Health care policy browsing by category


The Hobby Lobby Debate: Should Your Employer’s Faith Influence Your Options for Medical Treatment?

Monday, May 12th, 2014

It’s amazing to me sometimes how politicized women’s health has become. Case in point: Republican Mike Huckabee’s recent comments calling women who rely on birth control “victims of their own gender” and saying that the “Obamacare” contraception mandate “insults women… by making them believe that they are helpless without Uncle Sugar coming in and providing for them a prescription each month for birth control because they cannot control their libido or their reproductive system without the help of the government.”


Hobby Lobby, a company with 28,000 employees, must agree: they are trying to convince the Supreme Court that they should not have to provide insurance coverage for certain contraceptives for women, ostensibly because it goes against their CEO’s religious beliefs.

In an interesting side note, Hobby Lobby seems to have a problem with sticking to those beliefs consistently anyway, as while they deny IUD coverage to their female employees, they have no problem investing in companies that produce the contraceptive devices.

But this is not about tearing Hobby Lobby down; it’s about building women up, protecting them from tyrants and people who think that they can make medically sound choices for women based on religious faith rather than medical knowledge.

Birth control is one of the most common medications used by women, and protects them and their families from myriad health and financial risks. Exempting birth control from insurance coverage because of personal objections on the part of the CEO of the company is nothing short of ludicrous. Providing coverage for a necessary health service does not communicate religious agreement with it; it communicates compliance with a common-sense health policy.

Make no mistake: what’s at stake in this case (and the many that are sure to follow should Hobby Lobby come out on top) is the health of women and their families all over the country. The billionaires who run Hobby Lobby may not see an issue with forcing women to shoulder the financial burden of birth control on their own, but thousands of low-wage hourly employees will certainly have a different view.

What we’ve got here is not people who are simply trying to do the right thing, but rather people who are completely out of touch with the reality of the economic and health concerns many working families face. Emergency contraception is another method Hobby Lobby doesn’t want to cover, but I’m betting they aren’t going to step in and support those unplanned children when their families cannot provide for them adequately.

Policies involving women’s health (and all health policies, for that matter) must be grounded in medical fact, and not political ideology. Why should you or your daughters or her daughter have to make tough choices about medical care because of some politician or CEO’s personal religious beliefs? As doctors, it’s our job to advocate for women’s health, and that includes having options for birth control.

– Yvonne S. Thornton, M. D., M. P. H

Dropping Preschool Obesity Rates an Encouraging Sign

Thursday, April 3rd, 2014

The news is mixed when it comes to obesity rates in the United States. The good news is that the obesity rates in preschool-age children appears to be dropping. The latest data shows a decline in preschool obesity, from 14% to 8% since 2003. However, at the same time, obesity rates in women over 60 seems to be going in the opposite direction. The overall obesity rate hasn’t changed in the last ten years.

By analyzing data from the CDC’s National Health and Nutrition Examination Survey (NHANES), researchers determined that there has been a significant drop in obesity rates in two- to four-year-old children, particularly those from low income families who participate in federal nutrition programs. The news is encouraging because it means that there is hope for affording even more widespread and long-term changes.

One piece of information the new data does not provide is the precise reasons for the changes. However, in recent years, there has been an increasing initiative at both local and regional levels to provide enhanced opportunities for increased physical activity and improved nutrition in child care centers and schools, probably playing a role in the positive changes that are occurring. For example, consumption of sodas and other sugary drinks has declined, which is most likely one major factor.

The CDC also reported last year that only one in five adults gets enough exercise, something that could certainly contribute to the rising obesity rates in older women. Healthy adults over 65 should strive for the equivalent of 30 minutes of brisk walking five days a week plus strength exercises twice a week. Children need much more; those under 18 should be getting around an hour a day of aerobic exercise, plus muscle and bone strengthening activities.

