Well: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.


How to Measure Your Blood Pressure

Mistaken readings, which can occur in doctors’ offices as well as at home, can result in misdiagnosis of hypertension and improper treatment. Dr. Samuel J. Mann, of Weill Cornell Medical College, suggests these guidelines to reduce the risk of errors:

¶ Use an automatic monitor rather than a manual one, and check the accuracy of your home monitor at the doctor’s office.

¶ Use a monitor with an arm cuff, not a wrist or finger cuff, and use a large cuff if you have a large arm.

¶ Sit quietly for a few minutes, without talking, after putting on the cuff and before checking your pressure.

¶ Check your pressure in one arm only, and take three readings (not more) one or two minutes apart.

¶ Measure your blood pressure no more than twice a week unless you have severe hypertension or are changing medications.

¶ Check your pressure at random, ordinary times of the day, not just when you think it is high.

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Japan eased safety standards ahead of Boeing 787 rollout









Japan's government stepped in to give Boeing Co.'s now-grounded 787 Dreamliner and its made-in-Japan technology a boost in 2008 by easing safety regulations, fast-tracking the rollout of the groundbreaking jet for Japan's biggest airlines, according to records and participants in the process.

The concessions by an advisory panel to Japan's transport ministry reflected pressure from All Nippon Airways (ANA) and Japan Airlines (JAL) and a push to support Japanese firms that supply 35 percent of the 787 from the carbon-fiber in its wings to sophisticated electrical systems and batteries used to save fuel, people involved in the deliberations told Reuters.

"I believe the request for the changes came initially from the airlines. Ultimately, it was a discussion of measures to lower operating costs for the airlines," said Masatoshi Harigae, head of aviation at Japan's Aerospace Exploration Agency, one of the outside advisers who urged the eased regulatory standards.

There is no suggestion that easing regulatory standards contributed to the problems facing the Dreamliner, idled around the world after a string of malfunctions ranging from fuel leaks to battery meltdowns. There is also no evidence to suggest that continuing the mandate for more frequent manual inspections for new aircraft, including the Boeing 787, before 2008 would have helped catch signs of trouble earlier.

The looser regulations did not specifically address the risk of the Dreamliner's powerful batteries catching fire, the risk that safety investigators have zeroed in on in recent weeks.

But the steps taken by Japan's Civil Aviation Bureau in 2008 underscore how the deep commercial ties between Boeing and its Japanese suppliers and the backing of ANA and JAL helped build support for an easing of certification standards, based on a review of meeting records by the advisory panel released by the Ministry of Land, Infrastructure and Transport and comments from three of the seven experts who participated.

ANA and JAL declined to comment, deferring questions on regulatory standards to aviation officials and the ministry. Boeing in Tokyo said it couldn't immediately comment on the rule changes.

"We have not brought down our standards in comparison to other countries. This was a pragmatic revision," Tatsuyuki Shimazu, Chief Air Worthiness Engineer at the Civil Aviation Bureau, said.

ONGOING PROBE

Earlier this month, ANA was forced to make an emergency landing on a 787 domestic flight after a battery overheated and partially melted, triggering smoke alarms in the cockpit. The probe into that incident may take weeks or months as investigators still lack basic data to understand what went wrong, people involved have said.

In the meantime, the indefinite grounding of the Dreamliner has raised costs for both ANA and JAL and threatened to push back plans both carriers had for growth and new routes based on the new aircraft, analysts have said.

Boeing has yet to say whether it will compensate carriers for flight cancellations and higher operating costs. "We have been talking with our customers since (the 787 was grounded), but the details are confidential," said Rob Henderson, a Boeing spokesman in Tokyo.

After three meetings by a panel of industry and policy experts that concluded in March 2008, Japan's transport ministry said it would adopt 40 proposals to streamline regulations surrounding new aircraft. At the time, the ministry said the easier regulatory standards were designed in part to "quickly realize the benefits from the introduction of the 787."

