Archive for 2009

November 18, 2009

New Mammogram Guidelines Are Causing Confusion, But Here’s Why They Make Sense

New government guidelines recommending that women start screening for breast cancer at age 50 instead of 40 set off a round of criticism this week and caused much confusion for women who for years have been told that early detection saves lives.

But a number of women’s health organizations, including Our Bodies Ourselves, the National Women’s Health Network and Breast Cancer Action, for years have warned that regular mammograms do not necessarily decrease a women’s risk of death. Premenopausal women in particular are urged to consider the risks and benefits.

In fact, the NWHN issued a position paper in 1993 recommending against screening mammography for pre-menopausal women. It was a very controversial position at the time — even more so than now. The breast cancer advocacy movement was in its infancy and efforts were focused on getting Medicare and insurance companies to cover mammograms. What the NWHN found — and other groups have since concurred — is that the potential harm from screening can outweigh the benefits for premenopausal women.

That statement is tricky, and based on the poor explanations I’ve seen that fail to specifically address the potential dangers, it’s no wonder women are frustrated. Some are even questioning whether the guidelines were unveiled as a cost-cutting measure — a sign of the “rationing” to come under health care reform. In addition to delaying routine screening until age 50, the guidelines recommend screening women between the age of 50 and 74 every two years. It’s important to keep in mind this is intended for women with no known risk factors; women in high-risk groups should start earlier, and it may be prudent to schedule more frequent mammograms.

Adding to the confusion, cancer groups are split. The American Cancer Society came out strongly against the new guidelines. The National Cancer Institute, meanwhile, said it would reconsider its own recommendations in light of new studies. Some doctors said they would proceed cautiously before revising screening advice for patients.

I don’t believe the new guidelines are politically motivated, nor are they “patronizing” to women simply because they call into question the stress related to biopsies and false positive results. Rather, the guidelines provide a useful framework for helping each of us to decide when is the best time to begin screenings and the intervals at which they should be repeated.

The guidelines are in sync with international recommendations; the World Health Organization recommends starting screening at age 50, and in Europe, mammograms are given to post-menopausal women every other year and detection rates are similar to the United States. During an interview on MSNBC on Tuesday, breast cancer expert Dr. Susan Love said the government’s guidelines bring us into line with the rest of the world and with current research. (Read more at her blog.)

You might be thinking: Wait a moment, isn’t earlier better? Why would delaying detection be in my best interest? I’m going to explain why, but let’s first take a closer look at the guidelines, which were released by the U.S. Preventative Services Task Force (USPSTF), an independent panel of experts in prevention and primary care. (The task force operates under the Agency for Healthcare Research and Quality, the research arm of the U.S. Department of Health and Human Services.)

The guidelines are an update of the 2002 USPSTF recommendation statement, which called for mammograms every one to two years, starting at age 40. Dr. Alfred Berg of the University of Washington, who chaired the task force in 2002, told The New York Times this week, “We pointed out that the benefit will be quite small.” He added that while older women experience the most benefits from the screening, mammograms still prevent only a small percentage of breast cancer deaths.

Breast cancer is the second-leading cause of cancer-related deaths in women (lung cancer is number one). According to the National Cancer Institute, about 192,370 women will be diagnosed with breast cancer in 2009, and 40,170 women will die of the disease this year. A woman who is now 40 years old has a 1.44 percent chance of being diagnosed with breast cancer over the next 10 years.

For the 2009 update, the panel, now with different members, examined the role of five screening methods in reducing breast cancer mortality rates: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging. It also commissioned two studies:

1.) A targeted systematic evidence review of six selected questions relating to benefits and harms of screening.

2.) A decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals.

Here is the summary of the task force’s findings, published in the Annals of Internal Medicine. The grades are explained here; A is the highest recommendation (meaning there’s a high certainty the benefits are substantial), and D is the lowest. A rating of I indicates evidence is insufficient or conflicting.

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms. This is a C recommendation.

The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. This is a B recommendation.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. This is an I statement.

The USPSTF recommends against teaching breast self-examination (BSE). This is a D recommendation.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. This is an I statement.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer. This is an I statement.

Dr. Diana Petitti, a professor of biomedical informatics at Arizona State University and vice chair of the current task force, told The New York Times the panel knew the recommendations would surprise many women, but, she said, “We have to say what we see based on the science and the data.”

Frankly, I was surprised by the conclusion that self breast exams are not considered useful. News stories this week have included many anecdotes from women who found a lump that turned out to be cancerous, and every doctor I heard interviewed said that women should definitely contact their physician if they notice any changes in their breast. But what we’re learning is that feeling our own breasts for lumps is not statistically effective, and women who do self breast exams get twice as many biopsies.

