CMDA offers marriage principles

Excerpted from "Leading Christian medical association unanimously affirms traditional marriage," Life Site News, October 13, 2014, - The Christian Medical & Dental Associations (CMDA) unanimously adopted its Same-Sex "Marriage" Public Policy Statement September 18, criticizing the “radical revisionist view” which “ignores millennia of legal and cultural affirmation” of marriage, and endeavors to replace it with a subjective concept of marriage based on emotional relationship.

The CMDA said this skewed belief is divorced from the natural and objective elements of marriage - physical union and procreation.

“Marriage is a consensual, exclusive and lifelong commitment between one man and one woman, expressed in a physical union uniquely designed to produce and nurture children,” the CMDA statement said.

“The universal recognition of conjugal marriage by virtually every civilization throughout history, arrived at from both secular and theistic perspectives, testifies to the natural evidence for marriage, its objective structure and its significant contribution to human flourishing and societal stability.”

The CMDA statement was released just a few weeks prior to the U.S. Supreme Court’s October 6 dismissal of five U.S. states’ petitions to review lower court decisions overturning their marriage protection amendments.

The CMDA said that recognition of marriage as being between one man and one woman does not necessarily impede acceptance of other consensual relationships.

“The core debate hinges not on a moral evaluation of various types of relationships, but rather on the objective qualities that make marriage, marriage,” the CMDA statement said.

The benefits to children raised by both a mother and a father, the greater economic stability of intact families and the high cost to government and society when marriage breaks down were all listed by the CMDA to illustrate the government’s stake in preserving marriage.

The CMDA also critiqued court decisions that have asserted that support for marriage is not rational and instead based on hostility toward homosexuals, saying that these judgments have paved the way for religious persecution toward proponents of traditional marriage.

“Once the government adopts an official position that opposition to ‘same-sex marriage’ is based solely on animus and constitutes discrimination, the state can assert a compelling interest to advance this social policy--even if doing so means trampling the rights of religious conscientious objectors,” the CMDA statement said. “This assertion of government power to enforce the ideology of the state threatens not only the individual exercise of conscience but also the entire constitutional balance of the church-state relationship.”

“Such an aggressive, state-sponsored squelching of the free exercise of religion, as expressed in faith-based dissent, creates a powerful deterrent to free speech and the exercise of conscience,” the CMDA said. “Apart from the intervention of courts and/or a reversal of societal values, faithful supporters of conjugal marriage stand to face a virtual ideological Inquisition of increasing intensity.”

The CMDA statement concluded with a list of policy recommendations that would protect the rights of faith and conscience in law and policy, and in particular safeguard against legal assault of physicians who practice in accord with their conscience.

Commentary

CMA VP for Government Relations Jonathan Imbody: “Why even get involved in such a controversial area as same-sex marriage? How does this apply to healthcare professionals?

“A number of medical organizations have officially endorsed same-sex relationships, with sanctions and the censure of dissenting members sure to follow. The administration, through the Dept. of Health and Human Services and other federal agencies, has begun to require assent to its same-sex marriage ideology as a condition for receiving federal grants. As same-sex issues politics takes root in our legal system and professional organizations, you will likely find yourself at risk as a healthcare professional or student if you:

• deviate from governmental or professional organizational same-sex policies when counseling or treating patients regarding their sexuality;
• decline to provide a requested recommendation for a same-sex couple seeking to adopt a child;
• affirm, during a medical school or placement interview, the moral principle of reserving sex for male-female marriage;
• do not fulfill requests by same-sex couples for reproductive services such as in-vitro fertilization (physicians already have been sued successfully for this on grounds of discrimination).

“The church in Germany in the 1930s failed to heed the warning signs, succumbed to state coercion and experienced the absolute disintegration of their religious freedom. The tragic loss resulted in part because naïve people of faith opted for compromise with the rising Nazi regime and failed to confront ruthless oppression as Hitler marched toward absolute power.

America is not fascist Germany, but the principle remains the same: Government tends to increase its own power at the expense of individual freedoms--unless We the People take action. “Now is the time to determine to remain faithful, to defend truth and religious freedom--and also to prepare to take a stand in the face of pressure and even persecution.”

“Then Mordecai told them to reply to Esther, ‘Do not imagine that you in the king’s palace can escape any more than all the Jews’” (Esther 4:13, NASB).

“But Daniel made up his mind that he would not defile himself with the king’s choice food or with the wine which he drank...” (Daniel 1:8, NASB).

“Blessed are you when people insult you and persecute you, and falsely say all kinds of evil against you because of Me. Rejoice and be glad, for your reward in heaven is great...” (Matthew 5:11-12, NASB).

Action
Use our easy, pre-written form at our Freedom2Care legislative action website to urge your legislators to support the Marriage and Religious Freedom Act--S.1808, which prohibits discrimination because of moral beliefs regarding marriage and sex.

Resources

1. Read the CMDA statements on what marriage is and on same-sex "marriage." The two new, board-approved public policy statements on marriage state support for public policy measures that:
   • Recognize marriage as exclusively between one man and one woman.
   • Accord protections, incentives and privileges that reflect a recognition of the economic, social and child-related benefits to the state of conjugal marriage.
   • Do not conflate conjugal marriage with same-sex relationships.
   • Comport with the original intent of Amendment XIV of the U.S. Constitution.
   • Maintain equal protection of applicable laws for those who engage in homosexual activity without according special status or privileges based on that activity.
2. A Thoughtful Approach to God's Design for Marriage, by Sean McDowell & John Stonestreet.
3. What is Marriage? By Sherif Girgis, Ryan T. Anderson and Robert P. George.

Governor seeks to thwart abortion clinic law

Excerpted from "Gov. McAuliffe calls for review of abortion clinic regulations in Virginia," Washington Post, May 12, 2014 - Gov. Terry McAuliffe moved to free Virginia’s abortion clinics from strict hospital-style building codes on Monday, loading up the state health board with abortion rights supporters and ordering it to review rules that clinic operators say threaten to put them out of business.

The Democratic governor is also looking for ways to soften or suspend the rules to keep clinics open during the health board’s review, which could take more than two years. The General Assembly approved the regulations in 2011; they are set to take effect as early as June.

“I am concerned that the extreme and punitive regulations adopted last year jeopardize the ability of most women’s health centers to keep their doors open and place in jeopardy the health and reproductive rights of Virginia women,” McAuliffe said.

“This was an overtly political move,” said House Speaker William J. Howell (R-Stafford). “The General Assembly, by law, directed the Board of Health to establish regulations to protect the health and safety of women who seek an abortion. This seems like another attempt by the McAuliffe administration to undermine a law they don’t like, and that is very troubling.”

On Monday, McAuliffe appointed five people to the 15-member health board, filling one vacancy and nudging four other members to wrap up their terms about a month early.

McAuliffe, elected with help from abortion rights groups, made no pretense of ignoring the litmus test, stating flatly that his appointees reflected his views not only on abortion but also on the need to review the clinic regulations. The five appointees “share his commitment to women’s health and support his plan to review the health center regulations,” the governor’s office announced in a written statement.

Yet there could be a political downside for McAuliffe, who takes the step as he seeks to get conservative Republicans on board with Medicaid expansion. Abortion opponents characterized McAuliffe’s move as yet another end run around the legislature.

“Whether the governor and the abortion industry like it or not, the law of Virginia requires that abortion centers have health and safety standards,” said Victoria Cobb, president of the Family Foundation of Virginia.

“The governor is not a king, but he’s doing everything within his power,” Coy said.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: “Trying to clarify that ‘the governor is not a king,’ the spokesman for Virginia Governor Terry McAuliffe unwittingly highlights the autocratic nature of the governor's scheme to skirt state law on abortion clinic health and safety.

