Right To 'Preserve One's Health' At Stake In Supreme Court Case Concerning Federal Abortion Ban, Opinion Piece Says

The Department of Justice's appeal to uphold a federal law banning so-called "partial-birth" abortion and the Supreme Court precedent that is "[s]tanding in the government's way" are "not really about the contentious liberty to choose abortion" but "concern the fundamental right to preserve one's health," Randy Barnett, a professor of legal theory at Georgetown University Law School and author of "Restoring the Lost Constitution: The Presumption of Liberty," writes in a Wall Street Journal opinion piece (Barnett, Wall Street Journal, 12/9). President Bush signed the Partial-Birth Abortion Ban Act (S 3) into law in November 2003. The Planned Parenthood Federation of America, the American Civil Liberties Union on behalf of the National Abortion Federation and the Center for Reproductive Rights on behalf of four abortion providers filed lawsuits alleging that the law is unconstitutional because of the absence of an exception for procedures preformed to protect the health of the pregnant woman. In place of a health exception, the law includes a long "findings" section with medical evidence presented during congressional hearings that, according to supporters of the law, indicates the procedures banned by the law are never medically necessary. Federal judges in California, Nebraska and New York each issued temporary restraining orders to prevent enforcement of the ban, all of which were upheld by appellate courts. The Supreme Court last month heard oral arguments in two of the appeals, and the court is expected to rule on the case by July 2007 (Kaiser Daily Women's Health Policy Report, 11/9). The Supreme Court in deciding on DOJ's appeal and other similar cases will decide if Congress is "entitled to blind deference when a person's life and health is at stake" or if "the people themselves deserve deference when their choices are supported by state-licensed and regulated physicians and ... substantial medical authority," Barnett writes. Former President James Madison said the Ninth Amendment was added to the Constitution to affirm "'the just importance of other rights retained by the people,'" Barnett writes concluding, "We will soon learn whether the courts agree" (Wall Street Journal, 12/9).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved

Kansas Abortion Opponents Petition For Grand Jury Investigation Of Abortion Provider Tiller

The antiabortion group Kansans for Life on Wednesday delivered a petition asking for a Sedgwick County, Kan., grand jury to investigate abortion provider George Tiller, who has been charged with 19 misdemeanors for allegedly violating a state law that requires an independent, consulting physician to approve some late-term abortions, the AP/Wichita Eagle reports. In the petition, which contains 7,857 signatures, the group asks the Sedgwick County District Court to convene a grand jury and appoint an independent prosecutor to investigate Tiller (Hegeman, AP/Wichita Eagle, 9/6).

State Attorney General Paul Morrison (D) in June filed charges alleging that Tiller, who owns Women's Health Care Services in Wichita, Kan., had financial ties to physician Ann Kristin Neuhaus, from whom he received a second opinion before performing 19 late-term abortions in 2003.

A 1998 Kansas law says that before an abortion of a fetus of 21 weeks' gestation or more, two physicians must determine if continuation of a pregnancy will lead to death or "substantial and irreversible" harm to a "major bodily function." Consulting physicians cannot have legal or financial ties to abortion providers. Tiller's attorneys have entered a not guilty plea to the alleged misdemeanors and filed a motion to dismiss the charges. If convicted, Tiller could face up to one year in jail and a $2,500 fine for each of the 19 misdemeanor charges (Kaiser Daily Women's Health Policy Report, 8/7).
Grand Jury Petition
According to the AP/Eagle, petitioners want the grand jury to examine late-term abortions that Tiller performed during the past five years and the reasons cited for the abortions. The group said it does not want the Sedgwick County Office of the District Attorney or Morrison's office associated with the investigation because neither could conduct an unbiased investigation. According to the group, Morrison was not thorough enough in his examination of Tiller's case.

"We waited nine years for those in law enforcement to do their jobs," David Gittrich, state development director for Kansans for Life, said. Tiller's attorneys did not have immediate comment on the petition, according to a receptionist at the law office of Tiller attorney Lee Thompson. "I can assure you the attorney general will enforce the law regardless of his personal view," Ashley Anstaett, spokesperson for Morrison, said, adding, "He does not and will not let politics influence this or any other case." Georgia Cole, spokesperson for Sedgwick County District Attorney Nola Foulston (D), said, "We are confident they will do as the law allows."














According to the AP/Eagle, the number of signatures submitted by Kansans for Life is nearly three times the number needed to convene a grand jury (Hegeman, AP/Wichita Eagle, 9/6).
Morrison Allowed To Intervene in Planned Parenthood, Kline Case
In related news, the Kansas Supreme Court on Wednesday ruled that Morrison could intervene in the legal dispute between Planned Parenthood of Kansas and Mid-Missouri's Overland Park clinic Comprehensive Health and former state Attorney General Phill Kline (R), the Kansas City Star reports (Klepper, Kansas City Star, 9/5).

