View all Women’s Health Heroes. Voting closes May 14. Background info here.

Entrant: Emma McGuinnes
Nominee: Rita Arditti

As a women’s studies major, I have learned the importance of examining and understanding connections when fighting for social justice. Rita Arditti, a feminist, a human rights activist, an environmentalist and a biologist, spent her life exposing these intersections and advocating for the need to develop a consciousness about such links that contribute to oppression.

Rita was born in 1934 in Argentina and studied biology in Italy before settling in the United States. She co-founded the Science for the People movement in the 1970s, which pushed to show the connections between science, the Vietnam War and politics. The movement, which was anti-war in spirit, was to raise awareness about how science can be manipulated to support certain political agendas.

In 1974, Rita was one of four founders of the New Words Bookstore in Cambridge, Mass., a women’s bookstore that offered a space for words and voices of those who had been silenced to be showcased and heard. The bookstore also hosted several activism events bridging the gap between academia and the community.

Later in life, Rita also helped to found the Women’s Community Cancer Project, whose mission was to raise awareness about environmental exposures that contribute to women’s cancers. Rita herself lived with breast cancer for decades, and she was dedicated to showing the links between chemicals and the rise in cancer in women. Intersecting her feminist, environmentalist and biology background, Rita critiqued the medical world for being male-dominated and influenced by major chemical producers. She was not satisfied with the treatment-oriented approach to cancer research and advocated for looking at how to prevent women from getting cancer in the first place.

Rita Arditti passed away on December 25, 2009. She will be greatly missed and always be remembered. She raised a critical awareness about how fields traditionally taken as fact, such as science and medicine, can be misused to support certain political ideologies and to perpetuate oppression. Rita worked endlessly for social justice and for providing the space for those who have been marginalized to be heard.

Last summer, we shared that OBOS had joined an ACLU lawsuit challenging breast and ovarian cancer gene patents.

Briefly, the ACLU and the Public Patent Foundation (with plaintiffs including OBOS, pathology associations, and individuals) filed a lawsuit against the U.S Patent and Trademark Office, Myriad Genetics and the University of Utah Research Foundation, “charging that patents on two human genes associated with breast and ovarian cancer are unconstitutional and invalid.” The suit focused on the BRCA1 and BRCA2 genes, mutations of which are related to increased risk of breast and/or ovarian cancers, and for which Myriad Genetics controlled the patents (effectively controlling the available testing for important mutations).

As Breast Cancer Action explained, “When one company controls all the testing, less information and resources are available to both patients and researchers.” The New York Times story on the ruling also explains that “Some doctors and researchers contend that this monopoly has long held up not only competing, cheaper tests but has also hindered gene-based research.”

Last Monday, a U.S. judge ruling in the case invalidated the patents, arguing that “the company deserved praise for what is ‘unquestionably a valuable scientific achievement,’ but not a patent because the ‘isolated DNA is not markedly different from native DNA as it exists in nature.’” Essentially, the relevant genes are found in nature and thus aren’t novel enough to qualify for patent protection.

The judge dismissed the claim that the U.S. Patent and Trademark Office’s issuing of the patents was unconstitutional. The complete ruling can be found here [PDF]. The ruling has the potential to make the study of and testing for important genetic variations cheaper and more readily available.

Genomics Law Report has a good overview of the ruling, and several ScienceBlogs authors are also talking about the case, with one calling the ruling “a monumental step towards bringing sanity to biotech patents.”

This Sunday, CBS aired an episode of 60 Minutes that prominently featured the case. As OBOS was a plaintiff to the suit, we also got a chuckle out of the title of this editorial at the NYDailyTimes: Our bodies, ourselves: Judge rightly rules that no one can patent human genes

The ACLU itself also has commentary on the ruling, calling it “a huge victory for women’s health and scientific freedom,” and NPR’s Richard Knox has an interview with an attorney who explains the ruling and its implications.

For our Wellesley, Mass.-area readers, an upcoming panel discussion on new recommendations for mammography and breast self-examination may be of interest.

Panelists will include Cindy Pearson of the National Women’s Health Network and Ngina Lythcott of the Black Women’s Health Imperative, with moderator Susan Reverby from Wellesley College’s Women and Gender Studies department.

The discussion will take place on Thursday, Feb. 25, in PNW 212 (Pendleton West 212 Amphitheater Classroom) from 5 – 6:15 p.m.

