Best city for geezers? NY lays claim

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New York City seems to be all aglow in being named by the World Health Organization to its Global Network of Age-friendly cities. As Clyde Haberman reported about the event in the July 1 New York Times,

“It makes us members of a club of people who are struggling, in their own and perhaps much different ways, with learning about and thinking about and approaching this issue,” said Linda I. Gibbs, the deputy mayor for health and human services. “It’s really a lovely recognition.”

One reason for the acknowledgment was a plan that city officials and the New York Academy of Medicine announced last year to improve life for older New Yorkers. All sorts of ideas were put forth, on matters like transportation, housing, health care, job training, nutrition and cultural activities. To a large degree, it was more a wish list than a concrete program. But at least it showed that the city was thinking about issues that will only become more dominant.

Like other cities, New York has a population that is aging, if you will forgive a somewhat meaningless word that we are stuck with. After all, everyone is aging. It’s called living. The only people not aging are dead.

WHO says, of its Global Nework of Age-friendly Cities, that the problem lies with the fact that too many of us are aging and not dying.

Populations in almost every corner of the world are growing older. The greatest changes are occurring in less-developed countries. By 2050, it is estimated that 80% of the expected 2 billion people aged 60 years or over will live in low or middle income countries. The Network aims to help cities create urban environments that allow older people to remain active and healthy participants in society.

To that end, the Network got off the ground a few years ago, and now lists a few cities across the globe as having been accepted for membership. This week’s bulletin (excerpted above and below) lists the Big Apple as the first U.S. member, although the PDF of member cities also lists Portland, and one has to wonder how Portland’s going to feel about all of New York’s hoopla.

The WHO Age-friendly Cities initiative began in 2006 by identifying the key elements of the urban environment that support active and healthy ageing. Research from 33 cities, confirmed the importance for older people of access to public transport, outdoor spaces and buildings, as well as the need for appropriate housing, community support and health services. But it also highlighted the need to foster the connections that allow older people to be active participants in society, to overcome ageism and to provide greater opportunities for civic participation and employment.

The Global Network builds on these principles but takes them a significant step further by requiring participating cities to commence an ongoing process of assessment and implementation. Network members are committed to taking active steps to creating a better environment for their older residents.

A few years ago (2006) the Sperling’s Best Places people came out with a “Best Cities” list about which do the best job of caring for their aging folks. The “Best Cities for Seniors” study examined the state of senior care in the 50 largest metropolitan areas in the United States.

“This is different from the usual studies of retirement living,” said Bert Sperling, the study’s primary author. “When we first retire, we have the energy for traveling and sightseeing. At some point, we will all need specialized resources and facilities to help us cope with aging. That’s what this study examines.”

This unique new study, produced in partnership with Bankers Life and Casualty Company, identifies cities that offer the best resources for less active seniors. The study analyzed nearly 50 categories such as various senior living facilities, comprehensive medical care, specialized transportation services, and a significant senior population.

Top Ten Cities for Seniors

  1. Portland, OR
  2. Seattle, WA
  3. San Francisco, CA
  4. Pittsburgh, PA
  5. Milwaukee, WI
  6. Philadelphia, PA
  7. New York, NY
  8. Boston, MA
  9. Cincinnati, OH
  10. Chicago, IL

Haberman takes issue with that ‘Senior’ word along with the ‘aging’ word. “What does that make the rest of the populace — juniors?” This space (an unabashed fan of Sperling’s #3 city — sorry, #7; but you’re my #2) concurs. But Great Geezer Towns probably wouldn’t cut it with WHO.

On being treated to death – Part II

Is there a fate worse than death? Yes. In the U.S., often it is the fate of dying slowly: aggressively treated, over-treated and worn down by the system until that fate has made death truly a blessed relief.

Deborah Wright, an ordained Presbyterian minister and writer now working in secular fields while simultaneously serving as personal pastor to many, forwarded an article that proves out the fate-worse-than-death highlighted in this and recent other articles (see June 25 post below.) The fact that stands out, she comments, is that “the length of time we use palliative care services is growing shorter — because we start it too late.”

We start palliative care too late, we treat too aggressively and too long. The opening story in AP writer Marilynn Marchione’s thoughtful, poignant article just published in Daily Finance serves as a classic example:

The doctors finally let Rosaria Vandenberg go home.

