Theocrats At HHS

Readers from Indiana will understand why I found this recent Politico headline chilling: “How Mike Pence’s Mafia Took Over Health Care Policy.”

Pence, of course, could care less about health care, or policy of any sort that doesn’t advance his Christianist agenda. And he “serves” (or is that word “serviles”?) a President who has no discernible interest in any policy–or anything other than his own self-aggrandizement. So the fact that Pence has installed his preferred people at Health and Human Services tells us that health policy will be made on the basis of ideology, not science or evidence.

Behind the scenes, Pence has developed his own sphere of influence in an agency lower on Trump’s radar: Health and Human Services. It’s also the agency with the ability to fulfill the policy goal most closely associated with Pence over his nearly 20 year career in electoral politics: de-funding Planned Parenthood.

Numerous top leaders of the department — including Secretary Alex Azar, Surgeon General Jerome Adams and Medicaid/Medicare chief Seema Verma — have ties to Pence and Indiana. Other senior officials include Pence’s former legislative director from his days as governor and former domestic policy adviser at the White House.

“He has clearly recruited people connected to him who share his very extreme views on sexual and reproductive health care,” said Emily Stewart, the vice president of public policy at Planned Parenthood. “This has been one of the most active administrations ever on rolling back reproductive rights and there’s no way that happens unless you have people in the White House driving the effort to put out policies at such a rapid clip.”

Before the courts intervened, HHS was getting ready to implement rewritten federal policies to curb abortion and–Pence’s wet dream– cut funding to Planned Parenthood. The new regulations would also have tightened the conditions under which Title X federal family planning grants are awarded, ensuring that clinics wouldn’t even be able to refer women to entirely separate abortion providers.

And in a nod to Pence’s longterm efforts to privilege religious bigotry, the agency this month boosted “religious conscience protections” for providers who refuse to perform certain medical services, including abortion, citing religious or moral objections.

The changes to Title X are the culmination of a battle Pence waged first as a member of Congress, then as governor and now in the White House. The Title X rules, which force providers of federally funded family-planning programs to separate themselves from abortion providers, are aimed squarely at Planned Parenthood, which relies heavily on such funding. The Title X changes don’t cut off Medicaid funds from Planned Parenthood — although cutting off that big pot of money is on the GOP wish list as well.

Pence has installed a number of people at HHS who were part of his Indiana administration. As White House staff members have confirmed, from the very outset of the Trump administration, Pence had carte blanche to identify nominees he preferred  “particularly in roles Trump didn’t really care about,” as one GOP operative put it.

Even somewhat smaller projects appear to bear the vice president’s ideological imprint — for example, a recent HHS decision to grant South Carolina a waiver that allows foster care providers to reject potential families who have different religious beliefs.

These conservative and religious views have played into the administration’s foreign as well as domestic policy. Internationally, Trump and Pence have gone beyond even other Republican administrations in curbing access to abortion and contraception by expanding the so-called Mexico City policy barring U.S. foreign aid to groups that promote or provide abortion.

Trump is fixated on himself. Pence is fixated on imposing his peculiar version of Christianity  on America.

Neither they nor any of the criminals and incompetents they’ve installed as cabinet members and White House staffers care anything at all about We the People, the Constitution, or the Rule of Law.

If we don’t evict the whole crew in 2020, there may not be any going back.


Don’t Look Behind The Curtain…

On the 12th of this month, media reported that HHS was deleting twenty years of medical guidelines from its government website.

The Trump Administration is planning to eliminate a vast trove of medical guidelines that for nearly 20 years has been a critical resource for doctors, researchers and others in the medical community.

Maintained by the Agency for Healthcare Research and Quality [AHRQ], part of the Department of Health and Human Services, the database is known as the National Guideline Clearinghouse[NGC], and it’s scheduled to “go dark,” in the words of an official there, on July 16.

Medical guidelines like those compiled by AHRQ aren’t something laypeople spend much time thinking about, but experts like Valerie King, a professor in the Department of Family Medicine and Director of Research at the Center for Evidence-based Policy at Oregon Health & Science University, said the NGC is perhaps the most important repository of evidence-based research available.

Why would the administration delete this information? Experts say it was a unique repository that got 200,000 visits a month.

