Month Archives: July 2010

Elena What Memo? Kagan: Saletan Got One Big Thing Wrong

by Cathy Ruse

July 8, 2010

Theres a lot of buzz about Will Saletans incisive analysis of Elena Kagans role in shaping, from the White House, the medical conclusions of the American College of Obstetricians and Gynecologists on the partial-birth abortion method. (See full article, below.) The criticism of Kagan and ACOG is certainly welcome, especially coming from this pro-choice writer at this left-leaning magazine.

But Saletan is dead wrong on one central point: Kagan did substantively change the ACOG statement with the sentence she dictated to the organization. Before Kagans interference, the ACOG statement read:

a select panel convened by ACOG could identify no circumstances under which this procedure, as defined above, would be the only option to save the life or preserve the health of the woman.

Before Kagan, partial-birth abortion was equal to or lesser than other methods in ACOGs view. With the addition of Kagans wording that it may be the best method in a particular circumstance, partial-birth abortion now became potentially better than other methods in the official view of ACOG. Saletan apparently doesnt understand that making it potentially best in some unnamed hypothetical situation was equivalent to making it definitively best in the view of the reviewing courts. Even a cursory reading of the lower court rulings shows that the Kagan best language was absolutely key to the courts reasoning in overturning the bans.

Ultimately, of course, the Supreme Court got past this politicized medicine and got the ruling right. But this revelation should be a permanent black eye for ACOGs reputation on any abortion-related issue in the future, and is proof that Kagan is a zealous pro-abortion political animal trying to disguise herself in judges robes.

When Kagan Played Doctor

Elena Kagan’s partial-birth abortion scandal.

By William Saletan

Posted Saturday, July 3, 2010, at 2:12 PM ET

Fourteen years ago, to protect President Clinton’s position on partial-birth abortions, Elena Kagan doctored a statement by the American College of Obstetricians and Gynecologists. Conservatives think this should disqualify her from the Supreme Court. They understate the scandal. It isn’t Kagan we should worry about. It’s the whole judiciary.

Kagan, who was then an associate White House counsel, was doing her job: advancing the president’s interests. The real culprit was ACOG, which adopted Kagan’s spin without acknowledgment. But the larger problem is the credence subsequently given to ACOG’s statement by courts, including the Supreme Court. Judges have put too much faith in statements from scientific organizations. This credulity must stop.

The Kagan story appeared Tuesday in National Review and You can read the underlying papers at the Media Research Center. There are three crucial documents. The first is a memo from Kagan on June 22, 1996, describing a meeting with ACOG’s chief lobbyist and its former president. The main takeaway from the meeting, Kagan wrote, was that “there are an exceedingly small number of partial birth abortions that could meet the standard the President has articulated,” i.e., abortions in which the partial-birth technique was necessary to protect a woman’s life or health. She explained:

In the vast majority of cases, selection of the partial birth procedure is not necessary to avert serious adverse consequences to a woman’s health; another optionwhether another abortion procedure or, in the post-viability context, birth through a caesarean section, induced labor, or carrying the pregnancy to termis equally safe.

The second document is a draft ACOG statement on “intact D&X” (aka partial-birth) abortions, faxed by ACOG to the White House on Dec. 5, 1996. The statement said that

a select panel convened by ACOG could identify no circumstances under which this procedure, as defined above, would be the only option to save the life or preserve the health of the woman. Notwithstanding this conclusion, ACOG strongly believes that decisions about medical treatment must be made by the doctor, in consultation with the patient, based upon the woman’s particular circumstances. The potential exists that legislation prohibiting specific medical practices, such as intact D & X, may outlaw techniques that are critical to the lives and health of American women.

The third document is a set of undated notes in Kagan’s handwriting, offering “suggested options” for editing the ACOG statement. They included this sentence: “An intact D+X, however, may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman, and a doctor should be allowed to make this determination.” This sentence was added verbatim to the final ACOG statement released on Jan. 12, 1997, which read in part:

A select panel convened by ACOG could identify no circumstances under which this procedure, as defined above, would be the only option to save the life or preserve the health of the woman. An intact D&X, however, may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman, and only the doctor, in consultation with the patient, based upon the woman’s particular circumstances can make this decision.