ANA, the Dreamliner's biggest customer, and JAL committed to buy the first 787 in 2004, helping Boeing kick-start orders for the futuristic plane. Both subsequently increased their orders, with ANA planning to eventually fly 66 Dreamliners.

"At the time there was a lot of confidence in the aircraft. It was a discussion of measures to lower operating costs for the airlines," said Harigae.

Japan's government agencies often convene blue-ribbon panels of outside experts to review regulatory policy changes, as the transport ministry did for aircraft safety rules in 2007.

QUICKER TURNAROUNDS

Changes endorsed by the aviation group, including 40 revised safety guidelines, were presented as an effort to bring Japan into line with the framework of regulations in other markets, including the United States. At least five recommendations in the advisory report benefited the 787. Four mentioned support for the Dreamliner directly.

Three of the rule changes dealt with abbreviated testing and approval of pilots who had been cleared to fly the Boeing 777 and were preparing to switch to the 787. "It (787) is highly innovative and its safety is also advanced, but it's also very similar in design to the 777," said Kinya Fujiishi, an aviation journalist who sat on the panel. "This is why we thought it would be fine to revise the rule."

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Nightclub fire kills at least 200 in Brazil

A fire swept through a crowded nightclub in southern Brazil early Sunday, killing at least 245 people and leaving at least 200 injured, police and firefighters said. (Jan. 27)










SANTA MARIA, Brazil (Reuters) - A fire in a nightclub killed at least 232 people in southern Brazil on Sunday when a band's pyrotechnics show set the building ablaze and fleeing partygoers stampeded toward blocked and overcrowded exits in the ensuing panic, officials said.

The blaze in the university town of Santa Maria was started by a band member or someone from its production team igniting a flare, which then set fire to the ceiling, said Luiza Sousa, a civil police official. The fire spread "in seconds," she said.






Local fire officials said at least one exit was locked and that bouncers, who at first thought those fleeing were trying to skip out on bar tabs, initially blocked patrons from leaving. The security staff relented only when they saw flames engulfing the ceiling.

The vast majority of the victims, most of them university students, died from asphyxiation, officials said. Others were crushed in the stampede.

"We ran into a barrier of the dead at the building's exit," Colonel Guido Pedroso de Melo, commander of the Santa Maria fire squad, said of the scene firefighters found on arrival. "We had to clear a path to get to the rest of those that were inside."

An estimated 500 people were in the Boate Kiss nightclub when the fire broke out at around 2:30 a.m., police said. Witnesses said the club, which has a 2,000-person capacity, was always busy on weekends but wasn't any more crowded than usual.

The death tally was lowered slightly, with police saying at midafternoon that 232 people had been killed, down from an initial figure of 245.

When the fire began, many revelers were unable to find their way out amid the chaos, confusing restroom doors for exits and finding resistance from bouncers when they did find an exit door.

"It all happened so fast," survivor Taynne Vendrusculo told GloboNews TV. "Both the panic and the fire spread rapidly, in seconds."

Once security guards realized the building was on fire, they tried in vain to control the blaze with a fire extinguisher, according to a televised interview with one of the guards, Rodrigo Moura. He said patrons were getting trampled as they rushed for the doors, describing it as "a horror film."

Television footage showed people sobbing outside the club before dawn, while shirtless firefighters used sledge hammers and axes to knock down an exterior wall to open up an exit.

SAFETY STANDARDS IN SPOTLIGHT

Rescue officials moved the bodies to a local gymnasium, where the deceased were segregated by gender. Male victims were easier to identify, they said, because most of them, unlike the women, whose purses were left scattered in the devastated nightclub, had identification on them.

One of the club's owners had already surrendered to police for questioning, GloboNews reported.

President Dilma Rousseff, who started her political career in the Rio Grande do Sul state where the fire happened, cut short a visit to Chile to return to visit the scene. Before leaving Chile, she broke out in tears as she pledged government help for the victims and their families.

"We are trying to mobilize all possible resources to help in the rescue efforts," Rousseff said. "All I can say at the moment is that my feelings are of deep sorrow."

