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Health Care Policy

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Health Insurance Choice Is Bad?

Health insurance choice is bad?

The San Antonio Express News picked up a Washington Post op ed on those big, bad Republican plans to repeal Obamacare. Originally titled, “The reason Republican Republican health-care plans are doomed to fail,” by the editorial board that declared, “There’s no way to replace Planned Parenthood.”

And it’s bunk, even as prudently renamed and appropriately filed in the Opinion section.

What we are *actually *seeing *today is that costs are rising and insurers are withdrawing from States. Choices are certainly limited if there’s only one insurance company on the exchange and routine screening costs are “free” — But the care for treatment discovered at screenings is subject to high deductibles.

Limited coverage plans with major medical for extraordinary costs – rather than a wish list covered with other people’s money from first dollar – encourages personal responsibility and will cut costs. It would also allow people to own their insurance, rather than have it controlled and limited by current employers.

“Different” (Transgender at 4?)

The TexasGOPVote website chronicles the complaint by a “Conservative, Christian” mom  that her male to female (supposedly) transgender 6 year old shouldn’t be treated differently. I agree with the underlying sentiment that it is not the child’s fault.

The child is treated differently – by parents, peers, school nurses, and any educator, doctor or other professional or official who is complicit with this abuse of a 6 year old child – because the child *is* different. Medicine, physics, and the rest of the observable, measurable and verifiable universe don’t change because a child declares that cold is hot, up is down or boys don’t feel like “she” feels (at the highly experienced age of 6). 

It is disturbing to read about the apparent mistreatment of depression that this mother describes in her earlier blog. So disturbing that I’m inclined to ignore – or at least put off to another post – commenting on the stereotype in the description of “girly girl, Kai, in pink and sparkles” or of  the suggestion in mom’s earlier blog about Joseph as “gay” (at 2!)  for displaying supposedly “flamboyantly feminine mannerisms and love for all things girly.” 

How could anyone so misinterpret the repeatedly voiced desire of a 4 year old to be taken away to heaven because another 4 year old said her father called him a freak as equivalent to hating hair cuts ( or more “feminine mannerisms“)? How can she compare her “secret” research with the proper treatment her son needed?

Unfortunately, a 6 year old claiming to be transgender is different because he or she has had his or her perceptions of the world colored by the same adults who would not allow a child they loved to play with fire or jump off the highest point of the school building. 

The fact is that genetic and phenotypically female girls will always be “different” from Joseph. From the first penetration of the zona pellucida by a sperm bearing a Y chromosome, to the differentiation of the Wolffian duct, to the first time he urinated over someone’s shoulder into the air after birth, Joseph has been a male. Stereotypes aside, he will remain a male, however he acts or is medically or surgically manipulated. The genetic and phenotypical reality of his body will always affect any future medical or surgical treatment.

Hopefully, no one will be complicit with medical or surgical castration or other mutilation until this child is legally competent to consent. In that case,  his body will still be phenotypically male, entering puberty, when he enters middle school, whether as as Joseph or Kai. Now, that will be a  “difference” evident to all the girls, including the ones who have never seen male genitals. 

It will be very evident to the survivors ​of sexual abuse. Hopefully, they called the police after they were abused.

Contrary to the claim in the blog,  Lt. Governor Patrick and the “Bathroom Bill” didn’t start the trans debate.  School districts in Texas were changing policies, entire cities have passed ordinances, and the last President issued an Executive Order that threatened Federal education dollars. 

And preditors are taking advantage of the increased access available due to the transgender debate: men like Paul Witherspoon, Levandus Gacutan, Christopher Hambrook, Richard Rodriquez, Jason Pomare, Sean Patrick Smith, or the many unnamed men who have been not reported to the police when they enter previously gender-segregated areas like poolside changing rooms, shower rooms or gym locker rooms. (I’ll let you research those names.)

Thanks to “Conservative, Christian” mom, the world is being misrepresented to other children who are encouraged to consider pathological behavior as not “different.” Because of “feelings” the rest of us are repeatedly told to ignore the difference –  and observable,  measurable, and verifiable facts. 

And this specific child is being abused. 

Beverly B Nuckols, MD. 

Law makers to doctors: “Keep the patient alive” 

If only we doctors – or legislators, lawyers and probate judges – really had the power to “keep the patient alive” as this article claims two new Bills  (  HB 4090 & SB 1213) in front of the Texas Legislature will (force doctors to) do. 

The article is misleading in its claim that a committee or a hospital decides whether or not a therapy is given: Texas doctors practice medicine in Texas. Even the Bills make it clear that the “attending physician” makes the decision whether or not to follow the patient’s (or more likely, the surrogates’) medical request.

We – Texas doctors, hospitals, and legislators – have tried repeatedly over the last decade to amend the law, Texas’ Advance Directive Act,   to increase the time frame. Last Session, we helped to ensure that food and water can’t be withheld. The lawyers and those who would have Estate (probate) judges involved in every dispute – even at the bedside of the dying – have blocked effort after effort because the Bills did not include liability for the doctor. 
These Bills are just the camel’s nose under the tent of Texas’s tort reform. Worse yet, we’d end up with medical expert testifying against medical expert in court, with the judge eventually telling the doctor how to practice medicine. It would also severe the “ethicists” who actively seek to undermine conscience protections for health care professionals.
If you’ll notice, the Bills also remove the requirement for the patient to pay for any transfer, too. I don’t suppose that the tort lawyers ​will pay for the ambulance or plane ride.

Do you want Texas law to force doctors to practice against our consciences​? 

How long and how far should any man or woman be forced by law to act against his or her will?

​Would you like to refuse?

Shocking Bill from Texas’ Jason Villaba, Republican State Representative from Dallas’ District 114 :  HB 1938 would make organ donation after death “opt out” for anyone applying for a driver’s license in Texas.

Texas would be the first State to pass such a law.

Organ donation is a public good for those who wish to do so. However, there is no ethical or legal precedent for treating human bodies – living or dead – as public property or commodities.

From the Bill as introduced:

 (2)  for an applicant who is 18 years of age or older:
                     (A)  specifically ask each applicant the
  question, “Would you like to refuse to join the organ donor
  registry?” and state, “If you answer ‘no’ to the previous question
  or do not answer the previous question, you consent to join the
  organ donor registry by performing either of those actions.”; and
                     (B)  if the applicant does not affirmatively
  refuse to be included in the registry under Paragraph (A), provide
  the person’s name, date of birth, driver’s license number, most
  recent address, and other information needed for identification
  purposes at the time of donation to the nonprofit organization
  contracted to maintain the statewide donor registry under Section
  692A.020, Health and Safety Code, for inclusion in the registry.

http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB01938I.htm

Honk if you love pizza and abortion!

​Perfect pro-abortion slogan: “Honk if you love pizza and abortion!”


Because, equivalent, yes? And illogically proud of it – see the young woman in the left lower quadrant. That sign certainly is evidence that “reproductive rights” advocates are, indeed, “pro-abortion.” 

The Texas Tribune is providing its usual biased coverage of the Texas Legislature. The editors allowed the banality of a pro-abortion sign equating the love of abortion and pizza to creep into their report on the fears of the groups who make a profit from ending the lives of the most vulnerable humans and their advocates. 