Questions can be directed to ctaylor1 at wellesley dot edu.

Courts in Philadephia recently ruled in favor of two plaintiffs who sued Pfizer because they believed their breast cancer was caused by taking Prempro, an estrogen plus progestin combined hormone replacement therapy (formerly sold by Wyeth).

More than $100 million was awarded by juries between those two cases, although news reports indicate that Pfizer will appeal and damages awarded are likely to be reduced; a Pfizer spokesperson said the company does not believe the verdicts “were supported by the evidence or the law.” About 10,000 similar cases are apparently pending at this time.

In 2002, the Women’s Health Initiative study was released results indicating that women taking estrogen plus progestin hormone replacement (such as Prempro) were more likely to develop breast cancer than women taking placebo, and their cancers were more likely to be more advanced. The trial was stopped early that year after it became clear to investigators that the risks of combination hormone therapy outweighed the reported benefits.

As a result of WHI findings, in 2003 the FDA required the addition of a black box warning to the drug’s label to state that estrogen and estrogen plus progestin therapies should not be used for the prevention of cardiovascular disease, and to warn of increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women taking the estrogen/progestin combo.

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.”

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.

A commentary in the current issue of the journal JAMA addresses breast and prostate cancer screening and the complexities and limitations of current screening approaches. The authors explain that while screening for the two diseases has increased, “the absolute numbers of more advanced disease have not decreased nearly as much as hoped for either cancer,” and that mortality has not decreased as much as expected.

It’s a complicated topic, even without getting into issues of access to screening and racial disparities in screening and treatment (which the JAMA piece does not). Essentially, the key limitations of screening are that widespread screening with current methods may sometimes detect slow-growing or inconsequential tumors, resulting in unnecessary treatment (because it’s not yet possible to predict which tumors present little risk), while in other cases, early detection doesn’t decrease mortality rates, because certain aggressive cancers, even when caught early, will not respond to treatment.

These messages are not easy message to convey or understand, and some worry that the related headlines may lead people to think screening is unwarranted. In a New York Times article on the commentary one biostatistician expressed concern that “the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline. The fact that population screening is no panacea does not mean that it is useless.”

The authors of the JAMA commentary don’t propose abandonment of breast and prostate cancer screening, however – they propose an improved approach consisting of determining validation tools that can identify and differentiate high and low risk cancers, reduction of treatment for minimal-risk disease,  improved clinical and patient support tools to help guide decision-making, and identification of the the highest-risk patients for prevention initiatives. They suggest that there should be investment of significant funds – perhaps 10-20% of the $20 billion spent each year on screening – in these four areas “to improve screening, accelerate prevention research, and reduce harm from breast cancer and prostate cancer deaths.”

The New York Times article on the commentary also generated some controversy when it characterized the American Cancer’s Society’s response to the commentary as “saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated” and that the organization was as a result “reconsider[in] its message about the risks as well as potential benefits of screening.”

The American Cancer Society has issued multiple responses to this characterization, explaining that it is standing by its screening guidelines. Organization representatives stated that they have long acknowledged that cancer screening isn’t perfect, but that “The bottom line is that mammography has helped avert deaths from breast cancer, and we can make more progress against the disease if more women age 40 and older get an annual mammogram.”

However, this research adds more fodder to the question of whether and how effective mammograms are. The Cochrane Collaboration, which creates meta-analysis of high quality systematic reviews, states in its review Screening for breast cancer with mammography that while screening likely reduces breast cancer mortality, ” it is not clear whether screening does more good than harm.”

For more on this topic, see our online content, Mammography Screening Controversy.

As noted in a recent article for the LA Times, Planned Parenthood for Orange and San Bernadino Counties is in a dispute with the Orange County (California) government over money from tobacco settlement revenue (TSR) that would have funded a breast health program for uninsured/low-income women under age 40 at high risk for breast cancer.

The County claims that the organization was denied funding for the program due to a missed deadline, while PPOSBC argues that the County set an unreasonable deadline and created restrictions not applied to other clinics receiving the funds.

According to the LA Time Times, Planned Parenthood and 17 other community clinics have received tobacco settlement revenue from the county for the last eight years, but PP’s contract was suspended in March after someone questioned taxpayer money going to a group that performs abortions.

