individual personalities and fundraising opportunities of organizations.

It is outrageous that an organization purportedly committed to the rights and dignity of life would resort to such disingenuous tactics that deceive honest and caring people. What is worse is doing so in a way that perpetuates current law and may cause unnecessary patient suffering.

Texas Right to Life has no authority to articulate Catholic moral teaching, and certainly does not have permission to represent the views of the Roman Catholic Bishops of Texas. If you have any questions, please feel free to contact us at the Texas Catholic Conference. We are more than happy to answer any questions or provide the Texas Catholic Bishops’ position on any issue before the Legislature.

 

(Edited for spelling and grammar, 4/25/13 BBN)

NIH funded study: “the tobacco industry and the Tea Party”

How reliable is a US government funded study that uses the term, “astroturf?”

Research using your tax dollars is under scrutiny – once again – and the subject of recent hearings in Congress. The National Cancer Institute, a wing of the National Institutes of Health, paid for this “study.” It was published in a “peer reviewed” journal, Tobacco Control, one of the “BMJ Group” (British Medical Journal) publications.

Discussion

The tobacco companies have refined their astroturf tactics since at least the 1980s and leveraged their resources to support and sustain a network of organisations that have developed into some of the Tea Party organisations of 2012.

***

 

What this paper adds

Rather than being a grassroots movement that spontaneously developed in 2009, the Tea Party organisations have had connections to the tobacco companies since the 1980s. The cigarette companies funded and worked through Citizens for a Sound Economy (CSE), the predecessor of Tea Party organisations, Americans for Prosperity and FreedomWorks, to accomplish their economic and political agenda. There has been continuity of some key players, strategies and messages from these groups to Americans for Prosperity, FreedomWorks and other Tea Party-related organisations.

***

• Funding This research was funded by National Cancer Institute grants CA-113710 and CA-087472. The funding agency played no role in the selection of the research topic, conduct of the research or preparation of the manuscript. SAG is American Legacy Foundation Distinguished Professor in Tobacco Control.

• Competing interests None.

• Provenance and peer review Not commissioned; externally peer reviewed.

via ‘To quarterback behind the scenes, third-party efforts’: the tobacco industry and the Tea Party — Fallin et al. — Tobacco Control.

Obama Gives $13 Million Grant to Texas Planned Parenthood! @txprolife

We’ve all been hearing about the supposed “War on Women” by Conservative law makers – and, by extension, voters – in Texas. Well, President Obama and Secretary of Health Kathleen Sebellius just fired another shot in the war against Texas and State’s rights.

UPDATE: In an emailed statement, Texas Department of State Health Services spokeswoman Carrie Williams says that the agency just received notice that it will lose the Title X grant and is “reviewing the information to get a sense of the full impact.” The agency hopes the transition is smooth and the provider base remains strong, she wrote.
EARLIER: The federal government has pulled from the state of Texas millions in family planning funding, granting the money instead to a coalition led by the Women’s Health and Family Planning Association of Texas, which says it can serve a greater number of women with the available funds.
For more than four decades, federal Title X funding has been dedicated to funding family planning services and covering clinics’ infrastructure costs. The funds are generally granted to providers (like Planned Parenthood) and/or to state health agencies. In Texas since 1980, the majority of the funding has been administered by the Department of State Health Services — roughly $18 million in 2012, for example; since 2009, DSHS has been the sole grantor of Title X funds.

(Edit, maybe it’s only half of that.)

A Little History

Before this year, Federal tax dollars came back to Texas in two major funds: the Women’s Health Program and Family Planning, or Title X funds. Texas “matched” a certain amount and the Texas Department of Health and Human Services administered the dispersion of the money. Because the money paid for or freed up other funds for staff, marketing, and “infrastructure” or office overhead, PP was helped to keep their abortion clinics running. The overall effect was that State matching tax dollars helped PP to funnel patients, if not dollars, to their abortion clinics.

Texas was forced to make severe Budget cuts across the board in 2011, including Family Planning funds. This led to prioritizing what little money we had:

“State lawmakers cut funding for family planning services by two-thirds in the last legislative session, dropping the two-year family planning budget from $111 million to $37.9 million for the 2012-13 biennium. They also approved a tiered budget system for family planning funds, which gives funding priority to public health clinics, such as federally qualified health centers and comprehensive clinics that provide primary and preventative care over clinics that only provide family planning services.”

