Long COVID Has Forced the U.S. to Take Chronic Fatigue Syndrome Seriously

Katie Martin / The Atlantic; Getty
Only a couple dozen doctors specialize in chronic fatigue syndrome (ME/CFS). Now their knowledge could be crucial to treating millions more patients. Kira Stoops lives in Bozeman, Montana—a beautiful mountain town where it sometimes feels like everyone regularly goes on 50-mile runs. Stoops, however, can’t walk around her own block on most days. To stand for more than a few minutes, she needs a wheeled walker.

She reacts so badly to most foods that her diet consists of just 12 ingredients. Her “brain fog” usually lifts for a mere two hours in the morning, during which she can sometimes work or, more rarely, see friends. Stoops has myalgic encephalomyelitis, or chronic fatigue syndrome (ME/CFS). “I’m considered a moderate patient on the mild side,” she told me.

ME/CFS involves a panoply of debilitating symptoms that affect many organ systems and that get worse with exertion. The Institute of Medicine estimates that it affects 836,000 to 2.5 million people in the U.S. alone, but is so misunderstood and stigmatized that about 90 percent of people who have it have never been diagnosed.

At best, most medical professionals know nothing about ME/CFS; at worst, they tell patients that their symptoms are psychosomatic, anxiety-induced, or simply signs of laziness. While ME/CFS patients, their caregivers, and the few doctors who treat them have spent years fighting for medical legitimacy, the coronavirus pandemic has now forced the issue.

A wide variety of infections can cause ME/CFS, and SARS-CoV-2, the coronavirus that causes COVID-19, is no different: Many cases of long COVID are effectively ME/CFS by another name. The exact number is hard to define, but past studies have shown that 5 to 27 percent of people infected by various pathogens, including Epstein-Barr virus and the original SARS, develop ME/CFS.

Even if that proportion is 10 times lower for SARS-CoV-2, the number of Americans with ME/CFS would still have doubled in the past three years. “We’re adding an immense volume of patients to an already dysfunctional and overburdened system,” Beth Pollack, a scientist at MIT who studies complex chronic illnesses, told me.

The U.S. has so few doctors who truly understand the disease and know how to treat it that when they convened in 2018 to create a formal coalition, there were only about a dozen, and the youngest was 60. Currently, the coalition’s website lists just 21 names, of whom at least three have retired and one is dead, Linda Tannenbaum, the CEO and president of the Open Medicine Foundation, told me.

These specialists are concentrated on the coasts; none work in the Midwest. American ME/CFS patients may outnumber the population of 15 individual states, but ME/CFS specialists couldn’t fill a Major League Baseball roster.

Stoops, who is 39, was formally diagnosed with ME/CFS only four years ago, and began receiving proper care from two of those specialists—Lucinda Bateman of the Bateman Horne Center and David Kaufman from the Center for Complex Diseases. Bateman told me that even before the pandemic, she could see fewer than 10 percent of the patients who asked for a consultation. “When I got into those practices, it was like I got into Harvard,” Stoops told me.

ME/CFS specialists, already overwhelmed with demand for their services, now have to decide how to best use and spread their knowledge, at a time when more patients and doctors than ever could benefit from it. Kaufman recently discharged many of the more stable ME/CFS patients in his care—Stoops among them—so that he could start seeing COVID long-haulers who “were just making the circuit of doctors and getting nowhere,” he told me.

“I can’t clone myself, and this was the only other way to” make room for new patients. Bateman, meanwhile, is feverishly focused on educating other clinicians. The hallmark symptom of ME/CFS—post-exertional malaise, or PEM—means even light physical or mental exertion can trigger major crashes that exacerbate every other symptom. Doctors who are unfamiliar with PEM, including many now running long-COVID clinics, can unwittingly hurt their patients by encouraging them to exercise.

Bateman is racing to spread that message, and better ways of treating patients, but that means she’ll have to reduce her clinic hours. These agonizing decisions mean that many existing ME/CFS patients are losing access to the best care they had found so far—what for Stoops meant “the difference between being stuck at home, miserable and in pain, and actually going out once or twice a day, seeing other humans, and breathing fresh air,” she told me.

