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Archive for the ‘Health Morality’ Category

Looks like Governor (and Democratic Presidential Candidate) Bill Richardson is going through all the motions necessary to implement a state sponsored medical marijuana program without actually doing it. 

Gov. Bill Richardson ordered the state Health Department on Friday to resume planning of a medical marijuana program despite the agency’s worries about possible federal prosecution.

However, the governor stopped short of committing to implement a state-licensed production and distribution system for the drug if the potential for federal prosecution remains unchanged.

The department announced earlier this week that it would not implement the law’s provisions for the agency to oversee the production and distribution of marijuana to eligible patients. That decision came after Attorney General Gary King warned that the department and its employees could face federal prosecution for implementing the law, which took effect in July.

Even if Governor Richardson decided to implement the program he is planning, it seems like a smart move to keep that close to his chest for now.  He can control the story at this point and possibly put the Democratic congress and President Bush on the spot. 

Also Friday, Richardson, a Democratic presidential candidate, sent a letter to President Bush urging the federal government to allow states like New Mexico to implement medical marijuana programs without fear of federal prosecution.

Such as exception would require Congress to approve legislation changing the law, Gallegos said.

Last month, the U.S. House rejected a proposal _ on a 165-262 vote _ that would have blocked the Justice Department from taking action against state medical marijuana programs, including New Mexico’s.

Personally, if a doctor wants to prescribe marijuana and a patient wants to take the prescription and states want to allow it, I’m not entirely sure why Bush believes he’s got anything to say about it. 

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The L.A. Times has an excellent article about the practice of inducing labor, which has been on the rise for the last twenty or so years.  Apparently, for a variety of reasons, some hospitals have been trying to control this trend. 

Some hospitals and healthcare organizations across the nation share her concerns. Several have barred elective labor induction under certain circumstances, such as before 39 weeks of gestation (one week before the due date) or when there isn’t clear evidence that the mother’s cervix is primed for childbirth.

“There is renewed interest in these seemingly benign medical interventions,” says Dr. William Grobman, an assistant professor of maternal-fetal medicine at Northwestern University. “But the topic is somewhat hazy. We don’t have all the information we’d like to have about risks and benefits.”

The move appears to be a push back against the trend in recent decades to medically manage childbirth. Fewer than 10% of women underwent induction in 1990, but more than 21% did so in 2004, according to federal government statistics. No one knows how many of those inductions were prompted by legitimate medical concerns. But various studies have put the number of inductions for convenience at 15% to 55% of the total number.

At the same time, rates of caesarean sections increased to more than 29% in 2004, up from 23% in 1990, with many women requesting elective C-sections — surgical births without any medical justification. That trend too has generated debate about whether patients are undertaking unnecessary risks.

Labor induction is frequently, and legitimately, recommended when health problems complicate a pregnancy or when pregnancies are more than two weeks past the due date, obstetricians and gynecologists say. But sometimes the procedure is done solely for convenience. In a busy society, doctors and patients have grown increasingly comfortable with this practice.

“People want to schedule their birth like they schedule their nail appointments,” says Janie Wilson, director of nursing operations for women and newborns at Intermountain Healthcare, a Salt Lake City-based chain of hospitals that has tried to reduce the rate of labor inductions.

In my opinion, there are two underlying issues here.  One is money and the other is the notion that some people are treating childbirth as a medical procedure rather than a spiritual and philosophical process by which babies come into the world. 

There is little scientific evidence that labor induction causes any long-lasting harm to mother or baby. But even short-term medical problems are significant given the nation’s healthcare economics crisis, Wilson says. According to Intermountain’s data, healthy deliveries in the 39th week (and women whose cervixes were fully prepared) incur the lowest costs.

“It could be contributing to the double-digit premium increases you pay each year,” she says of elective labor induction’s effect on insurance rates. “Cost is the icing on the cake. But it’s not the main reason we should be doing this. We should do it because it’s safer.”

The argument that natural labor is safer, though, is in much dispute.  The article does a pretty good job surveying the two sides.  But here are a couple choice quotes about the lifestyle implications of inducing labor which seems to be offending some people. 

Hospital administrators no longer see sudden spikes in deliveries before major holidays, three-day weekends and Jazz basketball playoff games.

