HealthLawProf Blog

Fetus Pain Bill Fails to Pass House

Yesterday, the House of Representatives failed to pass the Fetal Pain Bill.  The San Francisco Chronicle reports:

House Republicans opposed to abortion rights failed Wednesday in their bid to pass a controversial measure that would have required women seeking abortions to be informed that some fetuses feel pain.

Although it was clear the bill would have stalled in the Senate, the abortion opponents hoped the House vote would provide a symbolic victory before control of Capitol Hill passes to Democrats in January. Instead, the vote dealt social conservatives a final setback in a two-year congressional session that has not produced a major piece of anti-abortion legislation.

The bill received majority support, 250-162. But that fell short of the two-thirds majority vote required under rules that limited debate. . . .

 The bill has not been a top priority for anti-abortion activists. Their movement suffered a tougher loss earlier in the fall when a measure to strengthen parental consent laws was derailed in the Senate after passing the House.

The fetal pain bill was sponsored by Rep. Chris Smith, R-N.J. . . .  The bill would have required that the women be offered the choice of having anesthesia administered to the fetus.

Talkleft provides a brief discussion on the bill as well.

Drop in Teenage Pregnancy Tied to Contraceptive Use

Reuters reports on a new study released by the American Journal of Public Health that has a rather unsurprising finding:  the decline in teenage pregnancy rates in the United States between 1995 and 2002 were mostly the result of improved contraceptive use, not of reduced sexual activity or abstinence.  The Reuters article describes the study and its findings as follows:

Dr. John S. Santelli from Columbia University, New York, and colleagues examined the relative contribution of declining sexual activity and improved contraceptive use to the recent decline in pregnancy rates among U.S. women between the ages of 15 to 19 years. The data were derived from interviews with nearly 1400 women in 1995 and 1150 in 2002.

The investigators estimate that the likelihood of pregnancy in this age group declined 34 percent between 1995 and 2002, and that 86 percent of the decline in pregnancy risk was attributable to improved use of contraception. Reduced sexual activity explained only 14 percent of the decline in teen pregnancy. . . .

"These data suggest that the U.S. appears to be following patterns seen in other developed countries where increased availability and increased use of modern contraceptives have been primarily responsible for declines in teenage pregnancy rates," Santelli and colleagues write.

"Our findings," they conclude, "raise questions about current U.S. government policies that promote abstinence from sexual activity as the primary strategy to prevent adolescent pregnancy."

Thanks to Salon.com's broadsheet for this citation.

Potential Future Use for RU-486

The LA Times reports on a recent UC Irvine study demonstrating that a sustained dose of RU-486 prevents breast cancer tumors in mice with BRCA1, a genetic predisposition for the disease.  According to the Times,

The UCI team, which reported its findings in the journal Science, surgically implanted 14 of the mice that had the BRCA1 mutation with RU-486 pellets, which released the drug over a two-month period. All of the mice made it to their first birthday without developing any breast cancer tumors, according to the study.

Meanwhile, four mice implanted with a placebo pellet had all developed tumors by the time they were 5.2 months old. All of the 25 untreated control mice had tumors by the age of 8.7 months, the study found.

"It is a greater effect than I would have expected," said Eliot Rosen, a cancer researcher at Georgetown University who linked progesterone to BRCA1 but was not involved in the latest study. "It is a little surprising that it completely prevented the tumors."

Currently, the best way for women with a BRCA1 mutation to substantially reduce their risk is to surgically remove their breasts and ovaries before tumors have a chance to form.

Lee said RU-486 probably wouldn't be the best candidate for a human treatment because in addition to blocking progesterone, it binds with receptors involved in immunity and other important functions. For short-term use to end a pregnancy, that isn't likely to be a problem. But if patients are going to take a drug for years, it should target progesterone more precisely, she said.

Perhaps future research will help find the target progesterone amount  . . . seems hopeful to me.

