Blue Dog Betrayal

It seemed like a miracle to elect a Democratic representative in the first district of Idaho. The guy who previously held the seat was a disgrace, and his failures were Walt Minnick's success. An Idaho blogger by the blogonym of Mountain Goat has a bone to pick with Minnick's manipulative and dishonest campaign that stood in support of sCHIP on principle. But health care for everyone else? No way! His constituents don't want that kind of socialized craziness! Take it away, MountainGoat!

On Halloween day last year, in an interview with University of Idaho's KUOI radio in Moscow, you scolded your opponent for voting against expanding the State Children's Health Insurance Program, saying, incredulously, "Who could be opposed to providing health care to single moms who don't have jobs?"

Bill Sali said we couldn't afford it and voted against it—four times.

You said, "There are some places this country has to invest," and called the votes shortsighted.

Read the whole thing n weep, folks.

Hard-working Idahoans like Tom and Karen sent you to Washington because you gave them hope. Hope that you could and would convince their country to see them as an investment. People of the 1st District had enough of the rigid ideology that told them they weren't worth the price and sent you to represent them instead. They didn't expect to get a more finely honed rigid ideologist. They didn't expect, nor did they deserve to get their lives turned into political footballs—least of all by you.

Yet that is exactly what you've done. You joined the chorus of townhall crazies and fear mongering ideologues who turned Tom and Karen and every other Idahoan who can't afford medical care into political footballs.

Instead of coming home and working to convince Idahoans that they had nothing to fear and much to gain from health care reform (something many of us were prepared to help you do), you and your advisors (with their legendarily acute grasp of messaging) sent out misinformation-laden press-releases playing up the fears of Idahoans using triggers like "socialized medicine," "big government" and "raising taxes."

Naively, I thought that getting an Idahoan into the Democratic majority could give the progressive agenda some kick to it. But those damn dirty blue dogs rolled right over when they saw blood in the water and donations to their re-election funds. I'm disappointed by Obama in a lot of ways, but I may in fact regret my vote for Walk Minnick.

I just wanted to highlight this fantastic post and give it a push, plus add my own frustrated feelings. WTF, Walt? You're not as silly as Sali, but you're about as useful.

You have to admit it's getting better

When Obama backs off, he really backs off, but I think I need to recognize that I should take what I can get for now. No public option!? This will do the opposite of reducing health care costs in this country, and just get more premium-payers contributing to Aetna (or whoever)'s massive bloat. I wish I knew more about nonprofit health insurance companies/co-ops, but as someone who's paying a massive premium to stay on Group Health's rolls, I know remarkably little. I will say this, though: the people praising Group Health are basically on the money. It doesn't come cheap, but this is American medicine here. I've run into only a few people who complain about GH, but most docs I've been to have been delighted when they found out the entity with which I am insured. I have a lot of half-baked theories as to why I've had such a good experience with them, but it can't hurt that they approve almost anything a doctor orders. When they reject it, they reject it, so I have spent almost no time fighting with them. I've had to show some rather expensive good-faith, but they've been pretty go-along get-along.

Talking about health care is getting extremely old, but it's kind of like looking at a car crash (or, really, the bills from the ER after a car crash).

The major failing in the "dialog" has been almost no serious proposals for reducing costs. And those that I've seen, like a general policy to skip ineffective treatments, have caused Republicans to scream bloody murder.

In other news, I've started working a part-time job at the U of Idaho - I'm training to caption classes for students who are Deaf or hard-of-hearing, and even the training is kind of fun. I recently got serious about a job hunt again, and scored two interviews. One was for this job and the other for one at a local biotech, basically doing the exact things I disliked about my previous job; I don't think I was really in the running for that one, though, and I think I'd have really hated it. This is a completely new direction for me, and takes better advantage of my natural talents.

As it is, I'm working just less than half-time, and I am a gajillion times more productive regarding things like housework when I am working outside the home at least a little. This is a new thing for me - I don't think I've had a part-time job while not doing anything else since I was 19 - and I'm going to take advantage of the fact that I can pretty much afford it. (I think the new "We'll live on love" is "We'll live on loans.").

