Letters to the Editor Transcending Politics to Promote Women’s Health To the Editor: It is erroneous to argue that regulation of medical practice by federal and state governments represents the politicizing of medicine. We are able to provide medical care to women because we have been licensed by our state medical boards. We prescribe U.S. Food and Drug Administration–approved medicine through state-licensed pharmacies and receive a significant proportion of our reimbursement from government dollars through Medicare and Medicaid. When doing research, we seek out National Institutes of Health funding for our proposals. In a host of other ways, our government—with its complex interplay of political parties—has and will continue to have inextricable involvement in the provision of health care in the United States. Although McNicholas suggests rhetorically that we would not allow the government to dictate medical practice to us in matters other than abortion,1 a little reflection would reveal that it happens in every field of medicine every day. Can it really be asserted that this legislative regulation represents a condescending denial of our rights as autonomous individuals purely for political gain? The American Congress of Obstetricians and Gynecologists’ (ACOG) Letters to the Editor Guidelines. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 6 weeks of the article’s publication online. Letters received after 6 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. A word count should be provided. The maximum number of authors permitted is four, and a corresponding author should be designated (and contact information listed). Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. A signed author agreement form is required from all authors before publication. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com).
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Fellows and districts have been active in lobbying state legislatures to prevent lay midwives and naturopaths from providing medical services to patients. Why? Because ACOG correctly recognizes that one function of the state is to ensure the safe provision of health care, even when a given piece of legislation may restrict a patient’s right to choose how (or from whom) she receives her health care. Why would we think that the provision of abortion services should somehow be immune to legislative oversight? Financial Disclosure: The author did not report any potential conflicts of interest.
Andrew Steele, MD St. Louis University, Department of Obstetrics and Gynecology, St. Louis, Missouri
REFERENCE 1. McNicholas C. Transcending politics to promote women’s health. Obstet Gynecol 2013;122:151–3.
Transcending Politics to Promote Women’s Health
face the exact situation or make the same choices as those who came before her. Women, as patients, deserve to be treated like the unique and sentient beings that they are. As physicians, it is incumbent on us to meet each woman and her needs as fully and individually as we can. Legislative interference in the doctor– patient relationship is at new and alarming levels. While the country has watched Texas decimate access to abortion, 43 other restrictive and paternalistic measures targeting women’s reproductive health have been enacted across the country.2 If we stand idly by, we, as physicians, will see more laws that regulate our medical practices and threaten our relationships with our patients. These laws are not based on scientific evidence, and they threaten not only the ethical responsibilities of physicians but also the autonomy of women.3 As Dr. McNicholas perceptively notes, these laws perpetuate and worsen a system in which pregnant women are not afforded the same rights, autonomy, and trust as other people. This is an affront to all physicians who are devoted to protecting and preserving the health of women. The urgency is profound. We are up for the challenge that Dr. McNicholas presents. We will stand with our patients. Who is with us?
To the Editor: We applaud Dr. McNicholas for her inspiring and thoughtful call to action, and we thank the Editorial Board for publishing it.1 Dr. McNicholas makes a strong argument for preserving the rights of our patients. Our patients deserve confidential and medically sound conversations with providers they trust. If this trust is lost, women cannot make the best decisions about their own reproductive health and the health of their families. Dr. McNicholas incisively parses the nuance and complexity of the decision-making process in which patients engage when consulting with their physicians about having an abortion. We, as women’s health care providers, know each woman’s decision is mediated by her own social, economic, physical, and psychological environment. No woman will ever
VOL. 122, NO. 5, NOVEMBER 2013
For a complete list of members of the Physicians for Reproductive Health Leadership Training Academy, see the Appendix online at http://links.lww. com/AOG/A441. Financial Disclosure: The authors did not report any potential conflicts of interest.