The disaster recalls other incidents including a 2003 fire at a nightclub in West Warwick, Rhode Island, that killed 100, and a Buenos Aires nightclub blaze in 2004 that killed nearly 200. In both incidents, a band or members of the audience ignited fires that set the establishment ablaze.

Brazil's safety standards and emergency response capabilities are under particular scrutiny as it prepares to host the 2014 World Cup soccer tournament and the 2016 Olympics.

Santa Maria, with a population of more than 275,000, is about 186 miles west of the state capital of Porto Alegre.

Rio Grande do Sul state's health secretary, Ciro Simoni, said emergency medical supplies from all over the state were being sent to the scene.

(Additional reporting by Guillermo Parra-Bernal, Gustavo Bonato, Jeferson Ribeiro, Eduardo Simões and Brian Winter; Writing by Paulo Prada; Editing by Todd Benson, Kieran Murray and Eric Beech)

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Stone Roses, Blur, Phoenix headline Coachella 2013 music fest






(Reuters) – British rockers Blur and The Stone Roses will be joining French indie-rock band Phoenix and Red Hot Chili Peppers to headline this year’s three-day Coachella Valley Music and Arts Festival, organizers said on Thursday.


The annual music festival, set for two consecutive weekends in April, has become one of the largest U.S. music festivals, attracting more than 80,000 people to the desert town of Indio, California.






After featuring electronic music DJs such as Tiesto, Swedish House Mafia, Afrojack and David Guetta among the top-billed acts last year, this year’s Coachella sees the music festival return to its rock roots.


The festival will take place on the weekends of April 12-14 and 19-21, with the same line-up both weekends.


Blur and The Stone Roses, who recently reunited after a long hiatus, will headline Friday. Phoenix, which has a new album coming out this spring, will take Saturday’s primetime spot.


Los Angeles rockers Red Hot Chili Peppers, who previously headlined the festival in 2003 and 2007, will close out the festival in the Sunday headlining slot.


Other anticipated names on the line-up this year include hip hop collective Wu-Tang Clan, Icelandic indie band Sigur Ros, Grammy nominees The Lumineers and electro-rock music group The Postal Service.


Previous years have seen acts such as Prince, Kings of Leon, Beastie Boys, Madonna, Muse, Pixies, Jay-Z and Kanye West take the headlining slots.


Last year, hip hop veterans Snoop Dogg and Dr. Dre grabbed headlines as they resurrected late rapper Tupac via hologram on stage for the closing night of the festival.


Ticket prices start at $ 349 and they will go on sale on January 29 at 10 a.m. PST (1800 GMT). This year, organizers said there will be no layaway option for those wishing to pay for their tickets in installments.


(Reporting by Piya Sinha-Roy; Editing by Elaine Lies and Lisa Shumaker)


Music News Headlines – Yahoo! News





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Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

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Pitching Chicago to China








World Business Chicago Vice Chairman Michael Sacks and former Commerce Secretary William Daley leave Sunday on a six-day business mission to China, Sacks' first official foreign trip as a top adviser to Mayor Rahm Emanuel.


Sacks said that he and Daley will pay their own way to China while World Business Chicago, a nonprofit that acts as the city's economic development agency, will cover the travel costs for two staff members, including one from the mayor's office.


Sacks and Daley will visit Hong Kong and Beijing before joining up with Choose Chicago CEO Don Welsh and the Chicago Symphony Orchestra in Shanghai.






There, they'll take in a CSO concert and co-host a reception for about 75 people, including tour operators, and China-based alumni of Northwestern University's Kellogg School of Management and the University of Chicago's Booth School of Business.


Sacks said he asked for Daley's help in selling Chicago to foreign officials, specifically the Chinese, after the former chief of staff to President Barack Obama returned home from Washington last year. Sacks said that was months before Daley said he was considering a run for governor in 2014.


"His gravitas, his stature as former commerce secretary and former chief of staff have made the quality of this trip better than anything I could have done myself," Sacks said. "I would not have been able to secure these meetings without him."


