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AAPS News of the Day Blog | from the Association of American Physicians and Surgeons | Page 63

The first issue of the official publication of the Hispanic American College of Physicians and Surgeons, Medicina y Cultura, features Spanish translations of three items from AAPS: the Oath of Hippocrates, a news of the day item on selective abortions, and one on estimated retiree medical expenses. (“Juramento de Hipócrates,” “Abortos selectivos por sexo ya se están practicando en los Estados Unidos,” and “Se estima que los retirados necesitarán $225,000 por pareja para gastos médicos.”)

Other articles concern historical events in Latin America; cosmetic procedures; the prevention of hip fractures; the scientific contributions of Sir William Harvey; and enjoyment of life at age 100.

Headquartered in Miami, the Hispanic American College of Physicians and Surgeons was founded in July 2008. Its founders practice many different specialties, and profess dedication to the ethical practice of medicine and the Oath of Hippocrates.

Membership services include reduced rates for document translation into Spanish.

Medicina y Cultura is currently available only in printed format.

Over time, male circumcision would probably protect more African women, albeit indirectly, than nearly any other achievable strategy for preventing human immunodeficiency virus (HIV) transmission, write Malcolm Potts of the School of Public Health, University of California at Berkeley, et al. (Science, 2008;320(May 9):749-750).

In nine southern African countries, more than 12% of adults are said to be infected with HIV, and infection has spread outside of the accepted high-risk groups, creating a generalized, heterosexual epidemic. This has frequently been attributed to poverty, illiteracy, limited health services, war, and gender inequity.

HIV has, however, remained concentrated in high-risk groups in countries where male circumcision is common and multiple sexual partnerships, especially concurrent ones, are unusual. For example, Niger, a Muslim country where male circumcision is universal and sexual behavior relatively constrained, HIV prevalence is 0.7%, although it is the lowest ranking country on the Human Development Index.

Botswana, the second wealthiest country in sub-Saharan Africa, has an HIV rate of 25%. It has high levels of multiple concurrent sexual partnerships and lacks circumcision.

UNAIDS has spent nearly $1 billion on condom promotion, probably contributing to a decline in some generalized epidemics, but “there is no evidence of a primary role.” Potts et al. write: “[C]onsistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion, to produce a measurable slowing of new infections.”

More than 45 studies have shown that male circumcision significantly reduces risk of heterosexual transmission. All three randomized controlled trials in Africa had to be stopped early for ethical reasons because of initial findings of at least a 60% reduction in HIV risk.

Modeling suggests that male circumcision could avert up to 5.7 million new HIV infections and 3 million deaths over the next 20 years in sub-Saharan Africa. Studies suggest that up to 80% of men in high-prevalence countries would accept the procedure if it were safe and inexpensive.

Educational efforts to reduce promiscuity have also proved effective. In Swaziland, the number of people reporting two or more partners in the preceding month was halved after a 2006 campaign focusing on the dangers of having a “secret lover.” HIV prevalence has declined significantly in Uganda and Kenya after similar campaigns.

At present less than 1% of requested funding is for this “surgical vaccine,” while large donor investments are made in interventions for which evidence of impact is weak.

An article in the Aug 6, 2008, issue of JAMA assesses risk factors for recent HIV conversion in Uganda. The adjusted odds ratio for being uncircumcised was 2.5 (P < .02), which was comparable to that for having more than two sex partners in the last year (2.9). For married men, the adjusted odds ratio for being uncircumcised was higher than for not using a condom with extramarital partners (4.1 compared to 3.2) (JAMA 2008;300:540-549).

Infant circumcision in the U.S. is a topic sparking tremendous interest on the www.SueEasy.com website, as pointed out by Medical Justice, Inc. One complainant said he would claim damages of $10 million.

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Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) should never happen, if only hospital workers practiced rigorous hygiene, writes former New York lieutenant governor Betsy McCaughey. In fact, “for most infections, the only acceptable rate is zero.”

Litigation over such infections, she predicts, “will cause the next wave of class-action lawsuits, bigger than the litigation over asbestos.”