For the first time in months, she was able to touch her 2-year-old daughter who had been afraid of the tubes and machines in the hospital. The little girl climbed up onto her mother’s bed, surrounded by family photos, toys and the comfort of home. They shared one last tender moment together before Vandenberg slipped back into unconsciousness.

Vandenberg, 32, died the next day.

That precious time at home could have come sooner if the family had known how to talk about alternatives to aggressive treatment, said Vandenberg’s sister-in-law, Alexandra Drane.

Instead, Vandenberg, a pharmacist in Franklin, Mass., had endured two surgeries, chemotherapy and radiation for an incurable brain tumor before she died in July 2004.

“We would have had a very different discussion about that second surgery and chemotherapy. We might have just taken her home and stuck her in a beautiful chair outside under the sun and let her gorgeous little daughter play around her — not just torture her” in the hospital, Drane said.

Marchione tells other stories of patients who might have had far more peaceful final days — and of patients who chose extensive, aggressive or experimental treatment for a variety of reasons. It should be the individual’s choice. But the reality is that discussion of palliative care or hospice care (there is a difference: hospice involves declining further treatment; with the newer “palliative care” concept some therapies may be continued) simply doesn’t happen until too late. If it happened sooner, many of us — likely including Rosaria Vandenberg — would choose hospice care over aggressive end-of-life treatment.  But physicians are too busy talking treatment, and patients have not considered their other choices. Comfort and peace lose to the system.

An article posted today on the website of the National Hospice and Palliative Care Organization points the finger in the right direction, right at you and me. If we took the time and energy to write our advance directives, and talk them over with family and friends, millions of days of suffering and millions of wasted dollars would be saved.

Recent media coverage on the challenges patients and families face with overtreatment of a life-limiting illness brings the issues of hospice and palliative care and advance care planning to public attention.

“It’s important to remember that quality of life and a patient’s personal wishes, beliefs and values must be a factor when making care decisions brought about by a serious or terminal illness,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

“Discussions helping patients and families understand the many benefits of hospice and palliative care must be more common and held long before a family faces a medical crisis,” Schumacher added.

Advance care planning—which includes completing a living will and appointing a healthcare proxy—is somewhat like planning a road trip to an unfamiliar destination.  Very few people would expect to get to a destination safely and comfortably without having a well-thought-out map in hand.   Yet, it’s estimated that 70 percent of Americans have not completed a living will.

  • A living will charts the course for your healthcare, letting your family and health care providers know what procedures and treatments you would want provided to you—and under what conditions.
  • A healthcare proxy or healthcare power of attorney form, allows you to choose someone you trust to take charge of your healthcare decisions in case you are unable to make those decisions yourself.
  • Advance directives can be changed as an individual’s situation or wishes change.

Still, you and I put it off. Or you may be putting it off, at least, and if so you are taking an absurdly unnecessary risk. You could, instead, download free forms, fill them out and avoid that risk.

Deborah Wright has shepherded countless friends and family members through their final days, and knows what a blessing hospice and palliative care can be. Problem is, though, “we start it too late.”

Americans are treated, and overtreated, to death – DailyFinance.

Grim outlook for public transportation

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Can we have a functional, effective transportation system in the U.S.? Can we afford not to? Those were the questions addressed by former Secretary of Transportation Norman Mineta and a panel of experts at a full-house 9 AM event at San Francisco’s Commonwealth Club Friday. Oh — and how are we going to pay for it all? The program was titled “Funding the Transportation System of the Future.”

“Within the next two decades,” Mineta said in his introductory remarks, “the Census Bureau estimates that the U.S. population will increase by as many as 50 million people. This population growth, combined with a growing backlog of overdue maintenance work on roads and transit systems, creates a need for significantly expanded transportation revenues. However, the current political climate is generally unfavorable to tax increases.”

The ensuing discussion continually returned to two general points: first, that our parents and grandparents funded the transit infrastructures and systems we now enjoy and it is incumbent upon us to do the same for our children and grandchildren; and second, as Mineta and others repeatedly said, that there is no political will anywhere to do the latter. One illustration of the first point was cited by panelist William Millar, president of the American Public Transportation Association, who observed that “the New York subway system was built 106 years ago for $35 million — and you couldn’t get a feasibility study today for $35 million.”

