Bill Maher is an astonishingly anti-science anti-vax crank

This week’s Realtime with Bill Maher was just about the most perfect example I’ve seen yet that maybe reality doesn’t have a liberal bias. Due to the measles outbreak becoming a hot-button issue, and the realization that his smoldering anti-vaccine denialism would not go over well, our weekly debate host decided to instead unleash all of his other incredibly stupid, unscientific beliefs about medicine.

This was astonishing. And because his panel, as usual, is composed largely of political writers and journalists, there was no one to provide a sound scientific counterpoint to the craziness. The sole non-crazy person (on this topic) was the conservative guy!

What a turn around for liberalism. It turns out, the problem hasn’t been that conservatives hold the key to anti-science crazy, we just haven’t had a good issue to expose the anti-science of the left wing for a while. Maher goes into a list of things he decides are examples of failures of “Western” medicine (because Eastern medicine has figured out cancer or something).

1. Bill Maher repeats the trope that the vaccine schedule is too much too fast – straight out of the anti-vax denial playbook! Human beings of course can handle thousands upon thousands of antigenic exposures daily. It’s called living on a planet where everything on it is trying to kill everything else all the time. It’s why we have an immune system.

2. Then in a feat of mental gymnastics only an unthinking crank can manage, he jumps into the hygiene hypothesis! He says he’s “not so sure that people who get a lot of them [vaccines] have as “robust” an immune system.” He then goes on to say we’re seeing more allergies and autoimmune disease, maybe vaccines or “environmental factors” are to blame. Now our children suddenly aren’t getting enough antigenic exposures! Our immune systems need to be challenged in order to grow and become strong. This is a fascinating feat of mental gymnastics. The antigen exposure of vaccines is “bad”, but somehow the antigen exposure from, say, measles is “good”. Granted those who have had actual infections develop stronger responses to those infections, there is no evidence that getting these childhood illnesses is protective from other illnesses, or against autoimmune disease. There is no reason to think that exposure to specific viral disease antigens would be protective for autoimmunity, not to mention since the vaccine is viral antigen exposure why wouldn’t it then serve the same purpose? The immune system just doesn’t work that way, and the hygiene hypothesis is about routine exposure to common antigens.

3. He complains none of his doctors have ever asked about his diet, because in his mind, what you eat is the most important thing ever. I can understand this for a couple of reasons. For one, Maher is thin. Generally if patients are thin, seemingly taking care of their bodies, a physician won’t typically interrogate them on their diet. If you then get a screening cholesterol panel that shows a high LDL and low HDL or triglycerides, the physician may start asking questions about diet, recommending exercise, more vegetables, less meat etc. Doctors aren’t here to micromanage your life, we are here to address problems, caution against the more harmful behaviors, and provide general recommendations for which there is good evidence. But in Maher’s mind, which seems to be the mind of the toxin fanatic, the only path to good health is through diet, so a doctor that doesn’t buy into this particular nonsense is a bad doctor. The reality is, there is not great data on which diet is best. There is no evidence that some foods are “super”, or carry some life-extending property. None of the claims made by the promoters of these foods has evidence of the caliber Maher is demanding from vaccines, and most of them have no evidence at all.

A good rule of thumb is, if a website uses the word “super” as a prefix, they’re full of it. Worse, the toxin hypothesis is nonsense. Toxins are not a significant source of human disease (at least not in Hollywood). Humans are extraordinarily good at detoxifying foods, and just because you’re eating plant material – the diet he promotes – doesn’t mean you’re not eating toxins. Plants are full of toxins they’ve developed over the years to prevent pests from consuming them and their fruit. It just happens that when a human eats a tomato, or chocolate, or one of the many plants we’ve genetically-modified through breeding and selection to suit our diets or learned to process since the birth of agriculture, we have an effective means of detoxifying them. Worse they make claims that non-toxic chemicals are actually toxic. Like glucose! The fuel your own body naturally makes to feed your brain is routinely castigated on the natural foody websites as a killer. This is the chemical your own body turns all these super-foods into! The inability to understand basic physiology is just wonderful.

