Beacon Broadside

Fragile Beginnings: Discoveries and Triumphs in the Newborn ICU

Half a million babies are born prematurely in the United States every year. In this gripping medical narrative, Dr. Adam Wolfberg brings readers into the complex world of newborn intensive care, where brilliant but imperfect doctors do all they can to coax life into their tiny, injured patients. As a specialist in high-risk obstetrics and the father of a child born prematurely, Wolfberg explores the profound questions raised by such fragile beginnings, both from the front lines of the NICU and from his daughter’s bedside.

His daughter Larissa was born weighing under two pounds, and he describes the precipitous birth at six months that left her tenuously hanging on to life in an incubator. Ultrasound had diagnosed a devastating hemorrhage in her brain that doctors reasoned would give her only a 50 percent chance of having a normal IQ. Through Larissa’s early hospital course, Wolfberg examines the limitations of newborn intensive care medicine, the science of “neuroplasticity,” and the dilemmas that surround decision making at the beginning of life.

Wolfberg also takes us into the lab where researchers are working to improve the futures of children born too soon. He follows a young scientist, Jason Carmel, who was inspired to study how the brain adapts to injury when his twin brother was paralyzed in an accident. Through lucid medical reporting, Wolfberg details current scientific practices and discoveries, and explores the profound emotional and ethical issues raised by the advancing technology that allows us to save the lives of increasingly undeveloped preemies.

As they make decisions about life-saving care in the first hours of a premature infant’s life, doctors and parents must grapple with profound moral and medical questions: How aggressively should doctors try to save the life of a premature baby, who will be severely neurologically and physically impaired? What might that child’s quality of life be like after millions of dollars are spent on her care? Wolfberg traces the fits and starts of the physicians, government policy makers, and lawyers who have struggled over the years to find the best way to make these wrenching decisions. Written from Adam Wolfberg’s unique experience as a reporter, as a medical specialist and researcher, and as the father of a prematurely born daughter, Fragile Beginnings lays bare the struggles, discoveries, and triumphs of the newborn intensive care unit.

Read a review of Fragile Beginnings in the Boston Globe.

Read Adam Wolfberg's blog at Huffington Post.

Read Chapter 1 of Fragile Beginnings on Scribd.

Watch the book trailer on YouTube.

Gone Too Far? Reproductive Politics in the Time of Obama

Roe v. Wade was decided on January 22, 1973, making it thirty-nine years old this weekend. In today's post, Carole Joffe looks at how the abortion debate remains one of the hot-button political issues in America today. Joffe is a professor emerita of sociology at the University of California, Davis, and a professor at the Bixby Center for Global Reproductive Health at the University of California, San Francisco. She is the author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us, Doctors of Conscience: The Struggle to Provide Abortion before and after Roe v Wade, and numerous other writings on abortion provision. 

This post originally appeared in On the Issues magazine.

What about abortion gives it staying power as the central issue in domestic politics, even in the period of the worst economic situation since the Great Depression of the 1930s? This is a question well worth pursuing.

I sounded a much more hopeful note in my recent book, Dispatches from the Abortion Wars. The book was started in the administration of George W. Bush, a particularly harsh time for the reproductive justice community. I finished the book in the first months of the presidency of Barack Obama, ending on a note of "cautious optimism" about a turnabout for the fortunes of reproductive health services and particularly for the provision of abortion. Candidate Obama, after all, had forcefully voiced his support for legal abortion, and nothing -- at the time -- seemed to be worse than the endless attacks on reproductive health services (not just abortion, but family planning , sex education, condom distribution for HIV patients and more) that were a key feature of the Bush presidency.

Quoting from the distinguished historian Carroll Smith-Rosenberg's work on an earlier period of abortion conflict in 19th century America, I even speculated that we might be entering a period in which abortion and related issues would no longer be "the central drama of (our) culture." Given the devastating recession that had already become very evident around the time of the 2008 election, I, like many others, reasonably thought that the economy would in fact become the "central drama."

But very soon after the 2008 election, it became very clear that social conservatives were not going away. On the contrary, they seemed more energized than ever. It also became clear that Obama the president was not going to be the forceful defender of reproductive rights that many of his supporters, including myself, had fantasized. Indeed, as early as January 2009, in his first weeks in office, reproductive politics emerged as a factor in the stimulus debates, and the new president blinked. The President's proposal had included a modest provision that allowed states to spend more Medicaid funds on family planning. The Republican House of Representatives leader, John Boehner, publically mocked this provision, asking incredulously what "spending millions for contraceptives" had to do with "fixing the economy." The provision was quickly dropped.

And, of course, many reproductive rights supporters are still smarting over Obama's key concessions to anti-abortion forces, particularly the Catholic Church, in order to win support for his health reform legislation. By late 2011, it was still unclear whether Obama would again cave to the Church's demands for very broad exemptions to the requirement that health insurance plans, under Obama's health legislation, provide contraception without co-pays. But while that was pending, the reproductive health community was stunned when, in a clear bow to politics, the Obama Administration took the unprecedented step of overruling the head of the U.S. Food and Drug Administration and rejecting the agency's recommendation that Emergency Contraception be made available without a prescription to women under the age of 17.

How the Wedge Works

My purpose in this essay, however, is not to simply catalogue all the disappointments that reproductive health advocates have suffered in the Obama administration, an indictment that has been done very well by others. (For the record, an unequivocally positive step that has occurred in the Obama presidency is the Department of Justice's vigorous enforcement of the FACE legislation that protects providers and patients from anti-abortion terrorism, an effort that far outstrips such activity by the Justice Department in the Bush years.)

Despite my hopeful predictions, abortion has maintained its dominance as a wedge issue. This is reflected in the various bills put forward by the new Republican majority in Congress after the November 2010 mid-term election, for example the Orwellian-named "Protect Life" Act, which stipulated that hospitals did not have to offer abortions to women, even in life-threatening situations.

Similarly, in state houses across the country after that pivotal election an unprecedented number of abortion restrictions were introduced by Republican legislators, including bans on abortion after 20 weeks, which clearly violate the Roe v. Wade decision and were intended, in the eyes of many observers, to lure pro-choice lawyers into a test case that could possibly overthrow that landmark ruling. Finally, as politicians compete to be the Republican nominee in the 2012 presidential race, the ante has been raised: in this election cycle, to be acceptable to the anti-abortion base, and to compete with each other, candidates must make clear their opposition to rape and incest exceptions and declare their agreement that "life begins at fertilization."

It is actually not surprising that Republican politicians at all levels insist on keeping abortion front and center, the economic crisis notwithstanding. Abortion is not only the best arrow in these politicians' quivers, in terms of pleasing a crucial segment of the Republican base -- it is arguably the only arrow they have. The reality, as has become evident since Obama's election, is that the Republican party is tied to economic policies -- opposition to infrastructure spending, fanatical devotion to tax cuts for the most wealthy -- that will not create jobs, but, in fact, will destroy them. So abortion has, once again, as I termed it in my book, become a "brilliant distraction" from pressing social problems.

For me, the more complicated -- and fascinating -- question is: Why do voters put up with this endless assault on abortion and contraception (and the corresponding neglect of the economy)? Why, for example, is there seemingly no price to be paid by a politician who is on record as saying its okay for a woman with an ectopic pregnancy to die?

The first, most conventional, answer is that the U.S. is a deeply apolitical country, with a notoriously low voting turnout, compared to other countries. Politicians therefore can take actions that speak to the minority of voters who are deeply engaged, and be confident that the rest of the country is not paying attention. A variant on this general political apathy is that the abortion issue, in particular, has been so divisive and raucous, for so long, that voters simply tune out abortion-related political news, assuming a "pox on both their houses" stance.

In contrast, a third intriguing possibility is that the public's backlash against Right-wing overreach may, just may, finally be at hand. The recent defeat, by a substantial margin, of the "fertilized-egg-as-person" amendment in Mississippi, a highly conservative state where the measure was widely predicted to pass, is suggestive of this. Furthermore, the "defund Planned Parenthood" campaigns, avidly pursued by Republicans both in Congress and in a number of states, have polled very badly with the public. Certainly, in April 2011, when Obama refused to bend to John Boehner's demand that cutting Planned Parenthood and other family planning programs be part of budget negotiations, the president gained -- not lost -- political capital.

It is, to be sure, demoralizing from a reproductive justice viewpoint, that it takes such surreal proposals as making fertilized eggs the moral and legal equivalent of living women, and the all-out demonization of birth control, nearly 50 years after the Supreme Court decision legalizing its use, to make the American people wake up to the threats posed by the fanatics of the Right, and the cynical politicians who do their bidding. And it may well be that these extremist proposals -- rather than causing a backlash -- will make more "normal" restrictions on abortion and contraception look reasonable.

So Bad That It's Good?

But the favor that the zealots now in ascendancy in social conservative circles -- that is, those who oppose all sexual activity except procreative sex within heterosexual marriage -- may have given us is the broad sweep of their proposals. In a society that is marked by deep economic inequality, it is hardly surprising that those women most affected by the assaults on both abortion and contraception are disproportionately poor women of color -- that is, those who have the least political, as well as economic power, and who are most vulnerable to cuts in public services. The unfortunate reality is that, while many of those in the reproductive justice movement work tirelessly on behalf of these women, most in this society -- including other women who also use reproductive health services -- worry little about these marginalized women. Nonpoor women have long been able to assume that contraception and abortion will always be available, as long as one has the means to purchase them.

In that sense, the Mississippi egg-as-person amendment, and similar efforts planned elsewhere, may truly be serving as wake-up calls for the electorate. For it was not just abortions (including lifesaving ones) that were on the line -- but most forms of contraception and IVF treatments (a service that, almost by definition, implies a well-to-do clientele).

Just as the Occupy Wall Street movement has brilliantly framed the economic inequality in the U.S. as existing between the one percent of the super-wealthy and the remaining 99 percent of the population, the current battles in reproductive politics reminds us of another 99 percent -- those American women who have ever used birth control in the context of heterosexual sex. The reproductive legacy of the Obama years may well be this huge group's recognition of itself as a political community. Again, I am cautiously optimistic.

Photo of President Obama from Bigstock.

Overdiagnosed: Making People Sick in the Pursuit of Health

Out in paperback today... Overdiagnosed: Making People Sick in the Pursuit of Health

"One of the big strengths of this relatively small book is that if you are inclined to ponder medicine's larger questions, you get to tour them all. What is health, really?... In the finite endeavor that is life, when is it permissible to stop preventing things? And if the big questions just make you itchy, you can concentrate on the numbers instead: The authors explain most of the important statistical concepts behind evidence-based medicine in about as friendly a way as you are likely to find."—Abigail Zuger, MD, The New York Times

Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening.

Drawing on twenty-five years of medical practice and research on the effects of medical testing, Welch explains in a straightforward, jargon-free style how the cutoffs for treating a person with "abnormal" test results have been drastically lowered just when technological advances have allowed us to see more and more "abnormalities," many of which will pose fewer health complications than the procedures that ostensibly cure them. Citing studies that show that 10 percent of two thousand healthy people were found to have had silent strokes, and that well over half of men over age sixty have traces of prostate cancer but no impairment, Welch reveals overdiagnosis to be rampant for numerous conditions and diseases, including diabetes, high cholesterol, osteoporosis, gallstones, abdominal aortic aneuryisms, blood clots, as well as skin, prostate, breast, and lung cancers.

With genetic and prenatal screening now common, patients are being diagnosed not with disease but with "pre-disease" or for being at "high risk" of developing disease. Revealing the economic and medical forces that contribute to overdiagnosis, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, excessive worry, and exorbitant costs, all while maintaining a balanced view of both the potential benefits and harms of diagnosis. Drawing on data, clinical studies, and anecdotes from his own practice, Welch builds a solid, accessible case against the belief that more screening always improves health care.

Buy Overdiagnosed at Beacon.org | Independent Bookstore | Amazon | Barnes and Noble | Powells

Some surprising facts from Overdiagnosed.

"A Pound of Prevention is Worth a Closer Look," Review in the New York Times. 

Dr. Gilbert Welch on Thom Hartmann's Radio Show

Vulnerable Women and Contraception: The Plan B Setback

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco (however, the views and opinions expressed here do not necessarily state or reflect those of the Regents of the University of California, UCSF, or the UCSF Medical Center). This post originally appeared at RHRealityCheck.

"For a woman to 'ask her physician' for a safe and effective contraceptive  presupposed that she had a physician, that she could afford a contraceptive, and that the physician would be willing to give it to her, regardless of her marital status."

These are the words of the historian Sheila Rothman, writing about the setbacks Margaret Sanger faced in the 1920s and 1930s in trying to realize her vision of making birth control widely available to all women, including the poorest—and about the ultimate “ownership” of contraceptive services during that era by physicians. Sanger’s original vision was a fleet of clinics, to be run by public health nurses. But as Rothman and others have documented, when she attempted to open such clinics, she experienced repeated arrests and the closures of her facilities, as contraception was then illegal. In the years leading up to the 1965 Supreme Court Griswold decision, which legalized birth control for married persons, only physicians were legally permitted to provide such services, and as the quote from Rothman implies, this situation put poor women at a tremendous disadvantage.

Rothman’s critique, written in the 1970s about events in the ‘20s and ‘30s,  is remarkably relevant to today’s leading reproductive controversy: the Obama administration’s overruling of the FDA decision to allow over-the-counter status of Plan B, an Emergency Contraceptive product, for young women under the age of seventeen. If one substitutes “teenager” for “woman” and “Plan B” for “a safe and effective contraceptive” in Rothman’s quote, one can readily appreciate how, once again in America’s longstanding reproductive wars, the needs of the most vulnerable are willfully neglected.

Secretary of Health and Human Services Kathleen Sibelius and President Obama justified the Administration’s action because of concerns about pre-teens’ ability to use EC correctly. But as ha been repeatedly observed, only a tiny portion of this age group is sexually active. It is 15- and 16-year-olds who are sexually active in far greater numbers, and therefore, far likelier to have need of EC (and to be able to use it correctly). But many in this group do not have a primary health care provider to whom they can go for a prescription. Some of those who do have a relationship with a provider may be too embarrassed, or afraid of a breach of confidentiality, to ask for such a prescription.

To be sure, some things have improved in the contraceptive world since the dominance of private practice physicians in Margaret Sanger’s time. In 1970, Congress authorized the Title X program, which made federal funds available for family planning services for poor women including, notably, teenagers. (As a sign of how much the reproductive battle lines have hardened in the last 30 years, Title X was signed by a Republican president, Richard Nixon, and one of its most enthusiastic sponsors in Congress was a future Republican president, George H.W. Bush). A number of contraceptive products are available on the shelves of drugstores.

And it is no longer just physicians who can advise and dispense contraception. In public health clinics and Planned Parenthood facilities, nurses are in fact the main providers of contraception. We can hope that some portion of those teenagers who need EC can find their way to a Planned Parenthood or other Title X site in the three day window in which the drug is most effective.

But this recent decision of the Obama administration on EC occurs, of course, in an atmosphere in which Republicans in Congress are attempting to abolish Title X, and various states have defunded Planned Parenthood, leading to a closing of numerous clinics. The reproductive wars drag drearily on—and in our times, as in Sanger’s, the most vulnerable of women pay the greatest price.

 

The Other 99 Percent: Women Who Use Birth Control

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco. This post originally appeared at RHRealityCheck.

