Many women decide to simply suffer through it without seeking help, but that could be a big mistake. According to the American College of Obstetricians and Gynecologists:

“… untreated maternal depression negatively affects an infant’s cognitive, neurologic, and motor skill development. A mother’s untreated depression can also negatively impact older children’s mental health and behavior.”

Everyone feels sad some of the time. It’s normal to have a bad day. But if your bad day stretches into weeks, for your own sake and the sake of your baby, you need to get help. If you don’t have a therapist, ask your ob-gyn for a referral if you experience feelings of hopelessness, sadness or despair. Don’t suffer needlessly. Help is available.

- Yvonne S. Thornton, MD, MPH

Still, you may not wish to have a surgical procedure that isn’t absolutely necessary performed on your baby.

Whatever you decide, that decision should be based on the facts and not the false controversies that have been swirling around the Internet.

Contrary to some inflammatory claims that have appeared on popular websites, there is no similarity whatsoever between male circumcision and the disfiguring procedure done on girls in some Third World countries that’s referred to as female circumcision. Male circumcision is a generally safe, simple procedure that removes only the foreskin of the penis. Female circumcision, by contrast, removes the entire clitoris and sometimes parts of the labia.

Female circumcision is a brutal, abusive act that has a negative lifelong effect on sexual function and pleasure in adulthood. Male circumcision has no effect on sexuality.

So don’t be swayed by false claims, even those made by experts. And, if you’re undecided, discuss the pros and cons of circumcision with your doctor.

- Yvonne S. Thornton, MD, MPH

“You’re going to see rate increases of 20, 25, 30 percent” for individual health policies in the near term, Sandy Praeger, chairwoman of the health insurance and managed care committee for the National Association of Insurance Commissioners, predicted Friday.

But you might think that this has nothing to do with you if you’re employed by a company that provides you with health insurance. Unfortunately, all of us are affected, no matter where we get our insurance.

The Anthem-Blue Cross increase is the harbinger of things to come in employer-provided policies as well.

Last week, I heard from someone whose employer had to switch from a comprehensive policy to bare bones insurance because the insurer raised the company’s group rate by about 30 percent. So now, instead of offering employees a policy that covers just about anything, from a broken ankle to a liver transplant, the company will offer its employees a policy with an annual cap of just $25,000.

That’s employer-provided insurance that’s in danger now. And that means that more Americans are at risk of having either no insurance or inadequate insurance when a medical emergency strikes.

As a doctor, I am well aware of the high cost of medical care and can assure you that a policy with a $25,000 annual cap won’t cover much if you need hospitalization. I’ve dealt with that reality, not just as a physician, but as a mother. As I wrote on this blog before, when my daughter had to be hospitalized a few years ago, we learned too late that her school-provided policy had a $25,000 annual cap. Lucky for Kimmie that her parents are both doctors and could afford to pay the tens of thousands of dollars in hospital and medical bills that her insurance didn’t cover.

What would you do if one of your loved ones needed medical care and your insurance was inadequate?

This is no longer an issue for the uninsured. It’s an issue for us all. Please tell your Senators and Congressional representatives that you support health care reform. The life of someone you know, maybe someone you love, maybe your own, may depend on what happens next in Washington, DC.

- Yvonne S. Thornton, MD, MPH

To address the shortcomings of the much-abused medical garb, the U.K.’s Department of Health recruited designer Ben de Lisi to give the hospital gown a design overhaul, the BBC reports. De Lisi, who has outfitted stars such as Kate Winslet, came up with a solution that offers more coverage while also including “entrance points” for the necessary medical access.

It’s about time.

Back when I was on the faculty of Cornell in the 1980s, I decided that no woman who visited my Cornell practice would be forced to wear one of those open-backed monstrosities.

They always made a woman feel all exposed. As a woman myself, I was especially sensitive to the indignity of it all.

So I designed a pretty blue poncho with an opening that fit over a woman’s head. It covered everything, and allowed for easy examination.

I’m surprised that more doctors and hospitals haven’t done anything similar but I like the U.K.’s new plan. Here’s hoping the U.S. follows suit.

- Yvonne S. Thornton, MD, MPH

First, I’ll quote a few of the points the president made and then I’ll explain why it matters to each of us, currently insured or not:

“The approach we’ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market.  It would require every insurance plan to cover preventive care.