You want non-toxic? Eat meat. It’s just protein, water and fat, just like us (although even a complete non-toxin like water can of course be toxic at high enough exposure). If you’re feeling sadistic and want to see the toxic effect of a superfood, feed these human foods to a non-omnivorous animal like a cat. They’ll get sick. Many of our “super foods” which the morons on these websites sell as “detoxifying” or laud their anti-oxidant properties (another bogus and unfounded diet hypothesis), are actually full of various plant toxins which we have no problem with because we have awesome livers. So thank your liver, and don’t buy into this toxin nonsense.

Finally other reasons he feels like he’s never heard a doctor ask about his diet (because we do) is he’s either not listening, or maybe he just sees a crappy doctor? So whoever is this magical “Western” doctor that Maher sees, please just ask this silly crank about his diet during the next visit so we don’t have to hear this tired nonsense anymore that doctors don’t care about diet. We do, we just don’t buy into the silly unfounded nonsense of the toxin hypothesis which is likely his real complaint.

4. He says “we overdid antibiotics” – This could be a fair point, however, the doom and gloom about antibiotics not working anymore and our whole medical system collapsing is a bit overblown. After all, most of the antibiotics we have developed over the years were discovered, not invented. We have been taking chemicals developed in the environment by various organisms and using them to suit our purposes. However, the targets of those chemicals have been engaged in this evolutionary war for millennia before we ever even got into it. Bacterial resistance is not “new”, or something created just by humans. We have to see this problem as an eternal struggle that’s been going on between micro-organisms for eons, and if we’re going to participate in it, we have to continue to innovate, just as life has, since the beginning. There is no “winning” here. There will never be a time when we can say we have solved bacterial resistance or have a perfect antibiotic, because we’re learning more and more we have to live with our bacteria in our biome, we can’t kill them all. We just have to keep working, keep innovating, and keep learning so we learn to develop antibiotics that are more specific, more targeted, and yes, more cautiously applied so we can continue to benefit from the ability to control these ubiquitous organisms that help us, are part of our normal physiology and function, but also occasionally overgrow and kill us.

5. He points out “not one country in the world does nearly as much surgery we do” – I recuse myself as I have conflict of interest.

6. He complains “I’ve heard on the news endlessly 2 drinks a day is good for you, I think no drinks a day is good for you.” And again Maher would be wrong. For one, no real medical authority has come out and said, “drink 2 drinks a day.” I’m sorry that the news misled you. I have no doubt there’s a bunch of crummy journalism out there that could be interpreted this way, but it’s not the medical establishment’s fault that science and medicine reporting is so full of bogus nonsense. This is still a controversial medical issue. The data from sources like NHANES show that there may be a protective effect for alcohol consumption with 1-2 drinks a day. This has been seen in multiple other studies, and in other countries. The effect is more profound in men. It might disappear if you eliminate co-morbidities (in other words some people may not be drinking because of health issues making the teetotaler data look worse). Ultimately doctors can’t really recommend you drink, but we typically won’t castigate you for drinking 1-2 drinks a day because the health effects are likely small, and for 1-2 drinks a day, their might be a slight cardiovascular protective effect. Prospective trials suggest 2 maybe even too many. So I would rate this as a major straw man argument. As a doctor I would say, 1-2 drinks a day is probably not harmful, but no one should be drinking saying “this is for my health”.

7. He wails we are Ok with aspartame, and GMOs! / and “One word, Monsanto” – and here we have it, Bill Maher’s clearest example of total crankery, his complete hysteria over GMO. There is a moment then when the conservative John McCormack butts in and points out there is no evidence that GMOs are harmful, and Maher and his panel of ignoramuses are shocked into silence, and one panelist gives this weighty sigh and covers her face in horror and Maher simply sighs. No, Bill Maher, it is we that should be asking you to justify your foolishness here, McCormack, the conservative who should supposedly be the one without the liberal bias of reality asked the right question. Where is your data? Where is the proof? There is no evidence, and worse, no even plausible mechanism by which he can describe the current GMO foods on the market to be harmful to humans. Despite consumption of billions by billions, you can’t point out one sickness or death. Instead they can only resort to the classic denialist correlation trope, which is exactly what the anti-vaxers have done for decades. And if someone wants to talk about the Seralini rat study, please don’t bother. Another retracted paper being the sole source of proof for a bunch of denialists, where have we heard this before?