But painful trade-offs might be necessary to finally drag American medicine to a place where it can treat these kinds of complex, oft-neglected conditions. Kaufman is 75 and Bateman is 64. Although both of them told me they’re not retiring anytime soon, they also won’t be practicing forever. To make full use of their expertise and create more doctors like them, the medical profession must face up to decades spent dismissing illnesses such as ME/CFS—an overdue reckoning incited by long COVID.

“It’s a disaster possibly wrapped up in a blessing,” Stoops told me. “The system is cracking and needs to crack.” Many ME/CFS specialists have a deep knowledge of the disease because they’ve experienced it firsthand. Jennifer Curtin, one of the youngest doctors in the field, has two family members with the disease, and had it herself for nine years. She improved enough to make it through medical school and residency training, which showed her that ME/CFS “just isn’t taught,” she told me. Most curricula don’t include it; most textbooks don’t mention it.

Even if doctors learn about ME/CFS, America’s health-care system makes it almost impossible for them to actually help patients. The insurance model pushes physicians toward shorter visits; 15 minutes might feel luxurious. “My average visit length is an hour, which doesn’t include the time I spend going over the patient’s 500 to 1,700 pages of records beforehand,” Curtin said. “It’s not a very scalable kind of care.” (She works with Kaufman at the Center for Complex Diseases, which bills patients directly.)

This also explains why the cohort of ME/CFS clinicians is aging out, with little young blood to refresh them. “Hospital systems want physicians to see lots of patients and they want them to follow the rules,” Kaufman said. “There’s less motivation for moving into areas of medicine that are more unknown and challenging.”

ME/CFS is certainly challenging, not least because it’s just “one face of a many-sided problem,” Jaime Seltzer, the director of scientific and medical outreach at the advocacy group MEAction, told me. The condition’s root causes can also lead to several distinct but interlocking illnesses, including mast cell activation syndrome, Ehlers-Danlos syndrome, fibromyalgia, dysautonomia (usually manifesting as POTS), and several autoimmune and gastrointestinal disorders.

“I’m still amazed at how often patients come in with Complaint No. 1, and then I find five to seven of the other things,” Kaufman said. These syndromes collectively afflict many organ systems, which can baffle doctors who’ve specialized in just one. Many of them disproportionately affect women, and are subject to medicine’s long-standing tendency to minimize or psychologize women’s pain, Pollack told me:

An average woman with Ehlers-Danlos syndrome typically spends 16 years getting a diagnosis, while a man needs only four. People with long COVID might have many of these conditions and not know about any—because their doctors don’t either. Like ME/CFS, they rarely feature in medical training, and it’s hard to “teach someone about all of them when they’ve never heard of any of them,” Seltzer said.

Specialists like Bateman and Kaufman matter because they understand not just ME/CFS but also the connected puzzle pieces. They can look at a patient’s full array of symptoms and prioritize the ones that are most urgent or foundational. They know how to test for conditions that can be invisible to standard medical techniques: “None of my tests came back abnormal until I saw an ME/CFS doctor, and then all my tests came back abnormal,” said Hannah Davis of the Patient-Led Research Collaborative, who has had long COVID since March 2020.

ME/CFS specialists also know how to help, in ways that are directly applicable to cases of long COVID with overlapping symptoms. ME/CFS has no cure but can be managed, often through “simple, inexpensive interventions that can be done through primary care,” Bateman told me. Over-the-counter antihistamines can help patients with inflammatory problems such as mast cell activation syndrome. Low doses of naltrexone, commonly used for addiction disorders, can help those with intense pain.

A simple but rarely administered test can show if patients have orthostatic intolerance—a blood-flow problem that worsens other symptoms when people stand or sit upright. Most important, teaching patients about pacing—carefully sensing and managing your energy levels—can prevent debilitating crashes. “We don’t go to an ME/CFS clinic and walk out in remission,” Stoops told me. “You go to become stabilized. The ship has 1,000 holes, and doctors can patch one before the next explodes, keeping the whole thing afloat.”