However, it’s important to recognize that adding more exercise into your daily routine alone will most likely not be enough to achieve significant weight loss. If you have extra weight to lose, and you are ready to get started, realize that while exercise plays an important role, nutrition plays a much more important one. This is partly because many people overestimate the number of calories they burn exercising, or they are hungrier after they exercise and eat more to compensate.

Sometimes creating small changes in your diet may be all you need; others will need to make more dramatic changes. Either way, making the changes gradually will probably help you develop more lasting habits and ultimately see better results. Focus on natural, healthy foods, and try some helpful tricks such as eating more slowly, planning meals ahead of time, and getting more sleep, if you don’t tend to get enough. Lots of helpful information can be found here.

The bottom line is that the unchanging overall obesity rate means that there is an ongoing need for education and initiative. However, the decline in preschool obesity is an encouraging sign that the scales may be starting to tip in the right direction.

– Yvonne S. Thornton, M. D., M. P. H.

Pros and Cons of Robotic Surgery

Monday, March 3rd, 2014

If you need surgery, you are likely to be presented with the option of robotic surgery. This means that instead of the surgeon working on you directly with his hands, he or she will manipulate a set of robotic arms with surgical instruments attached from a console. Should you go along with this, or should you question the practice?

It would be understandable if you were hesitant. Thanks to the media’s love of a good horror story, most people have heard of instances where patients were accidentally injured – or worse – during robotic surgery. Even the American College of Obstetricians and Gynecologists maintains that robotic surgery is neither the best nor the most cost-effective approach to hysterectomy.

Does this mean that you should flatly reject robotic surgery? Not necessarily. Like any surgical instrument, a robot is as good as the surgeon using it. Furthermore, every patient profile is different. There are a number of considerations for anyone making a choice about robotic surgery.

In 2000, there were (worldwide) only 1,000 robotic surgeries. Last year, there were 450,000. Proponents of the practice say its benefits are responsible for its rising popularity. Less blood loss, less need for pain medication post-surgery, and shorter hospital stays are among these benefits, along with smaller scars (which is also a benefit of laparoscopic surgery). Robotic procedures are less taxing for surgeons, who don’t need to bend over an operating table, but instead, can sit at a console viewing the surgical field on a screen.

But some feel that robotic surgery does not offer significant benefits beyond those of laparoscopic or other types of surgery, and that the “wow” factor is one of the real reasons robotic surgery is catching on. In our love affair with new technology, it’s possible we have a tendency to move ahead too fast without enough standardized evaluation. To be sure, any new medical technology requires proper patient selection as well as a full explanation of all options and their risks and benefits for informed decision making.

What Does All of this Mean for You?

The wisest approach for a patient who needs surgery is to make sure to get an explanation from the surgeon about possible procedures, including what to expect in the postoperative period. The surgeon should also explain why he or she feels that a particular method is the best option in an individual patient’s case. There is no one-size-fits-all when it comes to surgery.

Another consideration is the cost of the surgery. Robotic procedures tend to cost more, but the patient may end up spending less overall. The need for longer hospital stays and pain medications is potentially lower with robotic surgery, and patients might have a lower chance of being readmitted for complications, all things which can lower a patient’s total costs.

For now, robotic surgery appears safe and effective, but it remains just one of the options available to patients. Ask your surgeon about his or her experience with any procedure he or she wants to use, and about complications that have arisen in the past. Remember that the right choice will be different for different people, so talk to your doctor, and let his or her expertise and experience guide you to make the right informed choice for your unique situation.

– Yvonne S. Thornton, M. D., M. P. H.

Gynecology Board Reverses Male Patient Ban

Thursday, February 20th, 2014

Back in December, I covered the issue of gynecologists treating male patients at high risk for certain types of cancer. At that time, the American Board of Obstetrics and Gynecologists had disallowed the practice. However, in response to protests from both patients and doctors, the board has lifted the ban and said that gynecologists who choose to do so are free to treat men.

