Archive for the ‘public health’ Category

Shut Up and Drive?

December 14th, 2011 No comments

You would have thought the National Transportation Safety Board had launched an all-out attack on motherhood: Last night, we got word that NTSB is recommending a total ban on cell phone use in cars. The radical part of the proposal is that it would include hands-free phoning; no state has gone that far.

I can’t see these recommendations being enacted, but at least NTSB has provoked the right conversation. Because it turns out that the hands holding the phone aren’t the problem, it’s the chit-chat itself. But if in-car yakking is the problem, why not muzzle the passengers and turn off the radio? And, for the love of God, will someone please make the kids in the back seat shut up?

But not all conversation is the same. Radios can, I’m told, be turned off. Passengers can be asked, at first politely and eventually escalating to a scream, to clam up — indeed, most will instinctively do so when they see that the driver’s full attention is needed for some task (for instance, driving). Caution: not effective with children. The person on the other end of a phone, though, doesn’t know what’s going on in the car and drivers are often reluctant to tell them. They get caught up.

So will limiting cell phone use to hands-free models do any good at all? Yes, because it will also stop texting. As it is now, texting bans are useless without a ban on hand-held cell phones — because unless the cop is peering directly into the window (and what’s he doing there?), the driver can always claim to have been dialing, not texting.

And texting is the thing we really need to stop. Here’s a strategy I tried on my niece: When she told me she sometimes texted while driving, even though she knew she shouldn’t, I told her that I had an idea for safer driving:

Stop texting and consume a fifth of whiskey. You’ll be better off, statistically speaking. Given that her generation has been drilled — constantly and to some good effect — about the perils of drinking and driving, this message might click.

Please text the link to this post. But pull over first.

How Fat is the Governor of NJ?

October 1st, 2011 1 comment

How Chris Christie Manufactures His Angry Viral Videos

Yes, it’s a cheap joke line to emphasize the point I want to make: That Gov. Chris Christie’s weight isn’t a joke. Even though it seems like it’s impossible to resist making them when it comes to, well…anyone who’s overweight.

Our national response to obesity is a confusing and dismal mess, and tired fat jokes don’t help.  We shouldn’t be concerned whether it’s illegal for someone to jump rope in California…no, stop it.

Predictably, some, like Slate’s Daniel Engber, have argued that Christie’s weight should be a non-issue. But that’s wrong. Gubernatorial girth raises a couple of serious issues:

(1) Being grossly overweight is unhealthy. Chris Christie isn’t just obese, he’s morbidly obese. And that matters. For while a little extra weight isn’t as unhealthy as is popularly (and unfortunately) believed, a large load of freight is unhealthy. And, from the looks of it, Christie’s excess — while distributed generously over his body — is particularly great in his stomach. That’s the worst place for extra weight; as the CDC notes, “abdominal fat is a predictor of risk for obesity-related diseases.) Given the justifiably obsessive interest in Presidential health (as evidenced by the release of their annual medical reports), Christie’s weight is of course an important issue. I just spent a few minutes looking over some images of the Garden State Gov over the past two years, and I can’t see much evidence that he’s gained any weight, which would be even more troubling. But it’s as concerning as a history of heart trouble would be.

(2) Simplifying the issue doesn’t help. The causes of obesity are complex, and their interaction isn’t fully understood. Certainly, personal behavioral choices play a part. Christie’s been candid about that. “I eat too much,” he said in response to the question about why he’s fat. He’s also owned the need to exercise more. In these statements, Christie is following a popular narrative; one that’s even parroted, carelessly, by the usually thoughtful Michael Kinsley:

Controlling what you eat and how much is not easy, and it’s harder for some people than for others. But it’s not as difficult as curing a chemical addiction. With a determined, disciplined effort, Christie could thin down, and he should — because the obesity epidemic is real and dangerous.

Message from both Christie and Kinsley: If you’re overweight, you have only yourself to blame. But that’s much too simple. Again, the CDC:

Body weight is the result of genes, metabolism, behavior, environment, culture, and socioeconomic status.

