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

Maternal mortality is a big topic nationwide. The rates are unacceptable in the US, and particularly bad in the South. Arkansas, in a reasonable move to triage women for eligibility for home birth, have established a screening process. That screening process for women helps the State determine who may legally delivery at home. Heretofore, this screening did not require a vaginal exam. Now it does, and this has brought fire from patients and home birth midwives. It has always been our position that a patient may decline anything for any reason. However, to qualify for certain program certain requirements must be met. My position would be that women who do not want vaginal exams will have to forgo participation in that particular program. And, I must ask, what is the problem with vaginal exams ? Women are not fragile and information is power. This type of overly precious attitude toward the female body, even by women, is counter to the interests of maternal and fetal health. It is case of putting philosophy over responsibility. 

Texas OB/Gyns are starting to speak out about what they see are the causes of excessive maternal mortality rates. They are identifying system errors such as failing to recognize risk, as well as more subtle phenomena, such as unconscious bias. Race is of course a factor as black women are four times more likely to die than white women. A rally in Boston highlighted the same cause of maternal mortality. The centerpiece of the rally was a billion the US Senate which will promote the formation of state review committees for maternal mortality. 

Pennsylvania is also taking measures to try to curb maternal mortality and has established a committee through the State Health Department to scrutinize the problem. 

In an effort to get more pregnancy women into prenatal care, Connecticut has approved a bill to make pregnancy a “ qualifying life event”. This means that pregnant patients in the state my enroll in insurance plans anytime, and need not enroll within the confines of the enrollment period. 

With all this talk on maternal mortality, one might take a moment and discuss maternal morbidity. Morbidity means serious complications short of death. The CDC (Centers for Disease Control) has indicated that for every 1 mother who dies, 70 nearly die. That is an astonishing statistic and goes a long way in my mind toward explaining why Obstetricians have such burn out, and why their numbers are decreasing. Maternal morbidity comes from all the same things maternal mortality: worsening maternal health, worsening access to evidence based care. poorly funded health care systems, unconscious bias, race, etc. 

The Trump Administration is considering implementing the so called “gag rule”domestically. This would prohibit the dispensation of Title X funding to any clinics which even mentioned abortion. I wonder how this reconciles with freedom of speech ? Can you imagine trying to enforce this ? All patient consultation and exam rooms would need to have audio recording equipment and someone would have to review the recordings. Dystopian much ? 

The Trump administration is reappropriating about $15 billion in unspent funds from CHIP (Children Health Insurance Program) and certain part of the ACA ( Affordable Care Act). Democrats feel this is not the time to cap these budgets or reduce rainy day funds. However the Trump administration budget is ballooning and they are trying to cut costs anywhere they can even for vulnerable groups. 

Iowa has banned abortion once a fetal heartbeat is detected, which is at around 6 weeks. However, similar measures have passed in North Dakota and Arkansas but they have both been struck down as being unconstitutional and inconsistent with Roe V. Wade. 

Louisiana has seen a quadrupling of the rate of neonatal abstinence syndrome (NAS). NAS describes the condition of infants who are born to opioid addicted women. A recent feature in teh New You Times has reported that about 90% of pregnancies among addicted women are unintended. The reasonable inference here is that addicted women have a hard time using birth control effectively. 

ACOG (American College of Obstetricians and Gynecologists ) advises pregnant and breastfeeding women not to use marijuana for concerns about developmental delays. Nonetheless, a new study has shown that 69% of Colorado Dispensaries phoned do recommend it to pregnant women for nausea. Dumb and dumber. 

New data is coming out that induction at 39 weeks may be associate with fewer risks and lower C section rates. More research is needed. 

A new study on genetic testing for breast cancer has shown that those who do not meet the criteria for testing have harmful mutations AS OFTEN as those who do meet the screening criteria. Sounds like the screening criteria need broadening. 

In other genetics related news, we find that the number of genetics tests available is increasing. A new study has shown that only a small subset of physicians order genetic testing, and even fewer know how to interpret them. This appears to be a case of the technology moving faster than our understanding. 

The Human Genome Research Institute is developing “ preconceptual screening” for couples. Right now screening is piecemeal, meaning only for a selection of known genes. However, they are developing  a whole genome sequencing program, which has been made possible by NGS, or next generation screening. 3.5 % of participants had a medically actionable finding. As of yet, the majority of the information acquired does not have a clinical application. 

Yet more data has come out of a large study on the HPV (human papilloma virus). In a study of 73,000, it has been shown not only to prevent cervical cancer, it also prevents precancerous lesion of the cervix. Additionally it did not show any increased risk of side effects compared to control. 

