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  • The Health of All Women

    By Aliye Runyan
    AMSA Education and Research Fellow

    Do you know Roe v. Wade is currently under attack and the health of all women is at stake?

    Cleverly disguised as "state-based regulation", seven states have passed or will soon pass devastating legislation affecting access to family planning, especially in rural and underserved areas. This impacts not only the women and families in those states, but taken collectively, is a serious and deliberate blow to national family planning services.

    AMSA believes matters of reproductive health to be private and sensitive, and support the right of patients to make these decisions in confidence with their physician without the interference of any third party. In that spirit, we disagree with and discourage wholeheartedly the recent legislation affecting Ohio, Wisconsin, Texas, North Carolina, Virginia, Alabama, and Mississippi. These laws, sometimes "stuck in" along with other, completely unrelated legislation, do nothing more than prevent access to safe options for abortion. In cases of such legislation where clinics like Planned Parenthood are defunded, this not only prevents safe abortion options ( in those clinics which provide it) but also restrict and discourage access to family planning resources such as contraception and scientifically based sexual education, which in turn, reduce the need for abortion.

    The way most of these bills decrease access is through TRAP laws. TRAP stands for Targeted Regulation of Abortion Providers. Six states have made it illegal for abortion clinics to operate unless the physician has admitting privileges at a nearby hospital. In rural areas of Virginia and Wisconsin, two states that have recently passed TRAP laws, there is not a hospital close by.

    Dozens of rural clinics face closure because of TRAP laws. Those who support TRAP laws say they help ensure the safety of women by requiring their doctors to have admitting privileges. The vast majority of abortions are outpatient procedures that are less invasive than some dental work, colonoscopies, vasectomies, and plastic surgeries, yet only abortion providers are targeted for these unnecessarily restrictive measures.

    In an article in today's Chicago Tribune, professor emeritus of obstetrics and gynecology Dr. John Sciarra writes, "in those days [before Roe v Wade], 20 American women died for every 100,000 live births, many from unsafe abortions. We knew that legalizing abortion could save many of those lives, and we were right: today's maternal mortality rate is half of what is was then, because legal abortion is safe and back alley attempts are much rarer. We were optimistic that society would hail legalized abortion as a win for everyone. [...] Rather than increasing contraceptive availability as we recommended in 1972, ideologues attack family planning and are making all reproductive health care less available to the poor."

    Sciarra concludes with "no law that has ever been passed and no law that ever will be passed can prevent a determined woman from trying to end an unwanted pregnancy. Society and hospitals must accept their role in keeping women safe in that process."

    As a physician in training who believes in her patient's abilities to make their own choices and in the privacy and privileges of the doctor patient relationship, I absolutely agree with Sciarra's words.

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  • DOMA Falls!

    Today was a historic day for the gay-rights movement! AMSA applauds the decision announced by the Supreme Court of the United States holding (5-4) the Defense of Marriage Act (DOMA) unconstitutional.

    “Today was historic in the gay-rights movement and AMSA commends the DOMA ruling as a significant step toward eliminating disparities for same-sex partners,” says Dr. Nida Degesys, AMSA national president. “Now, more than ever, we need to keep advocating for equal rights. As the nation’s next generation of physicians, we must stand up for our patients. Marriage equality is a public health issue and we want an equal and just healthcare system for all.”

    DOMA includes a federal definition of marriage that fails to encompass all forms of legal partnership. Equal protection under the law necessitates that all individuals, including same-sex couples, are eligible for all benefits afforded to legally married couples. According to today’s ruling, DOMA is unconstitutional as a deprivation of the equal liberty of persons that is protected by the Fifth Amendment.

    In Hollingsworth vs. Perry, the Supreme Court did not rule on the constitutionality of California’s law prohibiting same-sex marriage, or “Prop 8”, and sent the appeal back to the lower court with instructions to dismiss, currently leaving intact the district court’s ruling that Prop 8 is unconstitutional.

    The Court’s “Prop 8” decision sends the case back to California, where state judges and the state’s top officials have said same-sex marriage is a matter of equal rights. “We had hoped that the Supreme Court would have taken a stronger stance and ruled Prop 8 unconstitutional, so that all partners could marry,” continues Degesys. “But the ruling does allow for same-sex marriage to become legal again in California. Today we celebrate but tomorrow we must continue fighting to end institutionalized stigma and discrimination. We must advocate for equal rights for all.”