“This is another study saying to women, ‘You can’t survive without us making things better; nature is completely off-track,’ ” says [Dr. Michael C. Klein, emeritus professor of family practice and pediatrics at the University of British Columbia.] “And there is a huge reservoir of practitioners out there who want to hear this message.”

“I’m not sure consumers think about the risks. They think, ‘Gosh, I want elective induction at 38 weeks because I’m tired of being pregnant,’ ” she says. “Hopefully, educating them up front and setting expectations will make it easier.”

Doctors who want the convenience to schedule daytime deliveries may be the biggest force for elective labor induction, says Lisa Sherwood, a certified nurse midwife and women’s healthcare nurse-practitioner based in San Clemente. Women who “haven’t slept well in weeks, have swollen ankles and sore backs” are vulnerable to the suggestion of elective induction. “People look at the doctor as the expert and will do whatever he or she suggests.”

So it’s not just the women who want to schedule child-birth at convenient times.  Some doctors seem to be pushing for labor induction too. 

Still this is not a simple issue.  There are a confluence of factors that seem to be informing people’s views:  money, safety, and lifestyles.  The least important part of that, in my mind, is money.  Sure something rubs me the wrong way about a doctor who would prefer to schedule a labor induction procedure around his playoff basketball watching schedule but one would assume informed consent of the patient is still required, right? 

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A federal appeals court ruled yesterday that terminally ill patients whose only chance of survival lies in investigational medicines should, essentially, suck it up and wait it out ’til the FDA rules that the drugs are 100 percent without risk.

That makes sense. I mean, if terminally ill patients take some drug without the FDA’s permission, it could be dangerous. They could die. Oh, wait …

Two judges dissented, pointing out the injustice of this situation:

The two dissenters said the ruling ignored the Constitution’s protection for individuals and their right to life, and instead bowed to “a dangerous brand of paternalism” that put the government’s interest first.

The majority, however, says people don’t have the right to “assume risk” that may save their lives unless a regulatory body says they can:

Judge Thomas B. Griffith, writing for the majority, said a right to experimental drugs was not deeply rooted in the nation’s history and tradition. Judge Griffith said the right of self-defense “cannot justify creating a constitutional right to assume any level of risk without regard to the scientific and medical judgment expressed through the clinical testing process.”

Sorry you’re dying, but we have rules and procedures, mind you This is no time for attempts at self-preservation, we have a bureaucracy to run here!

But perhaps I’m making this out to be more clear-cut than it is. The group filed the suit under a 5th Amendment claim, saying that not allowing patients these drugs deprived them their right to life. Perhaps the judges were not so much ruling on whether or not dying patients should be allowed to take test drugs but whether or not they have a constitutional right to do so. One of the judges in the majority noted that this is perhaps a matter better left to Congress than the courts. If these judges in the majority are truly constitutional purists, so be it. I think there are major merits to originalist interpretations. But as one of the dissenters notes:

“In the end, it is startling,” Rogers wrote, that the Constitution has been read to include unnamed “fundamental rights” to marry, to control a child’s education, to have sex in private and to have an abortion, “but the right to save one’s life is left out.”

The group who brought the suit, the Abigail Alliance for Better Access to Developmental Drugs, said they’ll appeal to the Supreme Court.

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A 50% cut in health insurance premiums would only reduce the number of uninsured Americans by 3%, estimates a Rand study out Monday, which suggests that incentives and government tax cuts won’t lead to universal coverage.

The study, published online Monday in the journal Health Services Research, says cost is just one obstacle to health coverage, with many uninsured citing other barriers, such as the hassle factor of buying insurance, the desire to spend money on other things or a belief that coverage is not necessary.

“A lot of people aren’t willing to pay for insurance; they have other things they feel are a priority,” Marquis says.

Hmm, people have other things that take priority over spending on health insurance. That makes sense. Some of them don’t feel it’s worth the hassle it takes to do so, some of them need their money for other things, and some of them are just pretty healthy and don’t think they need the coverage. Yep, yep, these all seem like pretty reasonable and rational reasons for choosing not to get health insurance. Cool.

Oh, wait … did we just determine that people are making reasonable and rational decisions based on their own indivudal economic status, health status, cost/benefit and risk/benefit analyses? Shit, man, we can’t have that! Cue government intervention!

A federal requirement that all people have insurance may be the only way to achieve (universal coverage), says study author Susan Marquis, an economist at Rand, a think tank.