“Virginia's legislature is one of dozens of state legislatures that in recent years have aimed to curb abuses and bring abortion clinics in line with reasonable health and safety requirements of similar facilities. Abortion clinic abuses uncovered in Texas, for example, included the illegal disposal of hazardous bio-medical and infectious waste, including tissue that appeared to be the partial remains of aborted babies; dirty and poorly maintained conditions inside and outside the abortion clinics; drug violations, including the illegal dumping of drug vials containing controlled substances and the availability and use of blank prescription slips; and widespread abuses of Texas’s informed consent law and the mandated 24-hour reflection period.

“Governor McAuliffe, however, is ignoring such abuses and plotting to put abortion ideology over the rule of law, seeking end-runs around the people's representatives and meanwhile stacking the state health board with abortion partisans.

“A year ago May 13, Philadelphia abortion clinic doctor Kermit Gosnell was convicted of murder. Gosnell had openly operated a squalid abortion clinic, let a patient die and butchered babies born alive. The Grand Jury report cited testimony revealing that when pro-abortion governor Tom Ridge took office, ‘high-level government officials’ decided to discontinue abortion clinic inspections. ‘There was a concern that if they did routine inspections, that they may find a lot of these facilities didn’t meet [health and safety standards] and then there would be less abortion facilities...’

“When abortion politics trumps health and safety, ‘back alley abortion clinics’ and their accompanying horrors thrive. As a healthcare professional, your support of abortion clinic health and safety regulation--through testimony before legislatures, behind-the-scenes expert advice and the use of electronic, print and social media--can prove very effective.

Action
Order model state legislation that your state can adopt to protect health and safety.
Use our easy Freedom2Care form to urge your legislators to support S. 369 - Child Interstate Abortion Notification Act.

Resources
CMA-led U.S. Senate taskforce report on abortion clinic regulation (access restricted to CMDA members)
After Gosnell's ''House of Horrors'': Women's Health and Abortion in America - webcast
Model clinic health and safety legislation

CMA commentary in LA Times responds to religious freedom editorial

LA Times editorial
(Excerpted from, "Critics want to overturn the Religious Freedom Restoration Act, but that's going too far," by The Los Angeles Times editorial board, February 4, 2014, Copyright 2014, Los Angeles Times.)

Two decades ago, Congress overwhelmingly approved and President Clinton enthusiastically signed the Religious Freedom Restoration Act. But now that the 1993 law is being used to challenge the Obama administration's requirement that employer health plans include contraceptive services, some supporters of the law are having second thoughts, and several organizations want the Supreme Court to declare it unconstitutional. That would be a mistake.

Congress passed the Religious Freedom Restoration Act, which says the government may "substantially burden a person's exercise of religion" only if necessary to further a "compelling government interest" and only if the law in question is the "least restrictive means" of achieving that interest.

Next month the Supreme Court will hear arguments in two cases in which owners of for-profit businesses argue that the law allows them to disregard the contraceptive mandate because of their religious objections. We hope and expect that the court will reject their claim. The law refers to burdens on "a person's exercise of religion," not a corporation's, and the burden must be substantial. Providing insurance coverage for a woman who uses it to obtain contraceptives no more implicates an employer in her decision than does the payment of her salary, which can also be spent on birth control. Finally, ensuring that women have access to preventive healthcare is clearly a compelling interest.

CMA response - published in LA Times

By Jonathan Imbody, CMA VP for Govt. Relations (Published Feb. 4, 2014 in The Los Angeles Times) – The Times rightly defends but wrongly interprets a federal law that forbids the government from imposing ‘substantial burdens’ on the exercise of religious convictions and requires federal officials to pursue the ‘least restrictive means’ of achieving any ‘compelling interest.’

The Times neglects 1st Amendment principles in defending the administration's attempts to force employers with conscientious objections to bow to the government's edict to provide controversial contraceptives and sterilization surgeries.

The government easily could avoid restricting religious freedom by directly supplying poor women with contraceptives, just as it does worldwide.

Just as the 1st Amendment protects the free speech of citizens and corporations such as The Times, it also protects the free exercise of religion by citizens and employers. When the administration attempts to force even elderly nuns to violate their religious convictions, clearly the government has trampled on sacred 1st Amendment ground.

Resources
CMDA Right of Conscience Resources

Action
Use our easy pre-written customizable message to support H.R. 940 - Healthcare Conscience Rights Act (House bill) and S. 1204 - Health Care Conscience Rights Act (Senate bill)

Brain-dead patient taken off life-support

Excerpted from “Brain-dead Texas woman taken off ventilator,” CNN Health. January 27, 2014 — A wrenching court fight—about who is alive, who is dead and how the presence of a fetus changes the equation—came to an end Sunday, January 26 when a brain-dead, pregnant Texas woman was taken off a ventilator. The devices that had kept Marlise Munoz's heart and lungs working for two months were switched off about 11:30 a.m. Sunday, her family's attorneys announced.

Munoz was 14 weeks pregnant with the couple's second child when her husband found her unconscious on their kitchen floor November 26. Though doctors had pronounced her brain dead and her family had said she did not want to have machines keep her body alive, officials at John Peter Smith Hospital in Fort Worth had said state law required them to maintain life-sustaining treatment for a pregnant patient.

Sunday's announcement came two days after a judge in Fort Worth ordered the hospital to remove any artificial means of life support from Munoz by 5 p.m. Monday. The hospital acknowledged Friday that Munoz, 33, had been brain dead since November 28 and that the fetus she carried was not viable. Her husband, Erick Munoz, had argued that sustaining her body artificially amounted to "the cruel and obscene mutilation of a deceased body" against her wishes and those of her family. Marlise Munoz didn't leave any written directives regarding end-of-life care, but her husband and other family members said she had told them she didn't want machines to keep her blood pumping.

Commentary

Since there are a variety of opinions on this difficult ethical issue, we have included 2 commentaries.

CMDA CEO David Stevens, MD, MA (Ethics):"While the medical technology being applied to Mrs. Munoz’s body might be considered “organ support” for her, it was “life support” for her unborn child. At the time of her death the baby was a few days from reaching 24-weeks gestation when survival rates approach 50%. Every day of continued life support improved the odds of the baby’s survival.

"A few days ago, on February 9th, Robyn Benson had a premature baby boy. Just after Christmas she suffered a cerebral hemorrhage resulting in her own brain death. She was maintained on life support until her baby was delivered. The ventilator was disconnected the day after her child was born. According to reports, the baby is doing well in the NICU.

"I don’t have access to the medical records in either of these cases, but a CNN article on the Benson case makes an inadequate effort to ethically differentiate between her baby’s situation and Mrs. Munoz’s. First, they let you know that one child was wanted by its father but the other was not. The worth of a human being does not depend on whether it is wanted or not. Secondly, the Munoz lawyer’s reported that an incomplete ultrasound had shown the baby had hydrocephalus and possibly other malformations. We should recognize that disposing of the disabled is unethical and simply eugenics. Who decides when a person is disabled enough for elimination?

"CMDA does not have an official ethics statement dealing with this complex issue. Maybe we should. You can contribute to the discussion of what it should say by clicking on the comment link below."

Clinical Ethicist and CMDA Trustee Robert D. Orr, MD, CM:“Marlise Munoz was dead, but her 14-week old fetus was alive. If Mom’s organs could be successfully perfused for another 12-14 weeks, her unborn baby could survive and be delivered by C-section. It is possible, though clinically very challenging. But should it be done?

“Marlise’s family did not want artificial support continued, and they were convinced she would not want it. The hospital believed Texas law prohibited removing life support from a pregnant woman. The legal issue was straightforward: Marlise was dead, therefore the support was not ‘life support’ for her, but ‘organ support’ for the benefit of the fetus. Continued support was legally optional.