The basic story is pretty clear: Kagan, with ACOG’s consent, edited the statement to say that intact D&X “may be the best or most appropriate procedure” in some cases. Conservatives have pounced on this, claiming that Kagan “fudged the results of [ACOG’s] study,” “made up ‘scientific facts,’ ” and “participated in a gigantic scientific deception.” These charges are exaggerated. The sentence Kagan added was hypothetical. It didn’t assert, alter, or conceal any data. Nor did it “override a scientific finding,” as National Review alleges, or “trump” ACOG’s conclusions, as Sen. Orrin Hatch, R-Utah, contends. Even Power Line, a respected conservative blog, acknowledges that ACOG’s draft and Kagan’s edit “are not technically inconsistent.” Kagan didn’t override ACOG’s scientific judgments. She reframed them.

But Kagan’s defense is bogus, too. On Wednesday, at her confirmation hearing, Hatch pressed Kagan about this episode. She replied that she had just been “clarifying the second aspect of what [ACOG] thought.” Progressive blogs picked up this spin, claiming that she merely “clarified” ACOG’s findings and made its position “more clear” so that its “intent was correctly understood.” Come on. Kagan didn’t just “clarify” ACOG’s position. She changed its emphasis. If a Bush aide had done something like this during the stem-cell debate, progressive blogs would have screamed bloody murder.

At the hearing, Kagan said ACOG had told her that intact D&X “was in some circumstances the medically best procedure.” But that doesn’t quite match her 1996 memo about her meeting with ACOG. In the memo, she wrote that

we went through every circumstance imaginablepost- and pre-viability, assuming malformed fetuses, assuming other medical conditions, etc., etc.and there just aren’t many where use of the partial-birth abortion is the least risky, let alone the “necessary,” approach. No one should worry about being able to drive a truck through the President’s proposed exception; the real issue is whether anything at all can get through it.

The language in this memo”imaginable,” “let alone,” the quotes around “necessary”depicts a conversation in which nobody could think of a real case where intact D&X was, as Kagan’s revision would later put it, “the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman.” Indeed, the participants doubted whether “anything at all” could meet Clinton’s standardnamely, a case in which intact D&X would be “necessary to preserve the life of the woman or avert serious adverse consequences to her health.” So Kagan’s statement at her hearingthat ACOG had said intact D&X “was in some circumstances the medically best procedure”considerably stretches the truth as she recorded it. It implies, contrary to her contemporaneous notes, that ACOG had affirmed a specific need for the procedure.

Kagan’s critics see her political meddling as a violation of science. The revised ACOG statement “was a political document, intended to bolster the case for partial-birth abortion, under the false flag of scientific objectivity,” says Power Line. National Review agrees: “Language purporting to be the judgment of an independent body of medical experts” was “nothing more than the political scrawling of a White House appointee.” These complaints are overboard. Science and politics aren’t mutually exclusive. The ACOG statement was largely scientific, and even Kagan’s insertion was more than political scrawling: It reframed but obeyed the constraints of ACOG’s objective beliefs.

But if conservatives are being naive about the relationship between science and politics, Kagan is being cynical about it. “There was no way in which I would have or could have intervened with ACOG, which is a respected body of physicians, to get it to change its medical views,” she told senators on Wednesday. With this clever phrasing, she obscured the truth: By reframing ACOG’s judgments, she altered their political effect as surely as if she had changed them.

She also altered their legal effect. And this is the scandal’s real lesson: Judges should stop treating the statements of scientific organizations as apolitical. Such statements, like the statements of any other group, can be loaded with spin. This one is a telling example.

National Review, CNSNews, and Power Line make a damning case that courts mistook the ACOG statement for pure fact. In 2000, when the U.S. Supreme Court struck down Nebraska’s ban on partial-birth abortions, it cited ACOG: “The District Court also noted that a select panel of the American College of Obstetricians and Gynecologists concluded that D&X ‘may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman.’” That sentence, we now know, was written by Kagan.