But the tendency is still to cast weight as a morality play, with those of us who can eat an entire elk without gaining weight tsk-tsking others who, for a variety of poorly understood reasons, have a tougher go of it. Christie doesn’t have to vie with Michelle Obama for the title of exercise ambassador, but he should be sensitive to the effect that his words can have — both on those who struggle with weight gain, and for those who stand in judgment of them. Like Michael Kinsley.

In sum: We shouldn’t be too judgmental. But we shouldn’t ignore the health risks, either.

Review of “Reconsidering Law and Policy Debates”

June 1st, 2011 No comments

I can’t help cross-posting (from Concurring Opinions) this great review of the book I edited. (The reviewer, Prof. Frank Pasquale of Seton Hall law, discusses a few of the chapters specifically, but not mine — so I’m more bragging on my co-authors!)


Review of Reconsidering Law and Policy Debates: A Public Health Perspective

posted by Frank Pasquale

Reconsidering Law and Policy Debates: A Public Health Perspective, edited by John Culhane, is a superb collection of thought-provoking essays which features some of the most well-regarded health law scholars in the US. It also includes contributors from schools of public health, public affairs, and public administration. The chapters are uniformly well-written and instructive. Though I cannot in this brief review give consideration to all of the essays, I will try to highlight contributions related to some of my own areas of interest in the intersection between public health and medico-legal research.

Several authors focus on the difficult questions raised by extreme inequality. For example, Vernellia R. Randall’s Dying While Black in America reflects on the disturbing disparity between white and black death rates in the US. A black American male can expect to live seven years less than a white American male, and black women face a four-year gap. Randall explores a number of potential explanations, including discriminatory policies and practices, lack of language and culturally competent care, inadequate inclusion in healthcare research, and hidden discrimination in rationing mechanisms. Randall argues that these disparities will never be addressed effectively until the legal system develops doctrines that can deter not only intentional discrimination, but also “negligent discrimination in healthcare:”

Negligent discrimination in healthcare would occur when healthcare providers failed to take reasonable steps to avoid discrimination based on race when they knew or should have known that their actions would result in discrimination. An example of this would be decisions to close inner-city hospitals and move them to the suburbs. (86)

Randall expertly characterizes race as a key “social determinant of health” in the United States. Countering the many current legal doctrines that promote the legitimation of discrimination, Randall envisions the type of guarantees of equality that will be necessary to realize the antisubordination and antisubjugation principles that animate the 14th Amendment properly understood.

Diane E. Hoffman also addresses stunning inequalities, this time on a global level. Hoffman’s long engagement with end-of-life care informs a consistently sensitive and insightful public health perspective. Considering the situation in the United States, Hoffman concludes that “it is not as all clear that we would want to give the state a public health justification for taking on end-of-life care,” because “we might have trouble reining in the government and preventing it from implementing increasingly more coercive measures” (59). This judgment is particularly pertinent in a political environment where extreme inequality and ever-lower taxes on the wealthiest have imperiled many important health programs for the aged.

However, Hoffman comes to a different conclusion in the case of many developing countries, where the question is less one of rationing access to life extending technologies than it is one of extending access to basic treatments for pain. In a sobering series of statistics, Hoffman presents a tragic panorama of human suffering. In India, only 1% of the 1.6 million people enduring cancer pain each year are likely to receive any type of pain medication. Morphine dispensaries are rare; Calcutta, with 14 million residents, has only one. Though nearly half its population is extremely poor, India is not an outlier. While developing countries account for 80% of world population, they use only 6% of the morphine consumed each year. Sometimes, shortages of medical personnel help explain the problem: for example, in Sierra Leone, there is only one doctor for every 54,000 people (as opposed to a 1:350 ratio in the US). But Hoffman gives several examples of easily preventable policies and business practices that keep painkillers out of the hands of the world’s poorest individuals. This is a truly neglected global crisis, generating levels of suffering that are rarely encountered or even imagined in the developed world.