The World Health Organization concurs: “There is no evidence on the effect of screening through breast self-examination (BSE). However, the practice of BSE has been seen to empower women, taking responsibility for their own health. Therefore, BSE is recommended for raising awareness among women at risk rather than as a screening method.”

Around 37 million mammograms are done each year. So what’s the problem there? For starters, mammograms use low-dose X-rays to examine the breast, and exposure to radiation can have a cumulative effect on the body. And they’re imperfect. About half of all premenopausal women, and one-third of postmenopausal women, have dense breasts, which makes their mammograms more difficult to read.

Mammograms produce false-positive results in about 10 percent of cases, leading to anxiety that can last for years, unnecessary and sometimes-disfiguring biopsies, and unneeded treatment, including surgery, radiation and chemotherapy — each of which present their own complications and health risks, including an increased risk of other cancers and heart disease.

According to the National Breast Cancer Coalition, U.S. estimates show a woman’s cumulative risk for a false-positive result after 10 mammograms is almost 50 percent. The risk for undergoing an unnecessary biopsy is almost 20 percent. Barbara Brenner, executive director of Breast Cancer Action, told me last year that research indicates that having more biopsies increases the risk of breast cancer, though the reason is unclear (read my post here).

Women are constantly being told “early detection saves lives,” but in reality we know some breast cancers, by the time they’re found, cannot be treated. Other cancers will never be life-threatening, and some will respond to currently available treatments. Unfortunately, the type of cancer cannot be determined at the time of diagnosis, which means we don’t know for sure whether the treatment will cause more harm than the cancer.

If you’re reading this and thinking you still want to keep that scheduled mammogram, you should certainly do so.

“No one is saying that women should not be screened in their 40s,” said Petitti, the task force vice chair. “We’re saying there needs to be a discussion between women and their doctors.”

Dr. Amy Abernethy of the Duke Comprehensive Cancer Center said she agrees with updated recommendations.

“Overall, I think it really took courage for them to do this,” she said. “It does ask us as doctors to change what we do and how we communicate with patients. That’s no small undertaking.”

Finally, I want to address the insurance question. At this point, insurance companies and Medicare administrators are saying that they will continue to pay for mammograms. Here’s what may change in the future, according to The New York Times:

The guidelines are not expected to have an immediate effect on insurance coverage but should make health plans less likely to aggressively prompt women in their 40s to have mammograms and older women to have the test annually.

Congress requires Medicare to pay for annual mammograms. Medicare can change its rules to pay for less frequent tests if federal officials direct it to. Private insurers are required by law in every state except Utah to pay for mammograms for women in their 40s.

But the new guidelines are expected to alter the grading system for health plans, which are used as a marketing tool. Grades are issued by the National Committee for Quality Assurance, a private nonprofit organization, and one measure is the percentage of patients getting mammograms every one to two years starting at age 40.

That will change, said Margaret E. O’Kane, the group’s president, who said it would start grading plans on the number of women over 50 getting mammograms every two years.

For more information, here are some good stories and links:

NPR: All Things Considered looks at the research.

Washington Post: A good overview of the guidelines and cost controversy.

ScienceBlogs: “From my perspective, these new recommendations are a classic example of what happens when the shades of gray that make up the messy, difficult world of clinical research meet public health policy, where simple messages are needed in order to motivate public acceptance of a screening test,” writes Orac. “It’s also an example where reasonable researchers and physicians can look at exactly the same evidence for and against screening at different ages and come to different conclusions based on a balancing of the potential benefit versus the cost.”


November 18, 2009

CDC Officially Reverses HPV Vaccine Requirement for Immigrant Women

Last week, the CDC issued revised vaccination criteria for U.S. immigration which will reverse the requirement that female immigrants seeking permanent residence or entry to the U.S. be immunized against HPV.

The new criteria require that any mandated vaccine must be age-appropriate for the immigrant applicant, and must either protect against a disease that has the potential to cause an outbreak or protect against a disease that has been eliminated or is in the process of being eliminated in the United States. As HPV does not meet these criteria, the vaccine will no longer be required starting next month (30 days after publication in the Federal Register).

We have written several times about the requirement, including the CDC’s initial comment on the matter and various action alerts/campaigns asking the agency to reverse the requirement.

As we and others noted, the requirement was problematic for multiple reasons, such the lack of an opt-out provision (in contrast to requirements for U.S. citizens), the expense of the series, the lack of significant public health risk posed by omitting this vaccine, and the vulnerability of the affected population.

