Stupidity and Women’s Health

I’m not a pothead, so, though I feel in my gut that our “war on drugs” is a massive waste of time (designed, intentionally or not, I would argue, to disenfranchise minorities and poor whites, but when I start talking like that, my dad calls me “crazy” so… whatever… I still think I’m right and that it’s intentional), I’m not joining NORML or sending the state legislature special brownies in an effort to point out to them how much tax money we’re losing from having one of our largest cash crops by necessity being off the books.

But I do tend to sit around with our friends, the libertarians, and complain about how stupid this is.

Because, folks, I really loathe stupidity.

And it’s a problem for me.

I’ll just say that I’m not sure what my qualifications for non-stupid are, because lord knows I could write you a long list of PhDs I think are utterly stupid and a long list of stoners (speaking of) who were lucky to finish high school who I think are brilliant.

If I were a libertarian (speaking of), I guess that wouldn’t be a problem.  I’d believe in the primacy of the individual and if other individuals don’t conform to my notions of smarts, kick them to the curb and let them get what’s coming to them. (Known, obviously, as the Sarcastro strain of libertarianism, which differs slightly from the Exador strain, which encourages taking their wallets after you’ve kicked them to the curb in order to “liberate” your tax dollars.)

But I am a pinko commie liberal (speaking of which, I was feeling bad about taking three years of Russian, but now that we’re going to restart the cold war, don’t I look brilliant?) and I also am firmly committed to the belief that there are lots of different types of people who do things and believe things that are very different than what I do and believe and just because I don’t understand it doesn’t mean it’s wrong or stupid.  And that I need to make an effort to try to understand and respect the differences between me and others in order to understand us both as sharing a common humanity.

Whew, that’s got to be the longest, most round-about way of introducing a topic I’ve every embarked on, which is saying something.

So, to get to the point, I’m following Rachel’s posts about Health and Human Services Secretary Mike Leavitt who is attempting to enact a public policy which would allow healthcare providers who don’t want to provide abortions to not provide abortions (see here and here).  On the surface, since this is already public policy, it would seems this would just be more of the Republicans’ strategy of legislative redundancy.

But his policy would allow for the healthcare provider to define abortion as pretty much whatever the healthcare provider decided an abortion was.  So, even though the scientific definition of a pregnancy is when a fertilized egg implants in a woman’s uterus, if a healthcare provider decided that, to her, a pregnancy began (and thus human life began) when an egg was fertilized, she could decide not to issue any form of birth control which might prevent the implantation of a fertilized egg.

Popular forms of birth control, like the Pill, for instance carry a very slight risk of preventing the implantation of a fertilized egg.  That’s not the way it works 99.99999999999% of the time, and lord knows enough women get pregnant on the Pill to prove that even in rare instances where women still ovulate while on the Pill, the Pill doesn’t always prevent the implantation of a fertilized egg.

But there’s a chance.  A vanishingly small chance–the sun and the moon and the planets and the stars would all have to be aligned exactly right–but it might happen.

Which means that a doctor could choose not to provide you with birth control.  Based on the astronomically small chance that the Pill, which somehow was not powerful enough to prevent you from ovulating (the job of the Pill), might be powerful enough to prevent the fertilized egg from implanting.

This irks me.

I mean, how convenient that you get to define pregnancy however you want and abortion how ever you want so that you can not do your job but still get to keep it and at my expense.  I find that very, very irksome.

But what has me just fuming is this part (I quote at length so that you can see):

This is not Leavitt’s first foray into physician conscience issues, nor the first time he has come down on the side of denying patient care in favor of provider ideology. In March of this year, Leavitt issued a letter to the American College of Obstetricians and Gynecologists protesting the organization’s own statement on physician conscience, and asking that the statement not be used to withdraw board certifications from physicians who object to providing abortion or other care. Anti-choice organizations had been protesting the statement for months, demanding that ACOG “repudiate and withdraw” their conscience statement. It is not clear if the uproar from anti-choice organizations such as the Family Research Council is responsible for the topic coming to Leavitt’s attention.

In the current blog post, he frames the newly proposed regulations by referring to this incident:

Several months ago, I became aware that certain medical specialty certification groups were adopting requirements which potentially violate a physician’s right to choose whether he or she performs abortion. I wrote to the organizations in question, protesting their actions. Frankly, I found their response to be dodgy and unsatisfying. I sent another letter, more of the same.”