Finally Maher complains, “we can’t ask any questions.” The classic cry of the persecuted crank! The same whiny response you see from the 9/11 truther, the climate science denialist, or any other individual who has found their ludicrous ideas has bought them some much needed societal shame. No on is telling them they can’t ask questions, but when you repeat the same question, that has been answered, and answered, again and again, and you don’t listen, eventually we are going to lose our patience and say enough! The debate is over! Vaccines do not cause autism. Enough with your crankery. Enough with the harm that has come from this bogus skepticism. We have an outbreak now. We are tired of hearing this question which has been answered and the accompanying obstinance has caused real-world harm.

Maher in this episode performs an astonishing Gish-gallop proving, once again, he deserves to be called out for denialism and being an infectious disease advocate. Can we drop the notion that liberalism is somehow protective against anti-science? Do we remember when he tried to blame cell phones for colony collapse disorder? (I couldn’t resist going to the old blog for that) Maher is resentful that his anti-vax nonsense is compared to global warming denialism. This is exactly like global warming denialism because all denialism ultimately comes down to the same tactics. I think we’ve a good example here of conspiracy (in one word! monsanto!), moving goalposts, cherry-picking, and a whole host of logical fallacies in his little Gish gallop (that’s four of five of the classic tactics). Let us dismiss him as a spokesman for science. He’s too easily impeachable as an anti-science crank.

Abortion can be lifesaving

While I realize Joe Walsh lost his election bid, it is still worth emphasizing that his infamous statements about abortion are false, especially considering efforts like those in Ohio to pass a “heartbeat bill”. Abortion is sometimes necessary to save the life of the mother. Via the Irish Times we hear the sad story of a woman being allowed to get sicker and sicker, while a non-viable but “living” fetus kills her.

“The doctor told us the cervix was fully dilated, amniotic fluid was leaking and unfortunately the baby wouldn’t survive.” The doctor, he says, said it should be over in a few hours. There followed three days, he says, of the foetal heartbeat being checked several times a day.

“Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.

“Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.

At this point the story is mostly upsetting because of the pain and distress the patient was undergoing for a nonviable fetus. But in the next sentence the story goes from describing mere horrific, dangerous medical care and patient abuse to total medical incompetence and wrongful death:

“That evening she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics.

If this timeline is correct, this sounds like “rigors”, a classic sign of impending sepsis. Her collapse is concerning for impending septic shock. One of the most important factors in preventing worsening sepsis after infection, per the Surviving Sepsis guidelines, is source control. That is, if there is a source for the sepsis – a foreign body, and infected wound, etc., it needs to be removed/drained so that the condition doesn’t worsen. This, in addition to being common sense, is medically imperative to prevent the worsening of symptoms.

However, for the sake of a non-viable fetus in the midst of a miscarriage, source control was ignored, and the patient proceeded to worsen and die.

At lunchtime the foetal heart had stopped and Ms Halappanavar was brought to theatre to have the womb contents removed. “When she came out she was talking okay but she was very sick. That’s the last time I spoke to her.”

At 11 pm he got a call from the hospital. “They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable. She stayed stable on Friday but by 7pm on Saturday they said her heart, kidneys and liver weren’t functioning. She was critically ill. That night, we lost her.”

This appears to be death from a critical delay in source control, in the face of septic shock. Removal of the fetus should have occurred emergently when she presented with signs and symptoms of sepsis in order to save her life. This was not done, and she almost certainly died as a result of this delay.