“But what about the ethical dilemma? Who should decide? What factors should be considered? Some believe it is morally obligatory to do everything possible to prevent fetal death. Others believe that ‘doing everything’ is not always obligatory, making this comparable to high risk, high burden prenatal fetal surgery, i.e., optional, decided by her family based on their understanding of her wishes and values.

“Not all believers will agree. We will agree that we are stewards of our lives, our bodies and our resources. And we will likely agree it is immoral to intentionally end prenatal life for trivial reasons. The intention in continuation was to possibly benefit a second life. The intention in stopping was to discontinue ineffective and unwanted treatment. I personally believe continued support in this case was discretionary. And I believe we should not harshly judge the Munoz family’s decision.”

Resources

CMDA Ethics Statement on Vegetative State
Resources on End of Life Care

A new study shows religion helps toughen the brain

Excerpted from “Religion, Spirituality May Build Resilience Against Depression by Toughening the Brain, Study Suggests,”Psychiatric News Alert. January 9, 2014 — The reason that religion or spirituality appears to protect people with a familial risk of depression from developing the illness may be because religion or spirituality thickens the cortices of the brain, Columbia University researchers Lisa Miller, PhD, Myrna Weissman, PhD, and colleagues report in JAMA Psychiatry.

Their study included 103 adults who were either at high familial risk or low familial risk for depression. The importance they placed on religion or spirituality was evaluated at two time points during a five-year period. The thickness of their brain cortices was measured with MRI at the second time point. The researchers found that the brain cortices of subjects who placed a high importance on religion or spirituality were thicker than the brain cortices of those who did not, but that, in addition, the cortices were especially strong in those individuals who placed a high importance on religion or spirituality and who had a high risk of depression.

"This study points to measurable, beneficial effects of presumably healthy spirituality, especially for individuals with biological predispositions to depression," Mary Lynn Dell, MD, told Psychiatric News. The study, she continued, "adds to substantial and growing evidence that psychiatrists should support healthy development in that sphere of patients' lives. Studies such as these may also inform the particular ways and methodologies religious professionals...employ to care for and work with depressed individuals, while at the same time staying true to their particular religious beliefs and traditions."

Commentary

Sr. Vice President, CMDA Gene Rudd, MD: “A single study finding that the cerebral cortex is thicker in people who place a high priority on religion or spirituality obviously requires additional investigation. But it is only one new addition to the large amount of literature linking many positive health outcomes with religion and spirituality. That accumulative data is impressive – more than 1,500 studies and counting.


“So if faith is so good for health, why are we not introducing it more in clinical care? In surveying Christian doctors, we found that the great majority have a desire to engage the spiritual lives of their patients, but the obstacles that prevent them are 1) concerns about time, 2) fear of ethical concerns, and 3) ignorance of how to appropriately do so. Would it surprise you to know that there are excellent answers and solutions to each of these concerns?

“To help Christian doctors overcome the obstacles, effectively engage the spiritual needs of patients and improve overall healthcare delivery, CMDA has developed a curriculum called Grace Prescriptions. Visit www.cmda.org/gracerx to find information as to where and when these seminars will be held in the coming months. While the live seminar experience is the best way to gain this knowledge and skill, we are also developing a video curriculum that can be used by groups in their local communities. The video curriculum is expected to be released by summer 2014.

“As a means of honoring Christ’s command that we be salt and light, and as a means of broadening the scope of healing care for your patients, we hope you will join us in learning how to provide Grace Prescriptions.”

Resources
Grace Prescriptions
Faith and Health

Therapists Explore Dropping Solo Practices to Join Groups

Excerpted from “Therapists Explore Dropping Solo Practices to Join Groups,” Shots: Health News from NPR. October 24, 2013 -- In the corporate world of American healthcare, psychologists and other mental health therapists are still mostly mom-and-pop shops. But the business model for therapists is shifting away from solo practices and toward large medical groups, say mental health experts. That change is propelled by the Affordable Care Act, which mandates mental health benefits in insurance coverage, and by the Mental Health Parity Law, which requires private and public insurers to cover mental health needs at the same level as medical conditions — by charging similar copays, for example.

Organizations that advocate for mental and behavioral health — groups that long complained that they were treated as second-class providers — have applauded the federal laws. But inclusion has come with some unhappy caveats, including less pay and more paperwork. Patients used to paying $150 in cash for a therapy session will, with some limitations, have sessions covered by their health plan. That means many therapists will have to figure out innumerable insurance plans and byzantine billing codes for the first time.

In many ways, therapists are encountering what medical doctors have complained about for years: the confusing, confounding and, some might say, hostile insurance bureaucracy that providers must tangle with in order to get paid. The increasing complexity of running a practice has meant more therapists are taking down their shingles or forming groups with other therapists to share the burden, executives at national mental health groups say. Others have joined large medical groups that offer mental health services as part of comprehensive care.

Commentary

CMDA Member and Psychiatrist Robert Rogan, DO, JD: “This article touches on several current issues in mental health affecting our society. One, the loss of autonomy, may be far more serious than we realize. The freedom to serve as we in conscience believe best is something we need as believing practitioners. Conscience issues are already prominent in current medical practice in general. If we can’t ‘choose our clients,’ we may find ourselves being asked to provide therapy in an area we find morally uncomfortable.

“People do seek mental health services and pay ‘out of pocket’ not just for insurance reasons but also for privacy. The HIPAA regulations with compliance that began on September 23, 2013 seem to reflect this possibility.

“Paperwork issues are not just documentation chores but very concerning potential legal traps. Billing is serious business for more than just reimbursement reasons. We need to be truthful but careful in what we write. Also, we need to be ultra-careful what we sign. We need to know every pitfall in contracts we sign. If there is legal terminology you don’t know, look it up or get legal counsel. A subtle term like ‘hold harmless,’ now in very common use, can be the entrance to a professional minefield.

“On the other side, solo practice can have physical dangers with our changing patient demographics. Group practice can provide more collegiality as ‘iron sharpens iron.’ We can be of great use in practices where mental health service is needed by other non-mental health practitioners.”

Resources
Healthcare Right of Conscience Ethic Statement
Augustine College at CMDA CD Set

Ethical dilemmas surround those willing to sell, buy kidneys on black market

Excerpted from “Ethical dilemmas surround those willing to sell, buy kidneys on black market,” CBS News. November 1, 2013 -- Government estimates show 18 people die each day waiting for a transplant, and every 10 minutes someone is added to the transplant list. The need for kidneys is especially high. As of October 25, 98,463 people were waiting for a new kidney in the U.S., the most requested organ by far. Thus far this year, only 9,708 kidney transplants have been completed.

The beauty of kidney donation compared to other organs is that people are born with two of them, making possible donation from a living person. But, the fact that people can live a normal life with one kidney has helped the black market kidney trade flourish.

Some argue that if the donor is made aware of all the potential risks and still consents, he or she should be free to sell a kidney. Advocates say if people are able to sell other body parts like hair or eggs, they should be allowed to get money for their organs. And recent research suggests paying for organs could reduce societal healthcare costs long-term. An Oct. study showed that if people were able to pay $10,000 for a living kidney donation, medical costs -- such as related to dialysis treatments -- would go down overall and patients would get additional quality years of life compared to the current system. However, the practice of getting paid for an organ is illegal everywhere except Iran.

Caplan believes that the current opt-in system of organ donations should be changed to an opt-out. Now, Americans select on their driver's licenses if they'd like to donate their organs, but they're calling for a system where everyone by default is a donor. The bioethicist noted that data show that most people are willing to be an organ donor, so the system should be changed, so the few who are against it can have their decision respected.

Commentary

Trauma Surgeon and CMDA Member Christine Toevs, MD: -- “This article touches on many of the current ethical issues related to organ procurement. The position offered by the organ procurement organizations (OPO) is as follows: organ transplantation is good and many people are waiting for organs; therefore, anything that increases organ donation is inherently good.

