Kaiser Family Foundation has released an important package of resources that shines a spotlight on health disparities between white women and women of color in all 50 states and Washington, D.C.,

The report (pdf), “Putting Women’s Health Care Disparities On The Map: Examining Racial and Ethnic Disparities at the State Level,” takes into account 25 indicators, including rates of diseases such as diabetes, heart disease, AIDS and cancer, and access to health insurance and health screenings.

The states with the largest rate of disparities were Arkansas, Indiana, Louisiana, Mississippi, Montana and South Dakota. States such as Virginia, Maryland, Georgia and Hawaii showed relatively smaller disparities between women of color and white women on health outcomes and health care access.

The reports also notes that white women and minority women were doing similarly well in Maine — and similarly poorly in Kentucky and West Virginia.

This introductory page includes links to the full report and numerous documents that look closely at health status, access to health care, social determinants and workforce statistics.

Among the key findings:

Disparities existed in every state on most measures. Women of color fared worse than White women across a broad range of measures in almost every state, and in some states these disparities were quite stark. Some of the largest disparities were in the rates of new AIDS cases, late or no prenatal care, no insurance coverage, and lack of a high school diploma.

In states where disparities appeared to be smaller, this difference was often due to the fact that both White women and women of color were doing poorly. It is important to also recognize that in many states (e.g. West Virginia and Kentucky) all women, including White women, faced significant challenges and may need assistance.

Few states had consistently high or low disparities across all three dimensions. Virginia, Maryland, Georgia, and Hawaii all scored better than average on all three dimensions. At the other end of the spectrum, Montana, South Dakota, Indiana, and several states in the South Central region of the country (Arkansas, Louisiana, and Mississippi) were far below average on all dimensions.

States with small disparities in access to care were not necessarily the same states with small disparities in health status or social determinants. While access to care and social factors are critical components of health status, our report indicates that they are not the only critical components. For example, in the District of Columbia disparities in access to care were better than average, but the District had the highest disparity scores for many indicators of health and social determinants.

Each racial and ethnic group faced its own particular set of health and health care challenges.
The enormous health and socioeconomic challenges that many American Indian and Alaska Native women faced was striking. American Indian and Alaska Native women had higher rates of health and access challenges than women in other racial and ethnic groups on several indicators, often twice as high as White women. Even on indicators that had relatively low levels of disparity for all groups, such as number of days that women reported their health was “not good,” the rate was markedly higher among American Indian and Alaska Native women.

Plus: Kaiser also put together a video companion to the report. Filmed at the Arlington (Va.) Free Clinic, the video looks at the challenges that uninsured women face.

In 1970, Kay Zakariasen sought treatment for a bladder infection. The resulting diagnosis (a too narrow urethra) and treatment (surgical dilation) set her on a course of pain and frustration for the next three decades.

In an article published at the National Women’s Health Network and at Our Bodies Ourselves, Zakariasen describes what it was like living with the constellation of bladder and pelvic pain symptoms that is often referred to as interstitial cystitis.  And she laments the lack of effective, evidence-based treatments:

Studies touting the effectiveness of surgeries such as hydrodistention and instillations often fail to follow basic practices of good scientific research. Almost no published reports on IC are randomized, controlled clinical studies in which both researchers and patients were “blinded” about the subjects’ conditions and the treatment being tested to ensure objectivity. Most studies also failed to include control groups, which compare a group getting the treatment being investigated with a control group receiving only a placebo. When higher quality scientific studies have been done, they often fail to support the initial positive results. As a result, experts suggest that the reported high success rates for IC treatments should be reduced by 35% to factor in the placebo effect, and by as much as 50% to address spontaneous remission of the patient’s symptoms. It’s likely that many women, if informed about these low success rates, would decide not to have invasive treatments.

Zakariasen found some relief for severe intestinal bloating — which many IC patients have, and which started for her about the same time as urological treatment with antibiotics and dilation — when a holistic internist treated her for food sensitivities and intestinal candida. But she did not get significant help for chronic bladder urgency and frequency until years later, when she was treated for “intestinal bacterial overgrowth.”

The experiences left Zackariasen frustrated by the dearth of evidence-based information about surgical outcomes and alternative treatments.

In  2003, with the help of Dr. Elizabeth Kavaler, a urologist, Zakariasen created a patient survey — www.cystitispatientsurvey.com — for women who had been treated for IC. Most of the respondents said surgeries either worsened or had no effect on their symptoms. More than 1,300 patients have completed the survey, and four physicians who analyzed some of the data published an article in the January 2008 issue of the journal Urology. Our Bodies Ourselves and the National Women’s Health Network contributed letters of support to the survey.

The survey is still open for women to share their experiences, and Zakariesen is seeking volunteer statisticians to help analyze more data.

Zakariasen is currently writing a book on her experiences and the history of treatments for interstitial cystitis. She asks readers who are willing to share their medical experiences to contact her at zakariasen@verizon.net.

In the article posted at OBOS, Zakariasen makes the case for more patient involvement in the treatment of IC, but her statement applies to all aspects of women’s health:

Despite the principle that patients should be the primary decision-makers regarding their own treatment and care, it is clear that many women are not given all of the information they need to make a truly informed decision. Patients have a right to know — for every treatment a doctor offers — the nature of the procedure, the quality of evidence supporting it, its benefits and risks, and any alternatives to that treatment.

Finding “Common Ground” on Abortion – How’s That Working?:  “President Obama has accomplished a lot in his first 100 days in office, but one campaign promise he’s been unable to keep is a vow to make peace in one of the most polarizing issues in all of American politics: abortion,” reports NPR.

Lines in the Sand: Speaking of the elusive common ground, On the Issues magazine chose “lines in the sand” as the theme for its current issue.

An email to readers said the choice was “provoked by today’s too-prevalent sentiment to compromise principles in the interests of seeking ‘common ground’ and reconciliation with opposing views. In these articles we explore the feminist and progressive values that must be held tightly, the ‘lines in the sand’ that we refuse to erase.”

Publisher and Editor-in-Chief Merle Hoffman says reproductive freedom is “the front line, the bottom line and the everlasting line in the sand,” in her editorial “Higher Ground, Not Common Ground.”

Also look for essays by Gloria Feldt, Loretta Ross and many more writers and artists.

Economics, Race and Pollution: A study by researchers at the University of Massachusetts and the University of Southern California tracking toxic emissions from factories confirms what we already know: poor, minority communities are disproportionately affected by harmful pollution. The Milwaukee Journal Sentinel reports on the findings. View the full report (PDF) here.

Public Attitudes Toward HIV/AIDS as a Health Issue: Kaiser Family Foundation has released its 2009 Survey of Americans on HIV/AIDS. In the United States, the sense of urgency about HIV/AIDS as a national health issue has decreased significantly. Residents’ concerns about the disease as a personal risk also has declined, even among some high-risk groups. This press release summarizes the findings. The study comes less than a year after the CDC  announced that there were 40 percent more new HIV infections each year than previously believed.

Egypt’s FGM Ban, One Year Later: In the year since Egypt outlawed female genital mutilation, the government hasn’t prosecuted a single case, Iman Azzi writes at Women’s eNews. Still, some activists say the law is a tool, among others, for gradually dismantling an ancient tradition.

Legalization – The “X” Factor: On May 1, thousands of activists took to the streets in favor of expanding immigrants rights. Suman Raghunathan, an immigration and public policy analyst, describes what immigrant women, particularly those who are undocumented, need: “A legalization program that’s broad, fair and workable for both immigrants and immigration officials.”

Raghunathan goes on to note that current federal immigration policy leaves it up to states to decide whether to provide free or low-cost health care to their undocumented residents. Several states, including New York, have expanded prenatal and neonatal care to undocumented women and children.

