Some years ago there was a baby girl born to an anxious mother waiting for her precious daughter. The baby was born with significant birth defects and had to be immediately rushed from Mandeville to the University Hospital of the West Indies (UHWI). The weather was bad, so although she should have been airlifted she had to be transported by car, wrapped in cotton and foil to keep her warm, carried by a nurse and her aunts. She very quickly had surgery done but remained in hospital for almost three weeks. Her hair was shaved off and IV's placed on the side of her head. They even had to cut both her ankles to get to her veins. By the time her mother was well enough to visit her in hospital she could hardly look at her baby because all the tubes and wires broke her heart. The baby girl eventually went home and grew into a cute, chubby little one with a beautiful head of hair.

I was that little baby.

Growing up, my family referred to me as the "miracle baby" because of all that I went through.

I was told by my family that I was born without the umbilical cord (navel string) attached to me; there was a big hole in my belly that the surgeons closed. It was this story that drove me to become a doctor. Since I was four years old I would say, "I'm going to be a baby doctor so I can help babies, just like how the doctors helped me." I have always been VERY proud of my story and would show off my scar where my belly button should be.

In medical school I would almost boast about how sick I was at birth, and that I was "born without an umbilical cord". Fortunately for me, I was able to trace my docket in the Health Records section at UHWI. I discovered that I was born with a rare condition. I was, in fact, born with an umbilical cord, contrary to what I had always believed. After learning my actual diagnosis I can only imagine how foolish I came across to my colleagues and teachers!

I'm sure there are many people who misunderstand their diagnoses and go about telling others they have "xyz" when it really is "wxy". This may seem trivial to some but to your doctor those two may be very different. It's important to know the correct diagnosis because you want your doctor to treat you appropriately by prescribing the relevant medications and ordering useful tests and investigations. No one wants to do an ultrasound when what you really needed was a simple blood test.

If you or your child has a chronic illness that requires frequent doctor visits for check-ups and necessitates you being on medications long-term, it is VERY important to know the names AND doses of the medications you are on, and whether you take them correctly. We need to know the doses of the medications to evaluate if they are working well for your condition. Do we keep the same dosage because it's effectively keeping your blood pressure down? Or do we increase the dosage? We can't increase the dosage if we don't know the dosage you are currently taking.

There have been many occasions when, while I am seeing a parent and child, I formulate my diagnosis and treatment plan, and tell the parent the diagnosis. When I ask if he/she understands the answer is, "Yes, doc". Then, a few minutes later, a nurse comes to me asking me to explain to this parent what is wrong with their child.

I get it. There are countless reasons you may want to leave my office — you've been there for hours, you want to catch the pharmacy before they close, your ride is waiting on you, or you just don't want to admit that you don't understand — but please let us know if you are confused or have any questions. We want you to be aware of what is going on with your health. We want you to understand why you need this blood test, and these four medications. We want you to feel confident that our treatment plan will help you.

I try as much as I can to follow up with questions like "Do you have any questions?" "Tell me what you understand based on what I told you", "Do you want me to go over anything?"

Speak up if you don't understand. There is no shame in enquiring about the health status of yourself or your loved one. Write down your questions you want to ask and bring it to your appointment. Ask for the diagnosis and medications to be written down (legibly). Bring a trusted relative or friend along as a second ear. Ask why you need to see this specialist when we refer you.

While I can't promise that we can answer every single question you may have, I can promise that we will try.

Dr Tal's Tidbit

It is important to know and understand your diagnosis and medications. If you misquote your diagnosis to your health-care provider it may affect your treatment course (to your detriment). Feel comfortable to ask your health-care provider any questions you may have about your health.

Dr Taleya Girvan has over a decade's experience treating children at the Bustamante Hospital for Children, working in the Accident and Emergency Department and Paediatric Cardiology Department. Her goal is to use the knowledge she has gained to improve the lives of patients by increasing knowledge about the health-care system in Jamaica. Dr Tal's Tidbits is a series in which she speaks to patients and caregivers providing practical advice that will improve health care for the general population. Email: dr.talstidbits@gmail.com IG @dr.tals_tidbits

While hypertension affects 180 million people in the region (18 per cent of adults), it "often has absolutely no symptoms nor signs and is therefore frequently undiagnosed and untreated", Dr Barbosa said during a media briefing today.

"This is serious because undiagnosed and uncontrolled hypertension can lead to heart attack, heart failure or stroke," he added.

Hypertension, or high blood pressure, is the primary risk factor for cardiovascular disease, which is the main cause of premature deaths in the region and is responsible for around 2 million lives lost each year.

Yet in the Americas over one third of men and a quarter of women with hypertension (aged 30 to 79 years) are unaware they have the condition. And of those who are aware they have hypertension and receive treatment, only a third (36 per cent) have it under control.

The PAHO director highlighted that countries must "intensify the scale-up and ensure equitable access to care for hypertension", and provide training to ensure that the latest approaches for diagnosis and treatment are practised in primary health clinics across the Americas.

These include the PAHO HEARTS initiative, a model of care for cardiovascular risk management which is currently being implemented in around 3,000 clinics across the region.

The director also urged countries to implement interventions to promote healthy diets, such as front-of-package warning labels on processed and ultra-processed food products, and measures to reduce salt intake.

Ensuring that primary health-care clinics have clinically validated blood pressure measurement devices is also key to accurately diagnosing and managing hypertension, Dr Barbosa added. Yet many lack vital equipment.

Countries can access these devices, as well as quality-assured, anti-hypertensive medications at competitive prices via the PAHO Strategic Fund, a pooled procurement mechanism for essential medicines and health technologies.

Lifestyle changes and lifelong use of anti-hypertensive medications are also key to reducing and controlling the condition.

World Hypertension Day is observed on May 17 each year to raise awareness of the urgent need to promote the prevention, detection and control of hypertension. The theme this year is 'Measure Your Blood Pressure Accurately, Control It, Live Longer!'

Researchers have found in a new research that Topical beta-glucan plus nanofractional radiofrequency and magnetic nanofractional radiofrequency effective treatment of stretch marks. 

The new study has been published in the journal Dermatology and Therapy.

Stretch marks are common atrophic dermal scars with significant physical and psychological effects. Therefore, there is a need for effective cosmetics and procedures for stretch mark treatment.Stretch marks affect over half of pregnant women and can lead to a negative self-image, thus impacting their quality of life. Many risk factors that cause stretch marks are difficult to control during pregnancy; therefore, an effective and tolerable treatment modality is required.

Several treatment strategies have been investigated, including the topical application of various creams or oils , superficial dermabrasion [18], trichloroacetic acid peel , platelet-rich plasma , radiofrequency (RF) and laser therapy .

This study aimed to evaluate the efficacy and safety of a novel treatment for stretch marks that is made up of topical formulations containing beta-glucan combined with nanofractional radiofrequency.

This randomized, blinded control trial enrolled 64 Chinese women aged 20–45 years at > 6 months after delivery with obvious white or silver abdominal stretch marks. Participants were randomly allocated to group A (blank group), group B (topical product group), group C (product combined with nanofractional radiofrequency), and group D (vehicle combined with nanofractional radiofrequency). The stretch mark width, skin elasticity, skin color, skin thickness, and collagen density were noninvasively measured. Two trained assessors evaluated the severity, color, outline, and relaxation of the striae.