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

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

Policy News:

Medical and civil rights organizations have come together to oppose the detention of pregnant women by the agency on Immigration and Customs Enforcement (ICE). They have cited harmful effects on the health of these individuals due to lack of access to proper prenatal care and due to the high risk of rape while detained. 

Senator Tammy Duckworth (D-Illinois) has been the first Senator to have a baby while in office. Adequate lactation rooms were ensured through a measure by Senator Nancy Pelosi in 2008 so that breastfeeding Senators could comply with breastfeeding recommendations from the American Academy of Pediatrics. However, the post partum senator may have more difficulty attending votes unless the current rules barring children from the Senate floor are modified. 

The Trump administration has added two new exemptions to the individual mandate which is the rule that says people must carry individual health insurance or pay penalties. One is an exemption for those who live in a place with only one ACA (Affordable Care Act) insurance carrier whose coverage includes abortion services. On the basis of paying into a fund whose services include abortion, they can be exempted. I can see why people feel such consumers should not be obligated to use such a plan. I believe, however, that same anti-abortion consumer should be obligated to follow through with their execution of conscience and be required, under pain of penalty to buy private health insurance so that the rest of society does not end up footing the bill for their conscience driven but unfunded health care.  

The second exception the the individual mandate is nonsense. It is a “hardship” exemption. Who more than those under hardship need quality health care ? This particular exemption is a recipe for making the poor or those under hardship even poorer. And what does it gain? It gains political brownie points under the guise of freedom, and a better appearing Federal spreadsheet for this administration to tout to the voting taxpayers. We need to do a better job a making it clear to people that they stand to gain much more buying health insurance than they do forgoing it. 

Four abortion restricting laws have been passed by the 2017 Arkansas legislators. However, several influential groups have filed amicus briefs at the 8th Circuit Court of Appeals in St. Louis. One is the American College of Obstetricians and Gynecologists pertaining to the criminalization of “D & E”, the procedure dilation and curettage. This procedure is a safe and effective method for abortion, the safest in fact for the second trimester, and is used in many medically indicated cases where the patient’s life is at stake. 

The New York Times has reported that Scott Lloyd, the director of the Office of Refugee Resettlement keeps a spreadsheet of all detained unaccompanied minors who are pregnant and are requesting abortion. Lloyd has directed that this "captive audience" received non medical “counseling”  regarding their requests. Does anyone else view this as a misuse of power ? Does anyone else view this an incursion of a non-medical authority into the realm of medicine and counseling ?

Medical News: 

 Ever heard of the term “Previvor”? Me neither.  Previvors are those that know they carry a genetic mutation for cancer but have not yet developed cancer. Many are people who have discovered their mutation through non- medical genetic screening such as through the popular company “23 and me”. Others are those with family member with cancer who have been advised to do testing. Either way they are in a grey zone, and do not always get the care they need to address their relatively new predicament. Enter Dr. Heather Macdonald, an Obstetrician Gynecologist at Hoag Hospital in Newport Beach, California. She has created a special tailored program for these patients. It is called the “ Breast and Ovarian Cancer Prevention Program. In it she has outlined the possible ways to address risk, which may range from surgery, to medication to health maintenance strategies. 

The nation is finally mobilizing on the issue of maternal morbidity and mortality. Five states were in on the creation of the Alliance for Innovation on Maternal Health (AIM), California, Florida, Illinois ,Michigan, and Oklahoma. Texas, the nation’s worst offender, has now joined. The initial states have since seen significant decreases in maternal morbidity using protocols called “safety bundles”. 

Young women still suffer stigma even in the confines of an office visit. New research indicated fully half of teens and young women do not feel comfortable discussing sexually transmitted infections (STIs). Moreover, over a quarter lie to their caregivers about their sexual history. Separate research has shown that that the incidence of STIs is at a many decade high. Nonetheless, 62% of women under 25 do not consider themselves at risk for STIs. Only 40% use condoms. What might be a way to change all this ? 

A recent study published in Obstetrics and Gynecology indicates that marijuana does show up in the breastmilk of using mothers. Infants who breastfed exclusively ingested about 2.5 percent of the maternal dose and peaked one hour after smoking. ACOG’s position on marijuana in pregnancy and breastfeeding is as follows: 

There are “...concerns regarding impaired neurodevelopment, as well as maternal and fetal exposure to the adverse effects of smoking”. 