In the meantime, Medicare will stop reimbursing hospitals for the treatment of certain infections, and hospitals will also be barred from billing patients.

“The evidence justifying Medicare’s new policy is compelling,” McCaughey writes. Beth Israel Medical Center in New York City has gone 1,000 days without a central line bloodstream infection in the cardiac care unit. The key was spending $30,000 to implement a checklist that doctors and nurses must follow. This is claimed to have saved $1.5 million in treatment costs, and priceless lives.

Other hospitals have also reached the goal of zero central line infections. “We have the knowledge to prevent infections. What has been lacking is the will” (Wall St J). 8/14/08

Blue Cross/Blue Shield and other insurers will follow the lead of Medicare in refusing to pay for a lengthening list of “never events,” including catheter-related urinary infections, hospital injuries, bedsores, and severe post-operative chest infections (Kansas City Star 7/16/08).

“What will happen, of course,” writes Dr. Lawrence Huntoon, “is that hospitals will implement protocols to test for bedsores, minor cognitive deficits, and infections on admission.” The threshold for identifying these conditions will be very low. It is likely that the cost of the testing will far outweigh any savings to insurers from refusal to pay for treating hospital-acquired conditions. “In essence, hospitals will assure that ‘never’ events don’t occur—on paper.”

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The Bush Administration has proposed a rule that would deny federal funding to medical facilities that discriminate against employees who choose not to provide services they deem to be morally wrong—such as performing abortions or making abortion referrals.

Unlike rules that ban discrimination on the basis of race, ethnicity, gender, or sexual preferences, this one is called an attack on “choice.” Sen. Patty Murray (D-WA) and Sen. Hillary Clinton (D-NY) objected to the proposed rule.

It is feared that the wording could be expanded to include oral contraceptives or the “morning after” pill (Seattle Times 8/25/08).

U.S. Health and Human Services Secretary Mike Leavitt says the regulation is about abortion, not contraception. But the meaning may depend on what an abortion is. And that depends partly on when pregnancy begins. In 1965, the American College of Obstetrics and Gynecology (ACOG) decreed that pregnancy begins after implantation, thus avoiding the charge that its members were encouraging, if not performing, early-term abortions in prescribing non-barrier contraceptives (PRI Weekly Briefing 8/12/08).

Karen Brauer, president of Pharmacists for Life, expects that members of her group would like to see states lose federal funding if they pass laws forcing pharmacists to fill prescriptions for what they consider to be abortofacients. And Catholic hospitals would like to be freed from requirements that they offer emergency contraception to victims of sexual assault.

Planned Parenthood Action Fund and MoveOn.org Political Action delivered 325,000 signatures of protest to Leavitt, but he signified that he planned to go forward with the rule, citing the need to protect medical professionals.

Their right to decline certain actions, including certain types of speech, is a “fundamental freedom: that “every American values,” Leavitt said (Stephanie Simon, Wall St J 8/22/08).

Leavitt believes that that freedom is threatened. On Aug 8, he wrote in the HHS blog: “Several months ago I became aware that certain medical specialty groups were adopting rules which potentially violate a physician’s right to choose whether he or she performs abortion. I wrote to the organizations in question, protesting their actions. Frankly, I found their responses to be dodgy and unsatisfying. I sent another letter, more of the same.”

This weblog notes that the proposed rule is open for comment for 30 days, and provides a link.

ACOG has been heavily criticized for its November 2007 Ethics Committee Opinion entitled “The Limits of Conscientious Refusal in Reproductive Medicine.” In addition to stating that physicians had the duty to refer patients for procedures they themselves were not willing to perform, it wrote: “Physicians with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place.”

A newly publicized twist on the question of what an abortion is concerns what ACOG terms a “labor-inducing abortion.” Although ACOG does not mention live birth as a complication in its patient education materials, this is the issue addressed by the Born-Alive Infant Protection Act passed by the U.S. Congress in 2002.