Planned Parenthood for Orange and San Bernadino Counties has information about the situation on its website, including a description of the breast health program and a copy of the letter [PDF] sent to the County of Orange Health Care Agency on July 29th addressing the deadline issue, the county’s refusal to fund or treat Planned Parenthood in the same manner as other clinics, and the perception that barriers to implementing the breast health program are being created because of the abortion services provided by Planned Parenthood.

PPOSBC President & CEO Jon Dunn writes:

The real reason behind this parade of barriers, unreasonable deadlines and refusals to negotiate has nothing to do with providing vital health care to the uninsured women of Orange County. It is because Planned Parenthood offers abortion-related services, wholly independent from any services funded through TSR either in the past or contemplated. The County obviously wants to use any excuse imaginable to preclude Planned Parenthood from participating in the TSR program due to its opposition to abortion. The real losers in this attack on Planned Parenthood, of course, are the medically underserved men, women, and children who live in Orange County.

[Hat tip to the Daily Women's Health Policy Report]

We’ve written previously about the ACLU’s concern about gene patents, especially regarding the possibility that “high licensing and diagnostic testing fees that some biotech companies charge for use of ‘their’ genes are inhibiting biomedical research and interfering with patient care.”

On May 12, the ACLU and the Public Patent Foundation filed a lawsuit against the U.S Patent and Trademark Office, Myriad Genetics and the University of Utah Research Foundation, “charging that patents on two human genes associated with breast and ovarian cancer are unconstitutional and invalid.” The suit focuses on the BRCA1 and BRCA2 genes, mutations of which are related to increased risk of breast and/or ovarian cancers.

In explaining the rationale for the lawsuit, ACLU Executive Director Anthony D. Romero wrote:

Knowledge about our own bodies and the ability to make decisions about our health care are some of our most personal and fundamental rights. The government should not be granting private entities control over something as personal and basic to who we are as our genes. Moreover, granting patents that limit scientific research, learning and the free flow of information violates the First Amendment.

The following video provides an excellent overview of concerns about BRCA gene patenting, with additional commentary from ACLU representatives and women concerned about how the patents affect their own health:

Our Bodies Ourselves has joined the suit as a plaintiff, along with the Association for Molecular Pathology, American College of Medical Genetics, American Society for Clinical Pathology, and the College of American Pathologists, several prominent individuals in genetics and pathology, genetic counselors, and individual women patients who have been affected by the patents.

Breast Cancer Action has also joined the suit as a plaintiff, explaining that:

When one company controls all the testing, less information and resources are available to both patients and researchers. Women unable to afford the $3,500 fee are prevented from access to the test; women seeking second opinions on any results they might receive have nowhere to go; and women of African, Hispanic, or Asian descent are at a significant disadvantage because they disproportionately receive ambiguous results when tested by Myriad.

BCA Executive Director Barbara Brenner notes the importance of the landmark case:

There are so many injustices and inequities in breast cancer. The time has come to address them in all their forms—as they affect genetic risk, as well as social, political, and economic realities. This case is an important first step.

OBOS Executive Director Judy Norsigian will appear in a segment on the issue produced by Ivanhoe Broadcast News’s “Smart Woman” team — we’ll post an update when the piece airs.

The suit itself, Association for Molecular Pathology, et al. v. U.S. Patent and Trademark Office, et al., was filed in the United States District Court for the Southern District of New York in Manhattan and can be accessed online via this ACLU webpage.

The ACLU is also providing answers to frequently asked questions about the issue, and a number of background resources and fact sheets. Individuals may also sign a statement of support for the plaintiffs.

Chole Angyal, a senior sociology major at Princeton University, discusses the complexities of an on-campus campaign to raise money for breast cancer research. This year, the campaign ads turned sexist (and juvenile):

Every year at Princeton University, the student group Princeton Against Cancer Together (PACT) holds an event called Manicure for the Cure, where they bring in beauty school students to do manicures for Princeton students in the days leading up to spring formals. Formals are this weekend, so advertisements for Manicure for the Cure are all over campus.

To advertise, they’re using the slogan “Save Second Base.” The phrase “second base,” in case you don’t know, refers to foreplay involving breasts, as in “I kissed Jenny under the bleachers and made it to second base.” “How far did you let him go, Jenny? To second base?” If it sounds antiquated and ridiculous… that’s because it is.