Returning to the US, the last two chapters in the book are very interesting contributions to ongoing debates about the nature and role of tort doctrine. Elizabeth Weeks Leonard expertly deconstructs the usual dichotomy between tort law’s individualism and the population focus of public health. As she notes, cases involving asbestos, lead paint, silicone breast implants, the Dalkon shield, hazardous autos, tobacco, firearms, Phen-Fen, OxyContin, and Vioxx have all combined efforts by individuals to secure compensation for injuries with broader strikes against destructive products and practices. Weeks succeeds in demonstrating the “counterintuitive fit between tort law and public health law” (189), arguing that each “offers approaches to addressing inevitable conflicts in organized society between individual interests and community needs.”

Jean Macchiaroli Eggen tries to make the fit better by focusing on punitive damages. Toward the end of her chapter, she proposes that states solve the “plaintiff windfall problem” in punitive damages by requiring that “the portion of the punitive award the plaintiff does not receive [due to split-recovery statutes and other measures] be allocated to a state or private program that will enhance the deterrence of the conduct that gave rise to the warden the particular case.” The contributions of both Weeks Leonard and Macchiaroli Eggen would be of great interest to tort classes and seminars considering the difficult issues raised by judicial efforts to address public health concerns.

John Culhane is to be commended for bringing together such an illustrious group of contributors to address public health, an issue that has been neglected in law schools. Knowing full well that factors like income, race, pollution, and even commute length may have a far greater impact on health than, say, dispute resolution methods used by insurance companies, law professors interested in health nevertheless tend to focus on purely legal topics. (I am as guilty of this as anyone, and credit this book (and many interventions by Daniel Goldberg) for pushing me to do more to consider the social determinants of health in my own work.) Well after the sturm und drang surrounding the constitutionality of the ACA has dissolved, we will still face problems of balancing liberty, equality, and welfare that this book’s thoughtful contributors address. Their voices deserve to be heard in those future, more substantive, debates.

Categories: public health Tags:

Andrew Sullivan Does Hit-and-Miss Public Health

May 17th, 2011 No comments

Yesterday, Andrew Sullivan reported on a recent, large-scale study that determined — pretty conclusively, for science — that HIV+ people on antiretroviral drugs were much less likely to transmit the disease to their sexual partners. His “duh” response was dead-on, and not just because it’s obvious. I wrote about this some nine years ago, reporting on a smaller-scale study in Uganda that showed even more impressive results (not one case of transmission among serodiscordant couples).1 So the information has been out there for awhile.

Sullivan may well be correct in his surmise that at least part of the reason that earlier studies weren’t touted by the CDC sooner was fear of more unprotected sex (and therefore a higher incidence of transmission), but it’s also true that large-scale studies of the sort just reported do take years. When the issue is the sexual transmission of HIV, which occurs only rarely (as a percentage matter) even under the riskiest circumstances, and where neither evidence of transmission nor symptoms are immediate, it’s not surprising that it took this long.

After that, though, he makes a series of statements that make my public health sense tingle (not in a good way, but in a Spiderman, danger-sensing way).

First, he calls for sero-sorting, in which HIV-positive men “do their best” to have sex only with other HIV-positive men. Let’s start with what’s good about that statement. One belated move by public health has been to get HIV+ men to own responsibility for their status, and the risk it entails to HIV- men, and (not by the way) to HIV- women. But there’s also a need for disclosure; once that happens, then sero-discordant couples (whether of the one-night variety or of the long-term kind) can negotiate the boundaries of their mutual risk/comfort levels.

But more seriously off-target is this last suggestion:

I wonder what the full effect would be if all men diagnosed with HIV were immediately put on retrovirals and all HIV-negative men were put on a basic anti-retroviral at the same time.

I bet you’d see a sizable decline in HIV transmission.