Maternal mortality in pregnancy is very rare thanks to modern medicine. However, when ideology trumps medically-appropriate care we turn back the clock to when women died routinely in childbirth.

What is the cause of excess costs in US healthcare? Take three – signs of reform

We’ve already extensively discussed why it costs twice as much for the US to provide healthcare for it’s citizens all the while failing to cover health care for all. Most recently, we discussed the hidden tax of the uninsured and the perverse incentive structure of US healthcare which encourage costlier care, more utilization, and more procedures.

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To summarize, the US spends more on healthcare compared to other industrialized nations because

  1. We deliver it inefficiently
  2. Without universality problems present when critical and in the ER
  3. Fee-for-service incentives in the form of excessive reimbursement for procedures and hospitals ramp up costs by encouraging doctors to overuse expensive tests and perform more procedures
  4. Direct-to-consumer advertising (we are one of two countries that allow advertisement of prescription drugs) and medicare part D encourage overuse of pharmaceuticals while tying providers hands when it comes to bargaining for lower drug prices
  5. Defensive medicine
  6. Poor management of end-of-life decisions and excessive and futile overuse of resources at the end of life
  7. Absence of a universal electronic medical record (or record format) to prevent redundancy and waste.

Now, what about the new Affordable Care Act? Are there going to be measures to address these sources of excess cost while creating universal coverage? The WaPo has an article outlining reforms addressing many of these specific problems.

First off, fee-for-service is going to be discouraged with increased use of “bundling” of costs:
Continue reading “What is the cause of excess costs in US healthcare? Take three – signs of reform”

2nd US Hospital to do full face transplant – today at University of Maryland

The news was just publicly announced that the University of Maryland is now the 2nd hospital to perform full face transplant in the US. Just a handful of these procedures have been performed around the world, and they are enormously complex ethically, surgically and medically.

To begin with, long before the surgery even became a possibility, there have been years of work put into setting up such a novel transplant program. Besides obtaining approval for what is still an experimental procedure from an IRB, it is necessary to very carefully screen a population of potential recipients. A face transplant is still quite high risk, especially if the surgery fails because it has the potential to cause serious morbidity and mortality. So, patients selected for transplant have to be vetted very carefully. In the case of the first Chinese transplant, the patient stopped taking immunosuppressive drugs in favor of traditional Chinese remedies, and died soon after. This emphasizes the importance of choosing potential recipients that will reliably take their medications as rejection can be catastrophic.

This surgery took approximately 32 hours from start to finish, and involved a huge multidisciplinary team including multiple transplant and plastic surgeons to perform the procedure. These procedures involve very complex microsurgery to reattach the vascular supply, muscles and nerves to the graft, and, since the jaw and tongue were also transplanted, bones as well.

The surgery is also just the beginning. A life-long course of immunosuppression is required, at least until we can reliably determine how to induce immune tolerance to transplanted organs (this is an exciting field which has also been in the news). And since the jaw contains marrow, there is a risk of graft versus host disease from the transplanted bone.

Then there are the complex ethical issues with facial transplant.

More below the fold…
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Transvaginal ultrasound now being legislated in Idaho

In the continual spread of assaults on women’s reproductive freedom in the wake of the 2010 tea party movement, another state, Idaho, is legislating women receive unnecessary and invasive medical procedures prior to obtaining abortion.

This is part of an unprecedented effort at the state level to restrict reproductive rights, and in 2011 a record number of these measures have passed.

And it won’t stop here, as we’ve seen in Georgia, they are trying to pass a law to force women to carry all 20 week gestations to term, even if the fetus is dead. And if you think that’s creepy, Georgia isn’t the first to do it, such laws have succeeded in Nebraska, Idaho, Indiana, Kansas, Oklahoma,Alabama and Utah.

