Thursday, August 30, 2012

GOP platform addresses abortion and marriage

Excerpted from "GOP OKs platform barring abortions, gay marriage," CBS News, August 29, 2012--Republicans emphatically approved a toughly worded party platform at their national convention Tuesday that would ban all abortions and gay marriages, reshape Medicare into a voucher-like program and cut taxes to energize the economy and create jobs.

The platform affirms the rights of states and the federal government not to recognize same-sex marriage. It backs a constitutional amendment defining marriage as the union of one man and one woman.

The party states that "the unborn child has a fundamental individual right to life which cannot be infringed." It opposes using public revenues to promote or perform abortion or to fund organizations that perform or advocate abortions. It says the party will not fund or subsidize healthcare that includes abortion coverage.

Editor's note: CMDA, which takes no position on political candidates, has signed onto letters to both political party platform committees urging platform planks that encourage respect for conscience rights and religious liberty.

Gene Rudd, MDCMDA Executive Vice President Gene Rudd, MD: “As the editorial note above states, CMDA is non partisan. Though we are sometimes accused of taking sides when we advocate a particular issue, we do not think or intentionally act in ways that advance a candidate or party.

“However, while we do not support candidates or parties, we are delighted when candidates or parties support our positions. Such is the case with these party planks on abortion and same-sex marriage. CMDA holds that humans are made in the image of God, sacred from their earliest beginnings and deserving of our protection. CMDA also holds that homosexual behavior and same-sex marriage are outside God’s design for us. We can also cite the negative health and social implications of failing to heed God’s command.

“Would that all parties and candidates hold these positions. To that end, CMDA continues to be a voice for our members to our culture, particularly to our leaders. May God grant us favor.”

CMDA Ethics Statement: Human Sexuality
CMDA Ethics Statement: Homosexuality
CMDA Ethics Statement: Abortion

Global Fund fights AIDS, TB and malaria while reforming itself

Excerpted from "Nigeria: Nation Receives U.S. $225 Million Grant for HIV, TB, Malaria," AllAfrica, August 26, 2012-- The Minister of Health, Professor Onyebuchi Chukwu in Abuja, on behalf of the federal government received $225 million from the Global Fund to fight the three pandemic diseases: HIV/AIDS, tuberculosis and malaria.

Global Fund is an international financing institution dedicated to attracting and disbursing resources to tackle these diseases. "The special thing about these grants we are signing today is that the Global Fund board, to my knowledge, for the first time approved the full funding amount available which allows us to include an additional $50 million for bed nets, upon further funding commitments by the government of Nigeria."

The health minister said data from the country's 2010 malaria indicator survey show that Nigeria is working hard on the new initiatives on controlling and eliminating malaria.

He stated, "This money coming in is going to contribute significantly to the total funding of malaria elimination program in Nigeria. The proposal as approved by the Global Fund...should be implemented with all due diligence. Nigerians should look forward to significantly reducing the burden of malaria before 2015."

David Stevens, MD, MA (Ethics)CMA VP for Government Relations, Jonathan Imbody: "The United States has provided the lion's share of funding for the internationally managed Global Fund, to the consternation of many in the faith-based medical and relief communities, who point out that precious little of that money has ended up in the hands of faith-based health groups overseas.

"I recently met privately with the Global Fund's new General Manager, Gabriel Jaramillo, for a candid conversation about this problem. I noted that the World Health Organization released a report revealing that between 30 and 70 percent of the health infrastructure in Africa is currently owned by faith-based organizations. The Gallup World Poll asked sub-Saharan Africans in 19 countries about their confidence in eight social and political institutions. Overall across the continent, they were most likely to say they were confident in the religious organizations (76 percent) in their countries. Yet less than five percent of Global Fund grants ever reach faith-based health organizations.

"We discussed potential reforms including more active oversight by the Global Fund of what goes on at the country level. Based on experience with discrimination against faith-based organizations in U.S. government agency grants for AIDS work, I noted the benefit of previewing grant opportunity requirements for anti-faith discrimination issues.

"The Global Fund leadership has embarked on an aggressive program of reform of both personnel and policies. Former U.S. Dept. of Health and Human Services (HHS) Secretary Mike Leavitt, with whom I also met recently to discuss conscience rights and religious liberty issues, has led a commission that has provided the Global Fund with recommendations to transform the organization, including reforms related to transparency, accountability and communication."