Texas Tribune

Options gang ready to go home

We’ve been in Joplin, Missouri, learning how to run an STI (sexually transmitted diseases) clinic. Now, we’re going home!

Genital Wart Decline Tracked to HPV Vaccine

Great news from Australia!

“In 2011 no genital wart diagnoses were made among 235 women under 21 years of age who reported prior human papillomavirus vaccination,” the authors noted. “The significant declines in the proportion of young women found to have genital warts and the absence of genital warts in vaccinated women in 2011 suggests that the human papillomavirus vaccine has high efficacy outside the trial setting. Large declines in diagnoses of genital warts in heterosexual men are probably due to herd immunity.”The study provided a glimpse of the impact of HPV vaccination in a real-world community setting as opposed to a clinical trial.

via Genital Wart Decline Tracked to HPV Vaccine.

Trial shows abortion’s ‘coarsening’ impact

http://m.bpnews.net/bpnews.asp?id=40078

I’m quoted on Abortion and Breast Cancer Risk

Several media outlets sort of quoted my testimony against HB 2945 in the Texas State House Affairs Committee on Wednesday. However, they proved Mark Twain’s assertion that there are “lies, damned lies, and statistics.”

In my testimony against HB 2945, I also pointed to the National Cancer Institute’s webpage, “Reproductive History and Breast Cancer Risk,” which outlines the protective effect of pregnancy. After all, the only women and girls receiving this information are pregnant women and girls!

Unfortunately, Representative Farrar focused on the “peer review” status of the Mabye article (“Did it go through the Medline or PubMed?”), ignoring the NCI data.

In that (yes, Jessica, it’s “peer reviewed”) New England Journal of Medicine article, the authors note that, while their study found no increased risk overall, there is a protective effect of pregnancy and an increased risk for some women: “Induced abortion had no overall effect on the risk of breast cancer, but we found a statistically significant increase in risk among women with a history of second-trimester abortion.” This was a small number of cases, but it was also in spite of the authors’ acknowledging that unknown thousands of unrecorded abortions ( those before 1973 computerization of records) were probably not accounted for.

From the Texas Tribune:

Dr. Beverly Nuckols, a family doctor from New Braunfels and board member of Texas Alliance for Life, testified against the bill. She cited a study published by the New England Journal of Medicine in 1997 that showed pregnancy decreases the risk of breast cancer.

“No one would prescribe pregnancy to prevent breast cancer,” Nuckols said. “We’re just letting them know that if they have a risk factor in their family, this pregnancy may cut their risk of breast cancer in half.”

via House Panel Debates Changes to Booklet on Abortion | The Texas Tribune.

Others:

Austin Chronicle, “A Woman’s Right to Know the Truth”

Lest we forget — “After-birth abortion: why should the baby live?” Journal of Medical Ethics

#Gosnell would be vindicated if these “ethicists” have their way

There are two reasons which, taken together, justify this claim:

The moral status of an infant is equivalent to that of a fetus, that is, neither can be considered a ‘person’ in a morally relevant sense.

It is not possible to damage a newborn by preventing her from developing the potentiality to become a person in the morally relevant sense.

via After-birth abortion: why should the baby live? — Giubilini and Minerva — Journal of Medical Ethics.

Nurses quit Planned Parenthood because of ‘dangerous and dirty work conditions’

Guess what? Virtually no media notice!

Two Planned Parenthood nurses quit their jobs because of dirty and dangerous work conditions and what they called ‘a meat-market style of assembly-line abortions’.

The former employees of the Delaware branch have spoken out about what allegedly takes place behind its closed doors and said that a rush to get patients in and out leaves the operating tables soiled and unclean and that doctors don’t wear gloves.

Jayne Mitchell-Werbrich, former employee said: ‘It was just unsafe. I couldn’t tell you how ridiculously unsafe it was.

‘It’s not washed down, it’s not even cleaned off. It has bloody drainage on it.’

via A meat-market style of assembly line abortions: Nurses quit Planned Parenthood because of ‘dangerous and dirty work conditions’ | Mail Online.

