HHS Sec. Michael Leavitt Has No Comment on Contraception and Ab-Only Proposals


Today at a session hosted by the Henry J. Kaiser Family Foundation, entitled, The Health Blogosphere: What it Means for Policy Debates and Journalism, Health and Human Services Secretary Michael Leavitt spoke about his experience being the first Cabinet Secretary to blog. He discussed the impact of new media on policy debates, and the absolute fact that the blogosphere will be important in shaping the coming health care reform debate. He shared some personal writing from his blog.

But he didn’t actually engage the public policy debate by answering a substantive question about health care policy, which I asked;

Mr. Secretary thank you for being here and sharing your thoughts about blogging, I’m hoping you’ll engage a policy question to give us something to blog about. Within the past two weeks, two highly charged issues have surfaced from HHS: a leaked memo redefining some contraceptive devices as abortion; and a waiver of the annual application for Title V abstinence-only programs.

The former will substitute an ideological and political definition of when pregnancy begins for the medical judgment of the American Medical Association and the American College of Obstetricians and Gynecologists. The latter will, for the first time, ignore Congress’ reluctance to make abstinence-only programs permanent — they have had 19 short-term extensions, and Speaker Pelosi said last week that with a stronger majority in Congress it will end. This effort potentially ties the hands of the next administration and promises states money that has not been authorized.

1) Will it be HHS policy that the 98% of Americans who use contraception at some point in their lives are terminating rather than preventing pregnancy?

2) Can you explain why this grant period should be treated differently than the previous 19 short-term extensions for abstinence-only programs?

 

Very politely, Secretary Leavitt refused to engage in the serious policy questions with a room full of bloggers by saying;

Those are very thoughtful questions. I do not have anything to add to your blog today. Next question.

 

Since the Secretary does believe in engaging the health care debate on his own blog, if not in person with bloggers as Speaker Pelosi did, perhaps he’ll provide a thoughtful reply on his blog. He may have started drafting it on his Blackberry on the way back to the office, a way he told the audience many of his posts start, others on the treadmill, others in international airports. He does write them himself, and the inherent risks of dealing with issues at the level he must, and writing about them in the blogosphere is without question a high wire act. He deserves credit for making the effort and not turning it into a publicity machine handled by staff.

The policies I asked him about were handled by staff, but ultimately the Secretary must address these hyper-politicized and ideological proposals as the spokesperson for the Department, as he said in his talk. The redefinition of contraception was like a prairie fire on the web, with traffic to RH Reality Check and other sites covering it spiking to two and three times the norm. If Secretary Leavitt engages the conversation he’ll likely see the same spike in traffic and introduce new readers to his courageous endeavor.

The abstinence-only funding proposal resonates more with policy watchers. The American people have already largely rejected abstinence-only policies to the point where they have become laughable, as seen in this You Tube video, not likely what Secretary Leavitt has in mind with a partnership between HHS and You Tube that he mentioned is coming this fall. The fact that abstinence-only policies risk teen health by preventing reality-based education makes them no laughing matter, and something many Americans are already blogging about.

The Panel

Panelists that followed the Secretary discussed what it means to be blogging about health care, and how the coming reform debate will be impacted. Much of the discussion was about audience, the blurring of the lines between mainstream journalism and blogging, and the niche nature of health care blogs.

One topic discussed was that of the Frost family, spokespeople for the S-Chip debate, and what E. J. Dionne of the Washington Post called the "ugly underbelly of the blogosphere" when conservative blogger Michelle Malkin invaded the family’s privacy. She reported second-hand information picked up from their neighbors. It was later discovered to have been part of a coordinated right-wing smear operation and Malkin herself complained about people invading her privacy.

Ezra Klein, Associate Editor of The American Prospect, called her "vituperous" and clearly indicated that she’d crossed the lines. Michael Cannon, Director of Health Policy Studies for the CATO Institute, countered by asking if we’d feel better about it if the information were reported by a mainstream journalist, or if a left-wing blogger had asked Leona Helmsley’s neighbors questions about her tax payments. Something about comparing average Americans trying to cover health care costs for their children and Leona Helmsley strikes me as odd, but highlights the ways in which the left and the right differ in their views of the world.

