Thursday, June 27, 2013

SCOTUS strikes "prostitution pledge" requirement for AIDS, human trafficking grants

Excerpted from "Supreme Court says law can’t dictate anti-AIDS groups’ speech, Washington Post, June 20, 2013 - The Supreme Court ruled Thursday, June 20 that it is a violation of the First Amendment for the federal government to force groups to endorse the government’s views opposing prostitution in order to receive funding to combat AIDS overseas. The justices ruled 6 to 2 that a requirement in a multibillion-dollar anti-AIDS program withholding money from organizations that do not have a policy “explicitly opposing prostitution and sex trafficking” violates their free-speech rights.
“This case is not about the government’s ability to enlist the assistance of those with whom it already agrees,” wrote Chief Justice John G. Roberts Jr. “It is about compelling a grant recipient to adopt a particular belief as a condition of funding.”

The provision at the center of the court’s ruling Thursday is of a 2003 law under which the United States is spending $60 billion to combat infectious diseases worldwide. It forbade any of the money being used to “promote or advocate the legalization or practice of prostitution or sex trafficking,” which are ways the diseases can be spread.

Justices Antonin Scalia and Clarence Thomas dissented. Scalia said the government was not coercing speech but simply acquiring partners who share its beliefs.

“The First Amendment does not mandate a viewpoint-neutral government,” Scalia wrote. “The government may enlist the assistance of those who believe in its ideas to carry them to fruition; and it need not enlist for that purpose those who oppose or do not support the ideas. That seems to me a matter of the most common sense.”


Jonathan ImbodyCMA Vice President for Government Relations Jonathan Imbody: "Some colleagues who focus on religious liberty issues had filed briefs opposing the 'prostitution pledge' provision. They reasoned that its allowance would let the government unconstitutionally dictate the ideological views of any organization that receives government funding. These groups understandably feared strengthening the Obama administration's attacks on religious liberty, buttressing local governments' attacks on pregnancy centers through speech requirements, and squeezing out campus student groups that decline to conform to university dogma on social issues.

"Other religious liberty colleagues, such as the American Center for Law and Justice, reasoned--rightly, in my view--that requiring grantees to supply proof of opposition to prostitution was an eminently reasonable requirement to further the goals of a government health program that hinges on stopping prostitution. The anti-prostitution requirement in this view, does not restrict the free speech of anyone--it just keeps the government from paying for speech opposed to the goals of this particular program, which provides funding on a completely voluntary basis.

"Whatever one might conclude regarding the theoretical impact of this case on religious liberty, what remains undeniable and real are the immediate harms, from a pro-life, anti-trafficking and anti-AIDS perspective, that result from this ruling:
  • more money to groups that see prostitution as legitimate 'sex work' rather than as an evil to be eradicated--including pro-abortion and pornography groups (like DKT International, which had filed a similar suit);

  • a blow to efforts to eradicate prostitution, along with prostitution's threat to public health and its degradation of and violence against women and children;

  • the prospect of yet more forced and elective abortions, resulting from relying on condom distribution programs and unionization of prostituted women and children rather than rescuing them out of sex trafficking and other forms of prostitution."
Read the complete CMA/Freedom2Care blog posting on the decision
Continuing Education for Human Trafficking - A Primer for the Healthcare Professional
Prostitution pledge sign on letter to President Bush

High court rules on two cases on same-sex marriage

Excerpted from "Supreme Court strikes down Defense of Marriage Act," Washington Post, June 26, 2013--The Supreme Court on Wednesday struck down as unconstitutional the 1996 Defense of Marriage Act that denies federal benefits to same-sex couples who are legally married in the states where they reside. The decision was 5 to 4, with Justice Anthony M. Kennedy joining the court’s liberals to form the majority. It did not address the question of whether there was a constitutional right to same-sex marriages.

Excerpted from "Supreme Court clears way for same-sex marriage in California," Washington Post, June 26, 2013 - The Supreme Court cleared the way Wednesday for same-sex marriages in California, declining to rule on the state’s Proposition 8, which defined marriage as between one man and one woman. The court ruled 5 to 4 that those who appealed a decision throwing out the constitutional amendment did not have legal standing to proceed. Thus, the Supreme Court did not rule on the merits of the case.


David Stevens, MD, MA (Ethics)CMDA CEO David Stevens, MD, MA (Ethics): (excerpted from CMA news release): "We as doctors have long recognized that the most important function of marriage is to protect the needs of children--not simply to fulfill the emotional desires of adults.