The board’s executive director issued the following statement: “This change recognizes that in a few rare instances board certified diplomates were being called upon to treat men for certain conditions and to participate in research. This issue became a distraction from our mission to ensure that women receive high-quality and safe health care from certified obstetricians and gynecologists.”

This past fall, gynecologists who chose to treat male patients were ordered to stop and threatened with loss of certification for noncompliance. The board prohibited treatment of male patients with the exceptions of newborn circumcision, transgender patients, and men who were part of a couple undergoing fertility treatments.

The decision was made then in order to protect patients and uphold the integrity of the specialty of gynecology. This was due in large part to gynecologists who were branching out significantly into other areas, such as cosmetic surgery, for instance, and even advertising their services and identifying themselves as “board certified” without specifying that they were gynecologists. This practice could have misled patients who believed that they were being treated by board certified plastic surgeons, or other types of specialist.

However, one group of patients that the directive directly affected was men at high risk for anal cancer. The gynecologists who treated them said that not enough doctors had experience in this type of screening, and they feared the ban would interfere with patient care as well as government-funded studies aimed at determining the effectiveness of these cancer screenings.

In December, the board relented and agreed that gynecologists could continue to treat their current male patients, but not accept any new ones. And after further pressure, the board in January stated that the ban on treating male patients no longer existed. Gynecologists are now free to treat male patients as long as they devote “a majority” of their practice to gynecology – a change from the specific 75% that used to be the minimum portion of a gynecologist’s practice that must remain within the specialty.

Interesting, since the board’s own definition of what a gynecologist is includes, “Obstetricians and Gynecologists provide primary and preventive care for women and serve as consultant to other health professionals.”

Some are calling the board’s decision a victory for patients, but is it? As I stated back in December, “…there is no reason that I can see why the specialty of gynecology should expand into unrelated disciplines. The very reason why we have specialties is so that specific areas of medicine can be studied thoroughly and the treatments we are able to provide kept up to the minute. A gynecologist should specialize in gynecology – delivering babies, taking care of women. Other practices and treatments are important and helpful, but they aren’t gynecology.”

– Yvonne S. Thornton, M. D., M. P. H.

Should Birth Control Pills Be Available Over the Counter?

Monday, February 17th, 2014

It’s a hot debate topic: should women really be required to obtain a prescription for birth control pills? Shouldn’t the most popular form of birth control be available over the counter (OTC)?

Proponents of making oral contraceptives prescription-free say that more access to the pill would lead to fewer unintended pregnancies. To be sure, there are women who would take birth control pills if they didn’t have to see a physician to get them and if the overall cost were lower. Women commonly site access, convenience, and cost as reasons why they do not use a consistent contraception method.

Those in favor of OTC oral contraceptives also say that the benefits of making them more available outweigh the risks, as these pills are widely prescribed and generally safe. There is no argument that access to birth control is very important. Unintended pregnancy has devastating emotional and financial effects on a woman’s life, often ensuring poverty, inability to continue her education, and much more.

However, the risks of taking birth control pills without medical advice are substantial. If they were to start being sold without prescriptions, it’s a safe bet that many women would not receive important medical counseling. For example, one of the reasons birth controls require prescriptions is that they have known drug interactions and potentially dangerous side effects.

For example, antibiotics can interfere with the effectiveness of the pill. Physicians counsel women on drug interaction dangers like this when they dispense prescriptions. Women who buy the pill over the counter may not realize that if they also take an antibiotic, they need a backup method of birth control that month. In addition, birth controls pills are completely useless against sexually transmitted infections (STIs). They are not a replacement for condoms.

And if a woman doesn’t have to see her doctor to obtain a prescription for birth control pills, might she be more likely to skip seeing her doctor altogether for longer periods of time? This certainly would not be an issue for all women, but the ones who go to the doctor only because they must to get the pill would encounter the additional risks involved in not obtaining regular preventive checkups, which can reveal health problems such as STIs and some cancers in their early (and treatable) stages.