There’s no logic in claiming that an abortion doesn’t end the life of a human. With current science and technology, it’s anti-science to make such a claim. Proponents of elective abortion deny that every human is endowed with inalienable rights. Instead, they defend the falsehoods that embryos and fetuses are less than human and definitely not human-enough to possess inalienable human rights. 

As to the complaints about insurance coverage for abortion? It’s called, “Elective abortion.” Insurance shouldn’t pay for “elective” procedures. And seriously: “a rider” to pay for elective abortion?  How fiscally responsible is that?  

“Heart” if you (heart) graphic proof of illogic and irresponsibility

Pay attention: it’s policy, not bias

screenshot_20161109-175849The consensus of media pundits and bloggers, as well as quite a few liberal and even Conservative op-ed authors, is that Donald J.Trump was elected President out of some misguided national populism and anger at Congress, fueled with a lot of racism, misogyny and hate. The fact that those same voters elected a Republican majority in the House and Senate  – sending virtually every eligible Republican incumbent back to DC – is glossed over.

The idea that Conservatives really believe in small government and equal opportunity supported by personal responsibility is rarely voiced. That we might actually vote, not only for President but consistently down ballot, in order to defend the Bill of Rights and the right to life is ignored while we are accused of xeno-, homo-, and poly-whatever-phobia. I read that I am “afraid” of other lifestyles, religions, and losing my “privilege” based on being a White Christian.

Personally, I approve of most of the Republican Platform, especially where it addresses core Conservative issues, such as low taxes and equal treatment under the law. I want a Legislature that will uphold the Constitution as it’s written and defend against the infringement of inalienable rights. I don’t want activist judges nominated or confirmed at any level of the Federal Court system, especially the Supreme Court. I hope President Trump and the Republican Congress majority will decrease the hassle factors and threats placed on the practice of medicine and business in general by an overreaching Federal bureaucracy.

And, yes, my sense of fairness hopes that our existing immigration laws will finally be enforced, as an outcome of the”equal treatment under the law.”

Instead of facile clichés fed by cherry-picked sound bites and the latest talking points from the Left, try looking at and listening to the 59 Million voters across the country who elected a Republican candidate for President, and ensured a Republican majority including all those “establishment” candidates in both the House and Senate. 

It’s the Republican platform and Conservative policy that we Conservatives voted for, not one man.

Obama’s Abortion Cronyism 

Obama’s new Health and Human Services regulations will prohibit consideration of whether a provider does abortions – or sells body parts – or not.

Kansas and Texas, among other States, attempted to prioritize their limited tax dollars, preferring to steer money – and patients – toward continuing and comprehensive caregivers – primary care providers- over  reproductive health “boutiques:”

When PP sued, they lost. But Obama arbitrarily stripped the State’s Title X funds and gave the money to PP, anyway.

The “most transparent Administration ever” went further:

 In New Hampshire, the administration even refused to disclose information about its direct Planned Parenthood grant, claiming disclosure would harm the nonprofit’s “competitive position.”””

What competition??? That’s pure cronyism and blatant support of the Democrat’s  – and Obama’s – pro-abortion political ideology.

Edited 11/12/16: misspelling of Services in first sentence BBB

Department of Defense Transgender Plans – Bottom Line

United States Secretary of Defense, Ash Carter, declared the US military Independence Day from biology and human development. There will be a necessary increase in the military’s dependence on medicine, however.

“In an historic and controversial move, the Pentagon on Thursday lifted its longstanding ban on transgender troops and began outlining how the military will begin allowing — and paying for — service members to transition, medically and officially, from one gender to another.

“Now transgender troops will no longer be considered “medically unfit” for military service. By October, transgender troops may begin an official process to change gender in the military personnel management systems.”

****

“”The most common treatment for gender dysphoria is hormone therapy.”

This shouldn’t be a problem, other than a few hot flashes here and there – wherever.  After all, the American Medical Association has decided that neither genetic nor physical sex – also known as”anatomy,” trump feelings – or official birth records.

““Breast implants may be medically necessary” for some individuals, said another defense official familiar with the medical aspects of transgender treatment.

“Cosmetic surgery for gender transition, however, would in most cases be considered an elective procedure and not be covered by the military health system, defense officials said. Many transgender individuals do not opt for a full sex-change operation to include “bottom” surgery that changes genitalia.” (Emphasis mine.)

So, the DOD may buy some estrogen and testosterone and a few “medically necessary” breast implants, they don’t plan to pay for “bottom surgery.”.   In light of current insurance criteria, a huge of ” the standard practice in the civilian medical community,” however, I’m not sure how long that plan will last. (See the excellent and thorough discussion of medical necessity for gender reassignment surgery, provided online by Aetna, here.)

Right now, the question seems to be more about what the well dressed transgendered soldier, sailor or Marine will be wearing next year.

I haven’t served, but it seems to me that the solution is a truly *uniform* we of “grooming standards and uniform-wear,” job descriptions and fitness requirements. If genetic or physical sex is irrelevant to”gender identity,” then they should certainly be irrelevant as to readiness standards.

BTW, this may just be the justification for “access to 100 percent of America’s population” for future drafts.

Texas’ Women’s Health, UT Study: Other than that*, the story was true.

*The authors of a study published in the New England Journal of Medicine admit to a narrow focus that ignored the multiple methods of funding Family Planning in Texas,  looking instead at a single type of “provider” – Title X clinics like Planned Parenthood (“PP”) – and a single source of funding for a specific set of services: long-acting reversible contraceptives such as the IUD and implants and injectables.

Yet, in typical fashion, the reports about the study claim much more. For example, the Texas Tribune has an article out, “Texas disavows Controversial Women’s Health Study,”  about the political fallout due to the skewed conclusions of the authors and the even more skewed editorializing in the media.

While the NEJM article (free article!) states in the “Methods” section that,

“After the exclusion, the provision of injectable contraceptives fell sharply in counties with Planned Parenthood affiliates but not in counties without such affiliates; subsequently, the numbers of claims in both groups of counties remained relatively stable during the next 2 years. In contrast, the provision of short-acting hormonal methods changed little in the two groups of counties in the quarter after the exclusion and declined steadily thereafter.” (Emphasis mine. )

the Tribune article reports that in answer to criticism,

Joseph Potter, one of the UT researchers who co-authored the study, said in an email that the paper addressed the “specific question” of how the exclusion of Planned Parenthood from the Texas Women’s Health Program affected women. Nothing raised in Traylor’s letter, he said, contradicted the researchers’ conclusions.

“We made no claims about access to reproductive health care as a whole in Texas,” he said, and he stood by the finding that claims for long-acting contraceptives fell after Planned Parenthood was excluded from the women’s health program.

The law in question, SB7, was passed with bipartisan support in 2011, a year when Texas, along with State budgets all over the Nation were tight. Although family planning was cut, no specific vendor was “excluded” and PP was not even mentioned in the legislation. Only because PP did not offer continuing, comprehensive care, that business would effectively be cut out.

The Obama Administration took great offense at our State’s attempt to take care of the whole woman and refused all Family Planning Title X money for Texas Medicaid.

Instead, Obama intervened to specifically direct $13 Million of Title X funds to a private organization,the Women’s Health and Family Planning Association of Texas (“WHFP”) which funds only Title X clinics, almost all of which are now Planned Parenthood businesses), so no money was lost even at PP.

The State Health Services no longer managed those Medicaid matching dollars once allowed by a special Medicaid waiver. Instead, State funding for the Family Planning programs and the Texas Women’s Health Program, was replaced by State dollars and directed toward programs and doctors that offer continuing, comprehensive care, such as Federally Qualified Health Centers (FQHC), State, County and local clinics and hospitals, and fee for service doctors that participate with Medicaid. Women could be diagnosed and treated for a much broader spectrum of health problems and their families were welcome at the same clinics.

Senator Jane Nelson, Chair of the Senate Finance Committee and sponsor of the Bill, objects to the implication by the NEJM that the authors were writing on behalf of the State. In her letter to the Executive Commissioner of Texas’ Department of Health and Human Services, Chris Traynor, Senator Nelson noted,

“This study samples a narrow population within the Texas Women’s Health Program (TWHP) — which represented only 33 percent of the overall number of women enrolled in our women’s health programs in Fiscal Year (FY) 2014. This ignores hundreds of thousands of women being served through the Expanded Primary Health Care Program; the Family Planning Program; and the 628,000 women of child-bearing age receiving full Medicaid benefits, 75 percent of which received contraceptive services in FY 14. Women often rotate in and out of our state programs, so we must look across our entire system to determine whether we are truly meeting their needs. Just because a claim for service was not submitted to TWHP does not mean a woman went without that service.
The study also creates an impression that fewer Texas women are accessing long-acting reversible contraceptives (LARCs). That’s simply not true. Across our state programs, there were more claims for LARCs in FY 2014 than there were in FY 2012 when Planned Parenthood was still a provider.”

In other words, women with private insurance and women who never had access to PP had similar numbers.

And another thing: Potter, a sociologist at UTAustin and the co-author quoted above, was the one who told the LA Times that,  “It’s not like there is a large, over-capacity of highly qualified providers of effective contraception out there just waiting for people to show up.”

On behalf of Texas’ Family Physicians, OB/Gyns, Pediatricians and Internists who accept traditional Medicaid and who had been unable to access the money in those competitive Title X grants awarded to PP, I’d like to inform him that yes, we have been waiting – for a chance to offer our patients this care.

But other than that ….

Human rights for this class of persons?

How human is human enough for human rights?

Justice Taney on slavery, in the ruling on the Dred Scott case:
“”

The question before us is, whether the class of persons described in the plea in abatement [people of Aftican ancestry] compose a portion of this people, and are constituent members of this sovereignty? We think they are not, and that they are not included, and were not intended to be included, under the word “citizens” in the Constitution, and can therefore claim none of the rights and privileges which that instrument provides for and secures to citizens of the United States. On the contrary, they were at that time considered as a subordinate and inferior class of beings, who had been subjugated by the dominant race, and, whether emancipated or not, yet remained subject to their authority, and had no rights or privileges but such as those who held the power and the Government might choose to grant them. “

Nevertheless,  today’s Supreme Court hearing didn’t deal with the question of whether the zygote/embryo /fetus is human enough. It dealt with the regulations for abortion businesses and the doctors who work for them. These are essentially the same rules imposed on Federally Qualified Healthcare Centers.

Doctors must offer continuing care and the buildings should allow safe egress and sanitary standards of care.  The challenge is against State protections for the women who have chosen abortion.

Posted from WordPress for Android. Typos will be corrected!

Death Politics

Someone named Rich DeOtte has written a Facebook piece attacking friends of mine. Rich mocks Dr. Joe Pojman as “a rocket scientist” and “knucklehead” (needless to say, that’s not popular in the Nuckols household) and takes a slap at Kyleen Wright, of Texans for Life Coalition and the Texas Medical Association.

Dr. Joe Pojman, Ph.D., is indeed a “rocket scientist,” who gave up his original career path of aerospace engineering to sacrifice as founder and Executive Director of Texas Alliance for Life, an organization I’m proud to support and serve as a Board member.

Joe wrote the op-ed that Rich attacks in direct response to the “misrepresentations” in another, political op-ed piece by Emily Kebedeaux Cook on the Texas Right to Life Website. Joe only wrote about issues, and did not engage in name calling or derision. The only reason Emily and TRTL are mentioned is because she’s the author of the political opinion piece about the “decline in the Texas Legislature’s efforts to protect human Life.”

As Joe points out, the very document to which Emily refers refutes her position: Texas was named one of three “Life List All-Stars” for 2016 by the Americans United for Life.

Joe laid out the case that our Texas Legislature’s pro-life laws are most definitely not at a standstill: we are ahead of the Nation. Joe’s position that Texas leaders gave us many successes in the 2015 84th Legislature is supported by the similar list of “Wins” reported by the Texas Catholic Conference, representing the Bishops of Texas. In an earlier letter, TCC notes that many of the criticisms Emily makes in her February 8th blog post were not previously scored “equitably” by TRTL. For instance, Senator Bob Deuell received no credit for authoring much of what became HB2.

In fact, Texas’ Legislative leadership in passing pro-life laws is why many of us are going to Washington, DC on March 2nd to bear witness when the Supreme Court hears testimony on the abortion facility regulations in HB2.

Emily and Rich focus most of their criticism on the efforts of pro-life groups, including doctors like me, to reform end of life care and the Texas Advance Directive Act (TADA). Session after session since it was passed, we in the pro-life community have had our efforts repeatedly blocked by the “death panel” accusations Rich makes and the demands in Emily’s op-ed.

I was one of the doctors appointed to the Texas Medical Association ad hoc committee that evaluated last sessions’ end of life Bills for TMA approval. Our group of doctors agreed to and helped fine tune HB 3074, what Emily called a “modest protection”: prohibiting the removal of Artificially Administered Nutrition and Hydration, including food and water by invasive medical methods like IV’s and “Total Parenteral Nutrition.” We were called anti-life and pro-“death panel” (Rich’s words) for including medical exceptions for the rare circumstances when the patient can’t process the AANH and/or when it actually caused harm.

Those “three strongest Pro-Life bills” that Emily mentioned were included in the “Wins” listed by the TCC. The Bills not only would have forced doctors to continue to indefinitely perform acts that we believe are not medically appropriate as long as a patient or his family demands it. They would have forced all disputes between the doctors practicing medicine and patients or their families into court and add “liability”(civil and criminal penalties) for the doctor.

Forget if you can, that if all disputes go to court judges would be required to determine medical care – to practice medicine – probably based on the testimony of dueling, paid medical expert doctors. Malpractice rates will go up for doctors taking on the most vulnerable patients – the elderly, the trauma victims and the victims of cancer. Those doctors will spend more time in courts, rather than in the ICU. And so will more grieving families.

We found out what happens when malpractice goes up in Texas, before tort reform was passed. Because of the malpractice crisis, there were no neurosurgeons west and south of San Antonio and Houston – none at all in El Paso or all of South Texas. We were losing obstetricians and family doctors willing to deliver babies and offer prenatal care, all over the State.

I don’t know how to translate past physician shortages directly into the possible shortage of doctors providing end of life care. However, I will predict that fewer family doctors, internists, pulmonologists and the ICU intensivists will be able to afford to practice in the ICU. Just as a patient had to be flown to Dallas, San Antonio or Houston from most of Texas for a head injury, only the tertiary medical centers in those cities will be able to staff their ICU’s properly.