Results

Group C showed the best treatment efficacy, with no adverse effects observed during the study period.

The findings indicate that stretch mark treatment using topical formulations containing beta-glucan, combined with nanofractional radiofrequency plus magnetic nanofractional radiofrequency, is tolerable and effective.

Reference:

Shu, X., Huo, W., Zou, L. et al. Treatment of Stretch Marks Using a New Formulation Combining Nanofractional Radiofrequency Plus Magnetic Nanofractional Radiofrequency. Dermatol Ther (Heidelb) (2023). https://doi.org/10.1007/s13555-023-00926-y

Gynecologist and laparoscopic surgeon Dr. Kalpana Bhatt and the Anaesthetist Dr. Rakesh Doshi have challenged the March order by the State Commission, which had directed the doctors to pay Rs 33,70,000 as compensation to the patients.

Medical Dialogues had earlier reported about the case that goes back to 2014, the patient had been suffering from abdominal pain and for this she had consulted Dr Bhatt. After examination, a tumor was discovered and the doctor had advised removal of tumor through laparoscopy.

On January 2, 2015, the operation was conducted and the condition of the patient became serious during the operation. The complainant, husband of the patient was informed that the patient had suffered shock during the procedure and it caused serious problems to her heart and lungs requiring shifting of the patient to the Critical Care Unit.

It was alleged that during procedure, patient had become unconscious and was requiring support of ventilator. Finally, the doctors advised shifting the patient to Sterling Hospital at Rajkot. During all the efforts, the patient died the next day.

Also Read:Death due to CO2 embolism during Laparoscopy procedure: Surgeon, Anesthetist ordered to pay Rs 33 lakh compensation

The discharge summary issued by Surgeon showed that there was anesthetic problem during the procedure and as a result of it, the patient went into shock. The Complainant alleged that when the patient had encountered problem during surgery, she should have been transferred to Critical Care Unit immediately. However, the doctors killed time in trying through general surgery. Alleging gross negligence against the treating doctors, the Complainant approached the State Consumer Court and filed a complaint seeking compensation.

On the other hand, the doctors denied negligence on their part and submitted that all pre-operative and post-operative checklist had been followed and after obtaining informed consent, the patient had been treated as per standard medical practice.

The surgeon submitted that the patient had developed pulmonary edema when the tumor was removed from bed through laparoscopic procedure, which is a known "complication" in laparoscopic surgery. Despite giving best possible treatment and medical assistance, the patient could not be saved.

Further, the doctor informed the State Commission that the patient had tumor in the broad ligament of uterus and to confirm it Color Doppler was also done and the report revealed that the tumor was non-cancerous. However, since it was painful to the patient, it was decided to remove the same. 

The doctors also submitted that live demonstration of surgical procedure was arranged so that relatives can see the entire procedure even outside the theatre. However, just after the tumor was dissected out of bed, patient developed pulmonary edema. It was argued by the doctors that when known complication occurs, Surgeon cannot be made liable.

While considering the matter, the State Commission opined

"Ordinarily, it is the complainant who has to prove his case of negligence with all evidences. But the facts mentioned herein above categorically suggest that incidence has taken place inside the operation theatre where complainant cannot have any access. In these circumstances, the explanation as to happening of events inside the theatre must come from the persons who are in possession of personal knowledge as to facts. It can be seen from the overall view of the facts that at relevant point of time (i.e. during surgery) only surgeon and anesthetist were in charge of treatment apart from the assisting staff."

Referring to the Discharge Summary given by the Surgeon, the State Consumer Court noted that "severe Pulmonary edema took place" immediately after the tumor was removed from the bed. The Discharge Summary further categorically mentioned that the surgeon was informed prior to removal of the tumor that the patient had developed ETCO2 level and she was requested to stop surgery.

At this outset, the bench observed, "Dr. Doshi, in his reply said that when he saw an increased level of ETCO2, he had requested he Surgeon to stop surgery. Thus, facts that can be said proved is problem of ETCO2 observed first and as a result thereof “Pulmonary edema” took place. Unless it is shown that increase of ETCO2 has any direct nexus with removal of the tumor from bed, it cannot be said pulmonary edema had taken place because of known complication. If increase of ETCO2 is not treated timely, it leads to Pulmonary edema as it mentioned in the medical literature which will be discussed herein after. It is in this circumstance, “Pulmonary Edema” caused to patient not because complication of laparoscopy surgery but because of no timely treatment to ETCO2 which is an independent cause. Thus, anesthetist is duty bound to give a plausible explanation for the occurrence of increase of the ETCO2 level and timely treatment for the same."

The State Consumer Court also referred to study material titled “ Carbon Dioxide Embolisms during Laparoscopic Surgery”, which opines that "Anesthesia providers play a crucial role in prompt recognition and treatment of carbon dioxide embolisms to provide life-saving measures to patients undergoing laparoscopic surgery. Communication between the anesthesia provider and the surgeon is an important step providing prompt, efficient, and safe interventions to adequately resuscitate a patient suffering from a carbon dioxide embolism. If left unrecognized and untreated, carbon dioxide emboli can have devastating effects, including death."

Discussing the role of the anesthetist, the commission observed that Dr. Doshi stated in his reply that “during intra-operative period, patient developed Hypertension which was controlled with Inj. Nitroglycerine infusion at the rate of 5 microgram / minute as continuous IV infusion. Then patient’s BP came to 130/84 mm of hg. After enucleating suddenly patient developed Hypercapnia and ventilator settings suggestive of high inspiratory pressure so the surgeon was asked to stop surgery and remove the Pneumoperitonium so CO2 insufflations stopped.”

"All these admissions on the part of opponents suggest that CO2 embolism had taken place is also established. As it mentioned in the aforesaid literature, CO2 embolism starts with beginning when procedure starts with placement of veress needle. It is therefore necessary for the Surgeon and Anesthetist to prove on record that before entering the veress needle all reasonable care and caution was taken regarding confirmation of site where it was to put. To prove this fact there is no evidence except bare statements that they followed standard line of treatment. Obviously, these facts were only within the personal knowledge of the opponents and despite that none of them has proved it through corroboration that they have taken such care. Thus, the opponents have failed to adduce best available evidence to discharge their burden," the Commission observed at this outset.

"Merely because “known complication” has taken place, it cannot be said responsibility of the treating doctors ceases. There are ways and measures to meet with eventual condition but doctor must come with true facts that these steps have been taken and despite that this has happened. Surprisingly, none of the opponents have produced on record any of their case papers," it further noted.

"The anesthetist, in his reply narrated facts but to support those facts, no documents have been produced. Being anesthetist, he is supposed to prepare a note regarding the actions taken during surgery. However, no such anesthetist’s note have been produced on record and therefore presumption also can be drawn that note is suppressed for the reasons best known to them," the Commission observed.

The State Consumer Court further noted that Carbon Dioxide Embolism is subject matter of anesthetist to take care of. However, there was nothing on record to give complete accounts of events from the anesthetist. 