Winning hearts and minds, losing medical coverage

Judy Berman has a post on Broadsheet summarizing the fight to keep "gender identity disorder" from being listed in the newest version of the DSM. The title of her article makes clear what opponents of GIS' listing in the DSM are upset about. The article is called "Are transgender people mentally ill?" gidreform.com's title bar reads "because our identities are not disordered," which I can certainly support in spirit, but not recoginizing gender dysmorphia as a pathology has already had nasty consequences for people needing sexual reassignment surgery in Manitoba, in that the surgery is categorized as being "cosmetic" and therefore ineligble for government subsidy.

If gender dysmorphia is a non-problem, it doesn't need to be treated with expensive surgery. Categorizing transexuals as suffering a pathology should be morally meaningless. If a transexual individual needs surgery to correct a mismatch between their gender and their sex, they have a problem with their original body that can be treated with surgery/medication/counseling - as far as I can tell, what advocates for sexual diversity are objecting to with GIS' listing is the ablist stigma that comes with mental illness. In the real world where transsexuals are subjected to violence and discrimination, it's probably asking a little too much to strike a blow against ablism and homophobia all in one fell swoop. SRS is not a one-size-fits-all solution to gender dysmorphia; plenty of transsexual individuals don't want to physically modify their bodies, so surgery is not indicated in every case. This detail would be crucial to GIS' listing in the DSM

When straight-and-narrow types want to tell transsexuals that they are disordered and should go to hell/the doctor for it, it takes some guts and nuance to say that re-education doesn't "work," but in many situations, gender reassignment does treat the suffering/pathology. This is where the comparison to delisting homosexuality in the 70s departs from the situation with gender identity disorder and the DSM. Homosexuality doesn't need to be/can't be treated with anything whatsoever. Transsexuals who pursue sexual reassignment surgery are meeting physical needs that cissexuals don't have.

Big Nutra's direct-to-consumer scams

Feministing pulled a post about the "feminine" aspects of naturopathic medicine to post on the front page, and I am quite the skeptic of alternative medicine, but I was also annoyed at the "conventional medicine is patriarchal and for lame men who might as well spend all their money on useless, dangerous treatements and get sick and die while their doctor is being a jerk to them" vibe.

ericamatluck said:

Historically, women's voices have been excluded from medicine. Medical research has been conducted by men, for men. There was actually a time when hysterectomies were performed because women were considered "hysterical". Although we have seen progress with regard to women's involvement in medicine, the situation remains inadequate. Our understanding of pathology is based on how a condition presents in a man. This understanding is applied to women, ignoring the fact that we have a unique chemical and structural composition, and may respond differently to the same pathology.

This brings up real problems with medicine as it's been applied to caring for women, but is not any kind of argument for naturopathy as feminine, and therefore more-suited to female patients.

The comments erupted into a huge flamewar over "natural," "homeopathic," and "herbal" medicine, which seem to be used interchangeably. "Natural" is a marketing term that basically means nothing (see"all-natural" on the side of the bag of chips you're eating), and homeopathy is truly superstition-based and ridiculous. Homeopathy relies on an essential characteristic of a substance being imbued upon a diluent, even as the substance is diluted to minute, if even still present strengths.

Ever hear about the homeopath that drank a glass of water?

He died of an overdose.

I'm not really clear on the difference between "natural" and "herbal," but I'll bet a Venn diagram where the "herbal" circle was completely encompassed by the "natural" circle would represent that relationship. I've spent almost a solid year working to straighten out some medical problems, mostly with conventional doctors and pharmaceuticals. When things began, I really didn't have much capability to decide what I should do. I basically just did what doctors told me to do at first.

I've since warmed up a little to "alternative" medical practices, since hey, I don't mind taking a few vitamins or other substances that I know won't hurt me (ie valerian or hops or fish oil). I also usually run a search on pubmed with any new snake-oil-ish thing I'm considering trying.

Googling anything medical is almost always a disaster. If it's not on pubmed, it's someone trying to sell you something. I've learned that there are no bigger conspiracy theorists than people who have chronic, incurable diseases.

The thing I saw over and over again in the thread on Feministing that I thought was weird was all of the "pharma's corrupt, but try my $30 bottle of fish oil tablets" kind of stuff. You don't get the kind of exclusive manufacturing rights for a naturally-occurring substance, but people selling omega-everything are sure making themselves some money.

People are rightly suspicious of pharmaceutical direct-to-consumer advertising, but the same branding and appeals to emotions are applied to the overpriced supplement products. They don't make as much money as Pfizer, but they don't have the same liabilities either.