Four years later, when U.S. district judge Richard Kopf ruled against the federal partial-birth ban, he wrote:

I have summarized only the statements of the two leading national medical associationsthat is, the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG)regarding substantive medical questions, but only to the extent the statements reflected the considered medical opinion of such groups after an apparent professional inquiry. I did not summarize the policy views of these or other associations.

Kopf explained why he trusted the ACOG statement:

In forming the task force’s proposed ACOG Statement on Intact Dilation and Extraction, the members relied on their own education and expertise, obstetrics and gynecology textbooks, CDC information, published information on the safety of D&E and the D&X subset of D&E, and information about the safety of available alternatives. The textbooks were referenced for information about specific abortion procedures. The task force did not rely on information received from the public, did not interview or receive testimony from doctors, and did not draft and circulate individual position papers or statements for review and comment by other task force members. … Before and during the task force meeting, neither ACOG nor the task force members conversed with other individuals or organizations, including congressmen and doctors who provided congressional testimony, concerning the topics addressed in the ACOG Statement on Intact Dilation and Extraction.

Kopf, like the rest of us, was apparently unaware that after the ACOG task force formulated its proposed statement, the statement was politically vetted and edited. Kagan’s memos and testimony confirm that ACOG consulted the White House and altered its statement accordingly. As a result, the statement reframed ACOG’s professional findings to support the policy views it shared with the White House.

All of us should be embarrassed that a sentence written by a White House aide now stands enshrined in the jurisprudence of the Supreme Court, erroneously credited with scientific authorship and rigor. Kagan should be most chastened of all. She fooled the nation’s highest judges. As one of them, she had better make sure they aren’t fooled again.

Bioethics Commission Has First Meeting

by David Prentice

July 8, 2010

The new Presidential Commission for the Study of Bioethical Issues will have its first meeting today and tomorrow. The topic for discussion is Synthetic Biology, as requested by the President, after the furor over the announcement of a semi-synthetic bacterial cell produced by the lab of Craig Venter.

This page gives the agenda and list of speakers (Venter is one of the speakers); there is also a link so you can watch a live video broadcast of the proceedings.

Kagangate Says as Much about ACOG as It Does about Kagan

by Chris Gacek

July 7, 2010

Hopefully, much more will be said and written about Supreme Court nominee Elena Kagans dishonest and manipulative behavior regarding the legislative effort to end partial-birth abortion (PBA) in the mid-1990s. Kagan worked with the American College of Obstetricians and Gynecologists to present a false picture of the medical-scientific need for that gruesome medical technique.

As duplicitous as Kagans behavior was, ACOGs presentation to the world of an authoritative opinion justifying PBA that appears to have been produced with language supplied by Kagan demonstrates that there is a pro-abortion scientific-political axis. For the basic facts, follow the link to this excellent CNSNews story.

Fortunately, there is an honest ob/gyn group in America. It is the American Association of Pro Life Obstetricians and Gynecologists (AAPLOG), and they have had a great deal to say about PBA. (See AAPLOG on PBA). One of AAPLOG’s brilliant doctors is Mary Davenport, M.D., and she recently wrote an important piece for the American Thinker website on PBA, ACOG, Kagan, and the politicization of science. Much of her June 30th article, Elena Kagan: No Respect for Science, warrants repeating in this space:

Incendiary memos written by Elena Kagan in 1996 have surfaced from her stint as President Clintons domestic policy adviser. At that time, Congress was in an uproar over the recently invented technique of partial birth abortion. Many Americans were horrified when they learned about this brutal abortion procedure, in which second and third trimester fetuses were killed by having their brains sucked out and skulls collapsed.

At that time there were no studies on partial birth abortion. It is clear from [the Kagan memos] that a select panel convened by ACOG … did not believe that the partial birth abortion was necessary to safeguard maternal life or health. The [AMA] opposed the procedure. However, President Clinton himself had insisted (inaccurately) that these abortions were done only in extreme circumstances and were necessary to prevent adverse health consequences for women and preserve their future fertility. For ACOG to have asserted that there was no medical necessity for the partial birth abortion procedure would have been a political disaster for the Clinton administration.