"There are insufficient data to evaluate the effects of marijuana use on infants during lactation and breastfeeding, and in the absence of such data, marijuana use is discouraged.”

Reference: 

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Marijuana-Use-During-Pregnancy-and-Lactation

PCO or polycystic ovarian syndrome is a complex medical condition that comprises problems with ovulation, fertility, menstruation and excess male hormones, and problems with acne and unwanted hair growth. It also includes problems with carbohydrate metabolism and may lead to cardiovascular disease and diabetes. New research also indicates is is associated with a higher prevalence of several psychiatric conditions including depression and anxiety. 

Initial testing of a personalized vaccine against recurrent ovarian cancer cells is showing promise. A patient’s own dendrite cells (DC) are treated and given separately or together with other immunotherapy. The DC vaccine induced potent anti tumor T cell responses and was well tolerated, and was associated with a better prognosis. Further clinical testing is planned. 

New research in the Journal Menopause has unearthed a connection between the severity of menopausal symptoms and the risk of heart disease. The research found that increased symptoms such as hot flashes were associated with artery stiffness and dysfunction. This research may come to influence the way we think about postmenopausal hormone replacement therapy which reduces both symptoms and arterial dysfunction. 

The biggest news of the week may be that alcohol is not as safe as once previously believed. A new international study has shown that even one drink of beer or wine per day can increase the odds of hypertension, stroke and heart disease and significantly shorten life. Numerous national and international recommendations are likely to be changed based on this. 

Stay tuned this week for more exciting news from the world of Obstetrics and Gynecology. 

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

Actual patient care through the weekend prevented a timely publication of Medical Monday. Thanks for your patience ! 

The health care sector’s initial responses to the Trump administration’s approach to health care policy ranged from shock to anger. Now people and corporations are starting to take action, especially in the face of the administration’s disarray and impotence. 

The Trump administration through the Department of Health and Human Services slashed $200 million from the Teen Pregnancy and Prevention Program. (Can anybody tell me the process that made this possible, or does the President just decide like a dictator ? ) The spokesperson of the National Campaign to Prevent Teen and Unplanned Pregnancy has spoken out and disputed the administration’s position which stated that there is “ very weak evidence of positive impact of these programs. “  Experts everywhere are dismayed since the programs are believed to have produced a 41% drop in the teen pregnancy rate since 2010. The CDC (Centers for Disease Control) and ACOG ( American College of Obstetricians and Gynecologists) both credit the declining teen birth rate to these programs. 

The Trump administration is bit by bit, trying to dismantle the ACA’s protections on reproductive health care. Most recently, the contraceptive mandate for employer sponsored programs is on the chopping block. ACOG has stated that the contraceptive mandate has driven the unintended pregnancy rate to a 30 year low, and eliminating this feature would be a threat to public health. 

The Trump administration has indicated its support for abstinence only sex education, which has no evidence to support its efficacy. However, the CDC has produced two meta-analyses which indicate that comprehensive sex education results in reduced overall levels of sexual activity and increased levels of protection among those that are sexually active. 

Indiana law classified the use of aborted fetal tissue as a felony. A group of Indiana researchers has challenged this legislation with a federal lawsuit. The group bringing the suit is from the National Institute of Health funded Alzheimers Disease Center where they do study brain tissue from aborted fetuses. 

A recent article in the Dallas Morning News has highlighted the new voice of corporate American in social policy. Corporate America needs a diverse and inclusive workforce, and it understand that inclusiveness is good for business. Accordingly, it has begun to stand up for diversity. From various quarters, highly placed business leaders have spoken out and defied the current administration’s divisive policies. Recent examples of these divisive policies and positions include the President’s reaction to the Charlottesville violence, as well as recent controversy regarding LGBT rights, i.e. the so-called bathroom bill. 

The writer of the Dallas Morning News editorial, Dr. Daniel Grossman of the Department of Obstetrics and Gynecology University of California, San Francisco, has called upon the business community to begin speaking out on women’s reproductive rights as well. He cites the fact that fully 70% of Americans support women’s access to full reproductive services including abortion, and this is also the position of the American College of Obstetrics and Gynecology and the American Medical Association. A broad based field of research has shown time and again that access to comprehensive and affordable reproductive health care for women leads to better health, higher levels of educational attainment, and improved economic stability for women, families and society at large. To learn more see https://www.ansirh.org, Advancing New Standards in Reproductive Heath, a division of the UCSF Bixby Center for Global Reproductive Health, http://bixbycenter.ucsf.edu. 

