Abortion is legal in the United Kingdom and a service provided by the National Health Service (NHS), so why would a woman who can get a free and safe abortion legally resort to these drastic and fatal measures? There are sadly too many reasons:

• Shame. Many women are ashamed to find themselves with an unwanted pregnancy. The effort to talk about it may seem Herculean. Given societal attitudes, this is all too common. Very few women speak up about their abortion experiences and so even though it is legal it has the air of something one doesn’t discuss in polite society. People talk about their migraines at cocktails parties. Ever hear anyone talk about their abortion?
• Access issues. Just because abortion is free and legal doesn’t mean it is readily accessible. For example, in Canada where abortion is also free and legal there is no abortion provider in the Province of Prince Edward Island (which is an island). So, women have to find an out of province provider and make arrangements to go to the mainland. For some, that is too many steps or too much cost.
• They are afraid. Afraid of their spouse, of their family, or perhaps of the man who raped them. Some are afraid of picketers. I have many, many women whose husbands monitor their movements and hide car keys, preventing them from going to doctor’s visits. Domestic violence also escalates in pregnancy.
• Disagreement with her partner over whether this was a wanted pregnancy.
• Not knowing it is free and legal. How is that possible you say? I have seen women who were told by their doctor that abortion was illegal. This was in Canada and it was both legal and free, just no local providers would do it. For many it took a while to get the right information (remember the shame? It makes it harder to ask around) and several weeks to save up enough money for a bus ticket and make their way to a big city.
• Medical naiveté. She might think the at home abortion method she chose is safe and effect. Sixty percent of people believe the medical information they find on-line is as good as the information they get in a doctor’s office. Really. I see this everyday about medical conditions that way less urban mythology than abortion.
• Money. But it’s free you say? Well, there is the issue of gas and arranging a babysitter for her five children.
• Her family or religion is opposed to abortion. This overlaps with shame, but what if your family is anti-abortion or you are Catholic? What if you are worried about running into your Priest or sister?
• Personal opposition to abortion. “What?” you say? There are many anti-abortion picketers who find themselves needing abortions.
• Previous maltreatment by a medical professional. When a person feels dismissed it is hard to go back and re-establish care. If a woman feels mistreated about her reproductive care, it makes it that much harder to re-engage with a women’s health care.
• Rape. Going to the doctor might cause her to re-live the experience or be an admission that it really happened.
• Intellectual difficulties. This makes it so much harder to navigate the medical system, especially if you might not want to tell anyone why you need medical care.
• Depression. Depression makes it harder to figure out all the steps, such as childcare and calling for appointments etc. It is also possible that a very depressed woman who is suicidal may think the dangers of the home abortions are just not something to worry about.
• It’s just too much. For some women it is all just too much to navigate and organize. This might be less of an issue where abortion is freely available, but what if you live in the United States in one of the 87% of counties that have no abortion provider, have to find a provider who might be 80 miles away, drive for your ultrasound appointment, and then drive back 24 later after you mandatory waiting period?

I do not know Mrs. Furey’s case nor implying that these scenarios were applicable in her situation. What I have listed above is simply what I know from evidence based medicine and from hearing many, many stories.

Even when it is free and legal there are too many reasons that can drive a woman to do a home abortion.

Why might she die doing it at home? There are no safe home abortions.

When a teen has a baby she has up a 12% to 49% chance of having another baby within the same year. Having two teenage births dramatically increases the risk of a premature delivery and a stillbirth with the second baby as well as further decreases the likelihood that the teen will finish high school and increases her likelihood of relying on public assistance. Abortion rates are also very high among teen pregnancies.

GIven these health and socioeconomic issues, preventing a second teen pregnancy should be one of our highest priorities. This should be a no brainer that both democrats and republicans can actively embrace (I mean decrease welfare, decrease abortion, decrease teen pregnancy, decrease premature delivery and stillbirth? Talk about a great unifying set of causes).

A study from the University of Colorado’s CAMP (Colorado Adolescent Maternity Program) tells us how we can achieve this goal of reducing a 2nd teen pregnancy: the etonogestrel contraceptive implant (Implanon).