Bleh. I don’t have a lot of opinions about health insurance, but this universal requirement business is the one plan I find absolutely infuriatingly awful. I think I’d rather have complete government-funded healthcare than this. Government-funded healthcare might be anathema to conservatives/libertarians for a lot of reasons, but at least it’s more onerous on the government than on the people, and not as infringing on people’s ability to make their own decisions. You wanna give me health insurance? Fine. Just don’t tell me I absolutely must buy it myself. It’s just raising the bar once again on what it takes to be a proper and law-abiding citizen …

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Via WSJ:

Anti tobacco groups also have been advocating a higher tobacco tax, which also appears to be getting attention in the House. Recently, the Campaign for Tobacco-Free Kids presented to House Democratic aides a survey it funded that showed substantial support – even among smokers — for raising tobacco taxes.

So I was skeptical of this statement, but I looked at the survey and results memo, though and the question seems pretty straightforward.

Would you favor or oppose a 75 cent per pack increase in the federal cigarette tax,
with the revenue dedicated to the program that provides health care coverage to uninsured children?

And apparently 51 percent of “current or occasional smokers” favor the tax increase. I suppose these could all be the “the-government-should-save-me-from-myself” contingent. There could also be some desirability bias at work here, though. Not many people really want to be perceived as saying, “No, I don’t want to help save poor children if it’s going to cost me an extra 75 cents!” (which isn’t exactly the issue, but you know, it can sound that way).

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I think we should start taxing people based on their weight. Weight tax, if you will. Healthy weight? Then you don’t have to get weight taxed. Overweight? Well, then you get taxed. And the taxes increase incrementally for every 5 pounds over healthy weight you are. Maybe if you don’t like it you’ll stop eating so much. In fact, maybe if everyone gets too burdened by the weight tax, fast food and other high-calorie crap will be eradicated all together. McDonalds will go out of business. It’ll be awesome. We can use that money we raise from your love handles to provide health insurance for orphans. What does one have to do with the other? Who cares??? This is America – you make an unhealthy lifestyle choice, the government should have the right to tax you exorbitantly for it.

Oh … wait. What? You think that’s unfair? Yeah, well, I think this is unfair:

Representatives from health advocacy groups Tuesday announced that a poll of 1000 likely voters showing widespread support for increasing the federal tobacco tax to reauthorize and expand the State Children’s Health Insurance Program (SCHIP). According to the survey, 67 percent of voters “strongly support” a 75-cent increase in the federal cigarette tax to fund health care coverage for uninsured children.

(from a CQ.com article that I can’t link to)

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There’s an article in Salon today that I don’t quite know what to make of. In MeMe Roth style, the article’s author, Debra Dickerson, takes on some woman known as “Buffie the Body,” who apparently regularly appear in magazines aimed at black male audiences. Dickerson is appalled that this large woman is being held up as a sex symbol. Although she begins her op-ed by mocking Roth for her “won’t-someone-please-think-of-the-children” posturing, she 180’s in the very next paragraph:

“(Roth) does help lead the way to a worthy point: the culturally accepted high level of obesity among black women and its related health problems. But Jordin Sparks isn’t the poster girl for this issue. Buffie the Body is. Buffie, with a 45-inch ass, is the reigning queen of this scene and her popularity speaks to blacks’ normalization of a very un-p.c. fatness.”

Won’t someone please think of the poor fat-black-women?

Bleh. Dickerson goes on to point out that “pre-kids” she was a “hardcore gym rat” who harassed co-workers “over the contents of their lunch sacks.” Why do we keep letting people with obvious body issues themselves appear in media to tell everyone what kinds of bodies should and should not be allowed in the media?

Yeah, people in this country should lose weight. But making sure NO FAT PEOPLE APPEAR IN THE MEDIA EVER!!!! isn’t really going to help things. Not to mention the people like Dickerson and Roth are condescending and operating under the theory that fat-people-don’t-know-they’re fat and certainly don’t realize it’s unhealthy to be fat and thus need to be told so by skinny people at every available opportunity. Besides, prime-time married-with-children sitcoms are filled with nothing but overweight fathers and husbands; where is the hand wringing for the bad example this sets for all the fat white middle-class males in society, eh?

EDIT: More about the race aspect of all this here.

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