In the revised criteria document, published in Friday’s Federal Register, HPV vaccination is specifically addressed as follows:

CDC has applied the criteria and determined that once these criteria become effective December 14, 2009, the HPV vaccine will not be required for aliens seeking admission as an immigrant or seeking adjustment of status to that of an alien lawfully admitted for permanent residence….Therefore, while HPV may be an age-appropriate vaccine for an immigrant applicant, HPV neither causes outbreaks nor is it associated with outbreaks (per explanation in the background section). Further, HPV has not been eliminated, nor is in the process of elimination, in the United States. Therefore, because HPV does not meet the adopted criteria, it will not be a required vaccine for immigrant and adjustment of status to permanent residence applicants.

Under the new criteria, the zoster (chicken pox) vaccine will also be removed from the requirements. The agency continues to recommend the two vaccines for U.S. citizens, but vaccine recommendations will no longer be automatically translated to mandates for immigration.

The National Latina Institute for Reproductive Health, the National Asian Pacific American Women’s Forum, and California Latinas for Reproductive Justice issued a statement commending the agency for the change and for “recognizing that all women and girls—regardless of their immigration status—must be treated with dignity in the context of any medical procedure, including the HPV vaccine.”


November 16, 2009

Judy Norsigian Featured on “Liberadio(!)”

OBOS co-founder and executive director Judy Norsigian has been in Nashville, TN, for the weekend, and this morning she was a guest on  Liberadio(!), Mary Mancini and Freddie O’Connell’s local political radio show.

Topics covered include the history of the organization and the need for its work (including the landmark book and newer initiatives), the PRIM&R conference Judy attended while in town, Senator Kennedy, health care reform, media portrayals of health reform proposals, the Stupak amendment, abortion, age discrimination, social justice and diversity, among others.

The show is archived online at http://tinyurl.com/yhadu9s (you may need to download RealPlayer to listen). Judy’s segment starts at about 1:32 of the 2-hour episode. No transcript is available, but you can get some quick text notes on the segment via Liberadio(!)’s Twitter updates from this morning.

Thanks to Liberadio(!), and to everyone who came out to the OBOS house party last night!


November 12, 2009

Searching for Credible Health Information Online?: Ask Rachel

In our second self-referential moment of the week, I wanted to point to several posts by OBOS blogger Rachel Walden that are featured in this month’s MedLib’s Round, a monthly blog carnival that highlights some of the best writing on medical librarianship.

From the carnival intro:

A 2008 study by the Center for Medicine in the Public Interest found that searching for health information online can be dangerous, with search engine results pages dominated by websites that appeared legitimate but had zero medical authority [1]. Our hope is that this edition of MedLib’s Round — themed Finding credible health information online— will offer ideas and advice to help people use the Web more effectively to search and find credible health information.

This post, “Tips for Savvy Medical Web Surfing” – A Critique, from Rachel’s own site, Women’s Health News, reviews  a CNN article on how to conduct online medical searches.

Can You Trust That Health Website?, published here, explains how to evaluate the reliability of health information websites. In Understanding Medical Research, also published at OBOB, Rachel offers tips on how to make sense of complex (and sometimes contradictory) studies and what it all means for your health.

Visit Highlight Health for more great selections from this month’s carnival, and congrats to Rachel!


November 12, 2009

If the Shoe Commercial Doesn’t Fit, Don’t Buy It: Reebok Ads High on Objectification, Low on Value

by Meg Young
Our Bodies Ourselves intern

Reebok recently launched a new ad campaign for its women’s “Easy Tone” sneakers that is definitely not focused on feet. The shoe’s selling point is that the sole is supposedly constructed in such a way that it works the wearer’s hamstrings, calves and glutes as she walks, resulting in “better legs and a better butt with every step.”

From watching Reebok’s ads, however, one would think that the company is promoting lingerie, not a new fitness sneaker.

reebok_adOne of the ads begins with a close-up of a woman’s breasts in a bra, then pans to her panty-clad backside before briefly flashing a picture of the sneakers. In another ad, the bra is long gone as a faceless woman stretches her body — almost naked except for underwear and sneakers — over a bed. The only thing missing is porno-groove music. Oh wait, it’s there, too.

In the only ad depicting a woman wearing clothes (short shorts and an exercise tank top), she is unable to get the cameraman to focus on her face (instead of her behind) as she presents the virtues of “Easy Tone” sneakers.

YouTube has tagged the videos as “inappropriate for some users” and requires viewers to state that they are 18 before watching.

The late-night style ads aren’t the only bizarre thing about this sneaker campaign. Jami Bernard at WalletPop points to this warning on the Reebok website : “Due to the instability of the balance pods, activities with unplanned side-to-side movement and/or any lateral-movement -sports such as tennis or basketball-should be avoided.”

