The day after the funeral

Back to work after attending what I believe is my eighth funeral in as many years.

I think the ritual is very important, at least for most people, to help them mentally shut the door on the relationship they had with the deceased and get on with their lives. The ritual doesn't need to encompass the full suite of wake, viewing/visitation, religious ritual, trek to the cemetery, graveside ritual, and final reception. But I tell you what, I come away more emotionally satisfied and ready to face work the next day when I'm leaving the end of a full Catholic send-off than when I've attended a brief meeting in a funeral parlor.

Must be the incense. Or the obligatory references to prayers for the unborn, which will come as surely as will the Protestant "sinners in the hands of an angry God" warnings to choose the right kind of resurrection when it comes to the listeners' own turn to go to sleep and await the event.

Was much more involved in arrangements this time than I've ever been previously. Medical ventilators are violent things. Coffins, vaults, and related services are expensive. Embalming is bizarro. There should be a website called "remove-your-damn-ballcap-when-you-enter-the-funeral-home dot com." And everyone is unlikely to be truly prepared for the actual volume of legal paperwork afterward.

And so I've spent some time today getting over my trauma -- which can't possibly compare to that of the deceased's immediate family -- by reading up on end-of-life practices in North America and round the world.

Also reviewing my advanced health care directive.

When abortions are illegal, women still get abortions

. . . and they get more of them. A study, published in The Lancet, covered the years 1995 to 2008 found:

Abortion rates were lowest in Western Europe -- 12 per 1,000 -- and highest in Eastern Europe -- 43 per 1,000. The rate in North America was 19 per 1,000. Sedgh said she and colleagues found a link between higher abortion rates and regions with more restrictive legislation, such as in Latin America and Africa. They also found that 95 to 97 percent of abortions in those regions were unsafe[, defined as] any procedure done by people lacking needed skills or in places that don't meet minimal medical standards.

The researchers' conclusion: "It is precisely where abortion is illegal that it must become safer," and providing education and birth control universally will go a long, long way.

The full text of the study is available free with registration at The Lancet's website.

Nonsense NYT Op-Ed suggests the Pill should be available over-the-counter

Kelly Blanchard of Ibis Reproductive Health, a women's health research group, has published a ridiculous op-ed piece in the New York Times asserting that the Pill should be available over the counter, without a prescription, because it's safer than acetaminophen. Blanchard explains the problems with requiring a prescription for the Pill:

[The Pill's] usefulness has been limited because it’s available only by prescription. As every woman who has run out of pills on a Sunday or forgotten to take them along on vacation knows, refills are not always easy to come by.

This is not a problem most easily solved by eliminating the need for a prescription. This is a problem most easily solved by women watching their medication supply and double-checking their luggage before they leave the house. Blanchard's message here is not particularly empowering.

The pill meets F.D.A. criteria for over-the-counter medications. Women don’t need a doctor to tell them whether they need the pill — they know when they are sexually active and want to avoid pregnancy. Pill instructions are easy to follow: Take one each day.

Ease of use is not the sole, or maybe even the most important, criterion for whether a medication should be available without a prescription. After all, heavy-duty sleep aids are also once-a-day pills, and some anti-osteoporosis drugs are once-a-month pills. To suggest that their dosing schedule should control their over-the-counter availability is absurd.

It’s true that the pill could be dangerous for women with certain conditions. Women who are 35 or older and smoke, and those with high blood pressure, are at greater risk of a heart attack or stroke if they take oral contraceptives that combine estrogen and progestin. But these are not complicated conditions to identify[.]

Huh? The author checks her blood pressure at home? In fact, there is a lot of undiagnosed hypertension among adult Americans. It's inconceivable to me how Blanchard could advocate letting a drug be sold over the counter to literally millions of women who would then have an increased risk of death or permanent disability.

Blanchard analogizes the Pill to cold remedies and condoms. But drugs that affect sex hormones are way different than antihistamines or barrier contraception. A woman should absolutely see some kind of health practitioner before starting on the Pill, so that they can talk about the options as to dosages and as to which type of hormone or combination she'll use. The health practitioner should check her blood pressure, remind her that the Pill won't protect against STDs, and discuss the risks of blood clots, depression, and negative sexual side effects. There are way too many medical issues with the Pill for me to agree with the suggestion that it should be available over the counter like a cough suppressant or a contraceptive sponge.

[T]here are no special health risks for younger women on the pill[.]

Well, that depends how "special" you think your sex drive is, I guess. I spent a year on the Pill when I was in my mid-20s, and it killed my libido dead. It took me several years and a pregnancy to get it back, and I'm not alone . . . says The New York Times itself, in a 2006 article that notes the lack of a warning about that particular possible side-effect in birth-control paperwork.