* * * * *

Of course the illusion that partial birth abortion is a medically necessary procedure could never have been sustained without the willing collusion of ACOG. ACOG, the principal professional organization of the 52,000 U.S. OBGYN physicians, claims to serve as a strong advocate for quality health care for women. Yet its policies have consistently mirrored the most radical elements of reproductive health ideology, rather than mainstream medical opinion.

Advocacy of partial birth abortion is not ACOGs only position contrary to sound science and medicine. When the Clinton administration imported RU-486 abortions from Europe into the U.S., the initial clinical trials included safeguards such as ultrasound to rule out tubal pregnancy and close physician supervision. However, under pressure from Barbara Boxer, who called the safety provisions draconian and ACOGs purportedly scientific recommendations, the FDA removed these safety provisions. A number of deaths occurred in the U.S. shortly after release as a result of the conversion of RU-486 abortion to essentially a do-it-yourself procedure. ACOG also has repeatedly failed to officially recognize the adverse psychological sequelae of abortion on women and their families, as well as abortion as a major cause of preterm birth and cerebral palsy despite hundreds of studies demonstrating these adverse effects.

Change Watch: Dr. Donald Berwick, Administrator, Center for Medicare and Medicaid Services

by David Prentice

July 7, 2010


NOMINEE: Donald M. Berwick

BIRTHDATE: 1946 in New York City, NY


B.A., Harvard University

M.P.P., John F. Kennedy School of Government, Harvard University

M.D. 1972, Harvard Medical School, Harvard University

FAMILY: wife Ann (Greenberg) Berwick; father of four children (two sons and two daughters)


President and Chief Executive Officer, Institute for Healthcare Improvement (IHI)

Clinical Professor of Pediatrics and Health Care Policy, Harvard Medical School

Professor of Health Policy and Management, Harvard School of Public Health

Associate in Pediatrics at Bostons Childrens Hospital

Consultant in Pediatrics at Massachusetts General Hospital

Liaison to the Institutive of Medicines Global Health Board and serves on the governing council

1991-2001 Chair of the National Advisory Council of the Agency for Healthcare Research and


1995-1999 Chair of the Health Services Research Review Study Section of the Agency for Health

Care Policy and Research

1990-1996 Vice Chair of the U.S. Preventive Services Task Force

1987-1991, Co-founder and Co-Principal Investigator for the National Demonstration Project on

Quality Improvement in Health Care (NDP)

Member of the Institute of Medicine of the National Academy of Sciences


2005 Honorary Knight Commander of the Most Excellent Order of the British Empire

2004 Inducted as Fellow of the Royal College of Physicians in London

2002 Award of Honor from the American Hospital Association

2001 Alfred I. DuPont Award for excellence in childrens health care

1999 Ernest A. Codman Award


The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”


You plan the supply; you aim a bit low; historically, you prefer slightly too little of a technology or service to much too much; and then you search for care bottlenecks, and try to relieve them.”


Limited resources require decisions about who will have access to care and the extent of their coverage. The complexity and cost of health care delivery systems may set up a tension between what is good for the society as a whole and what is best for an individual patient…Hence, those working in health care delivery may be faced with situations in which it seems that the best course is to manipulate the flawed system for the benefit of a specific patient…rather than to work to improve the delivery of care for all.


If we could ever find the political nerve, we strongly suspect that financing and competitive dynamics such as the following, purveyed by governments and payers, would accelerate interest in the Triple Aim and progress toward it: (1) global budget caps on total health care spending for designated populations, (2) measurement of and fixed accountability for the health status and health needs of designated populations, (3) improved standardized measures of care and per capita costs across sites and through time that are transparent, (4) changes in payment such that the financial gains from reduction of per capita costs are shared among those who pay for care and those who can and should invest in further improvements, and (5) changes in professional education accreditation to ensure that clinicians are capable of changing and improving their processes of care. With some risk, we note that the simplest way to establish many of these environmental conditions is a single-payer system, hiring integrators with prospective, global budgets to take care of the health needs of a defined population, without permission to exclude any member of the population.


Rational healthcare stakeholders are eroding a common good, simply doing what makes sense to them individually. In the short term everyone wins, but in the long term, everyone loses. … Healthcare is not entitled to everything it has, and it is surely not entitled to everything it can get.