Jill Stanek, R.N., gave testimony that infants who survived this procedure were placed in the soiled utility room to die; some lived for as long as 8 hours. She recounted having cradled one infant for 45 minutes as it struggled to breathe, and finally died.

What would have happened to a nurse or physician who had resuscitated such an infant, before this Act was passed?

While most people consider it infanticide to dispose of a baby who survives an abortion attempt, then-Illinois state senator Barack Obama considered the Born-Alive Infant Protection Act to be a ploy to undercut Roe v. Wade—one of many reasons he gave for blocking the identical bill in the Illinois Senate.

Other threats to freedom of conscience:

The California Supreme Court ruled, in Benitez v. North Coast Women’s Care Medical Group, that doctors have an obligation to provide medical care regardless of their religious views. The case concerned a lesbian woman who was refused artificial insemination on the basis that the physicians had determined to provide in vitro fertilization only to married patients (LifeNews.com 8/19/08).

The British parliament is debating a bill that would imprison staff at pregnancy centers for up to 2 years for counseling against abortion—if, in the opinion of the British government, the counseling was misleading or inaccurate. No similar penalties have been suggested for misleading pro-abortion counseling (LifeNews.com 8/27/08).

The Yale Human Rights and Development Law Journal has published an article by Carter Dillard, entitled “Rethinking the Procreative Right,” arguing that because it is not specifically enumerated in the Bill of Rights, the right to procreate is limited to one child. The only absolute reproductive right, he argues, is the right not to procreate at all. The right to bear children must be “balanced” against other rights—of other people, of future generations, of nature, of the wilderness, and of nonhuman species (LifeNews.com 7/23/08).

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U.S. senators are not allowed to do remunerative work that involves a fiduciary relationship, lest they be unduly influenced by colleagues or customers. Now pro-life Senator Tom Coburn (R-OK) is in the sights of the Senate Ethics Committee because he delivers babies free of charge at the Muskogee Regional Medical Center.

Coburn continued his obstetrics practice while serving in the House of Representatives, and campaigned for Senate on the pledge that he would continue to serve as a citizen-legislator, as the Founders intended. He earned only enough money as a physician to cover his expenses, such as professional liability insurance.

The Senate, however, does not distinguish between gross and net income, and demanded that he shut down his practice within 9 months (Jeffrey H. Birnbaum, Washington Post 4/6/05). Senate rules allow physicians such as former Senate Majority Leader Bill Frist, a cardiac surgeon, to practice free of charge (Kathryn Jean Lopez, National Review Online 9/28/05).

The ethics panel renewed its concerns after the Muskogee Regional Medical Center converted to private ownership in April, and has threatened Coburn with censure.

Coburn has paid tens of thousands of dollars out of his own pocket for costs related to his medical practice. As he has pledged to leave the Senate after two terms, in 2016, he wants to maintain his skills so he can go back to earning a living from practicing medicine.

Coburn spokesman John Hart stated: “In the 10 years Dr. Coburn has provided free healthcare to his neighbors while serving in Congress, the Ethics Committee has never pointed to a single conflict of interest. No lobbyist or any individual has ever attempted to infiltrate his medical office under guise of an invasive medical exam to discuss Senate business.”

Hart also observed that Senator Leahy is not being targeted for making a cameo appearance in Batman. He donated the $2,000 he earned to a library. Nor are Senator Boxer or Senator Reid facing possible censure for holding book signings in private bookstores.

It so happens that Coburn is currently engaged in a battle with Majority Leader Harry Reid (D-NV) over the legislative agenda. Reid was forced to devote most of the Senate’s time recently to overpowering the hold that Coburn had placed on 35 bills. Coburn’s office suspects that an Ethics Panel memo was deliberately leaked for political reasons (Susan Crabtree, The Hill 7/28/08).

The charges may also be motivated by abortion politics, Hart suggested, as the Ethics Panel is dominated by pro-abortion senators. Family Research Council head Tony Perkins said he doubted that the panel would be targeting Coburn if he were doing free abortions for Planned Parenthood (LifeNews.com). 8/7/08

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