In fact, ACOG is not responsible for board certifications, and the actual certifying body responded that Leavitt “took two and two and came up with five.” They also affirmed that the statement could not compel any physician to provide services to which she or he objected. In other words, certification was never in danger if physicians refused to perform abortions.

Yes, that’s right.  Leavitt, with the weight and power of the government behind him and being in charge of Health and Human Services, took the ACOG to task over a function THEY DO NOT PERFORM.

This is not some average joe failing to understand the bureaucracy of the government and guessing wrong as to whom he should send his protest.  This is the head bureaucrat.

And that offends me.  It offends me so much that I about can’t even tell you.  This guy doesn’t have his job because he’s the best person for it (or even a fine person for the job).  He has his job because he furthers an ideology and won’t let basic things like facts (about what an abortion is or what constitutes pregancy) or who actually is responsible for what stand in his way.

I lose patience.

I can understand people who are against abortion because they believe it’s wrong to willfully end a form of human life.  I can understand people who are against birth control, even, because they believe it’s their god’s decision about whether a sex act should lead to pregnancy, not theirs.

I disagree with those things, but I can understand and respect those positions.

They seem to me to be positions that could be held by thoughtful, concerned, deeply considerate people.

But this?

This?!

How, how in the world am I supposed to respect a public policy that is reducible to “healthcare providers should be allowed to believe any fool thing about when a pregnancy begins and what constitutes an abortion (a position I think is stupid but fine) and to inflict that upon you without any consequences.”

I mean, I’m just sitting here thinking that the vast, vast majority of health care providers know that birth control pills prevent ovulation and that pregnancy begins when a fertilized egg is implanted in a uterus.  The vast, fast majority of health care providers also know, for instance, that cancer can kill you, but that it can be treated by drugs and/or surgery.

Would we sit idly by if a segment of society tried to argue that cancer wasn’t really deadly (maybe that it’s not the cancer that kills you, but other things that might seem like complications from cancer, but we can’t really say) or that there were other treatments for cancer than drugs and surgery and that an oncologist ought to have the freedom of conscience to refuse to give you drugs or operate on you, even if most other doctors would say that was the right course of action and that’s what you wanted?

I would hope not.

And would we accept that argument from a dude too stupid to figure out who he should be registering those complaints to in the first place?!  When he runs the fucking joint?!

It’s offensive that we should have to take this just because it’s women’s health.

19 thoughts on “Stupidity and Women’s Health

  1. I don’t think I understand what’s going on the same way you do. I don’t think this is an attempt “to enact a public policy which would allow healthcare providers who don’t want to provide abortions to not provide abortions.” That would be pointless, since healthcare providers who don’t want to provide abortions already are not required to do so. Rather, it’s an attempt to make it impossible for potential employers (clinics, physicians’ groups, shared practices, etc.) to refuse to hire employees who won’t provide abortions or birth control when appropriate.

    Plus, I think we can all be pretty sure that Leavitt knew exactly who he was talking to and how irrelevant his comments were to that organization’s tasks. He was grandstanding for the base, not attempting to communicate with his audience that day.

  2. nm, I think that is to some extent what B is protesting, and what irks me so much – being head of HHS is not supposed to be about “grandstanding for the base.” It’s supposed to be about protecting and promoting the health of the American people, of which family planning is one aspect. I think you’re absolutely correct about the employment issue, but what you call “grandstanding” (and I don’t necessarily disagree), I would less charitably call “lying to people for the sake of a non-scientific agenda.”

  3. And on other days, I think it’s the stupidity of people who were not hired because they knew anything but because they had the “right” talking points down. *bangs head against wall*

  4. I dunno … I’m a lot older than you and I can’t remember a time when the civil service (including earlier incarnations of HHS) wasn’t at least somewhat politicized. The group that’s in now is a lot more blatant about it, to be sure, so there’s more grandstanding and less quiet policy implementation, but the policy implementation part is always to some end or other, by definition.

  5. I have a whole set of opinions on this guy, and how it came to be that people believe that crap, and the set of rules the policymakers follow versus the much more strict ones the rest of us should, and how it always seems to be that men with control issues are the ones that are so concerned about fetal life … but it would be a few thousand words. I’ll spare you.

