The American Association of Birth Centers has issued an appeal to supporters to contact Congress concerning a payment crisis that threatens insurance support for birth centers around the country.

After more than 20 years of providing funding, the Centers for Medicare and Medicaid Services (CMS) — the federal agency that runs Medicare/Medicaid — is now refusing to pay the federal percentage of Medicaid payments that states might make to birth centers.

“This is not a Medicaid crisis but a payment crisis for birth centers,” according to the AABC. “Historically all payers follow the lead of Medicaid.  If Medicaid stops paying the birth center facility fee so will other insurers.”

The AABC explains the background:

Over the past few years, CMS has begun disallowing federal matching funds for state Medicaid payments for freestanding birth center services. Birth centers have been recognized by CMS (and earlier, by HCFA) as a Medicaid provider type in State Medicaid Plans since 1987.

Recently, however, CMS has disallowed such payment by several state Medicaid Agencies, including Alaska, South Carolina, Texas, and Washington State, claiming that it lacks clear statutory authority and direction to do so. CMS has directed its regional offices to stop federal payments to any state for birth center services.

This action by CMS puts pregnant women at risk of losing access to safe, high quality maternity care.

Visit AABC for more information on how to contact your member of Congress and urge legislation to direct CMS to pay birth center facility fees. It would be great if midwives, women who have used birth centers and anyone who believes in the right to choose her own birth site got involved.

Here are some facts about birth centers:

• Birth Centers are part of a vital safety net for Medicaid mothers across the U.S.
• Birth centers fill the void left in many areas when hospitals — rural, urban or suburban — close their obstetrical services
• Many rural and urban birth centers serve a disproportionately high percentage of Medicaid recipients. Texas provides two examples – at least 95% of patients in an inner city Houston birth center, over 85% for a center in Weslaco, Texas in the Rio Grande Valley
• Birth centers have a proven history of reducing low birth weight and preterm birth, the main causes of neonatal death in the U.S.
• Birth centers provide innovative approaches to maternity care that reduce disparities for low-income and minority women, lower cesarean section rates, and reduce health care costs

Here’s a look at some health care news coming out of the Democratic National Convention and other interesting stories on politics and health care …

From Campaign for America’s Future (these events can be streamed at OurFuture.org):

- On Tuesday at 2pm MT, Campaign for America’s Future co-director Roger Hickey will talk about the principles of the new Health Care for America Now! Coalition to the thousands of activists and bloggers attending in person and online during the “Take Back America” event at the convention’s “Big Tent,” outside the Pepsi Center.  Rep. Jan Schakowsky, one of the progressive health care champions in the Congress, will talk about the need for health care change, sign HCAN’s statement, join HCAN in urging Members of Congress and candidates to publicly declare their position on the health care choice that confronts the new Congress:  Are you with us for a guarantee of quality affordable health care for all? OR Are you for leaving us on our own to buy private health insurance?

- On Wednesday at 2:30 pm MT, the Healthcare for America Now! Coalition and SEIU will host a rally featuring DeVotchka, Death Cab for Cutie, Chuck D and Jim Hightower at Sunken Gardens Park.

On “Fresh Air” today, Terri Gross talks with political scientist Jonathan Oberlander, who offers an in-depth comparison of the Obama and McCain health proposals. Oberland compared the candidates in his report, “The Partisan Divide — The McCain and Obama Plans for U.S. Health Care Reform,” which was published Aug. 21, 2008 in the New England Journal of Medicine. Audio will be available this afternoon. Here’s more background on the two plans.

Harry and Louise are back again, in a new ad with an interesting mix of backers. Trudy Lieberman writes at Columbia Journalism Review: “The significance of the current Harry and Louise redux is not that groups with wildly different agendas can now play nicely together — although arguably that’s the message the sponsors want to send. It’s that the range of acceptable solutions to the health care crisis hasn’t advanced much since 2000. Or since 1994, for that matter.

Is health care no longer a primary ailment? “It was once the ‘it’ topic of public policy that helped propel the Clintons into office, sparked open warfare among special interests, and then toppled a Democratic Congress,” writes Jill Zuckerman at the Chicago Tribune.

For a while, health care was that which was not spoken about following the 1994 legislative debacle. For Sen. Hillary Clinton, it was something that taught her great lessons. And in the drawn- out Democratic primary fight between her and Obama, the cost and availability of health care were daily fodder in the debate over which candidate would do a better job as president.

And now, there is … not much.

The continual tussle between the two presumptive presidential nominees — Obama and McCain — has largely centered recently on national security and the high price of gasoline. Public opinion polls have shown that among the top issues of concern to Americans, health care is languishing far behind the economy, the war and the price of gas. One CBS poll from July put voter interest in health care at just 3 percent. In August, it was at 8 percent.

But a number of political experts quoted say health care costs are still a concern, even though it doesn’t get as much attention or publicity as high gas prices and energy costs.

“Beneath all that, when you probe, when you ask people what’s bothering you about the economy right now, in economic downturns — problems paying for health care and health insurance really loom large,” said Drew Altman, president of the Kaiser Family Foundation. “After people’s fixations paying for gas prices, problems paying for health care are right at the top with job issues.”