In this observational study adolescents who had just delivered were offered immediate rod insertion (the manufacturer recommends waiting for 4 weeks, but there is not biological reason to delay a progestin post partum) or usual contraceptive counseling (as an aside all the teens were informed that inserting the rod early was not supported by the package insert). 171 teen moms opted for the implant and 225 decided on other contraceptive measures. 

The results: at 6 months post delivery NONE of the implant group were pregnant as compared with 9.9% (21) of the other contraceptive methods group. By one year 2.6% of the implant group were pregnant and 18.6% of controls. It is important to note that of the 4 teens who were pregnant in the Implanon group at one year, three had elected to have the implant removed and were using another method when they became pregnant. So there was only one rod failure out of the 132 teens who were still using that method at one year – a failure rate of < 1%.

So if a teen mom who has just delivered keeps the Implanon she has a < 1% chance of being pregnant within the year (and 86% still had the implant by a year). For the pro-life people, that also means a < 1% risk of abortion. If she goes with any other contraceptive option her risk of another pregnancy with 1 year is close to 20%. Keep in mind the CAMP program probably has a better overall repeat teen pregnancy rate than average as it is a dedicated teen health program with a significant emphasis on post natal and infant care that includes education and employment planning as well as parenting skills.  

Teen pregnancy remains a huge issue in the United States: there were 367,752 infants birth to mothers aged 15-19 in 2010. Half of teen moms don’t graduate high school. While teen pregnancy rates are slowly decreasing, given the significant health and socioeconomic ramifications with a repeat teen pregnancy and the success of using the Implanon post partum, every State should include (and emphasize) immediate Implanon insertion for teens post delivery as part of their maternal medical program.

Offering publicly funded Implanon to teens post partum is not the sign of a nanny state, it’s cost-effective high quality evidence based medicine that reduces both abortion and premature delivery. I call on every politician to get behind this effort now. 

Someone’s grandma might know about the old days. Drinking turpentine or Clorox, which is what the poorest women often did. They also took massive doses of quinine. Equally dangerous and, like the household cleaners, not a particularly effective abortifacient. Although as faded memories become urban myths no one seems to remember that these methods don’t work and often kill, and so they remain in the lexicon of “options.”

An Internet search, if she has access and doesn’t have to worry about the prying eyes of parents or an abusive partner, might lead her to misoprostol. A friend from Latin America or Asia might be more familiar with this “option.” Assuming she gets the right dose of the real medication and not some sugar pill or poison passed off as the real thing, she might have a 30-40% chance of inducing her abortion early on. Ironically, it gets more effective as the pregnancy advances. Like most women she’ll take the pills by herself, cramping and bleeding on the toilet or squatting on the ground. No one to hold her hand. No one to wipe her brow. No one to recognize when she has a fever or has lost too much blood.

Many women find their way to people who offer certain “skills.” Procedures, if you can even call them that, offered in back rooms. Rooms that don’t have an autoclave to sterilize tools or even basic resuscitation equipment. Some rooms have the essence of respectability, many do not. Almost none are operated by anyone who has more than a cursory knowledge of the reproductive tract.

On kitchen tables these women lie. Some might be offered a Valium or a Vicodin. For a price. It might ease the pain a little. These medications may also makes them less likely to cry during the sexual assault that can be part of the deal. After all, who is going to complain about getting raped at their illegal abortion?

Maybe their vagina and cervix is cleaned before hand, but maybe not. An instrument is pushed through the cervix by hands that do not know how to atraumatically dilate the opening of the cervix. Too much force is dangerous. The practitioner may not know (or care) that the wall of a pregnant uterus is like butter and any instrument, no matter how soft, is like a knife.

If they can’t navigate the opening of the cervix, or if they haven’t even bothered to look, the instrument is just forced up until there is no more resistance or until the screaming stops. This blind stabbing often leads the instrument to puncture the top of the vagina, weaker than the cervix, traveling alongside the uterus where the major blood vessels are found.