    But really, it’s offensive that, so frequently, women’s health is something so unimportant to so many that non-professionals like Leavitt are allowed to make policy based on ignorant gut reactions without an uproar from the medical community. Women’s health is reduced to pregnancy and childbirth and (sometimes) breast cancer, things that happen to other people, and we move from I-Thou discussion to I-It discussion.

    If we were talking about your cancer analogy, oncologists would be firing off angry missives and donating services to people who had been failed by their Stone Age doctors. So inconvenient pregnancies will be written off as a “consequence” of having sex, easily solved in the future by not having sex. And anything else afflicting women more frequently than men is, as well, likely to be written off: either she’s a hypochondriac or it would all magically go away if she’d eat a salad or two, or both.

  6. It seems there is a large problem of education here, about allowing people to believe falsehoods rather than ask them to rethink certain opinions in the fact of reality.

    Maybe Rachel can help me verify this point, but one rather well-informed medical ethicist told me that new laws and regulations regarding abortion aren’t even the biggest hurdle women face in accessing our reproductive freedom because so few medical schools – and even basic OB/GYN rotations – do not teach abortion techniques. So even people willing to perform them might not know how, even in an emergency.

    If even the doctors aren’t being taught the facts and procedures, are we surprised that other health care providers are uninformed? Of course, that doesn’t justify HHS allowing and almost encouraging such a state instead of combating it.

  7. Professor, I would have responded more generally earlier, but I wanted to look up the actual stats. For an article in the August 2006 issue of the journal Obstetrics and Gynecology, researchers send surveys to the directors “of all 252 accredited obstetrics and gynecology residency programs in the United States” asking about the availability and type (mandatory except for personal objection, elective, not available) of abortion training. 185 (73%) returned the surveys, with the following results: “94 (51%) program directors reported routine instruction in elective abortion, 72 (39%) optional training, and 19 (10%) no training.” Of those with “routine” instruction, the authors report that “more than 50%” receiving training. I don’t have a good sense of how adequate this amount of training is, but Medical Students for Choice has addressed it at http://www.ms4c.org/issueshortage.htm – it’s one of the things they work on. From the numbers above, though, it’s clear that this is not something on which all medical students, even all future ob/gyns, receive instruction.

  8. Thanks, Rachel. Those are really interesting and frightening statistics. The MSFC page is helpful and informative.

  9. I sort of stumbled on this and Rachel’s blog (linked from GingerSnaps), and I’ve got to say there is so much misinformation and/or misunderstanding regarding the ACOG/ABOG relationship, abortion procedural training, differentiating medical student and resident responsibilities, the definition of pregnancy and the mechanism of action of various types of contraceptive choices, to the HPV/Cervical Cancer link and Gardasil (in other threads), and on and on…..

    I’m actually not sure how to address all these issues, but as a physician educator who is a journal editor, and national speaker for the AAFP and ACOG, I always feel like I need to set the record straight.

    For now let’s say, medical students doing their “basic” 2 month OB/GYN rotation, have absolutely no business learning how to do an abortion (or a hysterectomy, or a sacrospinous fixation, or a colpopexy for that matter). They are there to learn the basics and fundamentals of Obststrics and Gynecology – not surgical technique.

    Secondly, though most OB/GYN residency programs don’t in fact teach elective abortions outright (regardless of what the Green Journal said), most any OB/GYN residency graduate can do a simple D&C which is what most abortions amount to. If you are talking about a D&E or hysterotomy, that’s a different story and amounts to ending the life of a fully formed late first to late second trimester fetus. Let’s not forget the partial birth abortion techniques that should never be taught – that end the life of a half-born third trimester to term baby.

    Thirdly, it is a medical fact that from the moment of conception, a life has begun. Pregnancy does not officially begin until implantation, but life exists nontheless. Normal pregnancy refers to implantation into the endometrial lining of the uterus. Other pregnancies must usually be terminated to preserve the life of the mother (ovarian, tubal, cornual, cervical, etc…)

    Finally, for now, there was genuine concern over ACOGs ethics statement. True, ABOG certifies, but the two organizations atre integrally linked. Given the language ACOG used, many were concerned that there was a loophole that could in fact be used to deny them recertification which would effectively end their career.

    As a side note, it is comforting to see that spin and fear-mongering are not the perview of any one side, but are shared equally among ultra-conservative and liberal alike.