“… It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office – the independent organization that both parties have cited as the official scorekeeper for Congress – our approach would bring down the deficit by as much as $1 trillion over the next two decades.”

When the president spoke of the insurance companies “worst practices” he didn’t elaborate. But it’s those practices that make us all, insured or not, vulnerable, and in need of reform. Too many Americans believe that they have great health insurance – right up to the moment when they get sick and find that their insurance won’t cover their medical bills.

Recently, one of the organizations advocating on behalf of health care reform shared the case histories of numerous people who, although insured, were unable to get their medical bills paid when they got sick. The following few cases are among dozens of similar stories. If we don’t think it can happen to you, you’re wrong. I speak from experience. Although I’m a doctor, when my daughter became ill, her insurance refused to cover all her medical costs and I had to pay tens of thousands out of pocket.

• An AT&T worker from Arkansas was in a coma for three weeks after a 2004 horseback riding accident. She and her husband had to pay more than $200,000 in medical bills because UnitedHealthcare wouldn’t cover her emergency surgery.
• A Realtor from Delaware, has a health care plan that forces her to pay for her cancer care “out of pocket.” She has turned to getting her chemotherapy medication from India in order to afford it.
• A minister from Tennessee has almost $175,000 in medical debt due to his wife’s muscular disorder. The family had health insurance through his wife’s job as an insurance claims adjuster, but the health insurance would only cover 14 days of her 91 days in intensive care.

Don’t let anyone tell you that if you’re insured, you don’t need to support health care reform. As the above cases illustrate, this affects us all. While there is no longer any chance of passing a new bill through the United States Senate, the House can vote for the Senate bill that passed over Christmas eve now and make changes over time.  It may be our last chance for reform in a generation. Please call your Congressperson today and remind him or her what’s at stake.

- Yvonne S. Thornton, MD, MPH

But what if your schedule doesn’t make breastfeeding a viable option?

Don’t let anyone make you feel like you’re an inadequate parent if you give your baby a bottle instead. There are no randomized clinical trials that prove the virtues of breast milk over formula feeding. And most working mothers simply don’t have the opportunity to breastfeed in our society, at least not exclusively.

When public lactation stations become the norm, and when most workplaces have specifically designated areas for breastfeeding, then it will make sense for more women to consider the breastfeeding-only option.

Until then, in a society where many women are either single parents or are the primary family breadwinners, exclusive breastfeeding must be seen as an unrealistic – and maybe even a chauvinistic — recommendation.

- Yvonne S. Thornton, MD, MPH

But our infant mortality rates tell us that that’s not so.

According to the Centers for Disease Control (CDC), infant mortality among African-American babies is more than twice that of white babies. Among the other troubling statistics in the CDC report:

• African Americans had 1.8 times the sudden infant death syndrome mortality rate as non-Hispanic whites, in 2005.
• African American mothers were 2.5 times more likely than non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all.
• The infant mortality rate for African American mothers with over 13 years of education was almost three times that of Non-Hispanic White mothers in 2005.

America is still a country where people of color face discrimination at every turn, even if it’s less overt than it was in our past. Bias limits educational opportunities, employment opportunities, and it even limits the opportunity of pregnant women to get access to good healthcare.

If Dr. King could see us today, I know he’d be pleased at how far we’ve come. But if we haven’t provided our youngest and most vulnerable citizens equality in medical care, we still have a long way to go.

- Yvonne S. Thornton, MD, MPH

Being obese during pregnancy greatly increases the risks of preeclampsia, diabetes, stillbirth, and blood clots, among other problems. Gaining more weight if you’re already obese makes complications more likely while limiting weight gain makes them less so.

But until my study was published, obstetricians lacked the evidence that limiting weight gain among pregnant women was safe. The ACOG’s guidance from the 1980s stated that, unless a woman, obese or not, gained at least 26 pounds, the baby in her womb would be at risk of dying.

Right before my study results were published, a government body recommended that obese women gain somewhat less weight: between 11 and 20 pounds. It was a start but still not enough. And most board certified obstetricians would wait for the ACOG to – you’ll excuse the pun – weigh in before they changed their practices.

I’m delighted to say that, in a commentary in the peer-reviewed journal Obstetrics & Gynecology, the ACOG has just come out in favor of limiting weight gain among obese pregnant women. My study, which was quoted in the commentary, appears to have been instrumental in effecting this turnaround.