John Scalzi has a guest post from a physician asking “where’s the outrage?”. Well it’s right here. Scalzi’s poster is suggesting that civil disobedience should follow, but I’m worried that that might be the excuse these states are looking for to shut down clinics and effectively ban all abortion within a state. While I agree the situation is untenable, and is requiring physicians to engage in unethical practice I worry that violating the law is just what the zealots are waiting for. But maybe this needs to happen. We need a test case in front of the courts that asks the question, “can legislatures dictate medical practice in conflict with medical ethics, and without medical justification?” I think the answer would be no, and should be no. Physicians shouldn’t be taking orders from the state on what they do in the examining room. Physician autonomy, ethical practice, reproductive freedoms, and the whole doctor-patient relationship are on the line here. Physicians are here to treat patients, not to serve as tools of the state, against our patients’ interests, to score political points for zealots.

Accountability in Science Journalism: two recent examples of failures in the NYT and Forbes

ResearchBlogging.orgEd Yong demands higher accountability in science journalism and has made me think of how in the last two days I’ve run across two examples of shoddy reporting. These two articles I think encompass a large part of the problem, the first from the NYT, represents the common failure of science reporters to be critical of correlative results. While lacking egregious factual errors, in accepting the authors’ conclusions without vetting the results of the actual paper, the journalist has created a misleading article. The second, from Forbes, represents the worst kind of corporate news hackery, and shows the pathetic gullibility of reporters regurgitating the fanciful nonsense of drug companies without any apparent attempt to vet or fact-check their story. With a google search the facts are smashed.

The first article Digital records may not cut costs, I think is typical of most science reporting. That is, it’s not grossly incompetent but it overstates the case of the article involved and fails to amplify the shortcomings of the research.

The NYT article is describing this article from Health Affairs, which caught my eye before the NYT article was even published because I believe electronic medical records (EMRs) will prevent redundancies and lower costs. So, am I wrong? Will EMRs save us money or possibly increase redundancy as the HA article suggests?

I haven’t given up hope. This article is a correlative study based on survey data, and proves precisely nothing.

Continue reading “Accountability in Science Journalism: two recent examples of failures in the NYT and Forbes”

What is the cause of excess costs in US healthcare? Take two

We’ve discussed it before, why are costs so much higher in US healthcare compared to other countries? The Washington Post has a pointless article which seems to answer with the tautology costs are high because healthcare in America costs more. How much more? Well, we spend nearly twice as much per capita as the next nearest country while failing to provide universal coverage:

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In the WaPo article they make a big deal of the costs of individual procedures like MRI being over a thousand in the US compared to $280 in France, but this is a simplistic analysis, and I think it misses the point as most authors do when discussing this issue. The reason things costs more is because in order to subsidize the hidden costs of medical care, providers charge more for imaging and procedures. For instance, Atul Gawande, in his New Yorker piece “The Cost Conundrum” wonders why is it costs are higher to treat the same conditions in rural areas and in a major academic centers like UCLA than at a highly specialized private hospitals like the Mayo Clinic? I think the reason is it’s not nearly as expensive to administer and provide care for a select group of insured midwesterners at the Mayo than it is to provide care to the underserved in the poor areas of inner-cities and in poor rural locations.

When you are serving a poorer, under-insured population like you get in LA or Baltimore for that matter, the insured are charged more because EMTALA requires hospitals to treat all comers, regardless of insured status. Medical centers like UCLA or University of Maryland are the final common pathway for the sickest and poorest patients who, even if stabilized at smaller local hospitals, are immediately transferred to such centers. These patients are expensive to treat, often have more co-morbidities like HIV or drug use and mental illness, and there is no reimbursement guarantee for taking care of them even though it is our legal and ethical responsibility to do so.

Further, the cost of defensive medicine, which applies to this patient population as much as any other, ramps the costs of all hospital admissions and medical practice in general. It is also incredibly hard to quantify its contribution to the overall costs of care.