"In absence of any such information it cannot be believed that he acted diligently just because he states on oath. Having accepted the patient for treatment, it is for the doctor to explain what preventive actions have been taken using reasonable “foresights” to minimize the effects of the known complications. The above literature also canvassed that presence of another anesthesia provider in the room all times to encounter Carbon Dioxide Embolism. In the instant case, no other anesthetist was present. Therefore this is a fit case, where presumptions can be made for absence of care on the part of doctors applying the aforesaid rule of “Res Ipsa Loquitur”," the State Consumer Court opined.

Holding the surgeon and the anaesthetist guilty of medical negligence, the Commission had observed,

"Thus, the doctors failed to convince this Commission that diligent efforts have been made during treatment and therefore I have no hesitation in holding that Surgeon and Anesthetist are liable for not providing efficient services to the patient Joshnaben. Their action lead to irreversible condition of patient and died on next day suggests that it is direct nexus with the cause of death of patient."

With this observation, the top consumer court directed the doctors to pay Rs 33,70,000 compensation to the Complainant along with interest at the rate of 10% from the date of complaint in 2015.

As per the latest media report by Indian Express, now the doctors have challenged the order before the NCDRC bench, which has admitted their appeal on Thursday. In their appeal, the doctors have submitted that the State Commission erred in holding them guilty of medical negligence.

They claimed that the State Consumer Court had passed the order "only on sympathy grounds" and also submitted that the State Commission have no expertise in the field of medical science and the Commission should have appointed a panel of medical experts to provide assistance to the Commission to arrive at a conclusion. The doctors argued that if such a panel had been formed, they would have been exonerated from the charges of medical negligence.

Further, the doctors have submitted that the State Commission did not consider that “a complication by itself does not constitute negligence” and also the fact that there is a “big difference between an adverse or untoward event and negligence”, and that there’s a “growing tendency to accuse the doctor of an adverse or untoward event”.

“A medical professional cannot be held liable simply because things went wrong from mischance or misfortune,” stated the appeal.

In their plea, the doctors have further relied on medical literature suggesting that there is risk associated with laparoscopic surgery and acute pulmonary edema after carbon dioxide embolism during Laparoscopic Ovarian Cystectomy as was the case with the deceased patient, who ultimately died.

While commenting on the doctors' appeal before the Apex Consumer Court, their counsel Advocate Nimit Shukla added that the appeal will now be heard on merits.

To read the State Commission's order, click on the link below:

https://medicaldialogues.in/pdf_upload/state-consumer-court-order-209664.pdf

Also Read: Leg amputated after botched procedure, delay in referral: Doctor absolved of negligence, Hospital asked to pay Rs 10 lakh compensation to patient

“Several nurses attached to the Princess Royal Hospital and clinics were presented with certificates for their service”

View the full post Nurses recognised on International Nurses Day on NOW Grenada.

Santo Domingo.- Benny Metz, the Vice Minister of Relations with Civil Society, has stated that the government is actively promoting the amendment of the Sports Law and the development of a legislative compendium aimed at safeguarding the health of children and young athletes.

Metz emphasized the need to update the Sports Law, which currently dates back to 2005 and is considered outdated. He asserted that the law should serve as the fundamental legal framework, providing general regulations that would subsequently lead to specific regulations for different sports and criminal offenses. The proposed amendments aim to address the evolving needs and challenges faced by athletes, particularly in relation to health and well-being.

These statements come in response to concerns raised by specialists regarding cases of acute renal failure in adolescents associated with the misuse of steroids. Metz characterized such behavior as voluntary homicide, stressing that the use of steroids without proper medical guidance or prescription is a serious offense.

To tackle this issue, the government is seeking to amend the existing Sports Law and establish a collaborative platform involving the Ministry of Public Health and the National Drug Council (CND). This platform aims to provide the necessary support to the Office of the Attorney General of the Republic, enabling them to effectively fulfill their role as legal prosecutors.

Metz further disclosed that several specific cases related to steroid misuse have already been reported to the Attorney General (Miriam Germán), and investigations are set to commence. The government is committed to addressing these cases and taking appropriate legal action to ensure accountability and protect the health and well-being of young athletes.

The proposed amendments to the Sports Law, along with the collaborative efforts of relevant institutions, reflect the government’s commitment to safeguarding the physical and mental well-being of children and young athletes in the Dominican Republic.

Santiago.- Experts consulted by Listin Diario have issued warnings about the greater harm caused by electronic cigarettes, or vapes, specifically on the bodies and behavior of young people compared to traditional cigarettes. In Santiago, where these devices have become increasingly prevalent among students, concerns have been raised regarding the potential risks associated with their widespread use. Pulmonologist Benjamín Hernández has even gone so far as to state that vapes are causing more damage than conventional cigarettes. Similarly, Dr. Samuel Ramos has highlighted that vaping can lead to brain immaturity, an increased risk of addiction, and changes in neurons among adolescents.

Dr. Ramos, the President of the Dominican Foundation for Obesity and Cardiovascular Prevention, has expressed concerns about the composition of vapes, which not only contain tobacco but also perfumes, glycerin, flavorings, and other substances that could have long-term cancer risks. He explains that nicotine, like any other drug, has a higher chance of causing addiction and long-term damage to brain cells in adolescents. Furthermore, young people are particularly susceptible to respiratory system damage due to their underdeveloped lungs, making them more prone to developing asthma at an early age or experiencing complications from pre-existing respiratory conditions.

Dr. Ramos emphasizes that autopsies have revealed short- and medium-term damage resulting from the accumulation of substances associated with vaping. Hernández adds that the continuous use of e-cigarettes can trigger bronchospasms, pulmonary infections, and significant damage to the pulmonary system. The constant exposure to these devices can also cause a crisis in bronchospasm and lead to inflammatory processes in the lungs, as well as the potential for extensive destruction of the pulmonary system.

Dr. Ramos further explains that not only individuals who vape themselves but also those who are exposed to secondhand vapor are at risk. He describes the aerosol produced by vaping as harmful, and even children can be affected by it to a lesser degree. He emphasizes that the consequences of widespread vaping among young people will extend beyond the immediate health impacts, potentially leading to a rise in hospitalizations, complications, intensive care admissions, intubations, and even deaths in cases of influenza, pneumonia, and other lung diseases.

The specialist warns that it is essential to address the issue promptly rather than waiting for the next pandemic to realize the increased risks faced by young individuals. Recognizing the higher likelihood of complications from lung diseases among this demographic, Dr. Ramos calls for preventative measures and proactive management to safeguard the health and well-being of young people.

 

At issue is a maneuver called alternative funding, which a growing number of drugmakers contend exploits their charitable programs. Basically, a plan sponsor excludes certain expensive drugs from coverage and taps an outside vendor to help patients obtain the medicines for free from patient assistance programs run by drug makers or foundations.

Continue to STAT+ to read the full story…

The Host

Julie Rovner
KFF Health News

@jrovner

Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

The formal end May 11 of the national public health emergency for covid-19 will usher in lots of changes in the way Americans get vaccines, treatment, and testing for the coronavirus. It will also change the way some people get their health insurance, with millions likely to lose coverage altogether.