There is another 99 percent group in our country, distinct from but inextricably entwined with the now more familiar #99Percent, those everyday Americans, who--in such a brilliant framing by the Occupy Wall Street movement--are to varying degrees affected by the vast economic inequality that characterizes American society. I refer to the 99 percent of American women who have ever had sexual intercourse and have used a birth control method at least some of the time. (As per the original Centers for Disease Control report, this statistic only includes contraceptive use reported by women during heterosexual intercourse).

Contraception obviously is a deeply held value by American women. But the fact that in the United States a startling half of all pregnancies are unintended makes clear that birth control is used only sporadically by some. There are a number of reasons why this is so, but a chief one is that so many women cannot afford contraception, especially the most expensive—and most effective--methods, such as birth control pills, and long lasting reversible contraception, for example, the newer (and far safer) models of IUDs (intrauterine devices).  In short, the same economic disparities that pervade every other area of American life manifest here as well: poor women depend on publicly-funded programs for their contraceptive services, but, according to the Guttmacher Institute, only a little more than half of the 17 million women who need these services currently receive them.

This situation of tremendous inadequacy was supposed to improve considerably. In one of the best pieces of news in the otherwise embattled reproductive health world since the battles over health care reform began, the Obama administration announced last August that it would accept therecommendations of a special panel of the Institute of Medicine and include contraception—including all FDA-approved birth control methods—as part of the basic package of preventative health services that health insurance plans must offer, without co-payments.

Predictably, the August announcement has produced a massive campaign from opponents of contraception, especially the Catholic hierarchy. Though churches in fact have been granted an exemption from this requirement, the U.S. Conference of Catholic Bishops and its allies are pushing for much broader exemptions, for example  to universities, social service agencies and other institutions with a religious affiliation—even if these institutions receive public funding.  Such a move could potentially affect millions of women, of all religious backgrounds (or none), who work in such institutions.

My young friends who have been involved in the Occupy movement tell me that issues of reproductive justice have been muted, if evident at all, at the various Occupy sites. But as the occupiers put forward their vision of a just society, the old feminist dictum bears repeating: women cannot be full participants in any society unless they can control their fertility. The New York Times quotes the president of the U.S. Conference of Catholic Bishops, reporting on a meeting with President Obama, as saying the latter “was very open to the sensitivities of the Catholic community.”  President Obama, please be open as well to the tremendous struggles of women--members of both 99 Percent groups--who are desperate to control their childbearing in very harsh times. 

These groups are asking you to join them in telling the White House not to throw women under the bus:

Emily's List

Planned Parenthood Federation of America

NARAL Pro-Choice America

 

Turning the Telephones on the Anti-Choice Bullies

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco. This post originally appeared at RHRealityCheck.

“Such hypocrites! They don’t like getting unwanted calls at home!”  

In an irony that he clearly relishes, Todd Stave, a Maryland entrepreneur, is telling me about the abortion opponents who contacted him and asked that he suspend the phone campaign he initiated against them.

Stave is currently the subject of a certain amount of buzz in the abortion rights community, after his appearance on The Rachel Maddow Show. He came to Maddow’s attention  because of his innovative, some would say ingeniously simple, way of responding to harassment from anti-abortionists. Stave is the owner of the property in College Park, Maryland on which sits the clinic building rented by Dr. Leroy Carhart, a longtime Nebraska abortion provider and former associate of the late George Tiller. After Tiller’s assassination, Carhart became a leading target of antiabortion forces, especially so when he began recently began performing later abortions in Maryland. (His move was a result of Nebraska legislation, targeted specifically at him, that banned abortions after 20 weeks). Besides vociferous protests at the site of the clinic itself, abortion opponents showed up on Parents’ Night  at the middle school of Stave’s daughter. Brandishing signs with the usual mangled fetuses, as well as Stave’s name, photo and phone number, the protestors urged people to call him and ask that he “stop the child killing.”

Stave was no stranger to anti- abortion activity. His father, the late Carl Stave, was himself an abortion provider in the same community in the period immediately following Roe and was the recipient of protests as well, including a firebombing of his clinic. His son took these earlier protests quietly. But showing up at his daughter’s school was too much for him. He noted the phone numbers of those who called him and organized a group of 20 friends to call the antis back. In a polite but firm way, Stave and his circle of volunteers told the abortion opponents that Stave would not back down from the agreement with Carhart.  Moreover, Stave asked his phone support team to notify their friends and associates about this activity and to contact him if they wished to be involved.

As Stave told me, to his astonishment within several weeks some 3000 people contacted him--“from all the U.S., from Europe, from Japan, I couldn’t believe it”-- asking to help with his campaign of call backs. Those who called or e-mailed him told how outraged they were by anti-abortion tactics and how happy they were to take action. Even more volunteers contacted him after his appearance on the Maddow show.

In his most recent campaign, Stave on very short notice mobilized his network to call the leader of a Maryland anti-abortion group that was planning to protest a “Run for the Cure,” in Baltimore, sponsored by the breast cancer group, the Susan G. Komen Foundation. (The Foundation has recently been targeted by abortion opponents because of donations it gives to Planned Parenthood for breast cancer screenings). Stave, who had subscribed himself to an anti-abortion listserv under an assumed name, read of the planned action, and saw to his delight that the leader had posted several phone numbers. Plausibly, he gives his volunteers credit for the reports that the “the planned protest fizzled to nothing.”

Stave has no illusion that campaigns of this nature will end all harassment from the opposition. “About 80 percent of people will stop the harassment after being contacted, 20%, the hard-core, won’t,” he speculates.  But there is no question that his campaign has struck a nerve--both among some abortion opponents who have experienced the unpleasantness of receiving unwanted phone calls, and  also among the large  mass of people who are  “pro-choice,” but one step removed from the abortion conflict—“civilians in the abortion wars” is how I have elsewhere referred to them. The response Stave has received thus far suggests the hunger among this group to find acceptable and feasible ways to counter the excesses of the anti-abortion movement. Stave has established an organization, Voice of Choice, which is currently operating with a small, mainly volunteer staff, and which continues to sign up volunteers willing to make phone calls on behalf of those who are harassed. As the organization’s website states, “Now it’s our turn.”

Why Lies About Reproductive Health Issues Matter

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco. 

“Non-factually based statements” about Planned Parenthood and the HPV vaccine:

Sen. Jon Kyl, R-AZ.: “If you want an abortion, you go to Planned Parenthood, and that’s well over 90 percent of what Planned Parenthood does.”

Rep. Michelle Bachmann, R-MN: “I had a mother come up to me last night here in Tampa, Fla., after the debate. She told me that her little daughter took that [HPV] vaccine, that injection. And she suffered from mental retardation thereafter.”

These two statements, the first by Jon Kyl, a U.S. Senator, the second by Michelle Bachmann, a Congresswoman who is also a Presidential candidate, have each received wide public attention. Each of these statements is blatantly untrue. These statements are a disturbing reminder that the field of reproductive health is particularly susceptible to politicians playing fast and loose with the truth in order to curry favor with social conservatives.

Reproductive health services have always stirred controversy, intersecting as they do with issues of sexuality, morality, parental rights, and so on. But it was during the presidency of George W. Bush that the attacks on this aspect of health care—especially abortion care—became increasingly disengaged from the truth.

As I have detailed in my recent book, Dispatches from the Abortion Wars, the Bush Presidency was marked by scandals such as government websites being pressured to list false information on the alleged links between abortion and breast cancer, and the purported ineffectiveness of condoms. An investigation of the curricula used in federally funded “abstinence only” programs found shocking evidence that some 80% of these programs gave misinformation to young people, such as “sweat and tears can lead to HIV transmission.”

The reproductive health community hoped that with the transition to a new administration these egregious distortions would stop. And in some respects the situation has improved. In the thank-goodness-for-small-favors department, we can be gratified that government websites no longer post such gross misinformation. But clearly, as the two quotes above make clear, untrue and irresponsible statements about reproductive health matters have not gone away in public discourse.

