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Free Birth Control For All? Yes!

Friday, July 22nd, 2011

When you’re on a strict budget, out-of-pocket costs can convince a woman to forego birth control. But getting pregnant is a much more expensive proposition and comes with a lifelong commitment — one that many women are neither emotionally or financially ready to make.

The new health care law requires the Department of Health and Human Services to create a list of health services that new health insurance plans must provide without deductibles or co-pays. And the National Academy of Sciences’ Institute of Medicine (IOM) has prepared a report recommending that birth control be on that list.

…the Guttmacher Institute estimates that 98 percent of sexually active women will use contraception at some point during their reproductive years, and that cost concerns are frequently cited as a reason for inconsistent use or use of a less then optimal method.

 

In fact, Guttmacher said in testimony submitted to the IoM earlier this year, “Women citing cost concerns were twice as likely as other women to rely on condoms or less effective methods like withdrawal or periodic abstinence.”

Along with the recommendations concerning birth control, the IOM recommended a number of other preventive care services for women be made available without deductibles or co-pays:

…annual “well-woman” visits; screening of pregnant women for gestational diabetes; screening for sexually transmitted diseases, including HIV; more support for breast-feeding mothers; and counseling and screening for possible domestic violence.

I urge HHS Secretary Sibelius to accept the IOM recommendations. Women’s health issues have taken a backseat for too long.

– Yvonne S. Thornton, MD, MPH

Posted in Contraception (birth control), Health care policy, Women's health issues, Women's health news | 1 Response »
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The Problem With Part Time Doctors

Friday, June 24th, 2011

As anyone who has read either of my two memoirs knows, I’ve worked long hours as a ob-gyn/maternal-fetal medicine specialist, throughout my career. While it’s been a challenge, at times, and I’ve had to juggle like crazy to be the kind of mother my children could always count on, it was the life I signed up for.

I don’t regret my career choices.  Becoming a doctor is as much a calling as a profession.

So, when I read an op-ed by a woman anesthesiologist, which criticizes a recent trend among women doctors to think of medicine as a part-time career, it struck a chord.

This section, in particular, offers food for thought:

Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time.

This may seem like a personal decision, but it has serious consequences for patients and the public.

Medical education is supported by federal and state tax money both at the university level — student tuition doesn’t come close to covering the schools’ costs — and at the teaching hospitals where residents are trained. So if doctors aren’t making full use of their training, taxpayers are losing their investment. With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine.

… The Association of American Medical Colleges estimates that, 15 years from now, with the ranks of insured patients expanding, we will face a shortage of up to 150,000 doctors.

When you look at training in the medical profession as a scarce resource, provided to a small number of people, in whose hands others place their lives, you can see that it isn’t the kind of career choice you make lightly. It’s a commitment. And those who don’t feel the need to fully commit, who think of it as a profession in which they can dabble, do a disservice to the patients who need them, as well as to those who would have committed fully to the profession, if only they could have gotten into medical school.

In our do-your-own-thing society, this might seem like a harsh, even an unfair judgment. But medicine isn’t practiced for the benefit of the practitioner. It’s a service to our fellow men and women. And as long as there are so few of us that some people have long waits for needed care, those who choose this profession must be willing to be there when they’re needed. And if they can’t? There are plenty of other professions with lesser requirements.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Health care policy, Something To Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, The Ditchdigger's Daughters, Women's health issues, Women's health news | No Responses »
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Are You Taking Advantage of The New Health Insurance Appeals Process?

Wednesday, June 15th, 2011

One of the big advantages of the Affordable Care Act (a.k.a. the healthcare reform bill) is that millions of Americans who once had no recourse when their insurers turned them down for coverage, now can appeal. Insurance company turns you down for a transplant? Appeal. Says no to a life-saving procedure? Appeal. Insists that you have to pay for something you believe is covered under your policy? Appeal.

And your appeal won’t be decided by the same administrator who turned you down in the first place. Under the new healthcare reform law, health insurance appeals are decided by an independent decision-maker, one who has no financial stake in the outcome.

This provision can be a lifesaver … but only if you know about it and act on it within the 180-day timeframe permitted.

According to Kaiser Healthcare News:

The provision took effect for most plans Jan. 1. But in response to self-insured plans’ concerns about being able to meet some of the requirements, the government said it wouldn’t require the plans to tell members about their external appeals rights until plan years beginning after July 1. Since most plans start their new year in January, that means they won’t have to notify members about their right to external appeals and how to file them until next year.