Kline in 2004 subpoenaed the records of 90 women and girls who in 2003 underwent late-term abortions at Comprehensive Health or Women's Health Care Services in Wichita, which is owned by Tiller, saying there is probable cause that each record contains evidence of a felony. The state Supreme Court in February 2006 ruled that Kline could seek access to the records but that he must return to Shawnee County, Kan., District Court Judge Richard Anderson and present his reasons for seeking the subpoenas. Anderson turned over the records to Kline's office in November 2006 after removing information that would identify individuals.

Morrison -- who defeated Kline in the November 2006 election -- in May in a letter to PPKM attorney Pedro Irigonegaray wrote that he has ended the investigation of Comprehensive Health. Morrison added that the attorney general's office "found no evidence of any criminal wrongdoing" by the clinic. Morrison in the letter also said that Kline forwarded copies of the medical records from PPKM patients to the Johnson County, Kan., district attorney's office on Jan. 5 -- three days before he left the state attorney general's office. Kline, who replaced Morrison as Johnson County district attorney, retains copies of the records, according to Morrison's letter (Kaiser Daily Women's Health Policy Report, 7/23). PPKM is seeking the return of the records used by Kline in the investigation.

According to the Star, Morrison also is suing Anderson in a separate lawsuit. Records in that case also are sealed. Kline said that if Morrison is attempting to force Anderson to return the records, it would be "unprecedented, bizarre and contrary to the responsibilities of a prosecutor." Anstaett declined to comment on the details of either lawsuit. She said that because of the court seal, Morrison's office could not review the Planned Parenthood lawsuit without getting permission to intervene (Kansas City Star, 9/5).

Six-Week Course Of Antiretroviral Nevirapine Did Not Clearly Reduce Risk Of HIV Among Breastfed Infants, Study Finds

A six-week extended course of the antiretroviral drug nevirapine did not clearly show a reduced risk of mother-to-child HIV transmission among breastfed infants, according to a study published Saturday in the journal Lancet, the New York Times reports. According to the Times, breastfeeding "presents a life-and-death dilemma" for HIV-positive mothers in developing countries. Although using formula can reduce the risk of MTCT, when formula is mixed with dirty water, it can increase the risk of death among infants from causes such as diarrhea and malnutrition. In most developing nations, women will continue to breastfeed because it is traditional, formula is expensive and because using formula "announces" that a woman is HIV-positive, according to the Times. At least 150,000 infants contract HIV through breastfeeding annually, experts estimate.

In an effort to prevent MTCT, researchers have "stumbled into their own terrible dilemma," the Times reports. A single dose of nevirapine can prevent MTCT, but a single dose is not always effective. In addition, nevirapine can have side effects, and some infants develop liver failure, rashes or low white blood cell counts. Resistance to nevirapine also develops quickly, meaning that an infant who receives nevirapine and still contracts HIV will be unable to combination therapies that contain it or any related drug (McNeil, New York Times, 7/29).

For the study, researchers administered nevirapine to infants in Ethiopia, India and Uganda whose mothers were HIV-positive (Britt, Bloomberg, 7/25). The infants were randomly assigned to receive a single dose of the drug, while the other half received a six-week course (Bollinger et al., Lancet, 7/26). The study found that infants who took daily doses of nevirapine for six weeks reduced their risk of MTCT by 15% (Bloomberg, 7/25). "Although a six-week regimen of daily nevirapine might be associated with a reduction in the risk of HIV transmission at six weeks of age, the lack of a significant reduction in the primary endpoint -- risk of HIV transmission at six months -- suggests that a longer course of daily infant nevirapine to prevent HIV transmission via breastmilk might be more effective where access to affordable and safe replacement feeding is not yet available and where the risks of replacement feeding are high," the researchers wrote (Lancet, 7/26).














However, three members of the research team led by Mrudula Phadke of the Maharshtra University of Health Sciences in Nashik, India, in a letter to the journal wrote that it is "wrong that a drug that has not shown significant benefit and which has serious toxic side effects in 38.4% of babies should be tried for longer." The study's design of six months was based on the 10 to 14 days that it takes nevirapine to build up in infants' blood, the three researchers wrote in the letter, adding that the finding that incidence was lower after six weeks "does not reflect the effect of six weeks of treatment at all." Instead of using nevirapine, HIV/AIDS experts should focus on methods to make infant formula more available and acceptable to HIV-positive mothers in developing countries, the researchers added.