Tom Rosenstiel, Director for the Project on Excellence in Journalism, suggested that the advantage of the blogosphere is that it is conversational, commenting on what the mainstream media is reporting. But Klein noted that many blogs are now regularly breaking news (to our knowledge no one in mainstream media has yet reported the HHS ab-only funding story) and Rosenstiel noted that reporters often have to learn issues in very short periods of time, giving bloggers with expertise an advantage at times.

In these and many other ways, the panelists seemed to agree that the lines between mainstream media and new media blogs is blurring, as more journalists turn to blogging themselves and mainstream media tries to find its role in a dramatically changing world.

John McDonough, Senior Health Reform Advisor to Sen. Edward Kennedy and a veteran of the Massachussetts health care reform process, noted that the blog he contributed to during the Massachussetts debate, Health Care for All, facilitated important conversations and allowed for immediate feedback during the debates and implementation. Jacob Goldstein of the Wall Street Journal Health Blog talked about the moves into new media by the venerable WSJ.

It was an interesting discussion, but the most interesting part is yet to come. Having agreed that reporting on the blogosphere, where perspective is out in the open, and mainstream media where we all know everything is fair and balanced, as Klein noted, "is no longer a place where much tension exists."

So let’s engage the substantive policy questions.

Secretary Leavitt? Let’s blog!

We eagerly await an answer to the substantive policy questions above on your blog.

 

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  • scott-swenson

    Secretary Leavitt’s blog, at least as far as HIV is concerned, is intriguing. It is the only section I’ve had a chance to read thoroughly after doing searches for abstinence-only, reproductive health, birth control, sex education, maternal health, women’s rights and abortion, trying to get a sense of what he’d written on the issues we focus on. None of those topics show up in his blog in a substantive way, except for in comments.

     

    On HIV I want to sample a few of his posts to give readers a sense of what he is writing about, and to highlight some of his more interesting observations.

     

    After a very moving discussion about the genocide in Rwanda and how it has torn that nation, he talks about HIV and the US role in preventing its continued destruction;

     

    I see our nation and others with us, sending tens of billions of
    dollars to fuel this effort. There has never been a more noble
    humanitarian effort made to stand between mankind and disease — and
    yet, we are losing. While we succeed in treating the sick and providing
    life and hope for millions, new cases are growing faster than our
    ability to treat them.

    Whether it is in the outback of Africa or the streets of American
    cities, we cannot treat our way out of this epidemic. Prevention is the
    only way to succeed. Prevention requires change of behavior. Changes
    in behavior happen only when there is change of heart.

     

    Later in the same blog he writes,

     

    The condom use part of our ABC policy (Abstinence before marriage; Be faithful in marriage and consistent Condom
    use in high risk behavior) is important because it recognizes the
    realities of human behavior but here’s another reality: In a world
    saturated with AIDS, any society that counts on the C (Condoms) part of
    ABC to facilitate a continued practice of males routinely having
    multiple and concurrent sexual partners will be overrun by AIDS and its
    harsh economic, social and health consequences.

     

    We agree Secretary Leavitt. Prevention is a priority and treatment is essential, but without prevention efforts based in reality and sound public health strategies, that include information about reducing sexual partners and being faithful in relationship with use of condoms and getting tested early, we will continue to lose. As you know, Sen. Coburn and other conservatives in Congress forced ideological changes to the original draft of the soon to be signed PEPFAR that actually weaken its prevention efforts. PEPFAR is an important and life saving bill, but the reality is without the misinformation about abortion and conservative ideologies like abstinence-only, it could have been much better.

