Efforts continue around the country to prevent changes to Title X funding. Title X funding is meant to supply federal funds for family planning and preventive health services. However, since those services have historically included birth control and abortion, the current administration is seeking to redirect these funds. In particular, the Trump administration would like to see those funds go to programs that promote abstinence only, which is not an evidenced based measure. Opponents of the changes including Planned Parenthood are arguiing that such charge are unconstitutional since they have not gone through a federal rule making process.
The House has passed a bill allowing Medicaid to pay for inpatient drug treatment in case of cocaine and opioid addiction. The bill is contested on both sides, with some Democrats saying its focus it too narrow.
The House has also passed more bills pertaining to the opioid crisis, mot notably by extending access to mental health and substance abuse disorder services to children and pregnancy women under CHIP, the Children’s Health Insurance Program.
“Association Health Plans” are potentially bare bones health insurance plans which may be obtained by groups of small businesses even across state lines. The idea there is that lower cost can be achieved by forgoing benefits like birth control or pregnancy care, things which have been mandated under the affordable care act (ACA). Many feel the omission of what are now defined as “essential services” is short sighted and will contribute to the weakening of health care markets overall.
A US District Judge has ruled in favor of two Christian Colleges to bar the enforcement of the contraceptive mandate as it applies to their University sponsored insurance. I understand that many Christians are opposed to abortion, and that many are also opposed to sex before marriage. However, what is the problem with contraception ?
Many people are not aware of the Pregnancy Discrimination Act. It is a clause to Title VII of the Civil Rights Act of 1964 and is for the purpose of prohibiting “sex discrimination on the basis of pregnancy”. Pregnancy is a temporary disability in the eyes of the law. Violating employment law pertaining to pregnancy wold be treated like violating employment law pertaining to disability. The Act protects women not only during pregnancy, but also during “pregnancy, childbirth and related medical conditions”.
In England there is a public health program. In 2008, an HPV vaccination program was instituted. Ten years later, we cannot see that this has resulted in infections with the most serious HPV viruses, types 16 and 18 fell 86%. Experts speculate that the vaccine could lea to the eradication of HPV related diseases such as genital warts or cervical cancer.
Focus on the American Maternal Mortality Crisis continues. New data continue to confirm what many have already observed, that black women die at three times the rate of white women from pregnancy related causes. May have suggested hypertension and racism are playing roles, as well as lesser access to quality care.
New and sobering data are coming in about the common disorder we call “PCOS” or polycystic ovarian syndrome. PCO is complex of hormonal problems leading to problems with ovulation, ovarian cysts, and trouble with androgens, insulin and the processing of fats and carbohydrates. We used to think of PCO as pertaining mainly to infertility, but PCO related infertility is quite treatable. However, now, more physicians like me are even more concerned about the downstream metabolic effects of this syndrome. The carbohydrate intolerance leads to obesity and the obesity leads to more carbohydrate intolerance. All of this leads tot higher BP and abnormal lipids, setting the patient up fro diabetes and heart disease later in life. In fact, we now know that about half of patients with untreated PCO will have diabetes before age 40. If you think you have PCO, please contact your doctor and ask to be referred for appropriate medical and lifestyle management.
Obesity in pregnancy is known to be associated with an increased rate of a number of pregnancy and brith complications. However, it now appears, that offspring of obese mothers are considered a high risk population for endothelial cell dysfunction, meaning cardiovascular problems. In fact, either maternal smoking or obesity predisposes daughters with PCOS. When will the nation and the medical profession come to terms with the obesity epidemic ?
Stay tuned for more news from the fascinating world of Obstetrics and Gynecology, here, next week on Medical Monday.