“Legal status,” she writes, “would mean that undocumented women are no longer left to the mercy of state legislatures and no longer denied appropriate nursing and doctoring.”

Plus: The L.A. Times reports on how some California counties are eliminating non-emergency health services for undocumented immigrants.

“We are mortgaging the future to scrape through the present,” said David Hayes-Bautista, professor of medicine and director of UCLA’s Center for the Study of Latino Health and Culture.

HRT and Heart Health: A study in the May issue of the journal Medical Care (abstract) looks at whether the decreased use of HRT has affected the rate of cardiovascular health outcomes, according to this release. The number of heart attacks in menopausal women has decreased, though it’s not conclusive that there’s a link. Researchers did not find a difference in the rate of strokes.

Before 2002, physicians believed HRT reduced the risk of coronary heart disease by up to 50 percent in menopausal women. As a result, physicians prescribed it broadly to treat many of the symptoms of menopause, as well as to protect women against cardiovascular disease. However, a report by the Women’s Health Initiative in 2002 revealed that HRT actually had the opposite effect — it increased the risk of heart attack in these women.

“After the 2002 report, the use of HRT in women aged 50 to 69 declined from more than 30 percent to less than 15 percent,” said lead study author Kanaka Shetty, M.D.

For many years, women who underwent hysterectomies also routinely had their ovaries removed, in order to prevent them from developing ovarian cancer in the future. A new study that will appear in the May 2009 issue of Obstetrics and Gynecology calls this practice into question.

The study, “Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses’ Health Study,” examines the long-term survival rates of women of women who have had hysterectomies (removal of the uterus) because of non-cancerous reproductive disease. It compares the medical outcomes of women who had their uterus and ovaries removed with women who had only their uterus removed. The study used the database from the Nurses’ Health Study, which included 122,700 registered nurses in 1976 when it began.

The study found that women who had their ovaries removed had a higher risk of death from any cause, primarily from heart disease and lung cancer. Removing the ovaries at any age did not improve life-span for this group of women.

One of the studies lead authors, William Parker, MD, a clinical professor at the UCLA School of Medicine, has written a summary of the study and its findings that was published at Our Bodies Ourselves:

Women often have their healthy ovaries removed when they are having a hysterectomy in order to prevent ovarian cancer from developing in the future. About 50% of women who have a hysterectomy between ages 40-44 have their ovaries removed, and 78% of women between ages 45-64 undergoing a hysterectomy have their ovaries removed. All together, about 300,000 American women have their healthy ovaries removed every year.

If the ovaries are removed before menopause, a sudden decrease in the hormones made by the ovaries, including estrogen, testosterone and androstenedione, results. Even after a woman enters menopause, her ovaries continue to make considerable amounts of testosterone and androstenedione, which are then changed into estrogen by other cells in the body.

Some studies had already show that women who keep their ovaries have a lower risk of heart disease. While ovarian cancer accounts for 14,700 deaths per year in the U.S., heart disease causes 326,900 deaths, and stroke causes 86,900 deaths each year. If a woman is not at high risk for ovarian cancer, then keeping the ovaries might benefit her overall health and survival.

We designed a study to see whether it was better for women who needed a hysterectomy to keep their ovaries or have them removed during the surgery to remove the uterus.

Continue reading Parker’s summary.

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.

Time magazine has a story about growing concerns over the long-term health effects of donating eggs, especially cancer and infertility.

The issue has become more urgent as more women are showing an interest in egg donation as a way to make ends meet. Some fertility clinics say that the number of applicants has increased as much as 55 percent in the past four months compared to the same period last year.

Catherine Elton writes:

Doctors say there is no biological reason that donating eggs would cause infertility, but they also cannot say for sure that it doesn’t. The long-term health effects of egg donation have never actually been studied, in large part because the high cost of studies doesn’t “seem justified in terms of what the possible risks [of the procedure] might be,” according to Sean Tipton, spokesman for the American Society for Reproductive Medicine (ASRM). He points out that egg donors undergo the same drug treatment as IVF patients — hormone injections and other drugs that stimulate follicles, promote egg maturation and prevent the release of eggs before they can be retrieved — and that studies of the latter population show it is safe.