"The best research shows that children consistently experience the most positive outcomes with a mom and a dad and too often experience negative outcomes in same-sex households1. When some research has attempted to convince us otherwise, rigorous examination of those studies has uncovered fatal research flaws, most likely the result of presuppositions and political agendas that undermined objectivity2.

"Some activists, both in the courts and in public policy, appear intent on forcing people of faith to bow to a new and radical viewpoint that ignores our faith convictions and the testimony of millennia regarding marriage. Such pressure inevitably threatens religious freedom, as same-sex relationship advocates insist that conformity to their ideology trumps First Amendment speech, religious liberty and conscience freedoms.

"The Supreme Court failed to recognize that 'We the people' should decide marriage policy. Activist judges with an agenda have been foisting their views on the people--based not on the original Constitution or the duly registered will of the people--but on what these judges imagine their progressive society should look like. Yet 38 states have affirmed that marriage is between a man and a woman. Regardless of this Court's decision, the debate on marriage will continue.

"We will continue to advocate for marriage and the children protected by marriage."


1. Thus, it is not simply the presence of two parents, as some have assumed, but the presence of two biological parents that seems to support child development (Child Trends Research Brief after reviewing the literature, June 2002). “Most researchers now agree that together, these studies support the notion that, on average, children do best when raised by their two married biological parents” (Center for Law and Social Policy, May, 2003).

2. Lerner, Robert, Ph.D and Nagai, Althea K., Ph.D. “No Basis: What the Studies Don’t Tell Us About Same-Sex Parenting.”Marriage Law Project, Washington DC. January 2001. “Lerner and Nagai, professionals in the field of quantitative analysis, evaluated 49 empirical studies on same-sex parenting. Lerner and Nagai found at least one fatal research flaw in all of the 49 studies.

Read full CMA news release
Supreme Court’s Mixed Decision on Marriage - Heritage Foundation
Marriage Matters - Alliance Defending Freedom
CMDA Ethics Statement: Homosexuality
Same-Sex Marriage--Have the Best Interests of Children Been Considered?

Thursday, June 13, 2013

I gave up on healthcare in America

Excerpted from “Doctor: 'I gave up on healthcare in America',” CNN, by Parija Kavilanz. April 26, 2013 -- It was time to quit. On August 19, 2011, Snyder sold his practice to a local hospital 30 miles away. "I gave up on healthcare in America," he said. Later that year, he moved to Australia and took up rural medicine there. The choice was heart-wrenching for Snyder. He didn't want to feel like he was abandoning his nearly 5,000 patients, and he'd been the only family physician in the area for 16 years. "I wasn't just a doctor there, I was part of this community," he said.

Snyder's decision to leave was years in the making, but Snyder wasn't ready to give up being a rural doctor, though. "It's what I loved to do," he said. Disillusioned with how healthcare had evolved, and how stressful and expensive it had become to be in private practice in the U.S., Snyder began to explore opportunities to work abroad as a "locum tenens," or freelance doctor. The work was strenuous and challenging personally and professionally, said Snyder. He traveled a lot and was away from home every other week. He couldn't easily refer patients to specialists, because there weren't many practicing in rural towns around Adelaide. Lack of medical technology was another challenge. "Here you don't have an MRI or CAT scan facility at every corner," he said.

Still, Snyder embraced the experience in a country where he said the locals were welcoming and "loved my accent." "Primary care is highly respected here. That's not the case anymore in America," said Snyder. "In the United States, healthcare has become more about the business of making money. The personal side of medicine is going away." In fact, Snyder said he wouldn't be surprised if more primary care doctors in the U.S. look for opportunities elsewhere. His own contract expires at the end of June but he's renewing it for another two years. Would he consider moving back at some point? If he could get the benefits he does in Australia back at home, he said, "I'd still be working in America." Full story can be found here.


Allan VicarsDirector of CMDA Placement Services Allan Vicars: "Over the last few years, we have witnessed a reduction in the number of independent private practices throughout the U.S. Many of them simply cannot compete with their local hospital systems and eventually sell their practices to larger entities. Due to declining Medicare reimbursements and reporting requirements, healthcare reform, overhead costs, declining patient visits, recruitment and retention of physicians, along with medical liability pressures, many physicians such as Dr. Snyder feel they have no other options.

"While many feel medicine has migrated more towards making a profit, our office still assists many independent practices that are financially stable and thriving. The conservation of private practices in the U.S. is extremely important as they provide physicians autonomy to practice as they choose. From our experience, integration of faith and medicine is much more prevalent in private practices compared to those owned and operated by hospital systems.

