Valerie Huber

Notes, emails reveal Trump appointees’ war to end HHS teen pregnancy program

March 20, 2018 user Leave a comment

The Trump administration’s abrupt cancellation of a federal program to prevent teen pregnancy last year was directed by political appointees over the objections of career experts in the Department of Health and Human Services, which administers the program, according to internal notes and emails obtained by NBC News.

The trove shows three appointees with strict pro-abstinence beliefs — including Valerie Huber, the then-chief of staff for the department’s Office of the Assistant Secretary for Health — guided the process to end a program many medical professionals credit with helping to bring the nation’s teen pregnancy rate to an all-time low.

Prior to serving at HHS, Huber was the president of Ascend, an association that promotes abstinence until marriage as the best way to prevent teen pregnancy.

The $213 million Teen Pregnancy Prevention Program was aimed at helping teenagers understand how to avoid unwanted pregnancies. It had bipartisan support in Congress and trained more than 7,000 health professionals and supported 3,000 community-based organizations since its inception in 2010.

In the notes provided to NBC News, Evelyn Kappeler, who for eight years has led the Office of Adolescent Health, which administers the program, repeatedly expressed concerns about terminating the program, but appeared out of the decision-making loop and at one point was driven to tears.

In a July 17, 2017 note, she says she was admonished to “get in line” and told it was not her place to ask questions about the agency’s use of funds. In a July 28 note, Kappeler recalled she was “frustrated about the time this process is taking and the fact that (her staff) has not been part of the discussions.” She described being “so rattled” that “my reaction when I got on (sic) the phone was to cry.”

She and her staff “were not aware of the grant action until the last minute” — an apparent reference to the decision, it says.

Last month, Democracy Forward, a nonprofit law firm and advocacy group, sued the administration for unlawfully terminating the program after the agency took months to respond to its Freedom of Information Act request.

The group claims the newly obtained emails show that HHS violated the Administrative Procedure Act that bars arbitrary decision-making and that the political appointees thwarted the will of Congress.

“Now that we’ve seen these documents, there is no question to us why the Trump administration withheld” the emails, said Skye Perryman, the group’s lawyer. The decision to end the program “was made hastily, without a record of any reasoned decision making and under the influence of political appointees who have long opposed evidenced-based policy,” she said.

Parties suing over the action include the city of Baltimore and the Healthy Teen Network, which represents grantees across the country.

HHS has given different explanations about its decision to terminate the program, including claims that it was ineffective or that it did not conform to the president’s proposed budget. HHS did not respond to emails or answer questions about who was responsible for ending the program.

HHS spokesman Mark Vafiades directed NBC News to a fact sheet and announcement on the agency’s website. They state that 73 percent of the projects funded by the program “had no impact or had a negative impact on teen behavior, with some teens more likely to begin having sex, to engage in unprotected sex or to become pregnant.”

“The evidence stands in stark contrast to the promised results,” the statement says.

The story behind the program’s demise is one of a growing list of examples of the control Trump political appointees are exerting at federal agencies.

It is also part of a broader narrative about programs benefiting women and children becoming political targets under a president who insists he is an advocate for women’s rights and health. Under Trump, a mandate under the Affordable Care Act to cover contraceptive coverage has been rolled back, while Republicans in Congress have sought to defund Planned Parenthood and proposed budget cuts to Medicaid, which covers half of all births.

In July 2017, the Office of Adolescent Health notified 81 grantees including the University of New Mexico Health Sciences Center and Cuyahoga County, Ohio, that it would be discontinuing funding under the Obama-era program beginning this June, with some programs cut off immediately.

After the program’s 2010 inception, teen pregnancy and birth rates fell faster than ever. Health care experts say considerable research and money that has already been invested in the program will be wasted and the number of at-risk teens will increase.

The president of the American College of Obstetricians & Gynecologists and women’s health advocacy groups, such as Planned Parenthood, have expressed alarm.

Haywood L. Brown, president of ACOG, called the program “vital.” The administration’s decision, Brown said in a statement, is “highly unusual” and a “step backward for ensuring healthy moms and healthy babies.”

In an op-ed last year, Ron Haskins, previously a Republican co-chair of a bipartisan commission on evidence-based policy making established by House Speaker Paul Ryan, R-Wis., said that by ending the program, Trump has “exploded one of our most promising evidence-based programs.”

In a June 21 note by Kappeler, Steven Valentine, Huber’s deputy, is described as having “taken the lead” in reversing the program. Valentine directed Kappeler to halt the review process for the grants, the notes say.

Before coming to HHS, Valentine was a legislative assistant to Rep. Chris Smith, R-N.J., an outspoken abortion rights opponent. Valentine also worked for a short time at the Susan B. Anthony List, a political organization that supports candidates who oppose abortion rights.

