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Contraception, evidence based medicine, health insurance

10 changes to health care that could happen if Supreme Court retracts contraception mandate

Birth-Control-Recall-In-US-300x300The Supreme Court has taken up the contraception mandate.

Despite the fact that the World Health Organization calls contraception a human right and the fact that every dollar spent here on contraception saves $4, in the United States freedom of religion means to some, “If you work for me and get insurance through my company then you have to accept the kind of medicine that I believe in, evidence be damned! And my religion says no to birth control”

Contraception is no different from any other medicine. It improves the quality of life and saves lives. But if contraception were to go on the chopping block then here are 10 other therapies that employers could say falls foul of their religion and deny coverage:

1) Blood transfusions (Jehovah’s WItness)

2) Organ transplants (Jehovah’s Witness)

3) Antidepressants (Scientology)

4) Addiction medicine (Scientology)

5) In vitro fertilization (Catholicism)

6) Antibiotics (Christian Scientist)

7) Screening for sexually transmitted diseases (Catholicism, no one is ever having sex outside of marriage so STD screening is not needed)

8) Tissue and skin grafts that leave the body to be prepared for implant/use (Jehovah’s Witness)

9) Treatment of alcohol intoxication and alcohol abuse (Islam, Mormon and all the other religions that forbid alcohol consumption)

10) Treatment of trichinellosis (a parasitic brain worm) from pork consumption (Judaism)

Ridiculous you say? The United States is based on case law, so why not? I find the contraception issue ridiculous, but here we are at the Supreme Court. If contraception in an undue burden on Catholic employers there would be little stopping anything on my list or even any employer from concocting a faith-based reason to deny a multitude of therapies. Health care is, after all, expensive.

And if medical care can be denied based on religion, could faith-based therapies become the only option covered by some employers? What if you were required to pray while getting your chemotherapy or worse,  instead of chemotherapy?

If the Supreme Court says that contraception is on the table then a multitude of other therapies are as well. Unless of course denying contraception is nothing to do with religion and everything to do with misogyny.

Can you think of other therapies that could be denied based on religion?

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Discussion

15 thoughts on “10 changes to health care that could happen if Supreme Court retracts contraception mandate

  1. Religion ( and yes I do believe in God ) is a man , not God , telling you what you can and cannot do .

    Posted by retawob26 (@riiibbit) | November 27, 2013, 7:52 am
  2. I’m not entirely sure if this is still correct; the Plymouth Bretheren used to have a policy of not being yoked to unbelievers. Insurance companies were seen by them as unbelievers; I’m not sure how they got round this. It might make any form of health insurance difficult.

    Posted by korhomme | November 27, 2013, 11:32 pm
  3. I might be wrong about this – but as far as I was aware, Jehovah’s Witnesses do not reject organ transplants per se. However they do reject blood products, and performing a transplant without blood transfusion is bordering on impossible. I think there might be a case or two of Jehovah’s Witnesses successfully having kidney transplants, without the use of blood products being required.

    Posted by Liz | November 28, 2013, 5:45 am
    • It’s the fact that the blood or organ leaves the body. Some won’t even take a cell saver (scavenges their own blood from suction from the surgical field). So it is my understanding that some interpret this as no organs.

      Posted by Dr. Jen Gunter | November 28, 2013, 8:35 am
    • When setting up an infusion, there is usually a little blood in the cannula which gets flushed through into the vein when the drip runs. I’ve heard that even this can be difficult for some Jehovah’s Witnesses.

      Posted by korhomme | November 28, 2013, 8:48 am
  4. Colonoscopies, if some religion decides to classify them as sodomy.

    Female physicians for men, or male physicians for women; extremist Muslims and Jews both have rules against touching an adult of the opposite sex you are not married to.

    Posted by M | November 28, 2013, 6:42 pm
    • Ultra-orthodox men and women cannot even touch/share a bed with/ pass an item to their spouse for half of the month, let alone anyone else! Women cannot be touched by their husband at all from labour onward for a period of weeks. Even in a normal month someone cannot pass her baby to her husband. She may pass it to a child, who then passes it to the man, or she must put it down on the floor/couch/table, then step away so that the man move in and pick the baby up.

      Posted by neverdefiled | December 5, 2013, 10:29 am
  5. I noticed your quote from the CDC on family planning. How do you advise your patients concerning contraception and sexual activity in view of recent CDC warnings that we are about to be struck by a form of gonorrhea which is totally resistant to all our current anti-biotics? According to some medical experts, this STD can even be fatal in some cases. Cases are already being seen in the U.K. What is your take as a physician on this CDC warning?

    Posted by Wolverine | November 28, 2013, 7:46 pm
    • You appear to be exaggerating.

