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Catholic Countries Slowly Move Toward More Progressive Reproductive Health Policies

A sex education and contraception access bill that had languished for over a decade passed the Philippines’ House of Representatives by a 133-79 vote margin this week — putting the conservative Catholic country on track to enacting more extensive reproductive health care legislation than ever before, including a more progressive policy on sexual education than the United States currently has.

As the New York Times reports, the so-called “RH bill” — which requires schools in the Philippines to teach accurate sex education classes and expands contraception access in poor, rural areas — had already passed the Senate. Now the two legislative houses will work to reconcile minor differences between their respective versions of the bill in order to enshrine it into law.

If passed, the law could make the Philippines more progressive than the United States on some reproductive health issues. The U.S. still doesn’t mandate comprehensive sexual education — allowing many public school students to receive ineffective and misleading “abstinence-only” education instead — and the Catholic Church has waged a full-scale war against the health reform law’s provision to expand access to affordable contraception. Even though Catholics in the U.S. overwhelmingly support birth control, and don’t even particularly oppose Obamacare’s birth control mandate, that hasn’t stopped the Catholic hierarchy from largely dominating the political conversation about women’s health issues.

Despite its recent progress on reproductive health issues, however, the Philippines still has strict anti-abortion laws typical of many Catholic countries. But there does seem to be some indication that — even in Catholic countries — slow gains are being made toward greater reproductive freedom. In Ireland, after worldwide outcry over the miscarriage-related death of a woman who was denied an emergency abortion, Irish lawmakers moved this week to consider loosening the country’s strict abortion laws.

New Cases Of HIV Infection Are Stabilizing, But Some Groups Remain Particularly Vulnerable

New data from the Centers for Disease Control estimates that even though the total number of Americans living with HIV steadily increased between 1980 and 2010, the rise is partly due to the fact that treatment programs are helping HIV-positive individuals live longer and healthier lives. Overall, new HIV infections have not increased, and the CDC estimates that prevention efforts have averted more than 350,000 cases of infection to date. Unfortunately, that good news doesn’t hold true for every community once the data is broken down by specific demographics.

The HIV epidemic is still disproportionately impacting the LGBT community — particularly men who have sex with men (MSM), who accounted for nearly two-thirds of all new infections in 2010. And the CDC reported last month that young people between the ages of 13 and 24 aren’t getting the message about HIV testing and treatment, despite the recent public education campaigns on the topic, which may be why the number of new HIV infections among MSM in that age group increased 22 percent from 2008 to 2010:

And gains in HIV treatment are also racially stratified, as African-American men continue to bear the biggest burden. Although the cases of new HIV infections among African-American women did decline between 2008 and 2010, black women still accounted for nearly two-thirds of all new infections among women in 2010. Nearly 90 percent of those women contracted the virus from heterosexual sex. Altogether, the rate of HIV infection for black Americans is about eight times higher than the rate for white Americans:

Fortunately, the U.S. made big strides toward combating HIV over the past year, a time period that is not reflected in the CDC’s new report. Breakthroughs in HIV research and drugs may help ensure that HIV-positive individuals’ life expectancy is extended even further, and the health reform law will help ensure that HIV testing and treatment is affordable for Americans who may have previously gone without it. The next time the CDC runs the numbers, there may be even more good news to report, even for typically hard-hit demographic groups.

Biotech Giant Will Pay Massive Settlement For Illegally Promoting Drugs And Committing Insurance Fraud

In a case that encompasses illegal drug promotion, corporate kickbacks to doctors, and pre-meditated Medicare fraud, Los Angeles Times reports that biotech and pharmaceutical conglomerate Amgen will be fined $762 million after pleading guilty to allegations of improper drug marketing.

Kassie Westmoreland, a former Amgen employee and a whistleblower in the suit, was one of several people to charge that Amgen promoted the anemia-treatment drug Aranesp for off-label use and overfilled doctors’ promotional samples of the drug. In a brazen twist, Westmoreland also claims that the company orchestrated a collusive scheme to allow doctors to fraudulently profit off of their patients’ drug benefits:

[Westmoreland's] suit charged that Amgen overfilled vials of Aranesp to supply doctors with extra medicine at no charge. She alleged the company then encouraged doctors to bill Medicare and private insurers for this surplus amount, reaping them extra profit. Amgen pursued this strategy to take business away from Procrit, a popular anemia drug sold by Johnson & Johnson, according to the suit.