But some women’s health advocates say that evidence isn’t strong enough, calling for further study and a national, trackable registry of egg donors. While the Centers for Disease Control and Prevention (CDC) logs the number of donated eggs transferred to infertile women each year — there were some 15,500 in 2006, the most recent year for which data are available — no one knows how many individual donors those eggs came from, who they were or whether they were exceeding industry guidelines of six donations in a lifetime. (The guidelines are intended to limit the number of offspring from a particular donor and to prevent overexposure to fertility drugs, but they are not based on scientific data.)

“Right now egg donors are treated like vendors, not as patients. Patients need to be followed up,” says internist Jennifer Schneider, who has been advocating for the government to track egg donors since 2007, a few years after her daughter, a three-time egg donor, died of colon cancer at age 31. “After the first few days of being discharged from the IVF clinic and seeing that there were no immediate consequences, they are never contacted again.”

Short-term risks include ovarian hyperstimulation syndrome, ovarian torsion or ruptured ovarian cysts. Our Bodies Ourselves Executive Director Judy Norsigian, who also supports a national registry of egg donors, tells Time that women she speaks to on college campuses are generally uninformed about the risks. Elton writes:

A recent study of past donors seems to support Norsigian’s impressions. In an article published in Fertility and Sterility in November 2008, researchers found, for example, that 34% of former egg donors didn’t recall being aware at the time of donation of the risk of ovarian hyperstimulation syndrome, the most common side effect. The majority of donors experience at least the mild or moderate form of this syndrome, which involves discomfort, bloating or nausea and usually resolves itself on its own. The severe version of this syndrome is rare — only 100 to 200 for every 100,000 women — but its consequences can include kidney failure and death. And then there are other side effects, such as bleeding, infection and death, which are associated with any surgery performed under general anesthesia. But fully 20% of the 80 donors interviewed said they didn’t know there were any physical risks to egg donation at all.

“There is a clear problem about informed consent here,” Norsigian says.

It’s a comprehensive story that raises a number of important issues — please share it.

Related: Egg Donation for IVF and Stem Cell Research: Time to Weigh the Risks to Women’s Health

This week, we learned of the Overlapping Conditions Alliance, a group of nonprofit organizations “seeking to advance the scientific, medical and policy needs of individuals affected by medical conditions that frequently overlap.”

The conditions – chronic fatigue syndrome, endometriosis, interstitial cystitis, irritable bowel syndrome, temporomandibular joint disorders (TMJ), and vulvodynia – disproportionately or solely affect women.  All are poorly understood, and many who suffer from these conditions are misdiagnosed and receive inappropriate treatment.

While the OCA website does not yet have a lot of detail, the partnered organizations are:

• Chronic Fatigue and Immune Dysfunction Syndrome Association of America
• Endometriosis Association
• Interstitial Cystitis Association
• International Foundation for Functional Gastrointestinal Disorders
• TMJ Association
• National Vulvodynia Association

The Overlapping Conditions Alliance will advocate for funding to research the common underlying mechanisms and risk factors for these conditions, so that preventive strategies and more effective treatments can be developed.

Reading List: Anna Clark interviews Michelle Goldberg, author of “The Means of Reproduction: Sex, Power, and the Future of the World,” at Bitch magazine (and happy birthday to Anna’s blog, Isak!).

Kathryn Joyce, author of “Quiverfull: Inside the Christian Patriarchy Movement,”  talks with Religion Dispatches. An excerpt of her book can be read here.

Planting a Future: Melissa Harris Lacewell digs through the meaning of Michelle Obama planting the new White House vegetable garden. More historians, authors and gardeners weigh in at the Washington Post.

