Honesty in women’s healthcare? We wish.

This article first appeared on Huffington Post

A small victory for reproductive justice: Google recently removed deceptive “crisis pregnancy centers” ads that come up when users look for abortion services. (Tara Culp-Ressler has an excellent summary of the issue on ThinkProgress.) The ads imply that CPCs offer abortion services, although their primary purpose is often to dissuade women from considering abortion. NARAL Pro-Choice America, which pressured Google to take down the ads because they violate the company’s “credible and accurate” policy, found that some 79 percent of CPC ads on Google were misleading.

What would happen if we instituted a Total Honesty policy on women’s health facilities?

For instance, the finger-pointing messages about Planned Parenthood clinics being “abortion clinics”? Those clinics, which are being forced to close at an astonishing rate, do a lot more than offer occasional abortions or abortion counseling. They serve men and women alike with information about birth control, contraception, family planning and STD’s. They provide women’s health information, counseling, breast exams, mammograms and a lot of critical healthcare for people of all ages, sometimes the only such care they can access.

Then there are independent clinics such as the Feminist Women’s Health Centers in several locations and Women’s Health Specialists in others, struggling to find funding. A godsend to many, they offer a wide range of excellent services to women of all ages and financial means.

I would venture to say, at the risk of seeming to betray the reproductive rights movement, that some pregnancy centers offer good services and don’t lie. CPCs unquestionably promote misinformation they must know is untrue: Birth control causes cancer? Abortion causes infertility? Or mental illness? Enough, already. But some centers say up front they do not counsel, advocate or refer abortion.

Could they be encouraged to join a campaign for honesty? Probably not. But if all the clinics offering desperately needed healthcare to women could be allowed to do so without having to fight against lies, politics and extremism it would be a nationwide blessing.

And that’s the honest truth.

Ahead for women: good news & bad

The years ahead could be not good times to be a woman.

Childcare support? Abortion access? Equal pay? Contraception coverage?

How we will fare in the years ahead — those of us who are females of the species — is an open question; and some of the answers being bandied about are not pretty.

Paul Ryan’s budget would repeal benefits and protections currently enjoyed by millions of women, forcing us to pay out-of-pocket for potentially life-saving things like mammograms and cervical cancer screenings. Cuts in food stamps would hit women disproportionately, cuts in Medicaid would have a similar impact: women make up 70 percent of Medicaid’s adult beneficiaries. Prescription drug costs? Up, thanks to the re-opened Medicare drug coverage gap, the late and un-lamented donut hole. The list goes on, almost as glaringly as the list of benefits to the super-rich goes up. There are not a lot of women, especially single head-of-household wage earners, among the super-rich.

At a recent Planned Parenthood Shasta Pacific (CA) gala, former Michigan Governor and Current TV host Jennifer Granholm ticked off these and other ways GOP policies take from women and give to the super-rich. But Granholm, in a conversation with CA Attorney General Kamala Harris moderated by San Francisco Chronicle columnist Carla Marinucci, framed the opposing political policies as overall good news. With the GOP’s social and economic attacks on women in such sharp focus, she said, they can be seen for what they are — and defeated.

One can hope.

There are plenty of smart, honorable registered women Republicans. Whether they will worry about senior women having to pay more for drugs, or low-income women losing health benefits, or all women continuing to have to work three months more per year just to make what men make, that’s one of the questions still open. Reproductive justice? All women lose when reproductive rights diminish.

But at another meeting last week the focus was on distaff good news. The National Abortion Federation held its annual meeting, complete with continuing medical education for physicians, nurses and all those who will enable the progress and preservation of reproductive rights in the years ahead. This writer was fortunate to be invited to the Membership and Awards Luncheon, surrounded by extraordinary men and women including several award winners I am privileged to call friends. NAF President and CEO Vicki Saporta was among the speakers, and her report was one of optimism. My own optimism about the future for women in the US.is centered in three of the award winners whom I quite fortunately happen to know. They include:

Maggie Crosby, Senior Staff Attorney with the ACLU of Northern California, honored for her decades-long fight for reproductive justice — or, more accurately, her repeatedly successful fights for reproductive justice wherever it was about to be compromised.

Beverly Whipple, an extraordinary woman whose story — at least some small snippet of it — is included in Perilous Times. Whipple was leaving immediately after the NAF meeting for an extended motorcycle trip around Europe with her partner, but they slowed down long enough for a table-full of us to celebrate at the awards luncheon. More on Beverly Whipple in a few days.