Not so much health-related, but Women’s eNews has coverage of a slew events taking place in Denver around women’s issues.

Here’s Nancy Keenan of NARAL, who spoke at the convention Monday afternoon:

Our Bodies Our Blog has invited the folks at Breast Cancer Action to write monthly guest posts on breast cancer and related issues.

by Brenda Salgado

Though billions of dollars have been spent on breast cancer research, the incidence of breast cancer is higher today than it was 20 years ago. Inequities in breast cancer mortality continue to increase, and we still can’t definitively figure out what’s causing this disease. Some gains have been made in treatment, but the results are simply not enough.

How can we ensure that research funds are used wisely and effectively? One model for how research should be done is the California Breast Cancer Research Program (CBCRP)

The CBCRP, which funds groundbreaking research, has changed how breast cancer is addressed around the world. Its research includes topics like psychosocial impacts, community-based participatory research, environmental exposures, and racial and ethnic disparities. It is also committed to disseminating research results.

You’d think a program like this would be reaping the rewards of funding, but no. In fact, the University of California Office of the President, CBCRP’s administrative home, wants to gut the program by eliminating the collaborative planning, evaluation and community outreach activities. This would impact the program’s ability to fund the best breast cancer research — and its ability to share these results with the community and health providers.

The CBCRP is funded by a state tobacco tax, donations from a voluntary tax check-off program, and individual contributions. It is the largest state-funded research program in the nation, and 95 percent of the money goes directly to funding research and education efforts.

The CBCRP was founded and is run by an unprecedented collaboration of women with breast cancer, advocates, activists, scientists, clinicians and researchers. Because of this collaboration, the program has a deep understanding of what breast cancer research has already been done, and what it needs to focus on next — such as environmental causes.

UCOP bureaucrats think they’re better suited to determine what research gets funded than the women and men working to end this disease. But UCOP can’t provide the insightful funding CBCRP has done for years. The CBCRP has funded important research that simply wouldn’t have seen the light of day otherwise.

UCOP and other research funders need to hear from women’s health advocates that we want effective and efficient use of our financial resources. Innovative health research programs like the CBCRP are about more than just breast cancer. They are models for how women and other affected communities can and must be included in deciding what research is funded and making sure that the results are shared with the public.

Want to help save this innovative and effective program? We’ve put together a letter you can email to U of C President Mark Yudof, asking him to stop this travesty. As we note in the letter, “We do not want or need more breast cancer research funding at the expense of smart breast cancer research funding.”

Brenda Salgado is the program manager at Breast Cancer Action. She manages BCA’s ongoing campaigns, oversees BCA’s legislative and policy work, and represents BCA on environmental and women’s health coalitions.

Yesterday, the Supreme Court of the State of Missouri reversed a lower court ruling in a 5-2 decision and upheld a 2007 law that would allow legal midwifery in the state. The law states that “any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services” - this would include both CNM/CMs certified by the American Midwifery Certification Board and CPMs certified by the North American Registry of Midwives.

After the bill, which dealt with numerous health issues as well as including the midwifery provision, was passed and signed into law by the Governor, the Missouri State Medical Association, The Missouri Association of Osteopathic Physicians and Surgeons, Missouri Academy of Family Physicians, and the St. Louis Metropolitan Medical Society filed suit to invalidate the section that would allow legal midwifery practice in the state. The lower court invalidated the statute, but an appeal was filed by the State of Missouri along with Friends of Missouri Midwives, the Missouri Midwives Association, and other parties.

The medical associations seeking to invalidate the law had claimed standing for the challenge by arguing that physicians may be subject to disciplinary actions if they cooperate with midwives, and that they should be allowed to challenge the law on behalf of patients as their representatives. The Court disagreed on both of these matters and indicated that the groups had no standing to challenge the Constitutionality of the law. They therefore reversed the lower court decision, allowing the law legalizing midwifery in Missouri to stand.

Organizations supporting midwifery in Missouri issued a press release in response to the ruling, stating that

“Today’s Missouri Supreme Court decision is a tremendous victory for Missouri families, who have been working for 25 years to gain legal access to professional midwives. The ruling increases access to maternity care in the state and allows women and families more birth options and affirms their ability to exercise their rights to choose how their babies are born.”

This ruling closely follows recent AMA/ACOG statements in which the organizations express intent to support legislation restricting or preventing both home birth and non-CNM midwifery. Susan Jenkins, legal counsel for the National Birth Policy Coalition and a consultant to the Missouri midwives, stated:

“This case confirms the message that’s been reverberating loud and clear in both the mainstream media and the blogosphere ever since the American Medical Association launched its attacks against midwives and home birth last week—physicians do not have the right to speak for patients when it comes to deciding who delivers their babies.”