I don't think there's anything more consumer-friendly in the business of wringing the oil out of fish and putting it in little caplets, than there is in the business of creating novel compounds and testing them against diseases/symptoms, and then manufacturing and selling them.

With substances that aren't exclusively owned and manufactured by one entity, there's room for competition, which can open up the field to better-produced or plain better products. I bought a bottle of cheap fish-oil supplements, and the fish burps were in-freaking-tolerable.

This phenomenon has played out with generics of brand-name hits, and there are definite preferences for different generics. Generics aren't actually required to be precisely equivalent to brand-name drugs (they have to be within 80%, to my knowledge), so lots of people stick with their brand-name greatest hits drugs. I'm sure that competing in the supplement marketplace is a lot like competing amongst generics. You're all selling the same substance, but you need to make some kind of superficial distinction between yours and theirs. Make a supplement that is branded such that people feel good about buying it, and have an advantage such as convenience or user-modifiability. I've taken two generic forms of Ambien, and the first I took was a pill in an oblong shape that was easily broken in half so I could use a half-dose if I wanted. I preferred it to the one I currently have, that's tiny and unsplittable. They both do what they're supposed to do, but it's not efficacy on which I am basing my preference. I once had the birth control pills I was taking switch to a generic, and I switched back to the brand at my own expense(despite being made fun of by the pharmacist), because the generics really didn't feel right - I'd started a new type of pill when I was having really terrible menstrual cramps, and the new pill cleared that right up. They came back with the generic, and I'm not going to take birth control pills about which I feel iffy.

Pleasant surprises

You guys, we really have a Democratic president. As I was walking out the door this morning, NPR was talking about how Obama's putting an end to the global gag rule, and that the FDA is approving stem cell research, and and and uh, something else I don't remember.

I am extremely pleased with the tough rebuke of torture we've seen so far. I was waiting to get disappointed on the global gag rule thing, but wow, I was wrong! I saw this video a few months ago (I think) and thought it was very good, but my hopes weren't high enough that I wanted to post it.

Leverage

Kevin, M.D. is concerned that single-payer healthcare plans dictate the prices of medical procedures to providers.

But that's exactly the point, Kevin. If providers don't like the contracts they've negotiated with insurers, they need better negotiators, or to find ways to cut the costs of procedures. It costs a heck of a lot more to get an MRI in the US than in Japan, and this isn't merely because the technology is more available in Japan.

McCain's plan for rural health care: walk it off, bumpkins

I'm only 26, but my middle name might as well be "preexisting condition," and finding expert care in my rural area has posed a huge challenge for me - especially since I have to be seizure-free for six months to drive in Washington. So, Mr. McCain, if my autoimmune condition confines me to a wheelchair in 10 years, how will good exercise habits keep me healthy? How will I get any kind of coverage? And if I could even buy insurance on the private market, how many hours would I be expected to travel to get medical care?

This is a problem Idaho has been trying to address for years. Programs helping pay for student loans for rural general practitioners have a lot of potential - a lot more than starting a med school from scratch in Idaho. Who's to keep students from Idaho Medical in the state after they receieve their training?

Satire executed too well...

...is not funny because it reminds you too well of the things that are tragically wrong. Senator Ron Wyden's reelection campaign has hit that sour note with this commercial

Katrina Lauderdale, RIP

I've been thinking a lot about this story lately, about a two parents who watched their three-month-old child born with a cleft palate starve to death when they were unable to feed her, afraid to seek medical attention without health insurance.

Their daughter, Katrina Lauderdale, was born in Burns, Ore., on Oct. 24, 2006, with a cleft palate, a facial deformity requiring special feeding procedures. While in Oregon, she was seen weekly by doctors who instructed the couple how to feed their baby and provided them with special bottle and nipple systems, according to a police affidavit.

But after they moved to Spokane last November when Charles Lauderdale took a new job, the doctor visits stopped. Charles Lauderdale lost his job and his wife went to work, leaving the baby in her husband’s care when she was working.

Two Oregon doctors concerned about the baby’s failure to gain weight had advised the parents they needed to keep Katrina under continuing medical supervision in Spokane, but the couple later told police investigators they had no health insurance, the court affidavit says. No Spokane doctors saw Katrina.