Physicians, not hospitals – and certainly not courts – practice medicine in Texas. Doctors must be allowed to practice medicine according to our medical judgment, which is a combination of education and experience, under the watchful eye of the community; not “death panels,” but fellow physicians, nurses, ethicists, lawyers (who may be any of the former) and lay people. In the end, if you force the hands and minds of doctors against their judgment, you will end up with doctors practicing without judgment, and humans with inalienable rights forced to act against our will and in violation of our conscience.

And, now, back to Rich’s Facebook post. Think twice when you read political posts full of  personal attacks and name calling. We should be able to discuss politics without, as Emily said in her blog post, “unnecessary, vicious, and vindictive fights inside the Republican Party.”

Edited to fix a name glitch – BBN

“Inaccurate and misleading” (Cruz attacks on Rubio)

At the Faith and Family conference, Senator Ted Cruz claimed that Senator Marco Rubio had not supported the defunding of Planned Parenthood by not voting against the annual budget vote in September, 2015.

I don’t know if most of my readers can understand what a big step it is for a group like National Right to Life to enter into this political debate between pro-life candidates. However, this accusation was enough to cause this statement to go out, as reported by Andrew Bair, @ProLifePolitics :

https://mobile.twitter.com/ProLifePolitics/status/698321269687775232/photo/1

“The following may be attributed to Carol Tobias, president of National Right to Life:tobias feb 2016

“Marco Rubio voted to defund Planned Parenthood before Ted Cruz ever got to the U.S. Senate (see roll call on H. Con. Res. 36, April 14, 2011). Since Ted Cruz joined the U.S. Senate, both he and Sen. Rubio have voted the same on every roll call that National Right to Life regards as pertinent to defunding Planned Parenthood. To suggest that Rubio voted wrong or missed meaningful votes on the Planned Parenthood issue is inaccurate and misleading. National Right to Life is pleased that all of the major Republican candidates for president, Sens. Rubio and Cruz included, have stated that, if elected, they would work to derail Planned Parenthood’s government gravy train. “

News: “U.K. Scientists Given Green Light To Edit Human Embryos” | IFLScience

http://www.iflscience.com/health-and-medicine/uk-scientists-given-green-light-edit-human-embryos

Cute. We’re assured that it’s still illegal to implant these “edited,” engineered embryos – but until now, it wasn’t legal to edit them! See the pattern?

The experiments are only supposed to only  use “surplus” embryos conceived by in vitro fertilization. Next will come the argument that embryos should by designed “from scratch” as a couple’s right (or group marriage partner’s rights.

The only embryos that will be helped as a result of this line of experimentation wold be extracorporeal embryos that are to be edited, themselves! Job security for the experimenters, perhaps.

We can be sure implantation will happen, moving closer to “designer babies.” Lots of science fiction has often dealt with the good and bad, the intended and unintended consequences of “editing” the humans or transhumans we conceive.

The unintended consequences can’t be known, but we can know that they will occur. And yet, that child of tomorrow can’t consent, his or her contemporaries can’t consent and their off spring certainly can’t consent.

The nascent  human once again unquestionably becomes the means to another’s end, rather than an end in himself.

Yes, someone will point out that  many or even most parents may have children for their own purposes other than to truly become one with their spouse or to reproduce and pass on their genes. The mere fact that anyone can contemplate “spare” or “excess” human beings is proof of that. (And don’t forget the “unwanted” child the abortion advocates constantly remind us of.)

Will there be a money-back guarantee for the “failed” comodified child?  Will those future generations think better of us than we regard past efforts at breeding a better human? Let’s hope that if we live among them, they tolerate us!

Lawyers, politics, and end of life

      Two days before Christmas, 46 year old Chris Dunn died in the ICU at Houston’s Methodist Hospital. Almost everything you’ve read and heard is a deliberate, political skewing of the facts.

Texas Right to Life turned Mr. Dunn’s imminent death from metastatic pancreatic cancer into a crusade against the Texas Advance Directive Act (TADA or the Act). The Act is invoked by the attending doctor – not the hospital or ethics committee – when family members demand that he or she perform acts that go against the conscience because they are medically inappropriate, causing the patient to suffer without changing his course.

In this case, the mother and father disagreed with one another about the care plan and the patient was unable to make legally binding decisions. The father agreed with Mr. Dunn’s doctors that the treatment was causing suffering, objected to surgery to place a tracheostomy, and wanted hospice and comfort care. The mother wanted dangerous, painful procedures performed that would not change the medical outlook except to possibly hasten death.

And, unless you read the court records, you wouldn’t know that the judge ruled that Chris was not mentally competent to make his own medical decisions, that the hospital never wanted guardianship and had voluntarily promised to continue care until the guardianship could be settled.  In fact all the lawyers, including the Texas Right to Life representatives,  signed off on an agreement acknowledging this promise on December 4th.  Abatement agreed Dec 4 2015 ( The official court records are available to view free of charge online at the Harris County District Clerk’s website as protected pdf images. See Family case number 2015- 69681.)

Inflammatory headlines falsely claimed that “the hospital” had imposed a “death sentence,” and was actively trying to kill Mr. Dunn by refusing to diagnose, treat or even give a prognosis.  That same blog post mentioned non-standard treatments that some in the family were demanding.

First of all, of course there was a diagnosis. Several, in fact. From the signed affidavit of Mr. Dunn’s attending physician, filed December 2, 2015 in response to the law suit:

“Based on my education, training, experience, as well as my care of Mr. Dunn, I, and members of my team, have advised his family members that Mr. Dunn suffers from end stage liver disease, the presence of a pancreatic mass suspected to be malignant with metastasis to the liver and complications of gastric outlet obstruction secondary to his pancreatic mass. Further, he suffers from hepatic encephalopathy, acute renal failure, sepsis, acute respiratory failure, multi-organ failure, and gastrointestestinal bleed. I have advised members of Mr. Dunn’s family that it is my clinical opinion that Mr. Dunn’s present condition is irreversible and progressively terminal.”

The primary diagnosis was metastatic pancreatic cancer. The cancer was a mass that blocked the ducts and blood vessels coming from the liver as well as the normal function of the intestines. As liver excretions backed up into the liver and the blood pressure in the liver increased, Mr. Dunn suffered a life-threatening gastrointestinal bleed, fluid buildup in the abdomen and lungs, and sepsis (an overwhelming infection). All of these would aggravate respiratory failure, the necessity  of a ventilator and lead to the kidney damage. Liver failure often results in hepatic encephalopathy  and variable delirium.

There was definitely treatment given, including tube and IV feedings, antibiotics, the ventilator, and periodic removal of the abdominal fluid. Again, this was all publicly documented in Court documents, in the media and even on the Texas Right to Life blog that claimed that “Houston Methodist has invested no time or effort in Chris’s health, instead exerting their energies into trying to kill him instead.” [sic]

The Intensive Care doctors as well as the Biomedical Ethics Committee, met with the parents to explain Mr. Dunn’s condition and his prognosis. The family was given notice before the Committee hearing and met with the (not at all “nameless” or “faceless”) Committee to discuss their (differing) wants. Thirty days’ worth of medical records, a hospital case worker and assistance in finding alternative care were made available to the family.

Then, there’s the complaint about the limits on visitors and videotaping. It is not unusual to limit Intensive Care Unit visits to specific times and to allow only close family, especially when the patient can’t consent and there is contention among family members. It is certainly standard to prohibit filming in the Unit, since patients are visible from one area to the next, in various states of undress and undergoing constant or frequent *intensive* treatments.