A fitness sneaker that you can’t play sports in? Huh?

Reebok’s website proclaims that upon wearing the sneakers, “88% of men will be speechless. 78% of women will be jealous.”

I’m 100 percent sure I can find a better way to spend $110.

Meg Young recently graduated from high school in Middlebury, Vt., and will enroll at Tufts University in the fall of 2010 after taking a gap year.


November 11, 2009

Breast Cancer Survivors May Experience Ongoing Pain After Surgery

The current issue of JAMA has an article and editorial on the chronic pain experienced by some women following breast cancer surgery. This is not a topic I’ve personally read or heard much, so I was interested and surprised to read the editorial’s opening statement that “Chronic pain after breast cancer surgery occurs in approximately 50% of patients.”

The associated study paper in the journal provides more detail.  The research looked at 3,253 women in Denmark who had undergone unilateral (one-sided) breast cancer surgery in 2005-2006. The women were surveyed 2-3 years after surgery. Clinical data on the surgeries and follow-up was extracted from Danish registries, and women were surveyed about the presence or absence of pain and its location, severity, and frequency.

The authors found that 47% of the surveyed women reported pain. Of these women, 13%  reported severe pain; 39% reported moderate pain; and 48% reported light pain.

Among the 13% of women with severe pain, 77% experienced pain every day. Many of the women experiencing ongoing pain (28%) had additional contact with a physician to try to address the issue, or were taking analgesics or receiving other therapy in attempts to relieve the pain.

Younger women were more likely to report pain. There was no difference in rates of ongoing pain for mastectomy vs. breast conserving surgery, but women who had mastectomy had a higher risk of moderate to severe pain as opposed to lighter pain. Women who received adjuvant radiotherapy also had a higher risk of reporting pain. Additional women reported sensory disturbances or discomfort.

With nearly 50% of women experiencing chronic pain 2 to 3 years after surgery, it’s clear that more research on effective ways of controlling or preventing the pain needs to happen.


November 10, 2009

Our Bodies Ourselves Guest Stars on “Gossip Girl”

We’ve heard from several readers who caught a glimpse of “Our Bodies, Ourselves” on a recent episode of “Gossip Girl.” (No, not that episode.)

We tried to embed the scene, but permissions just won’t let it happen. Fortunately Television Without Pity has the full (really full) re-cap, including the dialogue referencing OBOS.  New York magazine was as surprised as we were to find OBOS included …


November 9, 2009

Scott Roeder Confesses, Says Killing Dr. George Tiller was Justified

Scott Roeder, the man accused of shooting abortion provider George Tiller, confessed to the killing today and said that he plans to argue at his trial that his actions were justified.

Roeder, 51, talked to an AP reporter for more than 30 minutes by telephone. He has been charged with one count of first-degree murder in Tiller’s death and two counts of aggravated assault for allegedly threatening two church ushers who tried to stop him when he shot Tiller in a church foyer in May, just before the start of a Sunday mass.

The confession has no bearing on Roeder’s “not guilty” plea. His trial is scheduled to begin in January.

“Because of the fact preborn children’s lives were in imminent danger this was the action I chose. … I want to make sure that the focus is, of course, obviously on the preborn children and the necessity to defend them,” Roeder told the AP.

“Defending innocent life — that is what prompted me. It is pretty simple,” he said.

Roeder also said he has no regrets about killing Tiller.

“No, I don’t have any regrets because I have been told so far at least four women have changed their minds, that I know of, and have chosen to have the baby,” Roeder said. “So even if one changed her mind it would be worth it. No, I don’t have any regrets.”

A small group of abortion opponents today released a document — “Defensive Action Statement 3rd Edition” — that proclaims “whatever force is legitimate to defend the life of a born child is legitimate to defend the life of an unborn child.” The 21 signers state that “if Scott Roeder did in fact kill George Tiller, his use of lethal force was justifiable,” and he should therefore be acquitted.

According to this document (and bear in mind, it is difficult to read), this  statement was originally written by Paul Hill in 1993 and signed by 29 people who supported Michael Griffin’s shooting of Florida abortion provider David Gunn. One year later, Hill shot abortion Florida provider John Britton. Hill was executed in 2003.

The document is kept at the website of David Leach, who has written a legal brief (pdf) for Roeder to use in his defense.