That’s why the prospect of losing specialists is so galling. Stoops understands why her doctors might choose to focus on education or newly diagnosed COVID long-haulers, but ME/CFS patients are “just so lost already, and to lose what little we have is a really big deal,” she said. Kaufman has offered to refer her to generalist physicians or talk to primary-care doctors on her behalf. But it won’t be the same: “Having one appointment with him is like six to eight appointments with other practitioners,” she said.

He educates her about ME/CFS; with other doctors, it’s often the other way round. “I’m going to have to work much harder to receive a similar level of care.” At least, she will for now. The ME/CFS specialists who are shifting their focus are hoping that they can use this moment of crisis to create more resources for everyone with these diseases. In a few years, Bateman hopes, “there will be 100 times more clinicians who are prepared to manage patients, and many more people with ME/CFS who have access to care.”

For someone who is diagnosed with ME/CFS today, the landscape already looks very different than it did just a decade ago. In 2015, the Institute of Medicine published a landmark report redefining the diagnostic criteria for the disease. In 2017, the CDC stopped recommending exercise therapy as a treatment. In 2021, Bateman and 20 other clinicians published a comprehensive guide to the condition in the journal of the Mayo Clinic.

For any mainstream disease, such events—a report, a guideline revision, a review article—would be mundane. For ME/CFS, they felt momentous. And yet, “the current state of things is simply intolerable,” Julie Rehmeyer, a journalist with ME/CFS, told me. Solving the gargantuan challenge posed by complex chronic diseases demands seismic shifts in research funding, medical training, and public attitudes. “Achieving shifts like that takes something big,” Rehmeyer said. “Long COVID is big.”

COVID long-haulers have proved beyond any reasonable doubt that acute viral infections can leave people chronically ill. Many health-care workers, political-decision makers, and influencers either know someone with long COVID or have it themselves. Even if they still don’t know about ME/CFS, their heightened awareness of post-viral illnesses is already making a difference. Mary Dimmock’s son developed ME/CFS in 2011, and before the pandemic, one doctor in 10 might take him seriously.

“Now it’s the flip: Only one doctor out of 10 will be a real jerk,” Dimmock told me. “I attribute that to long COVID.” But being believed is the very least that ME/CFS patients deserve. They need therapeutics that target the root causes of the disease, which will require a clear understanding of those causes, which will require coordinated, well-funded research—three things ME/CFS has historically lacked.

But here, too, “long COVID is going to be a catalyst,” Amy Proal, the president of the Polybio Research Foundation, told me. She is leading the Long Covid Research Initiative—a group of scientists, including ME/CFS researchers, that will use state-of-the-art techniques to see exactly how the new coronavirus causes long COVID, and rapidly push potential treatments through clinical trials.

The National Institutes of Health has also committed $1.15 billion to long-COVID research, and while some advocates are concerned about how that money will be spent, Rehmeyer notes that the amount is still almost 80 times greater than the paltry $15 million spent on ME/CFS every year—less than any other disease in the NIH’s portfolio, relative to its societal burden. “Even if 90 percent is wasted, we’d be doing a lot better,” she said.

While they wait for better treatments, patients also need the medical community to heed the lessons that they and their clinicians have learned. For example, the American Academy for Family Physicians website still wrongly recommends exercise therapy and links ME/CFS to childhood abuse. “That group of doctors is very important to these patients,” Dimmock said, “so what does that say to them about what this disease is all about?”

Despite all evidence to the contrary, many clinicians and researchers still don’t see ME/CFS as a legitimate illness and are quick to dismiss any connection between it and long COVID. To ensure that both groups of patients get the best possible treatments, instead of advice that might harm them, ME/CFS specialists are working to disseminate their hard-won knowledge.

Bateman and her colleagues have been creating educational resources for clinicians and patients, continuing-medical-education courses, and an online lecture series. Jennifer Curtin has spent two years mapping all the decisions she makes when seeing a new patient, and is converting those into a tool that other clinicians can use. As part of her new start-up, called RTHM, she’s also trying to develop better ways of testing for ME/CFS and its related syndromes, of visualizing the hefty electronic health records that chronically ill patients accumulate, and of tracking the treatments they try and their effects.