Medical guidelines are best thought of as cheatsheets for the medical field, compiling the latest research in an easy-to use format. When doctors want to know when they should start insulin treatments, or how best to manage an HIV patient in unstable housing — even something as mundane as when to start an older patient on a vitamin D supplement — they look for the relevant guidelines. The documents are published by a myriad of professional and other organizations, and NGC has long been considered among the most comprehensive and reliable repositories in the world.

So what was the pressing issue that forced elimination of a well-regarded, well-used, totally unpolitical resource?

AHRQ agrees that guidelines play an important role in clinical decision making, but hard decisions had to be made about how to use the resources at our disposal,” said AHRQ spokesperson Alison Hunt in an email. The operating budget for the NGC last year was $1.2 million, Hunt said, and reductions in funding forced the agency’s hand.

Not even an archived version will remain.

It’s hard to credit the notion that fiscal restraints required the deletion. After all, our “President” is spending billions on such things as repainting Air Force One and requiring a military parade a la Third-World Dictators. Toward the end of the linked report, there’s a hint:

The NGC has a screening process designed to keep weakly supported research out. It also offers summaries of research and an interactive, searchable interface.

That gatekeeping role has sometimes made AHRQ a target. The agency was nearly eliminated shortly after its establishment, in the mid-90s, when it endorsed non-surgical interventions for back pain, a position that angered the North American Spine Society, a trade group representing spine surgeons. A subsequent campaign led to significant funding losses for AHRQ, and since then, the agency as a whole has been a perennial target for Republicans who have argued that its work is duplicated at other federal agencies.

Organizations writing the guidelines for the big drug companies are paid handsomely in order to promote the companies’ products. NGC’s process provided a vetted, evidence-based resource comparatively free of that kind of influence. Gee-I wonder why it became a target for the GOP?

In 2016, when former head of HHS Tom Price was still a Congressman, one of his aides insistently protested publication of a study that was critical of a drug manufactured by one of Price’s campaign donors. According to ProPublica, Price wanted the agency to pull the critical research down.

While Americans are transfixed and distracted by the antics of our demented (and probably traitorous) accidental President, the largely unrecognized and unseen functions of competent governance are being systematically dismantled.

Even if America survives this maniac and his cabinet of disreputable and incompetent tools, it will take generations to repair the damage.


Is This Really What Jesus Would Do?

The administration presided over by our thrice-married, p***y-grabbing, porn-star-fornicating President has announced its latest effort to protect religiosity.

The Conscience and Religious Freedom Division has been established to restore federal enforcement of our nation’s laws that protect the fundamental and unalienable rights of conscience and religious freedom…. The creation of the new division will provide HHS with the focus it needs to more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom, the first freedom protected in the Bill of Rights.

The “religious freedom” being protected by the new division and rules is the freedom of medical practitioners to deny medical care if providing that care would be “inconsistent” with their religious beliefs.  (Did the Good Samaritan check the sexual orientation of the injured man he helped? I forgot that part of the story…)

The Administration is clearly unconcerned with the religious beliefs or health needs of women who need reproductive services like birth control. The new rules allow almost anyone who works in the health field to refuse to provide a wide array of services; adding insult to injury, there is no requirement that religiously objecting doctors refer patients elsewhere.

Planned Parenthood warns that the rule could allow a pharmacist to refuse to fill a prescription for birth control, doctors to deny hormone therapy to transgender patients, and  pediatricians to refuse to treat the child of gay parents.

An Atlantic article looked at the implications.

There are already federal laws that protect medical personnel from being required to provide abortions. In addition, nearly every state also allows health-care providers to refuse to perform abortions, and 12 states allow them to refuse to provide contraceptives. In six states, even pharmacists are allowed to refuse to fill birth-control prescriptions.

According to reproductive-rights groups, the problem is these laws often mean patients who are denied services aren’t then referred to a doctor who will provide the care. According to one poll, only 57 percent of doctors nationally believe objecting physicians must refer patients to an accommodating provider. “Only in a couple of states are patients given information and referrals,” says Elizabeth Nash of the pro-choice Guttmacher Institute.

Given the language of the new regulation, the “protection” could be extensive.

“Under the new rule, you could have translators who refuse to translate for a woman undergoing tubal ligation,” says Elizabeth Sepper, a law professor at Washington University in St. Louis.