“The main solution provided to increase organ donation is to pay for organs; if we pay for organs, more will donate and we will save more lives. The problem with this argument is that studies have shown that paying for organs exploits the poor and very little of that money actually reaches the organ donor, most taken by brokers and middlemen. Since most of the organ donors would likely be poor, the risk of coercion and lack of informed consent increases. The aging of the population has resulted in an increase in chronic renal disease, and this increases the long-term potential health issues of the organ donor. When their kidneys fail, do they now go to the top of the recipient list? Who takes care of the organ donor and their complications when, which although rare, do occur?

“The OPOs have consistently demonstrated a lack of informed consent at any step of organ donation (is checking the box on your driver’s license really informed consent?). It is unlikely that even regulated markets for selling of organs will result in safer protections for the organ donors. People are not commodities with extra superfluous organs that should automatically go to others. There is great need for organs, but that need doesn’t allow for exploitation of others.”

Resources
Organ Donation Ethic Statement
Human Organ Transplantation Ethic Statement

Obamacare rollout highlights views of government

Excerpted from "An opening for the right," The Washington Post, commentary by Jennifer Rubin, October 27 - The Obamacare debacle challenges a number of liberal mantras that undergird a whole set of policies and campaign appeals. Here are the top 10 liberal tenets threatened by Obamacare:

1. If there is a problem, the federal government should attack it.
2. Government can compel people to act against economic self-interest by passing laws.
3. There is no downside to big government.
4. The welfare state is the best mechanism to help the poor.
5. Those opposed to big government hate the poor.
6. Government is capable of running highly complex systems effectively.
7. When addressing big problems it is best to centralize and standardize.
8. Unintended consequences of government programs are a small price to pay.
9. People will trust the government with private decisions and personal information.
10. Spending more and taxing more are evidence of concern for the poor.

All of these precepts have been challenged by conservatives, but there is nothing like a real example and personal experience to drive home a message. We don’t have just a few “glitches” or even a time crunch for putting up the exchanges, we have in Obamacare a fundamental misunderstanding of the limits of the government and citizens’ aversion to big, complicated entities. The effort to construct one big system with a highly regulated product (Obamacare-standard insurance) may in fact be the entire effort’s undoing.

Commentary

CMDA CEO David Stevens, MD, MA (Ethics):
“Our healthcare system is broken and badly in need of a fix. The root problem is that healthcare costs too much, so individuals and businesses can’t afford insurance. The Affordable Care Act, unfortunately, is built on the premise that most people’s health insurance programs are not adequate and all perceived inequities must be solved. So the law says preventative services and contraceptives must be free. It doesn’t allow surcharges for age or preexisting conditions. Children can stay on their parents’ plans until age 26. There are no lifetime cost ceilings. Plans must contain psychiatric, eye and other coverages that most insurance plans have not provided.

“I like all those things, just like I like all the bells and whistles on a Mercedes Benz 500 with its great ride and exquisite comfort. But I’ve never owned a Mercedes because I can’t afford one, just like most people in our country. I drive a Honda Civic and, you know what, it gets me there. We can’t afford the Affordable Care Act either. It will add a whopping $2.8 trillion to our healthcare costs over the next 10 years. Already, self-insured individuals are experiencing the reality of that sticker shock but they are no longer in a market-driven healthcare economy. They can’t buy a well-used insurance vehicle at an economical price. Only a Mercedes is adequate.

“We very well may be headed for a debacle. The ‘cure’ may be worse than the disease. If so, everyone may be so traumatized that they refuse to even give a hearing to a real solution.”

Should Christians engage in public policy?

Excerpted from "Should we pull back from politics?" blog posting by Russell Moore, President, Southern Baptist Convention's Ethics and Religious Liberty Commission - A recent profile in the Wall Street Journal highlighted a generational change in terms of the way evangelicals approach cultural and political engagement: toward a gospel-centered approach that doesn’t back down on issues of importance, but sees our ultimate mission as one that applies the blood of Christ to the questions of the day. The headline, as is often the case with headlines, is awfully misleading.

I don’t think we need a pullback from politics. I think we need a reenergizing of politics. Millennial and post-Millennial Christians are walking away from the political process, and this is what alarms and motivates me. They are disenchanted with movements that seem more content to vaporize opponents with talk-radio sound-bytes rather than to engage in a long-term strategy of providing a theology of gospel-focused action in the public square.

Those who wish to retreat are wrong. Ignoring so-called “political issues” doesn’t lead to a less politicized church but to a more political church. One cannot preach the gospel in 19th century America without addressing slavery without abandoning the gospel. One cannot preach the gospel in 21st century America apart from addressing the sexual revolution without abandoning the gospel.

A church that loses the gospel is a losing church, no matter how many political victories it wins. A church that is right on public convictions but wrong on the gospel is a powerless church, no matter how powerful it seems.

That means modeling a Christian political engagement that doesn’t start or end with politics alone. It starts and ends with the gospel and the kingdom of God. Those who oppose our convictions will hate us. Those who want to use our church voting lists as their political organizing tools won’t understand us. So be it. Kingdom first.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: (excerpted from "MLK and Wilberforce show why Christians should engage more--not less--in public policy," Freedom2Care blog, October 23, 2013) Imagine a world bereft of the political engagement of Christian religious leaders like Dr. Martin Luther King, abolitionist William Wilberforce and myriad lesser-known leaders like Jonathan Mayhew, whose sermons and writings helped undergird the American Revolution. Christian political engagement has helped secure racial justice, free slaves and throw off tyranny.

We demonstrate our faith in God by defending the defenseless, advocating for the poor, righting injustice. The political process offers one arena for such ministries. Public policy engagement for Christian believers means encouraging our countrymen to take faith steps toward God and His principles. To choose life, to defend the defenseless, to advocate for the poor and downtrodden.

With this perspective, we must not disdain but instead honor the ministry of working in the political realm as an evangelistic ministry. Rather than stepping back from politics, more believers need to engage in public policy, proactively advancing policies promoting the welfare of their countrymen and defensively advancing religious freedom for people of faith.

We can't desert the battlefield just because a few soldiers may have misfired. If some believers have fought political battles in an antagonistic way, let us show how to engage in a winsome way. If others have let bigotry and hubris mar their testimony, let us demonstrate Christ's love with grace and humility. If others have proven emissaries of ill will, let us serve as ambassadors of good will.

"Therefore, we are ambassadors for Christ, as though God were making an appeal through us; we beg you on behalf of Christ, be reconciled to God" (2 Corinthians 5:20).

Read full blog article by Jonathan Imbody

"Roe" abortion decision lacked medical evidence

Excerpted from a book review by Michael J. New in The Washington Times, October 13, 2013 - a review of Abuse of Discretion: The Inside Story of Roe v. Wade by Clarke Forsythe - Clarke Forsythe persuasively makes the case that even under liberal standards, Roe v. Wade is still deeply flawed. That is partly because the public health data and the historical information that Justice Blackmun relied on in his majority opinion were often incorrect, incomplete or misleading.

For instance, public health research that purportedly showed that abortion was safer than childbirth played a prominent role in Blackmun’s opinion. However, of the seven studies that Blackmun cited, none was peer reviewed and none even considered long-term health risks involved with legal abortion.

The concept of viability was never once even mentioned during the oral arguments. Mr. Forsythe presents correspondence between Justices Blackmun, Thurgood Marshall and Lewis Powell showing that their decision to expand the abortion right to viability was not based on any legal argument, but instead because it would mean more access to abortion.

This expanded access to abortion has had a profoundly negative impact on public health. Mr. Forsythe details the numerous abortion clinic scandals that have come to light since 1973. He also ably summarizes academic research that shows that abortion is linked to an increased risk of breast cancer and a higher incidence of various psychological problems. There is no evidence that Roe v. Wade significantly reduced maternal mortality, child abuse, spousal abuse, poverty or the out-of-wedlock birthrate.