Meanwhile, two FDA advisory committees voted unanimously this week to allow the over-the-counter sale of a specific birth control pill. Advocates of making the pill easier to get say it could remove significant barriers to the use of effective contraception and prevent thousands of unplanned pregnancies every year. The FDA, however, must still formally approve the change, and some of its staff scientists have expressed concerns about whether teenagers and low-literacy adults will be able to follow the directions without the direct involvement of a medical professional.

This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Tami Luhby of CNN, and Margot Sanger-Katz of The New York Times.

Panelists

Joanne Kenen
Johns Hopkins Bloomberg School of Public Health and Politico

@JoanneKenen

Read Joanne's stories

Tami Luhby
CNN

@luhby

Read Tami's stories

Margot Sanger-Katz
The New York Times

@sangerkatz

Read Margot's stories

Among the takeaways from this week’s episode:

• The formal public health emergency may be over, but covid definitely is not. More than 1,000 people in the United States died of the virus between April 19 and April 26, according to the Centers for Disease Control and Prevention. While most Americans have put covid in their rearview mirrors, it remains a risk around the country.
• The Senate Finance Committee held a hearing on “ghost networks,” lists of health professionals distributed by insurance companies who are not taking new patients or are not actually in the insurance company’s network. Ghost networks are a particular problem in mental health care, where few providers take health insurance at all.
• Another trend in the business of health care is primary care practices being bought by hospitals, insurance companies, and even Amazon. This strategy was popular in the 1990s, as health systems sought to “vertically integrate.” But now the larger entities may have other reasons for having their own networks of doctors, including using their patients to create revenue streams.
• Court battles continue over the fate of the abortion pill mifepristone, as a federal appeals court in New Orleans prepares to hear arguments about a lower-court judge’s ruling that would effectively cancel the drug’s approval by the FDA. In West Virginia, the maker of the generic version of the drug is challenging the right of the state to ban medication approved by federal officials. At the same time, a group of independent abortion clinics from various states is suing the FDA to drop restrictions on how mifepristone can be prescribed, joining mostly Democratic-led states seeking to ensure access to the drug.

Plus for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Slate’s “Not Every Man Will Be as Dumb as Marcus Silva,” by Moira Donegan and Mark Joseph Stern.

Joanne Kenen: The Baltimore Banner’s “Baltimore Isn’t Accessible for People With Disabilities. Fixing It Would Cost Over $650 Million,” by Hallie Miller and Adam Willis.

Tami Luhby: CNN’s “Because of Florida Abortion Laws, She Carried Her Baby to Term Knowing He Would Die,” by Elizabeth Cohen, Carma Hassan, and Amanda Musa.

Margot Sanger-Katz: The New Yorker’s “The Problem With Planned Parenthood,” by Eyal Press.

Also mentioned in this week’s episode:

• CNN’s “Here’s How the End of the Covid-19 Public Health Emergency Affects You,” by Tami Luhby and Alex Leeds Matthews.
• The New York Times’ “Corporate Giants Buy Up Primary Care Practices at Rapid Pace,” by Reed Abelson.
• Vox’s “Independents Back Abortion Rights. They’re Less Sure Democrats Do,” by Rachel M. Cohen.

Click to open the transcript

Transcript: The Crisis Is Officially Ending, but Covid Confusion Lives On

[Editor’s note: This transcript, generated using transcription software, has been edited for style and clarity.]

Julie Rovner: Hello and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent at KFF Health News. And I’m joined by some of the best and smartest health reporters in Washington. We are taping this week on Thursday, May 11, at 10:30 a.m. As always, news happens fast and things might have changed by the time you hear this. So here we go. We are joined today via video conference by Tami Luhby, of CNN.

Tami Luhby: Hello.

Rovner: Margot Sanger Katz, The New York Times.

Sanger-Katz: Good morning.

Rovner: And Joanne Kenen, of the Johns Hopkins Bloomberg School of Public Health and Politico.

Joanne Kenen: Hi, everybody.

Rovner: So the news on the debt ceiling standoff, just so you know, is that there is no news. Congressional leaders and White House officials are meeting again on Friday, and we still expect to not see this settled until the last possible minute. But there was plenty of other health news. We will start with the official end of the U.S. public health emergency for covid. We have talked at some length about the Medicaid unwinding that’s now happening and a potential to end some telehealth service reimbursement. But there’s a lot more that’s going away after May 11. Tami, you’ve been working to compile everything that’s about to change. What are the high points here?

Luhby: Well, there are a lot of changes depending on what type of insurance you have and whether we’re talking about testing, treatment, or vaccines. So I can give you a quick rundown. We wrote a visual story on this today. If you go to CNN.com, you’ll find it on the homepage right now.

Rovner: I will link to it in the show notes for the podcast.

Luhby: Basically, many people will be paying more for treatments and for tests. However, vaccines will generally remain free for almost everyone. And basically, if you look at our story, you’ll see the color-coded guide as to how it may impact you. But basically, testing — at-home tests are no longer guaranteed to be free. So if you’ve been going to your CVS or somewhere else to pick up your eight tests a month, your insurer may opt to continue providing it for free, but I don’t think many will. And then for lab tests, again, it really depends. But if you have Medicaid, all tests will be free through 2024. However, if you have private insurance or Medicare, you will probably have to start paying out-of-pocket for tests that are ordered by your provider. Those deductibles, those pesky deductibles, and copays or coinsurance will start kicking in again. And for treatments, it’s a little bit different again. The cost will vary by treatment if you have Medicare or private insurance. However, Paxlovid and treatments that are purchased by the federal government, such as Paxlovid, will be free as long as supplies last. Now, also, if you’re uninsured, there is a whole different situation. It’ll be somewhat more difficult for them. But there are still options. And, you know, the White House has been working to provide free treatments and vaccines for them.

Rovner: So if you get covid, get it soon.

Luhby: Like today. Right, exactly. Yeah, but with vaccines, even though, again, they’re free as long as the federal supplies last — but because of the Affordable Care Act, the CARES Act, and the Inflation Reduction Act, people with private insurance, Medicare, and Medicaid will actually continue to be able to get free vaccines after the federal supplies run out.

Rovner: After May 11.

Luhby: It’s very confusing.

Rovner: It is very confusing. That’s why you did a whole graphic. Joanne, you wanted to add something.

Kenen: And the confusion is the problem. We have lots of problems, but, like, last week, we talked a little bit about this. You know, are we still in an emergency? We’re not in an emergency the way we were in 2020, 2021, but it’s not gone. We all know it’s much, much better, but it’s not gone. And it could get worse again, particularly if people are confused, if people don’t know how to test, if people don’t know that they can still get things. The four of us are professionals, and, like, Tami’s having to read this complicated color-coded chart — you know, you get this until September 2024, but this goes away in 2023. And, you know, if you have purple insurance, you get this. And if you have purple polka-dotted insurance, you get that. And the lack of clarity is dangerous, because if people don’t get what they’re eligible for because they hear “emergency over, everything — nothing’s free anymore” — we’re already having trouble with uptake. We don’t have enough people getting boosters. People don’t know that they can get Paxlovid and that it’s free and that it works. We are still in this very inadequate response. We’re not in the terrifying emergency of three years ago, but it’s not copacetic. You know, it’s not perfect. And this confusion is really part of what really worries me the most. And the people who are most likely to be hurt are the people who are always most likely to be hurt: the people who are poor, the people who are in underserved communities, the people who are less educated, and it’s disproportionately people in minority communities. We’ve seen this show before, and that’s part of what I worry about — that there’s a data issue that we’ll get to whenever Julie decides to get to it, right?