Given the fact that most cities and counties could spend $35 million on overdue maintenance alone, most panelist comments and audience questions concerned the issue of finding funds at a time when tax increases are not very popular. “Creative funding” solutions appear to be the answer, even if there is currently far more creativity around than funds.

Asha Weinstein Agrawal, Director of the Mineta Transportation Institute‘s National Transportation Finance Center, cited a public opinion poll released yesterday (“one of those phone calls at dinner time…”) that surveyed 1500 people in English and Spanish to test receptiveness to eight variations of a possible gasoline tax. In general, opposition to such a tax is high, she said, but acceptance increases in proportion to benefits which individuals can see: tie the tax to emissions per vehicle and thus reduce greenhouse gases, for example. Agrawal recommended consideration of taxes linked to environmental effects.

Panelist John Horsley, Executive Director of the American Association of State Highway and Transportation Officials, said that because of funding cuts and declining revenues (from road usage fees etc), the U.S. Highway Fund will be insolvent some time between August and October of 2011, with the resultant loss of approximately 1 million jobs. He cited a few bright spots such as several states going ahead with high speed rail projects, “four states have actually raised gas taxes, Kansas has increased the sales tax, and New Hampshire sold itself a bridge” (which will get paid off through tolls.) High occupancy toll lanes were another potential funding source Horsley said could help until “fiscal sanity returns: investing in something good (rather than) borrowing forever.”

The consensus was aptly covered in one summation by California Senator Alan Lowenthal: “It’s a very difficult time for transportation.”

Whereupon this reporter got back on the #1 California Muni bus (catch a back seat, work on your computer for 30 minutes, no parking fee, no traffic hassle) and went home.

Life: does longevity trump quality?

“We have to get out of the way,” she said; “make room for other, new people on the planet.” Accomplished author/editor Cyra McFadden, at a recent dinner party, was talking about a group of women scientist friends’ excitement over discoveries they have made which show promise of extending life a fraction longer. Cyra was in fierce, though silent, disagreement.

It may be time for those of us who disagree with the rampant prolong-life-at-all-costs theories  to stop being silent.

Americans are, in fact (as reported in Epoch Times below, and elsewhere) living longer all the time. Sometimes that’s just fine, especially if we’re in reasonable health. But what if we’re not? What if we’d just as soon be getting on with whatever follows this temporary time on earth? Millions and millions of people are living for hours, days or extended months and years in circumstances they would not choose simply because we have created a culture that says we must be kept alive no matter what.

Average life expectancy continues to increase, and today’s older Americans enjoy better health and financial security than any previous generation. Key trends are reported in “Older Americans 2008: Key Indicators of Well-Being,” a unique, comprehensive look at aging in the United States from the Federal Interagency Forum on Aging-Related Statistics.

“This report comes at a critical time,” according to Edward Sondik, Ph.D., director of the National Center for Health Statistics. “As the baby boomers age and America’s older population grows larger and more diverse, community leaders, policymakers, and researchers have an even greater need for reliable data to understand where older Americans stand today and what they may face tomorrow.”

Where do we stand right now? Well, the same source that says we’re living longer and enjoying better health and financial security (hmmmm on the financial security business) reveals that Americans are “engaging in regular leisure time physical activity” on these levels: ages 45-64: 30%; ages 75-84: 20%; geezers 85 and over: 10%. Hello? Better health and financial security, just no leisure time physical activity? Could it bear some relationship to obesity factors in the same data: 30+% for men, 40+% for women?

Does living well need to be assessed in the compulsion to live long? Why not? Everyone should have the right to live at whatever weight and whatever level of inaction he or she chooses. But the system is weighted toward keeping us alive under all conditions, and bucking the system is not easy. A poignant, wrenching tale of her father’s slow decline and death — and her mother’s refusal to go down that same path — was recently told by California writer/teacher Katy Butler in the New York Times Sunday Magazine.

Almost without their consent, Butler’s gifted, educated parents had their late years altered to match the system’s preferences:

They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Given the limitless sources of victimization floating around, we should not have to add just-try-to-keep-them-alive-forever health care to the list.

