Saturday, July 31, 2004

Two For the Price of One

I'm quietly shaking my head in disbelief while reading a report that could've been aptly titled "The Not-So-Excellent Adventures of EC in Alabama".

Briefly, the Alabama health department tells all state clinics that they have to offer EC, or the state loses millions in federal funds. [In my opinion, a concern over federal funding is an inappropriate determinant of medical decisions. However, I'm not an expert on federal funding (read: I don't get how it works) so it's possible I'm missing the big picture.]

Because of personal objections to EC, 11 clinic nurses quit, and about 50 workers ask to be reassigned. [Let's get my bias out in the open, so we all know where we stand. When it comes to the MD/RN - patient relationship, the MD/RN's personal *whatevers* are irrelevant. You, the patient, are there to be treated and taken care of, not judged, converted, amused, convinced, befriended, or exposed to your health professional's Weltanschauung. A doctor or nurse recusing themselves from rendering care because of personal whatever--no problem. Personal whatever interfering in any way with the patient receiving appropriate care--big, huge problem.]

The Christian Coalition of Alabama(CCA) and Rep. Robert Aderholt (R-Ala.) say they've received calls from health department employees who had a moral objection to distributing EC. The CCA challenges the state's mandate and Rep. Aderholt contacts HHS Secretary Tommy Thompson.

In Secretary Thompson's reply letter: Thompson said in the letter -- which was made public on Wednesday -- that state clinics are expected to offer a "broad range" of contraceptive options but are not required to offer EC....[Translation: It doesn't matter what the medical standard of care is (offering EC to patients for whom this treatment is indicated). A government official has just 1) decided what your medical care should be, and 2) officially sanctioned malpractice (giving patients proper treatment isn't based on the eBay method; there's no offer/counter-offer).]

The CCA's stated goal: CCA President John Giles said that the group is trying to determine how it might help change the health department's policy on EC....

Rep. Aderholt's statement: Aderholt said he has "done all he can" to urge the health department to stop distributing EC, adding, "It's out of the federal purview,"....

[A religious group, a politician, and a government official confuse medicine and making medical decisions with a participatory democracy. Of course, since said medical decisions concern women's health, why not let everybody and anybody have a say in formulating the plan of treatment. After all, we can't possibly entrust women to make health decisions that would be in their best interest. You know, pretty little heads, vapors, and all that.]

The final word, from Dr. Thomas Miller, director of the Bureau of Family Health Services at the health department:

Although the state health department clinics are not required to distribute EC, Miller said that the agency would continue to distribute the pills, the Birmingham News reports. "It's excellent public health policy," Miller said, adding, "We have a rock-solid reason to do it. ... It's a good thing to do for the low-income women in this state. Other women already have access to it"

[Good for Dr. Miller. However, the rock-solid reason to do it is because it's the standard of care, not because it's a good thing to do for the low-income women. Medical problems affect both poor and rich women. Hence, all women should get the proper care, regardless of their income. In particular, low-income women should get proper care simply because they need it, not because we're good, or pious, or we're really, really nice and would like to help them out.]

But wait, there's more. Buried in this report from, I find this stunning editorial comment (emphasis added):

Although EC -- which can prevent pregnancy if taken within 72 hours after sexual intercourse -- works by preventing ovulation, preventing fertilization of an egg or inhibiting a fertilized egg from implanting in the uterus, medical and legal texts do not all agree on whether pregnancy begins at conception or when an embryo implants in the uterus (Kaiser Daily Reproductive Health Report, 7/2).

First, just because the words medical and legal are connected by an "and" in the original text, in real life legal texts (or, for that matter, TV Guides, religious texts, or engineering manuals) do not provide/establish medical information. Second, I know of no reference medical text that considers the start of the pregnancy an unresolved issue. Naturally, my curiosity was peaked. So, I followed the link given, thinking it would lead me to the reference. Here's the 7/2 Report, where we find the same statement, this time with a link to a 3/22 Report. This report sends us to another one, from 3/1...and on (2/19 Report)...and on (2/6 Report)...and on (1/12 Report). Unfortunately, the trail goes cold--in the 1/12 report there's no further link/reference for the initial statement.

However, fear not; I intend to remain on the case and call the Kaiser Family Foundation on Monday. I'm sure they'll be able to help and, once I track down this medical text, I'll report back.


At 4:32 AM, Anonymous Anonymous said...

Federal funds are one method the Federal Government uses to legislate laws that are actually the domain of the states. For example.

There is no federal law setting 21 as the legal drinking age. But any state with a drinking age lower than 21 will receive no Federal highway funds for new roads. So Congress in effect set the national drinking age to 21 without directly legislating it.

So I would assume that the same thing has happened here. Congress is requiring all public health departments to provide EC, even though congress does not have the legal power to make a law to that effect.

I'm from Alabama and the press coverage of this here has been quite confusing. The student Newspaper at the University of Alabama had a really strange headline. Sadly, the page seems to be having technical difficulties. But the headline was along the lines of "State forces Public Health nurses to quit" when the content of the article very clearly said the nurses resigned voluntarily.



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