Rovner: Yeah, I mean, and that’s the thing. With so much of the emergency going away, we’re not really going to know as much as we have before.

Sanger-Katz: In some ways, how you feel about this transition really reflects how you feel about the way that our health care system works in general. You know, what happened for covid is —and I’m oversimplifying a little bit — is we sort of set up a single-payer system just for one disease. So everyone had access to all of the vaccines, everyone had access to all of the tests, everyone had access to all of the treatments basically for free. And we also created this huge expansion of Medicaid coverage by no longer allowing the states to kick people out if they no longer seem to be eligible. So we had the kind of system that I think a lot of people on the left would like to see, not just for one disease but for every disease, where you have kind of more universal coverage and where the cost of obtaining important treatments and prevention is zero to very low. And this is definitely going to be a bumpy transition, but it’s basically a transition to the way our health care system works for every other disease. So if you are someone who had some other kind of infectious disease or a chronic disease like cancer, rheumatoid arthritis, whatever, you’ve been sort of dealing with all of this stuff the whole time — that you have to pay for your drugs; that, you know, that testing is expensive; that it’s confusing where you get things; that, you know, there’s a lot of complexity and hoops you have to jump through; that a lot depends on what kind of insurance you have; that what kind of insurance you can get depends on your income and other demographic characteristics. And so I find this transition to be pretty interesting because it seems like it would be weird for the United States to just forever have one system for this disease and another system for every other disease. And of course, we do have this for people who are experiencing kidney disease: They get Medicare, they get the government system, regardless of whether they would otherwise be eligible for Medicare.

Rovner: We should point out that Congress did that in 1972. They haven’t really done it since.

Kenen: And when it was much more rare than it was today.

Rovner: And when people didn’t live very long with it mostly.

Kenen: We didn’t have as much diabetes either.

Sanger-Katz: But anyway, I just think this transition kind of just gives us a moment to reflect on, How does the system work in general? How do we feel about how the system works in general? Are these things good or bad? And I agree with everything that Joanne said, that the confusion around this is going to have public health impacts as relates to covid. But we have lots of other diseases where we just basically have the standard system, and now we’re going to have the standard system for covid, too.

Kenen: You could have gone to the hospital with the bad pneumonia and needed oxygen, needed a ventilator, and when they tested you, if you had covid, it was all free. And if you had, you know, regular old-fashioned pneumonia, you got a bill. I agree with everything Margot said, but it’s even that silly. You could have had the same symptoms in your same lungs and you had two different health care systems and financing systems. None of us have ever thought anything made sense.

Rovner: Yes, well, I actually —

Kenen: That’s why we have a podcast. Otherwise, you know —

Sanger-Katz: And also the way that the drugs and vaccines were developed was also totally different, right? With the government deeply involved in the technology and development, you know, funding the research, purchasing large quantities of these drugs in bulk in advance. I mean, this is just not the way that our system really works for other diseases. It’s been a very interesting sort of experiment, and I do wonder whether it will be replicated in the future.

Luhby: Right. But it was also clear that this is not the beginning of the pushback. I mean, Congress has not wanted to allocate more money, you know, and there’s been a lot of arguments and conflicts over the whole course of this so-called single-payer system, or this more flexible system. So the U.S.’ approach to health care has been pushing its way in for many months.

Rovner: I naively, at the beginning of the pandemic, when we first did this and when the Republicans all voted for it, it’s like, let’s have the federal government pay the hospitals for whatever care they’re providing and make everything free at point of service to the patient — and I thought, Wow, are we going to get used to this and maybe move on? And I think the answer is exactly the opposite. It’s like, let’s get rid of it as fast as we possibly can.

Kenen: There’s money that the government has put in. I believe it is $5 billion into the next generation of vaccines and treatments, because the vaccine we have has certainly saved many lives. But as we all know, it’s not perfect. You know, it’s preventing death, but not infection. It’s not ending circulation of the disease. So we need something better. This debt ceiling fight, if the people in the government could spend all $5 billion today — like we were joking, if you want to get covid, if you’re going to get covid, get it today — I mean, if they could, they would spend all $5 billion of it today, too, because that could be clawed back. I mean, that’s — it’s going to be part of the coming fight.

Luhby: But the question is, even if they develop it, will anyone take it, or will enough people take it? That’s another issue.

Rovner: Well, since we’re sort of on the subject, I’m going to skip ahead to what I was going to bring up towards the end, which I’m calling “This Week in Our Dysfunctional Health System.”

Kenen: We could call it that way every week.

Rovner: Yes, that’s true. But this is particularly about how our health system doesn’t work. First up is “ghost networks.” Those are where insurers provide lists of health care providers who are not, in fact, available to those patients. A quote “secret shopper survey” by the staff of the Senate Finance Committee found that more than 80% of mental health providers found in insurance directories in 12 plans from six states were unreachable, not accepting new patients, or not actually in network. This is not a new problem. We’ve been hearing about it for years and years. Why does it persist? One would think that you could clean up your provider directory. That would be possible, right?

Kenen: Didn’t they legislate that, though? Didn’t they say a few years ago you have to clean it up? I mean, there are going to be some mistakes because there’s, you know, many, many providers and people will make changes or leave practices or … [unintelligible] …  jobs or whatever. But I thought that they had supposedly, theoretically, taken care of this a couple years ago in one of the annual regulations for ACA or something.

Rovner: They supposedly, theoretically, took care of the hospitals reporting their prices in a way that consumers can understand, too. So we’ve discovered in our dysfunctional health care system that Congress passing legislation or HHS [the Department of Health and Human Services] putting out rules doesn’t necessarily make things so.

Kenen: Really?

Rovner: Yeah. I just — this was one that I had thought, Oh, boy, I have a whole file on that from like the 1990s.

Sanger-Katz: It’s a huge problem, though. I mean —

Rovner: Oh, it is.

Sanger-Katz: You know, we have a system where, for large groups of Americans, you are expected to shop for a health insurance plan. If you’re purchasing a marketplace plan for yourself, if you are purchasing a Medicare Advantage plan when you become eligible for Medicare, and in many cases, if you have a choice of employer plans, you know, you’re supposed to pick the plan that’s best for you. And we have a system that tells people that having those kinds of choices is good and maximizes the benefits to people, to be able to pick the best plan. But for a lot of people, being able to have the doctors and hospitals that they use or to have a choice of a wide range of doctors for various problems, including mental health services, is a huge selling point of one plan versus another. And again, you have these ghost networks, when you have this lack of transparency and accuracy of this information, it just causes people to be unable to make those good choices and it undermines the whole system of market competition that underpins all of this policy design. I think you can argue that there are not a million gazillion people who are actually shopping on the basis of this. But I do think that knowing whether your medical providers are covered when you’re choosing a new health care plan is actually something that a lot of people do look into when they are choosing a health insurance plan. And discovering that a doctor that you’ve been seeing for a long time and whose relationship you really value and whose care has been important to you is suddenly dishonestly represented as a part of an insurance plan that you’ve selected is just, you know, it’s a huge disappointment. It causes huge disruptions in people’s care. And I think the other thing that this study highlighted is that health insurance coverage for mental health services continues to be a very large problem. There has been quite a lot of legislation and regulation trying to expand coverage for mental health care. But there are these kind of lingering problems where a lot of mental health care providers simply don’t accept insurance or don’t accept very many patients who have insurance. And so I think that this report did a good job of highlighting that place where I think these problems are even worse than they are with the health care system at large. It’s just very hard to find mental health care providers who will take your insurance.