      The recent CDC releases re. drug resistant gonorrhea emphasize that the highly resistant H041 strain has _only_ been reported in a cluster in Japan a few years ago, has not appeared since, and never was present in the United States. Nor has H041 yet been reported in the UK, according to NHS and HPA releases. There is a considerable amount of inaccurate reporting about the strain.

      There is of course longer-term concern of resistance to the current treatments spreading, and there are monitoring programs that regularly check which strains of gonorrhea are present in different places (by CDC in the US, by HPA in the UK, etc.). There are also some new treatment regimens, designed for use against the resistant strains that _are_ common in different places.

      I would expect that Dr. Gunter’s advice re. gonorrhea would be the same as CDC’s: do not have unprotected sex with a large number of partners; get screened if it is likely that you may have a gonorrhea infect; and if you do make sure that you follow current treatment guidelines. But I am not a doctor (or at least not that kind of doctor).

      And none of this is directly related to the CDC statement on family planning (or, I hope, to the Supreme Court case). Condoms and other barrier methods to prevent STI transmission are far from being the primary form of contraception.

      Posted by Michael W Busch | December 4, 2013, 2:36 pm
      • Mr. Busch, I would suggest you look again at the literature. The CDC is clearly calling this an urgent public health threat and is working closely with WHO to monitor the threat globally and collaborating in specific preparedness efforts with local and state STD centers. This comes from the CDC website. I understand that a study in the American Journal of Medicine back in January of this year reported nine cases of the antibiotic-resistant gonorrhea already on our turf. Dr. Robert Kirkaldy of the CDC has also clearly stated that treatment failures in this regard have now been confirmed in North America.

        Posted by Wolverine | December 4, 2013, 8:47 pm
      • @Wolverine:

        Would the CDC website piece you reference be this report from April? http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf . It does indeed list drug-resistant gonorrhea as an urgent health threat, which it is, with the need being to minimize the spread of resistance to the cephalosporins. But there is not one specific “totally resistant” strain (as the sources in the April report describe). Rather, there is a general pattern of decreasing suseptibility to the current treatments, indicating a gradual development of resistance in the population. This gives the potential for new drugs to be approved in time.

        There does not appear to be any such study in the American Journal of Medicine, unless I fail at searching the index. There _was_ a preliminary communication in _JAMA_ from January of this year reporting resistance to orally-administred cefixime, one particular cephalosporin drug, in 9 patients in Toronto between 2010 and 2011 (~7% treatment failure in the study population): http://jama.jamanetwork.com/article.aspx?articleid=1556149 . However, this is confirming prior data on the spread of resistance and again does _not_ indicate some single super-bug. As described in the article, current CDC treatment recommendations exclude cefixime as a front-line treatment, and recommend intramuscular ceftriaxone (a different cephalosporin) combined with oral azithromycin or doxycycline. There is currently less resistance to ceftriaxone, and the combination treatment is designed to rapidly clear as many infections as possible to minimize further spread.

        And yes, Dr. Robert _Kirkcaldy_ has detailed the spread of resistant gonorrhea. He’s the project officer for the CDC’s program to monitor gonorrhea drug resistance, after all. But again, the problem with drug resistance is _not_ a single can’t-kill-it-with-anything strain that has appeared somewhere. It’s steadily-and-gradually-less-suseptible strains appearing and slowly spreading from many different locations. And, again, the CDCs recommendations for individuals in this regard are to avoid risky sexual behavior, get screened if you may have an infection, and make sure your follow current treatment guidelines.

        And since none of this is directly related to Dr. Gunter’s post, I won’t continue the derailment further.

        Posted by Michael W Busch | December 5, 2013, 2:02 pm
  6. I think it’s worse than merely medical care (though that is bad enough). Employer-provided health insurance is part of the compensation workers get for their work. If the employer can dictate how health insurance dollars are spent, what’s to stop them from dictating how the employee spends the rest of the pay packet? Mormons and Muslims could stop their staffs from buying alcohol; Mormons could stop their staffs from buying caffeine; Muslims and observant Jews could stop them from buying pork products; Hindus could forbid them from buying beef. Under this logic, the employer is funding the employee’s life choices (even in foods and beverages) and the funds never really leave the employer’s control.

    Posted by Switchhttr | December 4, 2013, 12:48 pm
  7. - Any treatment of women, since men shouldn’t treat women, and women should stay at home instead of studying and working (strands of judaism and islam).
    - Any treatment of anyone, since you should pray instead of calling the doctor and taking medicines (christian science)

    Posted by K | December 4, 2013, 2:53 pm
  8. I hope that organisations not covering contraception have good matenity/paternal leave policies! You could always buy the contraception yourself if you can afford it.

    Posted by Catherine Voutier | January 21, 2014, 9:37 pm

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