Cell Phones and Cancer

You should feel free to continue to use your cell phone without fear that it raises your cancer risk.  Reuters reports on the latest study and its findings:

Using a cellular phone does not increase a person's risk of cancer, according to a broad study released on Tuesday involving more than 400,000 Danish cellular telephone users.  A team of researchers used data on the entire population of Denmark to determine that neither short- nor long-term use of cellular phones, also called mobile phones, was linked to a greater risk of tumours of the brain and nervous system, salivary gland or eyes, leukaemia or cancer overall.

It is estimated that more than 2 billion people worldwide use cellular phones.

"I think the results of this study are quite reassuring," Joachim Schuz of the Danish Institute of Cancer Epidemiology in Copenhagen, the lead researcher, said in an interview by cellular phone from Denmark.

The study, one of the most comprehensive to date, represented the latest evidence endorsing the safety of cellular phones. The data available to the researchers allowed them to look at a large number of cell phone users and assess potential risks many years after they first used them.  "The big advantage is a whole nation is included in the study," Schuz said. . . .

"We were not able to identify any increased risks of any cancers that could be related to the use of the cellular phones," John Boice, a cancer epidemiologist at Vanderbilt University who worked on the research, said in an interview.

Boice said the type of radiation involved in cell phones is not known to damage cells or DNA. "So there's no biological mechanism that would suggest that even this type of exposure could cause cancer or DNA damage," Boice said. . . .

Of course, other risks still exist from cell phone use - like bad driving!!

Fetal Pain Bill

Yesterday's Washington Post reports on the Unborn Child Pain Awareness Act currently being considered in Congress.

In a parting gesture by social conservatives before Republicans relinquish control, House leaders plan to bring up a bill tomorrow that would declare that fetuses feel pain and require abortion providers to offer pregnant patients anesthesia for their unborn child.

The scheduled vote may be the last on abortion-related legislation for years. That's because Democratic leaders hope to avoid confrontations over hot-button social issues that divide their caucus, and focus instead on military and pocketbook issues. . . .

At first blush, the Unborn Child Pain Awareness Act would seem to be anathema to abortion rights groups. It requires abortion providers to tell a woman whose pregnacy is 20 weeks past fertilization "there is substantial evidence" that the fetus will feel pain during the procedure -- a point hotly debated among physicians and pain specialists.

The woman would then have to sign a form accepting or declining anesthesia for her fetus. Some medical groups interpret the language to mean that the fetus would have to have an application of anesthesia separate from the mother's, a procedure that many abortion clinics are not capable of providing.

Even the bill's definition of pregnancy -- beginning at the moment of fertilization, rather than at implantation in the uterus -- is problematic to some abortion rights groups, since it would legislatively establish that some forms of birth control induce abortion by blocking implantation after fertilization.

Backers of the bill have framed it as a common-sense extension of existing state laws that mandate that patients receive information about abortion procedures before giving their consent.  "This is just a compassion piece of legislation to take informed consent to the level it should be at," said Rep. Phil Gingrey (R-Ga.), an obstetrician and antiabortion conservative.

While the measure has provoked strong opposition from Planned Parenthood and the National Abortion Federation, NARAL Pro-Choice America, perhaps the nation's leading abortion rights group, has stayed neutral.

"Pro-choice Americans have always believed that women deserve access to all the information relevant to their reproductive health decisions. For some women, that includes information related to fetal anesthesia options," Nancy Keenan, NARAL's president, has said in a statement on the bill. . . .

For some further thoughts (rather negative thoughts) on the legislation and a critique of NARAL's position, see Firedoglake

Choosing Genetic Defects

The Science Times section of the New York Times reporta on an interesting new study in the journal of Fertility and Sterility concerning parents who screen embryos for genes in the hopes that their children will have a disability similar to the parents.   I am not sure how I feel about this.  I am adopted so I must admit I don't value genetic connections like some other people do.  Here is an excerpt from the article,

Wanting to have children who follow in one’s footsteps is an understandable desire. But a coming article in the journal Fertility and Sterility offers a fascinating glimpse into how far some parents may go to ensure that their children stay in their world — by intentionally choosing malfunctioning genes that produce disabilities like deafness or dwarfism.