Learn more about the Global Fund at
Share your opinion on how to reform the Global Fund by sending an email to:
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  1. Your name and institution
  2. Your Global Fund constituency and home country
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CMDA Ethics Statement: AIDS

Administration pushes HHS lawsuits beyond election

Excerpted from "Wheaton HHS lawsuit dismissed," World magazine, July 12, 2012-- A last minute policy change absolving a Christian college from fines has enabled the federal government to avoid another legal challenge to its mandate for contraception coverage. On Friday, a federal judge in Washington D.C. dismissed a suit brought by Wheaton College against the government. The judge ruled the evangelical school in Illinois no longer had grounds to challenge the requirement that it cover contraceptive and abortifacient drugs under student and faculty health insurance policies.

As part of the 2010 healthcare reforms, the U.S. Department of Health and Human Services (HHS) announced last year that all employers would be required to cover contraceptive and abortifacient drugs. The rules offered an exemption to churches but not other religious employers, including schools and social service agencies. The mandate caused an uproar among Catholic and evangelical Protestant institutions, which vowed to fight the new rules. In an effort to delay the confrontation, the government offered religious employers a one-year reprieve, giving them until August 2013 to comply.

But Wheaton could not take advantage of the yearlong "safe harbor" because it had unknowingly offered coverage for abortifacient drugs Ella and Plan B, commonly referred to as "morning after" pills, under previous insurance policies. Without the reprieve, Wheaton faced thousands of dollars in fines every day. But with the latest policy change, the government succeeded in postponing Wheaton's suit for at least a year.
"The government has now re-written the 'safe harbor' guidelines three times in seven months, and is evidently in no hurry to defend the HHS mandate in open court," said Kyle Duncan, general counsel for the Becket Fund for Religious Liberty, which represents Wheaton. "By moving the goalposts yet again, the government managed to get Wheaton's lawsuit dismissed on purely technical grounds. This leaves unresolved the question of religious liberty at the heart of the lawsuit."

David Stevens, MD, MA (Ethics)CMDA CEO David Stevens, MD, MA (Ethics): "Trampling on right of conscience and religious liberty does not play well in the news in an election year, so I’m not surprised that the government kicked the ball down the field. Unfortunately, there has been no reversal in the government's core belief that religion is a private matter to be relegated behind the walls of churches, synagogues and mosques. The administration's position in this mandate and in other policies and court cases betray an ideology that would leave religion no place in the public square. History reminds us what happens when an individual's responsibility to the State is made to trump responsibility to God.

"It is critical to understand that the contraceptive mandate is not the big issue. The greatest danger is that if the new, exceedingly narrow definition of who qualifies as 'religious enough' to conscientiously object, enshrined for the first time in this regulation, is not completely excised it will metastasize throughout all levels of government. We will then have completely lost our 'freedom of religion' and replaced this most basic of all rights with merely an anemic 'freedom to worship.' That will have a greater impact than when the courts radically redefined the meaning of the Establishment Clause to an absolute 'separation of church and state' and began to push religion out of virtually every publicly funded institution and arena.

"We dare not let this new definition stand. Our forefathers fought and died to give us our religious freedom. Like them, we must summon our boldness and courage to resist this tyranny, lest future generations consider us at best foolish and at worst cowards."

Visit CMA's Freedom2Care website, which provides daily news updates, legislative resources, background documents on conscience rights and religious freedom and action items including petitions to government officials.

CMDA Ethics Statment: Right of Conscience
Right of Conscience Resource Page

Thursday, August 23, 2012

Berating, Belittling and Behaving Badly

Excerpted from "The Bullying Culture of Medical School ," New York Times, by Pauline W. Chen, MD August 9, 2012--For 30 years, medical educators have known that becoming a doctor requires more than an endless array of standardized exams, long hours on the wards and years spent in training. For many medical students, verbal and physical harassment and intimidation are part of the exhausting process too. It was a pediatrician, a pioneer in work with abused children, who first noted the problem. And early studies found that abuse of medical students was most pronounced in the third year of medical school, when students began working one on one or in small teams with senior physicians and residents in the hospital.