It makes me so sad, and so angry. From the description, it sounds like the couple did act gravely and criminally irresponsible, even in their bad situation. But I still feel for them. I'd like to think that there are public assistance programs they could have turned to, or that if I were in the same situation, I'd have brought the child to the emergency room, hospital debt be damned. I can also imagine some of the fears of the parents'; that if they brought the child to the hospital, she would have been taken away by state services, and if not now, when they hospital bills came due and they lost their home. Or maybe they hoped to wait it out, until the father found a new job or the mother finished her probationary period at work and began to receive health benefits.

But even if these two were simply stupid and cruel, their child was the last person who deserved to pay the price for it. If the parents didn't have to think about what a doctor's visit would do to their financial security, things would surely have turned out differently. Universal healthcare is fallible like any other system, but at least it doesn't punish families like Katrina's for seeking help. If a child's parents are already stupid and cruel, financial roadblocks between her and the medical care she needs aren't going to help.

And we see this so clearly in Katrina's case, where she thrived with public assistance, and starved to death without it. There are a patchwork of nurse home visitation programs in Washington, programs that have been shown to work, but Katrina was in the wrong place at the wrong time.

Even (especially?) the clever and kind among us realize that the Lauderdales had only bad and worse to choose from. Add some ignorance, a great amount of fear, and probably some wishful thinking, and it becomes clearer how these things happen. These are the stakes, and consciously doing nothing to change things has a real an impact on peoples' lives as any changes do. We can punish this couple as hard as we want, but as long as the same system puts the same pressures on all of us, we'll see the scenario play out over and over.

Idaho house delgation split over SCHIP: guess who's holding up health care for Idaho's children?

After Bush's shameful veto of the bipartisan-supported SCHIP expansion, all eyes are on the House of Representatives and the push to find the 15-ish Republican votes that would override the veto. Mike Simpson, one of Idaho's two representatives and a medical professional himself, voted for the SCHIP bill, saying:

"As a fiscal conservative, former dentist, and a person who believes we must invest in our children’s health and education, my vote in favor of the CHIP bill was a difficult decision.

"The bill ends coverage of childless adults and returns the program back to its original intent – a health insurance program to cover our country’s most vulnerable children. The bill also provides much needed dental coverage for these children in hopes that tragic losses, such as the young boy in Maryland who died from an abscessed tooth, can be avoided. Among other issues, the legislation prohibits new waivers to cover parents in the CHIP program.

"In order for a child to grow, prosper, and contribute to society, they must have access to quality healthcare. By improving healthcare and children’s access to it, we are investing in our nation’s most valuable and precious resource, our children."

Bill Sali, Idaho's first district representative, has demonstrated much more interest in spreading misinformation about this much-needed bill for Idaho's uninsured children than finding solutions for Idaho's uninsured. Sali's propaganda made its way into my inbox this morning, including this gem:

"This bill would raise taxes in order to provide a form of welfare for middle income people and illegal aliens. In short, this bill is going to hurt the people it is supposed to help, and help the people it shouldn't," said Sali. "This bill is very harmful. It takes money from hardworking Americans while opening the door to provide health insurance to undocumented foreign nationals, including gang members, drug cartel operatives and terrorists. Further, it taxes Idahoans to provide health insurance to people already covered by private insurance or those who can afford to get it."

...

The SCHIP bill, which was originally intended to focus on low-income children, expands the program to include people who are well above the federal poverty level - providing coverage to families who earn in excess of $80,000 a year. By allowing people with high incomes to join the program, it encourages people to give up their private insurance in favor of government-provided health coverage, and requires Idahoans to subsidize healthcare for people on the east coast earning more than $80,000.

Simply put, the Republican talking points Sali is leaning on are dead wrong. SCHIP coverage can only be provided to American citizens who provide social security numbers as is written in the law, and while it is possible for some states to increase the maximum income eligibility level (tied to the poverty level), these are states whose living costs far outstrip Idaho's. These states also provide far more tax dollars to the federal coffers than Idaho does (simply by virtue of Idaho's small population and relatively small incomes), and therefore will foot a proportionally larger chunk of the national bill than Idaho will.

I suppose it is possible that there are "gang members, drug cartel operatives and terrorists" amongst the ranks of uninsured American children, but if that's the case, there are more direct ways of dealing with such law enforcement problems than denying teeth cleanings and antibiotics to thousands of low-income American children. Sali has aligned himself with George W. Bush's veto and against the uninsured children and the majority of voters in this country.

