BlueGrassRoots

Medicine: does birth control save lives?

With the election of the new pope, and the use of birth control in the third world a hot topic, I decided to peruse the medical literature to see what I could come up regarding whether it is valid to say that a lack of access to contraception leads to poor maternal-fetal health. Here's a sample of what I've found. Those without Medline access may have trouble with the links.

Women in developing countries suffer considerable morbidity and mortality due to inability to control their own fertility and lack of access to family planning services. Over 500,000 deaths each year are related to pregnancy. Two thirds of these maternal deaths could be prevented by providing contraception to those women who wish to use it in developing countries.
The fifth freedom. Kincaid-Smith P. Bioethics. 1995 Jul;9(3-4):183-91.

Increased use of family planning and safe abortion might avert 100,000 maternal deaths each year due to pregnancy related causes and 200,000 maternal deaths due to unsafe abortion.
Curlin P, Tinker A. Women's health. Infect Dis Clin North Am. 1995  Jun;9(2):335-51.

And some info derived from the very important World Fertility Surveys from the early 80s, compiling data from 41 developing countries:

Only about 6000 of the estimated half million maternal deaths each year occur in developed countries. The indirect causes of maternal mortality are related to the unfavorable status of women reflected in poverty, illiteracy, lack of access to health care, and procreation patterns. The World Fertility Surveys indicate that 200,000 maternal deaths would be avoided each year if women not wanting more children had access to contraception. Contraceptive use would also prevent most of the estimated 100,000-200,000 maternal deaths from complications of abortion each year.
Aizenman DE. Impact of family planning on maternal-child health. The future of humanity depends on our children. Profamilia. 1988 Dec;4(13):28-33.

The Catholics for Choice website lists the following information, but there aren't proper citations. However, the information seems very consistent with previously properly cited work.

Access to contraception is proven to reduce maternal and infant deaths, slow the spread of HIV/AIDS, reduce the number and need for abortions, and improve the life expectancy of children. Every year:

• Half a million women die of pregnancy-related causes each year, because the pregnancies come too often, too close, too early, or too late in life.
• Seven million infants die because their mothers were not physiologically ready for pregnancy or lacked obstetric care.      
• 75,000 women die worldwide from unsafe illegal abortions, according to conservative estimates.

Regardless of whether the Catholic doctrine against contraception is consistent or inconsistent with scripture, it is a public health disaster of severely epic proportions that is simply unacceptable to non-Catholics, and should be realized and considered by the Catholic church itself. A ban on contraception may very well be inconsistent with support for a 'culture of life.'

Politics: Bush vs. Science

Kevin Drum blogs about the calling out of the Bush camp in quoting studies that support their policies. Actually, quoting studies that don't support their policies, but quoting them anyway and hoping nobody finds out. Amazing.

Bush Administration Gives Science a Wedgie, Indian Burn, and a Noogie! Oh and then He Stole Their Lunch Money Too!

According to CNN, the Bush Administration has been stifling the Scientific community by reducing budgets, refusing to listen to them on environmental policy, and that Scientist's were pressured not to have a conflicting opinion with the Bush Administration. 

With complaints that Research and Development have not been well funded Scientists point out to the Bush Administrations plans to visit the Moon and Mars as "eating everyone's lunch" or that's how they say it around the Congressional Budget Office at least.  Also, it has been pointed out that the Administration has been pressuring members of the EPA to change their research so it can support Bush Environmental Policy.  The Budget cuts to the Scientific Community are also damaging in Education, as K-12 and graduate students prepare for drop offs in their Scientific funding.

Medicine/Politics: F.D.A. to Create Advisory Board on Drug Safety

Which sounds like a good idea, right?  So, instead of creating a separate agency to do the extra work, we just realign the Food and Drug Administration, give them a new task that will cost a few ten-millions extra on top of what the FDA already doesn't have the money to do, give them no new funding to do that task, and expect results?