Anyway, “Save Second Base” is a slogan that’s used nationwide by breast cancer research fundraisers. And it rubs a lot of people the wrong way. After all, curing breast cancer isn’t really about saving breasts, it’s about saving women’s lives. So it annoys people, but there was no reaction on campus when Manicure for the Cure used the slogan last year. I think people mostly made their peace with the slogan, figuring that at least it was raising money for a good cause.

But this year is different. This year, the organizers of the event, in an attempt to include men, are offering massages in addition to manicures. To advertise these services, they made posters that said: “Gentlemen: Save Second Base.”

And that is when the proverbial poop hit the fan.

Keep reading … The comments that follow her essay are a great example of the mindset that needs to be changed. You’ll find more opinions voiced at Equal Writes, a Princeton student blog on feminism and gender.

I was away last week, so no Political Diagnosis, but it’ll be back to business on Monday …

Court Strikes Down Iowa Law Banning Same-Sex Marriage: The unanimous state Supreme Court decision means same-sex couples will be allowed to marry in Iowa by the end of the month — and the doors will be open to couples from other states. The decision seems pretty solid for now. Unlike California, voters in Iowa cannot directly initiate constitutional amendments. Instead, an amendment would have to be taken up by the state Legislature, and Democrats, who control both chambers, show no interest in making it a priority.

Here’s the Supreme Court summary and the full decision (both pdf).

Mammogram Benefits Under Debate: “The conventional wisdom about breast cancer screening is coming under sharp attack in Britain, and health officials there are taking notice,” writes Roni Caryn Rabin in The New York Times. “They have promised to rewrite informational fliers about mammography after advocates and experts complained in a letter to The Times of London that none of the handouts ‘comes close to telling the truth’ — overstating the benefits of screening and leaving out critical information about the harms.”

Do People Who Support “Traditional Values” Value Pregnant Women?: Lynn Paltrow writes at Huffington Post –  “I have to thank Andrea Lafferty, of the Traditional Values Coalition for her response to a piece I wrote opposing Personhood USA’s efforts to give full constitutional rights to the unborn from the moment of fertilization. In her commentary she hopes to discredit my organization, National Advocates for Pregnant Women (NAPW) by exposing our commitment to all pregnant women, including those who love their children but are unable to overcome a drug problem in the short term of pregnancy …”

The Search for a Donor: Frances Kissling, the former president of Catholics for a Free Choice and a visiting scholar at the Center for Bioethics at the University of Pennsylvania, will soon need a kidney. This is her story about learning how to ask.

Birth Centers Advocacy Update: As we previously mentioned, American Association of Birth Centers was looking for 100 physicians to sign a letter in support of legislation to mandate the facility fee in Medicaid. There are 102 signatures so far and counting …

Women Pay Higher Price For Health Insurance: NPR reporter Sarah Varney writes about a past experience seeking health insurance (a completely frustrating process) and the higher insurance rates women pay in some states. The piece concludes with some important news for workers laid off after Sept. 1, 2008:

If you had employer-sponsored health insurance and qualified for COBRA coverage, under the new stimulus bill, the federal government will pay 65 percent of your premium for up to nine months.

And that even includes laid-off workers who initially turned down COBRA coverage because they thought it was too expensive. They now have a second chance to sign up.

Plus: Also from NPR — the hidden costs of cancer treatment, even with insurance. And The New York Times offers tips for people with pre-existing conditions, whether you’re currently covered or shopping for insurance.

Congress Approves Budget: The House and Senate approved budget blueprints on Thursday that include funding for expansion of health care coverage; now the hard work begins in conference committee.

America Going Quiet on HIV/AIDS: A new Kaiser Family Foundation survey found that the percentage of people in the United States who say that they have seen, heard or read a lot about HIV/AIDS in the United States has fallen from 34 percent five years ago to just 14 percent today. The percentage of African Americans reporting this has fallen from 62 percent to 33 percent.

Global Women & Health Salon: President Obama this year has signed executive orders eliminating the “Global Gag Rule” and restoring U.S. funding for the United Nations Population Fund. “Now that [these two goals] have been met what else should the Obama administration do to promote the health and welfare of women worldwide?” asks Mark Goldberg, in the kick-off post for the After the Gag Rule Salon sponsored by RH Reality Check and UN Dispatch.