Plus: Sharkfu on nutrition, cost and Alice Waters; Mark Bittman on eating healthy, organic or not.

Dealing with the Recession: Over at Writes Like She Talks, Jill Miller Zimon put together a list of articles that provide perspective on the recession, job loss and the economic impact on women. At Women’s eNews, Mimi Abramovitz explains three new rules about jobless benefits in the stimulus package that will help women and correct a major gender bias.

Pregnant? Here’s a Pink Slip: “Last year the number of pregnancy-based discrimination charges filed with the E.E.O.C. was up nearly 50 percent from a decade earlier, to a total of 6,285. That number seems likely to rise even higher this year,” writes Lesley Alerman in The New York Times.

“Some employers are using the economy as a pretense for laying off just one person,” said Elizabeth Grossman, a lawyer for the Equal Employment Opportunity Commission. “And very often that person is pregnant or the oldest employee on staff. The economy may be the legitimate cause — or there may be discrimination.”

Tenn. Senate Passes Abortion Amendment: The Tennessee Senate passed a constitutional amendment that states in part, “nothing in Constitution of Tennessee secures or protects right to abortion or requires the funding of an abortion.”

Rachel writes: “Supporters keep insisting that the bill does not make abortion illegal, while not addressing the fact that if this ultimately succeeds (there are several more steps for this Constitutional amendment), it makes room for the numerous restrictions often supported by anti-choice folks — such as waiting periods, forced ultrasounds, required ‘informed consent’ scripts that are not medically accurate, and so on. It also makes room for an abortion ban in the event that national protections vanish.”

Meanwhile, “Illinois could be on the verge of passing one of the most progressive reproductive health bills, the Reproductive Health and Access Act, any state has seen in a long time,” writes Veronica Arreoloa. Here are the groups supporting  the bill. If you’re a resident of Illinois, contact your legislator and voice your support.

Cost of Domestic Abuse: Women who are abused by their partners spent 42 percent more on healthcare per year than non-abused women, according to a long-term study of more than 3,000 women published online in the journal Health Services Research.  The study, summarized in this press release, also found that the increased costs don’t end when the abuse does. Women who suffered physical abuse five or more years earlier still spent 19 percent more per year on health care than women who were never abused.

Recognition for the Rights of Persons with Disabilities: “We are living in a new era for persons with disabilities,’ writes Myra Kovary at On the Issues Magazine. The story details the Convention on the Rights of Persons with Disabilities, which was adopted by the General Assembly of the United Nations and has been signed by 50 nations so far.  The U.S. has yet to sign it, but President Barack Obama has said he will do so.

Facts of Life: Sarah Seltzer praises “the sex talk” on one of my favorite television shows, “Friday Night Lights,” and compares it to a conversation from over a decade ago on “My So-Called Life.”

More than half of the 48 baby shampoos, bubble baths and baby lotions analyzed in a recent laboratory test were found to contain formaldehyde and/or 1,4-dioxane, chemicals that have been linked to allergies and skin cancer.

The study was sponsored by the Campaign for Safe Cosmetics, a national coalition of nonprofit organizations focused on health and the environment. The full report, “No More Toxic Tub” (pdf), is available online. Among the findings:

• 17 out of 28 products tested – 61 percent – contained both formaldehyde and 1,4-dioxane.
• 23 out of 28 products – 82 percent – contained formaldehyde at levels ranging from 54 to 610 parts per million (ppm).
• 32 out of 48 products – 67 percent – contained 1,4-dioxane at levels ranging from 0.27 to 35 ppm.

Though the levels found were relatively low, the Campaign for Safe Cosmetics notes in this release “that babies may be exposed to several products at bath time, several times a week, in addition to other chemical exposures in the home and environment. Those small exposures add up and may contribute to later-life disease.”

Product labels do not disclose the chemicals because they’re contaminants (byproducts of the manufacturing process), not ingredients, and therefore are exempt from labeling laws.