Statistics and “Peer Review”

Typical of the reporting on the connection between abortion and breast cancer, a blogger at “RhealityCheck,” only reports half a sentence – the half that she likes.

I don’t know how long my comments will stay up, so here’s my part:

The author only quoted half a sentence. The article clearly states, “Induced abortion had no overall effect on the risk of breast cancer, but we found a statistically significant increase in risk among women with a history of second-trimester abortion.”

and

And here’s the link to the article in question. Please note that even this research must adjust for the age at first pregnancy and for number of pregnancies.

My testimony begins at 1 hour, 12 minutes in on the video of the hearing. I actually focused on the protective effect of pregnancy, especially early pregnancy, according to the National Cancer Institute. This information is only given to women and girls who are already pregnant, after all.

Interestingly, we learned how little the Committee members understood about scientific research and resources. Follow the hours of testimony on HB 2945 and HB 2365 and Rep.Jessica Farrar’s obsession and apparent slow realization about the meaning and significance of “peer review” and “PubMed” and “Medline.“At one point, 1:26, Ms. Farrar, who admits that she “barely got through biology,” asks whether the research was “peer reviewed” by “the Medline or PubMed.”

As the day went on, it seems that Farrar was educated that peer review is conducted by the Journals themselves, and that PubMed and Medline are merely indexes of scientifc literature.

State Rep Farrar: “Choice” to abort babies with spina bifida after 20 weeks

6:05/8:18 Farrar:  “So, so, this diagnosis is missed, they
have a fetal anomaly, the spine’s outside the body or something, you say you would not have an exception for that situation.”

Watch the video at 6:05 (See below ++) of the April 10, 2013 Texas House State Affairs Committee meeting hearing on HB 2364, by Representative Jodi Laubenberg,  as State Representative Jessica Farrar challenges a practicing OB/Gyn about his belief that abortion should not be performed when babies are found to have non-lethal “anomalies” after 20 weeks post-fertilization (or 22 weeks since last period).

I wonder how of you have heard of the trial of abortionist Kermit Gosnell* in Philadelphia, Pennsylvania? Most people, whether pro-choice or pro-life, are horrified by the way Dr. Gosnell and his staff treated the babies they delivered both alive and dead.

We also squirm at the intentional killing of children who could otherwise live.

The limit of viability for the unborn, using current medical technology, is 20 to 23 weeks gestation.  There have been reports of survivors born before this time. Who will be surprised when the limit moves even farther back? What will history say about us?

In fact, here in Texas, we have made it clear with our Prenatal Protection Act of 2003, spurred on by the deaths of Lacy and Connor Peterson, that our definition of individual (or person) includes all humans from fertilization to natural death.

++ Download the free Real Player app, open the video and then pull the timeline cursor out to 6:05. More Committee and Session videos are available at the Texas Legislature Online site.

*(Gosnell is accused of killing the babies who survive, of committing abortions after the legal age limit, and of mutilating the bodies of the babies after they were dead. One gruesome account is here.)

Texas will pay for destructive human embryo cloning at Texas Universities

The Committee Substitute was passed this afternoon with 9 yes votes in the House State Affairs Committee. The Chairman of the Committee, Byron Cook voted “yes,” after assuring the Committee that the Bill (which is not available online or in the Committee) will not outlaw human cloning at Universities.

Voting “no” were four brave Republicans – I’ll list them all as soon as I can verify and make sure I don’t miss anyone. Unfortunately, some of our conservative members weren’t present. I will also name them when I can do so without missing anyone.

I worked with Representative Raymond’s office to come up with good definitions, but I don’t know how much of those definitions made it into the final Bill.

Luckily, in spite of the lies we’ve read over the years, no one has yet been able to clone a human embryo.

What is now encouraged is the purposeful creation of a human embryo by cloning. The embryo may never be implanted, but the Bill declares that the nascent human should be killed and broken up

You decide: Physician-Assisted Suicide — NEJM

You can comment, let the New England Journal of Medicine editors and the world know your thoughts.

Do you believe that Mr. Wallace should be able to receive life-terminating drugs from his physician? Which one of the following approaches to the broader issue do you find appropriate? Base your choice on the published literature, your own experience, and other sources of information.