Daley and Sacks are expected to meet with 30-plus corporate executives, including the CEO of Hong Kong-based airline Cathay Pacific and billionaire Chinese entrepreneur Lu Guanqiu, whose son-in-law, Pin Ni, runs Elgin-based auto parts maker Wanxiang America Corp.; six Chinese officials, including the acting mayor of Beijing and China's commerce minister, Chen Deming; and U.S. Ambassador to China Gary Locke.


Sacks' role with World Business Chicago is a volunteer position. His day job is CEO of Grosvenor Capital Management. The investment firm is known as a hedge fund of funds because its primary business is to invest in multiple hedge funds on behalf of large investors, such as pension funds, corporations and sovereign wealth funds.


Sacks frequently travels abroad for his work, often adding city-related sales pitches to his itineraries. This, however, is his first foreign trip focused on his work at World Business Chicago.


Spertus changes name


The Spertus Institute this week will tweak its name — and with it, its identity — as part of an ongoing effort to recover from an unfortunately timed decision to open a new building on the eve of the financial crisis.


The institute, which has been a pillar of Jewish culture in Chicago since 1924, will now be called the Spertus Institute for Jewish Learning and Leadership. The institute also announced that its programming for children and families will be cut for the foreseeable future in favor of new academic offerings for people working at nonprofits.


"During the past 31/2 years, we eliminated a $3.8 million operating deficit, largely by dramatically reducing our programmatic footprint," said Hal Lewis, the institute's president, who took over in July 2009. "So I didn't have the money to go and get branding assistance. But I was convinced we had a branding challenge — because when I first became president I spent a good solid four months on a listening tour, in which people told me, 'Oh, yeah, I know something about Spertus,' but there was uncertainty about the work we did."


A grant from the Harvey L. Miller Foundation paid for most of the rebranding effort, which an outside consulting firm led.


"I should say I'm generally skeptical of consultants," Lewis said. "But they taught me something elegantly simple: Spend more time talking about the why and less time on the how. We know the enormous array of programs we offer ... but we never said why that's important. ... (The answer is) we believe that a learning Jewish community is a vibrant Jewish community. It is the historic experience of the Jewish people that learning doesn't stop at adolescence."


The institute has about 400 students in degree and certificate programs, from a one-day certificate in grant writing to a doctorate in Jewish studies, which can take up to 10 years to complete. The institute also offers public lectures on politics, arts and culture as well as museum-style exhibits.


Spertus plans to offer new leadership concentrations within its master's degree programs aimed at youth workers, camp counselors and early childhood teachers. It also plans to create programs in social entrepreneurship and lay-leader training. Lewis said also he may eliminate one of Spertus' existing education degrees, but these changes are not final and will not be announced until the spring.


"We were never best at early childhood education," Lewis said. "The synagogues are far better at that ... So this is not a retreat from one of our historic strong suits."


The seeds of the long-running overhaul of Spertus can be traced to the November 2007 opening of its building, an iconic glass sculpture at 610 S. Michigan Ave.


Lewis said so many assumptions about the building failed to materialize, such as revenue from room rentals. Nonprofits also heavily cut professional development funds during the recession, which, in turn, lowered enrollment because students were no longer able to get help paying for their master's degrees.


However, rentals and other economic indicators are beginning to reverse. The falling stock market hurt Spertus' program endowment, slicing it to about $6 million, and its building endowment to about $12 million. Those funds are now at about $7 million and about $17 million, respectively, Lewis said.


Steven Nasatir, president of the Jewish United Fund/Jewish Federation of Metropolitan Chicago, said his organization is assisting Spertus with fundraising. He said without the branding and other program changes Lewis is making, Spertus would be "treading water."


"The name change is a manifestation of resetting goals and is a positive thing," he said. "People have to better understand what you're attempting to do."


Melissa Harris can be reached at mmharris@tribune.com or 312-222-4582.


Twitter @chiconfidential






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Fire 'rekindles' at Bridgeport warehouse




















A vacant warehouse in Bridgeport continues to burn.




















































A nearly 100-year-old Bridgeport warehouse is on fire again this morning after it was gutted during a 5-alarm fire on Tuesday, according to the Chicago Fire Department.


