Illinois Pharmacists, Walgreen Reach Settlement On EC Distribution Rule

Illinois pharmacists who object to dispensing emergency contraception on moral grounds would be allowed to let another person on staff fill the prescription under a settlement filed last week between Deerfield, Ill.-based Walgreen and the state, the AP/Yahoo! News reports. According to the settlement, trained technicians or store owners would be able to contact a pharmacist at another location and then follow his or her directions for dispensing EC, which can prevent pregnancy if taken within 72 hours of sexual intercourse (Wills, AP/Yahoo! News, 10/11).

The Washington, D.C.-based American Center for Law and Justice in January 2006 filed a state lawsuit against Walgreen on behalf of four Illinois pharmacists who were suspended without pay in November 2005 for declining to dispense EC based on moral or religious beliefs. The lawsuit -- which was filed in Madison County, Ill., Circuit Court -- says the company violated the Illinois Health Care Right of Conscience Act, which allows health care providers to refuse to perform procedures that conflict with their moral or religious beliefs.

Under an Illinois rule -- which was proposed by Gov. Rod Blagojevich (D) and approved in August 2005 by the Illinois Joint Committee on Administrative Rules -- state pharmacies are required to dispense EC if they stock any FDA-approved contraceptive or risk losing their licenses. If any prescribed contraceptive is out of stock, pharmacies must provide an alternative, order the drug, make arrangements for another local pharmacy to fill the order or return the prescription to the customer. The rule allows pharmacies to opt not to sell any contraceptives (Kaiser Daily Women's Health Policy Report, 1/13).

Reaction
Francis Manion, an attorney for the pharmacists who filed the lawsuit, said the settlement is between Walgreen and the state, adding that his clients generally support it and will not continue with the litigation. "We think it's fair for us as well as our pharmacists," Walgreen spokesperson Tiffani Bruce said, adding that the deal "allows us to continue to care for patients." Attorneys said the settlement does not include any exchange of money.

"It seems to be a thoughtful settlement," Pam Sutherland, president of Illinois Planned Parenthood, said Wednesday, adding that the settlement gives pharmacists "an out, and it still makes sure the woman gets her prescription." The settlement must be reviewed by a legislative panel before it can take effect because it requires a change in state rules (AP/Yahoo! News, 10/11).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Low-Income Women Less Likely To Receive Mammograms, CDC Report Finds, USA

Women without a high school diploma or with an annual household income lower than $15,000 are less likely to receive mammograms than women with more education and a higher income, according to a CDC report published on Thursday in the Morbidity and Mortality Weekly Report, the South Florida Sun-Sentinel reports. The report, which focused on 35 metropolitan areas nationwide, examined 2000 census data and records from a national health survey conducted by telephone in 2002. According to the report, 78.5% of women ages 40 and older said that they had received a mammogram within the previous two years. Among those women, 68.4% with an annual household income of less than $15,000 underwent mammograms, compared with 82.5% with an annual household income of more than $50,000, the report found. The report said that more research is required to determine the reasons for the disparity, although the difference might result from factors such as access to health care, cost, availability of public transportation or availability of public heath clinics (McVicar, South Florida Sun-Sentinel, 10/7). The complete report is available online.


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Preventive Surgeries Linked To Lower Risk Of Breast And Ovarian Cancer

Women with the inherited mutations of the BRCA1 or BRCA2 genes who had preventive (prophylactic) breast removal (mastectomy) or the removal of the fallopian tubes and ovaries (salpingo-oophorectomy) were found to have a significantly lower risk of developing ovarian and breast cancers, says a study published in JAMA (Journal of the American Medical Association), September 1st issue.


The authors wrote that females who carry the inherited mutations of the BRCA1 or BRCA2 genes have a considerably higher chance of developing breast or ovarian cancer - there is a 56% lifetime risk of breast cancer and 84% lifetime risk of ovarian cancer.


The authors added:


Women who are mutation carriers have cancer risk-management options that include risk-reducing salpingo-oophorectomy, risk-reducing mastectomy, annual cancer screening, and chemoprevention.


Susan M. Domchek, M.D., of the University of Pennsylvania School of Medicine, Philadelphia, and team carried out a study involving 2,482 women who had the BRCA 1 and BRCA 2 mutations to find out what their cancer risk reduction was following a prophylactic salpingo-oophorectomy and mastectomy, incorporating mutation type (BRCA1 vs. BRCA2), and cancer history (prior history of breast cancer vs. none). The women's gene mutations were determined between 1974 and 2008.


The study was performed at 22 clinical and research genetics centers in North America and Europe. The participants were monitored through to the end of 2009.


Breast Cancer Risk: The investigators found that:

None of the women with the mutated genes who had a prophylactic mastectomy developed cancer during the 3-year follow-up period.
7% of the women with the mutated genes who did not have a prophylactic mastectomy developed cancer during the 3-year follow-up period.