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  • More med student spots

    Data released at the Annual Physician Workforce Research Conference, projects that from 2002-2003 there will be a 30% enrollment increase, nearing well over 21,000 new medical students by 2017-2018. With the new and occupied desks over the next few years, 55% of those will be accompanied by students in public medical schools; the southern regions of the U.S. making up for a good amount of the increase now through 2017.

    This is exciting news for the aspiring first year medical students. Depending on how you want to see it, I am sure to them, the glass is only half full waiting to be overflowed by the endless opportunities and possibilities.

    Read the full article from the Triangle Business Journal here.

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  • Calling Dr. iPhone

    Technology is in boom, especially in today’s medical world which is constantly growing and evolving to match the most up to date research and discoveries. Check out this Associated Press article, which appeared in USA Today, introducing the hottest new product on the market; your annual physical through your smart phone.

    Discussed at the 2013 TEDMED conference in Washington, D.C, this up and coming technology is designed to help patients independently monitor their health outside the doctor’s office. Whether it be checking your blood pressure, listening to your heart beat, or checking out the ears, nose and throat for possible infection - all can be done from your hand held device, and on the GO! In addition, sonograms can also be performed by your ultrasound technician with your smart phone, allowing them to be performed from virtually anywhere, and at a much more affordable price.

    It seems as though doctors believe these tools will be helpful to collect the patient’s data, and monitor their ongoing health conditions and concerns. With these types of applications and devices available office visits can essentially be reduced, allowing urgent and serious treatments to be readily available for patients in emergency situations. Although some products are still waiting for FDA approval, tools are available for purchase now.

    Read more from http://www.smartphonephysical.org, or watch a brief educational video from the Associated Press.

    Would love to hear what our nation’s next generation of physicians thinks of this trend. Do you think “iPhone physicals” are the next big thing?

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  • Why I'm Opting Out of the AMA Masterfile

    It’s hard for me to believe that I’ll have the privilege of calling myself someone’s doctor in a few short months. As a graduating medical student, I look back on my education and see that it was driven by a spark shared by all in all AMSA members: the fervent hope to help my future patients. And it’s precisely this hope that drives me to pledge to opt out of drug company access to my future prescribing information. I urge you to join me.

    When I started medical school, I had no idea that pharmaceutical companies know exactly what medicines each doctor prescribes to his or her patients. I was even more surprised to learn that this capacity is enabled by the American Medical Association through the sale of a database called the “Masterfile.” All medical students and doctors are automatically enrolled in the Masterfile—regardless of whether or not we are AMA members. Each year, the AMA makes more than $40 million selling this information, which allows pharmaceutical companies to link prescribing records to doctors’ identities. The result is targeted marketing pitches, often designed to promote more expensive medicines that aren't necessarily more effective. 

    The spooky nature of being watched by Big Brother/Big Pharma might be reason enough for many to opt out of this practice. But if that weren’t sufficient enough, this type of data mining hurts also hurts patients. First, prescribing more expensive medicines increases the cost of care without necessarily improving outcomes. Drug companies spend more than $30 billion marketing to doctors each year, and these expenses are surely reflected in the high price of medicines. Notably, the tremendous amount spent by these companies on advertising dwarfs by almost two-fold the amount they invest in research and development, which is often cited as why drugs are so expensive. 

    Second, this type of data mining encourages a brand of medicine that is neither evidence-based nor patient-centered. Surveys already show that 7 out of 10 patients feel that doctors’ prescribing habits are too-influenced by drug companies. Allowing drug companies to use the Masterfile for marketing purposes will further corrode the trust at the heart of the doctor-patient relationship. A new study further shows that an increasing number of patients are skimping on medicines in this tough economic climate. Why allow drug reps to leverage your own prescribing practices to promote expensive medicines through one-sided presentations?

    Today, I’m pledging to opt out of drug rep access to my future prescribing practices. As AMSA President Dr. Liz Wiley has stated, “Physicians should practice evidence-based medicine using the best existing clinical evidence—not carefully-packaged advertising—and continue to uphold personal and professional integrity.” I couldn't agree more.

    The AMA has made a mechanism by which residents and doctors can opt-out of drug salesperson access to prescribing information of doctors. Unfortunately, students cannot use this Prescription Data Restriction Program even though they have already been included in the AMA’s Masterfile. However, AMSA has set up a mailing list that will remind you to opt out through the PDRP when you’re able to do so. I hope that you will consider adding your name to this list and encourage your classmates to do the same.

    David Tian is a fourth-year student at Harvard Medical School and the Chair of AMSA’s PharmFree Campaign.

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