In the case of Senator Kyl’s statement, Planned Parenthood restated its frequent claims that abortions constituted 3% of its services, not the 90% the senator had claimed. The incident concluded, to the delight of many late-night comedians, with a Kyl spokesman acknowledging that “the senator’s remark was not intended to be a factually based statement.”

In the case of Congresswoman Bachmann’s “mental retardation” claim, this statement clearly proved to be a costly, possibly fatal error for her politically. Numerous commentators, including medical authorities, pointed to the complete lack of evidence for any link between the HPV vaccine and retardation. Bachmann appeared to worsen the situation when she responded to the growing backlash by stating defensively, ”I am not a doctor, I’m not a scientist, I’m not a physician. All I was doing is reporting what this woman told me last night…”

The dangers of non-factually based political discourse

Why do these untrue statements matter? After all, presumably most people—most importantly, the millions of women who go to Planned Parenthood for contraception, cancer and STI screenings—know Kyl was massively off base. Michelle Bachmann’s statement was roundly disputed by experts and seemingly has damaged her political fortunes. Nonetheless, I believe statements like these do very much matter. The normalization of lying about health care issues by prominent figures is a very serious breach of trust, and degrades our culture as a whole.

More specifically, these statements point to two different ways in which the field of reproductive health can be weakened by such deliberate distortions. In the case of Planned Parenthood, the attacks by Kyl and numerous other politicians who have sought to demonize the Federation have created a clever rhetorical trap, where the defense becomes, as shown above, that “only 3% of what we do is abortion.” In a version of the old “have you stopped beating your wife” question, these attacks succeed in further marginalizing abortion from other reproductive health care services in the public’s eye.

The serious damage done by Bachmann’s HPV anecdote is best illustrated by a headline that appeared shortly afterward in the New York Times Science Section: “Remark on HPV Vaccine Could Ripple for Years.” The article makes clear the dismay felt in the public health community about this incident.

In simplest terms, as the author puts it, “When politicians or celebrities raise alarms about vaccines, even false alarms, vaccination rates drop.” The HPV vaccine—most effective when given to young girls at ages 11 or 12, before they have started sexual activity—was already quite controversial, because some in the public felt it was a “license” for promiscuity (and there is increasing distrust of vaccines generally among some parent groups). As a result, even before the Bachmann remark, uptake of the vaccine was below expectations. Now, as a member of the American Academy of Pediatrics quoted in NYT article put it, “These things [politicians' misstatements] always set you back about three years, which is exactly what we can’t afford.”

Photo by rachel a. k. on Flickr used under Creative Commons. 

A version of this post appeared on the ANSIRH blog.

Coming to Terms With a Loved One's Dementia

In her new memoir, Remembering the Music, Forgetting the Words: Travels with Mom in the Land of Dementia, Kate Whouley strips away the romantic veneer of mother-daughter love to bare the toothed and tough reality of caring for a parent who is slowly losing her mind. In an interview we conducted at Whouley's home on Cape Cod, she recounted some of the lessons she learned as dementia took away her mother's ability to care for herself.  

In these YouTube videos, Whouley discusses her decision to find an assisted living facility to care for her mother, the fears that family and friends face as their loved one loses the ability to recognize them, and how her mother's disease taught her to live moment by moment. 

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Assisted Living: Making a Tough Decision

Alzheimer's and Dementia: Getting Past Our Fears

Caring for a Loved One with Alzheimer's: Living in the Moment

Rick Perry's Vasectomy: The Governor's Reliance on What He Denies His Fellow Texans

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco. She blogs at RHRealityCheck, where this post originally appeared.

Rick Perry has only two children?! As the biographical information flashed by on television during a recent debate of Republican presidential hopefuls, it was strangely incongruous to see that the rising star of the religious right was so woefully behind his competitors. Rick Santorum and Jon Hunstman led the pack with seven kids each, followed by Ron Paul, Mitt Romney and Michelle Bachman with five (and the 23 children she had fostered). To be sure, Newt Gingrich and Herman Cain also had a paltry two, but they, unlike Perry, were not considered to be the new favorite of the social conservative wing of the Republican. Recent polls show Perry supplanting Bachman in that role, notwithstanding her impressive numbers.

Perry’s late entrance into the race saved him from the awkwardness of having to deal with the “pro-marriage pledge," put forth by a leading Iowa conservative activist, and signed by some of his fellow candidates who had competed in that state’s straw poll. This pledge, among other things, asked signers to affirm that “robust childrearing and reproduction is beneficial to U.S. demographic, economic, strategic and actuarial health and security.” (Shortly after his official entry into the race, Perry did sign yet another pledge, this one in support of a federal amendment against gay marriage).  

The reason that Rick Perry has “only” two children, one can say with confidence about this normally private matter, is because of the widely disseminated fact of his vasectomy. cited in the New York Times among other places. (This procedure, to the delight of late night comedians, was apparently performed by his father-in-law).

Speaking as a reproductive health advocate, I have quite mixed feelings about Perry’s decision (presumably made with his wife) to have a vasectomy. On one hand, I strongly believe that men should share in the task of contraception, and I commend the governor for doing so. Despite tantalizing talk for years of research on a “male birth control pill,” vasectomies and condoms are currently the only contraceptive options for men. Though vasectomies have a proven record of safety, efficacy and satisfaction, only a relatively small number of American men elect this procedure, in part because of a belief that it might affect sexual functioning.

In theory, Perry, whose persona is that of a swaggering alpha-male, could help popularize this method, making clear that “real men” have vasectomies. Just as the late First Lady Betty Ford’s openness about her breast cancer spurred many women to undergo mammograms, Perry’s public endorsement could increase the popularity of vasectomies.

But that of course won’t happen. Perry’s choice of a vasectomy serves to highlight a mean-spiritedness toward the contraceptive options of his fellow Texans who don’t have family members who are surgeons. As governor, he presides over a state in which 25 percent of adult men have no health insurance, the highest rate in the country (the U.S. average is 16 percent). A vasectomy can cost up to one thousand dollars at some clinics, and doubtless more at others. Uninsured Texans who want a vasectomy would no doubt be unable to pay out of pocket for it given the low wages for which the Texas economy has become infamous. 

Moreover, Perry has led an attack on family planning services used by low-income Texas women. He recently signed a budget bill reducing the state’s family planning funding from $111 million to just $37 million. Following the playbook of the religious right in other states, Perry and the Texas state legislature have moved to defund Planned Parenthood clinics, the largest state to do so. To gain a sense of the magnitude of these cuts, in just one Texas affiliate—Planned Parenthood of the Texas Capital Region--- some 4,000 patients will lose access to birth control services, as well as breast and cervical screenings, and HIV tests.

It’s too late for Rick Perry to compete with the other Republican presidential candidates in the “robust childbearing” department. Perhaps some of the most fervent Christian conservatives will fault his vasectomy as it violates the biblical junction to “be fruitful and multiply.” But in his relentless attacks on contraception, and of course, abortion and comprehensive sex education, Perry is doing all he can to reassure his base that many of his fellow Texans will not have the same opportunity to control their childbearing as the Perry family had.

Rick Perry photo by Robert Scoble on Flickr. Used under Creative Commons. 

Betty Ford, Partisan Politics, and What Has Been Lost in the Abortion Wars

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco. She blogs at RHRealityCheck, where this post originally appeared.

How much I appreciated your gracious letter telling of plans for the Western Regional Conference on Abortion and inviting me to attend.

Although my upcoming personal and official commitments will not permit me to be with you, I am grateful for this opportunity to convey my warmest greetings to all attending and my hopes for the success of the Conference.