Don Wright, a senior career official at HHS, stated in a July 28 email to Kappeler that he himself was only “tangentially” involved in the discussions about the program’s termination. But one set of notes documents him instructing skeptical career staff members on the appropriate behavior of civil servants. He later complained to Kappeler about “rolling of the eyes by some staff,” her notes say.

Weeks later, Wright was made acting secretary of the department.

Also according Kappeler’s notes, some staff “expressed concerns about being able to ask questions in this environment and the lack of engagement by policy staff directly with the program office.”

Kappeler’s memos “are quite revealing of the agency’s improper and unlawful decision making,” said Perryman, Democracy Forward’s lawyer.

“The documents also show HHS disregarded the views of experienced career employees including those of the director of the Office of Adolescent Health,” she said.

Another appointee involved in terminating the teen pregnancy program was Teresa Manning, an anti-abortion activist and Trump appointee who was in charge of the department’s family planning programs and who has publicly questioned the efficacy of several popular contraception methods. She was previously a lobbyist for the National Right to Life Committee and for the Family Research Council. In January, Manning abruptly resigned.

In November, HHS announced a $10 million research initiative to ensure “any sex education programs follow the science to improve youth health and well-being,” including “sexual risk avoidance.”

Despite their popularity in some conservative regions and school districts, abstinence-only programs have been shown not to work.

A June 2005 study conducted by Case Western Reserve University found that the sexual education programs that Huber ran in Ohio promoting abstinence-only education had “critical problems.” The study suggested the program conveyed “false and misleading information” about abortion, contraceptives and sexually transmitted infections and misrepresented “religious convictions as scientific fact.”

In King County, Washington — one of the parties in the suit challenging the program’s termination — grantees created a 15-lesson sex education curriculum known as Family Life and Sexual Health (FLASH).

The FLASH program educates students on options including abstinence, the use of birth control and the importance of consent before engaging in sexual activity. It is now used in 44 states and taught in every school district in King County, which has seen a 63 percent drop in teen pregnancies since 2008.

King County was granted $5 million to conduct the first scientific evaluation of the FLASH program, and now it is unable to complete the study. The $3 million already spent is now wasted taxpayer dollars, according to King County spokesman James Apa.

[NBC News]

Reality

Data shows clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S

Trump has made the Department of Health and Human Services a center of false science on contraception

June 15, 2017 user Leave a comment

Contraception policy may not be the biggest target of the anti-science right wing — climate change and evolution probably rank higher — but it’s the field in which scientific disinformation has the most immediate consequences for public health.

So it’s especially disturbing that President Trump and Health and Human Services Secretary Tom Price have stocked the corridors of health policy with purveyors of conclusively debunked claptrap about contraception, abortion, pregnancy and women’s reproductive health generally.

That’s the conclusion of a new article in the New England Journal of Medicine identifying four Trump appointees as carriers of the disinformation virus. What makes them especially dangerous, says the author, bioethicist R. Alta Charo of the University of Wisconsin law school, is that the “alternative facts” they’re purveying could influence an entire generation’s attitude toward contraception, for the worse.

Among their themes is that condoms don’t protect against HIV or other sexually transmitted diseases and that abortions and contraceptives cause breast cancer, miscarriages and infertility. None of these assertions is true.

“The move toward misinformation at the level of sex education is dangerous,” Charo told me, “because you form instincts about what is safe very early in life.”

These appointments are all of a piece with Trump’s habit of staffing federal agencies with people actively in opposition to those agencies’ goals and statutory responsibilities — climate change deniers at the Environmental Protection Agency, corporate executives at the Department of Labor, and so on.

They’re also consonant with policies from the White House and Price’s office aimed at narrowing access to contraceptives by reducing government assistance to obtain them.

As Charo observes, the rate of unintended pregnancies has come down sharply, especially since the advent of the Affordable Care Act, which mandated that health plans make birth control available without co-pays or deductibles.

Price has defended reducing government assistance for contraception on the ground that “there’s not one” woman who can’t afford it on her own, but that’s plainly untrue; some long-lasting contraceptives such as Nexplanon or IUDs, can cost hundreds of dollars, a discouraging obstacle for many low-income patients.

Let’s take a look at the four horsewomen of disinformation on Charo’s list. What characterizes their approach to human reproduction, she says, is “rejection of the scientific method as the standard for generating and evaluating evidence.”

(We’ve asked both Charmaine Yoest, now the assistant secretary for public affairs at Health and Human Services, and the department for comment but have received no reply.)

Charmaine Yoest

Charmaine Yoest is now the assistant secretary for public affairs at HHS. Yoest is the former head of Americans United for Life, a prominent anti-abortion group. She and the organization promoted the claim that abortion increases a woman’s chance of breast cancer, a claim that was conclusively debunked by medical authorities years ago. The National Cancer Institute (a government body), declared in 2003 that thorough scientific studies “consistently showed no association between induced and spontaneous abortions and breast cancer risk.”