November 9, 2009

Public Comment Period Open on Virginia Midwives Regulation

A public comment period is currently underway regarding a proposed regulation [PDF] in Virginia that would require the state’s Certified Professional Midwives to:

disclose to their patients, when appropriate, options for consultation and referral to a physician and evidence-based information on health risks associated with birth of a child outside of a hospital or birthing center, as defined in subsection E of § 32.1-11.5, including but not limited to risks associated with vaginal births after a prior cesarean section, breech births, births by women experiencing high-risk pregnancies, and births involving multiple gestation.

As Brynne Potter of Mountain View Midwives explained:

The midwifery community in Virginia believes that even though this requirement is redundant to our existing statutory requirement to practice the Midwives Model of Care, which is based on informed choice, the opportunity to establish once and for all that women are choosing midwifery care and home birth of their own free and informed will, is worthy of our close attention and support. We believe that if we can engage the Board of Medicine in an unprecedented process of looking at evidence-based criteria for competent practice, we will widen the narrow band of understanding that is forming between medical and midwifery based maternity providers. In addition, we need to be vigilant during the process to make sure that any guidelines or rules established do not create unforeseen obstacles to care for women who may fall into gray areas regarding relative risk of home or hospital birth based on current standard of practice in many hospital settings. Mandated c-sections for VBAC, twins, and breech are good examples of the conundrum many midwives and their clients face when providing and making informed decisions for care.

You do not have to be in Virginia to comment; outside organizations and individuals may also weigh in. Brynne suggests that comments address the following key points:

  • Give a description of who you are and what your organization does.
  • Commend the VA Board of Medicine for it’s efforts to utilize evidenced-based information as a measure for competency in developing informed choice.
  • Any suggestions that you may have for resources that the Board should use while developing these documents.
  • Perhaps suggest that Virginia’s work may set a new standard or precedent for other states to use.

Brynne has further discussion of the law in these three posts at her blog, Midwife Monologues.

Comments will be accepted until midnight on November 25, 2009.


November 7, 2009

House Health Care Reform Bill Passes: 220-215

The passage is bittersweet, but finally it’s done … With 6:51 time remaining to vote, Democrats have secured the 218 “yea” votes needed to pass the Affordable Health Care for America Act (HR 3962).

Final tally 220-215; 39 Democrats voted “no.” One Republican — Rep. Joseph Cao, who represents the New Orleans area — voted “yea.”

“Democrats have sought for decades to provide universal health care, but not since the 1965 passage of Medicare and Medicaid has a chamber of Congress approved such a vast expansion of coverage,” reports the Washington Post. “Action now shifts to the Senate, which could spend the rest of the year debating its version of the health-care overhaul. Majority Leader Harry M. Reid (D-Nev.) hopes to bring a measure to the floor before Thanksgiving, but legislation may not reach Obama’s desk before the new year.”

As I watched Democrats congratulate themselves, it was difficult to feel celebratory. Passage of the Stupak amendment — which bars a government-run insurance plan from offering abortion *and* prohibits women who receive government insurance subsidies from purchasing private plans that include abortion coverage — sucked a lot of the energy out of the room.

As Princeton professor Melissa Harris Lacewell said on Twitter, “Stupak feels like Prop 8 [which overturned same-sex marriage in California the same night President Obama was elected]. When the ‘win’ is accompanied by legislation that attacks the most marginal it doesn’t feel like a win.”

For a look at how each House member voted, check out this Washington Post graphic. You can sort the list by how much money each member has received in campaign contributions from the health industry and by the percent of people without health insurance in each district . The New York Times does a nice job of showing the geography of the vote (mouseover the states to reveal individual districts).

We close tonight with a reminder of what this bill provides — and the work still left to be done. Read Maggie Mahar’s in-depth post “Heath Care Reform — Looking at the Glass Half-Full.” The National Women’s Law Center breaks down what this bill means for women in every state.


November 7, 2009

Stupak Amendment Debate Coverage & Results

The House is debating the Stupak amendment limiting access to abortion services — you can watch it on C-SPAN.org, or follow along on the Twitters (hashtag #stupak), where many of us are quoting the representatives for and against. I’m @cmc2

For more background, read “Abortion Fight Erupts in Health Care Debate” at The New York Times, and “House Democrats Will Consider Stupak’s Abortion Amendment On The Floor” at Think Progress’ Wonk Room.

And in case the current House bill’s provisions on abortion are in doubt, read Maggie Mahar’s analysis: “The fact of the matter is that the House bill contains more than two dozen references to abortion and virtually all of them describe how insurers can restrict or deny coverage for the procedure.”

Update: Amendment passed 240-194-1 (Republican Rep. John Shadegg of Arizona cast the lone “present” vote). A surprising number of Democrats – 64 — joined Republicans in passing the amendment. View the roll call here.

