Is there a Plan b for Plan B?

Plan B One-Step is a single-dose emergency contraceptive pill that contains higher levels of levonorgestrel, a hormone found in some birth control pills, and has been available in the U.S. since 2009. Its effectiveness is linked with timeliness of use: the drug should be taken within 72 hours of intercourse. The Food and Drug Administration (FDA), after reviewing the scientific evidence on its safety and effectiveness, recommended that it be available–without prescription–to females of any age.

On December 7, 2011, Secretary of Health and Human Services (HHS) Kathleen Sebelius overruled this FDA recommendation. While the Secretary of HHS has the authority to override the FDA, The New York Times reported that this issue was the first time a HHS secretary has publicly overruled the FDA. Secretary Sebelius’ action limits an attempt by the FDA to improve the accessibility of Plan B One-Step among young girls, but it does not affect the legality of the drug. Plan B One-Step remains available, without a prescription, to women who are 17-years old and older; and it is still approved for use, with a prescription, for females who are younger than 17.

Sebelius argued that there should be no change in the current law requiring females younger than 17 to obtain a prescription for Plan B One-Step because they require health-care provider guidance to use the pill properly and safely (to see Sebelius’ counterstatement to the FDA’s recommendation, click:
http://www.hhs.gov/news/press/2011pres/12/20111207a.html
). However, as FDA Commissioner Dr. Margaret Hamburg stated, “Based on the information submitted to the agency, [the FDA’s] CDER [the Center for Drug Evaluation and Research] determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases. Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a healthcare provider.” Further, young girls are able purchase a variety of over-the-counter medications and personal products that could be harmful in large doses, such as Tylenol, with no ill effects. President Barack Obama had the opportunity to overrule Sebelius’ decision, but instead agreed with her, noting that he felt uncomfortable, as a father, with the FDA’s decision.

What’s at play here?  What’s going on in this dance between science and good health policy? Did upcoming presidential race play a role here? Are there additional moral or ethical considerations about the proper age for emergency contraception? What’s going on?

How much should, or do,  data really matter in creating health policy? How we talk about – frame – this and other politically charged health issues matters. Consider the language used in various news sources covering the issue. The emotionally charged responses to this specific drug from both evidence-based and ethical-based sides merge to create a unique and complicated discussion. As we launch into an election year, how can we expand the conversation on the topic with our peers and colleagues to further consider the multiple dimensions influencing the availability and accessibility of Plan B for women of all ages across the U.S.?

December 13, 2011 Coverage Update:  14 U.S. Senators, including Minnesota’s Al Franken, have called for further explanation of Sebelius’ decision made on December 7, 2011. The letter–defending the importance of using science to create policy—asks Sebelius for “specific rationale and scientific data” behind limiting Plan B’s accessibility. To see the letter and co-signers, visit:
http://murray.senate.gov/public/index.cfm/newsreleases?ContentRecord_id=77e3d54b-bb6b-4c7c-9f05-bfe8c8d3b304
. Sebelius has not yet released a response.

Greetings from AMCHP

Hello from Washington DC, our nation’s capital and the stellar venue for this year’s Association of Maternal and Child Health Programs (AMCHP) conference. Minnesota’s MCH program is certainly well represented in 2011: counting yours truly, we have six current students at the conference along with several gainfully employed graduates. Each morning we convene for coffee and plan our strategies, pens and programs in hand, splitting up the sessions and then going our separate ways. Advocacy, community outreach, data analysis, and policywork — we’re trying to cover a LOT of ground here, people, while also reporting to our colleagues and friends at home.

Some of the workshops have been more interesting than others, of course, but all of us agree that this conference is  a great reminder of the important work ahead of us as MCH professionals. In every session, in every coffee chat, in the lobby and in line for the bathroom, we’re surrounded by passionate, articulate practitioners with substantial knowledge of public health both at the state and national level.

So, what are we hearing thus far? Well, incorporating the lifecourse seems to be a major theme, as does rethinking preconception health and transforming data into action. I’ve been hearing a lot more about “packaging” messages for policymakers and constituents, and honestly, this kind of market-speak makes sense, particularly as MCH leaders work with ever-shrinking budgets…

That, by the way, is the other big theme: budget cuts. Everyone I’ve spoken with is anxiously awaiting a decision on the proposed cuts to  MCH block grants. As you may have heard, last week House Republicans recommended a 32% decrease in Title V funding — or $210 million dollars for fiscal year 2011. On Friday, those budget cuts were revised to 8% — but that’s still $50 million dollars in cuts to essential programs for our most vulnerable populations. So along with attending sessions, we’re writing letters and making phone calls to our elected officials, and we’d like to encourage you to do the same.