If you're as unimpressed as I am, feel free to contact Sali and let him know.

Cross-posted at Red State Rebels.

We've tried nothin' and we're all out of ideas

Kate Harding's douchehound of the day reminded me of something that drives me nuts about hand-wringing over the fatness of the American people. Quoth the douchehound:

OK, how can you dismiss doctors who ask for lifestyle changes when you havent even attempted to make them?

Because for one reason or another, doctors asking for lifestyle changes has little to no long-term effect on patients' weight or health. If doctors are serious about the need for their patients to lose weight, they need to find methods that work (instead of methods that would work if they worked). What should be dismissed is the idea that dispensing instructions that are either ignored or impossible to follow at all resembles medical care.

Man, those wait times for receiving medical care...

I called to make an appointment with my doctor today, and the soonest available was on August 23. Boy, am I glad that we get to pass up rationing and wait times for our top-of-the-line(ish) medical care system!

Monique and the Mango Rains

I must have been projecting a little when I picked up Monique and the Mango Rains: Two Years with a Midwife in Mali, because I apparently thought that the title was really Sara and her issues with the female body. I heard about the book, which is a Peace Corps volunteer's story of living with and assisting a midwife in rural Mali, on NPR one day, and was immediately fascinated. The author, Kris Holloway, was talking about her previous attitudes about women and their bodies and children - she had never planned on having children or even getting married, and avoided the topic of pregnancy in general - and how completely insufficient they were when it came to understanding the reality of childbearing and women's bodies in a world where birth control is not something most people think of as a right.

I was really fascinated with the story that Holloway was telling, but I was especially interested in the book because of her perspective; I've never felt well-acquainted or emotionally certain about the reproductive capabilities and difficulties that are inherent in the female body. In my body.

In fact, I've sometimes had the dark thoughts that being a woman is a simple curse, that femaleness is a medical pathology, and that the terrible fates that befall women and women only make feminism a heartbreaking fool's game. And even if women's bodies aren't sick, they age quickly into ugliness. I remember when the bad news about hormone replacement therapy beame big news, everywhere I looked it seemed there were people telling me that women's lives go directly to hell when they approach menopause. Hot flashes and mood swings and changes in sexuality - from the loss of the ability to bear children to changes in libido and conventional attractiveness, all portrayed as humiliating and miserable - it sounded impossible, and even if I was only 18, so very soon. And if this natural defecit in the female body were going to be addressed with HRT, all someone had to look forward to was a heart attack or cancer. Oh - and cancer. Breast cancer kills women in their 30s and 40s, and women who do not have children and breastfeed face a higher risk of it. Reproductive cancers kill women in huge numbers. Ovarian cancer is hard to detect and therefore highly fatal.

It was only a couple of years ago, through slowly increasing dread in the back of my mind, that I remembered: women generally outlive men. I don't know if it's just that medical alarmism sells well with women, but I swear that the Your Delicate Lady Parts Are Rotting Out of Your Body as You Read This! genre of journalism is awfully ubiquetous. Back to the HRT revelations, I was incredibly relieved when I heard a doctor (a female doctor) on the radio mention that it's only the minority of women who have menopausal symptoms that are severe enough that they seek treatment.

Between the alarmism about women's medical problems and thinly-veiled contempt for women's bodies that dare to change over time, it's really difficult for me to think clearly about the reality of women's health, and even my own reproductive health. I picked up the book imagining that Holloway would walk me through her own revelations about these issues, but alas, it was not to be. Fortunately, it was a really interesting story about an amazing woman, and even if it didn't hold my hand through my own fears and anxieties about women's health, I suppose self-reflection is really my job.

Holloway says in an interview that she struggled with not centering the book around herself, since she wanted to express Monique's personality and achievements more than stand in the spotlight herself, but also her editor's requests to acknowledge her place in the story and use it as an anchor for white American folk (like myself) to identify with when learning about a different culture and a different outlook on life.

And the outlook on life the people she lives with is quite different than my own. The people of the village she lives in, Nampossela, live knowing they have very little control over which children die or which children live, over whether the rain comes at the right time, and are somewhat content in their understanding that these life or death issues are ultimately controlled by God himself, so they ought to make the best of whatever is handed to them. There's also a strong sense of communal responsibility and ownership - crops are grown in communal fields where all the townspeople contribute labor. With these dynamics, there's little sense of individual responsibility for the things that happen. Maybe one family slacks off in the fields, or a woman's husband won't let her rest enough during her pregnancy, but when the harvest doesn't bring quite enough food, or the woman dies in childbirth, it's best not to dwell on the whos and whys, and just continue knowing that God has a plan.