     

    In this blog from Tanzania he writes about a PEPFAR success story, inclusive of improved facilities and a treatment story;

     

    She told me an all too familiar story of her husband becoming sick
    with TB. He also had AIDS, but didn’t tell his wife. The husband died
    and several months later she began to feel symptomatic. At the urging of her neighbor, (the woman who volunteers with
    Pathfinder) she was tested.

    The result was positive; in fact, she was
    rather ill with a CD4 count, reflecting the strength of her immune
    system, of 140. (The CD4 count in an non-HIV infected adult can range
    from 500 to 1,500 and the CDC considers persons with CD4 counts below
    200 to have AIDS.) She told me, as others have, of their despair at
    that moment.

    She began getting treatment and has regained both health and hope.
    She has now become a volunteer doing the same for other people.

     

    In fact, most of the cases he writes about in his blog are about women who contracted HIV through marriage, another issue we care about deeply at RH Reality Check, and tried to get others to focus on more during the PEPFAR debates. Again, conservative ideologues prevailed by denying efforts to integrate reproductive health and HIV services suggesting, falsely, that the monies could be used for abortion. It derailed the debate and prevented improvements in PEPFAR.

     

    Secretary Leavitt, could you please educate those in your party in Congress on these important issues.

     

    In Mozambique, he encounters a young woman that brings home other startling realities;

     

    A dozen children scampered around me as I walked, excited about
    these mostly white strangers. Adults looked up from whatever they were
    doing, startled and curious. One of them was a pretty woman standing
    next to a little boy about three years old. I asked to meet her little
    boy.

    “His Father died a few months ago,” she said. I offered my second condolence in 100 feet and asked if this was her only child?“

    No, I have five.” I was surprised. She didn’t seem old enough. As
    we talked, it seemed evident her husband had died of AIDS, leaving her
    alone to carry the heavy cost of this pandemic. I didn’t ask, but
    wondered if she, like so many others I’ve seen on this trip, had been
    infected by a spouse, compounding the tragedy. I moved on.

     

    Women being forced to marry too young is a problem. Their lack of power in realtionships, inability to negotiate sex as equal partners, and lack of personal resources is the very sad reality. Leavitt also noted;

     

    Only $12 per person is spent on health care each year in Mozambique.
    (For perspective, in the United States it is nearly $6,000 a year.) Not
    surprising, 40% have no access to care at all.

     

    The links between poverty and HIV are clear in his writing, but I couldn’t tell if the 40 percent figure was a bit of a double entendre, referring to both lack of access in Mozambique as well as the number of uninsured in America. The latter however is not 40 percent, just well more than 40 million, an embarrassment when compared to other developed nations.

     

    He writes of another young woman who contracted the disease from her husband;

     

    I met an unforgettable woman that morning. She is in her mid 30’s,
    with an “out there” personality. She wore a black tee shirt with the
    words printed in large bold letters, “I am HIV Positive.”

    Her mission in life now is to give other women courage to face the
    world without stigma. She contracted HIV from her husband, who is now
    dead. She helps organize “positive teas” for the woman in this group.
    They get together, sing and talk, bolstering each other for the
    hardships of the week.

     


    From South Africa
    , Sec. Leavitt begins to connect the dots as colonialism, racism, apartheid, patriarchy, sexism and poverty all converge to create the pandemic;

     

    Dr. Salim Abdool Karim, the head of CAPRISA, told me women have
    their share of misconceptions. He told me of a study he had conducted
    where he asked women if they thought they were vulnerable to being
    infected; 32% said they were. When asked if they thought their partner
    was in danger, 78% said yes. There is an implicit admission inherent in
    those answers. The women surveyed clearly know their partners are
    having sex with multiple partners but don’t see it as a threat to them.

    Salim told me part of the problem can be attributed to the policies
    of apartheid. The black populations were forced to live in specific
    areas often far away from their work opportunities. The consequence was
    that they would rarely see their spouses/partners. In many areas it was
    common for four or five men to share what they call a “town wife.”
    While they were away from home, a worker would receive food, company,
    comfort and sex. In return, he provides a portion of the woman’s
    support.

