Thursday, June 28, 2012

CMA submits document to HHS critiquing contraceptives mandate

(Excerpted from CMA's official comment to HHS concerning its mandate under Obamacare that even conscientiously objecting individuals and organizations must subsidize free sterilization surgeries and potentially embryo-destroying contraceptives nationwide.)
CMA views the mandate as violating constitutional and statutory protections of religious freedom and conscience. The mandate also undermines the American values of free enterprise and, more importantly, respect for human life. Specifically, CMA objects to the rule because:
  1. The mandate is unlawful and unprecedented in that it violates the Religious Freedom Restoration Act (“RFRA”), by imposing a substantial burden on religious beliefs without employing the required least restrictive means, and by failing to demonstrate a compelling governmental interest (since as even the President has attested, contraceptives are readily available to virtually all women).
  2. The mandate is pragmatically unwise, in that it leaves conscientious objectors with no positive options whatsoever. We must either violate deeply held moral convictions, discontinue health care coverage for employees, or pay huge fines that will drain funds otherwise used to help the poor, the sick and other ministry beneficiaries.
  3. The administration offers no accommodation options whatsoever to protect secular conscientious objectors. Such discrimination against non-religious objectors--including employers, employees and insurers--disregards historical conscience protections and standards of medical ethics. Millions of individuals and organizations through the ages have based their moral convictions on secular ethical standards such as the millennia-old Hippocratic oath or the more recent Nuremburg code.
  4. The administration is instituting a decidedly un-American policy that (a) classifies pregnancy as a disease requiring mandated treatment and (b) advocates the prevention of child-bearing as a health care cost savings. Unlike communist leaders in countries like China, Americans historically have not viewed pregnancy as a disease or children as an unwelcome product posing a cost burden.
  5. No payment scheme developed to comply with the mandate can avoid moral compromise for faith-based objectors. If the insurer increases the premiums of objecting employers to recoup the costs of the mandate, faith-based employers clearly are forced to subsidize, through increased premiums, the items considered morally reprehensible. Increasing the premiums only of the non-objecting employers would unfairly force them to pay for the religious objections of objectors, and the government would essentially be compelling the subsidy of a religious group. Either option violates the First Amendment: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof...."
  6. The mandate tramples Fifth Amendment protections ("nor shall private property be taken for public use, without just compensation") by imposing costs on businesses while depriving them of the liberty to profit. The alternative to raising premiums that the administration advocates in the ANPRM--forcing insurers to cover the cost without raising premiums--is indefensible and an assault on the free enterprise system.
  7. While administration officials have talked at length about compromise and promising accommodation of religious liberty, nothing has actually changed in the final rule.

The administration retains only two realistic options regarding this unlawful, unprecedented, unwise and un-American policy: rescind the policy or face defeat in the courts. The CMA encourages rescission of this policy in its entirety.

Read the entire CMA document here.

Read HHS Advance Notice of Proposed Rulemaking

Sign petition to tell HHS to respect religious liberty and stop the coercion

Polling favors health care law repeal; GOP considers next steps

Excerpted from "54 percent Still Favor Repeal of Obama’s Health Care Law," Rasmussen Reports, June 25, 2012--With the U.S. Supreme Court decision on President Obama’s national health care law , most voters still would like to see the law repealed. It’s indicative of how steady support for repeal has been that this week’s finding is identical to how voters felt in the first survey after the law’s passage by Congress in March 2010.

The latest Rasmussen Reports national telephone survey shows that 54 percent of Likely U.S. Voters at least somewhat favor repeal of the health care bill, while 39 percent are at least somewhat opposed. This includes 43 percent who Strongly Favor repeal and 28 percent who are Strongly Opposed to it. (To see survey question wording, click here.)

The survey of 1,000 Likely Voters was conducted on June 23-24, 2012 by Rasmussen Reports. The margin of sampling error is +/- 3 percentage points with a 95 percent level of confidence.

CMA VP for Govt. Relations Jonathan Imbody "This poll suggests a simple lesson: One political party cannot implement its ideas exclusively and unilaterally in a country as diverse and deeply divided as the United States.
This week during a meeting at the U.S. Capitol, I asked a leading Republican physician Member of Congress what the GOP might do on health care reform after the Supreme Court ruled on the health care law. The physician's response included the following:
  • Repeal Obamacare.
  • Listen to and involve Democrats.
  • Take a measured, step-by-step approach.
  • Focus on achieving greater affordability and wider coverage.
  • Provide more consumer choice, less bureaucracy and more decision-making by physicians.
  • Ensure conscience protections for health care professionals.
  • Enact Texas-style tort reform to curb out-of-control malpractice litigation.
  • Reform Medicare and keep it from collapsing with means testing, ensuring care for the poor while giving greater responsibility to individuals who have the means to pay.
  • Emphasize health savings accounts, reasonable deductibles and co-payments as a way to bend the cost curve.
  • Return to a market-driven approach to health care and provide transparency of pricing on medical procedures so consumers can make informed decisions on their care.
  • Provide for patients with pre-existing conditions.
  • Enact tax reform, including lower tax rates, focused deductions and tax parity so that individuals can claim the same tax benefits for health care costs as do businesses.
  • Increase competition by enabling mobility of health insurance plans--allowing patients to transport their plans with them regardless of changes in employers.

