Trump Administration Censoring Information On Breast Cancer And Other Aspects of Women’s Health

It was unfortunate but not really unexpected when the Trump Administration took down government sites with information on issues such as climate change and LGBTQ issues. We know that these are issues which various aspects of Trump’s political base would object to. It is harder to understand why they would want to restrict information regarding breast cancer. The Sunlight Foundation reports on such censorship in an articled entitled, Unexplained censorship of women’s health website renews questions about Trump administration commitment to public health:

Today, the Web Integrity Project released our third report about Web censorship at the Office on Women’s Health (OWH). As we have released these reports, journalists and members of the public have asked us about the significance of these removals. Beyond indicating potential changes in policy, these removals sow real doubt about important health considerations for populations of vulnerable women throughout the country.

The report we released today, covered by ThinkProgress and others, documents the removal of the OWH Breast Cancer website, which included fact sheets about breast cancer and information on how to access free or low-cost breast cancer screening programs, from within WomensHealth.gov, the OWH website. Breast cancer, as the website noted before it was removed, affects 1 in 8 women during their lives.

Today’s report follows up on a pair of reports we released two weeks ago, covered by PoliticoNBC News and other outlets, documenting the broad overhaul of the OWH website and delving into the removal of webpages relating to lesbian and bisexual women’s health. For context, WomensHealth.gov was visited approximately 700,000 times in the last 30 days

The specificity of these removals adds more evidence to a growing concern: that public information for vulnerable populations is being targeted for removal or simply hidden. As we have highlighted before, the absence of transparent process around removing this information, which was done without notice, has sown further confusion…

The removal and alteration of content from federal government websites, relating to a wide range of topics including climate changeeconomicswomen’s health, and LGBTQ rights, reflects the social and economic agenda of this administration…

An archived screen shot of the old page is above.

The Drug War Extends To Medicare Patients

There is wide spread consensus that opiates were overused in the past, and their use has been greatly curtailed in recent years. Many people were placed on high doses for chronic pain when this was considered the standard of care, and the pharmaceutical industry did all it could to promote this practice. The problem is many people who are using high doses safely and responsibly are now being targeted by government efforts to decrease opiate use. While it makes sense to limit new prescriptions, and decrease their use in long-time users when possible, the government has been going overboard in intervening in patient care to decrease their use.

Both in January 2016 and January 2017 I encountered cases where Medicare drug plans abruptly reduced the doses of pain medications they would approve, and Medicare is now considering far more draconian cuts as of January 2018. This is largely based upon distorting recommendations from the Centers for Disease Control, with even writers of those guidelines protesting actions by the Medicare plans. Some patients have tried to get around this by paying for part of their prescriptions, but I have recently been informed by local pharmacists that they are now under pressure to stop filling prescriptions for amounts beyond what is approved. This is driving some to the use of cheaper street drugs such as heroin, increasing the risk of overdoses, contrary to the stated goals of regulations to reduce opiate use.

The New York Times has an excellent article on the situation. I have some excerpts below, but recommend reading the full article.

Medicare officials thought they had finally figured out how to do their part to fix the troubling problem of opioids being overprescribed to the old and disabled: In 2016, a staggering one in three of 43.6 million beneficiaries of the federal health insurance program had been prescribed the painkillers.

Medicare, they decided, would now refuse to pay for long-term, high-dose prescriptions; a rule to that effect is expected to be approved on April 2. Some medical experts have praised the regulation as a check on addiction.

But the proposal has also drawn a broad and clamorous blowback from many people who would be directly affected by it, including patients with chronic pain, primary care doctors and experts in pain management and addiction medicine.

Critics say the rule would inject the government into the doctor-patient relationship and could throw patients who lost access to the drugs into withdrawal or even provoke them to buy dangerous street drugs. Although the number of opioid prescriptions has been declining since 2011, they noted, the rate of overdoses attributed to the painkillers and, increasingly, illegal fentanyl and heroin, has escalated.

“The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” said Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.”

Dr. Stefan G. Kertesz, who teaches addiction medicine at the University of Alabama at Birmingham, submitted a letter in opposition, signed by 220 professors in academic medicine, experts in addiction treatment and pain management, and patient advocacy groups.