In addition, women who smoke and take birth control pills have a much higher risk of strokes, heart attacks, and death.

Birth control pills are a great option for contraception. They are easy to use, can’t be neglected in the heat of the moment (although they be forgotten earlier in the day), are noninvasive, and do not have lasting effects on fertility. However, the risks of using them and the need to use them properly call for medical advice before beginning them, at the very least.

You can find more information on birth control pills and other contraceptive methods in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Doctors Not Spending Enough Time Talking to Teens about Sexual Health

Thursday, January 16th, 2014

The sex lives of adolescents is a topic which many parents – and, apparently, doctors – would often prefer to avoid. But since almost half of high school students have had sex, we can’t pretend the sex lives of teenagers are nonexistent, nor can we neglect to teach adolescents about being responsible for their sexual health. Unfortunately, a recent study showed that only about 65% of physicians are talking to teens about sex, and when they do, the conversation lasts only an average of 36 seconds.

None of the 253 teenage patients in the study brought up sex themselves during their office visits, meaning that if the doctor did not initiate the conversation, it did not take place. The doctors were more likely to raise the topic with female patients. It may be true that girls are the ones who get pregnant, and must learn to protect themselves, but adolescent boys also need to know that they share equal responsibility when it comes to safe sex. Besides unexpected pregnancy, both girls and boys must be taught how to avoid contracting and spreading sexually transmitted infections.

And teens can’t count on learning the information they need at home or at school, either. Many sex-ed classes in schools fall short of comprehensive, and the subject is never brought up at all by many parents. For this reason, it is important for doctors to realize the magnitude of this need and be sure to talk to their adolescent patients about sex.

Parents can assist by not being present in the room during the exam – unsurprisingly, the study showed that doctors were much more likely to bring up the topic of sexual health when parents were absent. Longer visits were also more likely to include conversations about sex, one of many reasons why taking enough time with each patient and giving them individual, personal attention is so important.

Whether the doctors were uncomfortable talking about sex with teenagers, were concerned about making conservative parents angry, or were just too rushed isn’t clear. What is clear is that we can’t expect teens to make good choices if we don’t make the effort (uncomfortable as it may be) to educate them and provide them with the tools to make those good choices.

And since teens don’t bring up sex on their own during doctor appointments, it’s vital that we open up the conversation and give them a chance to ask any pressing or embarrassing questions they may have. Otherwise they will likely turn to their friends or the Internet, and there is far too much incorrect and downright dangerous information out there to neglect the job of teaching kids the facts and giving them the opportunity to talk to a trusted, knowledgeable adult about sex.

– Yvonne S. Thornton, M. D., M. P. H.

Gynecologists and Male Patients?

Thursday, December 5th, 2013

Gynecology is, by definition, the branch of medicine that deals with functions and diseases, especially of the reproductive system, specific to women and girls. However, recently, some gynecologists have been looking at this definition as more of a recommendation – and a flexible one at that. For example, a gynecologist at Boston Medical Center has added a new demographic to her patient roster: men.

Dr. Stier and other gynecologists who share her views have started caring for certain men; specifically, those at high risk for anal cancer. Anal cancer is rare, but it can be fatal and it is being seen more frequently, particularly among men and women who are HIV positive. Anal cancer is typically caused by the human papillomavirus (HPV) virus – the same virus that is often blamed for cervical cancer.

Dr. Stier sees mostly women, but last year she treated about 110 men as well. Using techniques she adapted from the ones developed to screen women for cervical cancer, she began screening men for anal cancer.

However, in September, the American Board of Obstetrics and Gynecology mandated that its members limit their practice to women with very few exceptions. In addition, they said that gynecologists were not allowed to perform the procedure Dr. Stier had been performing on men. Gynecologists, who often need their board certification to keep their jobs, cannot ignore directives like this.