Many of the products on the study list are  manufactured by Johnson & Johnson. The company released a statement, published in the Washington Post, noting that their “products meet or exceed the regulatory requirements in every country where they are sold.”

The European Union has banned 1,4-dioxane in personal care products, but the U.S. Food & Drug Administration has determined that trace amounts found in personal care products do not pose a threat. Health advocates are pushing for increased FDA regulation.

“The fact that we are bathing our kids in products contaminated with carcinogens shows how woefully out of date our cosmetics laws are and how urgently they need to be updated,” Rep. Jan Schakowsky (D-IL) told the Post. “The science has moved forward; now the FDA needs to catch up and be given the authority to protect the health of Americans.”

Sen. Dianne Feinstein (D-CA) said she will introduce legislation requiring stronger oversight of the cosmetics industry.

In an online discussion about safety limits on commercial products, Stacy Malkan, the study’s co-author and author of ” Not Just a Pretty Face: The Ugly Side of the Beauty Industry,” stressed that the purpose of the study was not to cause alarm but to point out that products advertised as “gentle” and “pure” may still contain contaminants.

Many companies are already reformulating products for markets with stricter regulation outside the United States. Our own safety standards need to be updated, said Malkan.

Current cosmetics laws in the U.S. were created in 1938 — they’re a bit outdated, to say the least! Scientists have learned a lot over the past few decades about the health risks of low dose chemical exposures, and the special vulnerabilities of children. Companies have also learned a lot about how to make high performance products without carcinogenic chemicals. I believe that shifting to cleaner product formulations will benefit the beauty industry in the long run, making them more competitive globally.

To get there, we need a smarter regulatory system that requires companies to remove chemicals that are known or highly suspected of causing cancer, reproductive harm or other health problems, and also requires them to fully disclose the ingredients in their products. In other words, we need a regulatory system that keeps companies honest and rewards the companies that are doing the best job of making the safest products. This will take an act of Congress. FDA currently does not have the authority to properly regulate cosmetics.

Plus: If you want to look up the products you use, the Environmental Working Group maintains a Skin Deep database with toxicity information on more than 42,000 products.

The March issue of the Guttmacher Institute’s journal, Perspectives on Sexual and Reproductive Health, includes a study on access to abortion [PDF] for incarcerated women in the United States, and found considerable variability in women’s access to these services.

The researchers sent surveys to correctional health providers across the country and asked questions about access to abortion, contraceptive counseling, and other women’s health issues, such as vaccine updates, STI screening, and mammography.

They received 286 responses; among the findings:

• 68% of respondents indicated women at their facility were allowed to obtain an elective abortion if they requested one.
• 54% percent of respondents who said yes reported that they also assist women in arranging an appointment for an abortion, and 88% replied that their facility arranges transportation for women seeking an elective abortion.
• 71% of providers counseled women about contraceptive options at some point during their incarceration.

The authors also note, perhaps unsurprisingly, that “By all of the measures we assessed, abortion appears to be more accessible to incarcerated women in states with predominantly Democratic or bipartisan legislatures than in states with Republican-controlled legislatures.”

A commentary [PDF] in the same issue of the journal by Diana Kasden of the ACLU Reproductive Freedom Project, points out that “even among respondents who indicated that their facilities do allow access to abortion, many said that women receive little or no logistical assistance in arranging, paying for and getting to the appointment,” and discusses the findings and related Constitutional issues.

Thanks to RaceWire for pointing to the study; author Michelle Chen comments on the study’s discussion of the obstacles incarcerated women have often faced in obtaining health care in their communities as well:

“Prison should not be a woman’s first opportunity to obtain quality medical care, though neither should it replicate the systemic problems that limited her opportunities on the outside. President Obama recently started redirecting federal family planning resources toward comprehensive clinical services and away from abstinence-only sex education programs. It remains to be seen whether some of the country’s least free women will see brighter prospects for reproductive freedom under the new administration.”