The disagreement among the study's authors is unusual, Lancet editors Pia Pini and Sabine Kleinert wrote in an accompanying commentary. They added that NIH, which funded the study, said there was no "breach of research integrity." They added, "In our opinion, publication of these important data, with complete disclosure, is the best course of action." Jeffrey Stringer and Benjamin Chi from the University of Alabama-Birmingham wrote in an accompanying commentary that "[e]xtended infant prophylaxis with nevirapine is simple enough to be implemented almost anywhere. It represents a long-awaited, if partial, solution to a mother's impossible choice. We should not delay" (Bloomberg, 7/25).


The study is available online. The letter also is available online.


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Nevada Mother-To-Child HIV Prevention Program Faces Funding Cuts

Nevada state officials recently announced plans to terminate funding for the University of Nevada School of Medicine's Nevada Care Program, which largely works to prevent mother-to-child HIV transmission through targeted antiretroviral therapy, the AP/Nevada Appeal reports. According to the officials, Nevada faces a possible $1.2 million funding shortfall for HIV/AIDS-related programs in 2010. Therefore, the state Department of Health and Human Services decided to end the $350,000 Nevada Care Program because of a projected increase in clients and medication costs. According to the AP/Appeal, the Nevada Care Program was the most affected by funding cuts targeting six HIV/AIDS programs in southern Nevada.

According to the AP/Appeal, when the Nevada Care Program began providing MTCT prevention services in 2006, Clark County had four reported HIV cases among infants. However, since the program launched, the county has reported no new cases, although 40 infants have been born to HIV-positive women. Echezona Ezeanolue, director of the Nevada Care Program, said eliminating the program is "a life and death decision that will have consequences far greater than the state has obviously considered." He said, "These children, who would otherwise have a 98% chance to be born without the HIV virus, will more likely be born with the virus." According to Ezeanolue, the budget cuts will not affect the availability of antiretroviral drugs, but they will prevent the program from having office space or medical assistants.

To address the funding shortfall, David Gremse, head of the School of Medicine's pediatric program, recently sent a letter to Rep. Shelley Berkley (D-Nev.) asking for assistance in securing funding to continue the Nevada Care Program. According to Gremse, eliminating funding for the program does not make financial sense. He wrote that by preventing MTCT for 40 infants, the program saved the state $12,124,000 over two years, based on the cost of providing health care for HIV-positive children. According to the AP/Appeal, Berkley has said that she is "hopeful that the financial resources will be found to keep this important program in place" (Harasim, AP/Nevada Appeal, 4/11).


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

FIGO's New Classification Of Causes Of Abnormal Uterine Benefits Patients

Abnormal uterine bleeding (AUB) in women of reproductive age may be due to a wide range of disorders or pathologies. Until now, there has been no universally accepted method for classifying such patients, which has impeded basic science and clinical investigation, as well as the practical, rational, and consistent application of medical and surgical therapy. As the result of a stringent 5-year review process, a multinational group of clinician-investigators with broad experience in the investigation of AUB has now agreed on a classification system to facilitate multi-institutional investigation into the epidemiology, etiology, and treatment of women with acute and chronic AUB. This classification has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO classification system and has been published in the International Journal of Gynecology & Obstetrics.



"There has been general inconsistency in the nomenclature used to describe abnormal uterine bleeding in reproductive aged women, and there is a plethora of potential causes-several of which may coexist in a given individual," commented Malcolm G. Munro, MD, FRCS(c), FACOG, Professor of Obstetrics and Gynecology at the David Geffen School of Medicine, UCLA and Director of Gynecologic Services, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California. "It seems clear that the development of consistent and universally accepted nomenclature is a step toward rectifying this unsatisfactory circumstance. Another requirement is the development of a classification system for the causes of AUB, which can be used by clinicians, investigators, and even patients themselves to facilitate communication, clinical care, and research."



Beginning with workshops in 2005, contributors from more than 17 countries on 6 continents developed the PALM-COEIN (pronounced "pahm-koin") classification system for causes of AUB in the reproductive years. The basic system comprises 9 categories: The first 4 are defined by visually objective structural criteria (PALM: polyp; adenomyosis; leiomyoma; and malignancy and hyperplasia); a second 4 that are unrelated to structural anomalies (COEI: coagulopathy; ovulatory dysfunction; endometrial; and iatrogenic), and a final category reserved for entities that are not yet classified (N). A draft system was developed and revised, distributed for comments, and then discussed at a face-to-face meeting held in association with the 2009 FIGO World Congress in Cape Town, South Africa.