    It does not take much imagination to construct the algorithmic
    progress a virus can make in such an arrangement. Especially if a
    significant number of the women left at home are engaged with multiple
    partners.

    In another interesting project, CAPRISA found 86% of new infections
    were among people with stable relationships; married or long term
    relationships. Researchers characterized the actual viruses and found
    in 25% of the cases, the female got the virus from a male other than
    her partner.

    I asked several of the patients I talked with if they had any sense
    that women they know were more selective about their partners if they
    suspected they could be HIV positive? Their responses did not give me
    confidence it was so.

    In all our research, we need to understand better the combination
    required to help people change their behavior. This work is about
    changing hearts. The status of a nation is defined by the aggregation
    of their hearts. When a heart changes, a nation changes in a small way
    with it.

     

    Again, I couldn’t agree more. I’ve seen the townships and the workmen’s dorms near Durban where Leavitt was, they are horrific and leave one wondering how any human can treat another this way – ever. What in God’s name ever justified the apartheid, colonialism and patriarchy that resulted in these conditions? Nothing.

     

    Hearts are changing. Old ways of colonialism, racism and sexism are being seen as worn out relics of humanity’s ignorance, and to keep patriarchy around will soon be seen akin to supporting apartheid. We must make certain that globalization does not become the new colonialism, and this disease has the potential of helping us see that reality – if we have the courage to learn from it, and not repeat the mistakes that created it.

     

    It is far more than sexual behavior that must change, it is a world view that creates circumstances in which people can ever degrade another human, for any reason. People are not inherently bad as some would have us believe, but the way some people have been treated, stigmatized, marginalized and abused, can lead to unhealthy and disrespectful behaviors.

     

    To get to this sort of understanding requires social conservative ideologues, like those in Congress, to stop stigmatizing and blaming people, to stop judging an individual and look at the deeper issues at play. To move beyond politics and accept public health strategies that can get the world through this period of difficulty as a result of this disease, and the other remnants of historic ignorance, while we focus on the hope we can deliver to future generations.

     

    I applaud Secretary Leavitt for at least bearing witness to these atrocities and blogging about them as he saw them, unfiltered. I admire the power of the reality he sees. He writes from a place that you can tell he has been moved.

     

    Clearly, policy differences exist between how people writing for this site and the Secretary view the world, but in his writing on HIV, there is at least a sliver of common ground on which to build hope for a future when all people are respected, have rights, accept responsibility for their actions, and are empowered to understand they are unique, and able to live in peace without oppression regardless of race, gender, orientation, income, religion, status, or other characteristics.

     

    Now Mr. Secretary, can we make the linkages between what is happening to people in Africa because of failed policies throughout history, and what is happening to people of African descent in America, rooted in our own failures to live the promise that "all are created equal."

     

    Be the change you seek,

    Scott Swenson, Editor

  • invalid-0

    To be fair, your question had nothing to do with blogging or the Secretary’s blog, other than the fact that you mentioned you were a blogger. The event was about blogging and your question was strictly about policy- not even about how blogging would relate to or influence the policy- and therefor, very much off topic. The event was not a press conference for bloggers, as was the event you refer to with Speaker Pelosi. While I agree with your view on the policy, I do not think the event was the appropriate venue to ask your policy questions. I guess it never hurts to try and you had to give it a shot though, huh?

  • scott-swenson

    Anonymous,

    You raise an interesting point. I thought the discussion was about how bloggers will impact health care debates, and the way to do that is to be present, resourceful, respectful and engage in policy discussions. I didn’t see any ground rules in the materials that indicated we were not allowed to ask substantive questions. I certainly didn’t intend to be inappropriate. So now, I’ve repeated the question in what you will agree is an appropriate forum, actual blogging, and hope the Secretary will respond. Thanks for writing, and yes, I agree, it never hurts to talk about serious policy issues. That’s what blogging, in part, is about. Especially where health care is concerned.


    Be the change you seek,

    Scott Swenson, Editor