“There are a lot of things that need to be fixed for this kind of care to be scalable,” Curtin told me. Had such shifts already occurred, the medical profession might have had more to offer COVID long-haulers beyond bewilderment and dismissal. But if the profession starts listening to the ME/CFS community now, it will stand the best chance of helping people being disabled by COVID, and of steeling itself against future epidemics.

Pathogens have been chronically disabling people for the longest time, and more pandemics are inevitable. The current one could and should be the last whose long-haulers are greeted with disbelief. New centers that cater to ME/CFS patients are already emerging. RTHM is currently focused on COVID long-haulers but will take on some of David Kaufman’s former patients in November, and will open its waiting list to the broader ME/CFS community in December.

(It is currently licensed to practice in just five states but expects to expand soon.) David Putrino, who leads a long-COVID rehabilitation clinic in Mount Sinai, is trying to raise funds for a new clinic that will treat both long COVID and ME/CFS. He credits ME/CFS patients with opening his eyes to the connection between long COVID and their condition.

Every ME/CFS patient I’ve talked with predicted long COVID’s arrival well before most doctors or even epidemiologists started catching up. They know more about complex chronic illnesses than many of the people now treating long COVID do. Despite having a condition that saps their energy, many have spent the past few years helping long-haulers navigate what for them was well-trodden terrain: “I did barely anything but work in 2020,” Seltzer told me.

Against the odds, they’ve survived. But the pandemic has created a catalytic opportunity for the odds to finally be tilted in their favor, “so that neither patients nor doctors of any complex chronic illness have to be heroes anymore,” Rehmeyer said.

By Ed Yong

Source: Long COVID Has Forced the U.S. to Take Chronic Fatigue Syndrome Seriously – The Atlantic

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Monkeypox Likely Spread By Sex at 2 Raves In Europe

This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak.

A leading doctor who chairs a World Health Organization expert group described the unprecedented outbreak of the rare disease monkeypox in developed countries as “a random event” that might be explained by risky sexual behavior at two recent mass events in Europe.

A leading adviser to the World Health Organization described the unprecedented outbreak of the rare disease monkeypox in developed countries as “a random event” that might be explained by risky sexual behavior at two recent mass events in Europe.

In an interview with The Associated Press, Dr. David Heymann, who formerly headed WHO’s emergencies department, said the leading theory to explain the spread of the disease was sexual transmission among gay and bisexual men at two raves held in Spain and Belgium. Monkeypox has not previously triggered widespread outbreaks beyond Africa, where it is endemic in animals.

“We know monkeypox can spread when there is close contact with the lesions of someone who is infected, and it looks like sexual contact has now amplified that transmission,” said Heymann. That marks a significant departure from the disease’s typical pattern of spread in central and western Africa, where people are mainly infected by animals like wild rodents and primates and outbreaks have not spilled across borders.

To date, WHO has recorded more than 90 cases of monkeypox in a dozen countries including Britain, Spain, Israel, France, Switzerland, the U.S. and Australia. Madrid’s senior health official said on Monday that the Spanish capital has recorded 30 confirmed cases so far. Enrique Ruiz Escudero said authorities are investigating possible links between a recent Gay Pride event in the Canary Islands, which drew some 80,000 people, and cases at a Madrid sauna.

Heymann chaired an urgent meeting of WHO’s advisory group on infectious disease threats on Friday to assess the ongoing epidemic and said there was no evidence to suggest that monkeypox might have mutated into a more infectious form.

Monkeypox typically causes fever, chills, rash, and lesions on the face or genitals. It can be spread through close contact with an infected person or their clothing or bedsheets, but sexual transmission has not yet been documented. Most people recover from the disease within several weeks without requiring hospitalization.

Vaccines against smallpox, a related disease, are also effective in preventing monkeypox and some antiviral drugs are being developed. So far, public health agencies in Europe have confirmed cases in the UK, Spain, Portugal, Germany, Belgium, France, the Netherlands, Italy and Sweden.

In a statement on Friday, the WHO said that the recent outbreaks “are atypical, as they are occurring in non-endemic countries”. It said it was “working with the affected countries and others to expand disease surveillance to find and support people who may be affected”.

