Needle Exchange

Common sense is once again ignored by the legislature during the "war" on drugs, and 3 activists may go to jail for trying to help the public, via a needle exchange program.

From the article: "Texas is the only state that does not allow such programs, according to state Sen. Bob Deuell, R-Greenville, a doctor who tried unsuccessfully to pass a statewide program in 2007"

A needle exchange program is one in which used needles may be exchanged for clean, sterile ones. This dramatically lowers the spread of diseases such as Hep C and HIV.

Via Wikipedia:

[S]tudies have shown needle exchanges to be effective at preventing the spread of HIV and Hepatitis C.

-Bastos, FI. and Strathdee, SA. (2000) Evaluating effectiveness of syringe exchange programs: current issues and future prospects. Social Science & Medicine 51:1771-1782

Rich, Joseph D., Michelle McKenzie, Grace E. Macalino, Lynn E.Taylor, Stephanie Sanford-Colby, Francis Wolf, Susan McNamara, Meenakshi Mehrotra and Michael D. Stein (2004) A Syringe prescription program to prevent infectious disease and improve health of injection drug users. Journal of Urban Health: Bulletin of the New York Academy of Medicine 81:122-134
ETC

This same program ran into snags last year when a bill to begin a needle exchange program died in committee

"I'm not persuaded that the public health benefit outweighs my concerns and my constituents' concerns about illegal intravenous drug use," Delisi said.

The implication here is that the program would somehow encourage drug use.

The key word here is "exchange". We would not be providing needles to users for free, to which taxpayers may object, instead we are removing possibly infected needles from circulation. Really, the program could be called a hepatitis C removal program. Beyond that, it could be called a hazardous waste clean up program. Since used needles are collected, they won't show up in our trash bags, the street, our play grounds. I'll happily pay a great deal of my tax dollars on a program that reduces the number of hepatitis infected needles lying around where I'm walking.

Reducing the instances of various infectious diseases is always going to have an economic and social benefit to the community. I'm in favor of programs to help these addicts to get clean, to get counseling, to straighten out their lives. But in the short term we have to face the reality that these users are going to be going to be injecting drugs one way or another, and I would prefer it if the community was protected in such an effective, low impact way.

Nuance

In response to Briana Roger's post on abolishing abortion, I should really only have to say "Instances of rape, incest, and health risks to the mother".

To be more specific, if we put aside the ideas of a woman's right to her own body, the separation of church and state, the economic impact of unplanned births on women or families etc, there is still this: Abortions are a medical procedure that sometimes have absolute, objective medical benefits.

It is not the legislature's job to make medical decisions. I do not contact my state rep when I need my wisdom teeth extracted, nor would I call and ask them if I should use an air splint or an immobilizing cast on the spiral fracture of a humerus.

I'm not responding to the ideas of protecting what may or may not be a living thing, nor the idea of a back up form of birth control. I'm responding to what could be presumed to be the "arrogance" of a blanket, absolute ban on abortion.

As Briana cites "According to this article most abortions are performed on women who either don't use contraceptives or don't use them consistently."

Most. Even if inconsistent use of birth control were a disqualifying factor in abortion procedures, this is not a factor in all of the cases.



What other procedures could be banned to save lives? People die during liposuction at what may be called a surprising rate. I mean, it's just a cosmetic procedure, why don't these people just exercise more, don't they know they could DIE? But, I'm not a doctor. I can't say whether or not there are going to be medical benefits to this procedure.

Why don't we ban the private possession of all radioactive isotopes? Those things give off cancer, can be used to build weapons, present complicated disposal problems, they're just awful. Well, goodbye x-ray machines, it's not like those have any medical benefits.


Zero tolerance means zero flexibility, a complete inability to adapt to a situation which can generally be described of as a just a bit complicated. There is nuance here, there are shades of gray.