The first surveys found that as many as 85 percent of students felt they had been abused during their third year. They described mistreatment that ranged from being yelled at and told they were "worthless" or "the stupidest medical student," to being threatened with bad grades or a ruined career and even getting hit, pushed or made the target of a thrown medical tool. Nonetheless, many of these researchers believed that such mistreatment could be eliminated, or at least significantly mitigated, if each medical school acknowledged the behavior, then created institutional anti-harassment policies, grievance committees and educational, training and counseling programs to break the abuse cycle. One medical school became a leader in adopting such changes. Starting in 1995, educators at the David Geffen School of Medicine at the University of California, Los Angeles, began instituting a series of school wide reforms. They adopted policies to reduce abuse and promote prevention; established a Gender and Power Abuse Committee; mandated lectures, workshops and training sessions for students, residents and faculty members; and created an office to accept confidential reports, investigate and then address allegations of mistreatment. To gauge the effectiveness of these initiatives, the school also began asking all students at the end of their third year to complete a five-question survey on whether they felt they had been mistreated over the course of the year. The school has just published the sobering results of the surveys over the last 13 years. While there appears to have been a slight drop in the numbers of students who report experiencing mistreatment, more than half of all medical students still said that they had been intimidated or physically or verbally harassed.

While their findings are disheartening, Joyce M. Fried, lead author of the paper and assistant dean and chairwoman of the Gender and Power Abuse Committee at the medical school and her colleagues continue to believe that medical student mistreatment can be significantly reduced - but only if all medical schools come together to work on the issue. "We're talking about the really hard task of changing a culture, and that has to be done on a national level," Ms. Fried said. Such an effort would include shared training programs, common policies regarding mistreatment and greater transparency about the mistreatment that currently exists in medical schools. Full story can be found here.

J. Scott Ries, MD CMDA’s National Director of Campus & Community Ministries J. Scott Ries, MD: "They called him 'Mad-Dog Madden' (last name changed to protect the guilty, but the moniker is sadly accurate) and I was fortunate enough to be assigned to his 'A-team' surgery rotation as a brand new, first-month-on-the-wards third year medical student. Mad-Dog was indeed a talented, respected and experienced surgeon. However, he was infamous for chewing up and spitting out students and residents faster than yesterday’s rawhide bone.

"One of my first OR experiences witnessed Mad-Dog berating a PGY-2 resident so badly (including dangerously throwing instruments around the OR) that the resident decided to drop out of his surgical residency altogether, even though he had 'made the cut' from his intern year to a resident. I believe he is a radiologist now.

"Though I escaped Mad-Dog’s rotation without a personal assault myself, many of our students even today are not so fortunate. One of our CMDA students posted last month on Facebook a quote from his attending directed toward him on the first day of his surgery rotation, 'Is that medical student standing in the corner going to actually do something or is he going to continue standing there like a retard?'

"I certainly would agree with Dr. Chen that this mistreatment of learners should be curtailed. But in what ways can we as followers of Christ personally help mitigate the decades-old belittling traditions? Here are three things for us to individually consider, whether we are in an academic center or a community practice.
  1. Self-check. Do I have a tendency toward critical comments of my staff, colleagues…and especially students and residents when they fall short of my expectations? Are my responses generally flavored by harsh criticism or by the fruit of the Spirit? (Galatians 5:22-23)

  2. Affirm others. Most all of us learn best when instructed in a gracious manner. Do I provide necessary instruction in what went wrong while not letting my student forget what they have done right? Do I affirm while correcting?

  3. Set the standard. The buck stops here. Will I set the tone by how I treat my students and staff? Do I have the moral courage to confront a colleague about their demeaning treatment of others in effort to be a part of the restoration of the standard?

"A seemingly small change of attitude on our part can have a profound impact on many, multiplying a culture of respect and grace over one of fear and bullying. We have a great opportunity to show a better way, regardless of how things were 'when I was a student.'”

Campus Ministries
Life Skills for Students and Residents

Sick Kids to Be Given 'Futile' Treatment?

Excerpted from "Deeply Held Religious Beliefs Prompting Sick Kids to Be Given 'Futile' Treatment," Science Daily, by Andrew Hough. August 13, 2012--Parental hopes of a "miraculous intervention," prompted by deeply held religious beliefs, are leading to very sick children being subjected to futile care and needless suffering, suggests a small study in the Journal of Medical Ethics. The authors, who comprise children's intensive care doctors and a hospital chaplain, emphasize that religious beliefs provide vital support to many parents whose children are seriously ill, as well as to the staff who care for them. But they have become concerned that deeply held beliefs are increasingly leading parents to insist on the continuation of aggressive treatment that ultimately is not in the best interests of the sick child. It is time to review the current ethics and legality of these cases, they say.