Abuse of Discretion should engage readers outside the pro-life movement by making a compelling argument that even under liberal standards of jurisprudence, Roe v. Wade is a deeply flawed decision.

Commentary

Author Clarke Forsythe, Senior Counsel, Americans United for Life:“Abuse of Discretion details and documents the erroneous medical assumptions adopted by the Justices in Roe v. Wade and Doe v. Bolton. The principal medical assumption was that “abortion was safer than childbirth.” That drove the outcome and the shape of the Court’s opinions in Roe and Doe, though there was no evidence or reliable data to support that assumption. Abuse of Discretion thoroughly disputes the accuracy of that assumption in 1972 and today.

“Chapter 8, entitled “Detrimental Reliance,” summarizes the contemporary international medical studies finding increased risks of, for example, pre-term birth after abortion.

“The Supreme Court has three abortion cases before it this fall, though the Justices have not yet decided to hear the merits of any of the cases. However, the medical data will be critical in these cases and in all future abortion cases in the courts.”

Physicians prepare to deal with increased demand, strain on practices under ObamaCare

Excerpted from “Physicians prepare to deal with increased demand, strain on practices under ObamaCare,” Fox News. October 1, 2013 -- As enrollment in ObamaCare begins, physicians throughout the country are preparing to deal with an influx of newly insured patients – as well as the increased financial demands this will place on their practices. While it will take a few years for doctors to fully determine how they will be affected by ObamaCare, some physicians are already anticipating the need to make major changes to the way they run their practices.

One of the most immediate changes that physicians in these areas expect to see is an increase in patients seeking preventive health care – something many avoided when uninsured. However, scheduling more routine check-ups and screenings may place a strain on already short-staffed practices in rural areas. As a result, some doctors are considering handing over some basic aspects of patient care and education to nurses, nurse practitioners, or physicians assistants in order to treat patients more efficiently. Dr. Jason Marker, of Wyatt, Indiana, is already looking to hire additional staff members in order to meet the increased needs in his community.

Rural areas throughout the country already face a shortage of primary care physicians and doctors like Marker fear that this problem might become exacerbated in coming years, as more patients have the means to seek regular care.

“We know definitively that health insurance coverage and access to a physician are what improve health care outcomes.” Marker said. “We’re about to get changes in coverage, but we don’t have a ready way to say, ‘Here’s another million family doctors.’ So there’s a pipeline problem where it will be another five to 10 years where we are able to get the volume of doctors to take all these patients.”

Marker said Congress will need to step up in order to help fix this problem. “The big weak link is whether or not Congress is willing to put additional dollars into family medicine residential training,” Marker said. “That’s the current bottleneck in the training pipeline, is having residency slots. It doesn’t do good to have residents interested if there aren’t slots to do training.”

Commentary

CMDA CEO David Stevens, MD, MA (Ethics): -- “When we went as missionaries to Africa, Jody knew we would be far from the grocery store yet entertaining many guests, so she bought a cookbook called More With Less. That phrase succinctly describes the focus that every healthcare professional will need as we move forward. There are going to be more patients to see than ever before but not enough physicians to see them. Though more medical schools are opening, including two Christian ones, there are not enough residencies being funded. Physician assistant and nurse practitioner schools are expanding to help fill in the gap, but the problem is bigger than that.

According to leading economic John Maudlin, reimbursement rates are going to plunge by 25 percent in the next five years. (I encourage you to read the eye-opening article.) The Cleveland Clinic now collects $6 billion a year and expends $5.5 billion. They are projecting their income to plunge to $4.4 billion by 2018, despite a significant increase in their patient load, as commercial insurance companies on average go from paying $.38 on the dollar billed to $.26. (Medicare now pays $.23 and Medicaid $.18.) Since 60 to 80 percent of their cost is for personnel, that is where cost savings will have to be realized. That is why you are already hearing of hospitals and practice groups laying off staff and if those staff are rehired elsewhere, they probably will be paid less.

CMDA’s Executive Vice President Gene Rudd, MD, told those attending the CMDA Midwest Regional Conference a few weeks ago that they would all need to become missionary doctors…but not necessarily by going overseas. They will have to have a missionary's mentality of working very hard and not getting paid as much, but doing it because God has called them to minister through medicine.

Though we will all being doing "more with less" I believe that the opportunities to minister through healthcare are going to be greater than ever! God does His best work in the midst of crisis and change if we simply rest and trust in Him!

Resources
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Why HR 3200 is No Healthcare “Reform” by Gene Rudd, MD
Affordable Care Act Impact on Doctors and Patients

Doctors Look For A Way Off The Medical Hamster Wheel

Excerpted from “Doctors Look For A Way Off The Medical Hamster Wheel,” Shots: Health News from NPR. August 14, 2013 -- Doctors are on a hamster wheel these days. We're compelled to run faster just to stay in place. It's about to get worse. Obamacare means millions more people will want our services, with not enough primary care doctors to meet demand. Government incentives that are pushing us toward computer-based records mean that doctors now spend as much time documenting our visits with patients as we do examining them.

As the hassles have gotten worse, I've seen many colleagues jump ship. But there might be another way. Dr. Christine Sinsky, an internist in Dubuque, Iowa, has made it her mission to find ways to mitigate the drudgery of modern doctoring. With funding from the American Board of Internal Medicine Foundation, she and four colleagues traveled the U.S. in search of practices that provide top-notch, effective primary care, while making the work satisfying for the doctors and other health professionals. Sinsky and her team found 23 examples of innovative practices from coast to coast, and reported on them in both an academic journal and an in-depth white paper.

Dr. Ben Crocker was so burned out in in 2007 that he lamented, "Working at Starbucks would be better." Now, his practice at Massachusetts General Hospital employs health coaches to work with patients on making the lifestyle changes that doctors recommend but can't adequately teach or monitor. Virtual visits have replaced some in-person visits. Perhaps most incredibly, the practice offers staff downtime each week to come up with innovations.

Sinsky offers examples of tedious tasks that take doctors away from providing undivided attention. No. 1 among them is data entry. "Inbox management" — all the phone calls, emails, forms to sign and prescription refills — can take up to two-thirds of a physician's day. "All of this inbox work can and should be handled by nonphysician personnel, freeing us up," she says. "So many mandatory tasks are crowding out the work of real doctoring.”

Commentary

CMDA Member Julie Griffin, MD: -- “Demanding schedules, flawless precision and an enduring calm in calamity—these are expectations of physicians. We have often placed these ultimatums on ourselves with our detailed, driven personalities pushing us to unattainable perfection. Nevertheless, the culture increasingly demands a new maximum.

Hardly imaginable is Hippocrates rushing around the office, then being paged across town for a delivery. Medicine’s revered father never had to defend his decisions to a third-party payer. We prefer the tableau of a wise, forbearing professional to grateful patients and an engaging professor to eager students. In truth, we were in this picture ourselves as we entered medical school.

Have our dreams run amuck? Perhaps, if we lose the focus of our callings in light of career demands. Yet, if we are confident of our callings and moved with the same compassion which moved Jesus (Matthew 9:36), we will not be distracted from our opportunities to serve.

To be sure, we must employ new methods, including delegation of duties. Medicine is moving to team-based care. This change is neither revolutionary nor futuristic. It is an overdue move toward our biblical heritage. Jesus readily embraced teamwork in ministry, and we as physicians should do likewise.

We must remember our calling and the true Strength by which we fulfill it—paperwork, phone calls and all. We cannot be chased out of our ministries for there is no joy or peace in life apart from our appointments as God’s coworkers in the gospel of Christ (1 Thessalonians 3:2-3).