Those crafting the new rules explain that requiring objecting physicians to refer patients to willing providers would also violate their tender religious consciences.

The proposed rule defines “referral” as providing “any information,” including a phone number or website on a pamphlet, about a health service that the provider disagrees with.

The Administration’s uber-solicitous concern for the religious sensibilities of providers is certainly not matched by any concern for patients, whose rights are far more likely to be violated even under current law.

In 2015, a lesbian couple in Michigan had a pediatrician decline to care for their six-day-old infant, Bay, because, as the doctor later explained to the couple, “after much prayer following your prenatal, I felt that I would not be able to develop the personal patient-doctor relationships that I normally do with my patients.”

Another case, also in Michigan, involved Tamesha Means, a woman who was rushed to her county’s Catholic hospital when her water broke at 18 weeks into her pregnancy. “Based on the bishops’ religious directives, the hospital sent her home twice even though Tamesha was in excruciating pain,” as the ACLU put it. The hospital staff did not tell her that she could, and probably should, end the pregnancy, according to the ACLU’s summary. Ultimately, Means returned to the hospital a third time, this time with an infection, and miscarried.

Critics of this new level of regulation point out that it is transparent political pandering; unlike the numerous cases where patients have been endangered, instances where providers have been discriminated against are vanishingly rare. As the article concluded,

“They’re setting up this office and using a lot of taxpayer dollars to solve a problem that doesn’t really exist,” Fogel says. “Health systems are already pretty good at accommodating people who have a genuine objection to participating in a service.”

Swartz agrees, saying the problem of conscientiously objecting physicians “is like voter fraud. Those instances are one in a million.”

Rare though they might be, these cases will now merit special attention by the U.S. government.

Perhaps this new division is protecting “Christian” doctors in return for that “mulligan” Evangelicals gave Trump…


The Parade of Horribles

Res Ipsa Loquitur is a legal term meaning “the thing speaks for itself.” Donald Trump’s personnel selections aren’t just speaking–they’re screaming.

Trump has chosen people for cabinet positions who are unalterably opposed to the mission of the agencies they would lead. It is difficult–okay, impossible–to imagine a more terrifying–or less competent– group of cabinet nominees.

Betsy DeVos wants to destroy public education, so Trump wants her to be Secretary of Education. Jeff Sessions is a (marginally) “kinder, gentler” white supremacist, so of course Trump wants him at the Justice Department. And my cardiologist cousin just sent me the following rundown on Tom Price, nominated to run Health and Human Services (HHS).

I’m not going to paraphrase it: I’m just going to share it. And then I think I’ll go throw up.


This is a summary of an article appearing in the New England Journal of Medicine (Jan 12, 2017). With regard to the department of health and human services (HHS), only two previous secretaries have been physicians. For the most part, all of us physicians work to defend not only our own patients, but society at large against dangers to health, and in the process, usually eschew venal and self oriented goals. That is why most of us chose this respected profession of care-giving in the first place.

Let us begin by describing the good doctors: Otis Bowen, our former Indiana Governor, was Ronald Reagan’s second HHS secretary, and he engineered the first major expansion of Medicare, championed comparative effectiveness research and, together with Surgeon General C. Everett Koop, another exemplary physician, led the fight against HIV-AIDS. Louis Sullivan, HHS secretary under President George H.W. Bush, focused his attention on care for vulnerable populations, campaigned against tobacco use, led the development of federally sponsored clinical guidelines, and introduced President Bush’s health insurance plan, which incorporated income-related tax credits and a system of risk adjustment. All these aforementioned physicians, serving in GOP administrations, drew on a long tradition of physicians as advocates for the most vulnerable, were defenders of public health, and enthusiastic proponents of scientific approaches to clinical care.

Now comes the bad: In sharp contrast with these previous examples, Tom Price, Trump’s pick for secretary of HHS, shows a record that demonstrates less concern for the sick, the poor, and the health of the public, in favor of greater concern for the economic well-being of the rich and the care-givers themselves.

To exemplify this point, let’s enumerate his previous positions.

1. Price has sponsored legislation opposing regulations on cigars and has voted against regulating tobacco as a drug, in reality, this product is actually far worse than most drugs!