Now Dr. Stier’s male patients are upset and her studies are in limbo. And she is not alone – other gynecologists who were engaging in the same practices have found themselves in similar circumstances. Researchers and doctors have asked the board to reconsider, but so far the board will not, pointing out that there are other doctors who could perform the screening procedures on men. The board also reiterates that the field of gynecology was specifically designed to treat women.

Apparently, Dr. Stier and others had not understood how absolute the definition of the field of gynecology was. But the board has drawn the line, emphasizing that its mission is treating women, not dabbling in spin-offs for their potential profitability. The screening process used by Dr. Stier, anoscopy, is not the only procedure in question nor is this the only incident of gynecologists straying from the original framework of gynecology; others had begun providing treatments such as testosterone therapy for men and cosmetic procedures such as liposuction for both men and women.

This trend is changing, however, thanks to the new rules the board posted on its website on September 12.  The new rules are explicit, specific, and outline exactly what gynecology should entail: treatment of women, with treatment of male patients limited to very specific circumstances, such as fertility evaluation, newborn circumcision, and emergency care.

Some doctors are upset by the new guidelines, including Dr. Stier, who is concerned that her male patients won’t get the follow-up they need now that she can no longer see them. However, there is no reason that I can see why the specialty of gynecology should expand into unrelated disciplines. The very reason why we have specialties is so that specific areas of medicine can be studied thoroughly and the treatments we are able to provide kept up to the minute. A gynecologist should specialize in gynecology – delivering babies, taking care of women. Other practices and treatments are important and helpful, but they aren’t gynecology.

– Yvonne S. Thornton, M. D., M. P. H.

Addressing Domestic Abuse

Monday, September 30th, 2013

Domestic abuse is the misuse of power by one adult in a relationship over another. It means that one partner uses control and fear to overpower the other. Domestic abuse may be physical, psychological, sexual, social, or financial. It may be regular and continual or it may be occasional. Domestic abuse accounts for some 85% of all violent crime against women.

Because domestic abuse takes many forms, it causes many different types of harm. Violence can cause physical injury as well as emotional. Depending on the form the abuse takes, the victim may experience physical, emotional, social, or spiritual injury. It can have severe repercussions on a woman’s sexual health and overall well-being. Domestic abuse increases the risk of depression and suicide. It disrupts family life and can have serious negative effects on children.

Warning Signs to Look Out For

When you are getting to know someone, any of these behaviors should make you think twice about continuing the relationship.

  • Jealousy or controlling behavior
  • Pressuring you to make a commitment too soon
  • Having unrealistic expectations
  • Attempts to isolate you or discourage you from seeing your friends
  • Blaming other people for his or her problems or feelings
  • Cruelty to animals or children
  • Pressuring you to have sex when you don’t want to
  • Verbal abuse; saying cruel things meant to hurt you
  • Breaking, throwing, or striking objects
  • Any use of force during an argument, such as grabbing your arm or holding you down

Why Do the Victims Stay?

It is easy to say you would never stay in an abusive relationship – until you find yourself in one. Abusers are master manipulators. Often women find themselves in situations where they believe they cannot get along, financially or emotionally, without the abusive partner. They feel trapped. They may fear the abuser too much to report the violence; they may be embarrassed and not want others to know about their situation.

Where to Turn for Help

If you find yourself in an abusive relationship, know that you are not alone. Millions of men, women, and teens have found themselves in the same situation: people of all races, socioeconomic statuses, education levels, and sexual orientations.

If you are in immediate danger, call 911 or get to a safe place quickly. Battered women’s shelters typically have various support services such as legal, emotional, and financial. If you have time to make plans, get in touch with friends or family members who will give you the support and help you need. There are many resources available for victims of domestic abuse. Try a national or local helpline. Or talk to your doctor for more information.

The National Domestic Abuse Hotline is 1-800-799-SAFE (7233).

– Yvonne S. Thornton, M. D., M. P. H.