My husband and I, having long ago signed advance directives with additional specific issues sheets (“If this happens, do that; if that happens, don’t do this,” etc) recently got them out and talked things over again, a very good thing to do for EVERYbody over 18. We will add dementia provisions to the existing documents while we can remember to do that (the closest you can come to avoid being warehoused in a memory-loss facility for umpteen years.) We are clear, and our friends and family understand, about having no interest in hanging onto life in a greatly diminished state if such an opportunity presents itself; for increasing thousands, it presents itself every day.

All this being said, there’s still a reasonable chance that I’ll be out of town one day when I’m in my 80s (which aren’t that far off), get wiped out by a speeding cyclist and picked up in a seriously mangled state by the paramedics, taken to a hospital that’s not Kaiser (which has all my directives on file,) miraculously brought into some heavily-sedated state of being because the hospital doesn’t consult Kaiser or the living will registry (which also has my directives) and kept alive by assorted mechanisms. By the time my husband or children get there to insist everything be unplugged — which of course will involve long hours and possibly court action — hundreds of thousands of dollars will have been needlessly spent.

I consider myself a highly valuable member of society, and my life a gift from God. But would those dollars not be better spent on a few kids needing specialized care?

Epoch Times – Americans Are Living Longer, According to Federal Report.

Marriage = procreation, Prop 8 backers say

It’s all about procreation, the Proposition 8 lawyers said; marriage between a man and a woman who produce babies to be raised by their biological parents, and thus insure the survival of the human race. Those arguments were the closing of an historic case that went to a federal judge in San Francisco yesterday.

During more than two hours of intense and sometimes skeptical questioning by Chief U.S. District Judge Vaughn Walker, attorney Charles Cooper maintained that society is entitled to reserve its approval of marriage for those who can naturally conceive children.”The marital relationship is fundamental to the existence and survival of the race,” Cooper said in closing arguments before a packed San Francisco courtroom. The reason the state regulates marriage, he said, is to steer “procreative sexual relationships” into a stable family environment so that children can be raised by their biological parents.

It’s an argument that has worked before, but supporters of same-sex marriage hope this time might be different.

Walker, who presided over the nation’s first federal trial on the issue, sounded dubious. He noted that the state allows couples unable or unwilling to have children to marry, suggesting that the institution has a broader purpose that same-sex partners might equally fulfill.

“Marriage is a right which extends fundamentally to all persons, whether they’re capable of producing children, incarcerated or behind in their child-support payments,” Walker said, citing Supreme Court rulings that allow people in all those situations to marry.

People marry not to benefit the state, but because they believe that “I’m going to get a life partner, who I’m going to share my life with and maybe have children,” the judge said. “Why don’t those same values apply to gay couples and lesbian couples loving one another?”

Cooper replied that same-sex couples are incapable of “irresponsible procreation,” which he said marriage laws are designed to discourage.

He also said California has provided equal treatment for all couples in its domestic-partner laws. But even a discriminatory marriage law would be valid, Cooper said, because the U.S. Constitution offers no special protection to gays and lesbians and “we don’t have to submit evidence” to justify treating them differently.Theodore Olson, lawyer for two same-sex couples who sued for the right to marry, responded indignantly. Prop. 8, he said, “takes a group of people who have been victims of discrimination” historically and prevents them from “participating in the most fundamental relationship in life.”

Gays and lesbians, Olson said, seek to wed for the same reasons as everyone else, to be in a committed, socially accepted family relationship with the one they love. “Tell me how it helps the rest of the citizens of California to keep them out of the club,” he said.

Walker’s decision, in whichever direction, is certain to be appealed.

Prop. 8 backers: Marriage promotes procreation.

When fear & hatred go viral

Illegal aliens threaten, Muslims are murderers, we should be Very Afraid. Or perhaps, like the author of these points, just Very Tired.

A super-patriot message (re)circulating in cyberspace could serve as a blueprint for how to spread hatred and fear across the land. It purports to spread Republican virtues, having been written (with apologies to someone else’s earlier blog in the same style) by retired military/public servant Robert A. Hall. Originally floated in a blog dated February 19, 2009, it has recently been picked up and dusted off for recycling. This writer has gotten it three times; though I am not on a lot of right wing Favorites lists I try to listen and understand messages received from friends with whom I disagree.