Our Bodies Ourselves was among those who submitted an amicus curiae (friend of the court) brief in support of reversing an injunction against the law and thereby making midwifery legal in the state. Judy Norsigian, Executive Director of OBOS, also addresses the central choice issue:

Many women’s health advocates working on pregnancy and birth issues are deeply concerned about current trends in childbearing, especially the strange way in which “choice” is selectively used. More obstetricians now promote the acceptability of medically unindicated cesareans (”elective” cesareans), while at the same time fewer obstetricians are working to preserve the option of vaginal birth after cesareans (so-called “VBACs”), which are known to pose (overall) fewer serious risks to the mother than planned repeat cesarean sections. In fact, ACOG (the American College of Obstetricians and Gynecologists) has a position that calls for the 24/7 presence of an anesthesiologist if a hospital is to offer VBACs.

Ironically, organized medicine is now spending considerable energy to oppose the licensure and regulation of Certified Professional Midwives (CPMs, now officially recognized in 24 states), and in mid-June, the American Medical Association passed an anti-homebirth resolution (proposed by ACOG) that many believe is a step towards an attempt to make homebirth ultimately illegal. Despite the absence of evidence that planned homebirth with trained caregivers is any less safe overall than hospital birth, the AMA and ACOG apparently don’t apply the principle of reproductive choice when it comes to this arena of decision-making for a pregnant woman.

Similarly, in our recent post on the AMA/ACOG issue, we included a letter from Dr. Andrew Kotaska, who argued that “Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficience, whether such recommendations are founded on sound scienctific evidence or the pre-historic musings of dinosaurs.” Another obstetrician, Dr. Lauren Plante, has generously granted permission to publish her recent letter to ACOG on the same topic:

Dear Colleagues,

I was dismayed to read the recent ACOG statement opposing home birth and specifically disallowing any support for individuals that advocate or support home birth. While I understand ACOG’s concern for mothers and babies, any reasonable support for patient autonomy–which the College favors when it comes to cesarean upon maternal request–would have to include autonomy in choosing a birth place. Many of us would not agree that choosing to labor and deliver at home subordinates the goal of a healthy baby to the process. As you know, home birth remains a viable option in several developed nations where birth outcomes for both mother and baby are excellent. Many ACOG members have backed up home birth providers in the past, and a few have attended a home birth. I personally know of several ACOG members who themselves have chosen to deliver at home. The recent ACOG statement further marginalizes both our patients and our members.

Sincerely,
Lauren Plante, MD, MPH, FACOG
Associate Professor, Obstetrics & Gynecology
Thomas Jefferson University
Philadelphia PA

Our sincere appreciation goes to those physicians who are willing to openly share their dissent, and all those working to preserve choice for women.

Last month, Vermont directed health insurance companies to cap the out-of-pocket cost of a mammogram, setting the limit at $25.

“Studies suggest cost is a factor in whether women seek and receive mammography services,” Vermont Gov. James Douglas said. “This law is to encourage every woman to get regular mammograms.”

While Vermont’s new law is a step in the right direction, universal, affordable access is still a far-off goal .

OBOB recently looked at the risks and benefits of routine mammograms for premenopausal women in their 40s. Despite the controversy concerning mammograms for premenopausal women, the value of routine mammograms for postmenopausal women is widely accepted.

But not everyone has access to high quality mammograms and, if necessary, subsequent treatment. This month, we’re looking at the cost of mammograms, insurance co-pays and programs that provide low-income women with free mammography and breast exams.

While 80 percent of U.S. women over age 50 reported having a mammogram within the last two years (as of 2006), according to Kaiser’s State Health Facts, this map shows how the percentage varies by state, with Massachusetts at the high end (87.5 percent) and Mississippi (69.7 percent) at the bottom. The states are further broken down by race and ethnicity, though there’s not always enough information available for comparison.

The average cost of a mammogram is between $50 and $150; digital mammograms cost even more. Most states now require health insurance companies to pay all or most of the cost — although for some women, the remaining co-payment amount can stand in the way of making the appointment.

Mammography screening rates remained steady until about 2003 — at that point, the rates started to decline among women aged 50 and older. “I suspect patients’ fear, lack of knowledge of efficacy, physical discomfort during the procedure, denial, geographic barriers, lack of primary care doctor and inability to pay are all factors,” Dr. Alan Sager, professor of health policy and director of the health reform program at Boston University’s School of Public Health, told ABC News earlier this year.

The drop itself may not be a concern if women are making informed decisions about their personal health and are not avoiding mammograms because of cost, said Barbara Brenner, executive director of Breast Cancer Action.

“Falling mammography rates don’t necessarily mean that the sky is falling,” Brenner told OBOB. “After all, in Europe, women are screened less frequently and at older ages, with outcomes essentially the same as we have in the United States in terms of incidence and mortality. Mammography screening has lead to a lot of overtreatment, so the question is about which are the most underserved communities in this context, and conducting targeted screening outreach to them.”

Medicare, which serves people 65 and older and some people with disabilities, pays 80 percent of the cost of an annual screening mammogram for women age 40 and older, leaving most recipients with a co-pay of approximately $10 to $30. Researchers at Brown University in Providence, R.I., looked at 366,475 women covered by 174 different Medicare managed-care plans and found women who have co-payments of more than $10 are less likely to get regular mammograms than those with more generous insurance coverage, ABC News reported.