Choosing the Right Gynecologist

Thursday, September 19th, 2013

There are many reasons why you might be looking for a gynecologist. Maybe you are looking for a doctor to see for the first time, or maybe things just aren’t working out with your current doctor. Maybe you have moved to a new place and must find a local gynecologist. In any case, this is a decision that should be taken seriously. Friends and family members can be valuable sources of recommendations, but realize that their recommendations are likely to be based on things like whether the doctor is personable and how long they have to wait for appointments, rather than whether the doctor is board-certified or how long they have been in practice.

Board certification is extremely important and a topic that I cover extensively in Inside Information for Women. Terms like “board eligible” or “board active” mean that the practitioner is not board certified. So, the first thing you should check for is current board certification to ensure that you are seeing a qualified gynecologist (or other specialist).

You may also need to check with your insurance provider to make sure that the doctor you are considering will be approved by them. Once you have narrowed your options down to a few conveniently located, board certified gynecologists, see if you can set up a meeting with each one. Your insurance company will probably not cover this meeting, so be prepared to pay out of pocket. If you choose not to set up a preliminary meeting, you can still get some useful information from a receptionist or secretary.

Things You Should Know Before Selecting a Gynecologist

Questions you should ask include how long it takes to schedule appointments if you have a non-routine concern and whether there are times when the doctor can be reached by phone. As this report shows, doctors are busier than ever, so ensuring that the doctor you choose will be available when you need him or her is important. You may want to know where the doctor attended school and completed his or her training. Also, ask which hospitals he or she is affiliated with; this may be especially important if you are planning to become pregnant. Finally, you may also want to know how long the doctor has been in practice. Again, if you can’t meet with the doctor before scheduling an appointment, an administrative person can answer any of these questions.

While the answers to these questions might tell you whether the doctor is competent, they will not tell you anything about your chemistry with the doctor or whether you will like him or her. Keep in mind that a competent doctor is much more valuable than a personable doctor – but if you can get both, all the better. If you really have poor chemistry with your gynecologist, it’s best to make a change – but be sure your new doctor is board certified and otherwise competent and available, not just someone who is located closer-by or smiles more.

– Yvonne S. Thornton, M. D., M. P. H.

Shared Medical Appointments (SMAs)

Monday, August 19th, 2013

There is a new trend in medicine that I find disturbing. I’m talking about the shared medical appointment. A group of patients participate in one shared appointment, 90 minutes or so, with one practitioner or a team of medical personnel.

Advocates of this arrangement say that patients get more time with doctors without increasing doctors’ workloads, and that patients can be an encouragement to one another. I say, it sounds like a way to increase billing without doing any extra work, and that if patients want to encourage one another, there’s always a coffee shop or a support group around the corner. I’m not saying that there’s anything wrong with a patient preferring this method; I just can’t imagine why anyone would. You spend your valuable time and money in order to see your doctor. You should be able to make the most out of every face to face appointment, and not have to share time with other people all seeing the same doctor, whose attention is inevitably divided now.

Each patient should have the right to a private, confidential interaction with a physician. It is well known that people behave differently when other people are around than they do when alone. SMAs require disclosing personal information in front of strangers. A woman might not mention something in a group that she would if she were alone with her doctor. I care about each of my patients too much to impose this kind of group setting on them. Your doctor’s appointment – even routine follow-ups – is your chance to talk with your doctor privately, sharing any concerns openly, and not giving a second thought to who might hear what you say. Furthermore, fans of shared medical appointmets say that they are a way to decrease costs – but they must not mean to patients, because in practice, most SMAs are billed as regular office visits with regular copays.

Finally, studies on SMAs are very limited. You will have to decide if the shared medical appointment is right for you, but you won’t see me implementing them anytime soon. I don’t believe this can ever have the value of consulting with a doctor one-on-one with the focus on you and finding the source of your medical problem. In short, shared medical appointments don’t save patients any time or money and do not deliver the same standard of care that an individual appointment can. This is one trend that I would like to see stopped in its tracks.

– Yvonne S. Thornton, M. D., M. P. H.