The process was systematically designed to create a practical system that could be used by clinicians in most countries worldwide to classify patients with AUB readily and consistently. Drs. Munro, Critchley and Fraser note that it is "recognized that the system will require periodic modification and occasional substantial revision depending on advances in knowledge and technology, and increasing availability of investigative options across geographic regions. Consequently, we recommend a scheduled systematic review of the system on a regular basis by a permanent committee of an international organization such as FIGO, which has already endorsed the establishment of a suitable ongoing Working Group on Menstrual Disorders."



FIGO Chief Executive Hamid Rushwan said: "There is no existing classification of the causes of these common gynecologic symptoms that allows good communication between practicing clinicians and researchers, and which encourages focus on the optimal approaches to modern management. Therefore, FIGO is pleased to have a role in facilitating the use of this ground-breaking new classification worldwide."



The article is "FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age" by Malcolm G. Munro, Hilary O.D. Critchley, Michael S. Broder, and Ian S. Fraser; for the FIGO Working Group on Menstrual Disorders (doi: 10.1016/j.ijgo.2010.11.011). The editorial is "The FIGO classification of causes of abnormal uterine bleeding" by Malcolm G. Munro, Hilary O.D. Critchley, and Ian S. Fraser (doi: 10.1016/j.ijgo.2011.01.001). Both appear in the International Journal of Gynecology & Obstetrics, Volume 113, Issue 1, April 2011, published by Elsevier.



Source:

International Federation of Gynecology and Obstetrics (FIGO)

Elsevier

Independence Blue Cross Delivers Important Reminder To Women During Cervical Cancer Awareness Month

Each year, about 11,000 women in
the United States are diagnosed with cervical cancer and 3,700 women die
unnecessarily from this disease(1). In recognition of Cervical Cancer
Awareness month, Independence Blue Cross will make more than 100,000 member
outreach calls reminding women that early detection and prevention of
cancer can help save lives.


During this educational campaign, Independence Blue Cross will remind
women ages 21-49 to receive their cervical cancer screening. In addition,
women will be encouraged to discuss the Human Papillomavirus (HPV) vaccine,
which is recommended for girls ages 11-12 and females ages 13-26, with
their health care providers. HPV is one of the most common sexually
transmitted infections in the United States and most cases of cervical
cancer are associated with previous HPV infection.



Independence Blue Cross is providing this important reminder to members
because research shows that receiving the three-shot HPV vaccine and
recommended cervical cancer Pap test screening can decrease the chance of
developing cervical cancer(2). However, it is important to note that even
if a woman has had the HPV vaccine, she will continue to require regular
cervical cancer screening by the Pap test and the HPV test when
recommended(2).



"Our goal is to help keep our members healthy today, tomorrow, and well
into the future," Says Dr. Esther Nash, senior medical director of
Population Health and Wellness at Independence Blue Cross. "Prevention is a
key. Providing important reminders about health screenings and
vaccinations, wellness education, and increasing members' awareness of
consumer tools and resources available to them are just some of the ways
we're helping to keep our members feeling great in '08 and beyond."



About Independence Blue Cross



Independence Blue Cross is a leading health insurer in southeastern
Pennsylvania. Nationwide, Independence Blue Cross and its affiliates
provide coverage to nearly 3.4 million people. For 70 years, Independence
Blue Cross has offered high-quality health care coverage tailored to meet
the changing needs of members, employers, and health care professionals.
Independence Blue Cross's HMO and PPO health care plans have consistently
received the highest ratings from the National Committee for Quality
Assurance.



Independence Blue Cross is an independent licensee of the Blue Cross
and Blue Shield Association. More information about Independence Blue Cross
is available at ibx.


References



1. American Cancer Society, 2007



2. National Cervical Cancer Coalition


Independence Blue Cross

ibx

New HHS Grant Will Allow Pennsylvania HIV, STI Education Program Targeting Hispanic Women To Continue

The Community Prevention Partnership of Berks County, Pa. -- which runs a program that provides Hispanic women with education about HIV and sexually transmitted infection prevention, as well as domestic violence -- has received a five-year, $335,000 grant from HHS to continue the program, the Reading Eagle reports. About 300 local women have completed the program, and the grant will allow an additional 400 women in the city of Reading and surrounding township with the opportunity to participate.

The partnership's executive director, Cheryl Guthier, said that it focuses on the city of Reading because of its large Hispanic population, adding that the program plans to expand to Muhlenberg Township, which also has a large Hispanic population. The Eagle reports that the program's classes help alleviate the stigma that can prevent open discussion about HIV/AIDS and substance abuse. The partnership has offered the program for about eight years, the Eagle reports. The recent grant is the third from HHS' Center for Substance Abuse and Prevention. Guthier said because the grant is for five years, there is "more time to do services in the community, more time to evaluate whether or not it's effective." She added, "It will enable us to reach more people" (Negley, Reading Eagle, 3/10).


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.