If I remember learning nothing else in my first year of med school, I learned that the FDA has an operating budget less than the University of Michigan.  With that budget, the FDA is supposed to monitor all drug development, attempt to oversee all the alternative herbal crap on the market, and even fight the tobacco industry (which it doesn't even bother trying to do, because there's no point without sufficient funding).

Smoke and mirrors.  The FDA is one of the few parts of our government that I feel consistently tries to work apolitically and objectively to protect the patient-citizens of our country (with a few very noteable exceptions regarding women's health).  And that's saying something, given that the FDA is monitoring drug companies that A) produce great drugs that they deserve to be compensated for so they can continue to research new drugs, and B) produce bad drugs that cause more harm than good but that could still be profitable if they can dupe the FDA into allowing them to kill people for profit.

So FDA Advisory Board on Drug Safety.  It might make Congress happy, it might shut up the media, but it's not making Brand New Pill X any safer for you.

Health Care: the neocon revolution

This LA times article has been making some rounds as it outlines the neoconservative approach to revolutionizing how people pay for their health care. As a rule, treating health care like any other economic commodity seems like an absolute disaster to me, especially as most market worshippers seem oblivious to the idea that there are, in fact, other human values besides efficiency. Justice, dignity, and equality come to mind. And a transition to catastrophic insurance/health saving accounts seems to favor efficiency over any other human value.

Which isn't to say there might not be a place for this model, and that some aspects of a pretty complex plan won't have merit. Forty-five million folks in this country have no insurance whatsoever, and that's an American indignity. I see no mention of what happens to someone whose health savings account runs out and whose "catastrophic" insurance won't pick up the bill, just as I see no mention of what happens to a senior whose investments run amok and can't afford groceries under a social security privatization/private accounts/personal accounts/flowers and rainbows plan.

Which is scary, given today's report that hundreds of thousands of Americans file for personal bankruptcy each year because of medical bills - even though they have health insurance. This seems to suggest that the prognosis for American health care would suffer under the HSA/"catastrophic" insurance approach.

Here's the MSNBC version of the HSA story, along with smart rebuttals to the schema:

[F]orcing individuals to make payment choices about their health coverage will mean many poorer individuals put off a trip to the doctor, or skimp on important surgeries or check-ups to avoid depleting the funds in their accounts. And younger, healthier people who use health services only occasionally will opt into these plans because it benefits them financially, leaving older, sicklier patients in traditional insurance plans, where they could see their health-care premiums rise.

And Rep. Pete Stark (D-Hayward), a leading lawmaker in California health care, has a pretty straight-to-the-point criticism of the HSA/"catastrophic" approach:

One danger with this is that people will not get needed care because they want to save a few thousand bucks. Healthcare isn't like buying a Chevrolet. You can go to Consumer Reports and read about the new Malibu, but if I asked you to describe a regimen of chemotherapy for someone who has colon cancer, you'd be out of gas. We are talking about highly technical services that 99% of the public doesn't even know how to spell the names of. Secondly, there is no uniformity within the medical community as to what services ought to be used. It's a 'by guess and by gosh' sort of practice.

We're making real headway in evidence-based medicine towards clarifying appropriate standard of care, but regardless, there's a reason why physicians train for ten to fifteen years to practice medicine. There's a lot of stuff to learn. And while health care providers do their very best to distill all of that knowledge into a ten minute clinic consult so that patients can make their own educated choices, something is always lost in translation.

Of course, maybe we shouldn't worry about everyone having health care. Besides, people should just work harder so they can afford these medical concierge services, right? I'd have no problem with rich people being able to pay for SuperCare if it weren't for the fact that, despite insanely high tuition at medical schools, the actual cost of medical education is still subsidized to a heavy degree by the public. And that, by nature, means that every doctor is a public servant to some degree bought and paid for by the American people. All of the American people. And specialized services that discriminate so heavily based on socioeconomic status will be appalling to me for as long as our country has one of the highest infant mortality rates among developed nations.

Priorities.  We need them.  We don't have them.

You can also find this post at The Sparkgrass Community.