Ultrasound machines are not used. They cost hundreds of thousands of dollars. Even if one were available, the chance that such a provider would know how to use one is slim. Gestational age is therefore a guess. Unfortunately, knowing about the long bones and skull is crucial in the 2^nd trimester. An unskilled hand can easily push splinters or larger pieces through the uterus into waiting bowel and blood vessels.

If blood vessels are transgressed, the bleeding is catastrophic and requires emergency intervention. Many women don’t get to the hospital in time. Who is going to call the ambulance?

If fecal material announces a bowel perforation a caring provider might stop and say, “You need to get the hospital.” Most are not that caring. Better she stagger home and call.

Even when the procedure seems to go smoothly, the risk of infection is high. Pretreatment with antibiotics to lower the risk of infection, standard with a safe abortion, doesn’t happen. Products of conception left behind by untrained hands and unsterile equipment take their toll in 2-3 days. If the woman is not too ashamed or afraid to go to the hospital she will need advanced care. She may need her uterus re-evacuated to remove what was missed and is now the nidus of infection. As there are fewer and fewer providers skilled to perform abortions, there are fewer and fewer hands experienced enough to do this without the back wall of the uterus falling apart from the currettage. Many will now get hysterectomies.

A CT scan might show abscesses in the belly and a punctured bowel. In these dire circumstances surgery, a colostomy bag, and a prolonged hospital stay will be the result. Infection and blood loss may also cause the body to attack itself, losing the ability to clot. This is disseminated intravascular coagulation and even with prompt, expert, intensive care it is often fatal.

But if she is so alone, so alone that she can’t fathom asking anyone she might take a stick, or a coat hanger, or a knitting needle and stick it up her vagina. She won’t know about the cervical os, the opening of the cervix, or that she has no hope of finding it blindinly. She’ll push. It will hurt. A lot. But she’s desperate. She might stick it into her uterus, or right through the uterus into bowel. After two or three days of fevers and cramping and vomiting she might go to the hospital and hopefully the damage and infection will be confined to her uterus. She might also slice through blood vessels and bleed to death by herself on her bathroom floor.

“It’s going to be challenged, of course, in the Supreme Court and all — but literally, we stopped abortion in the state of Mississippi, legally, without having to– Roe vs. Wade. So we’ve done that. I was proud of it. The governor signed it into law. And of course, there you have the other side. They’re like, ‘Well, the poor pitiful women that can’t afford to go out of state are just going to start doing them at home with a coat hanger.’ That’s what we’ve heard over and over and over.

“But hey, you have to have moral values. You have to start somewhere, and that’s what we’ve decided to do. This became law and the governor signed it, and I think for one time, we were first in the nation in the state of Mississippi.”

- Mississippi GOP state Rep. Bubba Carpenter

Many people wonder if HIPAA (the Health Insurance Portability and Accountability Act) would protect them from such legislation. HIPAA is a federal law that, among other things, protects medical records and health privacy.

HIPAA extends to any health care provider, health plan (even if it is provided by the government), hospital, and something called a health care clearing house (no idea what that really is, but according to the web site it involves processing non standard health information). Employers are NOT covered entities under HIPAA. The following organizations so not have to follow the Privacy and Security rules:

• life insurers,
• employers,
• workers compensation carriers,
• many schools and school districts,
• many state agencies like child protective service agencies,
• many law enforcement agencies,
• many municipal offices.”

So, your employer can ask you information about your health for sick leave, for worker’s compensation purposes, for wellness purposes, and for health insurance reasons (to name a few). They can also ask to drug test you, ask you to provide information about your vision or tuberculosis testing or anything else that may (or may not) be needed to perform your work duties. Of course, individual states may have stricter laws protecting rights of employees, but HIPAA is for health care not employment.

If this bill becomes law and your employer in Arizona wants to know why you are using contraception HIPAA will not protect you from releasing that information. The employer could even request medical records as proof. While you would have to agree to allow your doctor to release those records (i.e. under HIPAA your doctor needs your permission to release that information), as Arizona is an “at will” state for employment if you refuse to release the records your job could technically be in jeopardy.

So don’t look to HIPAA to protect you from your employer requesting health information. And yes, if bill 2625 becomes law Arizona will be one step closer to Gilead.