Some problems: You can’t simply put everyone on retrovirals. Some don’t have access to them  — yes, even here in the U.S., but even more so in most developing nations, where limited funding and daunting logistical problems mean that only those who are really sick have access. Even for those who do have access, though (and let’s assume that’s who he’s thinking about here), there’s the insurmountable issue of personal autonomy. Given the side effects of these drugs and the fact that HIV isn’t infectious in the way that, say, measles, is, there’s no sound justification in law or public health for putting “all men diagnosed with HIV” on these powerful drugs.

More problematic yet is the suggestion that all HIV-negative men be put on a basic anti-retroviral. Here the public health justifications and liberty-compromising justifications are even weaker. All HIV-negative men? Even sexually abstinent eighty-five year olds? Monogamous straight men? Even if he’s not suggesting that these men be compelled to go on the drugs, think of the costs and the side effects in administering these powerful pharmaceuticals to the public and the absurdity of this suggestion becomes manifest.

And why stop at men? Sullivan is writing from the perspective of a gay man (so am I!), and not thinking about other populations that are at serious risk of transmission — notably including poor women of color who are often infected by their male sex partners who, for cultural reasons, don’t know about or don’t disclose their HIV+ status. If we’re going to move in this direction at all (I don’t think we should, and in any case we couldn’t and shouldn’t force anyone to take these drugs), we need to carefully consider the populations really at risk. That’s hard to do, admittedly, but better than issuing a blunderbuss suggestion that “all men” be the targets.

  1. See John G. Culhane, Remarks, in AIDS in National and International Law,  Proceedings of the 96th Annual Meeting of the American Society of International Law, Mar. 13-16, 2002. Available only by subcription.

Primary Care, Stress, and Public Health

March 23rd, 2011 No comments

This week’s New Yorker (3/21) features a fascinating story (“The Poverty Clinic”) about the link being established between high stress in early childhood and subsequent poor health outcomes. It’s starting to look like these stresses cause poor health even if they don’t lead to unhealthy behaviors (like smoking, drinking, poor eating habits, and so on). The stress, it turns out, has a long-term effect on the body’s immune system and leads to greater susceptibility to a host of chronic, life-threatening diseases (including heart disease and possibly cancer). (You need a subscription to access the full on-line article, but here is the abstract.)

The results aren’t surprising, but they do highlight the need for a more integrated approach to primary care. The pediatrician featured in the piece, who has a Masters in Public Health as well as a medical degree,  has in fact initiated a team approach to the problem. Her clinic draws on a number of specialists outside the medical field to develop a cohesive approach to combating the social factors that cause elevated stress levels.  Given the depth of the social, behavioral, and economic problems that lead to stress, this won’t be easy. But this new approach could be revolutionary.

It’s at least promising, when so little else is.

Categories: public health Tags:

There’s No Such Thing as a Natural Disaster

March 13th, 2011 No comments

That’s not completely true, of course, and in the aftermath of the triple-barreled horrors in Japan — earthquake, tsunami, nuclear meltdown — it might even seem callous to suggest otherwise, as the title of this post does. Surely the first two of these are natural disasters in the purest sense.

But calling something a “natural disaster,” while a humbling reminder of the fact that, as one seismologist said, “nature always bats last,” sometimes gets in the way of looking into the deep questions that make such disasters more or less catastrophic. Indeed, Andrew Sullivan wrote:

Readers have asked why we haven’t covered this event exhaustively. My answer is that this is a natural disaster, unlike, say, a revolution or a war, which requires little added comment.

I couldn’t disagree more. Consider:

Hurricane Katrina was barely one when it reached New Orleans — the big story there was the ineptitude of the Army Corps of Engineers, local, state, and federal politicians and bureaucrats, and the ham-handed efforts by the Department of Homeland Security (forced into a public health role for which it had little appetite and less competence, as dramatized so chillingly in Zeitoun).