The same goes for the claim by Yoest’s group that abortion increases the risk of “serious mental health problems.” This notion is the basis for state laws requiring counseling before a patient is allowed to undergo an abortion. A study by UC San Francisco published last year found that the “greater risk” of “adverse psychological outcomes is faced by women denied an abortion. These findings do not support policies that restrict women’s access to abortion on the basis that abortion harms women’s mental health,” the study concluded.

Yoest was an architect of the strategy that led Texas to enact an anti-abortion law so extreme that it was slapped down by the Supreme Court last year on a 5-3 vote. The law placed heavy restrictions on abortion clinics, ostensibly to protect women’s health, that effectively shut many down. In his majority opinion, Justice Stephen Breyer essentially called that a subterfuge: “There was no significant health-related problem that the new law helped to cure,” he wrote.

Teresa Manning

Teresa Manning was appointed as HHS’ deputy assistant secretary for population affairs. Manning is a former lobbyist for the National Right to Life Committee and a legislative analyst for the Family Research Council. During a 2003 NPR interview, she said: “Of course, contraception doesn’t work. … Its efficacy is very low.” In fact, as Charo observes, hormonal methods are 91% effective, and IUDs are 99% effective.

In 2001, then as Teresa Wagner, Manning was quoted in a Family Research Council news release attacking prescriptions for the morning-after pill, which she characterized as an abortion method. She said doctors prescribing the pill were “accepting — and, in effect, — promoting promiscuity — the cause of the STD explosion, as well as the well known social problems of out of wedlock pregnancy and illegitimacy. We expect more from our doctors than collaboration with abortion advocates!”

Valerie Huber was appointed earlier this month as chief of staff to the assistant secretary for health at HHS. Huber is an abstinence advocate and the president of Ascend, a Washington group that advocates for abstinence-only sex education.

The problem there is that birth control experts have consistently found that abstinence education is ineffective at preventing teen pregnancies. In fact, just the opposite — a 2011 study at the University of Georgia reported that the “data show clearly that abstinence-only education as a state policy … may actually be contributing to the high teenage pregnancy rates in the U.S.”

Huber’s approach is moralistic. “As public health experts and policymakers, we must normalize sexual delay more than we normalize teen sex, even with contraception,” she told PBS last year. But studies consistently show that what reduces teen pregnancies is increased use of contraceptives.

Katy Talento

Katy Talento was named to Trump’s Domestic Policy Council. Talento has been the author of frequent anti-birth control screeds, including several that appeared on the Federalist, a right-wing website. Among them was an article whose headline called birth control “the mother of all medical malpractice,” and another asserting that women who took chemical forms of birth control risked “breaking your uterus for good,” ruining it “for baby-hosting altogether.”

Talento’s basis for this claim was what she called a “ground-breaking 2012 study” ostensibly showing that women who used birth control pills for several years had higher rates of infertility and miscarriage than those who did not. But as Jon Cohen of Science Magazine showed earlier this year, the study reported nothing of the kind — as its lead author confirmed. In fact, the researchers cited a study indicating that long-term use of the pill — five years — actually increased a woman’s subsequent fertility.

The lead author, Robert Casper, a Toronto fertility doctor, told Cohen that while his study found that using the pill sometimes led to thinner uterus linings, that wasn’t associated with more infertility or miscarriages — his study group was small and predisposed to fertility problems, he explained.

“The benefits of the birth control pill in preventing unwanted pregnancy or in treating painful menstrual periods far outweighs the rare possible case of thin endometrium,” Cohen wrote. “There is no evidence that the birth control pill is ‘seriously risky’ in terms of future reproductive health.”

As Charo observes, the “alternative science” underlying these appointees’ approach has infected public discussions of birth control and the courts. “Legislatures and even the Supreme court have tolerated individuals making up their own definitions for abortifacient [that is, abortion-producing] and pregnancy,” she writes, and then using them to justify refusing to fill prescriptions or offer insurance coverage for contraceptives.”

That was glaringly true in the Supreme Court’s egregious 2014 Hobby Lobby decision, which allowed owners of private companies to refuse to cover contraceptives under the Affordable Care Act. The Hobby Lobby plaintiffs specifically objected to four birth control methods — including IUDs and the morning-after pill because they produced abortions, which the plaintiffs found objectionable supposedly on religious grounds. But neither medical authorities nor the federal government classified those methods as abortifacients; the plaintiffs’ definition was accepted as gospel by Justice Samuel Alito, who wrote the opinion, which became the basis for allowing businesses to exclude all birth control methods from their health plans.

With adherents of similar viewpoints now ensconced in positions of responsibility in the Trump administration, their approach threatens to spread throughout government policy. But it’s no more based on legitimate science than it ever was.

[The Los Angeles Times]