As a result, to pay for excessive care of the uninsured, all procedures, all tests, all imaging, and all hospitalizations cost more. Caring for inpatients and the uninsured is expensive, so the costs are transferred to the prices of outpatient elective care and procedures which are often administered in a fee-for-service model. Hospitals have an incentive to provide as much outpatient elective care as possible in order to offset these other costs and to generate revenue. The providers that perform procedures or expensive testing then become far more expensive to pay as they are the major revenue generators for the hospital (hence surgeon vs pediatrician pay). Especially because in order to generate more revenue they are paid based on how many procedures they perform. All the incentives are towards more utilization, more procedures, more revenue generation. This is the hidden tax of the uninsured.

In a way, we have universal healthcare already, but we pay for it in the most irresponsible and costly way possible. We wait for small problems to become emergent, treat them in the most expensive outpatient provider possible (the ER), and then when we can’t pay the bills for the uninsured, we transfer the balance by increasing the costs of the care of insured patients showing up for their cholecystectomies or back surgery. Tack on the costs of defensive medicine and the fear of being sued unless everything is done to cover your ass, and you have a recipe for extremely costly care.

Other factors figure into higher costs as well, including hugely higher costs of medicare administration since Bush privatized it, higher prescription drug costs since Bush passed medicare part D and prevented bargaining with drug companies, and our incredibly high ICU expenditures at the end of life. the McKinsey report on excess costs demonstrated most of these issues in 2008. This is not news. The US spends far more on medical administration, outpatient/ambulatory care (with hospital-based outpatient care increasing most rapidly in costs), drugs, doctors salaries, and end-of-life care than we should as a percentage of our GDP.

So what should we do about it? At every step we need dismantle the tendency towards increasing costs. Here are my suggestions:
Continue reading “What is the cause of excess costs in US healthcare? Take two”

Virginia Ultrasound Bill Back from Dead

Turns out I gave Virginia governor McDonnell too much credit after he rejected the VA ultrasound bill on the grounds the state should insert itself into medical decisions. He’s gone and flip-flopped as a slightly revised version of the bill passes through the VA Senate:

The 21 to 19 vote, mostly along party lines, came a week after Gov. Robert F. McDonnell (R) asked legislators to revise the bill following protests on Capitol Square and repeated mocking on national television. Lawmakers amended the original bill, which mandated that women undergo a transvaginal ultrasound, a procedure that requires a probe be inserted into the vagina.

The bill will head back to the Republican-led House of Delegates, which already voted for similar measures this year and is widely expected to do so again. McDonnell, who signed legislation last year that imposed new regulations on clinics that perform abortions, told reporters that he will review the legislation but supports the concept.

“I think women have the right to know all of the medical information before they make a very important choice,” McDonnell said.

This is nonsense. Women know fully well what an abortion is and what it means. And it’s not the state’s job to legislate what medical information is relevant to the patient. That is a physicians job and there is no legitimate medical reason to perform the maneuvers the state is legislating. The state is legislating unnecessary, and therefore unethical and unlawful medical procedures. This is also from the state that brought us Buck V. Bell, so I guess they’ll never learn.

It’s a very simple ethical issue. The state has no business dictating medical practice. Worse, dictating physicians perform an unnecessary and invasive procedure is the state legislating unethical medical conduct. No physician should comply with this law, as I believe that forcing doctors to practice unethical medicine is unconstitutional.

Via Laden at ftb

Pennsylvania next in line to require transvaginal U/S prior to abortion

Pennsylvania is poised to enact a ultrasound bill even more stringent than Virginia’s failed bill.

Even as the transvaginal ultrasound bill in Virginia was causing national outrage, Pennsylvania conservatives were quietly pushing a even more restrictive abortion bill. The legislation is designed with so many difficult and differing restrictions that long-time abortion policy analyst Elizabeth Nash at the Guttmacher Institute told Raw Story, “I’ve never seen anything like it.”

In addition to mandating the much-maligned transvaginal ultrasound requirements since rejected by the state of Virginia, Pennsylvania legislators proposed strongly encouraging women to view and listen to the ultrasounds, forcing technicians to give the women personalized copies of the results and mandating how long before any abortion the ultrasound much be preformed — and that’s just for starters.