Now that the ACOG is changing its recommendations, obstetricians are more likely to change how they manage their patients. Fewer women will be told that it’s fine to gain weight during pregnancy if you’re already obese. And that will mean healthier moms and healthier babies.

I’m proud to have played a role in helping to make this happen.

- Yvonne S. Thornton, MD, MPH

The House had passed its version of health care reform months earlier. Now the two legislative bodies will have to come together and agree to a blended version.

That blended version almost certainly won’t have a public option because it would require 60 votes in the senate to get one. But here’s what we can be assured of getting in any final combination of the two bills:

• Insurance companies will have to cover everyone – you can no longer be turned down due to pre-existing conditions.
• Insurance can’t be snatched away from you via “rescission” when you get sick, i.e., voiding the policy when you need it the most.
• There will be limits on how much more insurers can charge you as you get older.
• Your insurance won’t run out when you need it due to annual or lifetime caps.
• Most lower and middle-income people will get subsidies to help pay for insurance.

For those who say the senate bill doesn’t do enough, remember that getting this passed was a Herculean task. This is just the start of reform. Over the years, our lawmakers can continue to improve the bill, just as they’ve done with Social Security and Medicare. This is a long overdue beginning to regulating the health insurance companies, which have been given carte blanche for so many years.

The Centers for Disease Control recently reported that 58.4 million Americans were uninsured for at least part of the year and almost 32 million had been uninsured for more than a year. The situation will only get worse if we do nothing. As President Obama is fond of saying, we can’t let the perfect be the enemy of the good. This is a good bill. And it’s the best present that the U.S. Senate could give us this holiday season.

Merry Christmas to all.

- Yvonne S. Thornton, MD, MPH

I recently learned payola is alive and well – but with a reverse twist, and in a different industry. Major pharmaceutical companies have been paying off generic drug companies in order to keep the generics off the market. So, instead of “pay to play” we have “pay to not play.” Without generic competition, major pharmaceutical companies can – and often do – charge exorbitant prices. It’s estimated that pharmaceutical reverse payola costs us $3.5 billion per year.

Here’s how the scheme works.

Let’s say a major pharmaceutical company manufactures a cholesterol-lowering drug that many doctors prescribe. Because the drug is patented, and the company has spent billions of dollars in research and development for that drug, the pharmaceutical company is then given a “head start” to charge whatever the market will bear in an attempt to recoup its investment and time spent developing the new drug.  The downside is that people whose doctors prescribe the drug either must pay the price or go without.

But the effective life of the drug patents on a name brand medicine is from seven to twelve years.  After the pharmaceutical company’s patent expires, other drug companies are permitted to manufacture and market identical chemical versions of the drug and cheaper generic versions of the drug become available to those who need it. How much cheaper? At Costco Pharmacy, a month’s supply of the name brand version of a popular tranquilizer costs $146.22. The generic version – which must by law provide the identical medication in identical amounts – costs just $8.32 for a month’s supply.

Obviously, if a drug company can continue to get close to 20 times the money for the same product, it’s going to look for ways to keep out generic competition. Some pharmaceutical companies are paying manufacturers of generic drugs in exchange for the generic manufacturers’ agreement not to market generic versions. A bipartisan effort is underway in the United States senate to make the practice illegal.

Such “reverse payola” could be compromising the health of our families and loved ones. According to a survey of 2,004 adults, done earlier this year by Consumer Reports, because prescription drugs costs are so high, 28 percent did one or more of the following:

• Failed to fill a prescription (16 percent).
• Skipped a dose (16 percent).
• Took an expired medication (11 percent).
• Cut pills in half (10 percent).
• Shared a prescription (4 percent).

About 23 percent said they cut back on groceries in order to afford their prescriptions.

Although brand name medications often are better formulated with better bioavailability and, therefore, are often more effective than generic drugs, patients and physicians should have the option to choose which is the best under specific circumstances.  They must weigh the cost of the drug with the intended outcome.  However, the practice of “reverse payola” is unconscionable and violates the principles of good medical and pharmaceutical practice.

Generic drugs are far more likely to be affordable – and therefore available – than brand name versions. That’s where you and I come in. We need to contact our senators and congressional representatives and tell them to make such practices illegal. We need to contact our local newspapers, TV stations and other media, and ask why they aren’t covering this story. We must ensure that we and our loved ones can afford the medicines we need in order to stay well.

- Yvonne S. Thornton, MD, MPH