If I could wave a magic wand…health care [would be] a common good—single payer…health care [would be] a human right—universality is a non-negotiable starting place…justice [would be] a prerequisite to health—equity is a primary quality goal.



Fifth, please dont put your faith in market forces. Its a popular idea: that Adam Smiths invisible hand would do a better job of designing care than leaders with plans can. I do not agree. I find little evidence anywhere that market forces, bluntly used, that is, consumer choice among an array of products with competitors fighting it out, leads to the health care system you want and need. In the US, competition has become toxic; it is a major reason for our duplicative, supply-driven, fragmented care system. Trust transparency; trust the wisdom of the informed public; but, do not trust market forces to give you the system you need. I favor total transparency, strong managerial skills, and accountability for improvement. I favor expanding choices. But, I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.


At the individual level, I dont trust incentives at all. I do not think its true that the way to get better doctoring and better nursing is to put money on the table in front of doctors and nurses. I think thats a fundamental misunderstanding of human motivation. I think people respond to joy and work and love and achievement and learning and appreciation and gratitude-and a sense of a job well done. I think that it feels good to be a good doctor and better to be a better doctor. When we begin to attach dollar amounts to throughputs and to individual pay, we are playing with fire.


Berwick complained the American health system runs in the “darkness of private enterprise,” unlike Britain’s “politically accountable system.” The NHS is “universal, accessible, excellent, and free at the point of care — a health system that is, at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just”; America’s health system is “toxic,” “fragmented,” because of its dependence on consumer choice.


In the United States, those hundreds of insurance companies have a strong interest in not selling health insurance to people who are likely to need health care. Our insurance companies try to predict who will need care, and to find ways to exclude them from coverage through underwriting and selective marketing. That increases their profits. Here, you know that that isnt just crazy; it is immoral.



You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized, and humane must must redistribute wealth from the richer among us to the poorer and less fortunate.


YouTube video of quote from speech


There is less progress in some areas…such as in specialty access, cancer outcomes, patient-centeredness, life expectancy and infant mortality for socially deprived populations.


I am romantic about the NHS; I love it. All I need to do to rediscover the romance is to look at health care in my own country.


The National Health Service is one of the truly astounding human endeavors of modern times.


We think nationalized health care was a wise choice in 1948 and that it remains so now.


NICE is not just a national treasure, he says, it is a global treasure.


NICE is extremely effective and a conscientious, valuable, and importantly knowledge-building system. The fact that its a bogeyman in this country is a political fact, not a technical one.


I hope you will never, ever give up what you have begun,” said Berwick. “I hope you realize and affirm how badly you need — how badly the world needs — an example at scale of a health system that is universal, accessible, excellent and free at the point of care — a health system that, at its core is like the world we wish we had: generous, hopeful, confident, joyous and just. [Source]

Some background on Britains system…

Michael Tanner notes that, NICE, however, is not simply a government agency that helps bureaucrats decide if one treatment is better than another. With the creation of NICE, the U.K. government has effectively put a dollar amount to how much a citizens life is worth. To be exact, each year of added life is worth approximately $44,305 (30,000). Of course, this is a general rule and, as NICE chairman Michael Rawlins points out, the agency has sometimes approved treatments costing as much as $70,887 (48,000) per year of extended life. [Source]

Dr. Milton R. Wolf notes that, Britain’s higher cancer mortality rate results in 25,000 more cancer deaths per year compared to a similar population size in the United States. But because the U.S. population is roughly five times larger than the United Kingdom’s, that would translate into 125,000 unnecessary American cancer deaths every year. This is more than all the mothers and fathers, aunts and uncles, cousins and children in Topeka, Kan. And keep in mind, these numbers are for cancer alone. America also has better survival rates for other major killers, such as heart attacks and strokes. [Source]

Robert M. Goldberg writes, It may not be joyous or just or configured correctly, but for nearly every disease, particularly cancer, stroke, and heart attacks, Americans live longer and healthier than the English because of better care. Americans spend less time in the hospital, have fewer doctors, and see doctor’s less often per capita than people in Great Britain. In the past two years the number of people waiting over three months to see a doctor in the NHS has increased by 50 percent. Productivity of the NHS — which was Berwick’s principal mission — declined 2.5 % over the past five years. Last year it cut primary care services and wound up with a 2 billion pound surplus. The NHS spent the money not on patients but on equipment, bonuses, and consultants in an end of the year rush. Meanwhile hospital-acquired infections in the UK remain as high as ever while they decline in “toxic” America. [Source]

Better Fireworks and BBQ Through Chemistry

by David Prentice

July 3, 2010

The American Chemical Society has produced a couple of timely videos for the Fourth of July holiday.