Rovner: And I would say, when you’re in mental health distress or you have a relative who’s in mental health distress, the last thing you need is to have to call 200 different providers to find one who can help you.

Kenen: A lot of the ones that are taking insurance are these online companies, and the good thing is that they’re taking insurance and that there may be convenience factors for people, although there’s also privacy and other factors on the downside. But there have been reports about, your data is not private, and I have no idea how you find out which company is a good actor in that department and which company is just selling identifiable data. I mean, I think it was The Washington Post that had a story about that a couple of weeks ago. You know, you click in on something — straight to the data broker. So, yeah, you get insurance coverage, but at a different price.

Rovner: Well, overlaid over all of this is consolidation, this time at the primary care level of health care. Margot, your colleague Reed Abelson had a big story this week on primary care practices being bought up by various larger players in the health care industry, including hospitals, insurance companies, pharmacy chains, and even Amazon. These larger entities say this can act as a move towards more coordinated, value-based care, which is what we say we all want. But there’s also the very real possibility that these giant, vertical, mega medical organizations can just start to name their own price. I mean, this is something that the FTC [Federal Trade Commission] in theory could go after but has been kind of loath to and that Congress could go after but has also been kind of loath to.

Sanger-Katz: Yeah, in some ways we’ve seen this movie before. There was a big wave of primary care acquisitions that happened, I think, in the 1990s by hospitals. And the hospitals learned pretty quickly that primary care doctors are kind of a money-losing proposition, and they divested a lot. But I think what Reed documented so nicely is that the entities that are buying primary care now are more diverse and they have different business strategies. So it’s not just hospitals who are sort of trying to get more patients referred to their higher-profit specialists, but it’s also Medicare Advantage insurers who benefit from being able to tell the primary care doctors to diagnose their patients with lots of diseases that generate profits for the plan, and it’s other kinds of groups that see primary care as kind of the front door to other services that can be revenue-generating. And it’s very — it will be very interesting to see what the effects of these will be and whether these will turn out to be good business decisions for these new entities and of course also whether it will turn out to be good for patient care.

Rovner: Yeah, I remember in the 1990s when hospitals were buying up doctor practices, the doctors ended up hating it because they were asked to work much harder, see patients for a shorter period of time, and some of them actually — because they were now on salary rather than being paid for each patient — were cutting back on, you know, in general, on the amount of care they were providing. And that was what I think ended up with a lot of these hospitals divesting. It didn’t work out the way the hospitals hoped it would. But as you point out, Margot, this is completely different, so we will — we will see how this moves on. All right. Let’s go back a little bit. We’re going to talk about abortion in a minute. But first, something that could prevent a lot of unintended pregnancies: On Wednesday, an advisory committee for the Food and Drug Administration — actually two advisory committees — unanimously recommended that the agency approve an over-the-counter birth control pill. This has been a long time coming here in the U.S., even though pills like these are available without prescription in much of Europe and have been for years. But while the FDA usually follows the recommendations of its advisory committees, we know that some FDA scientists have expressed concerns about over-the-counter availability. So what’s the problem with giving women easier access to something that so many depend on?

Kenen: There are trade-offs. And there are — some of the scientists at the FDA are more conservative than others about, What if the woman doesn’t understand how to take the pill properly? Things like that. I mean, obviously, if we go the over-the-counter route, as other countries are doing, there have to be very simple, easy-to-understand explanations in multiple languages. Pharmacists should be able to explain it like, you know, “You have to take it every day, and you have to take it at approximately the same time every day,” and things like that. So, you know, obviously not taking it right doesn’t protect you as much as taking it right. But there are a lot of people who will be able to get it. You know, getting a prescription is not always the easiest thing in the world. Or if you’re lucky, you just click on something and somebody calls your doctor and gets you a refill. But that doesn’t always work and not everybody has access to that, and you have to still see your doctor sometimes for renewals. So if you’re a working person who doesn’t have sick leave and you have to take time off from work every three months to get a refill or you have to hire child care or you have to take three buses — you know, it takes a whole day, and then you sit in a waiting room at a clinic. I mean, our health system is not patient-friendly.

Rovner: I was going to say, to go back to what Tami was talking about earlier — if pills are available over the counter, it’s going to depend on, you know, what your insurance is like, whether you would get it covered.

Kenen: The cost.

Rovner: That’s right. And it could end up being —

Kenen: But I don’t think the FDA is concerned about that.

Rovner: No, they’re not. That’s not their job.

Kenen: The pill is pretty safe, and these are lower-dose ones than the pills that were invented, you know, 50 years ago. These are lower-dose, safer drugs with fewer side effects. But I mean, there’s concern about the rare side effect, there’s concern about people not knowing how to take it, all that kind of stuff. But Julie just mentioned the cost of coverage is a separate issue because under the ACA it’s covered. And if it becomes over the counter, the mechanism for getting that covered is, at this point, unclear.

Sanger-Katz: But we do have a system now where, for a lot of women, obtaining birth control pills depends on being able to get a doctor’s appointment on a regular basis. I think, you know, this is not standard practice, but I do think that there are a lot of OB-GYNs who basically won’t write you for a birth control pill unless you come in on a regular basis to receive other kinds of health screenings. And I think many of them do that with good intentions because they want to make sure that people are getting Pap smears and other kinds of preventive health services. But on the other hand, it does mean that there are a lot of women who, if they don’t have time or they can’t afford to come in for regular doctor’s appointments, lose access to birth control. And I think over-the-counter pills is one way of counteracting that particular problem.

Rovner: And I think that’s exactly why so many of the medical groups are urging this. During the more than a decade-long fight over making the morning-after pill over the counter, the big hang-up was what to do about minors. Even President Obama, a major backer of women’s reproductive health rights, seemed unhappy at the idea of his then-barely teenage daughters being able to get birth control so easily and without notifying either parent. It seems unimaginable that we’re not going to have that same fight here. I mean, literally, we spent six years trying to figure out what age teens could be to safely buy morning-after pills, which are high doses of basically these birth control pills. I’m actually surprised that we haven’t really seen the minor fight yet.

Kenen: I think everyone’s waiting for somebody else to do it first. I mean, like Julie, I wasn’t expecting to hear more about age limitations, and that’ll probably come up when the FDA acts, because I think the advisory committee just wanted to — they were pretty strong saying, “Yeah, make this OTC.”