Jennifer Lesko, MD, MPH Washington, DC Rebecca Mercier, MD, MPH Philadelphia, Pennsylvania Sara Imershein, MD, MPH Washington, DC Caron R Kim, MD, MSc Los Angeles, California for the Physicians for Reproductive Health Leadership Training Academy
OBSTETRICS & GYNECOLOGY
REFERENCES 1. McNicholas C. Transcending politics to promote women’s health. Obstet Gynecol 2013;122:151–3. 2. Weinberger SE, Lawrence HC III, Henley DE, Alden ER, Hoyt DB. Legislative interference with the patientphysician relationship. N Engl J Med 2012;367:1557–9. 3. Guttmacher Institute. News in Context: State-level assault on abortion rights continues in first half of 2013. New York (NY): Guttmacher; 2013. Available at: http://www.guttmacher.org/media/inthenews/ 2013/07/08/index.html. Retrieved July 10, 2013.
Transcending Politics to Promote Women’s Health To the Editor: We applaud the editors of Obstetrics & Gynecology for publishing “Transcending Politics to Promote Women’s Health.”1 Dr. Colleen McNicholas makes a persuasive case against the rash of dangerous legislation offered by politicians across the country that interferes with our practices. She points out that such legislation “is clearly not about what is right for the patient but instead about creating obstacles based on ideologic differences.” This month, the American Congress of Obstetricians and Gynecologists (ACOG) took strong steps to make this same case in an open letter to the Texas legislature that called out all of the medical mistruths in the bills to restrict abortion that they have been debating. For those ACOG members who agree with these arguments and who feel moved to action, we want to let you know about the work we do. At Physicians for Reproductive Health, we train doctors to serve as lifelong advocates for comprehensive reproductive health care. Dr. McNicholas is a superb example of our work, as she has gone through our Leadership Training Academy. In this intensive program, we provide skills in talking to state and federal representatives, media training from on-camera interviewing to writing letters to the editor, as well as tools on how to organize within medical and educational institutions to promote sound reproductive health policies. For our graduates, we foster a national network that provides camaraderie and community as we advocate for our
VOL. 122, NO. 5, NOVEMBER 2013
patients and for sound, evidence-based practice. We know that entering into the advocacy arena can be a new and intimidating experience. We became doctors to practice medicine, not knock on the doors of legislators. But given the outrageous, unscientific dictates being placed on us by politicians, it is imperative that more physicians speak up. Our patients need our voices to protect them. Our professional integrity and sound science must be defended. We encourage all our colleagues to join their voices with ours and with ACOG’s to ensure that our patients have the best care, free of dangerous legislative interference. Financial Disclosure: The authors did not report any potential conflicts of interest.
Nancy Stanwood, MD, MPH Board Chair, Physicians for Reproductive Health, New York, New York Douglas Laube, MD, MEd Immediate Past Board Chair, Physicians for Reproductive Health, New York, New York
REFERENCE 1. McNicholas C. Transcending politics to promote women’s health. Obstet Gynecol 2013;122:151–3.
In Reply: I thank Drs. Stanwood and Laube for their support and for providing the readership with an introduction and invitation to join Physicians for Reproductive Health. This organization provides the training and support that busy physicians require to integrate active advocacy into their lives. I also thank Dr. Lesko et al for their letter of support; it is a powerful demonstration of the diversity of providers advocating for our patients. Lastly, I thank Dr. Steele, who points out the inevitably interwoven relationship of government and health care. Government always will have an “inextricable involvement in the provision of health care,” but we do not have to accept the synonymity of government and politics, especially when the latter results in targeting one specific
procedure under the pretense of patient safety despite no evidence to suggest such a need. Dr. Steele offers the example of state medical boards to support his claim that advocating against legislative interference is erroneous. Using Missouri, I first highlight that, although members of the Missouri Board of Healing Arts are appointed by the governor, the composition and the mission of the board should be free from political ideology. The board is composed of eight physicians and one public member and is responsible for assessing competence and upholding ethical standards. Compare this with three physicians in the 195-member Missouri general assembly. I would argue the former is more prepared to evaluate matters of patient safety, evidence-based practice, and physician competence. I also agree that this is a phenomenon extending beyond abortion, although I hardly see this as justification to abandon efforts to oppose the trend. Primary care physicians and pediatricians have been told by legislators that they cannot ask about the presence of firearms in the home1 despite a long-standing recommendation by the American Academy of Pediatrics.2 Examples such as this demonstrate that legislators no longer accept the historical standard of professional organizations’ (American College of Obstetricians and Gynecologists, American Academy of Pediatrics) providing expertise and oversight of the artful practice of medicine and lead me to conclude that, sadly yes, some legislation is purely for political gain. Financial Disclosure: The author did not report any potential conflicts of interest.