Resources
In Search of Balance by Richard Swenson, MD
Practical Practice Issues in Today’s Christian Doctor

Obamacare May Trigger Exodus of Christian Doctors

Excerpted from “Obamacare May Trigger Exodus of Christian Doctors,” CBN News. October 1, 2013 -- Thousands of Christian doctors across the nation are considering quitting medicine or working overseas because of concerns over the new healthcare law.

Dr. Gene Rudd, senior vice president of the Christian Medical Association, says they're worried they could be forced to facilitate abortions or prescribe drugs that violate their convictions.

Rudd says many of them have avoided hiring and taking on new patients due to uncertainty over Obamacare.

Thousands of the doctors provide care for the poorest areas of the United States and feel called by God to help the sick, but say they need to be able to do so with a clear conscience.

Commentary

CMDA Senior Vice President Gene Rudd, MD: “I rarely view or read media reports after I have been interviewed. (In part, this is because someone else at CMDA does that.) But being asked to comment on this article that was based on what I said to a reporter reminded me of how the media uses their perspectives and agendas to create the news. Too frequently I find a failure to report ‘the truth, the whole truth and nothing but the truth.’

“Timed to coincide with the beginning of the enrollment for Obamacare, my interview with this AP reporter covered many perspectives on healthcare reform, perspectives I classified as ‘the good, the bad and the ugly.’ My limited comments about Christian doctors were almost an afterthought. But only those comments made the news.

“Among the many perspectives I cited, one ‘good’ aspect of reform is that some of our neighbors who previously couldn't obtain health insurance coverage would now have some basic level of protection. A ‘bad’ aspect is that now healthy individuals and families who did not have coverage and had little healthcare costs will now have to pay either a penalty for failure to participate or pay premiums. Even with subsidies, one estimate placed the average family premium at more than $5,000. That will be a substantial burden to most family budgets.

“One of the ‘ugly’ aspects of the current reform bill is the permission assumed by the Administration to usurp individual rights and undermine the First Amendment. Already we have seen HHS interpret and implement legislation in a way that attempts to force employers to provide coverage that includes provisions they find morally objectionable. And under the guise of providing required services, we will be required to fund abortions. Only with the use of smoke and mirrors do they attempt to claim otherwise.

“Will reporters continue to filter the news to suit their agendas? Of course. But we will continue to speak the truth in love. Will Obamacare survive? I don’t know. But we will continue to contest provisions that are morally unacceptable and dangerous to our foundation of freedom."

Resources
Voice of Christian Doctors Media Training
From My Viewpoint: Healthcare Reform by David Stevens, MD, MA (Ethics)
Nationalized Healthcare – Prescription or Problem?

New Poll Results on Physician-Assisted Suicide

Excerpted from “Should Physician-Assisted Suicide Be Legal? Poll Shows Divide Among Experts,” Huffington Post. September 12, 2013 -- Medical experts in the U.S. remain divided in their opinion of whether physician-assisted suicide (PAS) should be legal, a new poll suggests, indicating that the way in which patients die and the role of palliative care will remain issues of much debate. In the poll conducted by the New England Journal of Medicine (NEJM), about 65 percent of votes were against the idea of permitting PAS. The rate among U.S. voters was similar, with about 67 percent voting against PAS. In PAS, doctors provide terminally ill patients with the means to end their own life - for example, giving them a prescription for a lethal dose of medicine, which the patient can later decide whether to take.


Proponents of PAS say that people, in face of an inevitable death, deserve the right to end their lives on their own terms, without pain and suffering. Opponents say that a physician taking a role in a patient's suicide violates a fundamental tenet of medicine by contradicting the doctor's role as a healer. Oregon was the first state to legalize PAS, with the passing of the Death with Dignity Act in 1997. Two other states, Washington and Vermont, followed suit. In 18 U.S. states, a majority of votes supported PAS. Interestingly, the researchers said, Oregon and Washington were not in that group.

More than 200 comments were posted, in which readers made arguments to support their beliefs. Many commentators on both sides of the divide agreed that palliative care, including hospice, are important for helping terminally ill patients manage their pain and suffering, both physical and psychological.

Commentary

Family physician, ethics consultant and CMDA Board of Trustees Member Robert E. Orr, MD, CM : “The New England Journal of Medicine recently reported that in its international poll, two out of three physicians oppose the legalization of PAS. They also reported several years ago on a survey of U.S. physicians that gave similar results.¹ The good news: (a) most physicians think PAS is a bad idea; (b) the NEJM is willing to report this in spite of their own editorial support of PAS. However, there is also bad news about such polls.


First, it is well documented that the way polling questions are worded can have a significant effect on the results obtained.² Equally important, poll results may (or may not) reveal what people think about an issue, but they cannot tell us whether the issue in question is right or wrong.

It is possible to effectively speak against PAS using arguments based on principle, virtue or consequences.³ For the believer, there is a strong additional reason to oppose PAS: each person bears the image of God and we must not intentionally end a human life.

Another piece of good news from the poll results is that most people, whether for or against PAS, agree that excellent hospice/palliative care is the preferred response to end of life suffering.⁴

Bibliography
¹Meier DE, et al. A national survey of physician-assisted and euthanasia in the United States. N Eng J Med 1998;338(17):1193-1201
²Hagelin J, et al. Surveys on attitudes towards legalisation of euthanasia: importance of question phrasing. J Med Ethics 2004;30:521-523
³Orr RD. What are the arguments against legalization of physician-assisted suicide and euthanasia? Today’s Christian Doctor 2011;42(2):30-2
⁴Orr RD. Pain management rather than assisted suicide. Pain Medicine 2001;2(2):131-137

Resources
CMDA Ethics Statement on Physician-Assisted Suicide
Resources on Physician-Assisted Suicide
What are the arguments against legalization of physician-assisted suicide and euthanasia? by Robert D. Orr, MD, CM

CMDA human trafficking expert teaches doctors and students

Excerpted from "Doctor on a mission to combat modern slavery," (Ky.) Courier-News, August 31, 2013 - As he talked to Louisville doctors and medical students last week, Ohio physician Jeffrey Barrows said he saw familiar expressions on their faces. Shock. It was the same response he had when he began learning about modern slavery less than a decade ago.

Barrows had worked for years with the Christian Medical & Dental Associations, conducting short-term educational trips throughout Asia and Africa. Through a contact with the State Department, Barrows said, he was asked to do research into the health effects of human trafficking as it relates to the global spread of HIV and AIDS.

“The more I read, the more I was shocked,” Barrows, an obstetrician and gynecologist, recalled in an interview Aug. 23 after his Louisville lecture. Many people are still not aware, he said — and his fellow doctors can play a vital role in combating it.

“Of all the sectors within society, health care is one of the most likely to encounter these victims,” he said. Research indicates that a quarter to a half of trafficking victims encounter health care professionals at some point when they are enslaved, Barrows said.

Barrows spoke at Norton Hospital at the University of Louisville Department of Pediatrics Grand Rounds, a continuing-education lecture attended by about 160 students, doctors and other social-service and government representatives. Barrows spends his time educating health care professionals on the signs of trafficking and promoting the development of homes that help recovering victims. He is vice president of Abolition International, a group that works to end sex slavery.

Emergency-room staff and other medical professionals need to watch for the signs of trafficking, Barrows said — just as they have been trained on signs of domestic violence and child abuse.

“Getting the word out is part of the puzzle, getting the people to understand this is happening,” Barrows said. Otherwise, “they’ll encounter a patient and they’ll walk away saying, ‘Something strange is going on, but I don’t know what it is.’”

