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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

LifeEthics quoted about Doctors for America posts

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

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

?No self breast exams?

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


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

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

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

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

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

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

Intentionally Skewed Cancer Survival Rates

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

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

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

Politics bites science

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

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

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

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

Follow up from Doctors for America

Received this message a few minutes ago.

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

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

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

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

Dear Beverly,

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

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

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

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

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

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

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

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

Sincerely,

Vivek Murthy, MD MBA
Doctors for America

Playing doctor with the White House

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

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

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

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

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

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

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

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

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

May 04, 2009
'Doctors for America' launches

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

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

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

Notes on the Conference Call

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Global Warming Ate the Science

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

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

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

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

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

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

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

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

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

Forget conscience - go straight to mandate

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

Here's an excerpt:

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

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

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

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

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

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

Former Senator Explains Consequences of Bill Language

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

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

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

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

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

Here's Senator Thompson's essay:

FRED THOMPSON: Phantom pains at The Post

Fred D. Thompson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABC explains the Obama Administration

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

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

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

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

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

Congressman Henry Cuellar on Planned Parenthood

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

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

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

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

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

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

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

Myth: doctors take out tonsils needlessly

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

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

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

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

Video and here.

Ann Coulter on government Health Care finance

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

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

Addendum -- Including this one:

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

Public Funding for Health Care in Real Life

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

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

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



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

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

Texas Medical Association Health Care Principles

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

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

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

AMA offers public plan compromise

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

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

AMA offers public plan compromise.

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

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

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

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

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

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

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

HELP (the whole government prepaid health plan)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TriCommittee Health Care Bill Summarized

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

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

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

UNITED STATES CONGRESS

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


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

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

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

Workforce Investments:

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

Prevention and Wellness:

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


Insurance Market Reforms:

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

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

Public Health Insurance Option:

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

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

Shared Responsibility:

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


Reforming the Health Care Delivery System and Ensuring Sustainability:

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

Modernizing, Improving and Preserving Medicare:

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

Downgrading American Medical Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

No arrests have been made in the case.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HPV Vaccine works for males

Good news from the Family Practice News:

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

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

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

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

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

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

Texas Legislators Seek to Limit Funds for Human Embryo Destruction

Senator Steve Ogden is a Texas Hero!

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

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

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

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

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

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

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

Why the medical home sounds good but won't work

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

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

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

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

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

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

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

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

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

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

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

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

More in a bit:


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

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

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

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

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

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

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

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

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

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

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

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

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


Source Information

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

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

References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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