The Westmoreland case cited internal spreadsheets used by Amgen sales representatives to allegedly show doctors how much more money they could make from the overfills.

“Amgen provided extra product in the Aranesp vials as a liquid kickback that doctors could then cash in with federal and state governments through Medicare and Medicaid reimbursements,” said Charles Kester, a Calabasas attorney who represents Westmoreland along with law firms in Boston and Washington, D.C. “Amgen is being held to account in a serious way for its choices to market this drug unlawfully.”

Amgen’s penalties highlight the fact that most federal health care settlements stem from Medicare fraud and pharmaceutical misconduct. While doctors can prescribe drugs for off-label use, it is illegal for pharmaceutical companies to advertise drugs for purposes other than what the Food and Drug Administration (FDA) has approved. But settlements of this kind — and the government’s ability to crack down on drug makers’ practices that may threaten public health — could soon be a thing of the past.

A recent appellate court ruling in favor of the pharmaceutical industries’ right to promote their products as they see fit has set the stage for a Supreme Court showdown over drug makers’ First Amendment rights — and opens up big questions about how stringently the FDA can regulate Big Pharma.

Michigan Lawmaker Didn’t Read The Anti-Abortion Bill He Voted For, But He’s Confident It’s Not About Women

Michigan lawmakers moved quickly to push an omnibus abortion bill through their lame duck session last week. Despite the massive undertaking that House Bill 5711 represents — the measure combines several of the worst attacks on women’s reproductive freedom into one 45-page piece of legislation — some GOP legislators may not have even bothered to read its full contents before making up their minds about it.

RH Reality Check flags an account from Emily Magner, who brought a group of her social work students to Lansing to discuss HB 5711 with their state legislators in late November. Magner recounts the conversation she had with state Sen. Howard Walker (R) — who ended up voting for the measure in early December — in which he admitted he initially threw his support behind the bill without reading it first:

We went on to talk specifically about how this bill will harm Michigan women, disproportionately women living in rural areas like ours. After we brought up a few of these points he put up his hands and said that he couldn’t really speak to those topics … he had not read the bill.

In front of him was a one paragraph synopsis I assume was from the Right to Life special interest organization who drafted the bill. [...]

We spoke with him for 20 minutes, the whole time he was dismissive, misinformed, and rude. When his handler told him, “5 more minutes,” I told him that I would never ask him to change his beliefs on abortion, I would protect his right to believe whatever he wanted, but I did want him to consider the harmful implications that this legislation would have on women and consider his ethical obligation to his field to leave his personal views at the door.

Before I could finish my sentence, he waved his hand dismissively and interrupted, “THIS ISN’T ABOUT WOMEN! THIS IS ABOUT PROTECTING FETUSES!”

It’s unclear whether or not Walker did have a chance to read the bill in between his November meeting with Magner and his December vote — but if he had delved a bit deeper into the legislation, he would have discovered that enacting HB 5711 would have several detrimental effects on the women in Michigan.

HB 5711 seeks to impose a host of new restrictions — such as requiring doctors to prove that mentally competent women haven’t been “coerced” into having the elective procedure, limiting abortion access for women in rural areas, and imposing unnecessary, complicated rules to regulate abortion clinics out of existence — that will ultimately hamper women’s ability to receive the health care they need. That’s why female members of Michigan’s House opposed the bill when it first came up for consideration, although their male colleagues were quick to deride them.

The measure has passed both chambers of the state legislature and now awaits Michigan Gov. Rick Snyder’s (R) signature.

Thanks To Budget Cuts, U.S. Remains Unprepared To Combat Future Public Health Emergencies

Despite numerous public health threats over the past decade — including bioterrorism threats like anthrax attacks, the spread of airborne diseases like the swine flu epidemic, and extreme weather disasters like Hurricanes Katrina and Sandy — a new report finds that states across the country still have serious gaps in their emergency preparedness plans.

The Trust for America’s Health report used 10 measures to evaluate states’ public health emergency preparedness, examining indicators such as whether states have met vaccination requirements or whether they have emergency evacuation plans for schoolchildren, and found that just five states currently meet at least eight of those markers. Thirty five states and the District of Columbia fell far short, meeting six or fewer of the 10 key public health indicators.