Sanger-Katz: I also think the politics around emergency contraception are a little bit different because I think that, while physicians understand that those pills are basically just high-dose birth control pills and that they work in just the same way as typical contraception, I think there’s a perception among many members of the public that because you can take them after unprotected sex, that they might be something closer to an abortion. Now, that is not true, but because I think that is a common misperception, it does lead to more discomfort around the availability of those pills, whereas birth control pills — while I think there are some people who object to their wide dissemination and certainly some who are concerned about them in the hands of children, I think they are more broadly accepted in our society.

Rovner: We obviously are going to see, and we’ll probably see fairly soon. We’re expecting, I guess, a decision from the FDA this summer, although with the morning-after pill we expected a decision from FDA that lingered on for many months, in some cases many years.

Kenen: And I think it’s at least hypothetically possible that states will not do what the FDA says. Say the FDA says they can be over the counter with no age limitations. I can see that becoming a fight in conservative states. I mean, I don’t know exactly the mechanism for how that would fall, but I could certainly think that somebody is going to dream up a mechanism so that a 12-year-old can’t get this over the counter.

Rovner: I want to move to abortion because first up is the continuing question over the fate of the abortion pill, which we get to say at this point: not the same as the emergency contraceptive pill, which, as Margot said, is just high-dosage regular birth control pills. Needless to say, that’s the one that we’re having the current court action over. And there was even more action this week, although not from that original case, which will be heard by the Court of Appeals later in this month. In West Virginia, a judge declined to throw out a case brought by GenBioPro. They are the maker of the generic version of mifepristone, the abortion pill. That generic, which accounts for more than half the market, would be rendered unapproved even under the compromise position of the Court of Appeals because it was approved after the 2016 cutoff period. Remember, the Court of Appeals said, We don’t want to cancel the approval, but we want to roll it back to the date when FDA started to loosen the restrictions on it. So, in theory, there would be no generic allowed, but that’s actually not even what the West Virginia lawsuit is about; it’s about challenging the state’s total abortion ban as violating the federal supremacy of the FDA over state laws. Joanne, that’s what sort of you were talking about now with contraceptives, too. And this is the big unanswered question: Can states basically overrule the FDA’s approval and the FDA’s approval for even an age limit?

Kenen: Well, I mean, I’m not saying they can, but I am saying that I don’t know where the question will come down. Go back to the regular birth control; I can certainly see conservative states trying to put age limits on it. And I don’t know how that’ll play out legally. But this is a different issue, and this is why the abortion pill lawsuits are not just about the abortion pill. They’re about drug safety and drug regulation in this country. The FDA is the agency we charge with deciding whether drugs are safe and good for human beings, and not the system of politicians and state legislators in 50 different states replacing their judgment. So obviously, it’s more complicated, because it’s abortion, but one of several bottom lines in this case is who gets to decide: the FDA or state legislature.

Rovner: And right: Do states get to overrule what the federal Food and Drug Administration says? Well, I —

Kenen: Remember, some states have had — you know, California’s had stricter regulations on several health things, you know, and that’s been allowed that you could have higher ceilings for various health — you know, carcinogenics and so forth. But they haven’t fundamentally challenged the authority of the FDA.

Rovner: Yet. Well, since confusion is our theme of the week, also this week a group of independent abortion clinics led by Whole Woman’s Health, which operates in several states, filed suit against the FDA, basically trying to add Virginia, Kansas, and Montana to the other 18 states that sued to force FDA to further reduce the agency’s current restrictions on mifepristone. A federal judge in Washington state ruled — the same day that Texas judge did that mifepristone should have its approval removed — judge in Washington said the drug should become even more easily available. In the real world, though, this is just sowing so much confusion that nobody knows what’s allowed and what isn’t, which I think is kind of the point for opponents, right? They just want to make everybody as confused as possible, if they can’t actually ban it.

Sanger-Katz: I think they actually want to ban it. I mean, I think that’s their primary goal. I’m sure there are some that will settle for confusion as a secondary outcome. I think just this whole mess of cases really highlights what a weird moment we are, where we’re having individual judges and individual jurisdictions making determinations about whether or not the FDA can or can’t approve the safety and efficacy of drugs. You know, as Joanne said, we’ve just had a system in this country since the foundation of the FDA where they are the scientific experts and they make determinations and those determinations affect drug availability and legal status around the country. And this is a very unusual situation where we’re seeing federal courts in different jurisdictions making their own judgments about what the FDA should do. And I think the Texas judge that struck down the approval of mifepristone, at least temporarily, has come in for a lot of criticism. But what the judge in Washington state did is sort of a flavor of the same thing. It’s telling the FDA, you know, how they should do their business. And it’s a weird thing.

Rovner: It is. Well, one last thing this week, since we’re talking about confusion, and the public is definitely confused, according to two different polls that are out this week — on the one hand, a Washington Post-ABC News poll found that a full two-thirds of respondents say mifepristone, the abortion pill, should stay on the market, and more than half say they disagree with the Supreme Court’s overturn of Roe v. Wade, including 70% of independents and more than a third of Republicans. Yet, in focus groups in April, more than a third of independents couldn’t differentiate Democrats’ position on abortion from Republicans’. As reported by Vox, one participant said, quote, “I really haven’t basically heard anything about which party is leaning toward it and which one isn’t.” When pressed, she said, “If I had to guess, I would say Democrat would probably be against it and Republican would probably be for it.” Another participant said she thought that Joe Biden helped get the Supreme Court judges who overturned Roe. We really do live in a bubble, don’t we? I think that was sort of the most mind-blowing thing I’ve read since — all the months since Roe got overturned, that there are people who care about this issue who have no idea where anybody stands.

Sanger-Katz: I think it’s just a truth about our political system that there are a lot of Americans who are what the political scientists call low-information voters. These are people who are just not following the news very closely and not following politics very closely. And they may have a certain set of opinions about issues of the day, but I think it is a big challenge to get those people aware of where candidates stand on issues of concern to them and to get them activated. And it doesn’t really surprise me that independent voters are the ones who seem to be confused about where the parties are, because they’re probably the least plugged into politics generally. And so, for Democrats, it does seem like this lack of information is potentially an opportunity for them, because it seems like when you ask voters what they want on abortion, they want things that are more aligned with Democratic politicians’ preferences than Republicans’. And so it strikes me that perhaps some of those people in the focus group who didn’t know who stood for what, maybe those are gettable voters for the Democratic Party. But I think — you know, we’re about to go into a very heated campaign season, you know, as we go into the presidential primaries and then the general election in which there are going to be a lot of ads, a lot of news coverage. And, you know, I think abortion is very likely to be a prominent issue during the campaigns. And I think it is almost certainly going to be a major goal of the Biden presidential reelection campaign to try to make sure that these people know where Biden stands relative to abortion, because it is an issue that so many voters agree with him on.

Rovner: And it makes you see, I mean, there’s a lot of Republicans who are trying to sort of finesse this issue now and say, you know, “Oh, well, we’re going to restrict it, but we’re not going to ban it,” or, “We have all these exceptions” that are, of course, in practice, you can’t use. Obviously, these are the kinds of voters who might be attracted to that. So we will obviously see this as it goes on.

