David Goldman / AP

Across the country, states are passing laws that determine what doctors can and cannot discuss with their patients, according to a new report from a coalition of four nonprofit organizations. Doctors might be prevented from asking patients about politically sensitive topics, like guns or fracking, or they might be forced to give patients medically inaccurate information, in the case of abortion.

Fracking

According to the report, written jointly by the National Partnership for Women & Families, National Physicians Alliance, Natural Resources Defense Council, and the Law Center to Prevent Gun Violence, more than 15 million Americans live within a mile of a fracking well that was recently drilled.

Numerous studies have linked fracking—the process of injecting water into rock in order to extract natural gas—to health risks, and some patients see doctors for illnesses they believe might be related to fracking-chemical exposure. However, the report notes, some states require doctors to sign confidentiality agreements with fracking companies before they can learn what chemicals are used in their wells.

In some cases, these agreements might prevent doctors from discussing those chemicals with other doctors, the patients’ families, and potentially the patients themselves. When Pennsylvania’s law, called a “gag rule” by opponents, was passed in 2012, NPR described how it might tie the hands of doctors who treat patients near fracking sites:

Plastic surgeon Amy Pare practices in suburban Pittsburgh where she does reconstructive surgeries and deals with a lot of skin issues. She tells me about one case, a family who brought in a boy with strange skin lesions.

“Their son is quite ill — has had lethargy, nosebleeds,” Pare says. “He's had liver damage. I don't know if it's due to exposure.” ...

Pare's first step was to figure out what chemicals the [local] drillers were using. But that information isn't easy to get. In this case, Pare says, the patient's family had a good lawyer who helped them find out what kind of chemicals the gas company was using.

“If I don't know what [patients] have been exposed to, how do I find the antidote? We're definitely not clairvoyant,” she says.

Two lawsuits brought by doctors to challenge Pennsylvania’s laws have so far been unsuccessful.

Abortion

Among the record number of abortion restrictions states have passed in the past five years are laws requiring doctors to give abortion patients information that many obstetricians say is false. According to the report, 12 states force doctors to tell women that their fetus can feel pain, even though evidence is weak that fetuses can feel pain in the first two trimesters, the cutoff for abortions. Other states require doctors to tell patients—falsely, according to ACOG and other doctors’ groups—that abortion negatively impacts their future fertility, that abortion is linked to breast cancer, or that an abortion can be reversed.

Some states also require doctors to perform ultrasounds on abortion-seeking patients and describe what they see.

The report quotes one doctor as saying, “Sometimes I find myself apologizing for what the state requires me to do, saying, ‘You may avert your eyes and cover your ears.’”

These laws impact roughly 40 million women of reproductive age. Statistically, 30 percent of them will seek an abortion by age 45.

Guns

Having a gun in the home is strongly correlated with both suicide and accidental shootings. The report authors say 1.7 million children live in homes with unsafe gun practices. About 7,400 children are hospitalized each year due to gunshot wounds, according to a 2014 study in Pediatrics.

Naturally, many pediatricians ask parents whether they have a gun at home, much as they might ask whether their swimming pool is fenced in. When doctors counsel patients about how to store their guns safely, the patients listen—the majority improve their firearm-storage practices, according to some studies.

In 2011, Florida passed a law—which is now likely headed to the U.S. Supreme Court—that severely curtailed doctors’ ability to discuss guns with patients, citing the privacy rights of gun-owners. Fourteen states have introduced similar legislation since then, though none as restrictive as Florida’s have been enacted, the report authors write.

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So what does this all mean?

It would be unfair to say that the lobbyists pushing for these laws actually want Americans to receive inaccurate information from their health-care providers. The proponents of each of these types of laws are acting in their own interests. In the case of fracking, competitive energy companies don’t want to give away their trade secrets. With abortion, pro-lifers truly believe abortion is one of the worst things a woman can do to herself (not to mention her fetus/baby), and pro-life groups are extremely powerful right now.

And Florida’s “docs vs. glocks” law was sparked by a patient, 26-year-old Amber Ullman, who refused to answer a question from her pediatrician about whether she owned a gun. Her frustrated doctor told her to go somewhere else, according to the nonprofit news site The Trace.

Whether it’s intentional or not, though, the laws’ effect is clear. They influence what doctors say when patients are at their most vulnerable, during a private medical exam.

The thing many Americans feared most about Obamacare, the storied “death panels,” never materialized. The idea that the government “shouldn’t stand between you and your doctor” is still a popular Republican anti-Obamacare talking point. Obamacare doesn’t do that, but these laws do, quite literally.

That might be a trade-off people are willing to make for the sake of cheaper energy, less abortion, and fewer questions about their guns. But it’s a choice they should at least be aware they’re making.

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