Only two states have met the CDC’s recommending goal of vaccinating 90 percent of young children for whooping cough. Thirty five states and the District of Columbia don’t have adequate climate change adaptation plans, which would help plan for the health threats that result from extreme weather events like Superstorm Sandy. Thirteen states don’t have enough public health staffers available to work around the clock to respond to an emergency outbreak like swine flu. And, as USA Today reports, the authors of the report cite state budget cuts as the biggest reason that states are falling short on these public health initiatives:

One of every five state public health jobs has been cut, the report says; federal funds for state and local preparedness have dropped 38% from 2005 to 2012. [...]

“Investments made after Sept. 11, the anthrax attacks and Hurricane Katrina led to dramatic improvements, but now budget cuts and complacency are our biggest threats,” says Jeffrey Levi, executive director of the Trust for America’s Health. “Since then, there have been a series of significant health emergencies, but we haven’t learned that we need to bolster and maintain a consistent level of health emergency preparedness.”

The country has not paid “sufficient” attention, the authors say, to “the everyday threats public health departments and health care providers face repeatedly.” In addition to extreme weather and foodborne illnesses, “we have suffered a deadly rise of West Nile virus, a fungal meningitis outbreak and a resurgence of old diseases we thought were largely conquered — whooping cough and tuberculosis — all in a growing era of antibiotic resistance.”

According to the report, 29 states cut their public health budgets from 2010 to 2012. But it’s not just the disaster preparedness funds that hang in the balance — House Republicans have also threatened to slash funding for disaster relief efforts, and have dragged their feet on authorizing federal funds to help clean up the significant damage that resulted from the recent Superstorm Sandy, despite the serious public health threats that linger in the storm’s wake.

And Kathleen Tierney, the director of the National Hazards Center at the University of Colorado in Boulder, warns that the funding situation may be even more dire than it appears on the surface. “This study doesn’t paint a pretty picture,” she told USA Today. “You have to be able to invest in sustaining problems, keep up with emerging problems, keep up with state of the art equipment, and learn what best practices are out there. Even for states that are maintaining their budget, that really means their budget is going down because costs are increasing.”

American Adolescents Suffering From Hunger Have A Higher Risk Of Mental Health Problems

According to a new study by the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), adolescents faced with food insecurity are more susceptible to every category of mental illness.

The report comes in the face of rising hunger levels in America, and concludes that hunger is a more significant factor in predicting mental illness than poverty or family education level:

Food insecurity was associated with elevated odds of every class of common mental disorder examined in the study, including mood, anxiety, behavioral, and substance disorders. Food insecurity was associated with adolescent mental disorders more strongly than parental education and income.

The findings suggest that the lack of access to reliable and sufficient amounts of food is associated with increased risk for adolescent mental disorders over and above the effects of poverty. These findings are concerning because recent estimates have suggested that more than 20% of U.S. families with children experience at least some degree of food insecurity. Given the dramatic increases in child poverty in the past decade, these findings argue for expanding programs aimed at alleviating hunger in children and adolescents.

Dr. McLaughlin said of the study, “The fact that food insecurity was so strongly associated with adolescent mental disorders even after we accounted for the effects of poverty and other aspects of socio-economic status suggests that lack of access to reliable and sufficient amounts of food has implications not only for children’s physical health, but also their mental health.”

JAACAP’s study underscores two particularly disturbing — and, as its findings demonstrate, interconnected — trends in America: the evisceration of the mental health safety net and the rising tide of American hunger. Close to 50 million Americans live in a food insecure household, including close to 4 million households with one or more hungry children.

Unfortunately, saddled with a public safety net susceptible to arbitrary budget cuts, such needy American children may have a hard time receiving either the sustenance or health care that they need. 2010 estimates show that while 20 million American children received public school lunch benefits, an additional 10.5 million hungry children did not receive the reduced-price or free lunches they were eligible for. And while the public school system remains young Americans’ primary resource for mental health care, 70 percent of children do not receive the treatment they need.

How The CIA May Have Undermined Polio Treatment In Pakistan

Child receiving polio drops in Pakistan

On Tuesday, a coordinated attack in Pakistan left four female health workers dead on the streets of Karachi, a major port city. In the city of Peshawar, another two aid workers were gunned down. And on Wednesday, another two people were killed and another was wounded in Peshawar — leaving many wondering if a program spearheaded by the Central Intelligence Agency to capture Osama bin Laden could be a contributing factor in all the violence.