As an American, I found myself thinking that there are some ways in which this just doesn't make sense, but one interesting way Holloway had of expressing the utility of this way of thinking came when Monique tells Holloway that her first sexual experience was being raped. Holloway is as shocked as a fellow rape survivor can be.

"'Ah Fatumata [Holloway's Malian name], it was this way for me, and for other of my friends,' Monique said, looking at me with a mixture of concern and confusion. She paused for a moment, watching me, moving slightly closer. 'It is normal. It happens.'

Her words made me feel less alone, safer. Yet I couldn't imagine that Monique, or anyone else, could think being forced to have sex was normal. But she hadn't called it rape, or anything violent. I had read about women and internalized repression, was this a sign of it? Rape, or forced sex, or whatever term one wanted to apply, was a reality faced by women all over the world, but Monique didn't seem to have baggage, no perception that she had somehow been violated, no shame or self-reproaching. That, I knew, was a great thing.

I'm still not sure what to make of this passage - I'm sure I'll be thinking about it for quite a while. One of the main themes of the book is the struggle between Holloway's instinctive tendency to look at Monique's life through her Western eyes, but to appreciate the lessons that Monique's way of thinking could offer in the face of poverty and sickness and death. Monique and Holloway spend much of their time teaching neighbors and friends about treatments for diarrhea, one of the most frequent factors in child mortality in the area, and their lessons clash somewhat with the "will of God" attitude about health and sickness.

Monique didn't lead me to any huge revalations about the cosmic fairness or unfairness of female reproduction. I am always glad to see that people's lives go on through the things that the media will sensationalize. I once read a long article about postpartum incontinence, and it had me pretty freaked out for quite a while. There are just so many things that can go wrong with labor, with bodies, with lives. But one evening, I was walking by a baseball field where families had gathered to watch their daughters play softball, and it dawned on me: just about everyone does it, and they don't seem crippled with shame or physical disability. I suppose it says a lot about the privilege I've been so fortunate to live in and my own general level of anxiety that I could be so shaken by the idea that life isn't fair, and that bad things happen to people all the time. There are plenty of things - mundane or not - that I can't imagine myself living through. But sometimes they happen, and I'm shocked to find that I'm still here, I'm not struggling with agonizing shame. And neither are the women in Monique's village, neither are the people all over the world whose lives aren't perfect. It's not any reason to let the chips fall where they may when there's something we can do to improve our own lives or the lives of others, but it's good to remember: life goes on.

Disappearing the sick

You may have heard about the increasingly-common practice of jailing people carrying highly-contagious, drug-resistant tuberculosis. I've seen more than one news article on the subject over the past year, but was really surprised when I heard this report on NPR yesterday, where the reporter was unable to get ahold of the patient, Robert Daniels, and had to resort to slipping her number to him through a messenger so he could call her collect, only to be cut off after ten minutes. He's been totally isolated in a criminal facility because he happened to catch the wrong bug.

While I recognize the real danger someone unknowingly or recklessly spreading dangerous diseases, I just can't believe that this is the best approach. A few years ago, Moscow had a with similar attributes, where a local man was convicted on felony charges of "knowing he was HIV-positive and transferring or attempting to transfer body fluid to women in Moscow without informing them he was infected." The problem with this when it comes to actually stopping the spread of disease is that if the man in the HIV case, Kanay Mubita, had never been tested for HIV, he would never have gotten in trouble. It creates a perverse incentive against being tested.

On the other hand, I do recognize that knowingly exposing others to deadly disease is not behavior that should go unpunished. If we're going to make what Mubita did a crime, we also need to make HIV testing mandatory. And if we're going to jail people like Daniels, we need legislation that defines his behavior as criminal, and to try them in court. I would accept some distinction between diseases that manifest themselves obviously (like TB) and those that one might not know they were carrying. But as it is, there are plenty of idiots out there who don't wash their hands before leaving the bathroom or undercook hamburgers, and they're not facing jail time. Mubita and Daniels have both put people around them at risk, but unlike the guy who didn't wash his hands, they're carrying sensationalistic diseases that people get excited about. Legislation can be a useful tool for preventing public health problems, but it needs to be tailored towards actual risk reduction, and not just making people feel less scared or more vindicated in the face of the latest scary disease.