Afghan Law Criticized: UN and Western aid agencies are urging Afghan President to repeal a law he signed last month that reverses freedoms won by Afghan women, reports BBC News. Human rights activists say the law legalizes rape within marriage, and women will need permission from their husbands to leave their homes.

The ACLU has taken an interest in gene patents, which allow human genetic sequences and gene tests to be patented,  expressing concern that “While the purpose of the patent system is to encourage innovation, the high licensing and diagnostic testing fees that some biotech companies charge for use of ‘their’ genes are inhibiting biomedical research and interfering with patient care.”

Although somewhat technical, this Human Genome Project Information page from the Oak Ridge National Laboratory provides an overview of the topic, including some of the arguments for and against gene patenting, with lots of links to related information.

A freely available article from Nature Reviews Genetics, Patenting human genetic material: refocusing the debate, also provides good background reading on this issue, including a discussion of concerns about patenting from “adversely affecting the research environment to hampering the distribution of useful technologies.” A number of other articles on this topic are also freely available through PubMed Central.

The ACLU is specifically focused on patents related to the BRCA1 and BRCA2 genes relevant to breast and ovarian cancer, explaining that:

“…the Utah-based company Myriad Genetics has patented two genes – BRCA1 and BRCA2 – and certain mutations along these genes that have been associated with an increased risk of certain forms of breast and ovarian cancer. The high licensing and diagnostic testing fees charged by Myriad have forced some researchers to discontinue research on breast cancer and have prevented women from having access to screening for mutations.”

The organization is currently conducting a survey to gather information on women’s experiences with BRCA testing:

We are interested in hearing from you if you have been advised to get the BRCA genetic test and fall into one of the following categories:

1) You were tested, and had problems with or concerns about the testing process (for example, your results were uncertain or incorrect, or you were advised you needed to be tested a second time); or

2) You were tested, and want to be tested again through another lab for verification; or

3) You wanted to be tested, but had financial problems getting the test (for example, you could not afford it or your insurance did not cover it); or

4) You want to determine the BRCA status of a deceased relative.

If your answer is YES to even one of these questions, please take the ACLU’s survey: www.aclu.org/brcasurvey. The ACLU is looking into the legality of patenting human genes, including the BRCA1 and BRCA2 genes, and the effects of gene patenting on research and testing.

For additional information on genetic testing and breast cancer in general, see our related content and this page from the National Cancer Institute.

Congress Considers Ban on BPA: Senate and House leaders on Friday said they would introduce bills establishing a federal ban on the chemical bisphenol A in all food and beverage containers. Meg Kissinger of the Milwaukee Journal Sentinel writes:

The move comes a day after Sunoco, the gas and chemical company, sent word to investors that it was now refusing to sell bisphenol A, commonly known as BPA, to companies for use in food and water containers for children younger than 3. Sunoco told investors it could not be certain of the compound’s safety. Last week, six baby bottle manufacturers, including Playtex and Gerber, announced that they would stop using BPA.

The bills would immediately outlaw the sale of all food and drink containers made with BPA. Anything on store shelves would have to be removed. It would suspend the manufacture of food packaged in containers that contain the chemical, but items already made could be sold.

For more information, check out the Journal Sentinel’s ongoing BPA investigation “Chemical Fallout,” at www.jsonline.com/chemicalfallout. Great reporting.

Tiller Trial Starts Monday: The L.A. Times previews the trial of Kansas abortion provider Dr. George Tiller, who faces charges stemming from late-term procedures, and the politics surrounding his prosecution.

Pregnant Inmates Denied Abortion Access: Writing at Feministing, Diana Kasdan, staff attorney for the ACLU Reproductive Freedom Project, discusses the limited access pregnant inmates have to abortion.

A new study, “Incarcerated Women and Abortion Provision: A Survey of Correctional Health Providers,” found that only 68 percent of respondents indicated that women in their facilities can obtain “elective” abortions. And a recent investigative piece in the Texas Observer reported, “For pregnant women in immigration detention facilities, it is virtually impossible to obtain an abortion.”

Racial Disparities and Breast Cancer: An article in the International Journal of Cancer points to high blood pressure as a cause for some of the disproportionately higher mortality rates among African American women with breast cancer compared with white women, reports Reuters. Hypertension explained 30.3 percent of racial disparity in “all-cause survival,’ as well as 20 percent of the racial disparity in breast cancer-specific survival. The study abstract is available online.