Colleen McNicholas, DO MSCI Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
REFERENCES 1. Murtagh L, Miller M. Censorship of the patient-physician relationship: a new Florida law. JAMA 2011;306:1131–2. 2. Dowd MD, Sege RD, Council on Injury Violence, Poison Prevention Executive Committee, American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics 2012; 130:e1416–23.
Letters to the Editor
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Fellows and districts have been active in lobbying state legislatures to prevent lay midwives and naturopaths from providing medical services to patients. Why? Because ACOG correctly recognizes that one function of the state is to ensure the safe provision of health care, even when a given piece of legislation may restrict a patient’s right to choose how (or from whom) she receives her health care. Why would we think that the provision of abortion services should somehow be immune to legislative oversight? Financial Disclosure: The author did not report any potential conflicts of interest.
Andrew Steele, MD St. Louis University, Department of Obstetrics and Gynecology, St. Louis, Missouri
REFERENCE 1. McNicholas C. Transcending politics to promote women’s health. Obstet Gynecol 2013;122:151–3.
Transcending Politics to Promote Women’s Health
face the exact situation or make the same choices as those who came before her. Women, as patients, deserve to be treated like the unique and sentient beings that they are. As physicians, it is incumbent on us to meet each woman and her needs as fully and individually as we can. Legislative interference in the doctor– patient relationship is at new and alarming levels. While the country has watched Texas decimate access to abortion, 43 other restrictive and paternalistic measures targeting women’s reproductive health have been enacted across the country.2 If we stand idly by, we, as physicians, will see more laws that regulate our medical practices and threaten our relationships with our patients. These laws are not based on scientific evidence, and they threaten not only the ethical responsibilities of physicians but also the autonomy of women.3 As Dr. McNicholas perceptively notes, these laws perpetuate and worsen a system in which pregnant women are not afforded the same rights, autonomy, and trust as other people. This is an affront to all physicians who are devoted to protecting and preserving the health of women. The urgency is profound. We are up for the challenge that Dr. McNicholas presents. We will stand with our patients. Who is with us?
To the Editor: We applaud Dr. McNicholas for her inspiring and thoughtful call to action, and we thank the Editorial Board for publishing it.1 Dr. McNicholas makes a strong argument for preserving the rights of our patients. Our patients deserve confidential and medically sound conversations with providers they trust. If this trust is lost, women cannot make the best decisions about their own reproductive health and the health of their families. Dr. McNicholas incisively parses the nuance and complexity of the decision-making process in which patients engage when consulting with their physicians about having an abortion. We, as women’s health care providers, know each woman’s decision is mediated by her own social, economic, physical, and psychological environment. No woman will ever
VOL. 122, NO. 5, NOVEMBER 2013
For a complete list of members of the Physicians for Reproductive Health Leadership Training Academy, see the Appendix online at http://links.lww. com/AOG/A441. Financial Disclosure: The authors did not report any potential conflicts of interest.
Jennifer Lesko, MD, MPH Washington, DC Rebecca Mercier, MD, MPH Philadelphia, Pennsylvania Sara Imershein, MD, MPH Washington, DC Caron R Kim, MD, MSc Los Angeles, California for the Physicians for Reproductive Health Leadership Training Academy
OBSTETRICS & GYNECOLOGY
REFERENCES 1. McNicholas C. Transcending politics to promote women’s health. Obstet Gynecol 2013;122:151–3. 2. Weinberger SE, Lawrence HC III, Henley DE, Alden ER, Hoyt DB. Legislative interference with the patientphysician relationship. N Engl J Med 2012;367:1557–9. 3. Guttmacher Institute. News in Context: State-level assault on abortion rights continues in first half of 2013. New York (NY): Guttmacher; 2013. Available at: http://www.guttmacher.org/media/inthenews/ 2013/07/08/index.html. Retrieved July 10, 2013.
Transcending Politics to Promote Women’s Health To the Editor: We applaud the editors of Obstetrics & Gynecology for publishing “Transcending Politics to Promote Women’s Health.”1 Dr. Colleen McNicholas makes a persuasive case against the rash of dangerous legislation offered by politicians across the country that interferes with our practices. She points out that such legislation “is clearly not about what is right for the patient but instead about creating obstacles based on ideologic differences.” This month, the American Congress of Obstetricians and Gynecologists (ACOG) took strong steps to make this same case in an open letter to the Texas legislature that called out all of the medical mistruths in the bills to restrict abortion that they have been debating. For those ACOG members who agree with these arguments and who feel moved to action, we want to let you know about the work we do. At Physicians for Reproductive Health, we train doctors to serve as lifelong advocates for comprehensive reproductive health care. Dr. McNicholas is a superb example of our work, as she has gone through our Leadership Training Academy. In this intensive program, we provide skills in talking to state and federal representatives, media training from on-camera interviewing to writing letters to the editor, as well as tools on how to organize within medical and educational institutions to promote sound reproductive health policies. For our graduates, we foster a national network that provides camaraderie and community as we advocate for our
VOL. 122, NO. 5, NOVEMBER 2013
patients and for sound, evidence-based practice. We know that entering into the advocacy arena can be a new and intimidating experience. We became doctors to practice medicine, not knock on the doors of legislators. But given the outrageous, unscientific dictates being placed on us by politicians, it is imperative that more physicians speak up. Our patients need our voices to protect them. Our professional integrity and sound science must be defended. We encourage all our colleagues to join their voices with ours and with ACOG’s to ensure that our patients have the best care, free of dangerous legislative interference. Financial Disclosure: The authors did not report any potential conflicts of interest.
Nancy Stanwood, MD, MPH Board Chair, Physicians for Reproductive Health, New York, New York Douglas Laube, MD, MEd Immediate Past Board Chair, Physicians for Reproductive Health, New York, New York
REFERENCE 1. McNicholas C. Transcending politics to promote women’s health. Obstet Gynecol 2013;122:151–3.
In Reply: I thank Drs. Stanwood and Laube for their support and for providing the readership with an introduction and invitation to join Physicians for Reproductive Health. This organization provides the training and support that busy physicians require to integrate active advocacy into their lives. I also thank Dr. Lesko et al for their letter of support; it is a powerful demonstration of the diversity of providers advocating for our patients. Lastly, I thank Dr. Steele, who points out the inevitably interwoven relationship of government and health care. Government always will have an “inextricable involvement in the provision of health care,” but we do not have to accept the synonymity of government and politics, especially when the latter results in targeting one specific
procedure under the pretense of patient safety despite no evidence to suggest such a need. Dr. Steele offers the example of state medical boards to support his claim that advocating against legislative interference is erroneous. Using Missouri, I first highlight that, although members of the Missouri Board of Healing Arts are appointed by the governor, the composition and the mission of the board should be free from political ideology. The board is composed of eight physicians and one public member and is responsible for assessing competence and upholding ethical standards. Compare this with three physicians in the 195-member Missouri general assembly. I would argue the former is more prepared to evaluate matters of patient safety, evidence-based practice, and physician competence. I also agree that this is a phenomenon extending beyond abortion, although I hardly see this as justification to abandon efforts to oppose the trend. Primary care physicians and pediatricians have been told by legislators that they cannot ask about the presence of firearms in the home1 despite a long-standing recommendation by the American Academy of Pediatrics.2 Examples such as this demonstrate that legislators no longer accept the historical standard of professional organizations’ (American College of Obstetricians and Gynecologists, American Academy of Pediatrics) providing expertise and oversight of the artful practice of medicine and lead me to conclude that, sadly yes, some legislation is purely for political gain. Financial Disclosure: The author did not report any potential conflicts of interest.
Colleen McNicholas, DO MSCI Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
REFERENCES 1. Murtagh L, Miller M. Censorship of the patient-physician relationship: a new Florida law. JAMA 2011;306:1131–2. 2. Dowd MD, Sege RD, Council on Injury Violence, Poison Prevention Executive Committee, American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics 2012; 130:e1416–23.
Letters to the Editor
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