Drug screening in prenatal care demands objective medical criteria, support services

Article Abstract:

Results of a study in which the urine of pregnant women was routinely screened for illicit drugs show that such tests may improve the outcome of pregnancy, but only if combined with drug counseling and support. Garrett H.C. Colmorgen and colleagues studied 1,088 women who gave birth between July 1, 1988, and June 30, 1989. Urine was tested for a variety of substances, including cocaine, opiates, cannabinoids (marijuana), amphetamines, benzodiazepines, and barbiturates. If the test was positive on the first prenatal visit, patients were offered drug counseling and follow-up by public health nurses, social workers, and other specialists. Almost 16 percent of the pregnant women used drugs, with cocaine (9.4 percent) and marijuana (5.6 percent) being the most commonly used substances. Women who used drugs had higher rates of complications before and after delivery than a control group of women who did not abuse drugs. In addition, the infants born to abusing mothers weighed less and were more likely to be born prematurely. They had a higher rate of birth defects (8.1 percent) than infants born to controls (3 percent). Eighty-three (48 percent) of the patients who tested positive for drug use agreed to counseling, and 61 percent of the women in counseling discontinued their drug use. Of the 90 who refused counseling, only 11 stopped using drugs. The women who stopped had higher-birth-weight babies and infants with larger head circumferences than those who continued using drugs. The researchers concluded that care provided in the framework of support, rather than judgement, can improve the outcome for drug-abusing pregnant women. Such an approach is difficult to institute in states where physicians are required to report evidence of drug use during pregnancy to authorities. In such cases, women who fear the loss of their children will be deterred from seeking prenatal care. A study found that black women who abused drugs were reported 10 times as often as white women, even though the actual rates of abuse were approximately equal. If reporting maternal drug abuse is to continue, it must be done in a way that is not affected by racial bias. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Complications and side effects, Mandatory drug testing, Drug testing, Drug abuse in pregnancy

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Christian scientists claim healing efficacy equal if not superior to that of medicine

Article Abstract:

A series of recent trials in which Christian Scientists have been convicted of motivated medical neglect in the deaths of their children have brought the healing efficacy of Christian Science into question. Child protection advocates claim that the parents use the pain and anguish of their children to demonstrate the strength of their belief in Christian Science. Church leaders believe that the right of parents to believe in and rely upon Christian Science rather than conventional medical practice constitutes a First Amendment right. Courts have consistently decided that the concept of religious freedom does not release a parent from the obligation to provide children with medical care. Recently, however, legislation in Colorado, Texas and Louisiana has provided a religious exemption under child neglect laws, and has established Christian Science as the legal equivalent of conventional medical care. Christian Science treatment is ''heartfelt yet disciplined prayer,'' and its followers are instructed that medicine is sinful and ''anti-Christian.'' Illness is considered an illusion for which the only escape is prayer. Christian Science healers are only required to undergo two weeks of religious training, and treatment is usually initiated over the telephone. Practitioners are paid for their efforts by Blue Cross/Blue Shield (in some states), major insurance payers, and Medicare. Despite the inability of practitioners to make medical diagnosis, they may sign certificates for sick leave and for disability payments. Such religious exemption may create an unacceptable double standard that holds conventional physicians to higher standards. Although a spokesperson for the church has claimed that the effectiveness of Christian Science practice is equivalent or superior to conventional medical, critics of the system claim that church records and statistics are unscientific and misleading. But even when medical practice is successful, the church argues that the patient and parents may have been damaged ''by the knowledge that the child's life was sinfully saved.'' (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Ethical aspects, Alternative medicine, Christian Science

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