Here’s the study abstract — and more from ABC:

Mammogram screening rates were about 8 percent lower among women who had to pay more than $10 or 10 percent of a mammogram’s cost, researchers found.

Researchers then examined health plans that once fully covered the costs of mammograms but later switched to only partial coverage. From 2002 to 2004, mammography rates decreased by 5.5 percent in seven of these plans. However, in 14 other plans that continued to offer full coverage of mammograms, screening rates for breast cancer increased by 3.4 percent.

And the number of plans requiring women to make higher co-payments are on the rise. In 2004, one out of nine women was forced to pay for at least 10 percent of the cost of a mammogram out-of-pocket.

The worst impacts were seen among minorities and patients from communities with lower income and education levels, as these patients were mostly likely to enroll in cheaper health insurance plans that require co-payments for mammography.

What about women who don’t have health insurance? At the national level, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a program of the Centers for Disease Control and Prevention, provides mammograms and clinical breast exams by a health professional to low-income, underinsured and underserved women. But the percentage of women reached is far from optimal.

One analysis of the 2002-2003 performance of the NBCCEDP found that:

Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40-64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.

According to the NBCCEDP, between 8 and 11 percent of U.S. women of screening age (40 to 64) are eligible to receive services. (Women 65 and older are eligible for Medicare.) Federal guidelines establish an eligibility baseline to direct services to uninsured and underinsured women at or below 250 percent of federal poverty level. Contact information for programs in every state is available at the NBCCED website.

Some states provide subsequent funding for uninsured and underserved women to increase access to mammograms and comprehensive screening programs (including breast exams). Eligibility is determined by age and income requirements and varies by state, so it’s best to check with your state health department or your local representative’s office.

Here in Illinois, for instance, access to free mammograms and treatment, as well as clinical breast exams, pelvic exams and Pap tests, was recently extended to all women without health insurance between the ages of 35 and 64 under the Illinois Breast and Cervical Cancer Program.

“No one should have to forgo health screening because they can’t afford it. But screening is only one part of the puzzle,” said Brenner. “If a woman is diagnosed with breast cancer after a low-cost mammogram, how will she pay for her treatment? In California, a woman whose breast cancer is diagnosed after a mammogram administered through a state-run program will be treated at state expense. This isn’t the case in every state .”

Universal health care would solve the problem of women being able to afford breast cancer screening and treatment, adds Brenner.

“I’ve had breast cancer twice, missed in both cases by mammograms. I know how devastating this disease is. But the reality is that this isn’t just about mammography and breast cancer. We shouldn’t have to fight for health care and coverage disease by disease, body part by body part. Everyone should be able to get the care they need — whether it’s screening or treatment — regardless of the health concern.”

“In an overwhelmingly overweight nation that worships thinness, many describe prejudice against the obese as one of the last socially acceptable biases,” writes Lisa Anderson at the Chicago Tribune. “Advocates for the plus-sized, particularly activists in the ‘fat acceptance’ movement, want obesity to become a category legally protected against discrimination, like religion, race, age and sex. But not everyone agrees.”

“I think it would help mostly because it would send a message that fat people are equal citizens. It’s not in the litigation rates, but the rights consciousness that comes after legislation,” said Anna Kirkland, an assistant professor of women’s studies and political science at the University of Michigan who is author of the new book, “Fat Rights: Dilemmas of Difference and Personhood,” which examines the question of whether weight should be a protected category.

The story goes on to discuss a law to ban discrimination against weight and height pending in Massachusetts. Here’s the text of House bill 1844 (PDF), sponsored by Rep. Byron Rushing.

Rushing has offered similar bills six times in the last 12 years. He told the Trib that last month’s public hearing on the bill showed “there is a growing number of people who think this should happen and an even larger number of people who think we should at least be talking about it.”

Similar anti-discrimination legislation is already in place in Michigan and the District of Columbia, and cities such as San Francisco, Santa Cruz and Madison.

“It’s not really about litigation, but about taking a stand,” said Marilyn Wann, a fat-rights activist who testified at the Boston hearing and helped get San Francisco’s law passed in 2000. “I do think when a government says it’s not OK to dismiss someone as a person because of weight, that’s helpful.”

Plus: Read Fat People: Please Stop Existing at Big Fat Blog.

The Washington Post has a front-page story today that’s a shocker: Lfe expectancy for some U.S. women is on the decline, and the data points to a growing inequality between the best-off and worst-off counties. Here’s the rundown:

In nearly 1,000 counties that together are home to about 12 percent of the nation’s women, life expectancy is now shorter than it was in the early 1980s, according to a study published today.

The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women’s life expectancy has decreased by more than five years since 1983.

The trend appears to be driven by increases in death from diabetes, lung cancer, emphysema and kidney failure. It reflects the long-term consequences of smoking, a habit that women took up in large numbers decades after men did, and the slowing of the historic decline in heart disease deaths.