Happy back up your birth control day!

Today, NARAL Pro-choice America is celebrating Back Up Your Birth Control Day by promoting awareness of emergency contraception and how to access it. See Vanessa's post at feministing for more information on EC, but also don't forget that every once in a while, it's a good idea to reassess how your birth control regimen is working for you, and what steps you could take to make it more reliable.

In keeping with the spirit of the day, I thought I'd share what I do, as a user of oral contraceptives.

1. I take my pills right before bed and leave them in my night stand. When I first started using oral contraceptives, I tried taking them in the mornings, and felt uncomfortable with the idea of maybe oversleeping and taking pills at dangerously inconsistent times.
2. My partner is on guard to remind me to take my pill every night. I forget everything, even things I do every day. I can accept this fact. I even forgot to pack a lunch today and had to eat crappy overpriced campus food. A reminder is always useful.
3. I keep backup methods of birth control in my nightstand. What I've got on-hand right now is the sponge, which I actually haven't had occasion to try, but I'm willing to give it a go someday.
4. I store my pharmacist's number in my phone. If I've missed a pill or have questions about how a course of antibiotics will interact with it, I give them a ring. I've been using the same pharmacy for several years now and have built up a good relationship with the pharmacists who work there, but even if you haven't any pharmacist is likely to answer your questions about using medication. Find one that will provide answers and keep their number close at hand.
5. (Possible TMI warning) I look on the bright side. A week where I've missed the pill doesn't have to be abstinence week or condom week - it can be oral sex week! Can't complain about that.

Anyone with other tricks to share to correctly and consistently use oral contraceptives - or any other type of contraception - please leave your ideas in the comments. If you'd like to post your list on your blog, I'll link to it. To paraphrase the old saying, effective birth control is part medication and part inspiration. Gimme all you've got, feminist hivemind.

Planned Parenthood's holistic care under pressure

Via Feministing, we learn that Missouri's governor has rescinded a years-long contract with Planned Parenthood to fund cervical and breast cancer screening to low-income women. Ann at Feministing picks up on the poorly-informed reasoning behind the move

"Patients should not have to go to an abortion clinic to access lifesaving tests," Blunt said in a written statement.

But Planned Parenthood of Southwest Missouri said the clinics that participated in the program have never provided abortions.

but fails to note that the governor has not simply cut the money for the screenings (he has actually increased it), and has awarded the contract to other health care providers. While there are still potential problems with the switch (Where are the new clinics located? Will they be accessible to women with low incomes, lacking transportation, or unable to take time off of work?) it's not fair to say that the governor, Matt Blunt, is sacrificing this important program for the sake of taking a political stance.

I don't know a lot about the process of bidding for public contracts, and I would wonder if a governor's pet peeve is enough to make this kind of move (PP does as well - the article says they're evaluating the legal ramifications), but this is action of which reproductive rights advocates need to be very wary. The process of disconnecting public funds from abortion has been long ongoing, and it's gone a long way toward separating reproductive rights issues from other health issues. (I liked stellaelizabeth's comment at Feministing, "maybe next this guy will restrict women from breathing, because they might end up inhaling the recycled air of a woman who has considered abortion. and they shouldn't have to do that.") Blunt is taking things a step further, and making it harder for PP to provide the holistic reproductive health care that it has been making available throughout its history.

Around my household, Planned Parenthood was always considered a force for good, a place where couples and individuals could find the means to take control of their reproductive health and plan their families. Planned Parenthood was where I had my first pap smear and felt the most comfortable seeking birth control as a teenager. I was surprised when I began exploring pro-life propaganda that many don't know or don't care about PP's services beyond abortion. It should be obvious by now that people like Blunt are actively working to amputate female reproductive health care issues like abortion and contraception from the picture of human health.

It's a frightening, bad-old-days goal, and one that advocates for women need to take seriously. When we have people advocating against a cancer vaccine for fear that people would not suffer bodily injury for having sex outside of marriage, and governmental forces that mandate misinformation about sex so that teenagers might fear the wrath of God enough to keep it in their pants, it's sometimes hard to remember that the forces we're fighting aren't always sheer ignorance and misogyny. Blunt is putting a stumbling block in the way of Planned Parenthood's goal of making reproductive choice a reality, and luckily, he's not willing to give women cancer to do it. He doesn't deserve extra credit for not being a caricature, though.