    A couple of suggestions – please reconsider your use of the word “anti-choice”. How would you like to be referred to as “pro-infantacide”? Also please reconsider referring to doctors as “providers”. Perhaps otehr groups like this language (PAs or NPs), but we prefer “physician”, “surgeon”, or even simply “doctor”. I think 12 – 15 years iof education and the significant amount of self denial earns a bit of distinction. Thanks for listening.

  10. Ok, 1 more thing that really bothers me (cause it’s dangerous). I can’t remember where I read it (it was either on your blog or Rachel’s), but to say HPV does not cause cervical cancer is just like saying HIV does not cause AIDS. Now if you’re going to nit-pick, you’re right, HIV causes CD4+ lymphocyte destruction, and that in turn allows AIDS to develop, but without HIV, it doesn’t happen.

    In the same way, HPV 16 and 18 cause cellular abnormalities at the level of the cell nucleus, which in turn causes cellular dysplasia and cellular invasion which becomes squamous cell cervical cancer. You just don’t get SCC without HPV. So to say HPV is merely “associated” with SCC is misleading, and quite frankly wrong. HPV causes Squamous Cell Cervical Cancer.

  11. I have never said “HPV does not cause cervical cancer,” and to suggest that I have is completely ridiculous. I seriously doubt B would have said so, either. ABOG specifically stated that certification was not in danger based on ACOG’s statement, so I don’t know how much clearer that could be.

  12. Rachel,

    I didn’t mean to imply that you or B said it. I did read it on one of your blogs – probably in the comments section – contributed by one of your readers.

  13. Dr. Hamada, I’m sorry to inform you that 12-15 years of education and a significant amount of self denial earns you NOTHING nothing nothing here more than the 12-15 years of education shit tons of my readers have and I’m not about to start treating you any differently than I treat them.

    Shoot Casey’s got a PhD and he’s still probably pissed at me about the other day. So, I’m sorry to say that, if you think “I’m a doctor, ooo, ooo, look at my big brain and give me the respect I deserve” is going to work as a rhetorical strategy, you are wrong.

    If you want respect, you’re going to have to do a little better than that. And I’m sorry to say that trying to further show what a large brain you have by “correcting” a commenter who said that HPV doesn’t cause cervical cancer when no such commenter actually exists is a poor, poor strategy.

    But it did make me laugh. You want respect but you don’t bother to show any? I certainly hope Hamada is your real name so I can avoid going to you, because you must be a shitty doctor.

    What makes me say that?

    Oh, goodness, I could spend all afternoon dissecting your comments here and showing the ways in which you reveal yourself to put your own feelings above the needs of your patients, but let’s just take this doozy: “Let’s not forget the partial birth abortion techniques that should never be taught – that end the life of a half-born third trimester to term baby.”

    Never be taught? Really? So, you think that a mother who’s carrying twins, one of which is anencephalic, should risk the life of the other twin, so that the doctor doesn’t have to perform the safest procedure available to remove the fetus? And you think that it’s serving some greater good that the mother can’t then hold that fetus and mourn its death?

    I mean, really, the worst kinds of monsters are the self-righteous ones, so I again thank you for leaving your real name, because women should know to avoid you.

  14. Yes, there’s a great deal of misinformation and/or misunderstanding on the web, for sure. I suggest that OLHamada not contribute to it by confusing specific religious beliefs with science. Let’s not forget that the beliefs Hamada is espousing beliefs as distinct from knowledge. And above all, let’s not forget that not all religious beliefs conform with Hamada’s, even with respect to fetuses.

  15. Well, Hamada’s own blog, which he links here, links to his LinkedIn profile, which describes his previous work for a CPC. Now, I’m not saying I’m not willing to talk to or argue with CPC-supporting folks, because that’s not the case, but he’s obviously coming from a very specific religious perspective, as nm suggests.

  16. Also please reconsider referring to doctors as “providers”. Perhaps otehr groups like this language (PAs or NPs), but we prefer “physician”, “surgeon”, or even simply “doctor”. I think 12 – 15 years iof education and the significant amount of self denial earns a bit of distinction. Thanks for listening.

    Perhaps, doctor, you’d consider extending that same courtesy:

    Evidently, many abortionists are getting around the recent Supreme Court’s ban on Partial Birth Abortion

    I took that quote from your blog. I;m pretty sure they would prefer doctor, surgeon, etc.

  17. Sarcastro, here at Tiny Cat Pants, we aim to leave little bon mots for the libertarians like that. It’s like finding a mint on your pillow.

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