It may also represent the leading edge of the obesity epidemic. If so, women’s life expectancy could decline broadly across the United States in coming years, ending a nearly unbroken rise that dates to the mid-1800s.

There was some decline noted for men, too, but the decline was smaller (affecting 4 percent of males) and limited to fewer areas of the country. According to researchers, higher HIV/AIDS and homicide deaths contributed substantially to the life expectancy decline for men, but this was not the case for women.

The news comes from this study (PDF) published in PLoS Medicine, an open-access journal of the Public Library of Science. The study is based on mortality statistics from the National Center for Health Statistics (NCHS) and population data from the U.S. Census, gathered for the years 1961-1999, the last year data was available from the NCHS.

Overall, the average life expectancy nationwide increased during that period from 66.9 years to 74.1 years for men, and from 73.5 years to 79.6 years for women. (It’s worthwhile noting, as this story does, that life expectancy is “not a direct measure of how long people live,” but is “a prediction of how long the average person would live if the death rates at the time of his or her birth lasted a lifetime.”)

Between 1961 to 1983, life expectancy kept going up everywhere, mostly because the death rate from heart attacks kept going down due to better prevention and improvements in medicine. But then researchers noticed a change:

By the early 1980s, however, the rapid gains were coming to an end. The low-hanging fruit on the tree of heart-attack prevention and treatment had been picked. Further strides tended to happen mostly in places where people were already healthy and long-lived.

As a consequence, the rise in longevity began to stagnate in places with the least-healthy people. In those counties, life expectancy increased by only one year (from 74.5 to 75.5) between 1983 and 1999, while in the healthiest places the life expectancy of women had reached 83.

It was during this interval that women’s life expectancy fell in nearly 1,000 counties. If one adds counties where it rose only insignificantly, then 19 percent of American women — nearly 1 in 5 — are now experiencing stagnating or falling life expectancy.

Precisely why these 1,000 counties are the most affected is something for further study. Christopher J.L. Murray, a physician and epidemiologist at the University of Washington who led the study, tells the Post that it “would be a reasonably obvious strategy” to target them for aggressive public health campaigns.

Campaigns are a positive step, but I wonder whether this news will spark more than well-intentioned programs. Addressing health inequalities in poor communities means addressing everything from access to medical care to access to grocery stores stocked with fresh fruit and vegetables. It means providing real economic opportunity.

Maybe the fact that the life expectancy decline is pretty much to the United States — save for some African countries stricken by the AIDS epidemic, or Russia following collapse of the Soviet Union — will make this country’s shocking health disparities an issue in the presidential campaign, right up there with, say, flag pins.

Today’s just a mini-dose … I’ll be at WAM! this weekend and hope to see many of you there!

More Women Pursue Claims Of Pregnancy Discrimination: “Pregnancy-bias complaints recorded by the Equal Employment Opportunity Commission surged 14% last year to 5,587, up 40% from a decade ago and the biggest annual increase in 13 years,” reports the Wall Street Journal.

The Carrot Some Vegans Deplore: Kara Jesella writes in The New York Times:

Two things that you can find a lot of in Portland, Ore., are vegans and strip clubs. Johnny Diablo decided to open a business to combine both. At his Casa Diablo Gentlemen’s Club, soy protein replaces beef in the tacos and chimichangas; the dancers wear pleather, not leather. Many are vegans or vegetarians themselves.

But Portland is also home to a lot of young feminists, and some are not happy with Mr. Diablo’s venture. Since he opened the strip club last month, their complaints have been “all over the Internet,” he said. “One of them came in here once. I could tell she had an attitude right when she came in. She was all hostile.”

The story begins like something straight out of The Onion, but it turns into a rather, er, meaty discussion of feminist politics and food … Read more at Feministing.com.

Perceptions: Feminists More Open-Minded on Weight: “A new study finds that women who describe themselves as feminists are more forgiving than other women when assessing the attractiveness of women who are either very underweight or very heavy,” reports The New York Times.

You’ll find the study in the journal Body Image — also see Rachel’s smart analysis. Here are some previous studies on feminism and body image.

The Mystery Suspect in the U.S. “Obesity Epidemic”: Writing at Women’s Media Center, Paula J. Caplan, Ph.D., an author and lecturer at Harvard, discusses the effect of psychotropic drugs on weight gain. She begins:

Here’s one surefire way to make anyone feel helpless, hopeless, even crazy: Teach them that others will value them mostly for being thin and being nurturing, and put them in situations where they are too agitated or sad to be cheerful caretakers for family and friends. When they ask for help, give them a pill that may calm them down or pep them up but will have a good chance of increasing their weight. This has been the fate of millions of women, who then are more likely than men to blame themselves for their part what is being called the U.S. obesity epidemic.

Rachel last week wrote a great post explaining what you need to know about medical trials — from costs to informed consent — and where to go to get other questions answered.

One question being asked now in Washington in the wake of a laptop theft is why protocols concerning patients’ privacy were not followed. From the Washington Post, which ran this story Monday on page 1:

A government laptop computer containing sensitive medical information on 2,500 patients enrolled in a National Institutes of Health study was stolen in February, potentially exposing seven years’ worth of clinical trial data, including names, medical diagnoses and details of the patients’ heart scans. The information was not encrypted, in violation of the government’s data-security policy.

NIH officials made no public comment about the theft and did not send letters notifying the affected patients of the breach until last Thursday — almost a month later. They said they hesitated because of concerns that they would provoke undue alarm.

You think?

Leslie Harris, executive director of the Center for Democracy & Technology, explains why it hurts: “The shocking part here is we now have personally identifiable information — name and age — linked to clinical data … If somebody does not want to share the fact that they’re in a clinical trial or the fact they’ve got a heart disease, this is very, very serious. The risk of identity theft and of revealing highly personal information about your health are closely linked here.”

A Modest Proposal: “Pregnant students in a Denver high school are asking for at least four weeks of maternity leave so they can heal, bond with their newborns and not be penalized with unexcused absences,” reports the Denver Post, which notes that Denver Public Schools has no districtwide policy, meaning it’s left up to schools to “to work out plans for students to continue their education.”

What that means is some schools have set a policy whereby girls who don’t show up for school the day after they give birth are charged with unexcused absences. Many of the comments on this story argue against “special treatment.”

Florida Considers Proposal to Teach “Abstinence Plus”: “The bill would still require that schools teach abstinence as ‘the only certain way to avoid pregnancy or sexually transmitted diseases,’” reports the AP. “But, the measure would require that starting in the 6th grade, sex education classes provide information about the health benefits and side effects of contraceptives.”

Iowa Gets Funding to Reduce Unintended Pregnancies: Former Iowa first lady Christie Vilsack launched a statewide project called “Iowa Initiative to Reduce Unintended Pregnancies” that will focus on women ages 18 to 30. “As a woman, as a teacher, as a mother, I believe we have a responsibility to give all women in our state the knowledge and the means to prevent unintended pregnancies,” she said. From the Des Moines Register:

Half of all pregnancies in Iowa in 2006 were unintended, Vilsack said, citing state Department of Public Health statistics. Of those, 14 percent ended in terminations, she said, citing Iowa Barriers to Prenatal Care Project statistics.

Iowa ranks 48th in the nation in making family planning services available and 39th in its public funding for those efforts. More than half of Iowa’s counties do not have family planning centers, Vilsack said.

C-Section Statistics Under Review: “In 2006, 31.1% of U.S. births were by C-section, a 50% increase over the previous decade,” notes USA Today in a story that examines the debate over safety of elective c-sections.

For more information, check out this earlier post on c-sections and the rise of maternal mortality, as well as Rachel’s post on c-section rates by hospital.

FDA Takes Action on Biodentical Hormones: “The Food and Drug Administration is cracking down on pharmacies that sell customized hormone mixtures as antidotes for menopause symptoms such as hot flashes, saying they are being promoted with false claims about their benefits and contain an ingredient the agency hadn’t approved,” reports the Wall St. Journal.

Here’s more from Well, where an interesting discussion follows, and the FDA press release.

Do You Google Your Health?: Rahul K. Parikh, M.D. doesn’t mind if you do and suggests websites that provide accurate, up-to-date medical information. Don’t forget Rachel’s great post on online health research — it includes questions to ask when evaluating the reliability of websites.

Medicare and Health Insurance Coverage: The Kaiser Family Foundation this week released a new issue brief providing an overview of Medicare’s financing and the fiscal challenges the program faces in the coming decades.

KFF also released two updated fact sheets that provide the most current information and data on health insurance coverage for women ages 18-64. The first, Women’s Health Insurance Coverage, provides new statistics on health coverage, describes the major sources of health insurance, summarizes the major policy challenges facing women in obtaining health coverage, and provides data on the more than 17 million women who are uninsured.

The second fact sheet, Health Insurance Coverage of Women by State, provides state-by-state data on the uninsured rate, as well as rates of private insurance and Medicaid coverage.

“Our research with consumers has told us that women today are increasingly mindful of making choices that positively impact their lives.” — Katie Bayne, CMO of Coca-Cola North America, Atlanta

What’s a company to do when its product is not recommended as part of a healthy lifestyle? Simple: Put on a little red dress.

Diet Coke and the National Heart, Lung and Blood Institute are teaming up to promote “The Heart Truth” campaign, which aims to raise awareness of women’s risk of heart disease. In 2002, The Heart Truth campaign introduced a red dress as a national symbol for women’s heart disease. If you haven’t seen it yet, you will soon.

Starting Jan. 22, the red dress will appear on Diet Coke, Caffeine-Free Diet Coke and Diet Coke Plus products — 2.5 billion of them, AdWeek reported Monday. Look for print and online ads to begin in February, during American Heart Month.

And what says heart disease better than Fashion Week? According to AdWeek:

Diet Coke will be leveraging events as well, sponsoring the Heart Truth’s Red Dress Collection fashion show during Fashion Week 2008. From mid-February through April, Diet Coke will tour 10 cities with the Heart Truth Road Show. The exhibit will show six red dresses previously worn by celebrities and offer free health screenings.