Jodi Jacobson just posted a piece at RH Reality Check that begins:

Tonight, with the aide of some 60 Democrats, women’s rights were effectively negated by the US Congress as the House passed the Stupak amendment to HR 3200, the Affordable Health Care Act of 2009.

More in-depth analysis of how we got here is forthcoming. But one thing is clear: The US Conference of Catholic Bishops (USCCB) apparently is running the US government, aided by a cadre of “faith-based advocacy groups,” the House Democratic leadership, the White House and members of the Senate.

Remember, this amendment is not a done deal. It still has to pass Senate and then survive the conference committee, and women’s groups are already mulling action in the weeks to come. But what a sad day it is when the only way to gain health care coverage is to lose a legitimate, legal health care procedure.

Another distressing point: The New York Times reports that only one male lawmaker — Rep. Jerrold Nadler of New York — joined women who spoke against the amendment on the House floor. A correction, however, is in order: My own Congressman here in Chicago, Mike Quigley, also spoke out (cheers!). But that may have been it.

Here, from the Times, are bits of what other lawmakers said during the debate:

Representing the abortion-rights segments of the Democratic membership, Representative Diana DeGette of Colorado called the amendment a “wolf in sheep’s clothing” that would deny women access to care. Representative Lois Capps of California argued that the underlying bill already prohibited federal financing of abortions. The amendment, she said, “Actually restricts coverage of a legal medical procedure.”

“Not one other medical procedure is singled out for rationing” in the larger bill, she said.

Others contended that this amendment would result in women having to go out and buy insurance that would cover such a procedure, a prospect one lawmaker scoffed at, saying a woman does not plan for an unplanned pregnancy.

Representative Nita Lowey, Democrat of New York, called it “a disappointing distraction” from the main event. Representative Barbara Lee, Democrat of California, said the amendment would take women “one step back” toward the dark days of back-alley abortions. Representative Rosa DeLauro, Democrat of Connecticut, said, “We should not be injecting this divisive and polarizing issue into our debate.”

And the full speech by Rep. Jan Schakowsky of Illinois:

This Stupak-Pitts Amendment goes way beyond current law. It says a woman cannot purchase coverage that includes abortion services using her own dollars — even middle-class women using exclusively their own money will be prohibited from purchasing a plan including abortion coverage in every single public or private insurance plan in the new Health Care Exchange.

Her only option is to buy a seperate insurance policy that covers an abortion — a ridiculous and unworkable approach since no woman plans an unplanned pregnancy.

This amendment is a radical departure from current law that will result in million of women losing the coverage they already have. Our bill is about lowering health care costs for millions of women and their families, not for further marginalizing women by forcing them to pay more for their care. This amendment is a disservice and an insult to millions of women throughout the country, and I urge a NO vote on this amendment.

These strong responses ultimately weren’t enough to kill the amendment, but they did serve as a reminder of the urgency of electing more pro-choice women to Congress. Anyone else have points to share?


November 7, 2009

Is Your Representative On This List? Call Now to Preserve Abortion Coverage

We’ve received news that these Democrats are on the fence about the Stupak amendment that would restrict abortion coverage in the health reform bill (read this post for background).

If you live in any of these districts, or know someone who does, please call your representative *now* and let him know (yep, they’re all men) that women’s healthcare should not be negotiable.

Rep. Chris Carney (Pennsylvania – 10th district)

Rep. Ben Chandler (Kentucky – 6th district)

Rep. Jim Cooper (Tennessee – 5th district)

Rep. Henry Cuellar (Texas – 28th district)

Rep. Artur Davis (Alabama – 7th district)

Rep. Joe Donnelly (Indiana – 2nd district)

Rep. Richard Neal (Massachusetts – 2nd district)

Rep. Earl Pomeroy (North Dakota – at large)

Rep. Vic Snyder (Arkansas  - 2nd district)

Rep. John Tanner (Tennessee – 8th district)

Rep. Peter Visclosky (Indiana – 1st district)


November 7, 2009

So This is What It’s Come To: Abortion Amendment Limits Access for Women

The House is expected to vote today on a $1.055 trillion health care package that would expand coverage for up to 36 million people — but first there will be a vote on an amendment that severely limits abortion coverage in a new government-run insurance plan and through private insurance that is bought using government subsidies.

After a back-room fight last night, House Speaker Nancy Pelosi agreed to allow the amendment proposed by Rep. Bart Stupak (D-MI). It reads:

The amendment will prohibit federal funds for abortion services in the public option. It also prohibits individuals who receive affordability credits from purchasing a plan that provides elective abortions. However, it allows individuals, both who receive affordability credits and who do not, to separately purchase with their own funds plans that cover elective abortions. It also clarifies that private plans may still offer elective abortions.