Ovarian Cancer Risk: The investigators found that:

Risk-reducing salpingo-oophorectomy was associated with a decreased risk of ovarian cancer, with no ovarian cancer events seen during the 6 years of prospective follow-up in BRCA2 mutation carriers without prior breast cancer who underwent the procedure.
Three percent of women without salpingo-oophorectomy over a similar follow-up period were diagnosed with ovarian cancer.

The researchers found no cases of ovarian cancer among women with the BRCA 1 mutation after salpingo-oophorectomy, which was also linked to a lower risk of breast cancer in BRCA1 and BRCA2 mutation carriers without prior diagnosis of breast cancer.


The authors wrote:


Compared with women who did not undergo risk-reducing salpingo-oophorectomy, undergoing salpingo-oophorectomy was associated with lower all-cause mortality (10 percent vs. 3 percent), breast cancer-specific mortality (6 percent vs. 2 percent), and ovarian cancer-specific mortality (3 percent vs. 0.4 percent).





"Association of Risk-Reducing Surgery in BRCA1 or BRCA2 Mutation Carriers With Cancer Risk and Mortality"

Susan M. Domchek, MD; Tara M. Friebel, MPH; Christian F. Singer, MD, MPH; D. Gareth Evans, MD; Henry T. Lynch, MD; Claudine Isaacs, MD; Judy E. Garber, MD, MPH; Susan L. Neuhausen, PhD; Ellen Matloff, MS; Rosalind Eeles, PhD; Gabriella Pichert, MD; Laura Van t'veer, PhD; Nadine Tung, MD; Jeffrey N. Weitzel, MD; Fergus J. Couch, PhD; Wendy S. Rubinstein, MD, PhD; Patricia A. Ganz, MD; Mary B. Daly, MD, PhD; Olufunmilayo I. Olopade, MD; Gail Tomlinson, MD, PhD; Joellen Schildkraut, PhD; Joanne L. Blum, MD, PhD; Timothy R. Rebbeck, PhD

JAMA. 2010;304(9):967-975. doi:10.1001/jama.2010.1237

Missouri's Constitutional Amendment Protecting Stem Cell Research Encounters 'Political, Financial Roadblocks,' New York Times Reports

A constitutional amendment approved by Missouri voters in November 2006 that was expected to expand and protect human embryonic stem cell research in the state has "run into political and financial roadblocks, putting the future of the research in doubt," the New York Times reports. According to the Times, the debate over the amendment has become a "fight over what constitutes 'cloning.'"

Supporters of the amendment say that it bans human cloning, which is defined in the amendment as an act that could result in a pregnancy and the creation of a human fetus inside a woman's uterus. Opponents say that cloning is the replication of cells, regardless of implantation in the uterus. Some state lawmakers who oppose the amendment said they will continue to fight it by introducing new bills that would ban some types of stem cell research.

"We think it's a false distinction to say that a clone exists only based on geography," Pam Fichter, president of Missouri Right to Life, said, adding that the group supports "ethical stem cell research, and we think cloning was misrepresented to voters. We know that a majority of Missourians oppose cloning." Donn Rubin -- chair of the Missouri Coalition for Lifesaving Cures, which led efforts to pass the amendment -- said that reproductive cloning was a major concern among voters. "What we protect is a very promising form of medical research that involves cells in a lab dish, not something that involves pregnancy," Rubin said.

Jaci Winship, executive director of Missourians Against Human Cloning, said the group is considering the possibility of a new initiative against the amendment, perhaps as soon as next year. Members of MRTL have been gathering signatures and contributions for the effort, the Times reports. According to Rubin, MCLC has continued raising money to prepare for another fight over the amendment.

Future of Research
According to the Times, although legislative efforts have failed so far, the "uncertainty" of the research's future in the state has made it difficult for facilities to attract stem cell specialists (Davey, New York Times, 8/10).

Many scientists who considered moving to Missouri to conduct stem cell research will not come to the state because of the uncertainty over whether the legislation will be overturned. The Stowers Institute for Medical Research in late July canceled plans to expand in Kansas City, Mo., because it was unable to recruit top stem cell researchers. The institute also transferred a large portion of its $2 million endowment to Delaware because the political climate in Missouri was too hostile (Kaiser Daily Women's Health Policy Report, 8/1).














Kevin Eggan, an assistant professor of molecular and cellular biology at Harvard University, said he strongly considered moving to Stowers but delayed his plans. "Everybody hoped that Missouri was going to be a good test case," Eggan said, adding, "It was exciting to us that stem cell research was being voted in a state which has very restrictive abortion laws. But it has turned out to be a big disappointment."

Sen. Chuck Graham (D) said, "For a bright shining moment in time, we were moving ahead as a state to protect research." He added, "But now the other side wants to walk away, not only from stem cell research, but all research. Their attitude now is, if there's a beaker or a Petri dish involved, we're not going to fund it." Rep. Jim Lembke (R), who opposes embryonic stem cell research and proposed legislation outlawing elements of the research, said, "As people are educated about this issue, they come around" (New York Times, 8/10).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.