Thursday, May 17, 2012
A number of news outlets have reported today that the U.S. Conference of Catholic Bishops is increasing its attack on PPACA’s definition of preventive health services to include contraception. The AP reports:
U.S. Roman Catholic bishops are rejecting the Obama administration's plan to accommodate faith groups that object to the birth control mandate. The bishops said in a statement Tuesday to Health and Human Services that the prospective new rules don't do enough to protect religious liberty. The mandate requires employers to provide health insurance that includes birth control for workers. The plan sparked protests from faith leaders because it included most religious nonprofits such as hospitals and colleges. President Barack Obama offered a compromise. He said insurers would bear the cost of the birth control instead of religious employers. However, the bishops argue that the compromise still makes their insurance plans a conduit for contraceptives. The administration is reviewing public comments before making any final decision.
This ongoing fight is notable for a number of reasons, one of which is that Dr. John Rock, an inventor of the birth-control pill, was a religious Catholic who firmly believed that the progestin-based function of the pill fit neatly within the Church’s idea of “natural” methods for preventing conception. Malcolm Gladwell wrote for the New Yorker in 2000:
The key fact was that the Pill's ingredients duplicated what could be found in the body naturally. And in that naturalness he saw enormous theological significance.
In 1951, for example, Pope Pius XII had sanctioned the rhythm method for Catholics because he deemed it a "natural" method of regulating procreation: it didn't kill the sperm, like a spermicide, or frustrate the normal process of procreation, like a diaphragm, or mutilate the organs, like sterilization. Rock knew all about the rhythm method. In the nineteen-thirties, at the Free Hospital for Women, in Brookline, he had started the country's first rhythm clinic for educating Catholic couples in natural contraception. But how did the rhythm method work? It worked by limiting sex to the safe period that progestin created. And how did the Pill work? It worked by using progestin to extend the safe period to the entire month. It didn't mutilate the reproductive organs, or damage any natural process. "Indeed," Rock wrote, oral contraceptives "may be characterized as a 'pill-established safe period,' and would seem to carry the same moral implications" as the rhythm method. The Pill was, to Rock, no more than "an adjunct to nature."
The Church rejected Dr. Rock’s pill, which apparently greatly surprised him. And, of course, Catholic women, like other women of reproductive age, have embraced the pill. As the Guttmacher Institute reports:
Among all women who are at risk of unintended pregnancy, 69% (including 68% of Catholics) are currently using a highly effective contraceptive method—male or female sterilization, the IUD, the pill or another hormonal method. Another 14% (15% among Catholics) are relying on condoms, and 5% (4% among Catholics) are relying on other methods, such as withdrawal. Only 1% of all women at risk of unintended pregnancy (2% of Catholics) use natural family planning, the only method of contraception sanctioned by the Catholic hierarchy.
The American Congress of Obstetricians and Gynecologists for years has fought to have contraception defined as preventive healthcare for women and describes contraception as “vital to women’s health and well-being.” Many will be watching closely to see how Secretary Sebelius responds to the Bishops.
Tuesday, May 15, 2012
I am delighted to be speaking at the Fourteenth Annual SIH/SIU Health Policy Institute later this week and honored to be included in a great group of speakers, here. I've been asked to do a summary of how we got to the current state of "Meaningful Use" (MU) and provide a critical analysis of the subsidy program. Obviously this has both quantitative and qualitative aspects. The former inquiry has been particularly challenging; I have been faced with a veritable soup of confusing data. For example, exactly what are the data in all those charts about the growth of EMR utilization, are they providers who have registered for MU, or attested, or received funds? When you read about the numbers of providers who have adopted EMRs is that limited to eligible providers and to users of certified technologies?
Moving to more qualitative aspects, exactly what technologies are being used? Are these smart EMRs that are integrated with sophisticated prescribing and clinical decision support technologies, or the EMR version of dumb-phones? And when a study notes a strong uptick in meaningful use, is that for real, or have the providers been able to punt on some of the harder objectives or report on measures with extremely low numbers of participating data subjects? It strikes me that there's still a lot of government and industry cheerleading going on out there, abetted by cherry-picked data.
I am also trying to move beyond the MU weeds and reflect on the thorny safety/regulatory issues as well as the still unsolved privacy and security questions. You have probably read about the value of "big data," and if not this McKinsey report is a fine primer. I confess that I had to look up what a zettabyte of data was! I will also try and reflect on ACA, EMR-based research, and future conceptions of health data, at least until the moderator loses patience and pulls the power from my slide deck. Maybe I'll see you there! [NPT]