About 10 a.m., a tower ladder truck was sent to the scene to handle the rekindle at the ruins, according to the fire department.


Last night, as crews began demolishing the warehouse at 3757 S. Ashland Ave., the fire department officially released its conclusion as to how it began.








"In layman's terms, that means something that was burning such as a flame or match got near something that would burn," Langford said.


Langford said the building had no gas or electric service and no one was known to be living there. But the night of the blaze, Fire Commissioner Jose Santiago told reporters that in the past, firefighters had been called to the warehouse for small fires caused when squatters lit fires to stay warm.


The matter has been forwarded to the Chicago Police Bomb and Arson unit to determine if the fire involved foul play, Langford and police said.


Friday morning, a private wrecking company hired by the owners of the building began its demolition, Chicago Fire Department spokeswoman Meg Ahlheim said.


Tuesday night, a fire department battalion chief spotted smoke from the blaze as he drove past around 9 p.m. A third of the department's on-duty personnel were called to fight a fire fed by century-old support timbers. Crews have remained there since, dousing flames from the smouldering debris.


chicagobreaking@tribune.com






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New purported Galaxy Note 8.0 images confirm S-Pen support







Earlier this week, images that were purportedly of Samsung’s (005930) upcoming Galaxy Note 8.0 tablet leaked onto the Web. The slate looked like an oversized Galaxy S III smartphone and included the company’s physical home button, which had perviously been omitted from earlier Galaxy tablets. French blog Frandroid posted additional images of the tablet on Friday that confirmed it will include an S-Pen stylus, similar to the Galaxy Note II and Galaxy Note 10.1.


[More from BGR: Sony’s PS Vita: Dead again]






[More from BGR: The Boy Genius Report: Apple’s iMac takes desktop crown]


The Galaxy Note 8.0 is rumored to be equipped with a 1280 x 800 pixel resolution display, 1.6GHz quad-core processor and a 5-megapixel rear camera. The slate is also believed to include 2GB of RAM, 16GB of internal storage, a microSD slot and Android 4.2.


Samsung is expected to announce the Galaxy Note 8.0 tablet next month at Mobile World Congress in Barcelona.


This article was originally published on BGR.com


Wireless News Headlines – Yahoo! News





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Lorne Michaels comedy pilot lands at NBC






LOS ANGELES (TheWrap.com) – “Saturday Night Live” boss Lorne Michaels is broadening his relationship with NBC via a new comedy pilot.


The untitled project will star stand-up comic (and “SNL” writer) John Mulaney, and is loosely based on his life.






Mulaney will also write and executive-produce the project, with Michaels, Andrew Singer, Dave Becky and David Miner also executive-producing.


The project will be produced by Universal Television, Broadway Video and 3 Arts Entertainment.


Last month, Michaels – along with “Up in the Air” director Jason Reitman and “Girls” co-executive producer Bruce Eric Kaplan – sold a comedy pilot, “People in New Jersey,” to HBO. That project centers around an adult brother and sister who puzzle over the big and small mysteries of life while living in New Jersey.


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Religious Groups and Employers Battle Contraception Mandate


Shawn Thew/European Pressphoto Agency


President Obama, with his health secretary, Kathleen Sebelius, offering a compromise on the contraception mandate last year.







In a flood of lawsuits, Roman Catholics, evangelicals and Mennonites are challenging a provision in the new health care law that requires employers to cover birth control in employee health plans — a high-stakes clash between religious freedom and health care access that appears headed to the Supreme Court.




In recent months, federal courts have seen dozens of lawsuits brought not only by religious institutions like Catholic dioceses but also by private employers ranging from a pizza mogul to produce transporters who say the government is forcing them to violate core tenets of their faith. Some have been turned away by judges convinced that access to contraception is a vital health need and a compelling state interest. Others have been told that their beliefs appear to outweigh any state interest and that they may hold off complying with the law until their cases have been judged. New suits are filed nearly weekly.