CMDA's internal polling suggests that most of our members favor an approach to health care that allocates decision-making power not to the federal government but to physicians and patients, with individual care decisions best made in the examination room rather than in the back rooms of Congress or in the maze of Washington bureaucracy. After the public backlash and lessons of the past two years, the prospects for Congress enacting such an approach appear more likely than ever.

Thursday, June 14, 2012

Morning-after pill labels questioned

Excerpt from "Morning-after pill labels may be wrong about implantation," MSNBC by Pam Belluck. June 6, 2012--Labels inside every box of morning-after pills, drugs widely used to prevent pregnancy after sex, say they may work by blocking fertilized eggs from implanting in a woman’s uterus. Respected medical authorities, including the National Institutes of Health and the Mayo Clinic, have said the same thing on their websites. Such descriptions have become kindling in the fiery debate over abortion and contraception.

Based on the belief that a fertilized egg is a person, some religious groups and conservative politicians say disrupting a fertilized egg’s ability to attach to the uterus is abortion, “the moral equivalent of homicide,” as Dr. Donna Harrison, who directs research for the American Association of Pro-life Obstetricians and Gynecologists, put it.

But an examination by The New York Times has found that the federally approved labels and medical Web sites do not reflect what the science shows. Studies have not established that emergency contraceptive pills prevent fertilized eggs from implanting in the womb, leading scientists say. Rather, the pills delay ovulation, the release of eggs from ovaries that occurs before eggs are fertilized, and some pills also thicken cervical mucus so sperm have trouble swimming. It turns out that the politically charged debate over morning-after pills and abortion, a divisive issue in this election year, is probably rooted in outdated or incorrect scientific guesses about how the pills work. Because they block creation of fertilized eggs, they would not meet abortion opponents’ definition of abortion-inducing drugs. In contrast, RU-486, a medication prescribed for terminating pregnancies, destroys implanted embryos.

While scientific and political disputes over emergency contraception may persist even if labels change, both sides consider the wording on labels central because it summarizes scientific consensus and shapes what medical authorities say. “F.D.A. labeling is important to us, it’s very important,” said Jeanne Monahan, director of the Center for Human Dignity at the Family Research Council, a conservative group.

“I would be relieved if it doesn’t have this effect,” said Richard Doerflinger, associate director of the Secretariat of Pro-Life Activities for the United States Conference of Catholic Bishops. “So far what I see is an unresolved debate and some studies on both sides,” he said, adding that because of difficulties in ethically testing the drugs on women, “it’s not only unresolved, but it may be unresolvable.” Several scientists acknowledged that absolute proof may be elusive; in science, as James Trussell, a longtime emergency contraception researcher at Princeton, said, “You can never prove the negative.” But he and others said the evidence from multiple studies was persuasive. Full story can be found here.

Gene Rudd, MDCMDA Senior Vice President, Gene Rudd, MD: “This article highlights a concern raised by CMDA in the early days when hormonal emergency contraception was first approved for prescription use and later as OTC. The science lacked an adequate explanation of the mechanisms of action. We also knew the science lacked the support for the industry assertions that Plan B was as effective as advertised (e.g., the claim of a 89 percent reduction in pregnancy). Nevertheless, driven by the unproven promise that these products would reduce unintended pregnancies and subsequent abortions, Plan B was approved. The underlying political agenda to remove restraint from reproductive choices overshadowed the science.

“The story began to unwind when actual experience with the product failed to alter healthcare statistics. Even in population studies where these products were freely and readily available, pregnancy and abortion rates were unaffected.1 Some in the pro-abortion community began to doubt the efficacy of the products.
“Keep in mind that these revelations unfolded during a time when healthcare professionals lost their jobs for refusing to prescribe these products because of their abortifacient potential (as confirmed by the FDA product literature). Employers, medical universities, medical academies, courts and even a state governor tried to coerce pharmacists and prescribers into drinking the Kool-Aid.

“CMDA raised these concerns:
  1. If the product is as effective as claimed, it must have a post-fertilization effect, not simply suppression of ovulation.
  2. Deceptive language used to describe the product to patients (e.g., it does not affect an “established pregnancy”), resulted in users being improperly informed -- a breach of medical ethics.
  3. Now, as some claim, if there is no post-fertilization effect, then patients have been and are being sold a bill-of-goods -- an inadequate product. This is also a breach of medical ethics.