His patients include formerly homeless veterans, many of whom have a constellation of physical and mental health challenges, and struggle with opioid dependence. For them, he said, tapering opioids does not equate with health improvement; on the contrary, he said, some patients contemplate suicide at the prospect of suddenly being plunged into withdrawal.

“A lot of the opioid dose escalation between 2006 and 2011 was terribly ill advised,” Dr. Kertesz said. “But every week I’m trying to mitigate the trauma that results when patients are taken off opioids by clinicians who feel scared. There are superb doctors who taper as part of a consensual process that involves setting up a true care plan. But this isn’t it.”

Some two dozen states and a host of private insurers have already put limits on opioids, and Medicare has been under pressure to do something, too. Last July, a report by the inspector general at the Department of Health and Human Services raised concerns about “extreme use and questionable prescribing” of opioids to Medicare recipients. In November, a report from the Government Accountability Office took Medicare to task, urging greater oversight of opioid prescriptions…

Opponents of the new limit say that doctors are already overwhelmed with time-consuming paperwork and that many will simply throw up their hands and stop prescribing the drugs altogether.

A delay or denial would put chronic pain patients — or those with inflammatory joint diseases, complex shrapnel injuries or sickle cell disease — at risk of precipitous withdrawal and resurgence of pain, doctors said.

The Medicare proposal relies on guidelines from the Centers for Disease Control and Prevention that say doctors should not increase an opioid to a dose that is the equivalent of 90 milligrams of morphine.

But experts say that Medicare misread the recommendations — that the C.D.C.’s 90-milligram red flag is for patients in acute pain who are just starting opioid therapy, not patients with chronic pain who have been taking opioids long-term. The acute pain patient, the guidelines say, should first be offered treatments like acetaminophen or ibuprofen. A short course of a low-dose opioid should be a last resort.

“We didn’t take a specific position on people who were already on high doses,” said Dr. Lewis S. Nelson, the chairman of emergency medicine at Rutgers New Jersey Medical School and University Hospital, who worked on the guidelines.

“We did say that established, high-dose patients might consider dosage reduction to be anxiety-provoking, but that these patients should be offered counseling to re-evaluate,” he added. “There is a difference between a C.D.C. guideline for doctors and a C.M.S. hard stop for insurers and pharmacists.”

Dr. Erin E. Krebs recently released a comprehensive study showing that patients with severe knee pain and back pain who took opioid alternatives did just as well, if not better than, those who took opioids. Nonetheless, she and seven others who worked on the C.D.C. guidelines signed the letter opposing the Medicare rule.

“My concern is that our results could be used to justify aggressive tapering or immediate discontinuation in patients, and that could harm people — even if opioids have no benefit for their pain,” said Dr. Krebs, an associate professor of medicine at the University of Minnesota.

“Even if we walk away from using opioids for back and knee pain, we can’t walk away from patients who have been treated with opioids for years or even decades now,” she added. “We have created a double tragedy for these people.”

Does Donald Trump Have Dementia Or Psychiatric Problems?

I have been wondering for quite a while whether Donald Trump’s primary problem is dementia or psychiatric. He has shown some signs of possible dementia, but they were hardly definitive. Psychiatrists have also been questioning Trump’s mental health. We probably now have an answer to the question of whether Trump’s problem is dementia versus psychiatric. Reportedly Donald Trump scored a 30 out of 30 on the Montreal Cognitive Assessment. The test is a pretty reliable indicator of dementia and with a score of 30 and, assuming the report of Trump’s score is factual, it is now doubtful that he has dementia.

With dementia ruled out, Trump should have thorough psychiatric testing, but it is unlikely that he will ever consent to this. The only way to force him to would by trying to remove him from office under the provisions of the 25th Amendment, and this is unlikely to happen unless there is a very clear deterioration .

Study Shows That Legalizing Medical Marijuana Decreases Violent Crime

The Guardian reports on another study showing a decrease in crime with legalization of marijuana:

The introduction of medical marijuana laws has led to a sharp reduction in violent crime in US states that border Mexico, according to new research.

According to the study, Is Legal Pot Crippling Mexican Drug Trafficking Organizations? The Effect of Medical Marijuana Laws on US Crime, when a state on the Mexican border legalised medical use of the drug, violent crime fell by 13% on average. Most of the marijuana consumed in the US originates in Mexico, where seven major cartels control the illicit drug trade.

“These laws allow local farmers to grow marijuana that can then be sold to dispensaries where it is sold legally,” said the economist Evelina Gavrilova, one of the study’s authors. “These growers are in direct competition with Mexican drug cartels that are smuggling the marijuana into the US. As a result, the cartels get much less business.”

The knock-on effect is a reduction in levels of drug-related violence. “The cartels are in competition with one another,” Gavrilova explained. “They compete for territory, but it’s also easy to steal product from the other cartels and sell it themselves, so they fight for the product. They also have to defend their territory and ensure there are no bystanders, no witnesses to the activities of the cartel.

“Whenever there is a medical marijuana law we observe that crime at the border decreases because suddenly there is a lot less smuggling and a lot less violence associated with that.”

In other words, the experience with marijuana prohibition is similar to what we experienced with alcohol prohibition.

This also shows a failure of our political system. Despite ending prohibition being both the sensible choice, and a choice favored by a large majority of Americans, there has been little pressure to change the system from either major political party. While the two parties find plenty to fight over, there is little difference over what they parties actually do on far too many issues.

Psychiatrists Debate Speaking Out On Donald Trump’s Mental Health

The Goldwater Rule has received considerable attention this year with the election of Donald Trump. The rule was put into place to dissuade psychiatrists from talking about the mental health of politicians without actually doing an exam after some had speculated about Barry Goldwater’s mental health.  As I noted in July, the American Psychoanalytic Association has released an emailed statement freeing its members to give opinions on the mental state of Donald Trump. The controversy has continued with the publication of a book entitled The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.

The New England Journal of Medicine has an article by a psychiatrist, Claire Pouncey, resonding to criticism of the book and making an argument for psychiatrists to be able to comment on the mental health of Donald Trump. Here is a portion:

…in October, psychiatrist Bandy Lee published a collection of essays written largely by mental health professionals who believe that their training and expertise compel them to warn the public of the dangers they see in Trump’s psychology. The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President rejects the position of the American Psychiatric Association (APA) that psychiatrists should never offer diagnostic opinions about persons they have not personally examined.Past APA president Jeffrey Lieberman has written in Psychiatric News that the book is “not a serious, scholarly, civic-minded work, but simply tawdry, indulgent, fatuous tabloid psychiatry.” I believe it shouldn’t be dismissed so quickly…

The relevance of the Goldwater rule has spiked in the past 2 years in the setting of Trump’s candidacy and now presidency. There are good reasons to respect the intention of Section 7.3. Most psychiatrists want to teach the public about the myriad presentations of mental illness and character pathology and not to oversimplify, stigmatize, promote stereotypes, or disparage the persons whose mental health we work to improve. We believe that people with mental illness can flourish and contribute to our communities, and on the flip side, we do not assume that everyone who behaves erratically or earns public disapprobation is mentally ill. Most psychiatrists do not think we have superpowers that let us know the inner thoughts and psychological workings of strangers. Section 7.3 reminds us to remain humble about the claims we can reasonably make and to present ourselves responsibly for the sake of our patients and our profession.

Increasingly, however, some psychiatrists are expressing professional concern about Trump’s public remarks and behaviors and what they mean for public safety. Lee and her coauthors clearly take themselves to be fulfilling the moral obligation of Section 7 by using their specific expertise as mental health professionals.

The Goldwater rule, like the other APA annotations, is meant to clarify a principle of medical ethics, not contradict it. Yet in March 2017, shortly after Trump’s presidential inauguration, the APA broadened the rule to apply to “any opinion on the affect, behavior, speech, or other presentation of an individual that draws on the skills, training, expertise, and/or knowledge inherent in the practice of psychiatry”5 — an expansion that would silence psychiatrists who want to honor the moral obligation of Section 7 by educating the public about the dangers they see in Trump’s psychology. The problem is that psychiatric diagnostic terminology has been colloquialized, so the public and the press use it to describe Trump, but when a psychiatrist does so, use of the same words is considered to be a formal diagnosis (at least in the eyes of the APA). As a result, psychiatrists are the only members of the citizenry who may not express concern about the mental health of the president using psychiatric diagnostic terminology.

The Dangerous Case of Donald Trump challenges the APA position that a psychiatrist cannot know enough about a person she has not interviewed to formulate a diagnostic impression. Contrary to the APA, a physician who has not formally evaluated a patient is not making a diagnosis in the medical sense, but rather using diagnostic speculation and terminology informally, with the benefit of education. That characterization applies to the orthopedist or physical medicine specialist speculating on the knee injury of the football player limping off the field and the dermatologist wincing at a stranger’s melanoma in the grocery line as well as to the psychiatrist interpreting Trump’s public statements. Physicians don’t stop knowing what we know when we leave the clinic. Psychiatric terminology has become part of the common parlance, and the authors in Dangerous Case describe and define that terminology much better than, say, Ralph Northam. The question is whether psychiatrists are the ones we should hear it from.

I expect that the APA will denounce and dismiss this book and its authors, but I encourage others not to do so. Dangerous Case is unapologetically provocative and political, and the authors clearly take themselves to be contributing to the improvement of the community and the betterment of public health, as the AMA (and APA) principles of medical ethics direct. Dangerous Case will have supporters and detractors for good reasons — some political, some social, some psychiatric — that have much more to do with views of Trump’s mental health than with the Goldwater rule. I believe that the APA, in the interest of promoting public health and safety, should encourage rather than silence the debate the book generates. And it should take caution not to enforce an annotation that undermines the overriding public health and safety mandate that applies to all physicians. Standards of professional ethics and professionalism change with time and circumstance, and psychiatry’s reaction to one misstep in 1964 should not entail another in 2017.

American Psychoanalytic Association Gives OK To Call Trump Nuts

It is customary to do an exam on a patient actually in their presence for psychiatrists to make a diagnosis. This led to what has been known as the Goldwater Rule prohibiting psychiatrists from giving their opinion about the psychiatric state of public officials they have not examined. The American Psychoanalytic Association has released an emailed statement freeing its members to give opinions on the mental state of Donald Trump:

The impetus for the email was “belief in the value of psychoanalytic knowledge in explaining human behavior,” said psychoanalytic association past president Dr. Prudence Gourguechon, a psychiatrist in Chicago. “We don’t want to prohibit our members from using their knowledge responsibly.”

That responsibility is especially great today, she told STAT, “since Trump’s behavior is so different from anything we’ve seen before” in a commander in chief.

STAT also reports:

In October, a book titled “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President” will be published.

“When the book comes out, there will be renewed furor about the Goldwater rule, since it is precisely about what is wrong with him,” said psychiatrist Dr. Lance Dodes, a retired professor at Harvard Medical School who is now in private practice in Los Angeles.

The Goldwater Rule got its name after some psychiatrists answered a survey on whether Barry Goldwater was fit to serve as president in 1964. His slogan, “In your heart, you know he’s right” was mocked by the Johnson campaign with the alternative, “In your guts, you know he’s nuts.”

There have always been exceptions to this rule. It has been customary for the State Department and other federal agencies to ask psychiatrists about the psychological state of foreign leaders based upon public behavior and speech. The rule also carried no penalties, and enforcement by government officials, including license boards, would likely violate First Amendment rights to freedom of speech.

Fortunately other medical organizations have not had such restrictions, as long as it is made clear when a medical opinion is being made without having examined the person. With that in mind, pointing out that I have never examined Donald Trump and that my opinion is based upon observing his public actions alone, in my professional opinion he should also be tested for early Alzheimer’s.

The opinion that Trump might be nuts is not limited to the psychiatric profession. The Washington Post reports on two Senators, Susan Collins (R-Maine) and Jack Reed (D-R.I.), being caught by an open mike questioning Donald Trump’s sanity:

“Yes,” Reed replies. “I think — I think he’s crazy,” apparently referring to the president. “I mean, I don’t say that lightly and as a kind of a goofy guy.”

“I’m worried,” Collins replies.

Finally something we have bipartisan agreement on.

Members of Presidential Advisory Council On HIV/AIDS Resign In Protest Over Policies Of Trump Administration

Six members of the Presidential Advisory Council on HIV/AIDS (PACHA) have resigned in protest over the lack of concern by the Trump administration for treating HIV. They have publicly announced their decision in an open letter published in Newsweek.  The letter notes that, “It is indisputable that the Affordable Care Act has benefitted people living with HIV and supported efforts to combat the HIV/AIDS epidemic.” It notes that, in contrast, provisions of the American Health Care Act which reduce access to health care “would be particularly devastating for people living with HIV.”

Following is the text of the letter:

Five of my colleagues and I resigned this week from the Presidential Advisory Council on HIV/AIDS (PACHA).

As advocates for people living with HIV, we have dedicated our lives to combating this disease and no longer feel we can do so effectively within the confines of an advisory body to a president who simply does not care.

The Trump Administration has no strategy to address the on-going HIV/AIDS epidemic, seeks zero input from experts to formulate HIV policy, and—most concerning—pushes legislation that will harm people living with HIV and halt or reverse important gains made in the fight against this disease.

Created in 1995, PACHA provides advice, information, and recommendations to the Secretary of Health and Human Services regarding programs, policies, and research to promote effective treatment, prevention, and an eventual cure for HIV.

Members, appointed by the President, currently include public health officials, researchers, health care providers, faith leaders, HIV advocates, and people living with HIV. PACHA also monitors and provides recommendations to effectively implement the National HIV/AIDS Strategy, which was created by the White House Office of National AIDS Policy in 2010 and revised in 2015.

The decision to resign from government service is not one that any of us take lightly. However, we cannot ignore the many signs that the Trump Administration does not take the on-going epidemic or the needs of people living with HIV seriously.

While many members of the public are unaware of the significant impact that HIV/AIDS continues to have in many communities— or that only 40 percent of people living with HIV in the United States are able to access the life-saving medications that have been available for more than 20 years—it is not acceptable for the U.S. President to be unaware of these realities, to set up a government that deprioritizes fighting the epidemic and its causes, or to implement policies and support legislation that will reverse the gains made in recent years.

Signs of President Trump’s lack of understanding and concern regarding this important public health issue were apparent when he was a candidate. While Secretary Clinton and Senator Sanders both met with HIV advocates during the primaries, candidate Trump refused. Whatever the politics of that decision, Mr. Trump missed an opportunity to learn—from the experts—about the contours of today’s epidemic and the most pressing issues currently affecting people living with HIV.

In keeping with candidate Trump’s lack of regard for this community, President Trump took down the Office of National AIDS Policy website the day he took office and there has been no replacement for this website 132 days into his administration.

More important, President Trump has not appointed anyone to lead the White House Office of National AIDS Policy, a post that held a seat on the Domestic Policy Council under President Obama. This means no one is tasked with regularly bringing salient issues regarding this ongoing public health crisis to the attention of the President and his closest advisers.

By comparison, President Obama appointed a director to this office just 36 days into his administration. Within 18 months, that new director and his staff crafted the first comprehensive U.S. HIV/AIDS strategy. By contrast, President Trump appears to have no plan at all…

We believe he should embrace the important work accomplished by the National HIV/AIDS Strategy. Public health is not a partisan issue, and this important document could easily be ratified by the Trump Administration. If the President is not going to engage on the subject of HIV/AIDS, he should at least continue policies that support people living with and at higher risk for HIV and have begun to curtail the epidemic.

While these actions and others are gravely worrisome to us as HIV advocates, the final straw for us—more like a two-by-four than a straw—is President Trump’s handling of health care reform.

It is indisputable that the Affordable Care Act has benefitted people living with HIV and supported efforts to combat the HIV/AIDS epidemic. Gains in the percentage of people with HIV who know their status, the percentage engaged in care, the percentage receiving successful treatment, and a decrease in new cases of HIV were seen in Massachusetts under Romneycare. We are beginning to see similar effects on a national level under Obamacare.

People living with HIV know how broken the pre-ACA system was. Those without employer-based insurance were priced out of the market because of pre-existing condition exclusions. And “high risk pools” simply segregated people living with HIV and other health conditions into expensive plans with inferior coverage and underfunded subsidies—subsidies advocates had to fight for tooth-and-nail in every budgetary session.

Because more than 40 percent of people with HIV receive care through Medicaid, proposed cuts to that program would be extremely harmful. Prior to Medicaid expansion under ACA, a person had to be both very low income and disabled to be eligible for Medicaid.

For people living with HIV, that usually meant an AIDS diagnosis—making the disease more difficult and expensive to bring under control—before becoming eligible.

Between reinstating that paradox by defunding Medicaid expansion, imposing per-person caps on benefits, and/or block granting the program, the changes to Medicaid contemplated by the American Health Care Act would be particularly devastating for people living with HIV.

And we know who the biggest losers will be if states are given the option of eliminating essential health benefits or allowing insurers to charge people with HIV substantially more than others.

It will be people—many of them people of color—across the South and in rural and underserved areas across the country, the regions and communities now at the epicenter of the U.S. HIV/AIDS epidemic.

It will be young gay and bisexual men; it will be women of color; it will be transgender women; it will be low-income people.

It will be people who become newly infected in an uncontrolled epidemic, new cases that could be prevented by appropriate care for those already living with the disease.

While we are in agreement that the ACA needs to be strengthened to lower premiums, improve competition, and increase access to care, it makes no sense to dismiss gains made under the ACA just to score political points.

Experts with real facts, grounded in science, must be in the room when healthcare policy decisions are made. Those decisions affect real people and real lives. If we do not ensure that U.S. leadership at the executive and legislative levels are informed by experience and expertise, real people will be hurt and some will even die.

Because we do not believe the Trump Administration is listening to—or cares—about the communities we serve as members of PACHA, we have decided it is time to step down.

We will be more effective from the outside, advocating for change and protesting policies that will hurt the health of the communities we serve and the country as a whole if this administration continues down the current path.

We hope the members of Congress who have the power to affect healthcare reform will engage with us and other advocates in a way that the Trump Administration apparently will not.

Scott A. Schoettes is Counsel and HIV Project Director at Lambda Legal . He resigned from the Presidential Advisory Council on HIV/AIDS on June 13, along with Lucy Bradley-Springer, Gina Brown, Ulysses W. Burley III, Michelle Ogle, and Grissel Granados.

Trump and Republicans Escalate War Against Planned Parenthood And Women’s Health

Republicans love to use rhetoric such as talking about small government and freedom, but their real goal is to use big government to impose their religious views upon others. Maybe deep down Donald Trump even realizes that these actions by the religious right are morally wrong, as the usually loud mouthed president signed a bill targeting Planned Parenthood in private. CNN reports:

“President Donald Trump privately signed a bill on Thursday that allows states to withhold federal money from organizations that provide abortion services, including Planned Parenthood, a group frequently targeted by Republicans.

“The bill, which the usually camera-friendly President signed without any media present, reverses an Obama-era regulation that prohibited states from withholding money from facilities that perform abortions, arguing that many of these facilities also provide other family planning and medical services.

“The bulk of federal money Planned Parenthood receives, though, goes toward preventive health care, birth control, pregnancy tests and other women’s health services. Federal law prohibits taxpayer dollars from funding abortions and Planned Parenthood says 3% of the services it provides are abortions.

Republican who support such measures cannot claim to be for either liberty or small government. This also contradicts all their rhetoric about keeping government from getting between patients and doctors.

Trump Executive Orders Include Expanding Global Gag Rule On Abortion & Reinstating Black Site Prisons Closed Under Obama

Donald Trump’s use of executive orders have confirmed the worst fears about what we would see from a Trump presidency. Everyone who is aware of the policy assumed Trump would reinstate the global gag rule which, since Reagan, has been in place under all Republicans and reversed when Clinton and Obama were in office. This prohibits American foreign aide to organizations involved in providing abortions. What we did not anticipate, and most did not even realize immediately, was that Trump expanded this policy considerably. Michelle Goldberg did notice this and wrote in Slate:

In the past, the global gag rule meant that foreign NGOs must disavow any involvement with abortion in order to receive U.S. family planning funding. Trump’s version of the global gag rule expands the policy to all global health funding. According to Ehlers, the new rule means that rather than impacting $600 million in U.S. foreign aid, the global gag rule will affect $9.5 billion. Organizations working on AIDS, malaria, or maternal and child health will have to make sure that none of their programs involves so much as an abortion referral. Geeta Rao Gupta, a senior fellow at the United Nations Foundation who previously served as deputy executive director of UNICEF, gives the example of HIV/AIDS clinics that get U.S. funding to provide antiretrovirals: “If they’re giving advice to women on what to do if they’re pregnant and HIV positive, giving them all the options that exist, they cannot now receive money from the U.S.”

This makes Trump significantly worse than George W. Bush regarding the gag rule. Bush at least did specifically exempt support for an AIDS program, the President’s Emergency Plan for AIDS Relief (PEPFAR) from the global gag rule:

Scott Evertz, who served as director of the White House Office of National AIDS Policy under George W. Bush, tells me, “It would have been impossible to treat HIV/AIDS in the developing world as the emergency that PEPFAR said it was if the global gag rule were to be applied to the thousands of organizations with which those of us involved in PEPFAR would be working.” Evertz offers the example of a standalone health clinic in the slums of Nairobi, Kenya. Would the U.S. have to certify that it never referred any of its patients to an abortion provider before enlisting it in the fight against AIDS?  “The notion of applying the global gag rule to them would have made it impossible to implement the program,” he says.

Other executive orders involve building the border wall and curtailing immigration, limiting Obamacare, backing the Keystone XL and Dakota Access oil pipelines, and Trump is now reportedly preparing an executive order which would reopen “black site” prisons closed under Obama. The New York Times reports on the later:

The Trump administration is preparing a sweeping executive order that would clear the way for the C.I.A. to reopen overseas “black site” prisons, like those where it detained and tortured terrorism suspects before former President Barack Obama shut them down.

President Trump’s three-page draft order, titled “Detention and Interrogation of Enemy Combatants” and obtained by The New York Times, would also undo many of the other restrictions on handling detainees that Mr. Obama put in place in response to policies of the George W. Bush administration.

If Mr. Trump signs the draft order, he would also revoke Mr. Obama’s directive to give the International Committee of the Red Cross access to all detainees in American custody. That would be another step toward reopening secret prisons outside of the normal wartime rules established by the Geneva Conventions, although statutory obstacles would remain.

Mr. Obama tried to close the prison at Guantánamo Bay, Cuba, and refused to send new detainees there, but the draft order directs the Pentagon to continue using the site “for the detention and trial of newly captured” detainees — including not just more people suspected of being members of Al Qaeda or the Taliban, like the 41 remaining detainees, but also Islamic State detainees. It does not address legal problems that might raise…

Elisa Massimino, the director of Human Rights First, denounced the draft order as “flirting with a return to the ‘enhanced interrogation program’ and the environment that gave rise to it.” She noted that numerous retired military leaders have rejected torture as “illegal, immoral and damaging to national security,” and she said that many of Mr. Trump’s cabinet nominees had seemed to share that view in their confirmation testimony.

“It would be surprising and extremely troubling if the national security cabinet officials were to acquiesce in an order like that after the assurances that they gave in their confirmation hearings,” she said.

Good News From Supreme Court On Abortion & The Typical News On Trump and Clinton

Abortion Sign

It was a good day with regards to reproductive rights as the Supreme Court struck down a law in Texas designed to restrict abortions by imposing absurd requirements on abortion clinics designed to make it too difficult to operate.  The New York Times reports:

The Supreme Court on Monday struck down parts of a restrictive Texas law that could have reduced the number of abortion clinics in the state to about 10 from what was once a high of roughly 40.

The 5-to-3 decision was the court’s most sweeping statement on abortion rights since Planned Parenthood v. Casey in 1992. It applied a skeptical and exacting version of that decision’s “undue burden” standard to find that the restrictions in Texas went too far.

The decision on Monday means that similar restrictions in other states are most likely also unconstitutional, and it imperils many other kinds of restrictions on abortion…

he Supreme Court on Monday struck down parts of a restrictive Texas law that could have reduced the number of abortion clinics in the state to about 10 from what was once a high of roughly 40.

The 5-to-3 decision was the court’s most sweeping statement on abortion rights since Planned Parenthood v. Casey in 1992. It applied a skeptical and exacting version of that decision’s “undue burden” standard to find that the restrictions in Texas went too far.

The decision on Monday means that similar restrictions in other states are most likely also unconstitutional, and it imperils many other kinds of restrictions on abortion..

One part of the law requires all clinics in the state to meet the standards for ambulatory surgical centers, including regulations concerning buildings, equipment and staffing. The other requires doctors performing abortions to have admitting privileges at a nearby hospital.

This law came from Republicans who claim to both oppose over-regulation of business and government take-overs of health care.

The New York Times also points out that the Court has leaned left with eight members when it avoids a tie.

Otherwise it was a typical day. Donald Trump said more stupid things, this time calling Elizabeth Warren a racist. Plus we have further evidence that Clinton was lying about her email as more examples were found of work-related email which appear to have been destroyed with the email Clinton claimed was personal. These stories come after too many examples of Donald Trump saying stupid things to list, and a similar report on Clinton’s email three days ago.