- Associated Press - Tuesday, November 1, 2016

The St. Louis Post-Dispatch, Oct. 30

The statistics don’t lie. St. Louisans need to have the condom conversation.

An annual report from the Centers for Disease Control and Prevention put St. Louis at the top spot in the nation last year for spreading two pernicious, sexually transmitted diseases - diseases that should be easily preventable if the city promoted better sex education, more disease testing and increased public awareness about the importance of condoms.

Medical providers are finding that women who use one of the most effective birth control methods available today, long-acting reversible contraceptives, do not see their health care providers often. That results in less frequent STD testing, and often more severe cases when they are diagnosed.

They are also finding that, even when women use effective birth control, they might not have enough information about the consequences of sexually spread diseases to force an uncomfortable discussion with a partner about using a condom.

Condoms have a high failure rate as a birth control method, but are extremely effective in preventing the spread of diseases in sexually active populations. Dr. Bradley Stoner, infectious disease specialist at Washington University, said the syphilis rate is climbing among homosexual men because better HIV drugs have led to reduced condom use.

Chlamydia and gonorrhea are the sexual diseases that are spreading most rampantly in St. Louis. Stoner said the syphilis increase was not reflected in the CDC report.

Abstinence is unquestionably the best way to prevent spreading diseases, but people who are sexually active are highly unlikely to regard abstinence as a serious option. For them, the consistent and correct use of male or female condoms is the most effective way to stop transmitting diseases.

Health care experts say female condoms are available through organizations such as Planned Parenthood, but are cumbersome and not often used.

State mandated comprehensive sex education would ensure that young people learn about diseases and become comfortable discussing condom use. Without that, health workers bear the greatest burden raising public awareness.

Consequences for ignoring the city’s STD epidemic extend beyond the infected group. Bacterial infections may become drug-resistant, requiring expensive treatment or hospitalization. The diseases can be spread from an untreated mother to her baby during childbirth, again resulting in high treatment costs.

People suffering from infections lose time from work, and women may become infertile or develop complications such as ectopic pregnancies and chronic pelvic pain.

Providing easy prevention methods up front would be less expensive and have fewer social repercussions. Planned Parenthood provides free condoms at seven area locations and hands out free safe-sex kits in bars the night before Thanksgiving.

Those are creative solutions, but parents and the broader community can do more to raise awareness of the life-threatening dangers of engaging in unprotected sex. Yes, these can be embarrassing topics to discuss, but sexually active youths and adults need to understand the consequences.


The St. Joseph News-Press, Oct. 29

To ease epidemic, prioritize treatment

A federal government with limited resources must set priorities, and protecting the public’s health should be near the top of that list.

This is the compelling argument for a proposed $1.1 billion investment a tenfold funding increase in treatment programs that can help victims of drug abuse.

Specifically, the funding would improve access to treatment for persons who have become addicted to opioid-based drugs. This class of drugs includes prescription painkillers such as Vicodin and OxyContin and also heroin.

As the News-Press reported, Agriculture Secretary Tom Vilsack is leading a campaign to have this funding approved by early December, before Congress breaks for the holidays. Viksack, a former governor of Iowa, takes special interest in the issue because of how this national problem reaches far into rural America, where the medical issues are the same as in big cities but resources often are much less.

Statistics show Missouri hospitalizations for opioid abuse rose 137 percent from 2005 to 2014. In all, hospitals and emergency rooms in our state saw 25,711 patients that year suffering from opioid overdoses. The wave of patients needing follow-up care, including counseling and medication-assisted treatment, is overwhelming the system.

Vilsack believes the enormous assets of the USDA can be helpful in rural areas. He has made grant funds available for communities to conduct drug addiction awareness efforts, to help hospitals use telemedicine to better treat individuals struggling with addiction, and to help communities build treatment and recovery facilities.

He also touts the importance of prescription drug monitoring programs that exist in all states except Missouri. He notes that because our state does not make this program available, fragmented approaches are being adopted by individual communities, such as St. Louis, and nearby states are seeing abusers cross the state line to get prescriptions.

The crisis of opioid abuse is costing the country at least $25 billion a year for increased medical care, $25 billion for lost worker productivity and $5 billion for higher expenses in the criminal justice system.

In this context, the proposal promoted by Vilsack makes sense both for those families suffering and taxpayers. Under the $1.1 billion plan, Missouri would be eligible for $17 million over two years to expand access to treatment.


The Kansas City Star, Oct. 25

Supreme Court nominee Merrick Garland shouldn’t be confirmed at this point

As we noted last week, the U.S. Supreme Court remains in a precarious position because Republican senators refuse to hold a confirmation vote on President Barrack Obama’s nominee to fill a vacancy on the court. Nearly seven months have passed since Obama nominated Merrick Garland to the seat left open by the death of Justice Antonin Scalia. If Hillary Clinton defeats Donald Trump on Election Day, he should withdraw Garland’s nomination.

There are two possible outcomes on Nov. 8: Either Clinton or Trump will win the presidency. Sure, there are other candidates, but none has a real shot at victory.

(There is a third possible outcome of the election, but it is too frightening to contemplate - a disputed election that lands in front of the Supreme Court, which is evenly divided between justices appointed by Republican and Democratic presidents.)

Suppose, then, that Trump wins. Many Republicans, particularly of the establishment sort, were never thrilled with their party’s nominee, but they held out hope that at least he would be better than Clinton. His Supreme Court nominee might be palatable to conservatives.

If Trump becomes president-elect, there is zero chance Republican senators will confirm Garland during the lame-duck session. Their line all along - and it was just a line - has been that the next president should get to choose Scalia’s replacement, and that the people should have a say by way of the election. Let President Trump choose.

Suppose, instead, Clinton wins. Here, things get much more interesting. Republicans could stick to their guns and not confirm Garland, giving Clinton a chance to nominate a justice on her first day. Maybe she’d stick with Garland, but maybe not.

Garland is a centrist judge who thrilled few progressives. For example, he tends to fall on the law-and-order side of criminal cases. Indeed, Republicans, at least before he was nominated, identified him as the sort of consensus pick they could get behind.

He also is relatively old for a Supreme Court appointment. At 64, he’s younger than Clinton and Trump, but the average age of the eight current justices at their appointment was 52. Presidents tend to choose judges in their 50s for lifetime appointment to the court so that they could shape jurisprudence for a generation. Progressives who hoped that Obama would follow suit were therefore disappointed.

Progressive disappointment, however, is good reason for Republicans to confirm Garland if Clinton wins. Better the moderate who will serve less time on the court than whomever Clinton might nominate.

Obama should deny them that opportunity. If Republicans have been cravenly political in preventing a confirmation vote, Obama certainly injected his share of political gamesmanship in picking Garland in the first place. He dared Republicans to reject someone they once supported, proving they are obstructionists in an election year.

He’s made his point. Now, if polls are to be believed, Obama should let the next president choose someone younger and more progressive.


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