Medical Monday: Breaking News from the World of OB/GYN

Contraception: Get yours while it's hot ! 

Contraception: Get yours while it's hot ! 

GOP leaders again met to discuss repeal of the ACA (Affordable Care Act). The same measures were discussed this week as last: health savings accounts, tax credits, and state high risk pools for the chronically sick. A bill is anticipated next week. 

A measure passed in the House which enables States to pull funding from any facilities who perform abortions. This funding is not specific to paying for abortions. It pulls funding from the facility altogether for all the care it provides, whether it is flu testing, mammograms, or pap smears. This will directly defund Planned Parenthood. In the short term, i.e. one year, it will save money, but in the long term, researchers estimate it will cost much more than current expenditures because of diseases untreated, disease caught later, and and of course, due to unplanned pregnancies and the costs they incur. 

Indiana is voting on a so called “ abortion reversal” procedure which has no basis whatsoever in scientific fact. The American College of Obstetricians and Gynecologists have weighed in, saying that it has “ not been scientifically proven to work”. There is no reason to believe that it would. 

Many states are working on measures to reduce abortion at a time when abortion rates are at a modern low. Today's rate is the lowest since Roe versus Wade was made law in 1973. According to the a broad base of research data from around the world, restrictive abortion laws do not prevent abortion. They simply prevent legal abortion, and lead to illegal abortion and it's consequences. Moreover, research has shown that access to contraception DOES prevent abortion. However, distressingly, these same states who are moving to pass restrictive abortion laws are also moving to restrict access to contraception. Teens have the highest rates of unintended pregnancies. Teens are also the most likely subgroup with unintended pregnancies to get abortions. Data from the Contraceptive Choice Project have shown that when teens have access to the free birth control of their choice, abortion rates plummet. In this study of 9000 subjects, the abortion rate went from 41.5 abortions per 1000 teens to 9.7 per 1000. 

In the fake out department, The current administration is introducing rules to help keep insurers in the ACA (Affordable Care Act) . This is ostensibly being done to stabilize the market. This sounds good, right ? However, it is being done in such as way as to make criteria for inclusion in the ACA stricter. Additionally the enrollment period will be reduced from 3 months to 45 days. Tightening the criteria and shortening the enrollment will shift costs onto patients and off insurers. 

The ACA will lose its teeth. Why ? The Trump administration no longer plans to withhold tax refunds from those who ignore the requirement to have health insurance. Instead these uninsured people can show up on the doorsteps of hospitals everywhere with God only knows what needs, get them promptly and properly taken care of.  As uninsured people, they then either pay their medical bills regular price out of pocket (fat chance, especially with something costly like heart disease, diabetes, cancer, trauma or worse) or leave hospitals, caregivers, and ultimately taxpayers and those of us that pay for insurance in the lurch. Meanwhile data has come in for 2016 that the uninsured rates dropped to record lows in 2016, to 8.8% to be particular. This is felt to be due to the ACA. 

In medical news, two new studies show that scalp cooling cuts chemo related hair loss in half. This study was done on women with early stage breast cancer. Hopefully it will reduce some of the insult that comes with this all too common injury of breast cancer. 

There is a widespread shortage of ObGyns in rural America, with only 6% of us working in the rural setting. People decry this and classify this as an “ access to care” issue. However, it makes sense that Ob/Gyns do not want to work in isolation, far from hospital and community resources. Truthfully, birth should take place within a community, however small, which has access to surgical services and support people of various kinds. I believe people who live remote even from these small scale services should plan according and make arrangements to “stay in town” when they have complications or get near term. I have many such patients who have rudimentary services near their homes on the plains or in the woods, but prefer to come an hour and a half  "to town” for their care. They are clear about valuing the beauty of their countryside or wilderness homes, but also clear about realizing that a modern medical facility just cannot be there. I appreciate their insight on the situation. 

In the good news department, our extreme preemies are surviving not only longer, but better, that they have in previous years. Specifically, they are doing measurably better in their neurodevelopment parameters. Kudos to our friends in Neonatology and the newborn ICUs around the US. Kudos too to all the ObGyns working to treat moms at risk for preterm delivery, and to those researchers who developed antenatal steroids. 

Also in the good news departments, LARCS (Long acting reversible contraceptive such as IUDs) are proving acceptable for the vast majority of users. No surprise there on these elegant and effective methods. 

And finally, in the we-already-knew-this department, exercise is proving effective at improving hot flashes and QOL (quality of life) in postmenopausal women ! 


Stay tuned for more interesting and relevant news from the world of Obstetrics and Gynecology, next week, on Medical Monday.