It is not yet clear why this unusual outbreak is happening now. One possibility is that the virus has changed in some way, although currently there is little evidence to suggest this is a new variant. Another explanation is that the virus has found itself in the right place at the right time to thrive.

Monkeypox may also spread more easily than it did in the past, when the smallpox vaccine was widely used. WHO’s Europe regional director Hans Kluge warned that “as we enter the summer season… with mass gatherings, festivals and parties, I am concerned that transmission could accelerate”.

He added that all but one of the recent cases had no relevant travel history to areas where monkeypox was endemic. The first case of the disease in the UK was reported on 7 May. The patient had recently travelled to Nigeria, where they are believed to have caught the virus before travelling to England, the UK Health Security Agency said.

There are now 20 confirmed cases in the UK, Health Secretary Sajid Javid said on Friday. Authorities in the UK said they had bought stocks of the smallpox vaccine and started offering it to those with “higher levels of exposure” to monkeypox. Spanish health authorities have also reportedly purchased thousands of smallpox jabs to deal with the outbreak, according to Spanish newspaper El País.

Australia’s first case was detected in a man who fell ill after travelling to the UK, the Victorian Department of Health said. In North America, health authorities in the US state of Massachusetts confirmed that a man has been infected after recently travelling to Canada. He was in “good condition” and “poses no risk to the public”, officials said.

By:

Source: Expert: Monkeypox likely spread by sex at 2 raves in Europe

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Scientists are Studying Blood Tests For Dementia

As pharmaceutical companies spend hundreds of millions of dollars on a potential treatment for Alzheimer’s disease, other researchers are focusing on a more elemental question. How can you tell whether a family member or loved one has Alzheimer’s or another form of dementia?

These researchers say a new generation of blood tests could offer an easier and accurate way to detect signs of Alzheimer’s, a disease that afflicts an estimated 6.5 million Americans. New research found one blood test can detect hallmarks of the disease in older adults with memory problems. It is among more than a half dozen blood tests being developed and tested to detect early stages of Alzheimer’s disease.

Experts say the tests are important because they would be easier, cheaper and available to more people than brain scans or spinal taps now used to detect biological hallmarks of the disease.

Developers of blood tests say the immediate payoff would be testing older adults with signs of memory loss as well as quickly screening large numbers of people necessary to test new drugs that aim to slow or halt Alzheimer’s disease. Eventually, the tests might be useful in detecting the earliest signs of disease, informing individuals of their risk years before memory and thinking problems take root.

Blood tests represent “a very early start to a new era of diagnosis for Alzheimer’s disease,” said Stephen Salloway, a professor of neurology and psychiatry at Brown University who directs a memory and aging program at Butler Hospital in Providence, Rhode Island. “I see them as being transformative for Alzheimer’s, because once we validate them a little bit further, and hopefully get coverage for them, we can use them both to screen for clinical trials and to screen for treatment.”

Diagnosing the disease is time-consuming and inaccessible to those who live far away from memory clinics or other specialists. Doctors might quiz a patient or family members about habits, changes in behavior or personality. Specialists conduct memory and cognitive tests and rule out other potential causes such as depression. Brain scans and spinal taps confirm biological signs of the disease.

One blood test, called the PrecivityAD test, which uses a technology called mass spectrometry, measures amyloid proteins and genetic risk for the disease. In two studies published April 21 in Journal of the American Medical Association Open, the test accurately detected the protein amyloid in 81% of samples when compared with a brain scan.

Amyloid accumulates and forms clumps in the brains of Alzheimer’s disease patients. Researchers and drug companies have spent hundreds of million of dollars over the past two decades on the theory that drugs clearing amyloid from the brain could slow memory decline, but those drugs have not proven to halt Alzheimer’s disease.

Other drug studies are now underway to administer amyloid-targeting drugs even earlier, before memory and thinking problems emerge. C2N Diagnostics CEO Joel Braunstein said the peer-reviewed study is an important step for doctors who want to see more evidence before recommending his company’s test to patients with memory and cognitive problems.

“Clinicians like to see evidence that a test works,” Braunstein said. “This was an important step forward because of the transparency of the scientific findings.”