First, there is The Chemistry of Barbecue, which includes some good tips on getting the most from your BBQ experience.

The Chemistry of Barbecue from ACS Pressroom on Vimeo.

And once you’ve eaten your fill, you’re ready for FIREWORKS!

Bytesize Science Presents: The Chemistry of Fireworks from ACS Pressroom on Vimeo.

Have a Happy Independence Day!

Tony Perkins Testifying at Elena Kagan Confirmation Hearing

by Carrie Russell

July 2, 2010

As one who has spent a number of years in uniform, as a Marine and a police officer, my remarks will focus primarily on Ms Kagan’s treatment of military recruiters at Harvard Law School.

As has been pointed out while Dean of the law school she defied the requirements of a federal law, known as the Solomon Amendment. Her violation of this federal law was motivated by her vehement opposition to the military’s prohibition against open homosexuality.

This protracted incident, combined with the just made public report of her re-writing of the medical findings of ACOG on partial birth abortion as advisor in the Clinton White House, raises doubts as to whether she possesses the requisite judicial temperament and impartial nature required of a Supreme Court justice.

We do not need a justice on the Supreme Court who sees it as her life mission to write the homosexual version of Roe v. Wade by striking down one-man, one-woman marriage across America. These positions and the temperament accompanying them make her unfit to sit as an associate justice on the Supreme Court. I urge the Senate to reject her nomination.”

Perkins’ complete prepared testimony can be viewed here.

Chronic Heart Failure Treated with Adult Stem Cells

by David Prentice

July 2, 2010

A German team led by Prof. Dr. med. Bodo Strauer has published the results of a long-term study of treating chronic heart failure patients with adult stem cells. The study, published in the European Journal of Heart Failure, is the largest study to date of patients treated for heart failure with bone marrow adult stem cells. The results show that treatment with adult stem cells improves heart pumping performance, quality of life and survival in patients with heart failure.

In this long-term study, 391 patients with chronic heart failure were studied. Of this total, 191 patients received intracoronary injections of their own bone marrow adult stem cells, while 200 patients served as the control group. The patients’ heart condition and overall health were followed for up to five years. Patients who received adult stem cells showed a significant improvement in heart function and a significant decrease in long-term mortality, with no side effects, compared with the control group.

This long-term study provides further evidence of the effectiveness of adult stem cells for treatment of heart damage. Prof. Dr. med. Strauer and his team continue to be leaders in the application of adult stem cell transplants to treat heart conditions. Strauer and his colleagues recently published a book on the use of adult stem cells for heart treatments.

Adult Stem Cells May Help Fight Infection

by David Prentice

July 1, 2010

Canadian researchers have found that mesenchymal stem cells, a type of adult stem cell found in bone marrow and some other tissues, may help treat septic infection. Mice that had a septic infection were treated with mouse mesenchymal bone marrow adult stem cells; animals also received standard antibiotic treatment. Mesenchymal stem cells are known to influence the immune system and help repair tissue damage. Five days after treatment, 50 per cent of the animals that received the adult stem cells were alive, compared to just 15 per cent of the control animals that did not receive the cells.

According to Dr. Duncan Stewart, senior author:

Our results suggest that mesenchymal stem cells may provide a promising new approach for treating organ damage caused by severe infection and we are looking to test this in patients in the near future.”

Sepsis is the second leading cause of mortality in Canadian and U.S. intensive care units, resulting in more than 200,000 deaths each year and more than $16 billion in health care costs.

The study is published in the American Journal of Respiratory and Critical Care Medicine.

  • Page 3 of 3
  • 1
  • 2
  • 3

June 2010 «

» August 2010