The two main causes of post c-section pain are nerve pain (covered here) and muscle pain. Muscle pain is actually the most common cause of chronic pain overall. Muscle pain can happen spontaneously; however, it can also be triggered by trauma (like surgery or childbirth). Throw in the hormonal changes of pregnancy and delivery as well as the lack of sleep and the stress of caring for a newborn and you have many of the ingredients for a chronic pain condition.

The formal medical term for this kind of muscle pain is myofascial pain syndrome, or MPS for short. It happens when (for whatever reason) a muscle tenses and contracts too much, forming tight bands (ever felt a knot of muscle in your neck? That is the kind of tight band or knot that happens with MPS, except with MPS the knot won’t go away). The spasms cause severe pain by reducing blood flow and squeezing nerves.

After a c-section, this kind of myofascial pain syndrome can affect the belly wall or it can affect the muscles of the pelvic floor (those are the muscles that you squeeze to stop your flow of urine and the muscles that contract during orgasm).

Muscle pain can be very severe and is often (but not always) worse with physical activity (including sex). Frequently I hear it described as the feeling of “a bowling ball” or a “fist” in the vagina.” I have also heard it described as “my insides are coming out.” Some women say it is a squeezing or a cramping sensation. Everyone has a unique pain experience, so descriptions certainly vary. Because these muscles surround the bladder and bowel, pelvic floor MPS can also cause the need to empty your bladder a lot and urgency (difficulty holding your urine) as well as pain with or after bowel movements.

There are no specific tests for muscle pain or MPS, it is diagnosed by exam. It can be hard for someone who isn’t used to diagnosing muscle pain to know if the pain is coming from the belly or the pelvic floor. However, if you lay flat on your back, press on your belly, and lift your head off the bed and your pain is worse, then the belly wall is probably involved (lifting your head flexes the belly muscles, and worsening of pain while the muscles are working can be a sign of MPS). Your doctor should also feel for specific tight bands in the muscle as well as specific points of pain called trigger points.

MPS of the pelvic floor requires a pelvic exam. The examiner will feel tight bands of muscle (like a violin string) and touching them will reproduce the pain. Many women feel as if their partner is hitting “a wall or blockage” during intercourse – that is actually contact with these tight bands of muscle.

The good news is once MPS is diagnosed most women respond to treatment. The first step is seeing a pelvic floor physical therapist. You can find one at in the International Pelvic Pain Society (enter your country, state and city and a list of providers will appear, you will be able to tell who is a physical therapist and who is not). The physical therapist will do manual therapy on the muscles and help release the tight bands (they may do other kinds of treatments as well). Other therapies may include some of the following:

• A TENS unit. A small device that sends an electic impulse to the muscles of the belly wall. This should be set up by a physical therapist (there are specific settings). A TENS can be very helpful for belly wall pain.
• Trigger point injections. Using a needle to mechanically break down the bands and knots in the muscle. Some local anesthetic is given to make this less painful (it sounds worse than it is). Trigger point injections are not stand alone treatment, they work in conjunction with physical therapy
• Ibuprofen or other anti-inflammatory pain relievers. If there are no contraindications, a 10-14 day course of prescription strength ibuprofen every 8 hours may help reduce inflammation and break the cycle of pain
• Nerve pain medications. When pain has been going on for several months the signalling in the nervous system starts to change and this can amplify pain (think of it as the volume being turned up too loud in the nervous system). Nerve pain medications, such as nortriptyline or gabapentin, can help reverse or dampen these changes. The medications don’t have to be permanent. Many times reducing the pain helps the nervous system get re-organized and the medications can be stopped with time. Nortriptyline can be used during breastfeeding if needed.
• Botox injections. Yes, you read that correctly. When physical therapy has been ineffective at relieving muscle spasm, Botox injections are a highly effective way to break the cycle of muscle spasm. They only work for about 12 weeks and have to be combined with physical therapy. Once the cycle of spasm is disrupted, the physical therapist can help you re-educate the muscles so the effect becomes long-lasting. Botox can’t be used while breastfeeding.
• Weight loss. The mechanical strain of extra weight (not uncommon after having a baby) makes muscle pain worse. In addition, belly fat churns out inflammatory chemicals that can make pain worse.
• Physical activity. Even though it might be painful, muscles are meant to be worked. The less they are used, the less blood flow and the worse the pain will become. Muscles also shorten over time when you don’t move. Some tips for getting started are walking in a pool (the water helps to carry your body weight, putting less strain on the muscles), walking around the block, or a gentle yoga class. When first starting it is important to only exercise every other day to give the muscles time to recuperate.
• Managing constipation. Straining will over work the pelvic floor muscles. Talk with your health care provider about the best way to manage your constipation. Fiber supplements or changing your diet (we need 25 g of fiber a day) is a good place to start.

