Medical Monday: Breaking News from the World of Obstetric and Gynecology

Policy

The GOP appears to be giving up on repealing the Affordable Care Act (ACA). Those who support the patient care aspects of the ACA may cheer, but they should not breathe a sign of relief, since the funding mechanisms of this plan remain somewhat undetermined. Encouragingly, there is increasing GOP interest in crafting legislation which will make the plan more fiscally stable. The goals in this case would be to guarantee Federal subsidies to insurers, and to reduce patient premiums while keeping essential benefits.

Do you think that people realize that the more people sign up for the ACA, the more stable it will be ? Well, it's true. It's easy. Go to heathcare.gov to see if you qualify. 

South Carolina has argued that a “ human being is a person at fertilization”. They have created a legal category “preborn humans” which incidentally my spell check refuses to recognize, and they propose these preborn humans be afforded due process and all protections under the law. ACOG, the American College of Obstetricians and Gynecologists, opposes the bill since it is not based on science. 

A 20 week ban on abortion failed the Senate. The bill’s proponents advanced the bill on the basis of their belief that 20 week fetuses can feel pain. ACOG has gone on record saying “ the fetus does not have the physiological capacity to perceive pain until at least the 24th week of gestation.”. We as a medical culture have a great deal of experience with 24 week babies since they routinely come to any large newborn ICU. Had the bill passed, it would have been challenged under the standing Roe V. Wade. 

Idaho has introduced a bill which introduces misinformation into the informed consent language for medical (pill based) abortion. The bill’s language asserts that medical abortion can be halted after the first of two pills is taken. The bill further requires providers to provide a list of other providers who can advise about “ abortion reversals”. None of the bills assertions are based in fact. A patient contemplating a medically induced abortion should not proceed if she has any doubts, since there is no evidence reversal is possible. I feel angry on behalf of distraught women who may be told this misinformation and who try to rely on it. 

A group of private donors has bankrolled the provision of medical abortion services for all public universities in California. A bill is under debate which will require public universities to provide this service. 

Another bill proposed in California would require larger businesses with new construction to provide space for breastfeeding. The bill stipulates these areas need to be be in place by 2019. 

The Utah bill which will require the offering of IUDs through Medicaid has passed the House and is heading to the Utah Senate. Republican lawmaker Ray Ward, has proposed the measure to decrease unplanned pregnancies, teen pregnancies, and abortions. 

Medicaid expansions may be able to move forward in several traditionally red states if they are paired with work requirements. What do you think ?

Medicine

 

Researchers out of UC San Francisco have come out highlighting the adverse effect of marijuana on the unborn. Dr. Dana Gossett has cited several recent studies which indicate marijuana increases risk of still birth and adversely affects how the babies brain develops. ACOG has already come out formally warning pregnant women not to use. This could potentially turn out to be a huge generational problem if these children, as a generation, have significant delays. This research also raises the question of what is marijuana does to the brains of children and adults who use. This research also raises the issue that state policy on marijuana has been made without any reference whatsoever to available science. 

Preliminary date from a Dutch population based study indicate that women with implants may be somewhat more likely to develop anaplastic large cell lymphoma. Further studies are needed to clarify the risk. 

It has been well established that obese women have an increased incidence of breast cancer based on weight aone. However it is now becoming clear that even fat/skinny women are also at increased risk. This means even a woman of normal overall weight with a high body fat percentage has increased risk. 

TDAP stands for tetanus diphtheria and acellular pertussis. This vaccine is given to children and to pregnant women. It turns out that that protection is afforded to the baby through the mother no matter when mother gets the vaccine in her pregnancy. Upshot: It is never too late to get a TDAP in pregnancy. Babies first vaccinations are not until 2 months, so baby needs passively acquired immunity from mom getting her shot in pregnancy. 

This season’s flu is on tract to be the worst of the decade. already it has surpassed the 2009 “ swine flu” epidemic. As f this writing, flu has led to 37 pediatric deaths nationwide. You may have heard that this year’s vaccine is only partially effective. This is true, but some protection is better than none. Get you and your loved ones vaccinated. Do not go to work of you are sick. Ask sick co-workes to go home. Do not take sick children to day care. Wash you hands twitch soap when you arrive at home. Be assertive ! If you think you have been exposed to flu, call your health care provider. You may be eligible for preventive medication, and certainly are if you are pregnant or immunocompromised. 