Public vigilance reaps rewards for imprisoned children

Despite recent changes, we're still keeping children in prison. There is a converted prison, the T. Don Hutto

Family Residential Center in Tyler Texas, that houses families of illegal immigrants. Whole families, children, infants, all.

This facility had come under harsh criticism in the past year for failing to meet basic requirements mandated by congress, to the DHS and by extension the Immigration and Customs Enforcement (ICE).

From the ACLU (3/6/2007)

In 2005 and 2006, Congress directed DHS to keep immigrant families together, either by releasing them or using alternatives to detention. If detention is necessary, Congress said immigrant families should be housed in non-penal, homelike environments.

...

Approximately 400 people are currently detained in Hutto, half of them children, and many of them are refugees seeking political asylum. What ICE calls a “Family Residential Facility” is in fact a converted medium-security prison that is still functionally and structurally a prison. Children are required to wear prison garb, receive only one hour of recreation a day, Monday through Friday, and some children did not go outdoors in the fresh air the whole month of December, 2006, according to legal papers filed today. They are detained in small cells for 11-12 hours each day where they cannot keep food and toys and they have no privacy, even when using the toilet.

This is the same facility that would on occasion separate parents from children, which is exactly what this facility's existence is supposed to prevent.
USA Today

An 8-year-old girl was separated from her pregnant mother and left behind for four days at a detention center established to keep immigrant families together while their cases are processed.

And why was that family here in the U.S.?

Banegas said the pair fled Honduras earlier this year to escape an abusive relationship and growing gang violence in that country, including attacks that broke her sister's ribs and left her with scars. She asked that her sister and niece not be named because of concerns for their safety.

Finally, 2 years later, changes are being made.

Statesman.com

The concertina wire is gone. So are the imposing steel doors in the booking area and the green and purple hospital-type scrubs issued to immigrants and their children. Also gone are the routine head counts by uniformed guards that awakened children in the middle of the night at the T. Don Hutto immigrant detention center.

The only reason these changes are being made is because of the public outcry, because of the coverage by the ACLU, NPR, the New York Times.
ICE plans to open more of these facilities (instead of say, electronic monitoring) which is troubling merely in the idea of more "family" prisons springing up. But beyond that, we must watch these new prisons, to make sure the "improvements" of the Hutto center continue. We must also be sure that conditions do not deteriorate once again to a travesty, once the spotlight has moved on.

Capital Punishment as Practiced in the Real World

I feel morally and intellectually obligated simply to concede that the death penalty experiment has failed. It is virtually self-evident to me now that no combination of procedural rules or substantive regulations ever can save the death penalty from its inherent constitutional deficiencies.
-Harry Blackmun Justice of the Supreme Court


Bobby has laid out several arguments in favor of the death penalty, specifically in Texas.

The death penalty, once carried out, is obviously irreversible. If new forensics technology or new evidence arises that may prove a prisoner’s innocence after his execution, there’s no “taking it back”.
The very idea of executing innocent people is the strongest argument against the death penalty, in my opinion. Bobby’s statement that “There is no conclusive evidence that any of these people were innocent.” is at best, misleading and I believe, highly inaccurate.

There is indeed ample evidence that innocent men and women have been sent to death row, some executed before they were exonerated. Take the case of Ruben Cantu
Cantu, executed despite no physical evidence linking him to the crime, and no witnesses who could have provided an alibi were interviewed. The lone eyewitness has recanted, claiming police pressure to identify Cantu.

Or the case of “>Cameron T. Willingham. Of two extremely similar cases of murder by arson,

The report says that prosecution witnesses in both cases interpreted fire indicators like cracked glass and burn marks as evidence that the fires had been set, when more up-to-date technology shows that the indicators could just as well have signified an accidental fire. In one case, the signs were accepted as proof of guilt, the report said; in the other, they were discarded as misleading. "These two outcomes are mutually exclusive," Mr. Scheck said. "Willis cannot be found 'actually innocent' and Willingham executed based on the same scientific evidence."