However, the government isn’t granting enrollees more time to file appeals, said an official at the Department of Health and Human Services, who spoke only on the condition of not being identified. Patients have 180 days from the date of initial denials to file internal appeals to the plan. If the appeals are rejected, they then have another four months to appeal to outside arbiters.

If nobody tells patients about their rights, this provision, in other words, might not be discovered by the people who need it most until it’s too late.

So, I’m urging you to link to this post wherever you can: Facebook, Twitter, Reddit, any and all social networks. Explain the need to be informed. Tell your friends and family: you have a right to appeal. For some, it can be a matter of life and death.

Don’t let the chance slip away.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Health care policy, Women's health issues, Women's health news | No Responses »
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Drug Maker Attempted to Capitalize on the Lives of Infants

Tuesday, April 5th, 2011

There is a synthetic form of progestin called hydroxyprogesterone caproate, or 17P, that is used to prevent mothers-to-be from delivering prematurely. Treating a mother at risk of having a preemie with hydroxyprogesterone caproate was found, in tax-payer funded studies by the National Institute of Child Health and Human Development, to reduce the incidence of pre-term births, which naturally means that babies suffer fewer of the complications that plague preeemies. The studies also found that giving this drug to mothers-to-be at risk of premature delivery could save the health care system at least $2billion per year.

Until recently, the drug had been available only through “compounding pharmacies” (pharmacies that formulate drugs that aren’t commercially available), at a cost of about $10 to $20 per dose. But the FDA recently licensed one manufacturer, KV Pharmaceuticals, to manufacture the drug commercially, and exclusively, for the next seven years.

What usually happens at the point where a manufacturer is given exclusive rights to market a drug is that compounding pharmacies are told that they may no longer produce the drug.

And that would have happened this time – if KV Pharmaceuticals hadn’t done something that has caused a huge uproar in the maternal-fetal medicine and obstetrics community. It raised the price of the drug from the $10 to $20 per dose that compounding pharmacies had been charging to (are you sitting down?) $1,500 per dose.

No, that’s not a typo.

They raised the price by an average of 100 times what it had been.

Remember, it was tax-payer dollars that funded much of the research, so the raise in price could not be attributed simply to recouping research costs. And driving the price that high would put it out of reach of most women (and babies) who needed it. A full course of the drug, given between the 16th and 36th weeks of pregnancy, had previously cost about $400. The price increase would push that cost to $30,000!

This story, at least, has a happy ending. Although, according to this article in the Seattle Times, KV Pharmaceuticals agreed  to drop the price to $690 per dose (still outrageously high, in the opinion of most in the obstetrics community), the FDA decided to allow compounding pharmacies to continue to formulate the drug when presented with a prescription.

But just imagine all the mothers and babies who would have suffered had the FDA allowed KV to put profits ahead of all else, and ordered compounding pharmacies to cease formulating the prescription.

As a maternal-fetal specialist and a mother, it sends shivers up my spine.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Health care policy, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Moms-to-be: A New Warning Against Smoking

Monday, March 7th, 2011

A study by the CDC, appearing in the journal Pediatrics shows, once again, that smoking cigarettes during pregnancy (with its nicotine and other toxic substances) is a health risk to your baby. Reuters Health reports:

…women who smoked early in pregnancy were 30 percent more likely to give birth to babies with obstructions in the flow of blood from the heart to the lungs, and nearly 40 percent more likely to have babies with openings in the upper chambers of their hearts.

We’ve known for many years of the dangers of smoking during pregnancy, and this study just adds to that knowledge. Mothers-to-be take note: what goes into your body affects your baby—possibly for a lifetime.

– Yvonne S. Thornton, MD, MPH

Posted in Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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The Latest News From the CDC on Birth Defect Risks

Saturday, March 5th, 2011

In a report published in the American Journal of Obstetrics and Gynecology, the Centers for Disease Control (CDC) [] warned against using prescription opiate-based painkillers such as codeine, hydrocodone or oxycodone (brand names include Vicodin and Oxycontin) during pregnancy.

According to an article about the CDC report:

In the study of data from 10 states, the CDC researchers found that 2 percent to 3 percent of mothers interviewed received prescription opioid pain killers, or analgesics, just before they got pregnant or early in their pregnancy. Any illicit use of painkillers was not assessed.