The article reviews the use of preimplantation genetic diagnosis, or P.G.D., a process in which embryos are created in a test tube and their DNA is analyzed before being transferred to a woman’s uterus. In this manner, embryos destined to have, for example, cystic fibrosis or Huntington’s disease can be excluded, and only healthy embryos implanted.

Yet Susannah A. Baruch and colleagues at the Genetics and Public Policy Center at Johns Hopkins University recently surveyed 190 American P.G.D. clinics, and found that 3 percent reported having intentionally used P.G.D. “to select an embryo for the presence of a disability.”

In other words, some parents had the painful and expensive fertility procedure for the express purpose of having children with a defective gene. It turns out that some mothers and fathers don’t view certain genetic conditions as disabilities but as a way to enter into a rich, shared culture.

It’s tempting to see this practice as an alarming trend; for example, the online magazine Slate called it “the deliberate crippling of children.”

But a desire for children with genetic defects isn’t new. In 2002, for example, The Washington Post Magazine profiled Candace A. McCullough and Sharon M. Duchesneau, a lesbian and deaf couple from Maryland who both attended Gallaudet University and set out to have a deaf child by intentionally soliciting a deaf sperm donor.  . . .

Controlling a child’s genetic makeup, even to preserve what some would consider a disease, is the latest tactic of parents in an increasingly globalized society where identity seems besieged and in need of aggressive preservation. Traditionally, cultures were perpetuated through assortative mating, with intermarriage among the like-minded and the like-appearing. . . .

Still, most providers of P.G.D. find such requests unacceptable. Dr. Robert J. Stillman of the Shady Grove Fertility Center in Rockville, Md., has denied requests to use the process for selecting deafness and dwarfism. “In general, one of the prime dictates of parenting is to make a better world for our children,” he said in an interview. “Dwarfism and deafness are not the norm.” . . .

Today, parents increasingly use medical procedures to alter healthy bodies. In 2003, for example, the Food and Drug Administration granted approval to Eli Lilly to market human growth hormone for “idiopathic short stature,” or below-average height in children — to make them taller, purely for social reasons. Theoretically, almost a half million American boys qualify for treatment. Why, some may argue, should choosing short stature be different? . . .

 

Trans Fats Ban in New York

New York City's health department decided that restaurants in the that city will start phasing out the use of  trans fats in cooking and ban the fats entirely by July 2008.  New York is the first major city to initiate such a ban.  As you may recall, NYC had attempted a voluntary ban but that was unsuccessful.  Trans fats have been linked to heart disease and diabetes as well as other unhealthy conditions.  USNews reports on the ban and states how such bans may be soon adopted in more cities,

Packaged foods have been required to list trans fat content on their labels since January, and many are now using the absence of the fats as a marketing technique, much as they've touted fat-free and low-carbohydrate goods in the past. Restaurant chains like KFC, Taco Bell, and Wendy's have also worked to replace trans fats in their products. Other cities are likely to follow New York's lead. "After it banned smoking in bars and restaurants, other cities fell like dominos," says Willett.

Unfortunately, the article continues by noting,

The fat switch, however, will not cause people to lose weight more easily. "Although the products may be made with a healthier fat, there's no difference in calories," warns Lichtenstein. To lose pounds, people will have to eat less and exercise more, not just swap one kind of fat for another. Moreover, says Willett, something could be completely free of trans fats and still be unhealthily heavy on pure starch and sugar, hepoints out. Instead of focusing on one ingredient, consumers should take a broader view of their diets.

The New York Times has more information here.

Pfizer's Troubles

The New York Times reports that Pfizer has decided to stop research on its new drug for treating heart disease, which may be one of the reasons for its recent announcement of pending layoffs.  The Times reports,

Pfizer announced last night that it had discontinued research on its most important experimental drug, a treatment for heart disease. The decision is a stunning development that is likely to seriously damage the company’s prospects through the next decades.