Beyond those, we have the long term study by James S. Liebman, a Professor of Law at the Columbia Law School. This is as summarized by Death Penalty Information Center

High error rates put people at risk of wrongful execution. 82% of the people whose capital judgments were overturned by state post-conviction courts due to serious error were found to deserve a sentence less than death when the errors were cured on retrial. 7% were found to be innocent of the capital crime.

Beyond that, what about questions of due process, or of race being a factor in death penalty cases? Again, as quoted by the Death Penalty research center: “"In 82% of the studies [reviewed], race of the victim was found to influence the likelihood of being charged with capital murder or receiving the death penalty, i.e., those who murdered whites were found more likely to be sentenced to death than those who murdered blacks."
- United States General Accounting Office, Death Penalty Sentencing, February 1990”

Or as the NACDL says:
“The [Texas Court of Criminal Appeals] also upheld at least three death sentences in a Houston case in which the lawyer for the defendant slept during the trial.”

Like the case of Calvin Burdine who at one point “[came] within hours of execution”.

The Texas Governor can be the court of "last resort" in these cases, claimed as another check on the innocent or the undeserving being executed. But take the tenure of Governor Bush, who “[spent] between 15 and 30 minutes on each case” (San Jose Mercury News via Common Dreams
“Judge Al Gonzales, who was Bush's legal counsel for the governor's first 59 executions, says Bush would typically spend about a half hour on each of the cases.”
via Salon


I could rail against the death penalty as barbaric, as a avenue for revenge, but I’d rather let the facts speak for themselves.
When the mistakes are irreversible, we cannot afford there to be a single flaw in this system. A flawless process is clearly not in place, and innocent people die because of it.

Texas Reproductive health, in a sad state.

Abstinence. The only 100% effective way to avoid unwanted pregancy and STDs. It's great until it isn't.

A ten year study by Mathematica Policy Research Inc |
2 showed that abstinence only education was not more effective in preventing sex among students, and beyond that, other studies show it was ineffective at preventing unwanted pregnancies.

...[A] paper by researchers at Columbia University and the Guttmacher Institute, published in the January issue of The American Journal of Public Health, attributed 86 percent of the decline to greater and more effective use of contraceptives — and only 14 percent to teenagers’ deciding to wait longer to start having sex.

Source: http://www.nytimes.com/2007/04/28/opinion/28sat1.html
Study: http://www.ajph.org/cgi/content/abstract/AJPH.2006.089169v1

14% versus 86%. The vast majority of people are going to have sex, eventually. They need to know what works. And it's not just unintended pregnancy. It's STD's as well.
As the APA puts it

Research shows that one in five adolescents will have sex before the age of 15 and most who continue to be sexually active do not use condoms consistently. Although some youth acknowledge their fears about HIV/AIDS, many do not perceive themselves to be at risk and lack accurate information about what circumstances put them at risk for HIV infection.

Over and over, we find evidence that comprehensive sex education is the only way to improve chances that those having sex, do it safely.

Texas continues to use an abstinence focused sex ed program. While Federal funding may require such a curriculum, how much is such an ineffective policy costing us in the long run? Be it in the health costs of mothers, or possibly the cost of the state raising foster children, sexually transmitted disease, or any other long term impacts that ineffective education may have.




On access to to alternative and emergency plans.

The Guttmacher Institute Ranked Texas very poorly in sexual health policies:

Among the 50 states and the District of Columbia, Texas ranked
* 43rd in service availability;
* 48th in laws and policies;
* 19th in public funding; and
* 45th overall.

Source: http://www.guttmacher.org/pubs/state_data/states/texas.htm

What's a straightforward way to help Texans gain access to reproductive health and treatment? For one, we could make sure that they have access to birth control

There have already been cases in Texas of a pharmacist refusing to dispense birth control on moral grounds, including "Plan B". And in at least one case, this was not in the usually expected case of condom failure, or other consensual actions, it was a the victim of a sexual assault.