Warning signs, he said, include:

The victim being accompanied by a highly controlling person — who might even be a family member.
The body language of the patient indicating fear of the accompanying person.
Tattoos indicating a handler’s street name — often a brand of “ownership” by the trafficker.
Signs of abuse.
For sex workers, multiple sexually transmitted diseases.
For manual laborers, such injuries as back trauma or hearing loss.
The victim may also be unaccountably silent on some issues — such as why he or she waited until symptoms became severe to seek medical help.

Commentary

CMDA Health Consultant on Human Trafficking Jeffrey J. Barrows, DO, MA (Bioethics) – “Dr. David McLario, a CMDA member, is on staff at Louisville Children’s hospital and made the arrangements for this presentation. He also did an excellent job organizing a symposium afterward to develop a protocol for their ED to respond to trafficking victims. His reward was encountering a patient the next day who, with further investigation, may turn out to be a victim of trafficking.

“Consider following his example by learning about trafficking and developing a strategy to respond. Every healthcare professional working with patients needs to be educated on human trafficking. Limited studies show between 28 to 50 percent of trafficking victims encounter a healthcare professional while being trafficked.

“CMDA has an excellent educational resource available online at cmda.org/tip. It’s even free if you don’t take the available CME credits. If you need assistance in developing a response strategy, contact me at jeff@abolitioninternational.org.”

Resources

CMDA human trafficking page

Action Take the CMDA education course, optionally with Category One CME credit, on human trafficking.

Washington Post: Zygote is not a "living being"

(Excerpted from "Ken Cuccinelli’s ‘personhood’ travails," Washington Post editorial, Sep. 4, 2013) -- Six years ago, when Virginia’s General Assembly considered the so-called “personhood amendment” to the state constitution, which granted full rights to “preborn human being[s] from the moment of fertilization,” the list of co-sponsors was short. Not only would the amendment have banned abortion, as the sponsors clearly intended, it also provided an opening to prohibit common methods of birth control, including the pill and intrauterine devices.

The practical effects of “personhood” measures … would easily include banning the most popular forms of contraception. This is because the pill, as well as other forms of birth control, work partly by preventing the implantation of eggs in the uterus wall after they have been fertilized. If the “preborn” are protected “from the moment of fertilization,” as the 2007 bill demanded, then contraception — which defeats a fertilized egg’s chances of becoming a living being — could be prohibited.

Commentary

CMA VP for Govt. Relations Jonathan Imbody: The Post is entitled to its own editorial opinions but not its own facts, and scientific fact clearly contradicts the assertion that "contraception … defeats a fertilized egg’s chances of becoming a living being."

Embryology textbooks clarify the lay term "fertilized egg" as "… a zygote or fertilized ovum which is the primordium or beginning of a new human being. Human development begins at fertilization…. This highly specialized, totipotent cell marked the beginning of each of us as a unique individual."¹

"Although life is a continuous process, fertilization is a critical landmark because, under ordinary circumstances, a new, genetically distinct human organism is formed…."²

So contrary to the Post, not only is a "fertilized egg" a living being; he or she is a human being. A human being is by nature a person, defined as "a human being regarded as an individual."³ But political ideology prevents the admission that abortion claims the life of a moving, smiling, hiccupping, grimacing, living human being--a person.

¹Keith L. Moore & T.V.N. Persaud. The Developing Human: Clinically Oriented Embryology, 6th Edition, 1998
²Ronan O'Rahilly & Fabiola Muller, 2001 Human Embryology & Teratology, 3rd Ed.
³Apple Inc. dictionary, ver. 2.21.
Resources

Reproductive Technology and Heath
The Beginning of Human Life
Abortion
Human Life: Its Moral Worth
The Endowment for Human Development

Action
Use the pre-written, customizable forms at CMA's legislative action website to encourage your legislators to pass life-honoring bills on issues such as abortion and stem cell research.

Lawmakers focusing on abortion and harms to women

Editor's note: AUL attorney Mailee Smith, whose commentary appears below, has written several amicus briefs for the Christian Medical Association, which has participated in 40 court cases.

Excerpted from "The state of pro-life legislation, commentary by Mailee Smith, staff counsel at Americans United for Life (aul.org), published in The Washington Times, Sep. 4, 2013 -- In 2013, life-affirming federal and state legislation designed to protect women from the harms inherent in abortion has garnered increasing attention and support from legislators and the American public — and engendered increasing fear and consternation among abortion advocates and their allies.

Abortion advocates appear particularly dismayed with recent legislative efforts to enact laws prohibiting abortion after five months of pregnancy. The reality is that a woman seeking an abortion at 20 weeks is 35 times more likely to die from abortion than she is in the first trimester. At 21 weeks or more, she is 91 times more likely to die from abortion than she is in the first trimester. Legislative efforts to limit abortion after this point directly protect maternal health, no matter how the pregnancy began. Even the liberal Huffington Post recently admitted that Americans overwhelmingly support limitations on such late-term abortions.

Yet abortion advocates oppose banning late-term abortion as well as laws requiring that women be informed of the health risks they face from abortion. The evidence of abortion’s devastating harms to women is overwhelming. Consider this partial list of the short-term and long-term physical and psychological risks associated with abortion:

• Short-term risks include blood loss, blood clots, incomplete abortion, infections such as pelvic inflammatory disease, cervical lacerations and other injuries to organs.
• Premature birth: At least 130 studies have shown an increased risk of subsequent premature birth and low birth-weight infants after abortion. The increased risk of these devastating complications is estimated to be approximately 37 percent after one abortion, 90 percent after two abortions and further increased risk for each additional abortion.
• Placenta previa is the condition during pregnancy in which the placenta covers the cervix, increasing the risks of life-threatening maternal hemorrhage, premature birth and perinatal child death. Abortion increases the risk of placenta previa in subsequent pregnancies by from 30 percent to 50 percent, and much more so for women who have had multiple abortions.
• Breast cancer: It is undisputed that a woman’s first full-term pregnancy reduces her risk of breast cancer. Numerous studies show that abortion may increase a woman’s lifetime risk of breast cancer. In one study funded by the National Cancer Institute, pro-choice researcher Dr. Janet Daling found that “among women who had been pregnant at least once, the risk of breast cancer in those who had experienced an induced abortion was 50 percent higher than among other women.”
• Mental health: A 2011 study in the British Journal of Psychiatry examined 22 studies conducted from 1995 to 2009 and found that women face an 81 percent increased risk of mental health problems following abortion. Women experienced increased risks for anxiety at 34 percent, for depression at 37 percent, for alcohol abuse at 110 percent and for suicide at 155 percent.
• Maternal mortality: Abortion advocates wrongly assert that abortion is safer than childbirth. Many studies show the opposite, including one that found maternal death to be three times more likely from abortion than from childbirth.
• Risks of later-term abortions: Abortion’s risks increase the further into pregnancy it is performed. Beginning at five months of pregnancy, the risk of complications from abortion rises dramatically.

Abortion advocates cannot counter this growing medical data. Instead, they resort to outrageous arguments camouflaging the fact that they are ignoring the health risks of abortion to pregnant women, who deserve our protection.


Resources

Court Briefs Summary
Korte v. HHS Amicus Brief
Isaacson v. Horne Amicus Brief of AAPS et al
Action

Use the pre-written, customizable forms at CMA's legislative action website to encourage your legislators to pass life-honoring bills on abortion.

Stem cells, tissues and regenerative medicine

Excerpted from "Stem cells mimic human brain," Nature. August 28, 2013 -- With the right mix of nutrients and a little bit of coaxing, human stem cells derived from skin can assemble spontaneously into brain-like chunks of tissue. “It’s a seminal study to making a brain in a dish,” says Clive Svendsen, a neurobiologist at the University of California, Los Angeles, who was not involved in the study. “That’s phenomenal.” A fully formed artificial brain might still be years away, he notes, but the pea-sized neural clumps developed in this work could prove useful for researching human neurological diseases.