The earthquake that decimated Haiti was, in its effect, far worse than the one that hit Japan, even though the magnitude of the first — 7.0 — was far less than the 8.9 (or is it 9.0?) of the more recent one.What’s the difference between 7.0 and 9.0? Here’s a quick Richter scale refresher:

[E]ach step on the Richter scale is 10 times greater than the one before it. An earthquake that measures 8.0 is ten times stronger than one that measures 7.0, and an earthquake that measures 9.0 is one hundred times stronger than one that measures 7.0. So Friday’s earthquake in Japan was almost 100 times stronger than the one in Haiti in 2010.

So why was the less powerful natural disaster more consequential than the much stronger one? Largely because of the vast differences in infrastructure and public health preparedness between the two island nations. It’s by now a commonplace of public health doctrine that any naturally occurring, negative incident — say, infectious disease or (let’s use the term here) natural disaster — will have far worse consequences for the poor than for the rich. And while Haiti is the poorest country in the Western Hemisphere, Japan remains one of the wealthiest nations on the planet. So the Haitian government estimated 230,000 dead (others guessed fewer, but all agree that the number exceeded 100,000), while the Japanese devastation, though too early to quantify yet, will almost surely be much lower. (As I write this, 20,000 is the new “best guess.”) So the earthquake about 100 times stronger (in Japan) will likely end up causing the deaths of about one-tenth as many people as the weaker one (in Haiti). Please don’t think I mean to minimize any of this. I’m trying to make a point, and I can barely stand to watch these images.

There’s plenty more to do, and to say, than to simply gawk at the horror and tally the dead. There are questions of constructing buildings to withstand earthquakes (and boy, did Japan do a good job there — not even one of the strongest quakes in recorded history caused a single skyscraper to topple; again, compare Haiti), personal preparedness for disaster (and the interesting psychological questions relating to why we don’t prepare for low-frequency, but high-impact events), and, inevitably, the safety of the nuclear power industry.

In its way, a natural disaster causes us to think about, report on, and try to fix just as many things as does a revolution; just in a different way. And it’s a mistake to think that one raises more complex questions that the other.  There are simply two very different kinds of entropy to be dealt with.

OK, OK (You Can Use a Condom, If and Only If…)

November 21st, 2010 No comments

The Pope has moved a teensy bit closer to sanity, recognizing that there are cases where condom use might be part of a strategy to reduce the incidence of STDS:

Pope Benedict XVI says that condom use is acceptable “in certain cases”, notably to reduce the risk of HIV infection, in a book due out Tuesday, apparently softening his once hardline stance.

In a series of interviews published in his native German, the 83-year-old Benedict is asked whether “the Catholic Church is not fundamentally against the use of condoms.”

“It of course does not see it as a real and moral solution,” the pope replies.

“In certain cases, where the intention is to reduce the risk of infection, it can nevertheless be a first step on the way to another, more humane sexuality,” said the head of the world’s 1.1 billion Catholics.

It’s a step, but an even smaller one than first appears. Male prostitutes don’t seem especially likely to listen to the Pope. Catholics who are married or in long-term relationships might be swayed, but the advice doesn’t apply to them — at least not clearly. It still seems as though the opposition to birth control trumps all, even a commitment to basic public health.

My Law and Public Health Book

November 1st, 2010 2 comments
Reconsidering Law and Policy Debates

Just about an hour ago, I received my ten advance copies of the book I’ve edited and contributed to, entitled:

Reconsidering Law and Policy Debates: A Public Health Perspective (Cambridge University Press 2011). If you click on the link, you’ll be e-whisked away to the on-line catalogue page, which describes the book and lets you click on an excerpt, which is the Introduction (which I wrote).

I’ll have more to say about this when officially published (although you can order it now; just saying….), but here’s the description:

This book offers fresh approaches to a variety of social and political issues that have become highly polarized and resistant to compromise by examining them through a population-based public health perspective. The topics included are some of the most contentious: abortion and reproductive rights; end-of-life issues, including the right to die and the treatment of pain; the connection between racism and poor health outcomes for African-Americans; the right of same-sex couples to marry; the toll of gun violence and how to reduce it; domestic violence and how the criminal justice model fails to deal with it effectively; and how tort compensation and punitive damages can further public health goals. People at every point along the political spectrum will find the book enlightening and informative.