If your doctor has never heard about muscle pain, print this page out and give it to them and point them to this article in UpToDate. In my experience, myofascial pain is the most common cause of post c-section pain. If your doctor is unsure, they can easily have you see a pelvic floor physical therapist who can be invaluable in confirming the diagnosis (as well as starting treatment).

Remember, this post does not represent medical advice.

• Preventing all doctors at KU medical center from doing abortions while in the State’s employment. Currently no abortions are allowed at KU Medical Center unless the life of the mother is in jeopardy, but this bill would prevent a doctor who worked at KU from performing elective abortions at another facility (it is common practice for doctor to have admitting privileges at other hospitals).
• Preventing residents (OB/GYNs in training) from obtaining abortion training during their work hours. This is in violation of the rules governing accreditation of residencies. The medical school was rightly concerned that this would affect accreditation of the OB/GYN program. If the OB/GYN program lost accreditation, the pool of trainees would dwindle as no one wants to spend 4 years in training and not have that training recognized. Secondly, the medical school would risk losing accreditation as an accredited OB/GYN training program is a requirement. KU is the only medical school in the state.
• Providing false medical information to women seeking abortion. And I quote: “A description of risks related to the proposed abortion method, including risk of premature birth in future pregnancies, risk of breast cancer.” Abortion is neither a risk factor for premature delivery nor for breast cancer. In what foul perversion of medicine is a doctor required to give false information to a patient at the behest of the government?
• Defining life as begining at fertilization (i.e. a personhood bill). Per SB 313, “The term “human being” means an individual living member of the species of homo sapiens, including the unborn human being during the entire embryonic and fetal ages from fertilization to full gestation.”
• That all women seeking an abortion be provided with pages of misleading material about the development of an embryo/fetus. There is mention of movement and taste buds and it is all written to sound as if a 14 week fetus is like a baby joey that could hop out of the pouch at any time, go for a walk, and then hop right back in. There is no mention of the fact that everything a fetus does before 24 weeks is reflexive, not purposeful or conscious. In addition, there is no evidence that suggests educational materials impact a woman’s decision to have an abortion so the purpose of these materials is anything but educational.

Those are just the “highlights” of the bill. There are many other aspects that are unscientific, punitive and just plain ridiculous.

It appears the bill went back to committee over the residency training component. While that is a very important point, it is easily removed. Given the political scene in Kansas it would not be surprising at all to see this bill re-emerge at some point with the false medical information and the personhood language intact.

I want to put the personhood amendment aside and focus on the medical misinformation and affecting residency training. Make no mistake about it, these bills represent the intrusion of government into the practice of medicine. Ask yourself, if the government can require that doctors not receive certain training and provide false information about abortion, what is to stop them from enacting legislation that mandates false information about contraception or any other medical condition or treatment? After all, why use facts for your medical care when you can rely on your friendly big republican government and their Medispeak. You certainly won’t be able to rely on your doctor, because their education has been “carefully supervised”.

Perhaps the new state motto for Kansas should be “Ignorance is strength.”

“THIS STATE OR ANY POLITICAL SUBDIVISION OF THIS STATE MAY NOT ENTER INTO A CONTRACT WITH OR MAKE A GRANT TO ANY PERSON THAT PERFORMS NONFEDERALLY QUALIFIED ABORTIONS OR MAINTAINS OR OPERATES A FACILITY WHERE NONFEDERALLY QUALIFIED ABORTIONS ARE PERFORMED FOR THE PROVISION OF FAMILY PLANNING SERVICES.”  (I’m sorry, they use all caps, and I like to cut and paste for accuracy because there’s lots of legal mumbo jumbo).