How very chic.

What’s not so chic — and what Coca-Cola would prefer doesn’t get mentioned — is that consumption of both regular and diet soda is linked to a metabolic condition that can lead to heart disease. A study published last year in the American Heart Association journal Circulation found that people who drink one or more soft drinks per day have a more than 50 percent higher risk of developing the metabolic syndrome that has been linked to heart disease, stroke and diabetes than people who drink less than one soda per day.

“The point is that the risk is high no matter how many soft drinks one consumes and no matter what type of soft drink one consumes,” said Dr. Ramachandran S. Vasan, associate professor of medicine at Boston University School of Medicine and one of the study authors. “This adds to what we already know about how soft drinks may be associated with weight gain and metabolic risk.”

The American Beverage Association took issue with the study (well, duh), and the American Heart Association responded with a statement: “It is important to note that the study does not show that soft drinks cause risk factors for heart disease. It does show that the people studied who drank soft drinks were more likely to develop risk factors for heart disease.”

Indeed, a number of nutrition experts quoted in this ABC News story doubt that diet soda, which doesn’t contain calories, would by itself increase risk factors. “There is no reason to think that soda — as much as I do not think it should be a part of a healthy diet — would cause heart disease,” said Dr. Darwin Deen, associate professor of clinical epidemiology at the Albert Einstein College of Medicine. “But it comes as no surprise that people who do drink soda do other heart-harming things, thus creating an association between soda drinking and [heart disease].”

Deen added that the sweetness of diet soda is on par with regular soda, and it could be acting as a trigger of sorts. “What this means is that soda drinkers are less likely to enjoy the taste of an apple or a fresh tomato and more likely to need stronger flavors (like salt) to make their food taste good. This may be part of the explanation.”

There are, of course, plenty of other reasons to avoid drinking soda; at the very least, soda displaces more nutritious drinks.

The Heart Truth campaign lists almost 30 corporate partners on its website. (So far, Coca-Cola is not mentioned.) At some point you have to wonder what the guidelines are for partnership — and whether association with an unhealthy beverage will alter the campaign’s taste.

Plus: Our Bodies Ourselves Executive Director Judy Norsigian discusses how campaigns to educate women about the risk of heart disease can potentially exploit women’s health concerns. And here’s coverage of racial bias in heart disease treatment.

You’d think Reference Man would be a handy know-it-all. But unfortunately RM is stuck in the 70s. And if you’re a woman, don’t look to him for medical advice.

A story at Women’s eNews explains that in determining the safe levels of ionizing radiation exposure — the kind of radiation put out by mammograms and smoke detectors — the EPA relies on the statistical model of a male who “dates to 1974, but he’s perpetually aged between 20 and 30 years old. He weighs 170 pounds, stands 5 feet 7 inches and hails from Western Europe or North America.”

Julie R. Enszer writes that the Institute for Energy and Environmental Research (IEER), along with other environmental and health organizations, are advocating that women and children — who are more vulnerable to the effects of radiation and have a higher risk of developing cancer from exposure — should take the place of “reference man.”

“We believe the government has an obligation to protect more than just adult white men from the hazards of radiation,” said Lisa Ledwidge, IEER outreach director. “Until these standards are changed, the government is not fulfilling its responsibility.”

Ledwidge says the immediate focus is getting the EPA, the chief agency in charge of regulating radiation standards, to lower current limits.

But the coalition of groups and individuals behind the Institute for Energy and Environmental Research-led “Healthy From the Start” campaign want reform throughout the government.

Ledwidge says the Department of Energy, the Nuclear Regulatory Commission and the Occupational Safety and Health Administration all use standards based on the “reference man” or some similar model.

Campaigners want the EPA to change the reference man to a “hypothetical maximum exposed individual,” based on a model that better represents those most vulnerable to ionizing radiation, such as a pregnant woman or girl.

This would mean lowering workplace exposure levels to 2 rems per year from 5 rems. But a much smaller exposure — 100 millirems — is considered the safe threshold for fetuses, which is why pregnant women are generally advised to avoid X-rays, including dental scans.

The website for the IEER-led Campaign to Include Women, Children, and Future Generations in Environmental Health Standards features a report (PDF) on radiation and radiation risk (including a section on women, pregnancy and the workplace), additional background information and statements from participating groups. Here’s the official definition (PDF) of “reference man.”

Linking Breast Cancer and Environmental Exposures: The Breast Cancer and Environment Research Centers (BCERC), a project jointly funded by the National Institute of Environmental Health Sciences and the National Cancer Institute to study the impact of prenatal-to-adult environmental exposures that may predispose a woman to breast cancer, held its fourth annual symposium on Cincinnati this week. Here’s a peek at the program.