Written by ten authors, all of whom have cross-disciplinary expertise, this book shifts the focus away from the point of view of rights, politics, or morality and examines the effect of laws and policies from the perspective of public health and welfare.

As you might guess, I wrote the chapter on marriage equality.

This is my first book (well, sort of mine), and I’m very excited. (To buy at a discount, enter code: F10CULHANE; the discount is available for a limited time.) As I said, I’ll write more when the book is officially published.

Of Brain Scans for Alzheimer’s, HIV Tests, and Unintended Consequences

July 14th, 2010 1 comment

Gina Kolata’s article in today’s NY Times discusses a proposed recommendation by medical experts to use brain scans to diagnose Alzheimer’s much sooner than is now possible. In practical terms, this “advance” would likely mean

“a two- to threefold increase in the number of people with Alzheimer’s disease. Many more people would be told they probably are on their way to getting it. The Alzheimer’s Association says 5.3 million Americans now have the disease.”

So, as many as 16 million Americans would have a diagnosis of this scariest of diseases, with untold millions more set off on a course of life-long worrying about an onrushing catastrophe that they can do nothing about. And at a staggering course for the new tests, to boot.

This is terrible public health policy. Aricept notwithstanding, at present there are no good drugs for battling this disease. While there would be research benefits to knowing who the at-risk population is, the article barely mentions the important, countervailing problem of unintended consequences. Dr. Doraiswamy at Duke put it well:

“We ought to be cautious that we don’t stimulate all this testing before we can give people something to manage their disease. There is no point in giving them just a label.”

Yet the guidelines for this testing are expected to be approved in the Fall.

This reminds me greatly of the early days of HIV testing — that decade-plus period when testing was available, but little besides AZT (the equivalent, very roughly speaking, of Aricept) was available to treat it. Elaborate state laws were crafted to manage the problem of delivering the bad news to those infected, including, in some states, a requirement that the grim tidings be accompanied by information about available counseling. (Not that anyone could hear what was being said right then, with all that blood rushing to their head and making a din that would drown out everything.) Many, quite understandably, avoided testing altogether. In the context of an infectious disease like HIV, of course, ignorance of one’s status presented a huge obstacle to reducing the incidence of transmission. So there was a good moral and public health reason to get tested anyway. But the fear of mortal knowledge was too great for some.

In this case, I can see only downside. Alzheimer’s isn’t infectious, so we don’t need to diagnose to protect third parties. There’s no good treatment right now, so the knowledge of early stage disease or, even worse, the likelihood of a future with Alzheimer’s will, for many, have only negative psychological (and resulting physical) consequences. Yes, there are some who think they’d like the information to be able to plan. But do those in, say, their fifties, really need or want to know what’s likely to happen to them in ten or fifteen years?

Do these guidelines need to be approved this quickly? Have these issues been sufficiently considered? And what counseling will be part of the package that accompanies these scary, high-tech tests?

His Holiness [sic] and the “Pro-life” Canard

March 20th, 2010 1 comment

I was Catholic, but only by circumstance, and that was a very long time ago. I didn’t so much leave the Catholic Church as I lost interest in all churches and in organized religion, generally. But it should be said that my experience growing up in the stultifying, boring Church didn’t exactly awaken whatever religious feeling I might otherwise have had. And my family was very low-key about it: No Catholic school, limited instruction in doctrine, little evidence of it at home. We went to Church most Sundays, unless there were swim meets in the way. But that’s about it.

For me, then, leaving the Church was easy and not even so much the product of a conscious decision. It’s more like I would have needed to decide to be a Catholic, rather than not to.

Yet growing up around all of that ritual and history had some effect on me, notably that I follow and in some way care about what the Church is doing more than I otherwise would. Most of the time, I’m either amazed or appalled (or both), but then there are the occasions when the socially progressive, charitably inclined part of what the Church is supposed to champion reminds me that it’s not all one-way traffic to Hell (to use one of their favorite scare words, among many).