To aid in your decision making, each of these approaches is defended in the following short essays by experts in the field. Given your knowledge of the patient and the points made by the experts, which option would you choose? Make your choice and offer your comments at NEJM.org.

via Physician-Assisted Suicide — NEJM.

My opinion is that poisoning Mr. Wallace, or writing the prescription so that he can attempt to intentionally commit suicide, is a direct infringement of Mr. Wallace’s inalienable right not to be killed.

Lieutenant Governor David Dewhurst

Talking about Texas’s history of conservative pro-life and pro-family laws.

Texas Alliance for Life Leadership Luncheon

Joe Pojman, standing at the podium. Our President, Davida Stike is seated at the head table. Next up, our Lieutenant Governor, David Dewhurst.

Back to Basics on Texas Advance Directive Act

Laws relating to ethics debates are generally behind medical advances. This is good because it means that there *are* medical advances.

However, the debates often become emotional and heated, and the individuals who are affected face real dilemmas and emergencies. When law-making is controversial, it’s best to go back to the basics of ethics for guidance: the inalienable rights to “Life, Liberty and the Pursuit of Happiness,” the Declaration of Independence, and Constitution.

 
All laws limit our rights, but good laws strike a balance between seemingly conflicting rights: they are meant to prevent one person from harming another. Most laws prohibit or punish harmful actions, they don’t *compel* a desired action against our will. Nor do they prohibit actions based on thoughts and opinion. In other words, laws prohibit harming or taking from another, but they usually don’t make you protect, nurture or give to another.

 
However,since the right to life trumps the right to liberty and property, there are very rare circumstances when it is appropriate for laws to compel individuals to act for the benefit of another. Parents are required to care for and protect their minor children. Doctors and lawyers must be licensed, obtain certain levels of education, and follow specific, positive actions when they wish to withdraw from a professional relationship with a patient or client. These laws should only go so far as to protect the life and safety of the vulnerable, for a limited time with the goal of allowing safe transfer of the obligation of the person with more power to someone else.

 
On Tuesday, March 19, 2013, the Texas Senate Health and Human Services Committee, under Chair Senator Jane Nelson, heard testimony on two Bills that would change TADA: SB 303 from Senator (Dr.) Bob Duell’s  and SB 675 by Senator Kelly Hancock.

 
The Texas Advance Directive Act of 1999 (TADA), in addition to describing “Advance Directives to Physicians” (a “Living Will),  was an attempt to outline the procedure for resolving the disagreement between a doctor and patients or their surrogates regarding end of life care.

When I first read the Act, I (naively) thought it was malpractice protection for doctors who did not want to withdraw or withhold care, such as the Houston Methodist Hospital doctors who invoked the act when they repaired Dr. Michael Debakey’s aortic aneurysm against his previously stated wishes – http://www.theheart.org/article/762619.do – in 2006.

 
Most of the time, however, TADA is invoked in cases when the attending physician disagrees with a request to actively administer medical treatment that he or she believes is medically inappropriate. The steps laid out in the law involve the doctor’s notification of the patient or the surrogate, rules for assisting with transfer of care to another doctor who believes the treatment request is appropriate, and convening an ethics committee at the hospital. If there is no other willing doctor can be found and the ethics committee agrees with the doctor, the treatment can be withheld or withdrawn. It does not allow patients to be killed by medicines.

 
Unfortunately, the Act has become known as the “Texas Futile Care Law,” and divides even the pro-life community. One side says doctors and hospitals have too much power and are killing people. While I’ve heard horror stories about doctors who have abused or broken the law, I maintain that there is no “Futile Care Law,” only a difference of opinion as to who should decide what is medically appropriate treatment. In the few cases that have come under the Act, patients and their advocates report trouble finding other doctors willing to provide the treatment the first doctor thought was inappropriate. In my opinion, that difficulty is due to physicians’ common education and shared experiences.