Dannon Goes rBGH-Free: As we reported earlier, General Mills, which makes Yoplait, agreed to stop using milk treated with artificial growth hormones in its yogurt. Now Dannon has followed suit. The decision makes economic sense: More than 200 hospitals around the country recently pledged to serve rBGH-free products to their patients, staff and visitors.

Writing about the move by both companies, Patty Fisher of the Mercury News notes that Yoplait never acknowledged any concern over rBGH and women’s health, despite promoting breast cancer awareness through yogurt sales. “The ‘rBGH-free’ label will be on the carton because it will sell yogurt. I guess that’s why the pink ribbon is there, too.”

New State Numbers: StateHealthFacts.org recently added new and updated data on Demographics and the Economy, Medicaid & CHIP, Medicare, Managed Care & Health Insurance, Providers & Service Use, Health Status and HIV/AIDS.

A list of all recent updates is available here. Statehealthfacts.org is part of the Henry J. Kaiser Family Foundation.

Plus: Utah, Hawaii and Wyoming top the nation in well-being in an analysis of more than 350,000 interviews conducted in 2008. Southern states West Virginia, Kentucky and Mississippi have the lowest well-being ratings, according to a new Gallup survey.

The Well-Being Index score for the nation and for each state is an average of six sub-indexes: life evaluation, healthy behaviors, work environment, physical health, emotional health and access to basic necessities.

National Women & Girls HIV/AIDS Awareness Day: March 10th was National Women and Girls HIV/AIDS Awareness Day. Here’s a great post by Veronica explaining why women and girls need to be the focus of an education and awareness effort.

Reproductive Health in Africa: North Carolina Public Radio reports on the high maternal mortality rate in Zambia, where the number of women who die during pregnancy or childbirth is 60 to 70 times higher than it is in the United States. As part of the series North Carolina Voices, Global Health Connections, Rose Hoban traveled to the Zambian capitol of Lusaka to spend time with health care workers who work with Ipas, a global nonprofit organization based in Chapel Hill that helps women get access to the full range of reproductive services.

Targeting Craigslist Over Prostitution: Cook County Sheriff Tom Dart filed a federal lawsuit against Craigslist, asking the website to remove its “erotic services” section, calling it a public nuisance that knowingly facilitates prostitution.

“At a news conference, the sheriff said his office has made hundreds of prostitution arrests, many of them based on ads found on Craigslist,” reports the Chicago Tribune. “But the sex-for-sale ads still proliferate on the site five months after Craigslist promised new safeguards to settle a nationwide lawsuit by the top state prosecutors from Illinois and 39 other states.”

Where Are the Female Coaches in Youth Sports?: University of Southern California sociologist Michael Messner has written a new book about the persistent gender divisions in youth sports, especially at the coaching level. He expands on his findings at Moms Team and shares tips from women coaches.

Overlooking Evidence: “When it comes to breast cancer, why is it so hard to get the most influential media to pay attention to the possibility that, in addition to better-understood risks, unnatural substances entering women’s bodies might also be a factor?” That’s the million-dollar question in this Fair! analysis on the surprising dearth of news coverage on environmental hazards and breast cancer. An excellent report by Miranda Spencer.

Skimping on Care: More than a third of people surveyed have skipped medical check-ups or dental visits over the past year due to concern over health care costs, and 27 percent have put off getting needed health care, according to the Kaiser Family Foundation’s first health care tracking poll of 2009.

Supreme Court: No Legal Shield in Drug Labeling: The Supreme Court on Wednesday ruled that people injured by drugs can sue the drug manufacturer in state courts, even if the drugs were approved by the Food and Drug Administration.

“The ruling could have significant implications beyond drug manufacturing,” writes Adam Liptak at The New York Times. “Many companies have sought tighter federal regulation in recent years in part to shield themselves from litigation.”

The case involved a Vermont woman, a musician, whose arm had to be amputated following an injection of the anti-nausea drug Phenergan. Levine sued the drug maker Wyeth because Wyeth had not changed the label indicating that one method of administering the drug had a small risk of error which caused irreversible gangrene. Nina Totenberg did a good report on the ruling. The NPR link also includes excerpts from the oral arguments heard last November.

Sunshine State Keeps Teens in the Dark: The Healthy Teens Campaign of Florida and the Sexuality Information and Education Council of the United States (SIECUS) have released a report on failed abstinence-only sex education programs in Florida’s public schools: “Sex Education in the Sunshine State: How Abstinence-Only-Until-Marriage Programs Are Keeping Florida’s Youth in the Dark” (pdf).