As mentioned in several past posts, States are starting to take matters into their own hands. They are, on their own State legislative calendars, enacting various bills that safeguard the requirements for insurance to cover various benefits such as birth control or prenatal care. The latest is Arkansas, which has passed a law which will require insurers in the State to cover indicated mammograms. 

In the good news department, we have word that there are bipartisan meetings planned in the first part of September, which will include Governors as well as State Insurance Commissioners. The goal of the meetings will be to stabilize existing insurance markets under the ACA. Things may actually start to get real. 

In medical news, the truth is starting to come out, as truth eventually does. New data published in a recent study shows that yearly mammograms starting at 40 (rather than every other year at 50) would prevent the most deaths due to breast cancer. According to this study out of Cornell and New York Presbyterian, for those aged 40-80, screening at 40 reduces breast cancer deaths by 40 % beyond current protocols. Those who read this column regularly already know that a whole segment of the health care world including ACOG, the American Cancer Society and the American College of Breast Surgeons among others, have always taken this view. They have taken serious issue with the short sighted recommendations of the US Preventive Services Task Force (USPTF) which has taken the position that mammograms in the 40s confer no benefit. 

All parties concerned recognize that this earlier and more frequent approach mammograms produces a higher number of false positives. However, actual clinicians ( doctors, nurses and nurse practitioners who see patients) do not take the position of the USPSTF(statisticians and epidemiologists largely)  that fear of mammograms, pain of mammograms, breast biopsies with benign results constituting a false positive, or even infected or bruised breast biopsies compare with a breast cancer death as a harm. In fact no number of these types of “harms” could ever add up to even one breast cancer death. 

The next item is in both the good news department and the we-already-knew-this department. A recent analysis published in the journal Menopause has indicated that vaginal estrogen does NOT confer increased cardiovascular risk. Vaginal estrogen does not appreciably enter systemic circulation. It stays local to the vagina, and does its job to relieve postmenopausal vaginal dryness. Vaginal estrogen was found to NOT increase risk for breast cancer or for any of these: colon cancer, uterus cancer, stroke, clots in the lung (pulmonary embolus) or deep vein thrombosis. Sheepish gynecologists should prescribe with confidence. 

A concerning new report published in the journal Pediatrics has brought to light that less than half of new moms are consistently putting their babies on their backs to sleep. Not doing so raises the risk of SIDS (sudden infant death syndrome). Three quarters state they “ usually" do so. Current guidelines clearly state that babies should be in their parents room, in their own bed, and on their back to sleep for the first six months of their life. 

Breast and ovarian cancer patients are not getting genetic testing at adequate rates. Genetic testing for these patients informs the care of their children. Moreover, it can also provide insight into their own treatment. Finally, it may ultimately provide information that could help us screen for and treat cancer in new and better ways. I look forward to the day when disease is understood and treated at a genetic level. To get there, we must as a society, contribute our personal genetic information in a meaningful way. 

That’s it for this week; Stay tuned next week for more news from the exciting world of Obstetrics and Gynecology. 

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

By now the whole world knows that Trumpcare version 1.0, the American Healthcare Act (ACHA) has failed. For now, Obamacare, the Affordable Care Act (ACA), remains the law of the land.

This last Friday, the ACHA bill went to the floor of the House for a vote. However, all day negotiations proved fruitless to bring over Democrats or close the deep divisions between House Republicans. House Republicans broke rank with the President, but did so in two camps. First those on the far right “ The Freedom Caucus”, withdrew support because they felt the bill was still too costly and still too much like Obamacare. Moderate Republicans withdrew support because the ACHA gutted federally funded Medicaid and is widely believed to lead to the loss of insurance for a great many people, putting that burden on the States. Paul Ryan, recognizing the tally, pulled the bill before the vote. 

House Speaker Paul Ryan has indicated the GOP will keep working on heath care. One little publicized option is for the Whitehouse to sue to stop the Fed from paying insurers for work done under the Affordable Care Act. This tact was going on before the ACHA was brought to the House. Their argument is that these contractual payments from the Fed to insurance are invalid and illegal. 

One of Trump’s major campaign promises was to reform healthcare, indeed to provide “universal coverage”. Progressives favoring Universal Coverage may attempt an uneasy alliance in the service of this goal. Senator Bernie Sanders plans to unveil such a proposal entitled “ Medicare for All “. 

Policy news is moving at light speed and I recommend everyone start reading it from various reliable sources. I also recommend people familiarize themselves with their elected representatives and give them and their staff regular meaningful input. 