So wrote Betty Ford, in February 1976, to the organizers of one of the first medical conferences on abortion to take place in the U.S. after the Roe v Wade decision in 1973—a message that would have been inconceivable for any of the Republican First Ladies that followed her. What Betty Ford said publicly about abortion, and what subsequent Republican women in that role could not, speaks both to the spirited and independent character of the former, who died on July 8 at age 93, and to the sea change in American politics that was shortly to come with the rise of the Religious Right and the role of abortion as that movement’s leading wedge issue.

But even in 1976, a newly emerged Right to Life movement was making clear that presidential candidates would be accountable for their positions on abortion, which had been legalized in 1973 with the Roe v Wade decision. And President Gerald Ford, running for his first election to the office (after taking over from the disgraced Richard Nixon in 1974) was under attack from antiabortion forces for his “waffling” views on the subject, arguing that  Roe v Wade went too far, and  that the abortion issue should be left to individual states. In contrast, his wife at that time publicly reaffirmed her full support of Roe, stating in a television interview  that the decision took the issue “out of the backwoods and put [it] in the hospital where it belongs. “

To be sure, it was not only on the topic of abortion that Betty Ford was outspoken. Again, in a way that would be unimaginable for later Republican First Ladies, she identified as a feminist, supported the ERA, and spoke frankly about the realities of premarital sex. Of course, not all her views were, in today’s terms, “liberal”—she was a strong supporter of the Vietnam War, for example. And the admiration she drew from the public—the New York Times in its obituary stated she was among the most popular of all First Ladies—transcended conventional politics. It was her candor about her struggle with breast cancer, at a time when the disease was rarely spoken of publicly, and even more courageously, her public acknowledgement of her struggle with alcohol and prescription drug abuse (which led to the founding of the Betty Ford Center for treatment of chemical dependency) that arguably is the main source of such lasting affection from the American people.

And what of Betty Ford’s Republican successors as First Ladies? Did they speak as freely as she did? On the abortion issue, there is reason to believe that all of the women in question—Nancy Reagan, Barbara Bush, and Laura Bush—were to varying degrees prochoice (as indeed, privately, may have been all their husbands), but all these women felt constrained from speaking frankly. Nancy Reagan’s views are perhaps the most ambiguous, but Lou Cannon, Ronald Reagan’s biographer, has written that while the latter was governor of California, both his wife and father-in-law supported the California Therapeutic Abortion bill signed in 1967. In his memoir the late Donald Regan, Reagan’s chief of staff during his presidency, quoted Nancy Reagan as saying privately to him, “I don’t give a damn about the right to lifers.” The views of Barbara and Laura Bush are much clearer. The latter, in a memoir published after her husband’s presidency stated her support of Roe v Wade.  The former, in the summer of 1992, while her husband was campaigning for reelection, even stated her belief that abortion and homosexuality were “personal choices” that should be left out of politics—though whether this was a case of Barbara Bush acting in a moment of genuine independence, or in a calculated move to draw in support of the rapidly diminishing moderates in the Republican party, remains debatable.

What is not debatable is that Betty Ford’s tenure as First Lady was the last time in American politics that someone in that role could inspire bi-partisan admiration—even while expressing her own political views. American politics has become so polarized, and the culture wars so fierce, that First Ladies can only be broadly liked if they suppress their own views on controversial matters. Betty Ford’s passing reminds us of what has been lost in our political culture.

Official White House photo of Betty Ford, 1974.

Who's the Bully? "Academic Freedom" vs. Freedom of Speech

Beacon Press author Carl Elliott has been under attack in a scenario best described by one of his many defenders as “Orwellian.” In order to defend academic freedom, his university argues, they must prevent him from speaking.

Please read some of these posts to learn more about this important (and disturbing) story. -- Helene Atwan, Beacon Press Director

Pharmalot Blog: A Seroquel Clinical Trial And Academic Freedom

Health Care Renewal Blog: Who Is Really "Bullying?" - Academic Leaders and the Stifling of Critics of Conflicts of Interests

Hastings Center Bioethics Forum: Freedom's Just Another Word For... Restriction?

Leiter Reports: The University of Minnesota "Clinical Trials" Fiasco--and the Apparent Attempt to Silence Faculty Critics

UPDATE 5/5/2011 more links...

Law.com: No Advice, Please: Minnesota University GC Embroiled in Research Dispute

Some Tax Day Advice: Use Your Tax Refund for a New You

Laurie Essig teaches at Middlebury College and is the author of American Plastic: Boob Jobs, Credit Cards and Our Quest for Perfection. Essig writes for the Chronicle of Higher Education's Brainstorm Blog.

The average federal tax rebate this year is around $3000. By now we all understand that there is no point investing that money in the national casino known as Wall Street. You could be fiscally responsible adults and take that money to pay off some debt, but that would counter the brilliant economic recovery policy first coined by George Dubbya after the 9/11 attacks: go shopping.

But shopping for what? How about taking the $3000 to spruce up the kitchen or go on a nice vacation? Not a bad idea. But perhaps an even better one is to invest in the most important thing of all: a new, more perfect you. In other words, maybe you should spend that tax rebate on some cosmetic surgery or at least some Botox?

As Joan Kron, a senior editor at Allure magazine told me when I was researching my book, American Plastic: Boob Jobs, Credit Cards and Our Quest for Perfection

No one says you shouldn’t go to college because you don’t want to improve your intelligence. What’s the difference between a facelift and college? People know they’ll keep their jobs if they make themselves look better.

Of course, $3000 doesn’t go very far in the world of plastic beauty. According to the American Society of Plastic Surgeons, breast implants, the most popular procedure for women, will cost you about $6500. A tummy tuck $8722. And a facelift a whopping $11,471.

Now you could do what many Americans already do and use that tax rebate to travel somewhere cheaper, warmer, and more willing to give you some lipo for a few thousand bucks. I’ve interviewed cosmetic surgeons from the Dominican Republic and Mexico who say their cosmetic surgery tourism business is busiest right after tax rebates arrive in the U.S. But there are obvious dangers to traveling outside the country for major surgery, like having complications later on that no US surgeon is willing to treat for fear of liability. Also, in terms of the Dubbyean economic policy of saving the US economy through consumption, it only works if we consume within our borders.

Probably the best answer is to do what nearly 85% of cosmetic surgery patients do: put your plastic surgery on plastic money. That’s right. Charge it. With $3000 down, you probably qualify through one of the medical credit loan sharks, uh, I mean companies, for the “low” rate of about 14%. Of course if you don’t want to put that $3000 down, expect to pay about 30% interest. Plus any fees and fines if you miss a payment.

In other words, cosmetic surgery is the subprime mortgage industry of the body. Banks, having learned long ago that the best way to make money is by charging high interest rates and fees (a process known by as “financialization”) figured out that they could lend Americans money for a more perfect body, charge them an arm and a leg, and make some serious profit. Care Credit, a division of General Electric, is the largest medical credit company. According to Barron’s, GE’s health care division has the opportunity for double-digit earnings growth.

Care Credit is happy to lend money for cosmetic surgery, not to the rich and famous, but to average Americans. That’s why over 70% of those getting cosmetic surgery earn less than $60,000 a year. It’s also why Care Credit is under investigation in the state of New York for “predatory lending practices.”

Of course if there’s one thing we now understand, it is that debt will make us poorer even as the corporations that lend us money much wealthier. And although we would all look more “perfect” with those new boobs, we won’t be able to do anything but work to try to keep up with the interest payments. So perhaps the real answer of what to do with our tax rebates is to invest in the seemingly recession-proof industry of plastic beauty and the American search for bodily perfection. After all, if we can’t look perfect, we can at least exploit the desire to do so for our own gain. And in this way make the roulette wheel that is Big Finance and Big Beauty go round.  

Terrorizing Abortion Providers: The Other “Abortion War” Quietly Continues

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco. She blogs at RHRealityCheck, where this post originally appeared.