The four workers killed in Karachi were all part of a program by the Pakistani government to vaccinate children against polio. Pakistan is one of the last countries where polio remains endemic, and a conference that opened on Wednesday was meant to highlight the country’s successes in combating the diseases over the past year. Cases dropped from a staggering 173 in 2011 to only 56 so far in 2012, in large part due to a huge public health effort from the government, international organizations, and non-governmental organizations.

That progress is now at risk, as the United Nations announced that World Health Organization and UNICEF employees on the ground in Pakistan were suspending their work due to the current violence. No group has officially taken credit for the attacks, but police have said that at least two of the incidents in Peshawar were carried out by members of the Pakistani Taliban. While officially having denied involvement, the Pakistani Taliban has been outspoken about their dislike of the Western-backed vaccination program.

Part of the Taliban’s opposition is due to the controversial way that the CIA sought intelligence on bin Laden’s presence in the Pakistani city of Abbotabad. In 2011, the Guardian revealed details about the CIA’s use of a fake vaccination program to collect “DNA from any of the Bin Laden children in the compound [which] could be compared with a sample from his sister, who died in Boston in 2010, to provide evidence that the family was present.” Pakistani doctor Shakil Afridi was jailed by the government earlier this year on charges of treason for his part in the deception.

In 2011, shortly after details of the ruse became clear, global health blogger Chris Albon noted the potential backlash that could result from the CIA program:

Insecurity has a serious negative effect on health care in rural communities. The greater the personal risks, the greater the appeal for both national and international health workers to stay within the safety of major cities, venturing out only in large convoys. This so-called “bunkerization” diminishes the ability of health campaigns to target rural communities — often those most in need of primary health care. The best way to overcome bunkerization is through building relationships with communities and local elites, allowing for the free movement of health workers in a region — exactly the kind of thing undermined by the CIA’s apparent operation.

And that’s what appears to be playing out now in Pakistan. While the DNA obtained in the CIA’s covert operation did in fact help prove that bin Laden was present, the effects of the CIA’s actions may have hindered the legitimate polio vaccination program in the country.

How Tobacco Can Be Deadlier Than The HIV Virus

As the global health community makes significant strides toward effectively combating the HIV/AIDS epidemic, HIV-positive individuals are now living longer and healthier lives, largely thanks to advances in treatments for the virus. Research suggests that the virus itself is hardly a death sentence anymore — and, for HIV-positive people, other public health issues are beginning to surpass their HIV status as the biggest threat to their life expectancy.

According to a new study, health complications resulting from smoking — and not from HIV itself — are actually the biggest cause of death among HIV-positive individuals. Researchers tracked HIV-positive people with access to highly active antiretroviral therapies (HAART), the medications that have drastically lowered the rates of HIV-related deaths since they first became available in 1996, and found stark differences between the smokers and non-smokers who received HAART treatment:

In a large case-control study, smokers with HIV had substantially higher rates of all-cause and non-AIDS mortality than HIV-positive nonsmokers, according to Marie Helleberg, MD, of Copenhagen University Hospital, and colleagues. [...]

The bottom line, Helleberg said in a statement, is that “more than 60% of deaths among HIV patients are associated with smoking,” compared with slightly more than a quarter associated with HIV.

In the general population, Helleberg and colleagues noted, smoking is one of the major factors that reduce life expectancy.

Among those with HIV, the advent of highly active anti-retroviral therapy (HAART) has meant that lifestyle factors are increasingly affecting survival, while the mortality risk associated with the virus has diminished.

Researchers also noted that HIV-positive individuals are much more likely to smoke than the people who are not infected with the virus, potentially due to stress or socioeconomic factors. In fact, men who have sex with men — the population that remains at the greatest risk for contracting HIV — are themselves more likely to be smokers, both because of minority stress and because Big Tobacco has worked to specifically target LGBT individuals. Anti-smoking activists emphasize that the U.S. should start focusing its smoking cessation campaigns specifically on the LGBT community.

The fact that tobacco could be deadlier than HIV is yet another reason why public health resources need to be invested into anti-smoking programs. But over the past few years, states have been dedicating fewer and fewer funds to anti-tobacco programs, as budget cuts have forced those public health initiatives to be scaled back or ended altogether.

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