“[O]ur research has exposed both the state’s appalling indicators of poor outcomes for young people and the equally appalling nature of how abstinence-only-until-marriage programs have become pervasive throughout the state,” writes Adrienne Kimmell at RH Reality Check.

Him/Her/They: Elizabeth Landau at CNN reports on the history of the search for gender-neutral pronouns, an issue that has recently been taken up on Twitter. An interesting story.

On the Issues: Good reads in the On the Issues Magazine cafe, including Diana Whitten‘s look at Women on Waves, a Dutch organization that provides on-ship abortions in international waters for women from countries where it is illegal. Women on Waves recently won an important victory in the European Court of Human Rights. And don’t forget to check out the winter issue, which features stories on topics from ratifying CEDAW to Second Life.

Moving Reproductive Services Off-Site (Six Feet Away): From Women’s eNews: For more than a decade, a hospital merger in New York state was held up by abortion politics. Last week, community activists gathered for a ribbon-cutting ceremony marking their hard-fought compromise. Rebecca Harshbarger reports.

Plus: Emily Douglas points to this Albany Times Union op-ed on the implications of a possible merger between two secular hospitals and one religious hospital in Rensselaer County, New York. The merger raises questions about reproductive health care for patients and employee health insurance benefits, since Catholic directives prohibit coverage for contraception.

In Translation: Over at Sociological Images, a blog sponsored by the American Sociological Association, there’s been some debate over the English and Spanish versions of a pamphlet for pregnant women offered by Kaiser Permanente. Kaiser provides a response.

The Economic Future and Women’s Roles: The Chicago Foundation for Women looks at how the stimulus package affects women’s economic security.

Teaching Domestic Violence Victims Safe Use of Technology: Via this press release, I learned about a Washington state program designed to help victims of domestic violence by increasing their knowledge of how to use technology safely.

“Domestic violence is built around control, not anger, and an abusive partner often limits a woman’s access to information and support. Monitoring computer activity is one of many ways to control a spouse,” said Jerry Finn, a University of Washington Tacoma professor of social work who also evaluates the effectiveness of human services programs.

The training covers how to prevent such things as identity theft; concealing browser history; how to be safe in a chat room; how to set up an e-mail account without using a real name; and how to prevent being followed with a GPS device. What a smart idea.

Welcome Particle, Wave, Astarte and …: To apologize for the late Double Dose, I offer some cute overload, via feminist poet and performance artist Diana Tigerlily, who also raises goats.

Meet the newest ones — five in all, if my counting is correct. Makes me think two dogs and two cats may not be enough : )

Yoplait yogurt will soon be free of artificial bovine growth hormone (rBGH), a synthetic hormone that has been linked to a number of health concerns, including breast cancer.

General Mills announced Monday that it will stop using milk produced from cows injected with rBGH (also known as rBST) in all Yoplait yogurts by August 2009.

“While the safety of milk from cows treated with rBST is not at issue, our consumers were expressing a preference for milk from cows not treated with rBST, and we responded,” Becky O’Grady, General Mills’ vice president of marketing for the Yoplait brand, said in a statement.

The hormone is already banned in Canada, Australia, Japan and the European Union. In the United States, corporations like Wal-Mart and Starbucks do not use milk from rBGH-treated cows in their products.

Breast Cancer Action launched a consumer campaign last year to encourage General Mills to follow Wal-Mart and Starbuck’s lead.

In a guest blog post at OBOB, Pauli Ojea, a community organizer at BCA, explained the connection between rBGH and breast cancer and criticized Yoplait for “pinkwashing” — a term used to describe companies that participate in breast cancer fundraising or awareness campaigns but manufacture products that may be linked to the disease.

BCA’s “Think Before You Pink” campaign warned that Yoplait’s donations to breast cancer (10 cents for every lid consumers mailed in) came from sales of yogurt made with milk from cows treated with rBGH.

“We’re delighted that General Mills has decided to do the right thing in response to consumer demand,” said Barbara Brenner, BCA executive director of Breast Cancer Action, said in a statement released today. “When a company uses the pink ribbon to sell their products, they are making a promise to support women’s health. We want them to keep that promise — and we’ll monitor the company to make sure they do.”