Hall, now a resident of Illinois but not an admirer of its current native son President, apparently served honorably in the U.S. Marines and the Massachusetts state senate. This space hereby commends him for his public service, accepts his right to whatever political beliefs he chooses, and takes very strong exception to his blog. It is the incendiary passage below that needs to be refuted:

I’m  tired of  being told that Islam is a “Religion of Peace,” when every day I can  read dozens of stories of Muslim men killing their sisters,  wives and daughters for their family “honor”; of Muslims  rioting over some slight offense; of Muslims  murdering Christian and Jews because they aren’t  “believers”; of Muslims burning schools for girls; of Muslims stoning  teenage rape victims to death for “adultery”; of Muslims mutilating  the genitals of little girls; all in the name of Allah, because the  Qur’an and Shari’a law tells them  to.

I have not read the Qur’an, though I doubt that’s what it says. Iftekhar Hai has.  Co-founder and director of interfaith relations for United Muslims of America, Hai understands what the Qur’an has to say far better than do Hall or I. Here are a few clarifications — if only they could circulate as widely as is the above screed:

Whatever faith you are born in, you are in God’s image. The message is the same, but people keep adding on and that’s what messes things up. Diversity is part of Islamic belief.”

The Qur’an does not condone the killing of non-believers. Religious leaders cannot decide who is a non-believer. Islam is not exclusive, and extremists are wrong to judge others.”

As to the status of women in Muslim countries, Hai says inequality for women has no basis in the Qur’an, but is a cultural matter (as in the wearing of the burqa by women in Afghanistan. Only 18% of Muslims, he says, live in Arab countries, with the majority in India, Pakistan and Bangladesh; he is quick to point out women leaders in those countries and in Indonesia.

It seems superfluous, but still appropriate, to mention that Christians have done a lot of killing “in God’s name,” as have people of just about every other faith, and that assorted acts of mayhem and violence are caused every day under every conceivable banner.

Iftekhar Hai, like millions of his fellow Muslims here and abroad, is a man of peace. He serves on the board of the San Francisco Interfaith Council and works with other organizations such as United Religions Initiative to promote understanding, cooperation and peace among all faiths. Wouldn’t less fear and hatred, and more peace and understanding be a good idea at this point in world history?

Your doctor's in shape… but may just be getting in shape to retire

U.S. doctors as a group are “leaner, fitter and live longer than average Americans… male physicians keep their cholesterol and blood pressure lower… women doctors are more likely to use hormone-replacement therapy than their patients,” according to several recent surveys.

That’s the good news.

The bad news is that they are taking all this health and fitness into early retirement. And thanks to the hordes of baby boomers hanging up their stethoscopes for good, finding enough doctors in any shape at all is going to be a challenge, particularly in light of the numbers of newly insured.

Nearly 40 percent of doctors are 55 or older, according to the Center for Workforce Studies of the Association of American Medical Colleges. Included in that group are doctors whose specialties will be the pillars of providing care in 2014, when the overhaul kicks in; family medicine and general practitioners (37 percent); general surgeons (42 percent); pediatrics (33 percent), and internal medicine and pediatrics (35 percent).

About a third of the much larger nursing workforce is 50 or older, and about 55 percent expressed an intention to retire in the next 10 years, according to a Nursing Management Aging Workforce Survey by the Bernard Hodes Group. New registered nurses are flowing from colleges, but not enough to replace the number planning to leave the profession.

“Moving into the future, we see a very large shortage of nurses, about 300,000,” said Peter Buerhaus, a nurse and health-care economist and a professor at Vanderbilt University. “That number does not account for the demand created by reform. That’s a knockout number. It knocks the system down. It stops it.”

According to the census, baby boomers include the 66 million Americans born between 1946 and 1964.

In an article for the Journal of the American Medical Association, Buerhaus and colleagues Douglas Staiger and David Auerbach predicted that there will be at least 100,000 fewer doctors in the workplace than the 1.1 million the federal government projects will be needed in 2020 under the health-care overhaul.

“There’s a much more rapid retirement of physicians,” Buerhaus said. “What does this retirement mean? This will mean at least 100,000 fewer doctors in the workplace in 2020.”He said the article does not estimate the change in demand or the level of recruitment by medical colleges, which is being beefed up significantly under the health-care law.