(BTW, one of the lawyers in the TRTL ICU video proves the basis for the rules: he is not compliant with the usual isolation procedures. Former Senator Joe Nixon didn’t wear the protective gown at all correctly, risking the introduction of infectious contamination into the room and/or taking germs home with him.)

It’s very unusual for patients on a ventilator to be conscious because of the severe discomfort associated with the foreign body – the breathing tube – that is necessary in the airways. It’s difficult to believe that anyone would complain about sedating Mr. Dunn in order to bypass his gag reflex.

Finally, the standard of care in advanced metastatic pancreatic cancer is pain relief and palliative support. The surgery to remove a pancreas is extremely dangerous for even healthier patients. As Mr. Dunn had already had an episode of bleeding and both liver and kidney failure, it’s likely that even a biopsy of the pancreatic mass or liver, much less surgery, would have caused more life-threatening bleeding. With liver and kidney damage, he wouldn’t have been able to tolerate trials of radiation or chemotherapy, either.

In fact, the doctors and nurses gave excellent treatment all along, as shown by his survival beyond the average for patients who presented in such a precarious state and acknowledged by Mrs. Kelly in her statement after Chris’ death.

The truth is that Methodist never made plans to “kill” Mr. Dunn. Mr. Dunn was never in danger of the hospital “pulling the plug.” The real problem was a disagreement between Mr. Dunn’s divorced parents over who would legally make medical decisions. That rift is bound to have been made worse by TRTL and the lawyers turning Chris’ illness into a public political battle. The accusations about euthanasia, killing and murder may cause other future patients harm, if they are reluctant to seek care because of these stories.

VA frauds sent to Phoenix instead of Prison !

thiefThe Veterans Administration demoted two women who defrauded the agency and manipulated other employees, to cost the agency $274,000 and $129,000. The agency also rewarded a woman who covered up malpractice with a promotion! None of the women were prosecuted. No one  demanded restitution! Instead, they kept their jobs and at least two were sent to work at the already-corrupt Phoenix VA hospital system.
From the Washington Examiner:

“. . . The VA’s watchdog found officials had used the program to get around prohibitions on giving raises to employees.

“Graves, who allegedly pressured another VA official to transfer so she could take his job, was reassigned to the Phoenix VA hospital, where a national scandal involving a cover-up of patient wait times erupted last year.

“The same day the VA announced it would not fire Rubens and Graves and instead shuffle them around within the agency, the VA also announced it had named a scandal-plagued official from the Vermont facility to run the Phoenix hospital.”

So, THAT’S the meaning of “good enough for Government work!!!

“Duty” to use human tissue?

Robbins smoking fetal researchWe should at least have as much care for the donation of tissue from aborted human fetuses and embryos as we do for the donation of organs from those killed by capital punishment. Both scenarios involve purposeful intervention to cause death and the collection of tissues, at least, must be carried out by licensed and regulated medical personnel.

Robin Alta Charo (a law and ethics professor at the University of Wisconsin) has an opinion piece in this week’s New England Journal of Medicine, “Fetal Tissue Fallout.” in which she claims that society has a “duty” to use tissues harvested after elective, intentional abortions.

I object to the idea that society has a “duty” to make use of the end products of either procedure. Both scenarios involve purposeful intervention to cause death by licensed and regulated medical personnel, making those of us who vote for the legislators who write laws complicit in the actions, at least remotely. Under a strict philosophy of ethics based on the protection of inalienable rights, each act should be weighed individually and should only be carried out when the one killed is a proven danger to the life or lives of others.

Robin justifies her elevation of the use of fetal tissues after elective abortion to that of a “duty” by citing past benefits of research using fetal tissues. She is more political and names past Republican supporters in an earlier op-ed, published in the Washington Post on August 4th.

Yes, society has benefited from these tissues.  However,  that picture at the side of this post depicts Dr. Frederick Robbins, one of the scientists who utilized fetal tissue in the 1950’s development of the Salk polio vaccine. Dr. Robbins is depicted smoking at work in the laboratory, while handling test tubes without gloves. We know better than that, now.  Isn’t it time that science and medicine researchers catch up with our knowledge that the human fetus is a human being from the moment of fertilization?

Where are the Ethics Review Boards that monitor for the unethical behavior we’re hearing about in the videos from the Center for Medical Progress?

In 2013, the science journal, Nature, published an article covering the history and evolution of informed consent and compensation for donors of human tissues, including the fetal tissue culture, WI-28.  Ms. Charo was quoted as supporting monetary compensation:

But, says Charo, “if we continue to debate it entirely in legal terms, it feels like we’re missing the emotional centre of the story”. It could be argued, she says, “that if somebody else is making a fortune off of this, they ought to share the wealth. It’s not a legal judgment. It’s a judgement about morality.”

Yes, “It’s not a legal judgment. It’s a judgement about morality.”

Regulate anti-vaccine docs?

syringe justiceWe may not ever solve the problem of an irresponsible tabloid press and sensation-seeking media, since the freedom of speech is too important to infringe.  But we do have power over those we license as physicians.

Dr. Walt Larimore enters the vaccine debate in his blog, not by suggesting forced vaccination, only the regulation of physicians. I wouldn’t support the recommendation without some leeway — I’m certainly not going to approve of every vaccine without a time trial in this very diverse lab that is the United States.

However, Dr. Larimore and his guest author, Dr. Russell C. Libby, are right to raise the ethical and medic0-legal responsibility of physicians who are licensed by the State and who advocate against good science and medical standards.

 

From the article:

“State medical boards must decide if the actions of healthcare practitioners who advocate against vaccination and undermine the public health efforts of their communities warrant investigation and intervention. There are a number physicians and other licensed healthcare professionals who trivialize and discourage immunization, whether it be for philosophical, financial, or self-promotional reasons.

“When the patients they influence contract preventable disease and have bad outcomes or they cause the spread to a vulnerable population, they should be held liable for malpractice. If it is in the midst of an outbreak or epidemic, medical boards need to sanction or suspend licenses.”

 

I’ve spent quite a bit of time — especially over the last week – attempting to educate interested people (including a family member) about the safety and usefulness or efficacy of vaccines.  My motto for these arguments has always been that, “Truth will out,” and, “If we’re right, we should be able to teach and convince.”

However, within the last week, an irresponsible Texas radio host trotted out the discredited and un-licensed doctor who fabricated the MMR/autism fraud and a Canadian newspaper published a hit piece on Gardasil. (You can find them easily on Google – I won’t give them “hits” from my page.)

When licensed physicians – men and women who should know better – spread demonstrable lies, even after being found guilty of fraud or when demonstrably spreading harmful misinformation, there should be consequences.

Boards of Family Medicine and Pediatrics in Collusion?

You’ve got to see this! From the blog, rebel.md:

“The same boards that treat doctors like criminals during our “secure board examinations” blatantly copy each other’s press releases. They’re more than “fellow members of the community of medical boards”, they’re in collusion against their own diplomats. Each board claims they are independently responding to their individual specialties, but they are clearly well-organized as a single entity against us. I’m not sure what the CEO of the ABP does for that $1.2 million salary, but writing original press releases doesn’t appear to be within his scope.”