Since a federally qualified abortion is one where the life of the mother is in danger or in cases of rape and incest, HB 2800 means is that no family planning money can go to a provider or a facility that does elective abortions or medically necessary abortions (medically necessary could mean worsening kidney disease in the 1rst trimester, for example). As Planned Parenthood is the biggest provider of abortion services, this will affect them primarily; however, many OB/GYNs who do office based abortions and teaching programs may also be restricted from Medicaid reimbursement for family planning services. Brewer released a statement saying, ”By signing this measure into law I stand with the majority of Americans who oppose the use of taxpayer funds for abortion.”

But here’s the irony (and the proof that HB 2800 is a backdoor offensive against Roe v. Wade).  Arizona currently funds abortions with state taxpayer dollars (albeit under a court order). In 2009 the Supreme Court of Arizona ruled that Arizona Medicaid had to pay for medically necessary abortions, not just abortion to save the life of the mother or rape/incest (i.e. Arizona Medicaid is more inclusive than the federal qualifications). In a well-written judgement the Supreme Court of Arizona recognized that many medical conditions could be exacerbated by pregnancy and that women who rely on Medicaid should not be disadvantaged in their medical care because they are pregnant. Again, to be clear, State Medicaid in Arizona does not pay for elective abortions, but pays for an abortion that a doctor recommends as medically necessary.

Since Arizona taxpayers already fund abortion, it is clear that HB 2800 is nothing more than an attempt to reduce the number of abortion providers in the state. Who will suffer? Women on Medicaid. Make no mistake about it, there are fewer and fewer providers accepting Medicaid. The reason is simple: reimbursement by Medicaid is often less than the cost of care. Planned Parenthood can afford to accept Medicaid because they raise funds to help provide services. So, the argument that Planned Parenthood (or any other provider who accepts Medicaid) is financially supporting abortion by Medicaid funded Pap smears that they do at a loss is ludicrous. It demonstrates a complete lack of knowledge of the realities of health care or it’s a damn the torpedos facts, this is a war on women approach.

By excluding abortion providers from the state family planning dollars it’s possible that there could be fewer Planned Parenthood clinics. Even though abortion is only 3% of the services provided by Planned Parenthood, they are the biggest abortion provider in the state. It won’t affect private practices, they’ll either quietly keep doing abortions and drop Medicaid or stop do abortions. Either way, women suffer.

Brewer must know it will be challenged, because similar laws are currently groaning their way through the legal systems in three states. This case won’t play out in federal court, because this is state funding, not misappropriation of federal funds (as in Texas). Considering the Supreme Court of Arizona believes Medicaid funds should support medically necessary abortion (and they took the medical facts as presented by caregivers very seriously in their judgement), it will be interesting to hear if they buy the false logic of Brewer and her cronies, that somehow doing a Pap smear below cost supports abortion or if they go with, you know, facts.

If you try to follow Brewer’s “reasoning” (I know it’s hard, it makes my head hurt) Arizona taxpayers don’t want to pay for abortion, but have no qualms paying the legal costs fighting about it. But Brewer isn’t interested in reality, medical care, women’s health, or tax dollars for that matter, she’s just chipping away at Roe v. Wade anyway she can. And if the more than 800,000 women in her state who are on Medicaid can’t find a provider and taxpayers fork out millions of dollars in legal fees, well, that’s just the price of war.

Number of women on Medicaid in Arizona

According to the Texas Attorney General the WHP is “designed to encourage preventative birth control and discourage abortion” (although that mission is not listed on the web site). It is a ludicrous, insulting, and lame argument that any kind of association, no matter how remote, with someone who performs abortion encourages women to have one. Pregnant women don’t enter a clinic seeking prenatal care and then get coerced by a stealth abortion provider in the hallway. Women who have abortions know exactly why they are making that choice and it is almost always socioeconomic.