If you are reading this on Saturday, stop. Call your representatives and tell them this amendment is unacceptable. Go, now. We’ll wait. [Update: See this list of 11 representatives who are on the fence. These members, in particular, need to hear from you.]

It looks likes the amendment has enough votes to pass may be a close vote, and lawmakers need to know that a health care bill that tosses out a legal medical procedure used by millions of women every year is unacceptable.

The Washington Post’s Ezra Klein writes:

The amendment is expected to pass with relative ease. Republicans will join with anti-choice Democrats to push it over the finish line. Once the amendment passes, the bill is cleared for a vote, and all parties expect that vote to succeed. Today looks likely to end with a historic, and important, vote. A vote that is a first step towards helping more than 30 million people secure health-care coverage, and making sure hundreds of millions are better protected from the vagaries of the insurance industry. But Stupak’s amendment is a bitter start. It is, however, not the end. Even if it muscles into the House bill, it will also have to pass in the Senate, and then survive conference, before it becomes law.

Illinois Democrat Jan Schakowsky told C-SPAN’s “Washington Journal” that she’ll vote for the bill’s passage today, even with the Stupak amendment, but would opposed the final bill if the amendment survives the conference committee.

“If that language were in the final final bill, I certainly couldn’t support it,” Schakowsky said.

Plus: This morning, members of the Democratic Women’s Caucus went to the microphone, one by one, to explain how the overall health care bill would benefit women. Republican Rep. Tom Price of Georgia responded with a stream of “I object. I object. I object.” It got ugly.

Here’s a five-minute video showing what went down; if you’re short for time, below is the “I object” mashup created by Media Matters.


November 6, 2009

New Blog, Weightless, Critiques Media While Promoting Well-Being

PsychCentral.com has launched a new body image blog called Weightless. From the site description:

Weightless is about well-being, not weight; about fostering body image, regardless of your size. It’s about exposing women’s magazines, other mediums and so-called experts, when they’re touting unhealthy tips and promoting restrictive standards.

The goal of Weightless is to help women develop a better body image and work toward accepting themselves as they are, while being healthy and happy (fad diets and skinny-mini standards prohibited!); and to become sharp consumers, who can pick apart a commercial or magazine article and know which advice is helpful or harmful.

In one of the site’s first posts, writer Margarita Tartakovsky identifies seven signs you may be suffering from a poor body image and suggestions to help readers be less self-critical. In the aptly titled “Minding Women’s Magazines: Asinine Advice,” Tartakovsky pulls out “tips” from magazines including Women’s Health, Self and Cosmopolitan and deconstructs the messages. To wit:

3. “Your fear: ‘I overeat at parties.’ Celebratory spreads make it easy to stuff yourself. But obsessing over every bit will ruin your night. ‘Ask yourself, How do I want to feel tomorrow? Bloated and disappointed or proud and healthy?’ Beck says. Strap your watch on the wrong wrist as a visual reminder of your goal; you’ll automatically eat less.” {Self, November 2009, pg. 87}

As I was reading the first few phrases, I found myself nodding in agreement — especially the part where we shouldn’t be obsessing about food — up until the value judgments rolled in. So what if I do enjoy one too many appetizers at a holiday party, instead of saying to myself how delicious the food was and acknowledging that I did overeat and will try to avoid that next time, I should feel like a bloated, disappointed failure. Thanks Self!

Since women are often made to feel like they’re overeating anytime they’re enjoying their food, I wish the response first questioned why we think we’ve crossed the line. For some, overeating at a party might mean consuming more than one tiny appetizer.

But though it sidesteps this question, I appreciate that a popular and respected website on mental health considers body image a topic worthy of its own blog. And I’m glad  Weightless launched in time to confront  the holiday weight smack-down.

Ralph Lauren digitally altered modelPlus: Last month, Randy Cohen, who writes The Ethicist column for The New York Times, asked whether ads using electronically altered images of models — making them ridiculously skinny — should  be banned or come with a warning label. The model pictured here was digitally altered for a Ralph Lauren window display in Sydney, Australia.

Speaking of Australia, a federal government advisory group comprised of educators, psychologists and media folks have put together a national strategy on body image (pdf).

One of the group’s members, Danielle Miller, writes about the recommendations, including the proposed educational curriculum and voluntary code of conduct for advertisers and fashion companies. In this frank discussion, Miller acknowledges the shortcomings of the proposal and the difficulties that lie ahead.


November 5, 2009

New CDC Reports on Infant Mortality, Pregnancy Rates, Births

The Centers for Disease Control and Prevention has released three new reports dealing with pregnancy and birth topics.