Pre-term babies and pre-pregnancy

Slate has an piece today about the US's relatively high infant mortality rate (compared to other industrialized nations), which argues that America's bad numbers are the result of a high rate of pre-term deliveries and not of bad health care. Darshak Sanghavi, the article's author, says quite reasonably that industrialized nations experience the most infant mortality in connection with early births, which are more likely when a couple uses fertility drugs to conceive. I haven't had the chance to do any Googling, but I'm not sure that Sanghavi convinced me that we're killing these infants by spending too much on their health care, but it did make me think back to the whole "pre-pregnancy" health idea that was unveiled soon after the US' infant mortality numbers came to light.

In my post on the subject last May, I discussed my suspicion that the CDC's recommendations were shifting the burden of good health from this country's inadequate and underserving healthcare system onto women who probably aren't risking much when they have a drink or five at some time during their childbearing years. Given what Sanghavi is arguing, it becomes even less believable that women neglecting to take daily folic acid supplements between the ages of 15 and 45 are what's behind the US' infant mortality rate.

Back up your birth control on March 20*

NARAL Pro-Choice America is promoting March 20th as Back Up Your Birth Control day, and spreading information about emergency contraception and how to get access to it. Visit their website to find out how you can help spread the good word and help people have access to birth control they can count on.

*Or do it today if you get the chance - there's no time like the present.

That's more like it

Washington State is offering the HPV vaccine to girls for free. In the article, Gov. Christine Gregoire says:

Addressing the Washington State Medical Association's annual legislative assembly and again in a news conference Monday, Gov. Chris Gregoire said such action [requiring the HPV vaccine for entry into school] seemed premature.

"I told the medical association that I was reticent to dictate when I think there is a lot of public education that needs to go on," Gregoire said. "To go out and start just saying everybody mandatorily has to have this is a little bit troublesome for me.

If I were Merck, I'd be scrambling to get the takers to participate in a study on the long-term effects of the vaccine. If, in 2 or 5 or 10 years the country decides to buy into requiring the HPV vaccine, Merck will still stand to make a mint. If they really believe in Gardasil's potential, they can wait.

Leaning in a new direction

In case it wasn't obvious in the last posts I've written about it, my first reaction to the news that the HPV vaccine is going on a roster of required vaccinations for school in Texas was, "Heck yes!" Cervical cancer kills, genital warts are a drag, and yearly pap smears are no party either. I'm not a doctor or a public health expert, but the information about Gardasil's efficacy and safety make it look like a pretty good bet for eradicating most cases of cervical cancer.

Still, I've come to the conclusion that I don't think it's wise to require vaccination against HPV in schoolchildren at this point. Loquacious commenter stickdog - who has an axe to grind, but I was wrong to call a troll - has given every possible reason to oppose widespread HPV vaccination, and while I'm not buying all of it, my change in position has definitely been guided by the info stickdog has brought.

I really, really want Gardasil to work, and nothing that I've learned about its approval process has set off alarm bells in my head. But the fact remains that there isn't a huge body of evidence supporting Gardasil's long-term efficacy and safety, and the health problems associated with HPV don't seem pressing enough that we ought to embrace Gardasil so enthusiastically. The current system of keeping a close watch on American cervices has failed many, but in my view, not so many that we couldn't take our time in evaluating Gardasil. Think of it this way: if we're going to be instituting a large and expensive public health program aimed at preventing cervical cancer, we might as well devote the money to access to the medical care that already works pretty well (say, refunding this program) as we wait to get a better picture of what Gardasil has the capacity to do.

I predict that Gardasil will be a valuable tool in eradicating cervical cancer in America. On the other hand, responsibly prioritizing public health spending means that if we're going to make an investment in a new tactic, we ought to be as sure that it will work as we can afford to be. If Gardasil is used on a country-wide scale and it flops, we'll be stuck with not only a huge bill and an unimproved HPV rate, but we'll have also spent money that could have been used to address other public health concerns. Considering the relatively low urgency of the problem that HPV presents for Americans overall, I think it would be smarter to wait for more information to roll in as people voluntarily vaccinate.