A new Zika vaccine has been fast tracked by the FDA. It is called TAK-426 and is currently being tested on 240 people between the ages of 18 and 49. 

Women have autoimmune disease 9 times more often then men. I will therefore report on two news items of interest to those with autoimmunity. The first pertains to Rheumatoid Arthritis. A new study has shown that women with Rheumatoid Arthritis tend to deteriorate after menopause. This hints at a relationship between autoimmunity and reproductive hormones. Unfortunately the relationship is not yet clear. Meanwhile, those with these issues should talk to their Gynecologist about navigating through menopause in a way that minimizes difficulty and risk. 

The second has to do with lupus, a condition which I have. New research indicates that a gene called “ Toll Like Receptor 7 (TLR-7) ” may be involved. Normally, only one copy (allele) a gene is active in a given individual. However, in lupus patients the second copy of TLR-7 does not deactivate as it should. The normal role of TLR-7 involves activation of type 1 interferon signaling which is critical to antiviral immunity. However too much of this powerful immune response can be damaging. Lupus nerds stay tuned with cautious optimism. 

Stay tuned next week, here, for more breaking news from the world of Obstetrics and Gynecology. 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

In policy news we find more of the same. Texas again figures prominently, so much so that I have decided to create a new category: Texas news. Texas is an unmitigated perinatal disaster and is an embarrassment to this country, particularly to its medical establishment. But make no mistake, if current trends in law and politics are any indication, women's healthcare in every state will be like Texas.

To wit: a new study through the Commonwealth Fund has shown that one quarter of working age Texas women still lack insurance of any kind. A significant percentage of those who are insured struggle to pay medical bills and admit to having skipped needed care because of cost. Texas did chose not to expand its Medicaid, and this is believed to be one of the causes for these phenomena.

Also in Texas, ordinary standard insurance does not cover abortion. A new bill passing the Texas House will require women to buy supplemental insurance coverage for this procedure. It also increases reporting on complications after abortion and on the incidence of minors receiving the procedure. 

Finally in the Texas news, the Texas physician Dr. Brett Giroir, a Pediatrician, has been nominated for assistant Secretary of Health at the Department of Health and Human Services. However, Democratic Senators have delayed his confirmation on concerns that he would not support women's health programs. And they wonder why Texas is in the state it's in.

The Trump administration has cut funding for the Texas Teen Pregnancy and Prevention Program. Now it proposes eliminating funding for all such programs across the country. Moreover the fundamental research for the Teen Pregnancy Prevention Project is situated at Texas A&M University and theses researchers have recently been notified that their funding has been cut.

In Texas, Planned Parenthood has been barred from receiving Medicaid reimbursement. As a result the number of comments coming in to the Center for Medicaid Services (CMS) have doubled from 9,000 per week to 18,000 per week. According to the Center for Public Policy Priorities this will remove healthcare access from 45,000 people.

In the good news department, a bipartisan group of high ranking Senators are trying to strengthen existing law regarding health care. They are recommending that the Federal government continue paying subsidies, and that all Americans enroll in coverage. They also recommend renewal of the Children’s Health Insurance Program. Even Senate Majority Leader Mitch McConnell has said that he would consider such a bipartisan effort to shore up subsidy payments to insurers to stabilize current insurance markets.

In the medical news, one is seven women experience anxiety or depression in the first year after giving birth. This remains vastly under-diagnosed untreated with only 15% of those affected seeking help. Obstetricians have been alerted to increase screening for these debilitating conditions. 

In other concerning news, the team suicide rate among girls has reached a 40 year high. This is according to a new report from the Centers for Disease Control and Prevention published this last week in the Morbidity and Mortality Weekly Report. As of 2015 it sits at about 5 per 100,000. 

Preterm birth has continued to be a significant perinatal problem and one that has been resistant to explanation and treatment. However, new research published in Obstetrics and Gynecology has indicated that sleep disorders may play a role in some cases. Data from over three million birth was studied, with conditions like apnea and insomnia being tied to preterm birth. 

New research indicates that risk of stroke is decreasing for men but not women. Stroke risk is related to the incidence of several medical conditions, including obesity, smoking, high blood pressure, diabetes, and high cholesterol. These conditions are on the rise among women. 