The United States has one of the highest teenage pregnancy rates in the developed world, and better access to the pill is part of the solution to this problem.

I don't disagree. But Blanchard is not a medical doctor; she's a sociologist. Sociological and economic research is an important way to figure out how populations are barred from getting the healthcare they need. And sociological and economic strategies are important ways to try to remove or at least lower barriers to getting needed healthcare. But there are some important medical reasons for requiring a prescription for the Pill, and it's not helpful to the discussion to minimize those reasons by saying the Pill is safer than Tylenol, or to equate a doctor's prescription with "a doctor's permission," as Blanchard inexplicably does in the last paragraph of her op-ed.

A more important barrier to eliminate is that not all health insurance plans cover the Pill. Almost half the states do not require health insurance companies to do so (PDF). (This is one reason why your health insurance company should not be allowed to incorporate in whichever state it darn well pleases.) Let's focus on this real barrier to reproductive equality. It's a straw-man argument to characterize doctors as paternalistic, permission-granting gatekeepers standing between women and their birth control pills. If any entity stands between a woman and the Pill, it's a health insurance company that's choosing to not fully pay for women's healthcare.

Now men can get Gardasil, too

The FDA has just "approved use of the vaccine Gardasil for the prevention of genital warts (condyloma acuminata) due to human papillomavirus (HPV) types 6 and 11 in boys and men, ages 9 through 26."

Since Gardasil is administered as a series of 3 injections, I've joked that my daughter will be getting the vaccine "early and often." Of course, the truth behind that joke is that I'm so happy I can do something so concrete to reduce her lifetime risk of cervical cancer. I hope the parents of her future partners feel the same way about their kids!

Open letter to HuffPo crackpots

Dear Huffington Post,

Please stop posting articles that are dismissive of and untruthful about vaccinations and supportive of homeopathy (which kills babies).

Sincerely,

Glomarization

Poll: popular support for "Obamacare"

New York Times and CBS News poll: "Americans on Health Care and Afghanistan" asks, "Would you favor or oppose the government offering everyone a government-administered health insurance plan like Medicare that would compete with private health insurance plans?"

Favor: 65%

Oppose: 26%

No Opinion: 9%

I've found that when I say, "President Obama's plan is like an opt-in Medicare for non-seniors," people think that it's a good idea. It's not forced on anyone; you can still shop around for a low-cost catastrophic plan on your own if you want; and maybe an invisible hand will magically make the health insurance companies offer lower-cost plans as well.

The biggest (and, interestingly, least frequent) concern I hear is how to pay for it over the long term. I've heard "cut waste in Medicare" and "preventative care now is cheaper than hospitalization later," which I swear I've heard somewhere before.

Health insurer's delay kills "Norma Rae"

Crystal Lee Sutton, the textile union organizer whose true life story inspired the film Norma Rae, is dead of cancer because her health insurer's death panel delayed 2 months before choosing to cover her treatment. But, hey, in the end, the company saved money. Yay, for-profit health insurance! The market solves everything!

News flash: homeopathic "remedies" don't cure . . . anything

In case you were still on the fence about whether water can have a memory, the World Health Organization has released an official warning against relying on homeopathy to treat HIV, tuberculosis, infant diarrhea (second only to pneumonia as the leading cause of death for babies and toddlers), malaria (another leading cause of infant and child mortality), and flu.

Driberally tonight

Drinking Liberally is a weekly social gathering where progressives talk politics and get to know one another. In Center City Philadelphia, we meet on Tuesday nights at Triumph Brewery's upstairs bar, where there are drink and food specials from 6:00 to 9:00 p.m. I hope to see you there!

Triumph Brewery is at 117 Chestnut Street in Old City. It's conveniently SEPTA-accessible via the Market-Frankford El (2nd Street station), all the buses that turn around at or near Penn's Landing (5, 12, 17, 21, 33, 42, 48), and a few other buses that pass nearby (9, 25, 38, 40, 44, 47, 57, 61).

This week's topic: Some attendees have noticed that the male-to-female ratio at Drinking Liberally has been about 24,358:1 lately. We need to recruit more women! Serendipitously, new research from Europe suggests that drinking beer can boost women's bone density. Thus, Drinking Liberally is healthy for women. Bring a few with you tonight!

"Come for the beer, stay for the check"

Canadian health care comment

There's been a lot of nonsense flying around about Canadian health care, so I've decided to throw my 2 cents in, because I know actual facts about the Canadian system, since one of my parents is from Canada.

My grand-dad was Canadian. He was well into middle age when Canada instituted its single-payer system in the province where he lived.