“So why is the Times raising this issue now? I suspect it has to do with the “contraception mandate” being promulgated by HHS. The government seeks to force religious organizations to pay for sterilizations and contraceptives against their moral teaching. Many Americans are not aware of how this undermines the right of conscience and religious freedom for all. In addition, the majority of Americans may have trouble identifying and supporting those whose religious teaching prohibit contraceptives. But the dynamics are different for abortion. The country is clearly divided on abortion. To have these products linked to abortion is damaging to their cause.

“Do these products have post-fertilization effect? For Plan B, it remains questionable. For Ella, it almost certainly does. But the pro-abortion community cannot have it both ways. Post-fertilization effects are necessary for these products to be effective as claimed. There is either deception about how they work, or how well they work.

“It is a small skirmish in a greater cultural war. We must beware; those with a social agenda will deceive to achieve.”

Raymond EG, Trussell J, Polis CB. Population effect of increased access to emergency contraceptive pills: a systematic review. Obstet Gynecol. 2007 Jan;109(1):181-8.

CMDA Ethics Statement: Hormonal Birth Control
Is Ella an Abortifacient

Religious Experiences and Brain Shrinkage

Excerpt from "Religious Experiences Shrink Part of the Brain, Scientific American by Andrew Newbert. The article, “Religious factors and hippocampal atrophy in late life,” Amy Owen and colleagues at Duke University represents an important advance in our growing understanding of the relationship between the brain and religion. The study, published March 30 in PLoS One, showed greater atrophy in the hippocampus in individuals who identify with specific religious groups as well as those with no religious affiliation. It is a surprising result, given that many prior studies have shown religion to have potentially beneficial effects on brain function, anxiety and depression.

In this study, Owen et al. used MRI to measure the volume of the hippocampus, a central structure of the limbic system that is involved in emotion as well as in memory formation. They evaluated the MRIs of 268 men and women aged 58 and over, who were originally recruited for the NeuroCognitive Outcomes of Depression in the Elderly study, but who also answered several questions regarding their religious beliefs and affiliation. The study by Owen et al. is unique in that it focuses specifically on religious individuals compared to non-religious individuals. This study also broke down these individuals into those who are born again or who have had life-changing religious experiences.

The results showed significantly greater hippocampal atrophy in individuals reporting a life-changing religious experience. In addition, they found significantly greater hippocampal atrophy among born-again Protestants, Catholics and those with no religious affiliation, compared with Protestants not identifying as born-again.
The authors offer the hypothesis that the greater hippocampal atrophy in selected religious groups might be related to stress. They argue that some individuals in the religious minority, or those who struggle with their beliefs, experience higher levels of stress. This causes a release of stress hormones that are known to depress the volume of the hippocampus over time. This might also explain the fact that both non-religious as well as some religious individuals have smaller hippocampal volumes.

This new study is intriguing and important. It makes us think more about the complexity of the relationship between religion and the brain. This field of scholarship, referred to as neurotheology, can greatly advance our understanding of religion, spirituality and the brain. Continued studies of both the acute and chronic effects of religion on the brain will be highly valuable. For now, we can be certain that religion affects the brain--we just are not certain how. Full story can be found here.

William Cheshire, MDCMDA Ethics Committee Chair and Academic Neurologist, William P. Cheshire, MD, MA: "Before brain scans, we evaluated other people's thoughts and beliefs by their words and actions. We came to understand our fellow human beings through the telling of stories, the sharing of struggles and the occasional smile.

"Enter the brain scan. High resolution neuroimaging can now peer into the living brain and chart neural activity corresponding to virtually any aspect of thought or behavior. Whether in illness or health, interpretations of human nature have shifted focus from the art of conversation to the science of the imaging console. In connecting these complementary perspectives, each of which is informative and valid, it is necessary to evaluate what the evidence does and does not show.

"The study by Owen et al. demonstrates interesting correlations but not causation. Whereas they hypothesize that religious experiences are stressful and therefore deleterious for hippocampal volume, they did not ask whether their subjects’ religious experiences were good or bad or if they had experienced nonreligious life stress. The lack of correlation of hippocampal volume changes with the study’s stress measure, moreover, seems to contradict their conclusion.

"Another interpretation of the data could be that individuals who endured stressful life experiences and recovered well enough to gain access to the research study were more likely to have found meaning, consolation and compassionate support through religious experience and involvement in a vibrant religious community. Similarly, if a study were to find that people with a history of illness were more likely to have visited a medical clinic, it would have to ask further questions to distinguish cause from cure.
"Investigations into neurotheology are worthwhile, and there is much to be learned about the spiritual aspect of the brain. While I agree with Newberg’s analysis, I find the provocative title somewhat disturbing, since it may invite stereotyping. As has always been true for instruments that measure the human cranium, we should be cautious to avoid prejudicial opinions of others based on assumptions about physical differences."