Physicians and patients, listen up: Physicians are doing a BAD Job at educating patients about marijuana use in pregnancy. Increasing State legalization has led many to believe marijuana is entirely safe under varied conditions. (Since when do we believe what politicians have to say about science and medical care ? ) This has not been substantiated. According to researchers at the University of Colorado in Denver, the data available is limited, and sometimes flawed. However, there is “ moderate evidence that the use of marijuana in pregnancy is associated with increased risk of reduced fetal growth, lower IQ scores in young children, adverse effects on a child's cognitive functioning and academic ability, an increase in attention problems” There may also be associations with low birth weight and preterm birth. Patients need to be honest with their caregivers, and caregivers have to help patients to meet their needs some other way than to use marijuana.

Stay tuned form more fascinating and important news from the word of Obstetrics and Gynecology, next week, on Medical Monday. 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

This week, the health care sector spent most of its time digesting the health care policy news from the end of last week. Reactions are coming in regarding Theresa Manning, Trump’s head of Title X family planning program. Here is a woman who criticizes the American College of Obstetrics and Gynecology (ACOG) on its endorsement of Plan B, the morning after pill, and who openly claims that contraception doesn’t work. 

Did you know that 22% of pregnant Texans under 18 have had multiple children ? Texas, the State recently enacting several curtailments to women’s reproductive services, is now grappling with it’s varied distinctions such as having sky high maternal mortality rates, and the highest repeat teen pregnancy rates in the Union. In a near comical about face, Texas is now considering a bill to provide free contraception to minors without parental consent. They have just now figured out this will reduce maternal morbidity, mortality, abortion rates and Medicaid costs. WOW. 

Reactions at a town hall meeting on New Jersey were quite clear, as participants boo’d their elected Senate Representative Tom MacArthur as he explained that rape victims could potentially be excluded from coverage. Talk about adding insult to injury. 

Pregnancy stands to be much more expensive under the ACHA. Those with prior Obstetrical complications such as C sections may fall under preexisting conditions and be charged exorbitant premiums. 

Senate Conservatives plan to drop millions of adults from Medicaid, which they say will reduce health care spending. They had originally said that tax credits instead would help people pay for health care, but now they wish to limit those on the fear that some may use their tax credit cash to pay for abortions. Paranoid much ? Moderate Republican Senators wish to keep the Medicaid expansion, citing it’s many benefits to their States. 

The Congressional Budget Office still appears to have teeth. They are the nation’s bean counters and they have yet to weigh in with REAL FACTS not #alternativefacts on how much the current administration’s ACHA (American Health Care Act) health care proposal will cost. This will include not only the cost of the insurance, but the uncovered health care costs incurred by those who lose their insurance. Polls show support of the ACHA is waning, and is down to around a third of Americans. 

A new study has shown that the credit card debt jumps for women but not men after a year of major medical expenses. Combine this with the fact that women have, on average, 20 % less income and spending power compared to men. Still ? 

As the weather gets warmer, Zika is back in the news. The CDC is now recommending all women at risk for Zika get a baseline Zika blood test. Once pregnant, they are to be retested every trimester. The CDC anticipates that this proactive schedule of testing will unearth many more cases of Zika this year. 

Hepatitis C has tripled its incidence between 2010 and 2015. Federal officials feel that the heroin epidemic is driving this. Among pregnant women, the infection rate has doubled. 

Perhaps in response to all the anti-contraceptive politics or perhaps for a variety of other reasons, the use of LARCs (Long acting reversible contraceptives such as IUDs) has increased seven fold between the years of 2008 and 2013. These are considered very good but still  underutilized methods. 

A new study presented at the annual meeting of the Association for Research in Vision and Ophthalmology states that marijuana smoked by pregnant women could damage the retinas of unborn children. The study utilized an animal model which showed this effect. 

Research presented at ACOG’s recent annual meeting indicated that patient information presented on Society Websites is too advanced for patients. These education materials do not meet the so-called health literacy standards, which are meant to ensure that information reaches it’s target. This is of particular concern to me as medical writer whose aim it is to convey information to a lay public and to my patients. 

What do you think ? Would you rather information be a little too simple or a little too complex ? It is quite hard to get it just right. 

Stay tuned for more breaking news next week on Medical Monday.