Sarp Aksel, Past president of Medical Students for Choice and current Executive Clinic Chair of the ECHO Free Clinic at Albert Einstein College of Medicine in New York City. For those of us in despair about the future of abortion rights, Sarp Aksel is the face of hope. Bright, highly skilled and highly trained, and totally committed to women’s health and autonomy, Aksel is representative of the men and women determined to protect women’s reproductive rights.

Those who would take away women’s right to choose or ability to earn might well make gains for the super-rich in the near future. But they will have to contend with people like Saporta, Granholm, Crosby, Aksel and a host of other fighters for justice… including most of the women of America.

Wanted children, planned families… Why not?

This article first appeared on Huffington Post

The wanted child, the planned family. Can anybody argue that the wanted child and the planned family are not infinitely better off for everyone: child, family and society in general?

So why are we fighting these battles?

The Supreme Court, for example, is taking up the question of whether Hobby Lobby — which presumably prefers unwanted children and unplanned families — can refuse to provide contraceptive insurance for its employees because doing so would somehow offend (the Religious Freedom Restoration Act uses the word “burden”) the religion of its corporate soul. Assuming corporations have a soul, which may or may not be true for Hobby Lobby — this is subject to individual opinion. The RFRA is, of course, also about people, but the Court has already hopelessly blurred the line between people and corporations.

This writer is not a Supreme Court judge, which most U.S. citizens would deem a good thing. But can we think this through? Hobby Lobby goes to a church that thinks sex should occur strictly for purposes of procreation, and conception should therefore never be prohibited. Never mind any Hobby Lobbyists who may have planned their own families; Hobby Lobby still finds it offensive that he should be required to help an employee plan his or her own family. Excuse me?

In particular, Hobby Lobby does not want poor people to plan their families. People of means (and Hobby Lobby is definitely a corporate person of means) have plenty of access to contraceptives enabling them to plan their families. Poor people could use a little help. According to a report recently completed by the Guttmacher Institute (full disclosure, this writer supports the Guttmacher Institute; Hobby Lobby does not), almost nine million disadvantaged women every year get help protecting their health and planning their families through the successful U.S. family planning effort. This effort — which includes funding for contraceptives — substantially reduces the rates of unintended pregnancy. In the process it saves us taxpayers some $10 billion per year.

Some of the details of the Guttmacher report, excerpted below, are worth noting:

• Nearly nine million women receive publicly funded family planning services each year. Three-quarters of these women (6.7 million) received this care from safety-net health centers and about 2.2 million from private physicians. Of these nine million women, 4.7 million obtained care from a health center that receives some funding through Title X.

• Publicly supported contraceptive care enables women to avoid 2.2 million unintended pregnancies each year; absent these services, U.S. rates of unintended pregnancy, unplanned birth and abortion would be two-thirds higher than they are.

• Underscoring the critical role these safety-net providers play in women’s lives, six in 10 women receiving contraceptive care at a health center consider that provider their usual source of care. For four in 10 women who visit a reproductive health-focused health center despite having other options, that provider is their only source of medical care throughout the year.

• Every public dollar invested in helping women avoid pregnancies they did not want to have saves $5.68 in Medicaid expenditures that otherwise would have gone to pregnancy-related care; in 2010, that amounted to a net government savings of $10.5 billion. Safety-net providers that receive some funding from Title X accounted for $5.3 billion of those net public savings.

Dollars saved, wanted children, planned families, individual rights and everything else aside, Hobby Lobby insists that provision of contraceptive coverage infringes upon its religious rights.

It is encouraging to note, though, that 47 religious organizations, through their leaders, have weighed in on the side of wanted children and planned families. They are Christians, Muslims, Jews, and others.

This Presbyterian is proud to join them.

Celebrating abortion providers

This essay first appeared on Huffington Post

You’d think, what with the incessant campaigns to hobble, harass and vilify them, that abortion providers would be somewhere right up there with ax murderers, and at least lying low under the radar. But you would be wrong.

The National Day of Appreciation for Abortion Providers is at hand. It is officially celebrated on March 10 by Planned Parenthood, NARAL Pro-Choice, assorted other reproductive rights organizations and every woman whose life has been honored and restored following the decision to have an abortion. The day comes exactly 21 years after the murder of Dr. David Gunn at his clinic in Pensacola, Florida, a tragedy that was followed by the killings of Dr. John Britton and clinic escort James Barrett in 1994, Dr. Barnett Slepian in 1998 and Dr. George Tiller in 2009.

The irony of such losses is that abortion providers – who still face serious risks – save the lives of countless women every day. Is a day of appreciation enough? One day, in return for all the millions of days of life returned to millions of women? I vote for celebrating at least throughout the month of March.