Source: http://www.kvue.com/news/state/stories/020304kvueprotest-jw.7c050c55.html
Source: ocw.mit.edu



Some states (Wisconsin and Illinois among others) have already passed laws obligating a pharmacist to dispense prescriptions for birth control, clarifying existing laws obligating them to dispense prescriptions that would not cause harm to the patient. In other words, obligating them to do their jobs. And this is supported by the vast majority of Americans.

A November 2004 poll conducted by CBS News and the New York Times found that eight out of ten Americans believe that pharmacists should not be permitted to refuse to dispense birth control pills.

Source: http://www.cfpa.org/issues/issue.cfm/issue/PharmacistRefusals.xml#endnotes

By preventing access to birth control pills or Plan B on the grounds that they cause abortions (Which is patently untrue), they increase the rate of unwanted pregnancies, and therefore abortions.

Isn't Texas based on independence? Let the people own their own bodies, let them own the choices and consequences of what goes on with them.

Emergency Room care is a national policy, but the price tag is very local.

Young: Rethink the emergency-room logic when it comes to health care

"People have access to health care in America. After all, you just go
to an emergency room."

— President Bush

That's right, Mr. President. And thanks for pointing out what's wrong
with a status quo you've done almost nothing to alter. Welcome to the
ER. It is America's answer to a phony debate. Health care: Is it a
right? Of course it is.

Bush, in that quote, is referring to
EMTALA, a policy that seems absolutely reasonable on its face (It specifies that a person cannot be refused emergency medical care at an ER, regardless of their citizenship, ability to pay, etc). But despite being mandated at the federal level, there is no federal funding specifically to cover the uninsured who arrive at the E.R.

The association's "Texas Medicare Manifesto" demands reimbursement rates that keep up with the cost of providing services. The National Governors Association sounds just as furious. It has denounced Medicaid regulations proposed by the Bush administration to shift billions of dollars in costs to the states. Where states don't pick up the slack, hospitals and ERs will.

That's how everyone ends up paying for the uninsured. Stop assuming the free market will resolve this.

This is not just a problem of uninsured citizens.
For example, if an illegal immigrant goes into labor, they can go to the local E.R. for their delivery. Since they're likely working illegally, they're almost certainly going to be uninsured. The costly price of that delivery is never paid for, and the hospital eats those costs, which they have to make up elsewhere.
I understand that illegal immigrants are paying huge amounts of taxes for government services that they never use (like 7 Billion dollars in Social Security a year) but these funds are not directly connected to the services they DO use.
The uninsured man unable to go in for check ups who then suffers a massive heart attack is a tragedy that could have been avoided, and a huge expense that will need to be paid. That he will even live long enough to collect social security is in question.

But when it comes to the cost of national coverage, statists' concerns about the price tag are disingenuous. We already pay for the uninsured through hospital costs and insurance rates. If more had health insurance, with real preventive care and health maintenance, we would have a healthier country with fewer pressures on hospitals and health-care costs.

The illegal immigrant angle is the only aspect missing from John Young's article that I can see, but since the list of "Gotcha's" on healthcare reform is so long, I can understand missing it, or deliberately omitting such a complication from this solid commentary. It'd confuse the message he's presenting, the the ER is not a local doctor's office, nor a health insurance fix.

The ER is expensive, it's "cataclysmic" care, for the unexpected tragedies. We don't rely on just the fire department to control fires in the home. We have smoke detectors, fire extinguishers, buckets of sand. It's far cheaper to keep a clean stove than it is to have the fire trucks hose down your burning home.

My personal point is, there will need to be ways to pay for everyone for health care reform to work. Taxing even low income workers (illegal or legal) directly will at least make sure there is some system in place for them, so that their first visit to a doctor is at an earlier, safer, cheaper time than when they have to be driven there in all-too-expensive ambulance.

http://www.mysanantonio.com/news/citycouncil/stories/MYSA012508.01A.stateofthecity.2a1e5e7.html