Frank Biro, director of the adolescent medicine division at Cincinnati Children’s Hospital Medical Center who is heading up a federally funded study looking at the link between chemicals called endocrine disruptors and breast cancer, told the Cincinnati Enquirer: “Most breast cancer is sporadic; it’s not inherited. Looking at the hereditary issues only accounts for 25 to 30 percent of breast cancers … Something else is going on, and that something else is probably going to be environmental in some way, or maybe an interaction between environmental factors and genetics.”

Plus: Lucinda Marshall looks at media coverage of breast cancer in the wake of the Global Summit on Breast Cancer.

Yet Another Study Proves Congress Wrong: The National Campaign to Prevent Teen and Unplanned Pregnancy released a report (PDF) this week that found abstinence-only programs do not reduce the rates of teen pregnancy or sexually transmitted disease. As Amie Newman writes, “How many studies, reports and polls do we need until we can finally shove abstinence-only programs in a box and hide them away in that scary hall closet that houses everything under the sun?”

Here’s a summary of key findings (PDF) compiled by the Guttmacher Institute. The ACLU, in a statement, said, the study “provides strong evidence that it is time for the federal government to support comprehensive sex education programs.”

Clinic Buffer Zone Increased: “The Massachusetts legislature gave final approval Thursday to a bill that requires protesters to stand at least 35 feet from clinics that offer abortions,” reports The New York Times. “The bill, which Gov. Deval L. Patrick is expected to sign next week, will be the nation’s strictest state law establishing fixed zones that protesters cannot enter around those reproductive health clinics that offer abortions.”

Authorities said the current law, which was enacted in 2000, was difficult to enforce — it prohibits protesters from going within 6 feet of a person in an 18-foot zone outside a clinic’s doors. The Times also notes that the country’s largest fixed buffer zone, 36 feet, is in effect in — wait for it — Melbourne, Fla.

Plus: The Center for Reproductive Rights answers the question “What if Roe fell?” with a look at the laws in each state that would go into effect.

Mental Health Q&A: Ever wonder why mental health benefits are less generous than insurance benefits for other conditions? The Washington Post has a Q&A column on equal coverage and other issues related to mental health coverage.

The Weight Debate: According to a new study published in the Journal of the American Medical Association, as reported in the Washington Post, “Being overweight boosts the risk of dying from diabetes and kidney disease but not cancer or heart disease, and carrying some extra pounds actually appears to protect against a host of other causes of death.”

Plus: Researchers at the University of California, San Diego School of Medicine have found that inflammation, not obesity, causes insulin resistance.

Did You Hear the One About …: Jokes about blondes and women drivers are not just harmless fun and games, according to a research project led by a Western Carolina University psychology professor. The article, “More Than Just a Joke: The Prejudice-Releasing Function of Sexist Humor,” is scheduled for publication in the February issue of the journal Personality and Social Psychology Bulletin.

“Our research demonstrates that exposure to sexist humor can create conditions that allow men — especially those who have antagonistic attitudes toward women — to express those attitudes in their behavior,” said Thomas E. Ford, a faculty member in the psychology department at WCU. “The acceptance of sexist humor leads men to believe that sexist behavior falls within the bounds of social acceptability.”

Revisiting the Prairie: The Washington Post runs an occasional series in which book critic Jonathan Yardley reconsiders notable and/or neglected books from the past. This time around: the “Little House” series by Laura Ingalls Wilder. “What surprises me a bit in thinking back to my own reaction to these books as a boy is that it seems to have made no difference at all that girls, not boys, were at the center of these stories,” writes Yardley.

A new state-by-state report card on women’s health indicates that most states have a ways to go to meet key health objectives set by the U.S. Department of Health and Human Services.

“Making the Grade on Women’s Health” was released by the National Women’s Law Center in conjunction with Oregon Health & Science University.

From Reuters:

The groups looked at 27 measures of women’s health, ranging from the rates of routine screening tests for breast and colon cancer to obesity and access to health care. The benchmarks were based on the U.S. Department of Health and Human Services’ Healthy People 2010 initiative.

“Overall the nation’s grade was ‘unsatisfactory.’ Only three of the 27 benchmarks were met,” Dr. Michelle Berlin of the Oregon Health & Science University told a briefing.

The three exceptions were in the percentage of women 40 and older getting mammograms, regular dental care and colorectal cancer screening for women over 50.

According to the report, the best state for women’s health is Vermont. The worst state is Mississippi. Click here to view data from your state.

On Monday, President Bush appointed Dr. Susan Orr as Acting Deputy Assistant Secretary for Population Affairs (a Health and Human Services Agency), placing Orr in charge of the nation’s family planning activities under Title X. In the past, Orr has applauded efforts to exclude birth control from health coverage for federal employees, stating that “fertility is not a disease,” and encouraged efforts to withdraw approval of RU-486.

Orr previously worked as an associate commissioner in the Administration for Children and Families, as well as for the anti-contraception and anti-reproductive rights Family Research Council.

This is the position previously held by Eric Keroack, another widely criticized appointment.

Additional coverage:

• Washington Post
• Feministe
• Womenstake
• Planned Parenthood (petition)
• RH Reality Check
• Wall Street Journal blog
• National Family Planning and Reproductive Health Association