In this New York Times story, Catherine Saint Louise tells of a 34 year old women, in her second trimester, denied urgent dental care because she did not have a note from her doctor. Weeks later when she was finally seen, two abscessed teeth had to be removed. She was bed ridden on pain killers.
This story raises two issues. First, pregnant women and their fetuses deserve evidence based care and treatment. But given the persistent exclusion of pregnant women from research, much of their medical care remains guess work. And, as this story illustrates, their care can be undermined by outdated views of risk management. We know that maternal periodontal disease is linked to preterm birth, low birthweight, and preterm low birthweight. Best practice requires timely treatment and management of periodontal disease during pregnancy. Something this young women was unjustly denied.
Second, we must weigh the benefits and risks in deciding whether to take medication or other health treatment during pregnancy. Too often this doesn’t happen. Risk, in the simplest sense, drives behavior during pregnancy. Many risks are not quantified or balanced against the potential benefits of an activity. One woman in New Zealand has “suspected” listeria from hummus; and hummus along with all prepared dips are added to the Dangerous Foods list. Many pregnant women stop using anti-depressants and blood pressure medication during pregnancy; when in many cases leaving the underlying medical condition untreated is in fact more dangerous for both the mother and the fetus.
India’s Supreme Court has recently denied an appeal by the Swiss pharmaceutical company Novartis, which was seeking patent protection for its cancer drug, Glivec. India’s Commerce and Industry Minister, Anand Sharma, claims that it’s necessary to strike a balance between the social obligation to provide affordable medicine and supporting innovation in research and development through providing patent protection.
The State of California recently banned discrimination against transgender patients in the provision of health insurance. It was only the third state to do so. Lack of access to health care is common for transgender persons. Reasons include—but are not limited to—fear of encountering stigma, employment discrimination which limits access to health insurance, and insurance providers refusing to cover medically necessary care.
In the state of Missouri, 5% of transgender adults report that they were refused EMT care, 13% report that they were refused Emergency Room care, and 24% report that they were refused care in a doctor’s office. The context of California’s policy change is thus one of serious health disparities for transgender patients and constitutes a step forward in public policy including transgender folks in our moral community and giving credence to their health care needs.
Several weeks ago, I heard an interesting report on visualizing pain on NPR’s “Morning Edition.” Here’s their published article on the story:
“Doctors Use Brain Scans To ‘See’ And Measure Pain”
The notion of objectively measuring the subjective is compelling. Evidence for ephemeral sensations like pain offers potentials for verifying experiences of particularly vulnerable patient populations. Accounts by patients whose experiences are often doubted or denied — patients like women, children, people with disabilities — can gain veracity through visible displays in brain scans. In this article, the AP notes special benefits for those who might literally lack a voice or the communication abilities to report pain: babies, people with dementia, people with paralysis that impedes speech. The AP also identifies potential benefits in understanding neurological differences between, say, physical and emotional pain, and in developing new treatments that act more directly on specific pain mechanisms and reduce dangers of addiction to medication.
A common reason that those suffering from serious mental illness are “noncompliant” with medication is the side effect of weight gain. Of those who stay on their medication, weight gain can be the most distressing side effect. According to the National Institutes of Health, mentally ill people are 50% more likely to be overweight/obese than the general population. Weight gain has significant negative health implications and is one reason why on average mentally ill people die younger than non-mentally ill people.