On to actual medicine. 

A new study from the Journal of the Academy of Nutrition and Dietetics indicates that most American women do not eat a healthy diet when they are pregnant. This is something we see in clinic on a regular basis. It is worth noting however the many women believe that they are eating healthy diet, even though they are not. These are well-intentioned people who have been taken in by advertising or who are victims of their busy schedules. Unless the physician or nurse midwife takes a detailed dietary history they will not know how their patient is really eating. Merely asking the person whether or not they eat healthy is not enough. People generally say they eat healthy and people generally say they are active or fit. That is because they believe it to be the case. Until people have objective definitions in front of them they cannot reliably answer these questions. Doctors take important shortcuts if they do not delve into a reasonable amount of history taking detail. When patients get specific explanations of exactly what we mean when we say "eat healthy", they're much more likely to do so. One of the problems of course, is that many doctors do not know precisely what it means to "eat healthy”. 

Four prior commissioners of the Food and Drug Administration (FDA) have produced a joint letter warning Congress about the legalization of importing drugs from other countries. Certain members of Congress have indicated that they would support this in an effort to reduce drug costs. In particular, the commissioners emeriti have warned against counterfeit, substandard and contaminated medications, since standards from other countries may not be adequate.

Pregnant women with HIV have a better chance than ever of avoiding transmission of their virus to their children. Preventive treatment including retroviral drugs given in pregnancy account for this progress.

In other viral news, a new gel treatment for genital and perianal warts is under study. These are caused by the human papilloma virus. The treatment is based on nitric oxide. Stay tuned for more on this nascent therapy.

Also regarding human papilloma virus, the American Society of Clinical Oncology has issued global statement regarding the primary prevention of cervical cancer. They recommend that all girls ages 9 to 14 receive two doses of the human papilloma virus vaccine also known as Gardisil. In the last few years there has been definitive evidence that Pap smears combined with this vaccination reduced the incidence of cervical cancer. The vaccine is also available for boys of the same age group.

Yet another study has demonstrated that exercise during pregnancy is safe and beneficial. This most recent study published in the Journal of the American Medical Association is meta-analysis of studies with more than twenty five hundred pregnant women. This is in line with ACOG (American College of Obstetricians and Gynecologists) recommendations which indicate "women without major medical or obstetric complication should get at least 20 to 30 minutes of moderate intensity aerobic exercise… on most days of the week."

In the concerning department, the FDA (Food and Drug Administration) has now linked anaplastic large cell lymphoma (ALCL)  to breast implants. This disease is a rare malignancy in the immune system which is statistically linked to breast implants, particularly those which have a rough versus smooth surfaces. The FDA has issued a statement indicating that women with breast implants have a very low but increased risk of developing ALCL compared to those who do not have breast implants. It is worth remembering that a statistical link does not prove causality. Concerned patients should speak to their plastic surgeon about this matter.

In other cancer news,  new research indicates that breast cancer gene testing is underutilized in America. A simple history in the caregiver’s office can identify whether or not a patient is at high risk of having abnormal genes, i.e. breast cancer gene mutation, or BRCA. Women with two first degree relatives such as a mother or sister are at high risk for having an abnormal gene and should explore the possibility of testing. Those patients with close relatives with any cancer should make sure their caregiver is aware of it. 

New research coming out of the Cancer Genome Atlas Project and the Cancer Research UK Database have indicated that only about a third of cancers are due to a special inherited genetic mutation. This means that two thirds of cancer-causing mutations arise spontaneously and are not able to be inherited by one's children.

We conclude with the good news department. A new device called the Alexis retractor is being tested across the world. Preliminary indications in Europe show reduced infection rates and reduced post operative pain after Cesarean section. 

Finally, many States are following another European lead and introducing baby boxes. Currently Americans put their newborn babies to bed in a wide variety of ways. However, clear research shows that the incidence of SIDS (sudden infant death syndrome) can be significantly reduced if babies are placed on a flat surface on their backs, head uncovered, in a special sleep sac or a one piece sleeper, and WITHOUT any blankets, swaddling, bumpers, padding or or toys. The sheet on the firm mattress should be fitted. The baby box programs are designed to provide all this teaching as well as an actual  baby box and mattress. For those who are not aware, the baby sacs are like insulated zip overalls with a closed bottom, which allow babies to move. They are not to be confused with swaddle wraps, which are also associated with SIDS. Babies typically wear a shirt and a diaper with it. Very cute inexpensive ones can be obtained at Ikea, Target and online. 