9.pm. In bed at hotel. Landline rings. 'Hello"? "Dr. Benton ?" "Yes. Who is this?" "How many babies did you kill today?"

I hung up. Heart started pounding. Someone who doesn't like me at all at all knows exactly where I am. I disconnect the landline.

Immediately cell phone rings. Blocked number. "Hello?" Same voice. I didn't say anything but listened as he spoke…Heart pounding. Someone who doesn't like me…knows my cell phone number and knows other things about me. …I hang up.

Immediately he called again. I didn't answer. He left a message on my voicemail, saying, "this isn't----(east coast state where Dr. Benton lives)—this is------------(southern state where she traveled periodically to perform abortions)."

I didn't sleep much that night.

The above is an excerpt from an e-mail I received from Dr. Felicia Benton (not her real name). I had recently concluded a phone interview with Dr. Benton about her experience as an abortion provider who travels from her home state several times a month to provide abortions in underserved areas. The matter of these disturbing phone calls did not arise until we continued our conversation via e-mail. Dr. Benton also mentioned that the caller knew in which city she lived, and had even left abusive messages on her elderly mother's answering machine.

The media's coverage of abortion these past few months have focused, understandably, on the seemingly endless assaults on the procedure by Congress and by individual state legislatures , who have passed measures ever more extreme and bizarre: e.g., the House bill that allows hospitals to refuse abortions even if a woman's life is at stake, the recently passed South Dakota law that compels women seeking abortion to first go for "counseling" to a religiously based, anti-abortion Crisis Pregnancy Center and then wait three days before they can legally obtain an abortion, and so on. But Dr. Benton's experience—which is hardly unique-- reminds us that there is, simultaneously, another war on abortion occurring, this one waged directly on abortion providers.

This war on providers has been going on so long that it has become essentially "the new normal," with significant public attention coming only when a member of the abortion providing community is murdered. There have been eight such murders thus far, the most recent being that of Dr. George Tiller of Kansas, in May 2009. Dr. Tiller's murder, and the upsurge of aggressive incidents reported at clinics immediately following this tragedy, continues a pattern of the worst antiabortion violence occurring during the administrations of Democratic presidents. (The seven murders preceding that of Dr. Tiller came during Bill Clinton's presidency).

Apart from these murders, how much antiabortion violence and harassment are there, and at what point can these acts legitimately be called "terrorism?" Certainly, noisy picketing outside a clinic can be annoying to both providers and patients, but such picketing is of a different order than a doctor in a hotel room receiving a threatening call on her unlisted cell phone number, which in turn is different from the firebombing of a facility, which in turn is different than attempted murders, which in turn are different from successfully executed murders.

The Guttmacher Institute, the National Abortion Federation, and the Feminist Majority Foundation are the organizations that have done the most to track violence against abortion providers and each make useful contributions to understanding a complex, and depressing, picture. From the Guttmacher Institute's latest figures, we learn that 88 percent of abortion clinics experienced at least one form of harassment in 2008, most commonly picketing, but—notably—42 percent reported picketing that also involved patient blocking. Nearly one fifth of clinics reported vandalism. Harassment was especially acute at larger abortion facilities: nearly all providers that provided 1000 or more abortions per year reported picketing (with a higher incidence of patient blocking) and nearly one in five of these reported a bomb threat.

The Feminist Majority Foundation's periodic surveys of clinic violence contains the category of "severe violence," referring to blockades, invasions, arson, chemical attacks, stalking, physical violence, gunfire, bomb threats, death threats, and arson threats. The worrisome finding from the 2010 survey is that 23.5 percent of all clinics reported incidents of such severe violence, up from 18.4 percent in 2005. Stalking was the most common event in this category.

The National Abortion Federation has tabulated incidents of violence and disruption against its member facilities since 1977. Here are some of the totals in various categories: besides the 8 murders, there have been 17 attempted murders, 175 incidents of arson, 41 bombings, 1429 incidents of vandalism, 2057 cases of trespassing, 661 anthrax threats, 526 cases of stalking, and 416 death threats. 

While this level of violence would be unacceptable—indeed unthinkable-- in any other branch of American medicine, in the case of abortion this violence is seen as acceptable fodder for politicians' wisecracks. For example, at a recent mayoral candidate forum in Jacksonville, one of the contenders, according to a local paper, said "the only thing he wouldn't do was bomb an abortion clinic, then….added, with a laugh, 'but it may cross my mind.'" Even more alarmingly, several states have recently introduced legislation permitting "justifiable homicide" in the defense of a fetus, which many feel would lead to open season on abortion providers.

To be sure, the federal government has tried to respond to the attacks on abortion providers. Most notably, in 1994, President Clinton signed the FACE (Freedom of Access to Clinic Entrances) Act, which made it a federal crime to impede patients' entry to an abortion entry. The FACE Act has been credited with significantly lowering the number of full-scale blockades of clinics that were commonplace in the late 1980s and early 1990s. And there is every reason to believe that President Obama's Justice Department takes seriously threats of extreme violence against providers. Nevertheless, the depth of local law enforcement's commitment to protect providers varies from place to place. The provider community is still haunted by the fact that Scott Roeder, Dr. Tiller's assassin, was seen the day before the murder, vandalizing another clinic, and though his license plate was reported to local authorities, there was no action taken.

And how, finally, should we understand the frightening calls that Dr. Benton received? Should they be seen merely as "harassment" or, as I believe—given the totality of the record of violence against providers since the 1970s-- as one element of a larger campaign of genuine terrorism? Though the three organizations mentioned above have done an excellent job of tabulating incidents on the spectrum of abortion violence, the more qualitative question of the impact of such incidents remains unanswered. In Dr. Benton's case, though admittedly shaken by the calls, she remains resolved to continue abortion work. For unrelated reasons, she no longer works at the southern clinic, but still travels to other facilities. What is unknown is how many providers have stopped such work—or never started it-- as a result of similar intimidation.

It's Not Just Unions: Scott Walker is Busting Planned Parenthood, Too

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco.

Interested in reading some good books in honor of International Womens Day? Check out our recommended reading at Beacon.org.

"(I am proud of) trying to defund Planned Parenthood and make sure they didn’t have any money, not just for abortion, but money for anything."

This is gubernatorial candidate Scott Walker speaking to Wisconsin Right to Life last April, boasting about his record as a state legislator. And for this constituency, now-Governor Walker has come through. His recently released budget proposes to repeal Wisconsin’s “contraceptive equity” law which stipulates that that health insurance plans in the state that cover prescription drugs cover contraception. The budget also eliminates the state’s participation in the Title V Maternal and Child Health program, which provides family planning services as well as other health services for both men and women, including prostate and cervical cancer screenings. Planned Parenthood of Wisconsin argues that such a move would mean the loss of four million dollars (of both state and federal funds) affecting 50 health centers in the state (PP receives about one quarter of Wisconsin’sTitle V funds).

Scott Walker’s actions in the short time he has been governor (he took office in January) were supposed to serve as a template for the newly energized Republican governors and state legislators who came to power as a result of the November 2010 “shellacking.” That is, please your religious right base by going after birth control services in general and Planned Parenthood in particular, and please economic conservatives by offering generous tax breaks to corporations, massively cutting social programs, and  greatly weakening, if not destroying, public sector unions.

As a fascinated country has seen for the past several weeks, that part about destroying the unions hasn’t played so well.  Walker’s poll numbers are tanking. The Republican leaning Rasmussen poll recently found that nearly 60% of Wisconsin likely voters now disapprove of Walker, with 48% “strongly disapproving.”  Observing Walker’s situation, a number of other Republican governors have backed off from earlier plans to similarly combat public sector unions in their states.