Lately, the Church has been in the news and mostly for terrible reasons. The unfolding horror of the sex scandals in Ireland and Germany,1 which have — let’s face it — implicated His Holiness [sic] in the cover-up is just the most dramatic of the stuff coming through the wire. There’s also the benighted response by the Diocese in D.C. in response to marriage equality (ending health benefits to employees’ spouses, discontinuing their foster care program), and the expulsion of pre-schoolers from the Sacred Heart of Jesus (remember him?) because their parents were lesbians. Add to that the bishops’ opposition to the Senate health care reform bill on the ground that it doesn’t do enough to make abortion even more difficult to obtain, and I’m left to say: Enough already.

Just in time, other voices in the Church have come forward to call the bishops on their slick, “pro-life” (read: anti-life) rhetoric. The Catholic Health Association (CHA), which describes itself as “the nation’s largest group of not-for-profit health care sponsors, systems, and facilities,” has taken on the bishops’ abstract, disembodied, and disconnected opposition to the health care reform effort. Here’s why:

The insurance reforms will make the lives of millions more secure, and their coverage more affordable. The reforms will eventually make affordable health insurance available to 31 million of the 47 million Americans currently without coverage.

CHA has a major concern on life issues. We said there could not be any federal funding for abortions and there had to be strong funding for maternity care, especially for vulnerable women. The bill now being considered allows people buying insurance through an exchange to use federal dollars in the form of tax credits and their own dollars to buy a policy that covers their health care. If they choose a policy with abortion coverage, then they must write a separate personal check for the cost of that coverage.

There is a requirement that the insurance companies be audited annually to assure that the payment for abortion coverage fully covers the administrative and clinical costs, that the payment is held in a separate account from other premiums, and that there are no federal dollars used.

In addition, there is a wonderful provision in the bill that provides $250 million over 10 years to pay for counseling, education, job training and housing for vulnerable women who are pregnant or parenting. Another provision provides a substantial increase in the adoption tax credit and funding for adoption assistance programs.

An association of nuns, representing 59,00o sisters, agrees and amplifies, from the point of view of those actually providing health services to the poor (compare the bishops):

We have witnessed firsthand the impact of our national health care crisis, particularly its impact on women, children and people who are poor. We see the toll on families who have delayed seeking care due to a lack of health insurance coverage or lack of funds with which to pay high deductibles and co-pays. We have counseled and prayed with men, women and children who have been denied health care coverage by insurance companies. We have witnessed early and avoidable deaths because of delayed medical treatment.

The health care bill that has been passed by the Senate and that will be voted on by the House will expand coverage to over 30 million uninsured Americans. While it is an imperfect measure, it is a crucial next step in realizing health care for all. It will invest in preventative care. It will bar insurers from denying coverage based on pre-existing conditions. It will make crucial investments in community health centers that largely serve poor women and children.

[T]his is the REAL pro-life stance, and we as Catholics are all for it….

Did this get Bark Stupak to rethink his position? What do you think? Perhaps because of unpleasant experiences with Catholic nuns in school (write your own joke), he blathered about getting his “pro-life” guidance not from them but from the bishops and organizations like Focus on the Family — the same group that has this advice for parents who find that spanking isn’t working: “The spanking may be too gentle. If it doesn’t hurt, it doesn’t motivate a child to avoid the consequence next time. A slap with the hand on the bottom of a multidiapered thirty-month-old is not a deterrent to anything. Be sure the child gets the message….”

If health care reform doesn’t pass tomorrow, it will be because Stupak has been able to hold on to enough fellow slavish devotees of the simplistic pro-life legislators. They should listen to the people who actually deliver health care services. If they did, they might take a position that is actually pro-life; instead of “pro-life,” complete with ironic quotations.

  1. There’s been great coverage of the issue over at the Daily Dish.