For those women, the risk of having a baby with hypoplastic left heart syndrome — a critical heart defect — was about double that of women who took no opioid drugs.

Risks of other birth defects, including spina bifida (a type of neural tube defect), hydrocephaly (build up of fluid in the brain), congenital glaucoma (eye defect), and gastroschisis (a defect of the abdominal wall), also somewhat increased among babies whose mothers took these drugs either shortly before or during pregnancy.

I have concerns about the generalization of both articles, but the conclusions may be valid. Taking a drug before you’re pregnant, or up to 17 days after conception, is unlikely to cause birth defects. It will either cause a miscarriage or will have no effect. But because most women don’t know precisely when they conceived, it’s best to avoid taking drugs at any time during pregnancy.

The greatest risk to a developing baby from a pregnant mother taking potentially toxic drugs occurs between 17 days post-conception to 12 weeks (end of the first trimester).

You’ve probably heard of Thalidomide, a sedative given in the 1950s to pregnant women in their first trimester. It dramatically illustrated the risks to a fetus’s development from drug effects during the critical first weeks. Thalidomide given early in pregnancy stunted the development of babies’ arms, legs, hands and feet, and caused other limb deformities.

If you’re pregnant, or planning to be, you should also be aware that most drugs, whether prescription or over-the-counter can have unknown effects on a growing fetus. The bottom line is: Every drug is, in some sense, a poison. Don’t consider any drug safe in pregnancy unless prescribed by someone who knows its toxicity as well as the risks and benefits of the drug.

– Yvonne S. Thornton, MD, MPH

Posted in Health care policy, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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When You Can’t Buy Health Insurance, at Any Price

Monday, February 21st, 2011

As you might already know, I’m a staunch advocate for access to health care, and cheered when health care reform became the law last year. We need the opportunity to stay well and keep our families well, and we need to be able to afford medical care when things go wrong. As a mother and a physician, I’ve seen firsthand how imperative this is.

There are those who say we should repeal the recent landmark health care reforms that Congress passed last year. But that would mean that some people would be shut out of health care completely. Some seem to believe it’s just those who are too poor to afford health insurance, or who can afford it but choose not to buy it, who go without. Those are faulty assumptions, as this op ed by the co-founder of Palm Computer, who was denied insurance before the new law passed, shows:

It never occurred to me that we would be denied! Yes, we had listed a bunch of minor ailments, but nothing serious. No cancer, no chronic diseases like asthma or diabetes, no hospital stays.

Why were we denied? What were these pre-existing conditions that put us into high-risk categories? For me, it was a corn on my toe for which my podiatrist had recommended an in-office procedure. My daughter was denied because she takes regular medication for a common teenage issue. My husband was denied because his ophthalmologist had identified a slow-growing cataract. Basically, if there is any possible procedure in your future, insurers will deny you.

If a woman with $millions couldn’t get approved because of a corn on her toe, what would happen to the average woman, or a child, with a more serious issue if health care reform were repealed?

We need to keep ourselves informed about what’s really at stake. And, trust me, there’s a great deal at stake. If health care reform is repealed, we go back to the days when life-saving care is denied to people who can’t pay the costs—oftentimes, hundreds of thousands of dollars—out-of-pocket. We go back to seeing our kids kicked off our policies when they’re just out of high school and don’t yet have jobs that offer health insurance. We go back to denials for pre-existing conditions as tiny—and ludicrous—as a corn on the toe. Or acne. Or depression. Nevermind more serious illnesses.

We can’t go back. Look at how far we’ve come. Please, be as informed as possible about your new rights under health care reform. You can find most of the information you need at this website set up by the government to guide you through your options and your rights.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Health care policy, Women's health issues, Women's health news | No Responses »
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Time to Deliver? Mother Nature Knows Best

Thursday, December 30th, 2010

For years, I’ve been sounding the alarm about Cesarean delivery on-demand, and have persuaded my patients that childbirth isn’t something you can simply pencil into your schedule when convenient. It’s not just that a baby needs all the time nature gives her within the womb to develop, and that delivering just a few days early can mean that lung development and other functions may be potentially compromised. Cesareans are major surgery, which brings inherent danger to both mom and newborn. Necessary Cesareans are often life-savers. Unnecessary Cesareans can be just the opposite.

