Sunday, October 21, 2007

Tancredo Promises Illegal Action, Romney Promises Nonsense

One presidential candidate pledges to break the law and ignore the standard of care if elected president, while another is not afraid to display his ignorance in all its glory.

First, the lawbreaker, Rep. Tom Tancredo (Colo.):

"As president, I will do everything in my power to support and promote the use of sonograms so that women are informed about their unborn child before making the decision to abort," Tancredo in a statement said after visiting the Women's Choice Center in Bettendorf, Iowa. The center provides no-cost sonograms and other services to discourage pregnant women from having abortions.

Except, performing an ultrasound (U/S) without an indication is both illegal and medically contraindicated:

Food and Drug Administration

Persons who promote, sell or lease ultrasound equipment for making "keepsake" fetal videos should know that FDA views this as an unapproved use of a medical device.

The FDA goes on to list some legitimate uses for U/S imaging. Patronizing pregnant women by presuming them incapable of giving serious consideration to personal medical decisions isn't among the indications. Also, performing routine U/Ss on random pregnant patients offers no medical benefit.

ACOG and American Institute of Ultrasound in Medicine (AIUM):

The use of either two-dimensional (2D) or three-dimensional (3D) ultrasound to only view the fetus, obtain a picture of the fetus or determine the fetal gender without a medical indication is inappropriate and contrary to responsible medical practice.

Second, the ignorant, former Massachusetts Gov. Mitt Romney:

"I would love to see an America where there was no abortion...."

Top advisers in August said Romney supports a two-tiered process in which states first would obtain authority to regulate abortion after Roe is overturned. The second step would be a constitutional amendment that bans most abortions nationwide....

Except, doing away with abortion is nonsense. Anyone who says that they want to eliminate abortion (an America where there was no abortion) is an utter incompetent who, at the very least, has no idea what an abortion is.

As a safe and effective medical procedure used to terminate a pregnancy, as long as there are pregnant women, there will always be abortions because some pregnancies will not be carried to term. It is no more possible to eliminate abortion than it is to eliminate vaginal birth. Some pregnancies will be delivered vaginally and some pregnancies will be aborted.

Furthermore, banning a medical procedure has no effect on the indications for that procedure.

If you want to reduce the C/S rate, you don't amend the constitution to make C/Ss illegal. You work on addressing the reasons women have the procedure in the first place. Some cases will be amenable to intervention (VBACs), some will not (placenta previa, women who don't want to deliver vaginally).

Same with abortion. Banning the procedure has no effect on either maternal of fetal indications for abortion (cardiac disease, malformations, ectopics or incomplete abortions). Neither does it impact the reason women have elective abortions, namely unintended pregnancies. Which is why the claim that the way to do away with abortion is to make abortion illegal because banning a medical procedure is associated with a zero/low abortion incidence is pure fantasy, not supported by the available evidence.

As the findings of the recent Guttmacher/WHO study of worldwide induced abortion trends show highly restrictive abortion laws are not associated with low abortion incidence. (And neither are unrestrictive abortion laws [predictive of] a high incidence of abortion.)

What has been shown to work in reducing the number of some abortions [those where the indication for having a termination is amenable to intervention in the fist place] is improved use of, and increased access to, birth control.

For example, the study found that the the sharpest decline was in Eastern Europe, where abortion rates declined by 50% [from 90 per 1000 women in 1995 to 44 in 2003] and where the reduction in abortion rates did coincide with substantial increases in contraceptive use in the region. (More regional data here, including the the study findings in Uganda, where abortion is illegal and sex education programs focus on abstinence, and the estimated abortion rate was 54 abortions per 1,000 women in 2003.)

Bottom line: When it comes to politicians and discussions about medical matters, yes, even [gasp] abortion, the discourse needs to be more grounded in reality and less in ideology and political calculations, and politicians need to be challenged when they promise to make health decisions for you based on fantasy and propaganda. Because, in medicine, unlike politics, fantasy and propaganda are dangerous to your health.

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