That last requirement has already been passed and struck down in Louisiana, partially over concerns of patients’ privacy and potential risks for women in abusive relationships, Nash said.

“This bill definitely suffers the legislators-playing-doctor problem. … There are a number of requirements in this bill that are medically unnecessary,” Nash said, pointing out that so many requirements packed into the 22-page bill could make it logistically difficult for abortion providers to comply with them. “This bill is something that would be unacceptable to most women seeking an abortion.”

You know how I feel about this. Legislating unnecessary medical procedures is unethical and unlawful, and real Republicans don’t believe government should legislate medical decisions. Hopefully this bill will suffer a similar fate.

Forcing Doctors to Perform Unnecessary Medical Procedures is Unethical and Unlawful

Many bloggers and commentators have expressed outrage over the decision by Virginia to require ultrasound examination, possibly transvaginal ultrasound, prior to women obtaining an abortion. From Bill Maher to Dahlia Lithwick people are outraged and have even suggested that it should be considered rape to force women to undergo vaginal examination by ultrasound prior to receiving abortion. Worse, it’s clear from statements like this one by delegate Todd Gilbert, that there isn’t a medical concern related to this intervention. It’s simply designed to humiliate women and interfere with the doctor patient relationship with exclusively anti-abortion motivations:

“the vast majority of these cases [abortion] are matters of lifestyle convenience.” And, 

”We think in matters of lifestyle convenience and in other matters that it is right and proper for a woman to be fully informed about what she is doing.

This just reflects how stupid these guys are, because anyone with half a brain could come up superficially plausible defense of the statute from grounds of medical safety. They’re just too brainless to do so and clearly are just trying to interfere with women and their doctors as they try to make a difficult decision.

There are some indications for ultrasound prior to abortion. Many physicians performing the procedure or especially offering medical abortion might perform a transvaginal ultrasound prior to proceeding. It can serve a few useful purposes. It can help confirm intrauterine pregnancy as well as uterine location. It may be needed to assess patients in their postoperative exam or medical follow up visits to rule out retained products of conception. In cases of uncertain dates, it can give you gestational age of the fetus, which may be critical in determining the appropriateness of the subsequent procedure used. After all, medical abortion is typically limited to the first 9 weeks and uncertainty about gestational age should result in ultrasound prior to use of medical abortifacients.

However, neither the FDA nor any professional organization of obstetricians and gynecologists indicate ultrasound should be a required component prior to medical or surgical abortion. The procedure is often unnecessary. So, what Virginia has done has legislated a requirement for an unnecessary medical procedure, unsupported by any professional medical association, on a specific subpopulation of women. Given the history of forced sterilization in Virginia, you’d think they’d be more sensitive on this issue. This is the state where Buck v Bell brought the issue of forced medical procedures to light.

This statute cannot, therefore, stand on either medical ethical or constitutional grounds. The state legislature can not force me or any other physician to perform an unnecessary, and therefore unethical, medical procedure. The state legislature can not pick on a subpopulation of citizens and force them to receive an unnecessary medical procedure.

I don’t think this law will stand, but it once again will require a legal fight, waste of time and resources, and all of this once again in a effort by governmental busybodies to interfere in women’s health decisions in a punitive fashion. The Republicans need to watch out. This is just another indication of a the size of the assault on women’s reproductive rights, and if they keep pushing, they’re going to see what a mistake it is to piss off 51% of the population.

**Update: I also noticed from Lithwick’s article Virginia has enacted a personhood law saying life begins at conception. More idiocy. This is like Indiana legislating the value of pi = 3. It is unscientific and illogical. Life does not begin. It is continuous. There is no dead state between parents and offspring. Sperm are alive, eggs are alive, the fusion of the two is alive. Instead they are legislating what constitutes life that is important, or more likely “ensouled”. As a fundamentally philosophic/religious and ultimately arbitrary point, government has no business legislating such a thing. But legislating that life has a “beginning” is biologically ignorant.