Here is an authoritative link from the NIH for those who want to learn more: 

https://www.nichd.nih.gov/sts/about/environment/Pages/look.aspx

Our photo for today's post was brazenly lifted from the pages of the National Institute of Health linked above. 

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

Medical Monday : Breaking News From the World of Obstetrics and Gynecology.

Republican efforts to repeal of the ACA (Affordable Care ACT) continues to worry many. In particular, the new administration is starting to hear from cancer patients and cancer survivors. These are people who will forever have a preexisting condition. They have been assured with promises to protect people with problems in any forthcoming health legislation. And, yet, no proposal has yet been put forth to sustain the viability of the insurance companies providing the health care. 

Tackling the ACA has, understandably proven to be more difficult than Republicans estimated. Leaders in the House and the Senate have been meeting with patients, hospitals and insurers. With all these legitimate concerns being brought to the table, divisions are developing among Republicans despite the fact that both the House and the Senate are dominated by Republicans. No one said it would be easy. 

Republican led States are petitioning to reduce Medicaid costs by increasing coverage restrictions. These could take the form new small premiums, work requirements for the non-disabled, and time limitations on coverage. This could lead to different Medicaid benefits in different States. Governance of States' Medicaid programs may come under increasing control of individual States, rather than the Federal government. 

Republicans seek to increase utilization of Health Saving’s Accounts (HSAs). HSA’s are basically registered accounts in which people may place money, tax-free, to spend on health care, usually their out of pocket portion of their insurance. The idea behind this is that when people are spending “ their own money rather than the insurance companies’  money” they will be more careful with it. If a person who has low income and therefore a low tax rate has a high deductible, as many do, for example $5000 to pay their deductible out of an HSA is still $5000. However, if a person in a high tax bracket socks away the amount of his deductible in an HSA and is not taxed on it, they make save as much as 35% of that money as saved taxes. As far as I can see, HSA’s will only help people in high tax brackets. 

Popular support of the ACA increased since the inauguration from 41 to 45%. 

The contraceptive mandate, part of the ACA, requires the birth control be covered with no copay. However, it is believed that the new Secretary of Health and Human Services, Tom Price, will try to repeal it since he did not support it to begin with. Again, it is my opinion, and the opinion of many, that the contraceptive mandate is a money saver, and a abortion preventive. There is solid evidence to both effects. Some was cited in last week's blog post. 

A Federal Judge in Austin Texas has blocked the withdrawal of funds from Planned Parenthood in Texas. He stayed that that State did not provide evidence of any violation warranting such termination. This will protect care for about 11,000 of the State's poor who currently get their Medicaid funded care through Planned Parenthood. 

President Trump has vowed to enforce a “global gag rule” whereby family planning funds from the US will be withdrawn from any international organization who so much as speaks about abortion, let alone performs it. By doing so, $600 million will be withdrawn from these organizations providing broad family planning and health services to women. As a response, the Netherlands has started a fund to replace the shortfall, and has been joined by Norway, Sweden, Denmark, Belgium, Luxembourg, Finland, Canada, and Cape Verde. 

Last week the Indiana House Public Policy Committee passed a law which will require abortion providers to discuss a procedure which does not exist, namely “abortion reversal”.  I have no idea what they can even say about such a thing since it simply does not exist. ACOG (American College of Obstetrics and Gynecology) spoke truth to power about this, but it did no good. 

This week other lawmakers in Arizona are considering a bill to require lifesaving treatment for babies miscarried or aborted at 20 weeks of age which show some signs of life. Babies at this gestational age can briefly have gasping, or a slow heart rate for a very short period of time, but it does not indicate any potential for surviving. This law would require that these babies receive advanced life support measures, similar to an adult with a cardiac arrest. Again, another impossibility. When will lawmakers acknowledge that scientific reality should have a role in laws ? 

Many lawmakers across both sides of the aisle have taken exception to the new president’s anti-vaccine philosophy. They are beginning to speak out in support of their State’s respective vaccine policies. 

Policy news seems to have overshadowed medical news this week. However, there is something from the “ we-already-knew-this” department. New research published in the American Geriatrics Society indicated that, in older women, central body fat is associated with shortened life, more so that being fat overall. They also discovered that being underweight shortens life as well. 

Finally, ACOG has recommended that all pregnant women be offered genetic screening and carrier screening. Formerly, we based carrier screening on ethnicity. However, now it is believed that a large number of Americans are of mixed or unknown ethnicity, and so carrier screening for specific disease causing genes is indicated for all. 

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