My own abortion, a back-alley experience following a 1956 workplace rape, was emblematic of a time when there were no such people to honor. Luckily, I got my life back. No one will ever know how many women did not, how many were left maimed or dead because they had no safe, legal option. Since 1973, thanks to passage of Roe v Wade (but no thanks to those who are trying to send us back to the dark ages) they have had trained professionals motivated by compassion – and stories of women like me.

Early on there were individuals like Dr. Harry S. Jonas, now retired after long years of medical practice, teaching, and advocacy for family planning. Jonas speaks of a woman he met when doing an Ob/Gyn residency some years before Roe v Wade. She was dying of massive infection and multiple abscesses from a botched self-induced abortion after having endured 14 pregnancies. “I still remember that patient,” Jonas says, “I remember what she looked like. I remember the bed she was in on Ward 1418. I will never forget it.”

Today there are providers in heavily regulated states – most of whom remain anonymous for very good reasons – with similarly tragic stories. They tell of women who misuse abortion-inducing drugs because they can’t get to a clinic, or girls barely past puberty too frightened by protesters to access care that is their constitutional right. Of a 14-year-old incest victim pleading for help to reach the nearest clinic many miles distant. Of a sick, troubled mother of five having to choose between multiple required – and unnecessary – trips to the clinic and the job she desperately needs to keep. The physicians who are there for these women often face the need to treat their souls as much as their bodies.

Among those who choose to be open in their activism is my personal hero, Willie J. Parker. I have never met Dr. Parker, an African-American Ob/Gyn, other than on phone calls while researching Perilous Times: An inside look at abortion before – and after – Roe v Wade. He speaks with passion and conviction. Currently Associate Medical Director of Family Planning Associates Medical Group in Chicago, Parker grew up Southern Baptist, in a community which taught that abortion is wrong. His own views changed on hearing a sermon about the Good Samaritan preached by Martin Luther King, Jr. “(King) said that what made the good Samaritan ‘good’ was that instead of thinking about what might happen to him if he stopped to help the traveler, he thought about what would happen to the traveler if he didn’t stop to help. That led me to …place a higher value on compassion. I couldn’t stop to weigh the life of a pre-viable or a lethally flawed fetus against the life of the woman sitting across from me.” In addition to his day job, Parker offers help in other parts of the country where help is critically needed. He shrugs off questions about personal risk.

Almost any one of today’s providers could make more money, and have a far easier life, in another job. Instead, they choose to do what they do, so women can choose to control their bodies and their lives. That’s worth celebrating.

So light a candle. Write your congressperson. Send a few bucks to the nearest clinic and the organizations that fight for women’s reproductive rights. One national day is just a fraction of the appreciation abortion providers deserve.

On choosing one’s words…

I was taken to task, rightly so, by a reader who categorized my saying “no one… has an abortion without anguish” (you can read B’s articulate comment, and my response, in the 2/22 Comments) as “hokum.” She might also have said “hogwash.” Mea culpa. “Anguish” was a poor descriptive choice. “Serious thought” maybe; “self-reflection,” “concern.” Actually, the decision does involve anguish for many women, especially those whose rights are being denied by lack of access or harsh state restrictions.

But one word can wreak havoc.

Take the hyphenated word “pro-life,” which has been appropriated by those who are ferociously anti-woman. As if the issue of abortion — always complex and private, and occasionally anguishing — involved nothing at all beyond the (potential) life of a fetus. I consider myself ferociously pro-life, it’s just that I value the life of a woman. And am pro-woman’s-life enough to honor and trust her ability to make her own decisions about her body.

Or the emotionally charged word “suicide.” Those of us who believe in the individual’s right to a compassionate and dignified death have worked hard to get that word out of the discussion. Suicide is the desperate act of a despairing person; “physician aid-in-dying” is a compassionate choice made by a terminally ill, mentally competent adult.

Word choices took much of the focus in a fascinating panel on “Defining Death” sponsored recently by the University of California San Francisco Medical School. More about that event on HuffingtonPost as soon as I can get to it. Cases under study included the tragic, ongoing story of 13-year-old Jahi McMath, and the equally tragic story of 14-week-pregnant Marlise Munoz, whose brain-dead body was briefly kept on “life” support because the hospital and the State of Texas placed the potential life of that pre-viable fetus above the expressed wishes of her husband, parents and even Munoz herself. The distinguished UCSF panel of experts on medicine, law and ethics spoke repeatedly of how much anguish — the word definitely fits here — might have been prevented if only a few, kind words could have replaced some of the jarring words that unfortunately must eventually be said.

