Since 1992, the federal government has spent close to $1 billion on abstinence-only sex education, despite growing evidence that these ideology-based programs are ineffective in delaying the onset of sexual activity, preventing teen pregnancy and the spread of sexually-transmitted disease among teens. Meanwhile, comprehensive sex education—the kind where teens are given information about both abstinence and contraceptives—has received virtually no federal funding.

That’s why it was so encouraging when President Obama released his budget earlier this year and the $50 million per year since 1996 that’s been devoted to abstinence-only programs was missing. It looked like this ill-conceived emphasis on “Just Say No” sex education had finally ended.

Except it hasn’t. It turns out that Senator Orrin Hatch attached $50 million a year for 5 years into the health care bill; it made the cut to the final version, and funding for abstinence-only sex education has been reborn. It’s not clear why the funding stayed in the final legislation—reports are that it was used as a sweetener to score the votes of socially-conservative Democrats—but now $250 million is once again available for states that agree to offer only the most restrictive no-sex-before-marriage curriculum.

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In his latest post on GoozNews,  Merrill Goozner asks; “Why Is Tom Friedman Championing Higher Health Care Costs?” Goozner is referring to a recent op-ed piece in the New York Times in which Friedman gushes about a medical device start-up called EndoStim that he says “is the epitome of the new kind of start-ups we need to propel our economy: a mix of new immigrants, using old money to innovate in a flat world.”

This new-style start-up has no headquarters and keeps expenses low by depending on “teleconferencing, e-mail, the Internet and faxes — to access the best expertise and low-cost, high-quality manufacturing anywhere,” according to Friedman. EndoStim also plans on conducting clinical trials for its experimental implantable device in India and Chile where expenses are low. “[O]nly by spawning thousands of EndoStims — thousands — will we generate the kind of good new jobs to keep raising our standard of living.”

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Abortion was such a hot-button issue in the battle over health reform that it threatened to derail the process on multiple occasions—including the final push to get the legislation through Congress.

Supporters of comprehensive reproductive health benefits stood by and watched in frustration as the Hyde Amendment’s draconian ban on federal funding for abortion was extended even to private insurance plans available through the new exchanges. Their only solace was that the restrictions in the legislation would at least temporarily tamp down the furor over “taxpayer-funded abortions.” And with the legislation mandating increased funding for family planning and sex education, the nation could instead focus on the other strategies Obama—and seemingly many Americans—support to reduce unwanted pregnancy.

Now it’s became clear that the abortion fight is far from over; anti-choice activists are far from mollified and are eager to push their agenda far beyond health care reform. Today, Nebraska’s governor signed into law legislation banning abortions that occur in that state at or after 20 weeks gestation, using a new standard that assumes fetuses feel pain after this point. Gov. Dave Heineman also signed a law requiring women who seek abortions to receive screening and counseling for vague “risk factors” both before and after the procedure. Failure to identify such a “risk factor” could result in a doctor facing a penalty of $10,000.

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David Leonhardt had a piece in the New York Times today called “In Medicine, the Power of No,”  that focuses on reducing health care costs by scaling back our current “do everything possible” approach to care. “Deep down, Americans tend to believe that more care is better care,” he writes, “We recoil from efforts to restrict care.”

The era of managed care revealed a pretty clear picture of how Americans feel about forced limits on the care they can receive. More recently, Conservatives fomented panic with their attacks on health reform that focused on the looming threat of government rationing of care—including “death panels” and refusals for surgery and treatments based on cost alone. Leonhardt writes;

“From an economic perspective, health reform will fail if we can’t sometimes push back against the try-anything instinct. The new agencies will be hounded by accusations of rationing, and Medicare’s long-term budget deficit will grow.

“So figuring out how we can say no may be the single toughest and most important task facing the people who will be in charge of carrying out reform. ‘Being able to say no,’ Dr. Alan Garber of Stanford says, ‘is the heart of the issue.’”

I agree that a sea-change is needed in how Americans view health care—but I think it would be a mistake to assume that health care costs are out of control because consumers are clamoring for more and more care and need to be reined in. 

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Back pain is endemic: It affects 8 out of every 10 people at one point in their lives. Americans spent some $86 billion in 2005 on doctor’s visits, surgery, imaging, and drugs to treat back and neck pain—and costs continue to rise each year. Despite being ubiquitous—and an enormous drain on medical resources—back pain continues to be poorly treated as well as over-treated. Recent research has shown that doctors consistently fail to follow accepted guidelines in treating their patients; ordering X-rays and MRIs when they aren’t useful, prescribing expensive prescription drugs when over-the-counter pain relievers would work just as well and resorting to surgery without evidence that it will actually relieve pain and disability.