Estimated Pregnancy Rates for the United States, 1990–2005: An Update [PDF]
This report provides information on trends in U.S. pregnancy rates from 1976-2005, with an emphasis on the period from 1990 to 2005. Among the findings, it indicates that in 2005 (the most recent year available) the pregnancy rate was 103.2 per 1,000 women, about 11% below the 1990 peak (115.8), but very similar to the rate (102.7) in 1976 when the data collection started.

The report notes that the pregnancy rate for teenagers fell 40% during the 1990–2005 period, to 70.6 pregnancies per 1,000 women ages 15–19, the lowest reported since 1976. The report notes, however, that “Preliminary data on births extending to 2007 show that the long-term decline in the teenage birth rate was halted with increases from 2005 to 2006 and from 2006 to 2007.”

Expanded Health Data From the New Birth Certificate, 2006
In 2003, the CDC began asking providers to provide additional information on birth certificates, with questions on risk factors, obstetric procedures, characteristics of labor and delivery, method of delivery, and congenital anomalies. This report is based on the additional birth data collected from birth certificates in 19 states since 2003.

This report is more of a snapshot of what is happening in pregnancy and birth care, and focuses less on trends. Among the findings:

  • External cephalic version (ECV) to adjust fetal position was performed in 3.2 of every 1,000 births, and was considered successful about 73% of the time;
  • 31.4% of births were by c-section; of the c-sections, about 20% had attempted a trial of labor;
  • 59.9% of women received epidural or spinal analgesia;
  • About 15% of women received antibiotics during labor.

The authors do provide a caveat that studies of the quality of this data are ongoing, and that, for the revised forms, “data quality may suffer initially as hospitals and states become familiar with the new checkboxes and new collection processes” — in other words, it’s possible that some interventions may be under- or over-reported.

They detected racial and ethnic disparities, in that “for all of the interventions featured in this report (cervical cerclage, antibiotics for the infant, epidural or spinal anesthesia, etc.), Hispanic mothers and infants are consistently less likely overall to receive treatment than non-Hispanic white and non-Hispanic black mothers and infants.” The report also notes, however, that Hispanic mothers may need fewer interventions in some cases, for example by being less likely to have gestational diabetes.

Related to the 15% receiving antibiotics, a new retrospective case-control study published in the journal Archives of Pediatrics and Adolescent Medicine (written by some CDC-affiliated authors) compares women whose infants had congenital anomalies with women whose infants did not and surveyed them about antibiotic use during pregnancy.

They found fairly low rates of anomalies among women who took penicillins, erythromycins, and cephalosporins, with somewhat higher odds of anomalies among children of women who took sulfonamides and nitrofurantoins during pregnancy (and a need for additional scrutiny of these drugs). They note, however, that it is not possible for them to tell whether the increased odds of an anomaly with some antibiotic drugs is related to the drug itself, the underlying infection, or some other unexplained factor. More summary detail is provided here.

Behind International Rankings of Infant Mortality: How the United States Compares with Europe
Finally, this report compares infant mortality rates in the U.S. with other nations. It includes a handy chart of reporting differences between countries that can help make sense of how the rates compare. Because some countries exclude live births prior to 22 weeks from their data, this CDC report looks only at births and infant deaths at 22 weeks and beyond.

They found that, when births at less than 22 weeks of gestation were excluded, the U.S. infant mortality rate was still higher than for most European countries, at 5.8 per 1,000 live births. The lowest rates were 3.0 for Norway and Sweden, and a number of other nations had better rates between 3.0 and 5.8. The authors note that the infant mortality rate in the U.S. is comparable or favorable to European rates for preterm births, but not for term births.

They explain:

The infant mortality rate for infants born at 24–27 weeks of gestation was lower in the United States than in most European countries (except Norway and Sweden); seven countries had higher rates. For infants born at 28–31 weeks of gestation, the U.S. rate was lower than for all countries shown except Austria, Denmark, and Sweden. For infants born at 32–36 weeks of gestation, the U.S. infant mortality rate was lower than for all countries shown except Austria and Norway. However, for infants born at 37 weeks of gestation or more, the United States’ infant mortality rate was highest among the countries studied.

The U.S. also had higher rates of preterm birth (at 12.4%) than the other countries in the study; Ireland fared best, at 5.5%. The authors attribute the higher rate of infant mortality primarily to preterm births, and estimate that possibly 1/3 of U.S. infant deaths might be avoided if our distribution of births by gestational age looked more like Sweden’s. They don’t, however, offer any possible explanations for the U.S.’s poorer infant mortality rates for term births.