Last year, a measure passed that requires researchers who receive federal funding from the National Institutes of Health to abide by a public access policy and make their research papers available through PubMed Central, a free online archive of life and biomedical science journal literature.

As a result, much more literature medical research is expected to become available to the public (although much of it will become available only after 12 months have passed since publication). Librarians and consumer advocates have been among the champions of this policy because it will increase access to scientific and medical knowledge.

Last week, it was announced that this policy of access no longer needs to be renewed every year, making it more likely to succeed in providing the public with access to medical research funded by their tax dollars. Supporters of the policy, however, are currently fighting a legislative challenge from Rep. John Conyers (D-MI); it has been suggested that his and others’ opposition the public access policy may be related to political donations received from the publishing industry.

In addition to the individual articles to be made available through the public access policy, a number of journals are already available in full online as “open access” journals — journals which are freely available to the public “without financial or other barrier other than access to the internet itself.” In other words, you or your library do not need to pay for a subscription to access these titles.

Currently, BioMed Central seems to be the biggest publisher of open access medical journals. A complete list of BioMed Central journals is available online. A few that might be of particular interest to our readers:

• BMC Pregnancy and Childbirth
• BMC Women’s Health
• Breast Cancer Research
• Conflict and Health
• Globalization and Health
• International Breastfeeding Journal
• Reproductive Health

For more information on open access publishing (which is distinct from the NIH public access policy), check out this introduction and the fairly detailed Wikipedia entry.

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 : )

Publicly Funded Family Planning Programs Make Sense: This new report (pdf) from the Guttmacher Institute on the essential role of family planning shows the pay-off: prevention of nearly 2 million unintended pregnancies and more than 800,000 abortions each year, saving billions of dollars.

“Report co-author Rachel Benson Gold called the family planning program ’smart government at its best,’ asserting that every dollar spent on it saves taxpayers $4 in costs associated with unintended births to mothers eligible for Medicaid-funded natal care,” reports the AP.

Iran’s Women Are Taking On The Mullahs: “Iranian women, and not just the sporting queens or Nobel prize winners, are standing up to the mullahs. And some of them are experiencing a frightening political backlash,” writes Katherine Butler at The Independent. A strikingly good story, it provides an in-depth look at life in Iran. Grab a cup of coffee and settle in for this one.

Sex-Discrimination Suit at Boston Hospital: Dr. Sagun Tuli, a 39-year-old neurosurgeon, filed a lawsuit against her employer, Brigham and Women’s Hospital, and her boss, Dr. Arthur Day, the chairman of the neurosurgery, alleging a hostile work environment and retaliation against her when she complained.
After a seven-week trial, a jury agreed and awarded Tuli $1.6 million, reports the Boston Globe.

Read more analysis from Vanessa Merton at Feminist Law Professors.

Facts Matter Most: When you need to be reminded that kids today are (generally) all right, check in with Mike Males, a senior researcher for the Center on Juvenile and Criminal Justice in San Francisco who also heads up YouthFacts.org, which aims to debunk media myths, such as all girls are “girls gone wild.”

Star Tribune columnist Gail Rosenblum recently wrote about a lecture Males gave, sponsored by the University of Minnesota’s Konopka Institute for Best Practices in Adolescent Health, that separated fact from fiction.

Plus: Here’s a great response to the media coverage of Chris Brown & Rihanna, penned by Alex Pates, 15, and Ansheera Ace Hilliard, 17, members of the Chicago-based Females United for Action. FUFA is a youth group that works on issues of violence against women and media justice.

Beautiful Cervix Project: It took a headlamp and a lot of mojo, but photos of a cycling cervix are now available. From the author’s introduction: “I am a 25 year old woman who has never given birth.  My intention with this project was to better understand my cycle and the changes in my cervix throughout the month. As a doula and student midwife, I used this project to help me see how a cervix might look different throughout the cycle in the absence of vaginal infections and to understand speculum exams.”