Should scientists pay women who provide eggs for stem cell research? This involves both a pragmatic and ethical question. Pragmatically – how are scientists going to convince women to undergo the onerous process of hyper-ovulation and egg extraction in the absence of any compensation? Ethically – if society deems stem cell research as worthy of pursuing, and a subset of the community is required to provide the eggs to conduct that research, then egg providers should receive the fair compensation for the socially-valuable role they take on. Of course, this presumes that stem cell research is worth pursuing and stem cell scientists need human eggs to do the research. I’ll assume both answers are yes for now. Prima facie – payment seems fair. And yet payment for egg providers raises concerns about exploitation. Why is that? Exploitation involves the unfair use of someone else’s vulnerability. So strategies for reducing or avoiding exploitation are (1) avoid the use of others vulnerability all together = prohibit that kind of relationship or transaction; or (2) increase the payment so that the vulnerable party receives a fair share. We need to think about whether those who provide eggs are vulnerable; what sort of compensation would be fair (e.g. New York suggests US$5,000-$10,000); and/or whether the exchange of eggs for cash in order to pursue stem cell research is the ‘type’ of relationship we want to socially endorse. Read more in the recent ISSCR position statement on payments for eggs. [NB: the views expressed here are my personal views and do not reflect the views of the ISSCR committee on public policy and ethics.]
Newly tenured? Time to start a family.
Marcia Inhorn has some advice for female graduate students and other early-career professionals – freeze your eggs. Lynn M. Morgan and Janelle S. Taylor respond.
The Supreme Court of the United States (handily referred to in short as SCOTUS) heard arguments on April 22, 2013, weighing speech rights of grant-receiving non-profit organizations against the rights of the U.S. government to put restrictive conditions on the grants which they give. At issue is whether the U.S. government, through the U.S. Agency for International Development (USAID) can require groups doing anti-HIV work supported by USAID to take a stance against prostitution.
Whether or not women have access to safe termination of pregnancy is a critical issue for women’s health. In Australia, access to termination of pregnancy is governed by a patchwork of state laws. Many states still have abortion listed under nineteenth crimes act, creating the situation in which abortion is illegal unless certain conditions are met. These conditions may be specified in the various acts, or have been determined through case law. They usually relate to the likelihood that continuing the pregnancy will pose a grave threat to the health of the woman, and require certification from two doctors before the woman can legally be offered the procedure.
The New York Times editorial page of April 3, 2013 cautions against putting too much stock in comments by Justice Ruth Bader Ginsburg “critical of the court’s 1973 Roe v. Wade decision that legalized abortion nationwide. It is not the judgment that was wrong, but “it moved too far, too fast,” she said at Columbia Law School last year, a view she has expressed in various speeches and law review articles.” Ginsburg’s comments are being used by those opposed to marriage equality to caution against a Court ruling that would affirm marriage equality as constitutional right.
The “Ashley treatment” (as Ashley’s parents and doctors have dubbed it) is a combination of hormone treatments and surgical procedures that Ashley, then a six-year old girl with profound cognitive and physical disabilities, underwent with the aim of attenuating the growth and inhibiting aspects of sexual development. The procedure involves treatment with massive does of estrogen, and the removal of breast buds and uterus (leaving ovaries in place). The parents requested these procedures and the doctors consented on the grounds that keeping Ashley small, given her profound disabilities, would allow the family to continue to care for Ashley at home and involve her in family activities. The treatment raised a great deal of concern and disapproval but Ashley’s parents and physicians defended the treatment and even encouraged other parents because they believed that it would help other parents who were struggling with the care of children like Ashley (who they call their “pillow angel”). This has reemerged as an issue because of reports, published in the Guardian, that the procedure is being carried out in the United Kingdom. Peter Singer was invited to respond to an article in the Guardian. The following is a letter I wrote to the editors, which they never published. I am delighted to have a forum to publish the response, as well as express my regret that the only voice that was given expression was that of Singer.
Continue to read the letter…
a href=http://www.cnn.com/2013/04/12/health/bionic-hands/index.html?hpt=hp_t1This article/a by Danielle Dellorto reports on the experience of Jason Koger, the first double amputee to receive a new, incredibly sensitive bionic hand, the i-Limb Ultra Revolution (by Touch Bionics). This prosthetic is far more dexterous than previous models and can be programmed, in part, through an iPhone app. While the hand itself is remarkable, also interesting is Koger’s discussion of the variety of prosthetics he uses, including a metal claw (waterproof, unlike the i-Limb). I’m fascinating by such advancements in technology, but also in their limitations, and the adaptability and necessity of the old school models. The future is here, but it’s not 100% ready to replace the past.br
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