“This is highly likely to end up at the Supreme Court,” said Douglas Laycock, a law professor at the University of Virginia and one of the country’s top scholars on church-state conflicts. “There are so many cases, and we are already getting strong disagreements among the circuit courts.”


President Obama’s health care law, known as the Affordable Care Act, was the most fought-over piece of legislation in his first term and was the focus of a highly contentious Supreme Court decision last year that found it to be constitutional.


But a provision requiring the full coverage of contraception remains a matter of fierce controversy. The law says that companies must fully cover all “contraceptive methods and sterilization procedures” approved by the Food and Drug Administration, including “morning-after pills” and intrauterine devices whose effects some contend are akin to abortion.


As applied by the Health and Human Services Department, the law offers an exemption for “religious employers,” meaning those who meet a four-part test: that their purpose is to inculcate religious values, that they primarily employ and serve people who share their religious tenets, and that they are nonprofit groups under federal tax law.


But many institutions, including religious schools and colleges, do not meet those criteria because they employ and teach members of other religions and have a broader purpose than inculcating religious values.


“We represent a Catholic college founded by Benedictine monks,” said Kyle Duncan, general counsel of the Becket Fund for Religious Liberty, which has brought a number of the cases to court. “They don’t qualify as a house of worship and don’t turn away people in hiring or as students because they are not Catholic.”


In that case, involving Belmont Abbey College in North Carolina, a federal appeals court panel in Washington told the college last month that it could hold off on complying with the law while the federal government works on a promised exemption for religiously-affiliated institutions. The court told the government that it wanted an update by mid-February.


Defenders of the provision say employers may not be permitted to impose their views on employees, especially when something so central as health care is concerned.


“Ninety-nine percent of women use contraceptives at some time in their lives,” said Judy Waxman, a vice president of the National Women’s Law Center, which filed a brief supporting the government in one of the cases. “There is a strong and legitimate government interest because it affects the health of women and babies.”


She added, referring to the Centers for Disease Control and Prevention, “Contraception was declared by the C.D.C. to be one of the 10 greatest public health achievements of the 20th century.”


Officials at the Justice Department and the Health and Human Services Department declined to comment, saying the cases were pending.


A compromise for religious institutions may be worked out. The government hopes that by placing the burden on insurance companies rather than on the organizations, the objections will be overcome. Even more challenging cases involve private companies run by people who reject all or many forms of contraception.


The Alliance Defending Freedom — like Becket, a conservative group — has brought a case on behalf of Hercules Industries, a company based in Denver that makes sheet metal products. It was granted an injunction by a judge in Colorado who said the religious values of the family owners were infringed by the law.


“Two-thirds of the cases have had injunctions against Obamacare, and most are headed to courts of appeals,” said Matt Bowman, senior legal counsel for the alliance. “It is clear that a substantial number of these cases will vindicate religious freedom over Obamacare. But it seems likely that the Supreme Court will ultimately resolve the dispute.”


The timing of these cases remains in flux. Half a dozen will probably be argued by this summer, perhaps in time for inclusion on the Supreme Court’s docket next term. So far, two- and three-judge panels on four federal appeals courts have weighed in, granting some injunctions while denying others.


One of the biggest cases involves Hobby Lobby, which started as a picture framing shop in an Oklahoma City garage with $600 and is now one of the country’s largest arts and crafts retailers, with more than 500 stores in 41 states.


David Green, the company’s founder, is an evangelical Christian who says he runs his company on biblical principles, including closing on Sunday so employees can be with their families, paying nearly double the minimum wage and providing employees with comprehensive health insurance.


Mr. Green does not object to covering contraception but considers morning-after pills to be abortion-inducing and therefore wrong.


“Our family is now being forced to choose between following the laws of the land that we love or maintaining the religious beliefs that have made our business successful and have supported our family and thousands of our employees and their families,” Mr. Green said in a statement. “We simply cannot abandon our religious beliefs to comply with this mandate.”


The United States Court of Appeals for the 10th Circuit last month turned down his family’s request for a preliminary injunction, but the company has found a legal way to delay compliance for some months.


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