If Texas lawmakers actually did a little research and used some common sense (both apparently too much to ask) they would learn that the domino effect of this rule will likely increase abortions as well as cost taxpayers millions of dollars. Here’s why:

•  Fewer Planned Parenthood clinics. This law prevents Planned Parenthood from offering care in WHP network. The reduction in clientele (many of the more than 130,000 women who use this program get care at Planned Parenthood) will result in some clinic closures throughout the state. Now the almost 2.9 million uninsured Texas women between the ages of 18 and 64 will have fewer low cost options for reproductive health care. Less access to contraception means more unplanned pregnancies because it is unplanned pregnancies that have a 50% rate of ending in abortion, not the planned ones.
• Women who rely on the WHP will have a harder time finding a provider. No provider who performs abortions, works in a facility where abortions are provided, or is a member of a large medical practice where one member does abortions can participate in the WHP plan. While it seems clear the rule is directed at Planned Parenthood, many private doctors quietly do first trimester medical and surgical abortions in their offices. It may also exclude teaching programs as abortion training is part of OB/GYN residency. At the end of the day, considering the paltry reimbursement and this new hurdle, many providers may simply decide it’s not worth the hassle. Again, fewer providers translates into difficulty accessing care and thus more unplanned pregnancies.
• More women and children on Medicaid. Medicaid pays for 64% of births that result from unintended pregnancies and many of the babies from these pregnancies will also be Medicaid eligible. A study from California tells us that every dollar spent on family planning for women at or below 200% of the federal poverty limit saves $2.76 within 2 years and $5.33 within 5 years of public finds. This is, of course, the reason programs like WHP exist.
• The $36 million has to come from somewhere…or not. To find $36 million (as Rick Perry has promised) some other state program will be cut, Texas will start a state income tax program, or the Governor will demonstrate his new skill of spinning straw into gold. Or the money won’t come from anywhere and the WHP will be decimated (I’m betting on this outcome, not the Rumplestiltskin project).
• Texas has to pay for the legal costs of fighting this is court. Planned Parenthood filed suit in Federal Court. On Monday (April 30) a federal judge issued an injunction preventing Texas from implementing the new restrictions; however, on Tuesday, Judge Jerry Smith of the 5^th Circuit Court stayed the injunction. Planned Parenthood responded, but regardless how the 5^th Circuit ultimately rules it is almost certain this case will continue in the court system consuming tax dollars.

Logically this rule can only have two reasons: a back door approach to undermine Roe v. Wade and a show of anti-abortion dogma to shore up right wing fundraisers at the expense of the 31% uninsured women in Texas. Apparently nothing energizes the right more than a sound uterine rattling.

The only legislation that reduces abortion is publicly funded, easily accessible family planning.  But apparently that’s not Texas style reproductive health.

****UPDATE****  The 5th Circuit upheld the lower courts injunction on Friday, May 4th and while this case winds through the legals system Texas women on Medicaid can continue to go to any provider who accepts Medicaid

Number of uninsured women in Texas

My first act as Supreme Empress will be to ban trans fats. Yes, I know everyone is slagging on sugar, but it’s not really the rat poison that it’s portrayed to be. Yes, we Americans eat a lot more sugar than we should and diets high in sugar do increase the risk of diabetes and obesity. But let’s not forget that sugar is in every fruit and vegetable. It’s why a ripe peach is heavenly and a roasted beet, divine. The sugar molecule itself isn’t bad, it’s the Coke, Pepsi, and those little powdered donuts that are.

The same cannot be said of trans fats. Trans fats are unsaturated fats (plant oils) that have been modified so they are easier to use commercially. They’re in that unique food group that my kids call McChemicals. As an aside, there are some natural trans fats, called ruminant trans fats found in small quantities in meat and dairy products. Studies indicate that ruminant trans fats do not carry the same risk as the McChemical trans fats, so the ban proposed by HRH the Supreme Empress of Health only refers to the McChemical kind.