Imagine you’re the patient, or family, or attending healthcare worker (try to leave the lawyers out of this.) When does a moments-ago-healthy person become a “corpse”? A “dead body”? Who decides if a pre-viable fetus is a “person”? How can the average person even understand “brain-dead”? If you bring the lawyers in, you encounter “property.” In more than a dozen states there are laws on the books that say that if a pregnant woman dies her body must be maintained until the fetus can be delivered… no matter what advance directives she may have that specify her wishes to the contrary. One family fought against this outrageous miscarriage of justice by claiming their dead loved one’s body — which was, in the eyes of the law, their “property.”

It’s a scary world we live in. But that word JUSTICE. If we can only hang onto that one.

 

 

The bewildering curse of face blindness

You have trouble remembering a name? Imagine being unable even to remember a face.

Oliver Sacks, the remarkable physician/writer/author/professor of neurology — what does he do in his spare time? — wrote a long and fascinating article in a recent (August 30) New Yorker in which he details a lifelong affliction with face blindness, officially known as prosopagnosia, the inability to recognize faces. What Sacks doesn’t do in his spare time is socialize comfortably. It’s hard to be comfortable when you might walk right past your best friend. (Or greet a perfect stranger you think is your next-door neighbor.)

I had made it through seven decades (Sacks and I happen to be the same age, but that’s about where the similarities end) without ever hearing of face blindness. Then one day renowned artist Chuck Close turned up on PBS NewsHour, discussing a new biography. At some point in the program Close mentioned that he was face blind. Come on, I said to myself and the TV screen. A creative genius known worldwide for, among other things, his remarkable portraits and he doesn’t know faces? Close went on to talk of how he works from photographs, largely because once he reduces a face to two dimensions he can commit the image to memory.

Sacks theorizes that the “flattening” allows Close to memorize certain features. “Although I myself am unable to recognize a particular face,” Sacks writes, “I can recognize various things about a face: that there is a large nose, a pointed chin, tufted eyebrows, or protruding ears.” But he is better at recognizing people by the way they move, their “motor style.” He is “reasonably good at judging age and gender, though I have made a few embarrassing blunders.”

Sacks writes that he avoids parties, conferences and large gatherings as much as possible in order not to have the inevitable embarrassment it brings. Consideration of how difficult it has to be to negotiate through life with such a problem makes the common complaint of, say, blanking on an old friend’s name (and don’t we all!) so trivial as to be embarrassing itself.

Sacks cites the work of research scientist Ken Nakayama, who “is doing so much to promote the scientific understanding of prosopagnosia.” Nakayama heads the Prosopagnosia Research Center at Harvard, on whose Web site one can learn about symptoms, causes, history and where the name came from (the Greek word for face: prosopon.) You can also find, on the site, tests and questionnaires to assess your own face recognition. Sacks is particularly appreciative of a notice posted on Nakayama’s own site which reads: “Recent eye problems and mild prosopagnosia have made it harder for me to recognize people I should know. Please help by giving your name if we meet. Many thanks.”

A very small gesture, for those who take face recognition for granted.

Medicinal pot, Yes. Legal pot, bad idea

Wafting around California these days is a lot of rhetoric about legalizing marijuana, a proposition (#19) that will be on the ballot in November. Californians being Californians — I’m one; I know — and pot being pot, there is no shortage of heated opinion. Here is one more.

Countless Americans suffer from chronic or short-term conditions which could be relieved by marijuana. To deny them such relief simply makes no sense at all. The sooner everyone wakes up to the logic of marijuana as comfort care, and it becomes universally legal and available, the better.

Legalizing the weed for recreational delight, though — essentially making it available to all comers — makes very little sense at all. It’s an addictive substance, folks. It messes with your mind. All we need is a whole new population of messed-up folks to add to the messes we already have.

This is just one addict’s opinion. But if one addict’s opinion is only anecdotal, some others, below, are worthy of serious consideration. They were offered by the California Society of Addiction Medicine in an op ed piece by the Society’s president, Dr. Timmen Cermak, in the San Francisco Chronicle, August 22. The Society is taking no position on Prop. 19, Cermak explains, “but we wish Californians would look at the research before they make up their minds on how to vote.” This space applauds that suggestion.

The Society of Addiction Medicine is made up of “the doctors who specialize in the treatment of drug abuse; we work every day with people addicted to drugs, including alcohol,” Cermak writes. “We are a diverse group of doctors committed to combining science and compassion to treat our patients, support their families and educate public policy makers.”

Since very few of the Society of Addiction Medicine’s 400 physician members believe prison deters substance abuse, legalizing marijuana would have that small, back-handed benefit. “Most (of us) believe addiction can be remedied more effectively by the universal availability of treatment,” Cermak writes. “When, according to the FBI, nearly half – 750,000 – of all drug arrests in 2008 in the United States were for marijuana possession, not sales or trafficking, we risk inflicting more harm on society than benefit. Prop. 19 does offer a way out of these ineffective drug policies.”