2. In 2007, during the presidency of George W. Bush, he was one of only 47 representatives to vote against the Domenici-Wellstone Mental Health Parity and Addiction Equity Act, which improved coverage for mental health in private insurance plans.

3. He voted against funding for combating AIDS, malaria, and TB, and against expansion of the State Children’s Health Insurance Program, and in favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments.

4. He favors converting Medicare to a premium-support system.

5. He opposed reauthorization of the Violence Against Women Act, and has voted against legislation prohibiting job discrimination against LGBT people and against enforcement of laws against anti-LGBT hate crimes.

6. He favors amending the Constitution to outlaw same-sex marriage.

7. He opposes stem-cell research and voted against expanding the NIH budget and against the recently enacted 21st Century Cures Act, showing particular animus toward the Cancer Moonshot. Would he continue this stance if he developed cancer himself?

8. He is a leader of the repeal of the ACA (“Obamacare”) in favor of a regressive “plan” which, without going into details, will offer much greater subsidies relative to income for purchasers with high incomes and more meager subsidies for those with low incomes. In effect, Price’s replacement proposal would make it much more difficult for low-income Americans to afford health insurance, diverting federal tax dollars to people who can already afford it, and also substantially reducing protections for those with preexisting conditions. The end result would be a shaky market dominated by health plans that offer limited coverage and high cost-sharing.

9. Strongly anti-abortion and advocating the defunding of Planned Parenthood, he has accepted the validity of the fraudulently modified videotapes used against this organization—despite their many pro-health programs for the poor.

The HHS Department oversees a broad set of health programs that touch about half of all Americans. Over five decades covering nine presidential tenures of both parties, HHS secretaries have used these programs to protect the most vulnerable Americans. The nomination of Tom Price highlights a sharp contrast between this tradition of compassionate leadership and the priorities of the incoming administration.

I am not at all proud of this “fellow” physician!


A Political Eddie Haskell

As I was driving to work yesterday,  NPR was broadcasting a snippet of a speech made the night before by Mitt Romney. That’s when it hit me. I’d been trying for weeks to pin down who it was that Romney reminds me of, and with the patent insincerity of that speech, it finally clicked.

Mitt Romney is the Eddie Haskell of politics.

Eddie Haskell, for those of you too young to remember, was the disgusting little sycophant on “Leave it to Beaver.” The character was so vivid, his very name became synonymous with dishonest sucking up.

In the speech fragment I heard, Romney was feigning outrage over the new regulations promulgated by HHS, requiring all employers who offer health insurance–including religious employers like hospitals and universities–to include coverage for contraception. As I previously blogged, there are legitimate concerns when government issues regulations that are intended to protect or benefit the general public when those rules run afoul of some folk’s religious beliefs. But there was no such nuance in Romney’s attack–not to mention any recognition of the fact that several states have imposed similar regulations for years. Nope, according to Mitt, Obama was purposely attacking religion, and he wouldn’t do that if he were President. No siree!

Let’s just deconstruct that attack.

Romney is a Mormon, and the federal government long ago outlawed polygamy. The effect of that prohibition was to deny Mormons the ability to live by what was at the time considered an essential tenet of their religion, yet Romney has never criticized that restriction–indeed, he has said he agrees with it. The HHS regulation, on the other hand, does not require anyone to use birth control in contravention of their religious beliefs; it merely requires them to make that option available to employees who come from different religious traditions and/or hold different beliefs. The regulation doesn’t apply to churches–just to large religiously-run organizations like hospitals and universities, where employees represent a wide diversity of backgrounds and faith traditions.

There are plenty of laws that have incidental effects on religious practices. For example,laws requiring schoolchildren to be vaccinated pose problems for Christian Scientists. Quakers believe they should not be required to pay taxes that support wars (the courts have not been receptive to that argument). Laws requiring photo IDs for driver’s licenses are a genuine dilemma for fundamentalist Muslim women whose beliefs require them to wear full burkas. (Somehow, I doubt Mitt would get too worked up over that one, since the base he is so shamelessly pandering to tends to be virulently anti-Muslim.)

None of these “attacks on religion” have merited even a passing mention from Mitt Romney.

That’s the problem with channelling Eddie Haskell. The insincerity overwhelms the message.