Thus far, however, neither Republicans in Congress or in state houses show signs of retreating from the harsh and increasingly bizarre war they are waging on abortion and contraception. In Congress, Republicans (and a handful of Democrats) voted to defund Planned Parenthood and Title X, a program that funds family planning and other basic reproductive health services, and passed legislation that permits hospitals to deny lifesavingabortions. At the state level, several states are considering legislation that has been interpreted as making the killing of abortion providers “justifiable homicide,” Georgia is considering a “prenatal murder” bill that would make miscarriages  suspect  unless a woman could “prove” she did nothing to cause it,  and S. Dakota has decreed that before a woman can receive an abortion she must first go to a blatantly antiabortion “Crisis Pregnancy Center” for counseling—and then wait three days before seeking an abortion.

But there are signs that the American public is noting with alarm these fanatical measures. Just released data from the Pew Research Center for the People and the Press shows a “movement toward a liberal position on abortion.” While much has been made of a 2009 poll that showed the public evenly divided on the question of whether abortion should be legal, Pew reports that “support for legal abortion has recovered” and now stands at 54%, with 39% opposed. Similarly, two recent polls show voter disapproval of the defunding of Planned Parenthood, with particularly strong opposition among women and younger respondents.

Though both the right and the left have tended to treat economic issues, including the fate of labor unions, and reproductive rights as separate phenomena, with two different constituencies, in the real lives of working people, these issues are very much connected. Hardly surprisingly, in difficult economic times people try to control their childbearing. This was true during the Great Depression of the 1930s, and it is true today. The Guttmacher Institute released a report, at the height of the current recession  that showed that many women did not feel they could afford another child and that they they were committed to using birth control more consistently. Yet the report also showed that one in four respondents put off a visit to a family planning center because they could not afford it.

It is too soon to know the significance of the poll numbers cited above, or of the nation-wide demonstrations in recent weeks in support of both labor unions and Planned Parenthood. Possibly, though, this political moment may mark a serious pushback against the Right’s extraordinary overreach, since the 2010 election, in its eagerness to abolish both the workplace conditions and health care services needed  by so many.

Photo by mrbula on Flickr. Used under Creative Commons. 

65-Year-Olds Don't Go To Planned Parenthood for Abortions

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco.

Though many people are shocked by Congress’ recent withdrawl  of funds from Planned Parenthood clinics to provide family planning services, in fact right wing attacks on this organization are nothing new.   For example, the Texas legislature in late 2005 passed legislation that redirected millions of dollars from Planned Parenthood and other family planning providers in the state to Crisis Pregnancy Centers, organizations which promote pregnancy and offer no contraceptive services.  Here is an excerpt from a blog written by an impoverished Latina woman, “Tanya,” the day this new policy was announced:

So this morning I dragged myself out of bed before dawn to be at planned parenthood at 730 and wait in the freezing morning shade until 9 for my annual exam. At 930, myself and the 25 other women (of color) grumbled in solidarity and confusion, wondering why we were still waiting and shivering, finally an employee opened the doors, and corralled us inside just to inform us that there would be no walk-in exams today. or tomorrow. or ever. Boys at the texas state legislature cut pp’s funding by 40% last Friday.

I stood at the office stunned, while 3 mothers began to cry. Another woman, at least 65 years old, turned to me and asked, “que dijo?” (what did she say?). as I tried to explain what I still didn’t understand, I began to feel my anger swell. Overnight one of the safest, most reliable, most critical social services vanished.

As Tanya’s blog makes clear, low income women come to Planned parenthood clinics for a variety of services. As Planned Parenthood spokespersons endlessly repeat, only 3% of the organization’s services involve abortion, and no public funds are used to subsidize those procedures. The elderly woman mentioned in the blog was presumably there,  like Tanya herself, for an annual exam that includes breast and cervical cancer screenings, and Tanya was there as well for reduced -costs birth control pills.

So, to address the obvious question: why these attacks, at both the state and federal levels by virulent opponents of abortion, on an organization whose mission, contained in its very name, is to reduce unplanned pregnancies?  How did Planned Parenthood come to be so demonized? This after all, is an organization once so mainstream that the wife of conservative icon Barry Goldwater founded its Arizona chapter and in 1965 former presidents Harry Truman and Dwight Eisenhower agreed to be co-chairs of an honorary advisory board.

For me, the two most compelling answers to this question lie in the reframing of contraception within antiabortion circles, and the continued dominance of the religious right in Republican circles, all the buzz about the Tea Party notwithstanding. As I discuss at greater length in my recent book, Dispatches from the Abortion Wars, while once politicians on both sides of the abortion divide viewed contraception as true “common ground” (in the late 1970s, as a Texas congressman, George H.W. Bush was such an enthusiast for subsidized family planning, that his nickname in the House was “Rubbers”), over time this understanding broke down.

Particularly after Ronald Reagan was elected in 1980 with the active help of social conservatives, contraception, and the facilities that provided such services, such as Planned Parenthood clinics, came to be seen as “supportive of the abortion mentality,” because often these two services were delivered in the same building (albeit with strict separation of funding). Also, as abortion opponents frequently put it, with a certain logic, those who tried to prevent conception were more likely to choose an abortion if contraception failed.

In yet another evolution, the attack on contraception escalated from   being seen as “supportive” of abortion to actually  being an “abortifacient,” that is something that causes an “abortion.”  Therefore, by the late 1990s, the pharmacy became a new battleground in the U.S. reproductive wars, with numerous instances of “prolife”  pharmacists refusing to dispense both emergency contraception and “regular” birth control pills.

Finally, the attacks on Planned Parenthood (as well as other recent appalling legislation we have seen in Congress, for example the Orwellian named “Protect Life” act, which allows hospitals to deny abortions in life-threatening situations) are occurring because clearly the Republican leadership thinks such moves are good politics. The massive budget cuts proposed by Republicans, egged on by Tea Partiers, will not create jobs; indeed economists such as Paul Krugman have argued that such massive cuts are job weakening. Moreover, such cuts have the potential to create hardships for conservative families as well as the hated liberal ones, and in any case, these budgetary actions will not survive intact, after the Senate and the president deal with them. The one part of the Republican core constituencies that can be reliably rewarded is the religious right, an absolutely crucial group for the Party, both in terms of donations and precinct level electoral work.  

Of course, one can reasonably hope that neither the defunding of Planned Parenthood nor the various legislative attacks on abortion will survive either, in their present form, once they reach the Senate. But these votes reassure the base that their concerns are being heard, and most importantly, do serious damage by moving the “center” of reproductive politics farther to the right. It may be too much for the Democratic-led Senate or the president to defund Planned Parenthood entirely, but it will seem a reasonable compromise to significantly cut the group’s allotment, and to continue the longstanding policy of inadequately funding contraceptive services more generally. Maybe hospitals will not have the option of letting women die if an abortion would save their lives, but other cruel restrictions (refusing an abortion if it would cause serious health damage) will, again, be seen as acceptable—or at least, necessary--compromises. Until enough American voters see the absurdity of these compromises—not to mention the misogyny of denying poor women cancer screenings at a Planned Parenthood clinic—the United States will fall even further behind other industrialized countries with respect to basic reproductive health care.

Photo by S.MiRK on Flickr. Used under Creative Commons.

Learning the Right Lessons From the Philadelphia Abortion Clinic Disaster

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco.

Reading the Grand Jury report on Women’s Medical Society in Philadelphia, the now-closed abortion clinic ran by Dr. Kermit Gosnell, is stomach turning. This was truly a chamber of horrors: a filthy facility, with blood stained blankets and furniture, unsterilized instruments, and cat feces left unattended. Most seriously, there was a jaw dropping disregard of both the law and prevailing standards of medical care. Untrained personnel undertook complex medical procedures , such as the administration of anesthesia, and the doctor in question repeatedly performed illegal (post viability) abortions, by a unique and ghastly method of delivering live babies and then severing their spinal cord. Two women have died at this facility and numerous others have been injured. What remains baffling is how long this clinic was allowed to operate, in spite of numerous complaints made over the years to city and state agencies, and numerous malpractice suits against Dr. Gosnell. Indeed, it was only because authorities raided the clinic due to suspicion of lax practices involving prescription drugs that the conditions facing abortion patients came to law enforcement’s attention.