In the latest advance, scientists developed bigger and more complex neural-tissue clumps by first growing the stem cells on a synthetic gel that resembled natural connective tissues found in the brain and elsewhere in the body. Then they plopped the nascent clumps into a spinning bath to infuse the tissue with nutrients and oxygen.

“The big surprise was that it worked,” says study co-author Juergen Knoblich, a developmental biologist at the Institute of Molecular Biotechnology in Vienna. The blobs grew to resemble the brains of fetuses in the ninth week of development. Under a microscope, researchers saw discrete brain regions that seemed to interact with one another. But the overall arrangement of the different proto-brain areas varied randomly across tissue samples — amounting to no recognizable physiological structure.

“The entire structure is not like one brain,” says Knoblich, adding that normal brain maturation in an intact embryo is probably guided by growth signals from other parts of the body. The tissue balls also lacked blood vessels, which could be one reason that their size was limited to three to four millimeters in diameter, even after growing for 10 months or more.

Commentary

CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “There have been numerous stories lately about using induced pluripotent stem (iPS) cells to form various tissues, including vascular endothelial cells for blood vessels, myocardial tissue for heart muscle regeneration and even brain tissue for study of normal and abnormal brain development.

“The iPS cells, because they are created from the patient’s own normal cells, could potentially provide tissues for personalized drug development or for transplant. There are still significant practical problems to overcome with iPS cells, including their penchant for growth, which may make them more suitable for laboratory study than for the clinic.

“But the ethics of the research is also significant. The iPS cell creation technique (for which Dr. Yamanaka won the Nobel Prize) does not rely on creation or destruction of human life—it does not use embryos, eggs or cloning techniques. Thus, it provides an ethical source of cells for study (as long as the molecular tools used for creation of the iPS cells are ethical, of course; i.e., not using aborted fetal tissue for DNA production, etc.). As more and more cellular and molecular techniques approach the clinic, this ethical consideration is very important if we are to maintain our stance for life. “Do no harm” applies not only to the patient treated, but to the origin of the treatment as well. We should reject any ethically-tainted treatments just as we would reject any bacterially-tainted or chemically-tainted drug or instrument.”

Resources
CMDA Ethics Statement on Stem Cell Research and UseScientific Demagoguery in the Stem Cell Wars by David Stevens, MD, MA (Ethics)

Using social media in clinical practice

Excerpted from "Docs Need to Get Up to Speed, Social Media Advocate Says," MedPage Today. August 15, 2013 -- Bertalan Mesko, MD, PhD, is counting on old media to convince more clinicians about the value of new media. The clinical genomics specialist has just published a handbook on social media in clinical practice -- and he hopes it will bring late adopters up to speed with their social-media-savvy colleagues, and even with some of their electronically empowered patients.

While "expert" patients voraciously pursue credible medical information and communities online, clinicians "usually lag behind," Mesko, who is based in Budapest, said in an email exchange with MedPage Today. Instead of disdaining this kind of behavior, doctors need to see themselves as a gatekeeper of vetted online information and activities, he said.

“Social media provides us with a lot of opportunities, but only if we know the potential limitations and security issues. Acquiring such knowledge takes years, and my goal with the handbook was to shorten this time significantly for those medical professionals who would like to become a bit more digital, but at the same time use these online tools in a secure way,” said Mesko in an online engagement via email.

“I think communication methods in real life and in the online world are the same. If medical professionals understand this and create a proper online presence, as well as give their patients a chance to communicate with them through certain online channels, the doctor-patient relationship can become more efficient by saving time for both parties. Using digital technologies, especially social media, is now an integral part of medical communication, and as more and more patients use these platforms, their physicians must be able to deal with this in an evidence-based manner,” said Mesko.

Commentary

CMDA Vice President and National Director of Campus & Community Ministries J. Scott Ries, MD: "Mention 'social media' during a conversation with one of your colleagues and observe the resulting reaction of the facial muscles. I predict you'll identify a subtle pupillary dilation, upturning of the corners of the mouth and an increase in pace of speech...or else you'll view a burrowing of the forehead creases, tightening of the lips and clenching of the jaw. When in past history has any other 'tool' ever evoked such emotional response from its users (or haters)?

"At its core, social media is indeed simply a tool—a forum to communicate, share ideas, explore information, engage conversation and create community. If you already embrace social media at some level, you won't be surprised to hear that I'm more likely to be contacted via Facebook than email by students, residents and even some doctors.

"If you find yourself beset with the clenched jaw, here are a few things that might help you dip your toe in the social media waters without catching a cold.

1. Recognize that social media does not equal Facebook. Not all of social media is Facebook. As social media expands, the relative amount of the landscape occupied by Facebook is diminishing. If Facebook seems daunting to you, choose another option to explore.
2. Peruse areas of CMDA’s social media engagement. CMDA is actively engaged with social media with both the current and upcoming generations of doctors.
3. Consider following just one blog, along with following their Twitter and/or Facebook posts. This will let you ease into the foray a bit without becoming overloaded.

For more practical insight into how to use social media, the benefits it can offer you and your practice and other information, check out Social Media in #Healthcare: Why You Should (Like) Social Media by Bill Reichart, MDiv.

"But won't social media consume any vestiges of time remaining in our overloaded schedules? Only if we let it. It's like when I was taking driver's ed as an inexperienced 15-year-old. In attempting to pass a slow moving truck, I was hesitant to exceed the speed limit. Seeing the approaching car, the instructor promptly pushed her 'instructor’s accelerator' to quickly get us by the truck, while calmly saying 'Control the car. Don't let the car control you.' So it is with social media. However you choose to engage, control it...don’t let it control you."

Resources
Social Media in #Healthcare: Why You Should (Like) Social Media by Bill Reichart, MDiv

CMDA's Social Media Pages

• Facebook
  
• CMDA Student Life Facebook
  
• Twitter
  
• YouTube

Morning-after pill conscientious objection ends in job loss

From Freedom2Care blog by CMA VP for Govt. Relations Jonathan Imbody, Aug. 8, 2013:

Tolerance. Diversity. Broad-mindedness. Those are the words.

Bullying. Discriminating. Compelling. Those are the deeds.

The contradictory words and deeds often come from one and the same individuals--and in a case I learned about today, companies. Turns out the words of tolerance, diversity and broad-mindedness only apply to those who comply with the dogma and submit to the will of the speakers.

Here’s an email I received this morning from a pharmacist member of the Christian Medical Association:

"Subject: Forced to resign over mandate to sell the morning after pill.

"Just to let you know that Rite-Aid corporation came out with a stricter policy on July 5, 2013 that requires all employees to accommodate the sale of the morning-after pill to all comers, of either gender and of any age. I tendered my resignation within the hour, it was accepted, and my last work day is July 20th. I realize that I am an 'at will' employee and I do not expect any recourse. Just for your information to add me to the list of those quitting pharmacy solely because of the policy change. Keep up the good work. The battle rages. The Lord is able to supply our needs."

Remember that even the Obama administration health department opposed the unlimited sale of the morning-after pill, citing health concerns. So presumably, even the radically pro-abortion Secretary of Health and Human Services, Kathleen Sebelius, is not radical enough to work at Rite Aid.


Unfortunately, Secretary Sebelius and President Obama trashed the only federal regulation protecting healthcare professionals from discrimination and firings for reasons of conscience. They and other abortion advocates also can't seem to muster enough liberality to support the tolerant, diversity-respecting and broad-minded principles of the Healthcare Conscience Rights Act (S 1204 and HR 940).

While the regulation and the law apply specifically to government-funded programs, each can help establish an environment of true respect for conscience, tolerance and diversity that will protect health care professionals nationwide. Until then, pharmacists, obstetricians and family docs who still adhere to the Hippocratic oath and faith tenets remain subject to job loss, discrimination and ostracism for their life-affirming views.