But other research should raise alarm bells. Cermak’s essay is excerpted below, with a few points worth pondering bold-faced:

“Two-thirds of our members believe legalizing marijuana would increase addiction and increase marijuana’s availability to adolescents and children. A recent Rand Corp. study estimates that Prop. 19 would produce a 58 percent increase in annual marijuana consumption in California, raising the number of individuals meeting clinical criteria for marijuana abuse or dependence by 305,000, to a total of 830,000.

“The question of legalizing marijuana creates a conflict between protecting civil liberties and promoting public health… between current de facto legalization in cannabis clubs and revenue-generating retail marijuana sales… The society wants to make sure voters understand three basic facts about how marijuana affects the brain:

“– The brain has a natural cannabinoid system that regulates human physiology. The flood of cannabinoids in marijuana smoke alters the brain’s delicate balance by mimicking its chemistry, producing a characteristic “high” along with a host of potential side effects.

“– Marijuana is addicting to 9 percent of people who begin smoking at 18 years or older. Withdrawal symptoms – irritability, anxiety, sleep disturbances – often contribute to relapse.

“– Because adolescent brains are still developing, marijuana use before 18 results in higher rates of addiction – up to 17 percent within two years – and disruption to an individual’s life. The younger the use, the greater the risk.

“Marijuana is a mood-altering drug that causes dependency when used frequently in high doses, especially in children and adolescents. It’s important that prevention measures focus on discouraging young people from using marijuana.

“Prop. 19 erroneously states that marijuana “is not physically addictive.” This myth has been scientifically proven to be untrue. Prop. 19 asks Californians to officially accept this myth. Public health policy already permits some addictive substances to be legal – for instance, alcohol, nicotine and caffeine. But good policy can never be made on a foundation of ignorance. Multiple lines of scientific evidence all prove that chronic marijuana use causes addiction in a significant minority of people. No one should deny this scientific evidence.”

So we could use the tax revenues from legalized pot. But it may surely be worth thinking twice about what the concurrent costs will be, in illness and crime and human lives.

Early cancer tests, surgeries questioned

Was this mastectomy necessary? It’s a question few breast cancer survivors want to ask, and one that few are likely to answer absolutely. But after years of aggressive emphasis on early diagnosis and treatment, some previous imperatives are being called into question. Noting that breast biopsy has long been considered the “gold standard,” a report in today’s New York Times addresses the new rethinking:

As it turns out, diagnosing the earliest stage of breast cancer can be surprisingly difficult, prone to both outright error and case-by-case disagreement over whether a cluster of cells is benign or malignant, according to an examination of breast cancer cases by The New York Times.

Advances in mammography and other imaging technology over the past 30 years have meant that pathologists must render opinions on ever smaller breast lesions, some the size of a few grains of salt. Discerning the difference between some benign lesions and early stage breast cancer is a particularly challenging area of pathology, according to medical records and interviews with doctors and patients.

Diagnosing D.C.I.S. “is a 30-year history of confusion, differences of opinion and under- and overtreatment,” said Dr. Shahla Masood, the head of pathology at the University of Florida College of Medicine in Jacksonville. “There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin.”

Much of the current finger-pointing is toward pathologists, where their money comes from, whether they are ‘certified’ or not and in general, how good a job they do.

In 2006, Susan G. Komen for the Cure, an influential breast cancer survivors’ organization, released a startling study. It estimated that in 90,000 cases, women who receive a diagnosis of D.C.I.S. or invasive breast cancer either did not have the disease or their pathologist made another error that resulted in incorrect treatment.

After the Komen report, the College of American Pathologists announced several steps to improve breast cancer diagnosis, including the certification program for pathologists.

For the medical community, the Komen findings were not surprising, since the risk of misdiagnosis had been widely written about in medical literature. One study in 2002, by doctors at Northwestern University Medical Center, reviewed the pathology in 340 breast cancer cases and found that 7.8 percent of them had errors serious enough to change plans for surgery.

This space has argued occasionally for reconsideration of yearly mammograms and for longer, stronger consideration of other options before a mastectomy is performed. Especially in the case of older women.

Would I insist on further studies or opt for less radical treatment if I were diagnosed with breast cancer today? Probably. Can I undo the mastectomy I had at 72? Not exactly. Second-guessing is beside the point for someone who is healthy and fit, but asking questions won’t ever hurt.

Earliest Steps to Find Breast Cancer Are Prone to Error – NYTimes.com.

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