Grandpa died of cancer when I was in high school. While he was still able to stay at his home, he had a nurse making house calls for him 2 or 3 times weekly. Understand, Grandpa and Grandma lived on a farm in the middle of nowhere, on the edge of a town of 1,500 souls -- Alice Munro and Robertson Davies country, about an hour from the nearest full-service hospital. He spent his last weeks in a hospital room, pretty well doped up because the cancer had taken over both his back and his lungs; he was in pain from both breathing and lying down.

But my point, and I do have one, is that cost was never a consideration in any of the conversations the family had about his care. The nurse and her 2-hour round-trip to care for him, the diagnostic imaging and treatments before we switched to palliative care, the final weeks in the hospital, all free. The family upheaval around his end-of-life care did not include stress about where the money to pay for it would come from. It's hard to express how much of a difference that makes, though it seems to me that it should be obvious.

Grandma spent her last few years in an assisted-living facility. It wasn't free, but it cost spectacularly less than American facilities generally cost. She saw her doctor regularly, and, again, we never had to factor in the cost of her pills or treatments or hearing aids when we looked at her budget for the facility.

Anecdotally, I've never heard from any of my Canadian relatives that they had to wait in line for some life-saving treatment. It may take a while to get a check-up, but that doesn't differ from my own experience here in the States. In comparison, I need to see a dermatologist about a funny-looking mole, and was told that I probably couldn't be seen for 4 or 5 months, even though I have a family history of melanoma.

If I recall correctly, the Canadian system doesn't cover dental, though you can opt for private dental insurance if you want. So my Canadian relatives tend to have teeth that are more, shall we say, English-looking than mine. But this is because they are tight-fisted with their money, not because their health insurance system is wanting. Also, most of the guys played hockey in their youth, and those of my parent's generation didn't use helmets or mouthguards.

And Grandpa smoked a pipe for decades. His teeth were worn down where he held the pipe in his mouth. I don't know when he ever saw a dentist, though I know he had a small bridge that he'd use pretty much only when he was eating. One day we were sitting at the kitchen table playing cards and eating jellybeans. Suddenly, he pulled a jellybean out of his mouth, with one of his teeth still attached to it. We all of us thought it was hilarious. Who breaks their tooth on something as soft as a jellybean?

Court-enforced doctor's orders when there's a fetus involved

Speaking of laws interfering with women's medical decisions, this past March, a mother of 2, with number 3 on the way, was ordered to bed rest by her obstetrician. She sought a second opinion, because she couldn't see how she could manage raising 2 kids from bed. Her doctor's response was to get the courts involved:

[T]he Circuit Court of Leon County [Fla.] ordered Samantha Burton -- a mother of two suffering from pregnancy complications -- to be indefinitely confined to Tallahassee Memorial Hospital and forced to undergo any and all medical treatments deemed necessary to save her fetus. After three days of state-compelled hospitalization, Ms. Burton suffered fetal demise and was released from the hospital.

(ACLU.) She was detained at the hospital, where she miscarried a few days later anyway. The ACLU has filed a friend-of-the-court brief on Burton's behalf.

If this kind of state action is allowed, there are at least 2 ways women (and the people who love them) should be concerned. First, it will act as a deterrent to seeking prenatal care. Every year, some 1 million pregnant Americans get inadequate prenatal care, or none at all, and it puts their babies at higher risk of low birth weight, prematurity, stillbirth, and infant mortality. Do the state of Florida and Burton's doctor want to give mothers another reason to avoid seeing their doctors before labor kicks in? Why do they hate healthy babies so much?

Second, I can't be the only person to see a slippery slope here. In a country where (usually poor, black, and young) women are jailed for testing positive for illegal or even legal drugs while pregnant, or lose custody mostly for refusing a C-section, now we have a county court that ordered a woman confined because she wanted a second opinion on the bed rest order of a single physician. Pregnancy-induced hypertension is not an infrequent complication. Both my sister and my mother had it. My sister's doctor ordered her to bed rest toward the end of her pregnancy. Of course, she got up to do some housework and run some errands, even though the doctor had told her to get up only for toileting. Luckily for her, the baby arrived several weeks early (and hale and healthy). If she'd miscarried, or if the premature birth had injured the baby, should the state have prosecuted, figuring that they could prove a causal relationship between her disobeying doctor's orders and the miscarriage?

Since when is my doctor a state actor? Can he get a court to order me to spend my pregnancy in the hospital if I test positive for fast food, nicotine, and Kenzinger?

And who was watching Burton's other 2 kids while she was forced to stay in the hospital, leaving them motherless?