Although TADA lays out requirements for hospitals and hospital medical ethics committees, the fact is that it applies to the “attending physician” who could be forced to act against his conscience. Texas law is clear that only doctors may practice medicine by diagnosing and treating patients directly or “ordering” other medical personnel. These treatments are not one-time events and they aren’t without consequences. They are interventions that must be monitored by observation and tests, and adjustments need to be made so that the treatment is effective and not harmful. Medical judgment is how doctors utilize our education, experience, and consciences as we plan and anticipate the effect of each medical intervention.

Senator Duell’s Bill, SB 303, significantly improves TADA. Among other things, the Bill would add protection of the patient’s right to artificially administered hydration and nutrition, increased access to assistance, records, and time before and after the ethics committee meeting, and prohibits so-called “secret DNR’s.”

Senator Hancock’s Bill, SB 675, focuses on the intentions and motives of the doctor, requiring the medical committee to decide whether the disagreement is due to: “(1) the lesser value the physician, facility, or professional places on extending the life of an elderly, disabled, or terminally ill patient compared to the value of extending the life of a patient who is younger, not disabled, or not terminally ill; or “(2) a disagreement between the physician, facility, or professional and the patient, or the person authorized to make a treatment decision for the patient under Section 166.039, over the greater weight the patient or person places on extending the patient ’s life above the risk of disability.”

Our laws normally prohibit actions and only very rarely compel people to act. Under the conditions laid out in SB 303, the doctor can be forced to act against his conscience and best medical judgment, but only for a limited, stated time. SB 303 improves the Texas Advance Directive Act by protecting the patient’s access to artificially administered hydration and nutrition. It also adds time to prepare for the ethics committee meeting and to transfer care a new doctor. It is an attempt to balance the patient’s wishes for medical intervention with the right of conscience of the doctor. In contrast, SB 675 would attempt to legislate intentions or thoughts, with none of the added protections of SB 303.

Edited 4/27/13 to fix the link to the article about Dr. Debakey and 4/30/13 for grammar and formatting – BBN.

Using Stem Cells To Identify Better (And Cheaper) Drugs – Forbes

Non-destructive induced Pluripotent Stem Cells used to test new drugs:

Rubin works mostly with iPSCs, derived from real patients. If his lab can develop drugs that they can identify in a screen as candidates that might be useful, they can test them across ranges of patients –many individual patients.

“And that can pretty much only be done, practically speaking, using an iPSC approach,” he said.

“So, as an example, we discovered a compound, something we were excited about for ALS. Kevin Eggan (also at HSCI) and I collaborated to test that compound on 60 different motor neurons in parallel, using a very interesting technology we developed in my lab from live cell imaging which was required.”

via Using Stem Cells To Identify Better (And Cheaper) Drugs – Forbes.

Senate panel OKs abortion bill requiring stricter standards – Houston Chronicle

One woman claimed that the standards shouldn’t be the same as an ambulatory surgical center because they do abortions on 9 year olds!

Minimal standards are considered too much by the abortion industry. They’ve fought every move to keep women and girls safe, and whip out those coat hangers every chance they get.

Women who have D&C’s after a miscarriage have them at a hospital or surgical center, not at in an office setting. But according to the abortionists, healthy mothers having abortions – or 9 year old girls – should be happy with a clinic setting.

AUSTIN – Abortion clinics would be required to meet stricter standards under a bill approved 5-2 by the Senate Health and Human Services Committee Tuesday after emotional testimony over whether the measure would protect women’s health or risk it by causing clinics to close.

“My intent in filing this bill is only to protect Texas women who undergo this procedure,” said Sen. Bob Deuell, R-Greenville, who authored the measure with two fellow doctors, Republican Sens. Donna Campbell of New Braunfels and Charles Schwertner of Georgetown.

Planned Parenthood called the measure, Senate Bill 537, a “back-door abortion ban.”

via Senate panel OKs abortion bill requiring stricter standards – Houston Chronicle.

Florida Senate panel rejects Medicaid expansion | Modern Healthcare

Good for the Florida Legislature!

A Florida Senate committee has essentially killed Gov. Rick Scott’s plan to expand Medicaid coverage to roughly 1 million of Florida’s poorest residents.

Instead, the committee proposed Monday that the state adopt a managed care system that requires patients have a copayment.

*****

A House panel last week also rejected expanding Medicaid.

via Florida Senate panel rejects Medicaid expansion | Modern Healthcare.