You’ve heard it said that Doc So-and-So is “Board Certified,” right? That means that he (or she) has taken a test or two – the Board exams for his (- assume I’ve said, “or she,” from now on) specialty  – and maintains a certain level of credentialing and Continuing Medical Education (CME). While not mandated by law, in many cases, it’s a necessary hoop through which to jump if a doc plans to get hospital privileges or insurance contracts.

For Family Physicians, that used to mean that we took 50 hours of CME each year and re-took our Boards each 6 or 7 years. (The “security” around those “secure board examinations” became so onerous that I was fingerprinted several times on the day I took my third set: Once on entry to the exam room, once when I returned from lunch and then when I returned from a trip to the bathroom. They graciously supplied facial tissues, since we weren’t allowed to bring in our own into the room. In fact, we were required to place purses, wallets, etc., in a locker during the exams!)

Over the last 7 or so years, the American Board of Family Physicians has phased in a convoluted system of make-work and extra tests to assure our “Maintenance of Certification” or “MOC.” (Believe it or not, that’s a trademarked name, belonging to the American Board of Medical Specialties, the overlord of all Certifications.) It’s expensive and time consuming and frankly, is of no practical use other than as a source of the CME, which we were getting anyway.  That didn’t stop the Boards from attempting to convince the Feds that our licenses and/or pay should be tied to their certification.

And the profit is a big deal. MOC is a great source of revenue for the Boards, which used to only receive our $1000 or so when we took the Boards. Now, they make much more.  In 2010 (according to the latest tax form I can find), the ABFM took in $24Million from family docs, paid the President of the Board just shy of $800,000, socked away $12M in “excess” revenue, and has over $72 M in assets. Family docs who work hard don’t earn 1/4 of what Dr. Puffer is paid.

Many of us refuse to play any more. When I resigned from the American Academy of Family Physicians, I decided to drop the pretense of Board Certification, also.  The MOC process was impossible for my practice as a locum tenens, working in other doc’s offices.

And I’m not alone in my dissent. See Dr. Charles Kroll’s video on the corruption within the American Board of Internal Medicine (ABIM), here,  and the letter from Dr. David D Fitzpatrick at the Authentic Medicine blog.

Well, the ABIM, unlike the ABFM which jumped on MOC before all the other specialties, sort of heard its members and has pledged to hold its fees stable (and struggle along on $43 Million a year in revenues) and delay a couple of requirements. The ABIM even apologized!

Well (again), the ABFM and the American Board of Pediatrics  (ABP) certainly heard that! And they evidently were in the same meeting when it happened. How else to explain the fact that each sent out nearly identical letters to their members, including 120 matching words in phrases from 9 to 31 words long?

Plagiarism?

 

 

 

“How Government Killed the Medical Profession”

Contrast the Hippocratic ethic in which a physician recommends treatment to his patient, based on his best medical judgement in the patient’s interest, with that of the “veterinary ethic,” where decisions are made by the “payor” — or owner. Now, consider the effect of Government regulations which arbitrarily force doctors to learn protocols and guidelines (rather than adjust to the patient’s course of illness), to fit a patient’s illness into International Clinical Diagnoses (out to the nth decimal place) and which withhold payment when a patient becomes ill enough to need readmission to the hospital within 30 days of the last admission.

In an article published online by Cato, Dr. Jeffery Singer lays out the history of the destruction of Medicine as  a profession. In the past, Dr. Singer described the ethical transition toward the “veterinary ethic.”

Each of these articles is worth your time and consideration. The first article gives one of the best explanations of the Government move to “coding” of medical diagnoses in exchange for payment “reimbursement,” on through the forced move to Electronic Medical Records without evidence that patients will benefit and Accountable Care Organizations which assign patients to employee “providers.” The second, earlier article, reviewed the necessary change in medical ethics to allow doctors to practice without – or in contradiction to – their conscience.

Forget patient autonomy, long elevated by the lawmakers, lawyers and  Ph.D’s (in the name of “Bioethics”) above the traditional physician Hippocratic values of beneficence and its foundation, non-maleficence. In the world of Government medicine, your life is in the hands of the “payor:” the Golden Rule of “He who has the gold makes the rules.”

 

 

 

NEJM admits “ObamaCare” isn’t “Affordable” without subsidies

The New England Journal of Medicine has some free articles you might want to read this week. (I’m afraid you will have to register – will you let me know if you do?)
The first asserts that we’re stuck with ObamaCare – but it calls ObamaCare, “ObamaCare.” The author, Jonathan Oberlander, Ph.D, also acknowledges that the only way the ACA (the Affordable Care Act) is “Affordable” is if the Federal government hands out cash subsidies. In fact, if the Supreme Court rules that the language of the law forbids subsidies in States that don’t have their own exchanges,

Here’s an excerpt:
“The calendar cannot be turned back to 2009. The ACA has made some irreversible changes in U.S. health care.

“Even if they have unified control of the federal government in 2017, Republicans will confront the reality that Obamacare has redefined U.S. health policy and the terms of the debate. In practice, future repeal legislation would probably not scrap the whole ACA, but rather remove specific provisions and remake other policies to conform to a more conservative vision. A Republican President could, through waivers and other means, undermine Obamacare in important ways, but he or she could not eliminate it.

“The Supreme Court’s decision to hear a case (King v. Burwell) challenging the legality of providing premium subsidies in federal exchanges is crucial to the GOP precisely because the chances for legislative repeal of Obamacare are so remote. The Court can seriously damage the ACA in a way that congressional Republicans cannot. A decision to prohibit subsidies for helping the uninsured to purchase coverage in the 34 states that have federally run exchanges would destabilize the health insurance marketplaces and unravel the individual and employer mandates in those states, exacerbating the already large disparities in insurance coverage among states. It would cause both a sizable increase in the uninsured population and sizable losses for the insurance industry and medical care providers as millions of Americans lost their health coverage.  Such a ruling could, in turn, produce enormous pressures on affected states and Congress to adopt measures to stave off those outcomes. Yet the ACA’s shaky political foundations would complicate policymakers’ responses, and Obamacare’s opponents would be emboldened to resist any fixes. A ruling against federal subsidies could have a spillover effect, dampening the chances for Medicaid expansion in some states. (Emphasis mine)

 

The ACA appears to be on track to destroy the financing of health care in our country, whether or not it is fully implemented.

 

The Ethics of Quarantine

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed . . .”

Yes, I’m using the Declaration of Independence to explain the ethics of quarantine. In fact, I suggest that the inalienable rights to life, liberty and “the pursuit of happiness” actually requires that a “just government” quarantine people who endanger the life of others, while doing as much as possible to preserve the rights of those who are quarantined.
The threat of the Ebola virus has spurred the discussion about quarantine in the United States, due to the high mortality rate of the disease. We’ve forgotten the quarantines of the past and most people are unaware of the existence of Presidential Executive Orders concerning formal lists of “Quarantinable Diseases.”
Inalienable or fundamental rights are negative rights. Consider the proverb that “Your (inalienable) right to swing your fist ends at my nose.”
Negative rights are limited to prohibiting action, in contrast to positive rights, which would force others to act for our benefit. That means that we have the right not to be killed, enslaved, or coerced into acts by others – you have the right to swing that fist as long as you don’t hit anyone else by intention or accident.