They base their conclusions on a review of 203 cases which involved end-of-life decisions over a three year period. In 186 of these cases, agreement was reached between the parents and healthcare professionals about withdrawing aggressive, but ultimately futile, treatment. But in the remaining 17 cases, extended discussions with the medical team and local support had failed to resolve differences of opinion with the parents over the best way to continue to care for the very sick child in question. The parents had insisted on continuing full active medical treatment, while doctors had advocated withdrawing or withholding further intensive care on the basis of the overwhelming medical evidence. The authors emphasize that parental reluctance to allow treatment to be withdrawn is "completely understandable as [they] are defenders of their children's rights, and indeed life." But they argue that when children are too young to be able to actively subscribe to their parents' religious beliefs, a default position in which parental religion is not the determining factor might be more appropriate. They cite Article 3 of the Human Rights Act, which aims to ensure that no one is subjected to torture or inhumane or degrading treatment or punishment. "Spending a lifetime attached to a mechanical ventilator, having every bodily function supervised and sanitized by a care giver or relative, leaving no dignity or privacy to the child and then adult, has been argued as inhumane," they argue.

And they conclude: "We suggest it is time to reconsider current ethical and legal structures and facilitate rapid default access to courts in such situations when the best interests of the child are compromised in expectation of the miraculous." In an accompanying commentary, the journal's editor Professor Julian Savulescu advocates: "Treatment limitation decisions are best made, not in the alleged interests of patients, but on distributive justice grounds." In a publicly funded system with limited resources, these should be given to those whose lives could be saved rather than to those who are very unlikely to survive, he argues. "Faced with the choice between providing an intensive care bed to a [severely brain damaged] child and one who has been at school and was hit by a cricket ball and will return to normal life, we should provide the bed to the child hit by the cricket ball," he writes. In further commentaries, Dr Steve Clarke of the Institute for Science and Ethics maintains that doctors should engage with devout parents on their own terms. "Devout parents, who are hoping for a miracle, may be able to be persuaded, by the lights of their own personal...religious beliefs, that waiting indefinite periods of time for a miracle to occur while a child is suffering, and while scarce medical equipment is being denied to other children, is not the right thing to do," he writes. Leading ethicist Dr Mark Sheehan argues that these ethical dilemmas are not confined to fervent religious belief, and to polarize the issue as medicine versus religion is unproductive, and something of a "red herring." Referring to the title of the paper Charles Foster of the University of Oxford, suggests that the authors have asked the wrong question. "The legal and ethical orthodoxy is that no beliefs, religious or secular, should be allowed to stonewall the best interests of the child," he writes. Full story can be found here.

David Stevens, MD, MA (Ethics) CMDA CEO David Stevens, MD, MA (Ethics): "The Science Daily significantly toned down their reporting of the article in The Journal of Medical Ethics (the same journal that recently published an article advocating ‘post-birth abortion’, i.e. infanticide). The original paper was so anti-religious and anti-parental rights that it generated newspaper headlines around the world castigating the religious for ‘torturing’ their children.

"The article espouses a stark utilitarian ethic claiming, without supporting data, that other children are denied lifesaving interventions because of these parent’s decisions. They also argue that parent’s religious beliefs should have no sway in the care of their children since the children cannot 'subscribe' to any religious view. Therefore, according to their reasoning, a secularist worldview should guide the state in making life and death decision for severely disabled children.

"All of us have taken care of patients where hope or denial outweighs their reasoning in making healthcare decisions, but there are better alternatives than steamrolling over their religious beliefs, attempting emotional blackmail or denying parental rights. Alternatives include:
  • Transfer care to a physician who better understands and is more supportive of the parent’s religious persuasion. Parents are more likely to accept their advice.
  • Allow time for parents to work through their denial and time for the healthcare team to build rapport and fully explain their assessment.
  • Build trust. Marshall the family’s pastor, priest, rabbi or other religious leader whom the parents already trust. They may help the family work through the decision.

"In reality, the authors demand a new paternalism rather than autonomy. Doctors and ultimately the state would become the final arbitrator over life and health. They dangerously redefine parental beneficence as maleficence. While they claim they are for justice, they single out those with religious beliefs to be stripped of it.

"Sadly, this is another example of having more 'ethicists' than ever before but being less ethical.”

Standards4Life: Faith and Health

Genetically engineering babies

Excerpted from "Genetically engineering 'ethical' babies is a moral obligation, says Oxford professor," The Telegraph. August 16, 2012--Professor Julian Savulescu said that creating so-called designer babies could be considered a "moral obligation" as it makes them grow up into "ethically better children." The expert in practical ethics said that we should actively give parents the choice to screen out personality flaws in their children as it meant they were then less likely to "harm themselves and others". The academic, who is also editor-in-chief of the Journal of Medical Ethics, made his comments in an article in the latest edition of Reader's Digest.

He explained that we are now in the middle of a genetic revolution and that although screening, for all but a few conditions, remains illegal it should be welcomed. He said that science is increasingly discovering that genes have a significant influence on personality – with certain genetic markers in embryo suggesting future characteristics. By screening in and screening out certain genes in the embryos, it should be possible to influence how a child turns out. In the end, he said that "rational design" would help lead to a better, more intelligent and less violent society in the future. So where genetic selection aims to bring out a trait that clearly benefits an individual and society, we should allow parents the choice. To do otherwise is to consign those who come after us to the ball and chain of our squeamishness and irrationality. Indeed, when it comes to screening out personality flaws, such as potential alcoholism, psychopathy and disposition to violence, you could argue that people have a moral obligation to select ethically better children.

Rational design is just a natural extension of this, he said. He said that unlike the eugenics movements, which fell out of favor when it was adopted by the Nazis, the system would be voluntary and allow parents to choose the characteristics of their children. "We’re routinely screening embryos and fetuses for conditions such as cystic fibrosis and Down’s syndrome, and there’s little public outcry," he said. "What’s more, few people protested at the decisions in the mid- 2000s to allow couples to test embryos for inherited bowel and breast cancer genes, and this pushes us a lot close to creating designer humans." Whether we like it or not, the future of humanity is in our hands now. Rather than fearing genetics, we should embrace it. We can do better than chance. Click here to read full story.

Andre Van Mol, MDCMDA Member, Moral Revolution Board member and “Ask the Doc” blogger Andre' Van Mol, MD: "Eugenics/master races are false promises that consistently lead to cruelty. Genes determine predisposition, not destiny. Heritability is not inevitability. Genotype is not fixed to a single phenotype. Genetic contributions to behavior are best categorized as small by those who deal in this field.1 The professor’s premise is replete with logical fallacies and misunderstanding of behavioral genetics, yet he is willing to 'screen out' pre-born children based on it. Notice, 'screen out,' not treat. Eugenics usually means genocide.

"So what happens when the currently or allegedly 'undesirable' genes turn out later to have had some considerable 'up' side, even a group survival advantage? Bummer for us. We already abort 90 percent of Down Syndrome children.2 Are we kinder and gentler for it? Does compassion spring forth from abolition of imperfection? And what happens when your or my imperfection is next on the chopping block? Second bummer.

"A previous article in the press spoke glowingly of prenatal screening possibilities for 3,500 problems.3 Notice once again, they don't mean screening to treat, but screening to terminate. A Dutch palliative care specialist Dr Ben Zylicz noted that once you allow physician-assisted suicide/euthanasia, you eliminate the motivation to solve difficult problems, and then learning stops.4 Why bother when the 'problem' is 'solved' for $50 worth of termination medicine? Likewise, selecting out supposedly inferior preborn children won't do much to spur perinatology, neonatology and pediatrics on to greatness in working out difficult problems. This is the road to nowhere."
1. Dar-Nimrod, I., & Heine, S.J. (2011b). Some thoughts on essence placeholders, interactionism, and heritability: Reply to Haslam (2011) and Turkheimer (2011). Psychological Bulletin, 137(5), 829-833.
2. Mansfield, C, et al. Termination rates after prenatal diagnosis of Down syndrome, spina bifida, anencephaly, and Turner and Klinefelter syndromes: a systematic literature review.Prenat Diagn. 1999 Sep;19(9):808-12.
3. Adams, A. Unborn babies could be tested for 3,500 genetic faults. 06 Jun 2012.
4. Hugh, M. “Better palliative care could cut euthanasia” Hugh Matthews, BMJ 1998;317:1613 (12 December) News.