Trans fats lower good cholesterol (HDL), raise bad cholesterol (LDL), and increase the risk of heart disease. Trans fats also increase inflammation in the body (not a good thing) and animal studies tell us that offspring exposed to trans fats during pregnancy have brain inflammation that affects hunger signaling and are more likely to be obese. So, trans fats appear to be harming future generations before they are even born.

Artificial trans fats are so unhealthy that the Food and Drug Administration (FDA) requires the content be listed on food labels. The problem? If there is less than 0.5 g per serving the food can claim to be trans fat free. (Hey FDA, what IS that all whole “free” and “zero” meaning < 0.5 about anyway? You want to redefine “the” while you’re at it as well?). So, you only know if food is really free of all trans fats by reading the label and looking for the term partially hydrogenated oil. Sigh.

Most researchers believe there is no safe lower limit of trans fats and many believe they are be the worst macronutrient when it comes to increasing the risk of heart disease. Even worse than our old friend sugar. Some estimates put the deaths directly attributable to trans fats between 30,000 and 100,000 a year.

Despite the known toxicity of trans fats the official recommendation is to keep the intake at less that 1% of total calories for the day. With a 2,000 calorie a day diet, that’s less than 2 g a day of trans fats. Duncan Hines frosting has 1.5 g of trans fats in 2 tablespoons, and everyone stops at 2 tbsp, right? Given how many foods contain trans fats, it’s very easy to surpass the daily requirements before you even get to desert.

Some foods, like trans fats, are born bad – there is simply no biologically justifiable excuse for their existence. Accordingly, when I am the Supreme Empress of Health Care my first decree will be the banning of trans fats. This move will cost the government nothing, the tens of thousands of fewer cases of heart disease will save millions and millions of Medicaid and Medicare dollars, and it will save lives. I just don’t see the down side (then again, I’m not the CEO of General Mills or Nabisco).

Lead was removed from paint and mercury from thermometers. Why should food safety be any different?

Girl Scouts, Samoas. Nutritional label says 0 g of trans fats, but ingredients list says otherwise (the 2nd ingredient, no less).

Yes, you read that correctly. In their haste to report on such a fantastical story, msnbc.com and several other major media outlets forgot a little thing called fact checking. (Just so you know, if a reporter had asked me to comment on the piece before they went to press, I’d have said, “No fucking way. Prove it.”).

So, what about things that are slightly harder to check than GESTATING NINE BABIES? If the media can’t get the simple facts straight about a woman who claims to be a nonomom, how accurate can they be about real health information? Not so good, it turns out. In one study of pediatric health information only 55% of news sites had medically accurate content. And if you’re a frequent reader of this blog, you’ll know I post often about the medical misinformation reported by the media, from G-spots to abortion.

So why do news sites have such a hard time with accurate health content? I suspect it’s a combination of the following:

• Sloppy reporting. Not fact checking the source, not getting verification from an actual medical expert in the specific area, or using a bad article or a case report as the basis for the article.
• The desperation for eye grabbing headlines (OMG, nine babies!)
• Pandering to inaccurate medical hot buttons, like anti-vaccine stories, because it drives traffic (you’ll notice Huffington Post didn’t win the Pulitzer for their *cough* health reporting)
• Not removing out of date pieces. What what was standard of care in 2003 might now, in the light of new studies, actually be poor advice. Government web sites circumvent this problem as these site are curated by medical librarians, who fact check, cross-reference, and cull out of date information.

Some news media get it right. When I submitted an opinion piece to USA Today, before it was even accepted for publication, not only did I have to provide medical articles to support every fact I discussed, but I had to give the phone number of the doctor I quoted so the fact-checker could call and independently verify. I’ve also had many similar positive experiences with Cosmopolitan and Glamour magazine where I’ve been contacted by a fact checker to not only make sure I’ve been quoted correctly, but to also review the article for accuracy. Although, I’m disheartened to report in one instance when I disagreed with a claim made by a reporter the magazine simply removed my name as a source and ran the article with the false, but attention grabbing information intact instead of making the necessary, but less titillating changes.

Makes me wonder if the worth of an online health reporter to a news agency is not in the accuracy of their content or the societal value of their information, but rather the clicks garnered by salacious headlines.

Caveat lector.