And now, at last, the word is spreading.

The San Jose Mercury News reports:


Babies born early through induction or C-section without a medical reason are nearly twice as likely to spend time in the neonatal intensive care unit, researchers say. They also are more likely to contract infections and need breathing machines, according to a 2009 study in the New England Journal of Medicine and a number of other reports.


“We are finding out that the last weeks of pregnancy really do count,” said Leslie Kowalewski, an associate state director for the March of Dimes.


“At 35 weeks, the brain is only two-thirds of what it will weigh at 40 weeks.” Many organizations are responding with programs designed to eliminate early elective deliveries. Most significantly, chapters of the American Congress of Obstetricians and Gynecologists have begun to notify doctors about the serious consequences of performing early elective births.

With luck, as information about potential consequences spreads, expectant mothers and their doctors will decide to let nature take her course, for the sake of the mom’s health and her baby’s.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, General health news, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Aspirin, a “miracle” drug, adds another notch to its belt

Friday, December 17th, 2010

Most people know that daily low-dose aspirin is often prescribed by doctors to help prevent heart attack and stroke. Now, a new study shows that aspirin may help prevent cancer, as well.

We’ve known for some time that people who take aspirin appear to have lower incidences of certain cancers, but this study, published in the December 7, 2010 issue of The Lancet, and authored by Oxford University neurologist, Peter Rothwell, offers far more convincing evidence than we’ve had to date. Rothwell analyzed eight previous randomized, controlled studies, that studied the effects of regular aspirin use among more than 25,000 people. About half were given a daily low-dose aspirin (equivalent to a “baby” aspirin) and the other half were given a placebo. Those on aspirin had a 21 percent lower death rate from solid tumor cancers.

According to Time magazine, here’s what Rothwell found:

“Deaths from esophageal cancer were reduced by 60% in the aspirin-takers (who took the drug for at least five years), compared with the placebo group. Lung cancer deaths were reduced by 30%, colorectal cancer deaths were cut by 40% and prostate cancer deaths were lowered by 10%, compared with the patients who got placebo.

“What’s more, the longer people took aspirin, the greater their reduction in cancer risk. The findings are in line with other research that has found anticancer benefits of aspirin in the lab, as well as observational studies that have shown aspirin’s protective effect against colorectal and other cancers. Researchers say the drug’s benefit may have to do with its anti-inflammatory effect.”

Does this mean that everyone should take aspirin? Well, no. Even that innocent looking little pill you buy over-the-counter at the drug store comes with some very serious potential side-effects. Bleeding in the gut, caused by aspirin, can, itself, cause serious illness and even death. Only use aspirin on a regular basis  – or any other drug, over the counter or not –if your physician has recommended it and is monitoring your use.

But if your doctor already has put you on an aspirin regimen, it’s good to know that you might be getting a very valuable side-benefit.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | No Responses »
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New Rules on Health Insurance Keep Insurers Honest.

Tuesday, November 23rd, 2010

Starting in 2011, health insurance companies will be limited in how much they can charge you for insurance. If you work for a large employer, your health insurer will have to use at least 85 percent of your premiums to pay for actual health care or activities that improve health care quality. If you’re self-employed or work for a small business, your health insurer will be required to use 80 percent of your premiums for health care and improving health care.

That means that health insurance companies can no longer divert more than 20 to 25 percent to profits, or salaries, or marketing, and other overhead.

How much will this affect you? Potentially, a great deal.

Kathleen Sebelius, secretary of the Department of Health and Human Services (HHS), told reporters at a press event that some health insurers currently spend less than 60 percent of premium revenues on health care. And that drives up your costs for health insurance:

“Those overhead costs contribute little or nothing to the care of patients and to the health of Americans. And while some administrative costs are certainly necessary, we believe that they have gotten out of hand. And that’s going to change in 2011.”

But what if health insurance companies fail to follow the new regulations? Starting in 2012, if your insurer doesn’t spend 80 to 85 percent of revenues on health care or activities that improve health care quality, you’ll be due a rebate on your premiums.

It’s about time that consumers had some clout when dealing with health insurance companies, and I applaud these changes. I also look forward to hearing your stories about how the new health care law affects you and your family. Has the new law helped your family get or keep health insurance? Get better care? Please let me know in the comments section.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Health care policy, Women's health issues, Women's health news | No Responses »
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