The trend, unfortunately, is continuing. A new study published in this week’s issue of the Journal of the American Medical Association found that although the rate of lower-back surgery among older Americans had declined slightly between 2002 and 2007, the rate of the most complex, medically risky and most expensive type of lower back surgery increased 15-fold (from under 1% of operations to 14.6%) during this same time period. There is little upside to this increase in intervention: Besides driving up health care costs, the authors found that overuse of the expensive, risky technologies put patients at increased risk of death and life-threatening complications without providing a corresponding increase in pain relief or mobility.

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The figures are alarming: The cesarean rate in this country has increased 50% since 1996; hitting an all-time high of 32% of all deliveries. What could possibly be fueling this dramatic rise in surgery?

The latest figures come from a report released yesterday by the National Center for Health Statistics
and have added more fire to an already simmering debate over the increased use of cesarean sections. Cesarean deliveries carry greater risks for mothers and newborns; require longer recovery times and incur hospital costs that are almost double those for a vaginal delivery, according to the report.

In the past, some medical groups have attributed the rise in c-sections to factors like older mothers and an increase in multiple births. But the NCHS report found that the rate of c-sections rose in all age groups between 1996 and 2007; with women under age 25 experiencing a 57% increase in cesarean deliveries, the largest increase of all. Increases were found across the board in all racial and ethnic groups and at all gestational ages. And surprisingly, the rate of c-sections for single births increased substantially more than cesarean rates for multiple births.

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How much medical care do we want in our lives? H. Gilbert Welch poses this question in his excellent op-ed piece for the LA Times entitled, “The Medicalization of Life”  and tells us that the answer will be vitally important for reining in the spiraling cost of health care.

We’ve written a lot about cutting out the waste and over-treatment that is inherently part of our profit-driven health care system. The culprits are clear: Too many scans, too many diagnostic tests, too much surgery and too many prescriptions for expensive new drugs. But despite increasing evidence of where cuts can be made, we’ve always assumed that Americans help drive health care spending with their constant demand for newer and more advanced treatments and technologies.

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Last week, Virginia became the first state in the nation to pass a law that aims to block the individual mandate for health coverage, a key element of  President Obama’s health reform plan.

Virginia has a history of defying federal action—most notoriously when the state failed to follow school desegregation orders in the 1950’s. But this time the state is not alone in launching legislation to challenge key elements of federal health reform. On March 9, Utah and Idaho both passed bills through their state assemblies that would invalidate the individual mandate that people buy health insurance. Similar “health care freedom” legislation—in the form of statutes and ballot measures—has now been proposed in some 34 other states.

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The editor of the British Medical Journal, Fiona Godlee, writes that “organized sceptism,” or the  “requirement that scientific claims be exposed to critical scrutiny before they are accepted” is one of the basic tenets of good science.Yet in the UK, where a firestorm is raging over libel lawsuits being used to silence scientific debate, that  “critical scrutiny” could land a skeptic in court.

Right now, the legal case garnering the most attention involves British journalist Simon Singh, author of a Guardian article that strongly questioned the benefits of chiropractic treatments for some pediatric problems. Singh, who is also co-author of the book “Trick or Treatment? Alternative Medicine on Trial” wrote;

“The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.”

The British Chiropractic Association demanded that The Guardian print a retraction of Singh’s article. The newspaper refused to retract the piece but offered the group the opportunity to publish a rebuttal. Instead, they chose to sue Singh for libel. The BCA claims that the wording of the article would lead the public to believe that the chiropractic group was being consciously dishonest.

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President Obama’s latest plan for health reform brought a flurry of commentary in the last two days; including divergent views on whether his commitment to "transparency" is helping or hurting the process.

Yesterday, the Los Angeles Times blamed the current “healthcare backlash” on Obama’s insistence that the messy business of hashing out health reform be done in Congress, not behind closed doors in the Oval Office. In the L.A. Times’ view, there’s been too much transparency:

“By leaving the overhaul in the hands of Congress, [Obama] has given the public a full view of how lawmakers do business. The result is an anti-Washington mood that Republicans have tapped into.”

Meanwhile, the House GOP leader John Boehner, calls the Obama plan—introduced yesterday on the eve of the “bipartisan” health summit—a “Democrats-only backroom deal” that “doubles down on the same failed approach that will drive up premiums, destroy jobs, raise taxes, and slash Medicare benefits.” In the Republican’s view of things, there’s been too little transparency in the health reform process.

So which is it: Back-room dealing or a too-public view of the dirty business of lawmaking?

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