As information about this clinic spread, many have understandably compared Women’s Medical Society to the notorious “back alley” facilities of the pre-Roe era, when unscrupulous and often unskilled persons (some trained physicians, some not) provided abortions to desperate women, in substandard conditions . This is an apt comparison. But Gosnell’s clinic should not only be understood as a strange throwback to the past. Women’s Medical Society represents to me an extreme version of what I have termed “rogue clinics,” facilities that today prey on women, disproportionately women of color and often immigrants, in low income communities.

Overdiagnosed: Making People Sick in the Pursuit of Health

Health is much more than not being able to find something wrong. It’s how people feel, it’s a state of mind. And it’s hard to feel good when things are constantly being found wrong with you. But we are moving towards a [notion of] health that means the absence of any abnormalities. That’s not a good definition.-- Dr. H. Gilbert Welch, Wall Street Journal Health Blog Q&A

Diagnoses of every condition, from high cholesterol and high blood pressure to osteoporosis, diabetes, and even cancer, have skyrocketed over the last few decades. Yet Americans are living longer than ever. While the medical establishment credits aggressive early disease detection as the cause of improved public heath, it is in fact the reason so many of us are told we are sick. Going against the conventional wisdom that more screening is the best preventive medicine, Dr. H. Gilbert Welch builds a compelling counterargument that what we need is fewer, not more, scans and tests.

Drawing on twenty-five years of medical practice and research on the effects of screening, Welch explains how the cutoffs for "abnormal" test results have been drastically lowered while at the same time technological advances have enabled doctors to detect more and more "abnormalities," many of which will pose no health complications. Now, with genetic and prenatal screening common practice, patients are increasingly being diagnosed not only with disease but with "pre-disease."

Examining the social, medical, and economic ramifications of a health care system that unnecessarily diagnoses and treats patients, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, debilitating anxiety, and exorbitant costs.

Read Dr. H. Gilbert Welch at CNN.com discussing the negative ramifications of a blood test for cancer.

Overdiagnosed by Dr. H. Gilbert Welch, Dr. Lisa Schwartz, and Dr. Steven Woloshin, Excerpt

Link Roundup: Pink Slips and Poor Health, Stepford Sluts, and the Value of Marriage

On the New York Times' Well blog, Dr. Danielle Ofri (Medicine in Translation) looks at the connection between unemployment and poor health. Dr. Ofri also contributed a "Cases" column for the Times about how a physical examination can help a patient's mental well-being.

From Stepford wife to Stepford slut: Gail Dines (Pornland), looks at how the idealized pop culture feminine image has morphed from Betty Draper to hardcore porn star. Also check out this great interview about gonzo pornography at vocalo.org.

"'Jesus!' he said. 'Did you see how many Mexicans they’ve got?'" This Is American Soccer posted a second excerpt from Steve Wilson's The Boys from Little Mexico.

Sonia Sanchez "drenches her words in honey goodness so they sound like the sweetest thang you've ever heard," The Root gushes in this feature interview, where the poet discusses what she's reading and the future of African-American literature.

Chalk the union of one man and one woman up to the good influence of their gay friends: it took a lesbian wedding for Jeremy Adam Smith to understand the importance of marriage.

At Education Next, David Chura discusses teaching students behind bars.

Eddee Daniel (who appeared on Beacon Broadside as a guest blogger a while back) reviews The Coming Population Crash.

Have a great weekend!

Link Roundup: Global Challenges, Global Ethics

From our justice system to immigration, our authors have been working within and on behalf of progressive communities agitating for change in our world. Here's a sampling of their many conversations this past week:

David Chura's book I Don't Wish Nobody To Have a Life Like Mine brings attention to the lives of kids in adult lockup through a thoughtful piece from Sam Roberts in the New York Times.

In response to a recent New York Times article on the inherent racial biases in police killings, Jason Marsh, co-editor of Are We Born Racist?, remains optimistic in an article he wrote for Greater Good. "New York State's recognition of the problem," he says, "is certainly an important step forward."

Bruce Rich's interview with Religion Dispatches ran on the website for the Canadian Centre for Progressive Christianity. Rich, the author of To Uphold the World, discusses "the overarching challenge of our age" when he states that "a global world system and a global economy require a global ethic."

John Buehrens, coauthor of A House for Hope, writes openly and warmly about a "liberal religious renaissance" in a guest blog post for Washington Post's "Political Bookworm." In the blog, Buehrens states, "Conservatives in religion too often operate out of lesser rules, and out of cultural stereo-types of what constitutes a loving family. Too often they seem to pander to the fear of change. And for the past 30 years they have had the loudest religious voice in America."

Carole Joffe, author of Dispatches from the Abortion Wars, appeared on KPFA's "Against the Grain" to examine the role women's sexuality plays in American society.

In a fascinating article in The Washington Post on the aging baby boomer generation, Fred Pearce covers the idea of the retirement age, an older workforce, and the inspiration of a lively 108-year-old Japanese woman named Ushi Okushima. A quote from his book, The Coming Population Crash, can be seen over on Grist. The Guardian reported on Pearce's appearance at the 2010 Hay festival.

The Willamette Week welcomed a look into the lives of the Hispanic teenagers at the heart of Steve Wilson's debut book, The Boys from Little Mexico: "what this book offers is an actual human face on immigration and the people affected by it." Oregon Magazine applauded Steve's "riveting sports writing coupled with a compassion for his subjects' lives." 

While tensions continue to rise on the Arizona-Mexico border, the Tucson Weekly advises readers to add The Death of Josseline to their summer reading lists, calling Margaret Regan's work "heartbreaking and infuriating and uplifting, all at the same time." Be sure to also catch Regan's discussion of immigration on New American Media.

 

The Legacy of George Tiller

Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco. See her much-read original response to Dr. George Tiller's killing, here. Take action here.

In the year since the murder of Dr. Tiller, the polarization around abortion in the United States shows no signs of abating. State legislatures have passed a host of measures restricting abortion provision in various ways, measures which are noteworthy for the mean-spiritedness directed toward women. In Oklahoma, for example, among the new laws are a mandate that women must view an ultrasound of their fetus and hear a doctor describe various parts of the fetal body (with no exception for victims of rape or incest), and another law that requires that women fill out a 36-page questionnaire, giving extensive demographic information as well as the reason for their abortion. Yet another law passed in that state exempts doctors from lawsuits if they decide to withhold information about fetal anomalies from pregnant women, as a strategy to prevent these women from aborting.

In the period since Dr. Tiller's death, many clinics have reported an upsurge in threatening and aggressive behavior by protestors. Tiller himself continues to be vilified by his enemies, most recently at the annual meeting of ACOG (American College of Obstetricians and Gynecologists), where protestors stood outside the conference hotel carrying signs that read "George Tiller is burning in hell."

Far more encouraging, however, are the actions that have been taken by Tiller's former colleagues in the abortion providing community. Aware that Tiller's death left a huge gap for those women needing later (post 24-week) abortions (as discussed in the piece linked here), physicians, researchers and advocates have formed a network which is strategizing how to increase the availability of such services, and which disseminates accurate information about this subject to both clinicians and prospective patients.

Most notably, Dr. Curtis Boyd, a longtime abortion provider in New Mexico, and a close friend for decades with George Tiller, has recently expanded his practice to include post-24 week abortions "on a case-by-case basis." Two of the physicians who worked with Dr. Tiller in Kansas now work with Dr. Boyd. When I asked Dr. Boyd about this change in his practice, he told me, "We felt we had to do it…both for the women who need this service and to honor George's memory."