However, when a third party’s action or negligence threatens to infringe on our fundamental rights we have the right to protect ourselves and our fellow citizens, in the form of government, have a duty to assist us.
This protection should involve the use of the least force possible, for the least time possible, and we must take care not to become guilty ourselves of unnecessarily infringing the inalienable rights of others by abusing the government enforcement of quarantine. When government acts to limit the liberty of people by quarantine, it is imperative to ensure that there is a real threat to the lives of others, to limit the time of quarantine to the time the person is a possible threat, and to protect the lives of those people by providing food, shelter and medical assistance for those who can’t provide for themselves.
Not only is it ethical to implement restrictions on people coming to this country from areas where the disease is epidemic, it is the duty of government to protect the right to life of our citizens by implementing procedures for involuntary quarantine within our borders.

The Insider – FeatureID 383

Read this article for a history (you probably don’t know about)  of the many attempts and failures in healthcare reform over the last 20+ years.

In 2001, Rep. Bill Thomas (R-Calif.), chair of the House Ways and Means Committee, brought a tax credit bill to the House floor and passed it over objections of congressional liberals favoring Medicaid expansion. In the Senate, however, Majority Leader Tom Daschle (D-S.D.) blocked the tax credit bill twice. Nonetheless, as a political matter, conservatives were playing offense on health care policy for the first time in memory. While small, the proposal was a psychological victory for those who wanted to fix health care with more free markets.

via The Insider – FeatureID 383.

I say “fertilization,” you say “conception”

Forty years ago the words “fertilization” and “conception” meant the same thing to doctors, lawyers, and embryologists alike: the joining of the 23 chromosomes in the sperm with the 23 chromosomes in the oocyte (“egg”) to form a new complete, unique human organism. “Contraception” was defined as any method that worked before the existence of the embryo by preventing fertilization. These were the hormonal treatments and devices that prevent ovulation of the egg and condoms, diaphragms and sterilization that serve as “barriers” between the sperm and egg.   Drugs and devices that may or may not end the life of the embryo after fertilization were legally and correctly called “abortifacients.”

 

However, legalized abortion and the ability to accomplish fertilization through in vitro methods led to new legal definitions of “pregnancy” and “conception” as beginning at implantation rather than fertilization.   Even in vivo, healthy human embryos in healthy mothers were deprived of legal protection as human beings for at least the first 5 – 10 days of their lives, the window of opportunity for implantation when the developing embryo grows to hundreds of cells organized in 2 or 3 recognizable tissue layers and interact with the mother’s body in ways that may affect the timing of birth or risk of diabetes and other health concerns. Possible abortifacients that work after fertilization but before implantation were redefined as “emergency contraception.”

 

In spite of what you may have heard on the news, the June 30, 2014 Burwell v. Hobby Lobby decision by the Supreme Court of the United States (SCOTUS) didn’t deny birth control for anyone. Everyone may still purchase his or her own FDA-approved birth control.  SCOTUS simply ruled that the government can’t force some employers to buy things that they believe are immoral.

 

In fact, Hobby Lobby only asked to be exempt from purchasing insurance plans that paid for specific drugs and devices used for “emergency contraception.” Before the passage of the Affordable Care Act (“ObamaCare” or ACA), the company purchased insurance that included true forms of contraception, including,

  • Those that prevent ovulation by preventing the normal ups and downs of the hormones estrogen and progesterone, such asBirth-control pills with estrogen and progestin (“Combined Pill”),Birth-control pills with progestin alone (“The Mini Pill”),Birth control pills (extended/continuous use), Contraceptive patches, Contraceptive rings,Progestin injections, andImplantable rods

and

  • Those that act as “barriers” to fertilization by preventing the union of sperm and egg: Male condoms, Female condoms, Diaphragms with spermicide, Sponges with spermicide, Cervical caps with spermicide, Spermicide alone, Vasectomies, Female sterilization surgeries, and Female sterilization implants.

The problem is that regulations written by the Obama Administration mandated that all insurances pay for all pregnancy “preventatives” approved by the FDA, including drugs and devices that may function after fertilization to end the life of the new human embryo:

  • Pills that mainly delay ovulation but may impair implantation and development of the placenta if fertilization takes place, such as over-the-counter Plan B and generic levonorgestrel tablets, and ella, which requires a prescription, and
  • Devices that mechanically and hormonally make the uterus inhospitable to implantation by the embryo, such as intrauterine devices like the copper-T, Mirena, and ParaGuard. These are inserted up to 5 days after unprotected intercourse to prevent implantation and then left in place to prevent fertilization and implantation for as long as 5-10 years.

 

 

Although the words we use do not change the fact that the human embryo is the same human life before implantation as after, they can change his or her legal status.

 

 

 

 

 

Wider impact of Hobby Lobby ruling? : SCOTUSblog

Remember, no one is forbidden to buy anything.  However, the US Government will not force people or their companies to pay for devices and drugs they believe are immoral.

 

The Affordable Care Act regulations issued by the federal government, however, required twenty different preventive methods or services, including sterilization and pregnancy counseling. Depending upon how lower courts now interpret the Hobby Lobby decision, companies that fit within the Court’s “closely held company” bracket and offer religious objections could be spared from having to provide any of those services through their employee health plans.

In three cases in which a federal appeals court had rejected the challenges to the mandate, the new Supreme Court orders told those courts to reconsider, applying Monday’s decision. The companies or their owners had taken those petitions to the Court.

On three petitions filed by the federal government, involving appeals court rulings rejecting the challenges by corporations. their owners, or both, the Justices simply denied review.

via Wider impact of Hobby Lobby ruling? : SCOTUSblog.

Protect the Privacy of Your Medical Records |

I’ve had privately insured and Medicare patients – and at least two families visiting our town from Canada – ask me to keep records about one or another history or ailment. I told them I’d do my best, but explained the legal problems with Medicare laws. Since 1997, doctors have been prosecuted for refusing to allow Medicare auditors to see everything in the office. One woman doctor was arrested for refusing to unlock a drawer in her (private?) desk.

 

And now, the IRS wants control of your medical care.

 

The confidentiality of the medical relationship and records has to be maintained or patients will not disclose the true nature of their problems. This results in harm to the patient and prevents the physician from truly helping the patient.

via Protect the Privacy of Your Medical Records |.

Do you feel male, female, American, other?

It's all in your headCan’t help worrying that I might be prosecuted for hate speech for insisting that physical evidence matters, but . . .  if a person can demand a corrected birth certificate based on his/her subjective feelings about his/her gender, why can’t an illegal alien access his/her own new birth certificate if they feel American?

And if it’s all in our heads, why make Medicare pay for surgery?

The same month that the American Medical Association voted that the physical body is irrelevant to gender, President Obama uses his pen to award physical privileges to those people who claim/decide/are born to be transgendered. But he’s doing it very, very quietly.

The latest wins came this month, when the Office of Personnel Management announced that government-contracted health insurers could start covering the cost of gender reassignment surgeries for federal employees, retirees and their survivors, ending a 40-year prohibition. Two weeks earlier, a decades-old rule preventing Medicare from financing such procedures was overturned within the Department of Health and Human Services.

Unlike Obama’s support for same-sex marriage and lifting the “don’t ask, don’t tell” ban on openly gay troops, the White House’s work to promote transgender rights has happened mostly out of the spotlight.