For a press release from the Congressional Appropriations Committee, click here:
http://appropriations.house.gov/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=259&Month=2&Year=2011

And for a synopsis from Kaiser Health News, click here:
http://www.kaiserhealthnews.org/Daily-Reports/2011/February/12/GOP-health-cuts.aspx

Edward Ehlinger appointed Health Commissioner

More news in the good-for-Minnesotans (and GREAT for MCH) category…

Edward Ehlinger — former medical director at the University of Minnesota’s Boynton Medical Center and adjunct faculty at the School of Public Health — was recently appointed Commissioner of Health by Governor Mark Dayton.

Ehlinger is a stalwart proponent of public health, one who regularly speaks out about health disparities here in the Midwest and acknowledges the important role of policy in ensuring good health for all. If you’re curious about his stance on health reform, preventative care, or the importance of collecting surveillance data, I recommend recent episodes of his local access television show. Archives of “A Public Health Journal” are available online: click here for details.

To read Ehlinger’s 2009 testimony in favor of the Minnesota Health Act, click here:
http://muhcc.org/sites/muhcc.org/files/TestimonyEhlinger02-25-09.pdf

To read the MDH’s press release on his appointment, click here:
http://www.health.state.mn.us/divs/comm/ehlinger.html

Ehlinger also wrote a piece in the recently published CityLights (a publication of CityMatCH) celebrating 20 years of that national MCH membership organization, availabe here:
http://webmedia.unmc.edu/community/citymatch/CityLights/CityLights2010Conf.pdf

CityMatCH is a freestanding national membership organization of city and county health departments’ maternal and child health (MCH) programs and leaders representing urban communities in the United States. The mission of CityMatCH is to improve the health and well-being of urban women, children and families by strengthening the public health organizations and leaders in their communities.

And, if that isn’t enough -  for a statement from Ehlinger on the importance of taking a community-wide approach to sexual/domestic violence prevention, check out this presentation:

More data, please! Ezra Klein on the investment deficit (and why numbers matter)

A column by Ezra Klein in last week’s Washington Post should provide some comfort to recent (and soon-to-be!) graduates of public health programs around the country.

The bad news first: along with the staggering federal budget deficit, Americans face an investment deficit that will have repercussions for decades. Americans need to invest more money into our infrastructure:  education, job training, and new technologies — in short, we need to invest in the systems that support human capital.

The good news: now is a good time to invest in those same systems. As Klein asserts, “government borrowing costs are lower” than they’ve been in decades.

Okay, more bad news: we don’t have the data to evaluate existing programs and substantiate funding. Klein interviews Michael Greenstone, former chief economist for President Obama’s Council of Economic Advisers, who sums it up bluntly: “In the first year of the Obama administration [...] I appointed myself to run around and argue that the stimulus was the greatest opportunity for evaluation of federal programs that’s ever happened. But the federal government is not equipped to do that. No one is against it, really, but it’s not a priority. It’s not part of the culture. And so it doesn’t have the sense of urgency that running a fit government would require.”

And finally, some more good news. This idea of government “fitness” — of regular, rigorous evaluation, of applying data to support (or shelf) programs — is getting some play beyond the beltway.

So now, some questions for you, dear reader: is data being used to support your programs? Would you like more support for evaluation efforts in the field?  Share your thoughts in the comments.

“Don’t ask, don’t tell” and your health

The recent repeal of “Don’t ask, don’t tell” (DADT) should provide some additional holiday cheer for public health professionals–as it represents a substantial victory not just for GLBTQ advocates, but for all of us who care about protecting and promoting sexual and reproductive health.

DADT, a federal law designed to prohibit gay and lesbian military members from revealing their sexual orientation, was first signed into law in 1993 as part of a larger policy compromise by President Bill Clinton. At the time, members of the military who were gay or lesbian would be discharged immediately. Advocates of DADT noted that it was meant to protect these individuals, particularly after a series of violent, well-publicized attacks.

An excellent commentary by Dr. Kenneth Katz in the latest New England Journal of Medicine (available here for NEJM subscribers:
http://www.nejm.org/doi/full/10.1056/NEJMp1012496
) gives us a sense of what happens when military members are afraid to reveal portions of their health history. In Katz’s community, men who would otherwise have regular testing and treatment for STIs might neglect these same services, fearing discovery and dishonorable discharge. Katz asserts, “I’ve heard the same thing from scores of other active-duty service members I’ve cared for clinically or interacted with socially.” In fact, Katz notes, “during a 2-month period in 2002, active-duty U.S. Navy sailors accounted for 9% of the clients of a gay men’s health clinic in San Diego”–men who were eligible for free, convenient on-base health services through TriCare.

We may never know exactly how DADT affected the health of gays and lesbians within the military. But we do know that most Americans–gay, bisexual, and straight–support its repeal.

For an interview with a local officer discussing the repeal, click here:

http://minnesotaindependent.com/75513/a-gay-officer-reacts-to-the-repeal-of-dont-ask-dont-tell

To watch President Obama sign the repeal, click below: