Wednesday, August 26, 2015

"Anchor Babies and Tourist Babies"

The latest controversial issue raised by Donald Trump is the "anchor baby" - which I believe he defines as a baby born to a mother who entered the United States for the sole purpose of insuring that her infant is born in the United States, thereby guaranteeing her child United States citizenship, by virtue of the 14th Amendment.   Trump is questioning the interpretation of the 14th Amendment.

The pertinent part of the amendment read as follows:

Section. 1. All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside.

This has been interpreted by some to exclude children of non-citizens or non-resident aliens since these children are not "subject to the jurisdiction" of the United States as they are children of citizens of other countries.  In fact current immigration law specifies that a baby born on American soil to a member of the foreign service of another country or a foreign military prisoner is not an American citizen by birth.  Congress can, however, grant citizenship for such excluded persons on a case-by-case basis.

Let's assume that, in fact, the 14th Amendment actually does permit any infant born on U.S. soil to be eligible for automatic U.S. citizenship.   In fact many of these babies, also referred to as "tourist babies," are  not born to "illegal aliens," but to foreign women with tourist visas - often owners of U.S. real estate - who are among the privileged class in their countries, and wish to insure U.S. citizenship for their offspring.

Isn't there something wrong with this concept?  Isn't there something "not right" when pregnant citizens of other countries enter the U.S. for the sole purpose of giving birth to "an American baby?"

By the way, know that the United States is one of the few countries that has such "jus soli" (by right of the soil) citizenship rights.  The vast majority of other countries do not.  Some of examples of "non-birthright" states include Australia, United Kingdom, Germany, Israel, Saudi Arabia, Czech Republic, Japan, Austria, Belgium, Switzerland, Norway, Sweden, Finland, Denmark, France, Greece, Spain, Italy.......and quite a few more.


Wednesday, August 12, 2015

Pounds and Ounces in Prevention and Cures

We're all well aware of the old adage that "an ounce of prevention is worth a pound of cure."  Well, as it turns out - not so!  Margot Sanger-Katz, in a recent New York Times article (Aug 7), has written how the opposite is true.  Turns out, in fact, that "you have to give a lot of people those ounces of prevention to end up with one person who's getting that pound of cure."  As an example, according to the New England Journal of Medicine, 2500 women would have to be screened over 10 years for a single breast cancer death to be avoided.

Prevention is not cheap.  Obamacare mandates prevention coverage.  More and more subscribers are  confirming the status of their general health by taking advantage of these screening options, consequently increasing health care costs.  Providing people with more preventive measures is satisfying and usually reassuring, but expensive and rarely productive.

Early discovery of diseases using preventive screening techniques may result in a longer life - but at a not insignificant expense.  Early intervention for an asymptomatic latent condition results in increased physician visits, increased diagnostic testing,  increased need for the preventive medication, and, of course, an increase in cost. The disease is almost never cured, but its process is prolonged, and death may be delayed.    However, as one survives this condition to live on to an advanced age, the occurrence of other diseases such as Alzheimer's, or other costly illnesses, increases greatly.

Staying healthy is not cheap.  A lot of health care dollars are spent on prevention and a prolonged life.  Preventing diseases is good, new treatments are good.  But none of this occurs without significant cost.

It takes dollars of prevention for one cent of cure!

Thursday, August 6, 2015

Discussing Livers and Hearts Over Lunch

So much of what one says in a private tête-à-tête is dissimilar from what one would otherwise say.

The recent videos of officials from Planned Parenthood discussing the distribution of fetal parts, between bites of salad during a private lunch,  is not a reason to critique the issue or to defund a program.  One may understandably be opposed to late-term abortions or the use of fetal tissue in research efforts to advance medical science, but such a conclusion should not be based on private "intra-professional" conversations.

Physicians often discuss patient-related issues or disease-related issues over coffee or lunch.  Yes, we take bites of hamburgers while discussing illnesses, and may even chuckle or laugh during the conversation as we talk about an unusual situation that may have come up - not always using "appropriate language."  Operating rooms and diagnostic labs are filled with, what some might term,  rather irreverent banter.  It is the nature of our "business."  It is in the nature of any "business" to speak "informally" when "businesss" matters are tossed around among close colleagues.

Saucy collegial conversations regarding medical issues are very common.  One should not use such surreptitiously recorded conversations as a tool to promote or condemn a point of view.