Some advances have gone unnoticed because they also benefited the much larger gay, lesbian and bisexual communities. That was the case Monday when the White House announced that Obama plans to sign an executive order banning federal contractors from discriminating against employees on the basis of their sexual orientation or gender identity.

In other instances, transgender rights groups and the administration have agreed on a low-key approach, both to skirt resistance and to send the message that changes are not a big deal, said Barbara Siperstein, who in 2009 became the first transgender person elected to the Democratic National Committee.

 

 

 

Sen. Deuell challenges Texas Right to Life over “slanderous” ads | Dallas Morning News

Remember: Senator Bob Duell was instrumental in convincing the medical community to adopt voluntary procedures to protect patients and families affected by the Texas Advance Directive Act, even though actual amendments to the law have been blocked by the very people attacking him.

How much “freedom” does a third party Political Action Committee have in their paid ads? Is it wrong to challenge them legally when the ads are blatantly false?

In this case, the ad opens by implying that Senator Duell is responsible for the too-short 10 day period allowed to find alternate care when the family or patient disagrees with the doctor at the end of life.

Senator Duell was not in the Senate when the Texas Advance Directive Act was passed in 1999. Members of the PAC, Texas Right to Life, were present and lobbied in favor of the Act.

In contrast, Senator Duell has for years been a strong advocate for amendments that would have increased the power of families to protect their loved ones in the case of disputes with the doctor.  The amendments would have changed the waiting period to at least a month before any disputed decisions by the doctor would take effect.

As to the challenge, Senator Duell has excellent support for his case:

The Texas Catholic Conference and Catholic Bishops of Texas, who supported Deuell’s bill, have debunked the claims. They said that Texas Right to Life “has tried to stoke fear through ridiculous claims of non-existent death panels and assertions that doctors are secretly trying to kill patients. Both claims are absurd.” The Catholic Conference also ripped Texas Right to Life for spreading “fabrications” about the position of Catholics on the issue.

via Sen. Deuell challenges Texas Right to Life over “slanderous” ads | Dallas Morning News.

American Academy of Family Physicians resignation

AAFPI wrote a very difficult letter today. I  resigned from the organization that is supposed to support Family Physicians in our education, practice management and good medical care of our patients. Instead, the American  Academy of Family Physicians too often strays toward forcing its members to be complicit with controversial policies such as condoning gun control and over-the-counter contraceptive drugs, and condemnation of “reparative therapy” for homosexual patients, even when those patients are unhappy with their sexuality. I write about my main conflicts and the “final straw” in the letter:

 

It is with great regret that I write this letter as notice that I have decided not to renew either my Texas or American Academy of Family Practice membership. While I am still a family doctor, neither the Texas Academy of Family Practice (TAFP) nor the American Academy of Family Practice (AAFP) represent my political or ethical views.

The political, social and ethical controversies were the main reason I remained in the Academy for the last few years since I left full time practice. I hoped that I could make a difference by volunteering my time and money as an active participant in the Texas Academy, the National Conference of Special Constituencies, the AAFP list serves, the Academy Legislative meetings in DC and our annual AAFP Congress of Delegates.

From the time of Hillary Clinton’s closed meetings on healthcare to the endorsement of the passage of the ACA before it was written, the political actions of the AAFP leaders has disappointed me in Washington, DC. Our practice hassle factors have grown and grown, too often with the blessings of – and sometimes due to the experiments with alternative methods of practice by – the Academy.

The AAFP advocated for elective abortion before I joined as a Student member and I accepted that the burden of persuasion was on those of us who disagreed.

However, the Academy’s decision to advocate for the redefinition of marriage in 2012 and the refusal to reconsider the extracted Resolution on marriage neutrality at the 2013 Congress of Delegates in San Diego were the final proof that there’s no tolerance for family doctors who hold conservative politics or traditional ethics in the Academy.

Unfortunately, our TAFP spokesperson to the 2013 AAFP Reference Committee on Advocacy misrepresented the Texas Delegation’s instructions from the Directors on marriage. As I remember the discussion and vote, the intention was to allow the Texas delegates wide latitude in voting on any final form of the Resolution.

I hereby resign from the Texas Academy of Family Physicians, the American Academy of Family Physicians and as a Fellow of the AAFP.

 

I waited to resign after nearly 30-year membership until the last minute before being dropped (for lack of paying my annual dues). There were several reasons for my hesitancy. For one thing, I didn’t want to be an undue influence on other members when they considered whether or not to write that hefty annual check to the Academy. For another, while I will continue to work with the AAFP and the Christian Medical and Dental Association to protect the right to life, marriage, the conscience rights of doctors within the profession of medicine and the specialty of Family Medicine, I do believe that it is important to work to persuade from within the organization. The biggest problem with finally writing the letter was that I was looking for a way to somehow keep my integrity while allowing the Academy to claim to represent me.

However, now that I’ve resigned, please consider sharing my letter with your family doctor. Many of them are unaware of the policies that our professional organizations push on good doctors of today and the students and residents who will be our doctors of tomorrow.

Fifth Circuit Paves Way for Supreme Court Showdown on Chemical Abortion Regulations | National Review Online

The Fifth Circuit pointed out that Planned Parenthood offered no real evidence to support its challenge to the Texas provision. On the other hand, the State provided ample medical evidence to support the regulation. Citing the State’s expert Dr. Donna Harrison, the court noted that the FDA approved the RU-486 regimen with restrictions, including a patient agreement that requires the woman (and the physician) to confirm that she is no more than 49 days pregnant.

Further, the court rejected Planned Parenthood’s claim that chemical abortion is necessary for some women who cannot undergo surgical abortion—noting that the abortion giant provided no real evidence for that claim. To the contrary, Dr. Harrison testified that 6 percent of chemical abortions fail and eventually require surgery, meaning that it would be medically irresponsible for a physician to administer a chemical abortion to a woman for whom a later surgical abortion might be contraindicated.

It’s important to note that the decision marks one of the most straightforward applications of the Supreme Court’s 2007 Gonzales v. Carhart decision. Citing Gonzales, the Fifth Circuit concluded that the Texas chemical-abortion regulation does not require an exception for the life and health of the woman because the group of women who allegedly “need” chemical abortions (those for whom Planned Parenthood claimed surgical abortion is contraindicated) was vague and undefined, because Planned Parenthood failed to provide any evidence that such a group of women even exists, and because, as highlighted by Dr. Harrison’s testimony, there is disagreement regarding whether chemical abortions are “safer” for these women when subsequent surgical abortion—alleged to be dangerous for such women—may be necessary.

via Fifth Circuit Paves Way for Supreme Court Showdown on Chemical Abortion Regulations | National Review Online.

Texas abortion restrictions withstand legal challenge – San Antonio Express-News

Great news. If there must be abortion, and it’s “between a woman and her doctor,” shouldn’t the doctor have hospital privileges to care for complications? Or does he cease being “her doctor” when she needs him most?

A federal appeals panel on Thursday overturned a lower court decision that had deemed a portion of Texas’ controversial sweeping abortion restrictions as unconstitutional.

A three-judge panel of the 5th U.S. Circuit Court of Appeals had already temporarily lifted a district court injunction that blocked a state provision requiring abortion doctors to get admitting privileges at nearby hospitals from going into effect.

Thursday’s ruling gives Texas the green light to continue enforcing the provision on a permanent basis.

via Texas abortion restrictions withstand legal challenge – San Antonio Express-News.

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