President Obama’s HHS Mandate Is Bad for Women’s Health and the Practice of Medicine

Dear Senators Boxer, Murray, and Shaheen:

In a Feb. 7, 2012 Wall St. Journal op-ed, you claimed that President Obama’s HHS mandate, which forces everyone, including religious institutions, to pay for abortifacients, oral contraceptives (OCPs), and sterilizations as mandatory benefits in health insurance policies, was a victory for women’s health.  As practicing physicians, we can attest that nothing is further from the truth.  President Obama’s mandate is bad for women’s health and for the profession of medicine.

First, birth control is not preventive medical care like breast exams and pap smears performed to prevent a late diagnosis of cancer or immunizations to prevent pneumonia and influenza.  A child is not a disease, nor are fertility and pregnancy.  They are physiological states of healthy individuals.

Second, OCPs contribute to significant disease and dysfunction, such as increased rates of blood clots, strokes, and heart attacks (especially in smokers); increased rates of HPV transmission; and increased incidence of cervical cancer and liver tumors. The same synthetic hormones in OCPs that make a woman’s body behave as if pregnant all the time also change her body chemistry, rendering her more susceptible to STIs.  As physicians, we frequently must care [for] women suffering from the unanticipated side effects of OCPs.

OCPs can lower the incidence of ovarian cancer.  But only 1 in 72 women will develop ovarian cancer.  Of greater concern should be the many studies showing that OCPs increase the risk of breast cancer—especially in young women who use them for more than 4 years before their first full-term pregnancy—since breast cancer rates have increased from 1 in 12 (in 1960 when the pill was first introduced) to 1 in 8 fifty years later.  The International Agency for Research on Carcinogens declared estrogen and progesterone Class I carcinogens in 2005.  Why would we promote any substance which increases the risk of cancer, and describe it as preventive care?

With regard to “cost savings” in health care, the Guttmacher Institute’s own data show that increases in contraception use lead to increased demand for abortions, and that women are more likely to have unplanned pregnancies when using contraception.  There are no valid statistics demonstrating that use of contraception and abortion have improved the health of women and children.  In fact, the rates of premature and low birth weight infants have been rising precipitously since rates of abortion and OCP use have increased.  One in 8 babies is now born prematurely. NICU care now accounts for 25% of the entire maternal/newborn budget!

Finally, it is important to realize that mandating “free contraception” is not free—it will mean higher insurance premiums for everyone and/or less money for the treatment of real diseases.

A President who is willing to use the power of the federal government to violate the rights of religious freedom, conscientious objection, and free speech of thousands of religious institutions, and of many other Americans who object to this mandate on grounds of conscience, will also have no qualms about ordering physicians to participate in providing contraception, sterilization, and abortion even if it violates their ethical and professional judgment.  In gutting the conscience protection rule enacted in 2008, and in refusing to include clear protections for conscience in PPACA, the Obama administration has demonstrated its hostility to the conscience rights of health-care professionals.  Attempted coercion in this area will drive out of medical practice many physicians who take their ethical obligations and the Hippocratic Oath seriously.  If this happens, millions of women will lose access to physicians who share their beliefs, and all patients will be more at the mercy of future government dictates about what health-care services can be offered or not.

As Catholic physicians, we swear before God to serve the sick with competence, compassion, and charity, always to their benefit and never to their harm.  Abortifacients, OCPs, and sterilization do not belong in a preventive services mandate because they are not preventive medicine and not good for women’s health.  President Obama’s mandate will prove harmful to women’s health and to the practice of medicine. It must be rescinded immediately.

Maricela P. Moffitt, M.D., M.P.H., President, Catholic Medical Association
Mary Keen, M.D., M.R.M.
Rebecca Peck, M.D.
Kathleen M. Raviele, M.D., F.A.C.O.G., Past President, Catholic Medical Association
Laura G. Reilly, M.D., A.B.P.N.

Reprinted with permission form the Catholic Medical Association.  This letter also appears in full at the CMA’s blog.

In 1999, at the ripe old baseball age of 35, Barry Bonds, one of the five or six greatest players ever to carry the bat, was finally beginning to wear down. Even aside from the effects of aging, the long baseball seasons take their toll on the body: nagging little injuries, a pulled muscle here, a sprain there, a touch of arthritis, a fractured bone that never quite healed right. The muscles don’t contract with the same old lightning speed. You’re smarter, and you make fewer mistakes, but your batting average drops, you lose range in the field, and you’re out of the lineup more often. So it was with Bonds that year. He batted just .262 and played in 102 games, his lowest figures in a decade. What with his power and his batting eye, he was still a great player, but his best years were behind him.

Except that they weren’t, not exactly. Bonds arrived in camp the next year with a new body. He had put on weight, but lost body fat. And his bat speed was breathtaking, so much so that pitchers were afraid of leaving the ball anywhere over the plate. In 2001, the 37-year-old Barry Bonds hit 73 home runs, 24 more than he had ever hit before, and slugged .863, almost 200 points more than his previous high. From 2000 through 2004, Bonds’ records are wholly unlike those of any other player in baseball history, as witness his unimaginable 232 walks in 2004, when he was 40 years old.

Well, we know the reason for these strange results, and for the sudden ability of otherwise ordinary infielders to slam the ball over the fence to the opposite field. It’s “steroids,” the popular term for artificial testosterone, ingested to repair and build muscle. Some of these steroids may be legally prescribed for certain medical conditions, normal aging not among them. Similar drugs that were legal at the time, like the androsterone taken by Mark McGwire in 1998 when he hit 70 home runs, meet with the reproach of fans anyway. Lovers of baseball have, with remarkable unanimity, decried these years as the “steroid era.” They accuse the players of a kind of cheating that goes far beyond the gamesmanship, say, of a pitcher “cutting” the ball on his belt buckle, or a man on second stealing signs from the catcher. In fact, they seem unwilling to elect any of the cheaters to the Hall of Fame, at least until many years pass by.