"One has the ability to set their own hours, philosophy of care and the amount of time spent with each patient. A constant dilemma for most healthcare providers is the desire to spend more time with patients. Most physicians enter into medicine to be in their own practice and that is what makes them happy. Many seek employed opportunities due to economic factors or heavy debt. Physicians need to look inside themselves and ask if they will be happy and if this is where the Lord is leading them. Physicians should be encouraged to continue in private practice and seek avenues, policies and financially viable options, such as IPAs, that will assist them to remain independent and thriving."

CMDA Placement Services
Medical Opportunities
Dental Opportunities
Administrative Opportunities

Genetic Database and Genetic Privacy

Excerpted from “Accord Aims to Create Trove of Genetic Data,” The New York Times, by Gina Kolata. June 5, 2013 -- More than 70 medical, research and advocacy organizations active in 41 countries and including the National Institutes of Health announced Wednesday that they had agreed to create an organized way to share genetic and clinical information. Their aim is to put the vast and growing trove of data on genetic variations and health into databases — with the consent of the study subjects — that would be open to researchers and doctors all over the world, not just to those who created them. Millions more people are expected to get their genes decoded in coming years, and the fear is that this avalanche of genetic and clinical data about people and how they respond to treatments will be hopelessly fragmented and impede the advance of medical science. This ambitious effort hopes to standardize the data and make them widely available.

In just the past few years, the price of determining the sequence of genetic letters that make up human DNA has dropped a million fold, said Dr. David Altshuler, deputy director and chief academic officer at the Broad Institute of Harvard and M.I.T. As a result, instead of having access to just a few human genomes — the complete genetic material of a person, including genes and regions that control genes — researchers can now study tens of thousands of them, along with clinical data on peoples’ health and how they fared on various treatments. “The question is whether and how we make it possible to learn from these data as they grow, in a manner that respects the autonomy and privacy choices of each participant,” he said. No one wants to put DNA sequences and clinical data on the Internet without the permission of patients, he said, so it also is important to allow people to decide if they want their data — with no names or obvious identifiers attached — to be available to researchers. But there are no agreed-upon standards for representing genetic data or sharing them, experts say. And there are no common procedures for assuring that patients consent to sharing their information.

Dr. Francis Collins said that cancers are so genetically complex that, most of the time, a mutation seen in a cancer patient will be uncommon. To figure out its significance, data from hundreds of thousands of patients — the world’s collected data — on that mutation are needed. Pooled data are also needed to understand mutations that lead to rare diseases in children, Dr. Altshuler said. A disease might occur in one in 1,000 or one in 100,000 babies, he said. A medical center might never see a child with that disease, or might see just one. “Since everyone sees zero or one, no one ever learns,” Dr. Altshuler said.

Over the past couple of years, genetics researchers puzzled over the data-sharing problem, seeing it as central to making progress. On Jan. 28, 50 leading researchers from eight countries met and agreed on the need for a global alliance. The group, which included ethicists and disease advocates, stressed that because individual study subjects had to be able to decide whether to share their genetic and clinical information, the system for data sharing had to include ways to track and manage these permissions. The group wrote a white paper and a letter of intent that has now been endorsed by an ever-growing international group. “For us, this is a gratifying development,” Dr. Collins said. Full story can be found here.


David PrenticeCMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: "This is a very promising development in regards to moving ahead in genetic diagnosis and even treatments for a number of conditions, but as researchers move forward, there are significant problems that will be faced in maintaining genetic privacy and providing adequate informed consent. The potential for advances in diagnosis and treatment is tremendous. Large data sets are important for determining many genetic correlations, and rapid access to a large genetic database could speed discoveries. One hurdle to overcome will be development of standard formats for presenting genetic data. But a much bigger and very serious hurdle will be developing standards that maintain genetic privacy and anonymity, as well as providing full informed consent for anyone who agrees to participate in genetic studies and clinical testing.

"Such assurances will also be important in recruiting people for genetic studies, and as more genetic correlations are developed not only for diseases but for non-disease traits. The ability to identify someone based only on their DNA sequence and current public databases has already been demonstrated, so it is critical that privacy standards and even masking protocols be firmly in place before genetic information is made public. It will also be incumbent on those who develop and implement such standards that professionals and the public alike be aware of the real limits of genetics and genetic correlations. We are fearfully and wonderfully made, but that also means we are so much more than merely our DNA!

"Identifying Your Name Using Your DNA,"

CMDA Ethics Statement: Use of Genetic Information and Technology
A History of Eugenics
Standards4Life: Human Genome