Another Sign of the Financial Crisis: We know advertising standards have loosened over the years, but it took an economic downturn for some media outlets to let alcohol and sex ads go prime time, reports the L.A. Times.

Food/Access Studies: There’s new research out linking the availability of healthy food and the quality of one’s diet with place of residence. The studies, by researchers at the Johns Hopkins Bloomberg School of Public Health, appear in the March 2009 issue of the American Journal of Clinical Nutrition and the December 2008 issue of the American Journal of Preventive Medicine.

“Place of residence plays a larger role in dietary health than previously estimated,” said Manuel Franco, MD, PhD, and lead author of the studies, in this release. “Our findings show that participants who live in neighborhoods with low healthy food availability are at an increased risk of consuming a lower quality diet. We also found that 24 percent of the black participants lived in neighborhoods with a low availability of healthy food compared with 5 percent of white participants.”

Paging Mr. Whipple: A Toilet Paper Crisis: “The national obsession with soft paper has driven the growth of brands like Cottonelle Ultra, Quilted Northern Ultra and Charmin Ultra — which in 2008 alone increased its sales by 40 percent in some markets, according to Information Resources, Inc., a marketing research firm,” writes Leslie Kaufman at The New York Times.

“But fluffiness comes at a price: millions of trees harvested in North America and in Latin American countries, including some percentage of trees from rare old-growth forests in Canada. Although toilet tissue can be made at similar cost from recycled material, it is the fiber taken from standing trees that help give it that plush feel, and most large manufacturers rely on them.”

As Christine mentioned in her most recent Political Diagnosis, the recently passed stimulus bill includes $1.1 billion for comparative effectiveness research, which compares “the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions.”

Comparative effectiveness research is intended to inform medical decision-making. For example, it may ask whether an expensive new drug really works any better than an old, generic treatment, or whether it is enough of an improvement to justify the added cost. It may take the form of new clinical research, or of systematic reviews of the existing evidence. As respected medical blogger Kevin, MD explains regarding the value of this type of research:

Physicians need an authoritative source of unbiased data, untainted by the influence of drug companies and device manufacturers. With treatments and medications announced daily, having an entity definitively compare these newer, and often more expensive, options with established treatment regimens will be particularly useful in everyday practice.

The only way to tackle such a huge project is with money, and indeed, the Obama administration recognizes this fact by including $1.1 billion in comparative effectiveness research in the economic stimulus package.

Kevin also notes the source of some objections to this type of research:

“The pharmaceutical and device industry would like both the public and physicians to continue to assume that ‘newer means better.’ Not asking these questions allows them to continue promoting profit-making brand-name treatments.”

Indeed, a Wall Street Journal piece published prior to the passage of the stimulus bill suggested that drug and medical-device industries were “mobilizing to gut” the provision. Others critics have suggested that the funds will result in the government mandating or withholding medical treatments; the conference report on the stimulus bill, however, specifically states that a Federal Coordinating Council for Comparative Effectiveness Research will be created to coordinate the efforts, and that:

“…nothing shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer. Further, the conference agreement includes language to clarify that none of the reports submitted or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment.”

As the New York Times noted in their coverage of the funding, supporters of the provision include “Consumer groups, labor unions, large employers and pharmacy benefit managers,” who expect the research to “fill gaps in the evidence available to doctors and patients.”

For resources related to evidence-based medicine, systematic reviews, and comparative effectiveness, see:

• The Agency for Healthcare Research and Quality – includes a section specific to women
• The Cochrane Library – their new and updated reviews currently include a number of topics relevant to women’s health, such as those on treatments for lactation suppression and Chinese herbal medicine for PMS.
• The Comparative Effectiveness Resource Center of the ECRI Institute
• The US Cochrane Center’s online tutorial on understanding evidence-based medicine (which we covered last month)
• The Centre for Evidence-Based Medicine

Full disclosure: one project I contribute to in my daily work is funded through the AHRQ, an agency which will receive some of the comparative effectiveness dollars included in the stimulus package.