They are also not going to accept the argument that the ingestion of testosterone is a matter of individual choice. That is because of the nature of the game. It would give an advantage to the players who “juice”—a considerable advantage, as it turns out. It would also compromise the venerable history of the game, making it impossible to judge the worth of contemporary players against that of players past. In other words, to allow the use of testosterone would immediately immiserate those who do not use it; and it would alter the game itself. It would do so, moreover, by means of a tissue-growing hormone that poses obvious medical risks: the growth of cancerous tissue, for instance.

Yet, when one compares this sex hormone, testosterone, to the sex hormone now in the news, estrogen, it is hard to see why, on medical and social grounds alone, the one would be severely restricted and the other so freely dispensed that people are ready, not simply to affirm its legality, but to mandate that people and institutions violate their religious faith to purchase it for women who want it.

There are some medical uses for estrogen, as there are some medical uses for testosterone. These are not at issue. The Catholic Church does not oppose the use of estrogen to treat a disease. But there is also an immediate health-related benefit that testosterone secures. It builds and repairs muscle. That is, taken by itself, a good thing. If it helped Barry Bonds to swing a bat, it would help Barry the Miner to swing a pickax, or Barry the Infantryman to climb up a cliff, or Barry the Roadworker to heal from the battering his frame takes when he spends a day with the jackhammer. Yet we judge, correctly, that these Barries should not be ingesting testosterone. As I see it, we do so for three reasons: the benefit is not necessary; the benefit is outweighed by the risks of the drug; and the use of the drug by some men would put others at an unfair disadvantage—it would immiserate them. The first two reasons have to do primarily with the individual; the third, with society.

Now compare this drug to estrogen. Unlike testosterone, estrogen does not confer any obvious medical benefit upon a woman who ingests it. Its use when ingested for non-medical reasons is to fool the body into the condition of pregnancy when it is not actually pregnant. If anything, the drug is attended by a host of troubles, from minor annoyances to those severe enough that some women cannot use it. Testosterone will help Barry lift things up and put them down, and that, considered alone, is a good thing. We need strong men to lift things up and put them down. But estrogen enhances no such practical performance.

Someone might justify the use of testosterone on the grounds that our bodies are always repairing muscle; indeed the only way to build muscle is to tear it down and “persuade” the body to compensate by building even more. I do not buy the argument. I only note that it makes at least a superficial claim to being medical in nature: it has to do with a bodily function that needs repair. But the use of estrogen as contraception is not medical at all. Quite the contrary. A couple who use estrogen to prevent the conception of a child do not ingest the drug to enhance the performance of their reproductive organs, or to heal any debility therein. Their worry is rather that those organs are functioning in a healthy and natural way, and they wish they weren’t. They want to obtain not ability but debility. They want not to repair but to thwart.

Here it is usually argued that the drug is medical because it prevents a disease. But that is to invert the meaning of words. When the reproductive organs are used in a reproductive act, the conception of a child is the healthy and natural result. That is a plain biological fact. If John and Mary are using their organs in that way, and they cannot conceive a child, then this calls for a remedy; that is the province of medicine. It is also the province of medicine to shield us against casual exposure to communicable diseases—exposure that we cannot prevent, and that subjects us to debility or death. Childbearing and malaria are not the same sorts of thing.

Moreover, estrogen, like testosterone, is a tissue-growing hormone, and therefore subjects the woman who ingests it to a much higher risk of developing cancer, not to mention other serious medical troubles. Indeed, if it were not dangerous, drug companies would not be struggling to keep the dosage as low as possible. So the widespread use of estrogen actually involves widespread and grave medical harm. In a country as large as ours, with breast cancer as common as it is, even a smallish increase in the risk of cancer would mean thousands of deaths; and the increase in risk is not small.

And this brings us to the heart of the matter. The argument for the use of this drug is not medical (since it does not remedy anything, it does not shield against communicable disease, and it actually subjects the user to medical risk). It is social. It is simply this: Without the drug, many millions of sexually active women would become pregnant who do not wish to be so. But now we are not in the realm of individual choices alone. We must address the whole of society. We must address the common good.

Here is where the comparison with testosterone helps clarify matters. Again, if Bonds uses the drug, that immediately immiserates those who do not wish to use it. It helps this player, here, turn on the inside fastball. But no player is an island unto himself. The drug hurts everyone, because it hurts the game itself; it is destructive of the common good.

The same is true of the artificial estrogen. It “helps” this couple, here, do the child-making thing, without making a child. It “helps” that couple, there, do the marital thing without being married. But it immiserates all those couples who, in a healthier age, would not wish to do so. It alters everyone’s view of what marriage and sexual congress are for. The result is, as anyone with a little common sense could predict, that there are far more children born out of wedlock now than there were before the artificial estrogen changed the whole nature of the game. We have produced now generations of people who have never known an intact marriage. The sexual revolution has devastated the lower classes, and renders us ever less willing to practice the difficult and self-denying virtues, while we are ever more willing to surrender genuine liberty for the illusions of license.

Anthony Esolen is Professor of English at Providence College in Providence, Rhode Island, and the author of Ten Ways to Destroy the Imagination of Your Child and Ironies of Faith. He has translated Tasso’s Gerusalemme liberata and Dante’s The Divine Comedy.  This article appeared on March 8, 2012 at Public Discourse: Ethics, Law and the Common Good and is reprinted here with Dr. Esolen’s permission.