A History of Eugenics
Eugenics Through Abortion
CMDA Ethics Statement: Eugenics and Enhancement

Thursday, August 9, 2012

Teenagers can be corrupted by Hollywood

Excerpted from "Teenagers 'can be corrupted' by Hollywood sex scenes," The Telegraph, by Andrew Hough. July 18, 2012--Watching sex scenes in Hollywood films can make children more promiscuous and sexually active from a younger age, a new study has suggested. Psychologists concluded that teenagers exposed to more sex on screen in popular films are likely to have sexual relations with more people and without using condoms. The study, based on nearly 700 popular films, found that watching love scenes could "fundamentally influence" a teenager's personality. The researchers from Dartmouth College in New Hampshire concluded youngsters were more prone to take risks in their future relationships. They also concluded that for every hour of exposure to sexual content on-screen, participants were more than five times more likely to lose their virginity within six years.

"Adolescents who are exposed to more sexual content in movies start having sex at younger ages, have more sexual partners, and are less likely to use condoms with casual sexual partners," said Dr. Ross O'Hara, who led the study. "This study, and its confluence with other work, strongly suggests that parents need to restrict their children from seeing sexual content in movies at young ages." The findings provided a link between exposure to sex on screen and sexual behavior. Participants also said they tried to mimic love scenes they had seen on screen in the real world. The researchers also assessed the sexual content of 684 of the biggest grossing films released between 1998 and 2004. They found some of the most popular films from that time included scenes of a sexual nature, ranging from sexual scenes to heavy kissing. More than a third of G-rated movies were found to contain "sexual content" compared to more than half of PG films and four in five R-rated movies.

Dr. O'Hara said that the combination of sexually explicit films and adolescence had a profound impact on their behavior. He found that the “wild hormonal surges of adolescence” made cautious thinking amongst teenagers more difficult. He said that while more than half of adolescents use movies and the media as their “greatest source of sexual information” many could not differentiate between what they saw on a screen and what they confronted in real life. Dr. O'Hara added: “These movies appear to fundamentally influence their personality through changes in sensation-seeking, which has far-reaching implications for all of their risk-taking behaviors.” Full story can be found here.

Andre Van Mol, MDCMDA Member and Moral Revolution Board member and “Ask the Doc” blogger Andre' Van Mol, MD: "The longitudinal study of U.S. adolescents by O’Hara, et al., found that higher movie sexual exposure (MSE) predicted, both indirectly and directly, earlier age of sexual debut, more partners, more frequent unprotected intercourse and a rise in the normal increase in teen sensation seeking for both genders. They calculated a five-fold increased risk and found that the risky sexual behavior persisted into adulthood. The authors cited previous work ‘positing that the effect of media on sexual behavior is driven by acquisition and activation of sexual scripts . . . [which] provide behavioral options in social situations.’ No surprises there.

"Be careful little eyes what you see, or as scripture instructs in Ecclesiastes 1:8, '…the eye is not satisfied with seeing, nor the ear filled with hearing' and in Matthew 6:22, 'The lamp of the body is the eye…' (ESV, ASV). Exposure is not inert.

"Media relentlessly comes after our children with its ‘sexual script.’ Simple avoidance will not do. Christian parents need to be proactive. Open communication with our children about sex needs to occur early, clearly and often. Explain the dos, hows and whys more than just the don’ts. We shouldn’t assume understanding based on terse answers and must provide a whole-picture approach. God gave us a sex drive, and our job is its management. We can provide God-and-life-affirming scripts through Scripture, a Christian worldview and our own testimony, remembering Revelations 19:10, ‘…For the testimony of Jesus is the spirit of prophecy’ (ESV).

"My wife and I try to limit our children to pre-recorded movies and programming, but when surprised by inappropriate content, I tend to immediately ask my children, ‘What is the director wanting you to believe?’ and follow that with a redirecting question such as ‘What is the truth?’ or ‘What does God think about that?’
"A further resource to consider is Dr. Joe McIlhaney’s book Hooked, which is full of great information and guidance on the topic of casual sex and our children.”

CMDA Ethics Statement: Human Sexuality
U.S. Pediatricians Decry Media's Portrayal of Sex

Are we running out of doctors?

Excerpt from "Is America running out of doctors?," The Week. July 31, 2012--The primary objective of President Obama's overhaul of the healthcare system is to extend coverage to the tens of millions of Americans currently without insurance. "But coverage will not necessarily translate into care," because there may not be enough doctors to treat everyone, say Annie Lowrey and Robert Pear at The New York Times. The U.S. is already facing a severe shortage of doctors, particularly in rural areas of the country, and the problem is only expected to get worse as more Americans gain insurance.

The pool of new doctors hasn't kept pace with several factors boosting the number of people seeking care: population growth, the Obamacare expansion and an aging Baby Boomer generation that requires additional medical attention. Furthermore, the U.S. is facing an acute shortage of primary care physicians, leaving many patients without access to general practitioners, pediatricians, family doctors and other providers of basic medical care. "A shortage of primary care and other physicians could mean more-limited access to healthcare and longer wait times for patients," say Suzanne Sataline and Shirley S. Wang at The Wall Street Journal. The shortage will likely most affect those on Medicaid, the insurance program for the poor and disabled, since Medicaid's rolls are expected to expand significantly under Obamacare. The shortfall of doctors could reach 100,000 by 2025.

Obamacare contains modest provisions increasing Medicaid primary care payments and incentives for medical students to become primary care physicians. The number of primary care residencies climbed 20 percent between 2009 and 2011, but it's still not enough. Communities have been encouraged to create more walk-in clinics, and to allow more nurses to provide primary care. In addition, the U.S. could alter its immigration policies to attract doctors from overseas, "which should be very easy to do since doctors in the U.S. earn on average about twice as much as their comparably trained counterparts in Western Europe and Canada," says Dean Baker at Business Insider. Click here to read full story.

David Stevens, MD, MA (Ethics)CMDA CEO David Stevens, MD, MA (Ethics): "Though the facts in the article are not completely correct, the problem is obvious. There may be one million licensed physicians in the U.S., but according to a 2010 report from the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality, only '624,434 physicians in the United States…spend the majority of their time in direct patient care.' Less than one-third of these physicians are in primary care, yet they saw 51.3 percent of the office visits that year.

"A number of contributing factors to the primary care shortage are not mentioned. The high cost of medical training and growing graduate debt loads puts increasing pressure on students to select more lucrative specialties. More and more physicians in primary care refuse to take Medicaid and Medicare patients due to meager reimbursements, further exacerbating the problem of too many patients and too few doctors. Faith-based physicians are more likely to work in underserved rural and urban environments, but attacks on healthcare right of conscience could severely diminish their numbers.

"However, we do see some positive signs. The number of osteopathic schools doubled from 17 to 34 since 1997 and the number of graduates is increasing by more than 7 percent each year. While more than 50 percent of osteopathic graduates go into primary care, less than 8 percent of allopathic medical students went into family medicine in 2011. The number of allopathic graduates entering primary care decreased by 51 percent between 1997 and 2010. That showed some modest improvement in 2011. There were 100 more family medicine residency positions in 2011 than in 2010 and a net increase of 176 U.S. graduates took these positions. Unfortunately, that growth hardly begins to meet projected needs.

"What should be done? Since 95 percent of family medicine graduates stay in their specialty compared to only 21 percent of general internal medicine residents, we need to focus on increasing the number of family practitioners. It is going to take money to do it because money created the problem. Reimbursement rates may need to significantly increase if the patient-centered medical home is going to become a reality. The mean salary for a family practice doctor has increased modestly to $175,596, great disparities still exist between doctors involved in primary care and other specialties.

"A better solution would be to create a loan forgiveness program that could be even more successful in increasing the number of physicians in primary care. Federal Qualified Clinics (FQC) already have a government program that can forgive up to $30,000 dollars a year in debt for physicians who practice in their clinics. An increasing number of young doctors planning to go into medical missions are practicing at FQCs to pay off their debts before serving. Why not do the same for U.S. graduates staying in primary care? It would be a great incentive and could level the playing field with other specialties.

"Continuing to exacerbate the brain drain from less developed countries by recruiting their physicians is not the answer. More physicians, nurse practitioners and physician assistants need to be trained to meet the looming need. The time to start is now, especially since it will take seven years before physicians enter practice even after new schools are created or medical school classes expanded. I’m excited that some of the projected need will be met from the five Christian osteopathic schools (William Carey – Mississippi, Campbell University – North Carolina, Liberty University – North Carolina, King College – Tennessee and Indiana Wesleyan – Kansas) that have opened or are being planned. Each of these schools is focusing on creating primary care physicians. Together, these five schools will turn out 750 graduates per year. With every problem, there is an opportunity. This crisis is already spawning a greater Christian influence in medicine."

Affordable Care Act Impact on Doctors and Patients (PDF)
CDD STAT - Stewart Harris Professor of Constitutional Law at Appalachian School of Law
CDD STAT - Richard Doerflinger Associate Director of Pro-Life Activities at the United States Conference of Catholic Bishops