   

Preliminary research found that the drug, torcetrapib, appeared to be linked with deaths and heart problems in the patients who were taking it. For people with heart disease, Pfizer’s decision to stop the trial represents the failure of a drug that many cardiologists had viewed as a potentially major advance in efforts to reduce heart attacks and strokes.

Torcetrapib is designed to raise levels of so-called good cholesterol. It was to be used in combination with older drugs called statins, like Lipitor and Zocor, which reduce so-called bad cholesterol.

As recently as Thursday, Pfizer executives had hailed the drug at a meeting with investors and analysts at the company’s research center in Groton, Conn.  “This will be one of the most important compounds of our generation,” said Jeffrey B. Kindler, Pfizer’s chief executive. . .

In a news release issued yesterday, the company said that it would immediately halt clinical trials of the drug and end its development.

The decision was based on interim results from a 15,000-patient clinical trial. The trial, called Illuminate, was scheduled to be completed in 2009. Pfizer had hoped it would prove that the combination of the two drugs was significantly more likely to reduce heart attacks and strokes than Lipitor alone does.

Even before yesterday’s announcement, some cardiologists had raised concerns about torcetrapib, noting that the drug raised blood pressure in many patients, a serious side effect for a heart medicine. But Pfizer said those concerns would prove to be unfounded, arguing that torcetrapib’s effects on good cholesterol would overwhelm its negative impact on blood pressure.

At this point, it is unclear whether the drug’s failure was due to a specific problem with its chemistry or whether other drugs to raise good cholesterol will also face unexpected problems in clinical trials. Pfizer has other drugs similar to torcetrapib in its pipeline, but they are in much earlier stages of development. . . .

HSAs: More Information On Potential Savings

Ezra Klein does yet another excellent job discussing the economics of the Health Saving Accounts.  He notes that the cost savings from these accounts are not quite what some might think.  He states,

I'll take the posting of the latest Health Wonk Review to belatedly respond to Bryan Caplan's snarky argument that HSA's will too bring down the costs of health care, because it's basic economics. Much of his post relies on some analogy about traveling to China, but I tend to think chemotherapy is different from jaunts to Shanghai in obvious enough ways that it's not a terribly useful metaphor. . . .

Now, Bryan isn't a health care expert, he's an economist, and from that perspective, what he's actually arguing is correct: If you make people pay a lot of money for their health care, they'll use less of it.  The problem is, HSA's don't do much of that for the costliest patients -- they save money on low level treatments, disincentivizing an array of basic care services.

World AIDs Day

Firedoglake has excellent post on the importance of this day and how much work there is still to do. 

Treasury Must Make Money Changes for Disabled

This week, in American Council for the Blind v. Paulson, a federal district judge ruled that the U.S. Treasury must make it possible for individuals with visual impairments to distinquish between paper money denominations.  According to the AP:

Give blind people a way to tell a $20 bill from a single, says a judge who told the government to change the nation's paper money so it doesn't all feel the same.   

For a fuller discussion of the case and its importance, please click here.  You can find the full opinion here: 

Thanks to Joseph A. Hodnicki for the case link!

U.S. District Judge James Robertson on Tuesday ordered the Treasury Department to start working on the problem, leaving it up to government officials to determine the best solution. Possible changes include making bills of differing sizes or adding embossed dots or raised ink.

The government has 10 days to decide whether to appeal the ruling. The Treasury Department had no immediate comment.

Robertson said U.S. paper money violates the Rehabilitation Act, which prohibits discrimination on the basis of disability in government programs. The opinion came after a four-year legal fight.

Electronic devices are available to help blind people differentiate between bills, but many complain that they are slow, expensive and unreliable. Visually impaired shoppers frequently rely on store clerks to help them.

"It's just frankly unfair that blind people should have to rely on the good faith of people they have never met in knowing whether they've been given the correct change," said Jeffrey A. Lovitky, attorney for the blind plaintiffs in the lawsuit.