Kenen: But Julie, do you remember whether they were actually voters? Because I had the same reaction to you: like, of all the things to not be sure of, that one was pretty surprising. But we also know that in places like Kansas where, you know, where there are not that many Democrats, these referenda won. Voters have supported abortion rights in the 2022 elections and in these state referenda. So independents must be voting with the —

Rovner: I was going to say, I think if you’re doing —

Kenen: Something isn’t totally — something is not totally adding up there.

Rovner: If you’re doing a focus group for politics, one presumes that you get voters. So, I mean, I think that was — that was the point of the focus group. But yeah, it’s —

Kenen: Or people who say they’re voters.

Rovner: Or people who say they’re voters. That is a different issue. All right. Well, something not that confusing: Now it’s time for our extra credit segment. That’s when we each recommend a story we read this week we think you should read too. As always, don’t worry if you miss it. We will post the links on the podcast page at kffhealthnews.org and in our show notes on your phone or other mobile device. Tami, why don’t you go first this week?

Luhby: OK. Well, I picked a story from CNN by my colleagues on the health team. It’s titled “Because of Florida Abortion Laws, She Carried Her Baby to Term Knowing He Would Die,” by Elizabeth Cohen, Carma Hassan, and Amanda Musa. And I have to say that when I first read this story, I couldn’t get through it, because it was so upsetting. And then when I selected it as an extra credit, I had to read it in full. But it’s about a family in Florida whose son was born without kidneys. They knew that he was going to die. And it’s about all of the effects from everything from, you know, the mother, Deborah Dorbert, on her physically and emotionally. But it also, you know, talked about the family and, you know, the effect on the marriage and the effect — which was just so upsetting — was on the 4-year-old son, who became very attached. I don’t think they even knew — well, it wasn’t a girl. It was actually a boy. But for some reason, this older son felt that it was a girl and just kept saying, like, “My sister is going to do X, Y, Z.” And, you know, how did the parents break it to him? Because he saw that his mother was, you know, pregnant and getting larger. And, you know, it was just figuring out how to break it to him that no baby was coming home. So the details are heart-wrenching. The quotes in the third paragraph: “‘He gasped for air a couple of times when I held him,’ said Dorbert. ‘I watched my child take his first breath, and I held him as he took his last one.’” So, you know, these are things that, you know — and we just talked about how the states are arguing over what exceptions there should be, if any, you know, and these are the stories that the legislators don’t think about when they pass these laws.

Rovner: I think I said this before because we’ve had a story like this almost every week. This one was particularly wrenching. But I think the one thing that all these stories are doing is helping people understand, particularly men, that there are complications in pregnancy, that they’re not that rare, that, you know, that they sort of throw off and say, “Oh, well, that’s, you know, one in a million,” — It’s not one in a million. It’s like one in a thousand. That’s a lot of people. So I mean, that’s why there are a lot of these stories, because there are a lot of pregnancies that don’t go as expected.

Luhby: Right. And it really shows the chilling effect on doctors because, you know, you would say, “Oh, it’s simple: life of the mother or, you know, life of the fetus” or something like that. That seems pretty straightforward, but it isn’t. And these doctors, in cases where, you know, other cases where it is the life of the mother, which seem, again, very straightforward, the doctors are not willing to do anything because they’re afraid.

Rovner: I know. Joanne.

Kenen: This is a story from The Baltimore Banner that has a very long title. It’s by Hallie Miller and Adam Willis, and it’s called “Baltimore Isn’t Accessible for People With Disabilities. Fixing It Would Cost Over $650 Million.” Baltimore is not that big a city. $650 million is a lot of curbs and barriers. And there’s also a lot of gun violence in Baltimore. If you drive around Baltimore, and I work there a few days a week, you see lots of people on walkers and scooters and wheelchairs because many of them are survivors of gun violence. And you see them struggling. And there were quotes from people saying they, you know, were afraid walking near the harbor that they would fall in because there wasn’t a path for them. It is not invisible, but we treat it like it’s invisible. And it’s been many years since the Americans with Disabilities Act was passed, and we still don’t have it right. It’s a — this one isn’t confusion like everything else we talked about today. I loved Margot’s phrase about confusion as a secondary outcome. I think you should write a novel with that title. But it’s — this isn’t confusion. This is just not doing the right thing for people who are — we’re just not protecting or valuing.

Rovner: And I’d say for whom there are laws that this should be happening. Margot.

Sanger-Katz: I had another story about abortion. This one was in The New Yorker, called “The Problem With Planned Parenthood,” by Eyal Press. The story sort of looked at Planned Parenthood, you know, which is kind of the largest abortion provider in the country. It’s — I mean, it’s really a network of providers. They have all these affiliates. They’re often seen as being more monolithic than perhaps they are. But this story argued that people who were operating independent abortion clinics, who do represent a lot of the abortion providers in the country as well, have felt that Planned Parenthood has been too cautious legally, too afraid of running afoul of state laws, and so that has led them to be very conservative and also too conservative from the perspective of business, and that there is a view that Planned Parenthood is not serving the role that it could be by expanding into areas where abortion is less available. I thought it was just interesting to hear these criticisms and hoped to understand that the community of abortion providers are, you know, they’re diverse and they have different perspectives on how abortion access should work and what kinds of services should be provided in different settings. And they also view each other as business competition in some cases. I mean, a lot of the complaints in this article had to do with Planned Parenthood opening clinics near to independent clinics and kind of taking away the business from them, making it harder for them to survive and operate. Anyway, I thought it was a very interesting window into these debates, and it did mesh with some of my reporting experience, particularly around the legal cautiousness. I did a story before the Dobbs decision came down from the Supreme Court where Planned Parenthood in several states had just stopped offering abortions even before the court had ruled, because they anticipated that the court would rule and they just didn’t want to make any mistake about running afoul of these laws such that, you know, women were denied care that was still legal in the days leading up to the Supreme Court decision.

Rovner: Yeah, it’s a really good story. Well, my story is kind of tangentially about abortion. It’s from Slate, and it’s called “Not Every Man Will Be as Dumb as Marcus Silva,” by Moira Donegan and Mark Joseph Stern. And it’s about a case from Texas, of course, that we talked about a couple of weeks ago, where an ex-husband is suing two friends of his ex-wife for wrongful death, for helping her get an abortion. Well, now the two friends have filed a countersuit claiming that the ex-husband knew his wife was going to have an abortion beforehand because he found the pill in her purse and he put it back so that he could use the threat of a lawsuit to force her to stay with him. It feels like a soap opera, except it is happening in real life. And my first thought when I read this is that it’s going to make some great episode of “Dateline” or “20/20.” That is our show, as always.

Kenen: Or, not “The Bachelor.”

Rovner: Yeah, but not “The Bachelor.” That is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us too. Special thanks, as always, to our ever-patient producer, Francis Ying. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can tweet me. I’m still there. I’m at @jrovner. Joanne?

Kenen: @JoanneKenen.

Rovner: Tami.

Luhby: @Luhby.

Rovner: Margot.

Sanger-Katz: @sangerkatz.

Rovner: We will be back in your feed next week, hopefully with a little less confusion. Until then, be healthy.

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