Although current studies involve more than a little conjecture — Will professions in the medical field continue to be as attractive as other areas? Will doctors and nurses work longer if truly needed? — there is no doubt about the coming shortage.

Lori Heim, president of the American Association of Family Practitioners, said someone might soon have to replace her. “My age group is looking at when we are going to retire,” said Heim, who is 54. “More physicians are changing their practice, doing things that have less calls. They want administrative roles.”

Heim said her statement is based on an impression. “I haven’t seen any numbers on this.” But, she said, her association is among the many that for years have pointed out the shortage of primary care doctors and nurses to the White House and Congress.

Staying healthy might be the best defense.

Retirements by baby-boomer doctors, nurses could strain overhaul.

New 'morning after' pill meets opposition from abortion foes

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With global overpopulation among the most critical problems of the 21st century, news of a highly effective contraceptive becoming available in the U.S. would seem very good news indeed. But as health writer Rob Stein reports in the Washington Post, it may not happen:

A French drug company is seeking to offer American women something their European counterparts already have: a pill that works long after “the morning after.”

The drug, dubbed ella, would be sold as a contraceptive — one that could prevent pregnancy for as many as five days after unprotected sex. But the new drug is a close chemical relative of the abortion pill RU-486, raising the possibility that it could also induce abortion by making the womb inhospitable for an embryo.

Plan B (the last emergency contraceptive vetted by the FDA), which works for up to 72 hours after sex, was eventually approved for sale without a prescription, although a doctor’s order is required for girls younger than 17. The new drug promises to extend that period to at least 120 hours. Approved in Europe last year, ella is available as an emergency contraceptive in at least 22 countries.

“With ulipristal (ella), women will be enticed to buy a poorly tested abortion drug, unaware of its medical risks, under the guise that it’s a morning-after pill,” said Wendy Wright of Concerned Women for America, which led the battle against Plan B.

Plan B prevents a pregnancy by administering high doses of a hormone that mimics progesterone. It works primarily by inhibiting the ovaries from producing eggs. Critics argue it can also prevent a fertilized egg from implanting in the womb, which some consider equivalent to an abortion.

Ella works as a contraceptive by blocking progesterone’s activity, which delays the ovaries from producing an egg. RU-486, too, blocks the action of progesterone, which is also needed to prepare the womb to accept a fertilized egg and to nurture a developing embryo. That’s how RU-486 can prevent a fertilized egg from implanting and dislodge growing embryos. Ella’s chemical similarity raises the possibility that it might do the same thing, perhaps if taken at elevated doses. But no one knows for sure because the drug has never been tested that way. Opponents of the drug are convinced it will. “It kills embryos, just like the abortion pill,” said Donna Harrison, president of the American Association of Pro-Life Obstetricians and Gynecologists.

A federal panel will convene this week to consider endorsing the drug. Those favoring approval are worried that the ambiguous sentiments, and the power of abortion foes who seem poised to weigh in against it, will influence the outcome.

“FDA should be a ‘Just the facts ma’am’ organization,” said Susan F. Wood, an associate professor at the George Washington University School of Public Health and Health Services who resigned from the FDA to protest delays in making Plan B more accessible. “I’m hoping the FDA will take that position.”

There is an great unmet need out there for emergency contraception that is effective as this for so long,” said Erin Gainer, chief executive of HRA Pharma of Paris. Studies involving more than 4,500 women in the United States and Europe show that ella is safe, producing minor side effects including headaches, nausea and fatigue, she said.

The company has no plans to test ella as an abortion drug, but it did not appear to cause any problems for the handful of women who have become pregnant after taking the drug, she said.

“The people who are opposing this are not just opposed to abortion,” said Amy Allina, program director at the National Women’s Health Network. “They also opposed contraception and they are trying to confuse the issue.”

Back to the issue: the planet has a finite amount of space for human beings. When one human being (and often two human beings acting as one) seeks not to add an unwanted human being, would it not make sense to furnish all available safe, legal tools to assist in that humanitarian effort?

Stay tuned for the answer from the FDA.

New ‘morning-after’ pill, ella, raises debate over similarity to abortion drug.

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