The test, which has been available since 2020, is now mostly used to accelerate research for new drugs being studied to slow cognitive decline and memory loss in people with Alzheimer’s disease or other forms of dementia. Braunstein believes more doctors will be willing to recommend the test as they grow comfortable from findings in the studies.

Blood tests promise quicker, cheaper diagnosis

Scans and spinal taps now used can be invasive and don’t work for all patients. For example, people who are on blood-thinning medication might not be able to get a spinal tap, Salloway said. In such cases, a validated blood test would be suitable replacement.

Blood tests also might be more affordable than positron emission tomography, or PET scans, which cost consumers $3,000 out of pocket, according to the Alzheimer’s Association. Hospitals charge for administering a PET scan, which includes special chemical tracers to reveal the amyloid. Consumers also can expect a bill from an imaging specialist who interprets the results to verify whether a patient has amyloid.

The PrecivityAD test, which is not yet covered by Medicare or private insurers, costs $1,250. The company offers financial assistance for eligible consumers, Braunstein said, while it is “making progress” in efforts to get Medicare and private insurers to pay for the test.

The company is allowed to market the test under Food and Drug Administration rules because it’s performed at the company’s lab, which is certified under the Clinical Laboratory Improvement Amendments, the federal laboratory law known as CLIA. Doctors or testing sites ship samples to the lab and the company completes the test within 10 days, Braunstein said.

Braunstein said the company’s lab has the capacity to handle tests performed within the United States and Canada. As the company seeks to offer the test overseas, it probably will partner with other labs that can perform the intricate measurements the test requires.

Another blood test developed by Eli Lilly detected signs of Alzheimer’s disease 20 years before cognitive problems were expected in a group of people who carry a rare genetic mutation, according to a study published in 2020 in JAMA. The p-tau217 test measured the tau protein on more than 1,400 people already enrolled in dementia studies in Sweden, Arizona and Colombia.

Eli Lilly used the test during a 257-patient Phase 2 study of its Alzheimer’s drug called donanemab. The drugmaker also will use the test to screen people for a prevention trial to test donanemab in at-risk patients who have not yet exhibited memory and thinking problems. Lilly plans to send mobile units to communities and use the test to screen people, which would expand the company’s efforts to recruit patients from diverse populations, a Lilly spokeswoman said.

Quest Diagnostics, a national lab company, launched a new blood test in March that measures two amyloid variants, a Quest spokeswoman said.

Advocacy organizations would like to see tests that are simple, inexpensive and accessible to doctors and their patients, said Heather Snyder, vice president of medical and scientific relations at the Alzheimer’s Association.

“We ultimately want to be at a place where we can identify an individual at the earliest possible point who may be at the greatest risk and may have initial changes associated with the disease,” Snyder said.

She said it’s important for the field to have “a toolbox of potential interventions” such as medications or lifestyle changes “that would allow us to stop or slow the progression of the underlying biology at that time.”

In 2021, the Food and Drug Administration approved Biogen’s Aduhelm, a $28,000-a-year drug that yielded mixed results in clinical trials, even though the agency’s own experts suggested the agency reject the application. The agency that oversees Medicare decided to pay for the drug only in clinical trials.

Aduhelm is part of class of Alzheimer’s drugs known as monoclonal antibodies, several of which could soon land before FDA decision-makers. Lilly expects to submit donanemab, a monoclonal antibody, for approval later this year. Roche’s Genentech has studied two Alzheimer’s drugs, gantenerumab and crenezumab, in late-stage clinical trials.

By:

Source: Scientists are studying blood tests for dementia: ‘A new era of diagnosis for Alzheimer’s disease’

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As Medication Abortion Becomes Dominant, Red States Restrict Pills

The abortion drug mifepristone was approved by the FDA more than 20 years ago. The FDA recently relaxed some of the rules for dispensing the drug. Now, some legislatures are trying to restrict access.

For most of the almost 50 years since the Roe v Wade Supreme Court decision legalized abortion nationwide, clinics have been the focus of the battle over abortion rights.

Protesters gather outside on sidewalks. And Republican state lawmakers try to regulate what happens inside — through laws restricting which healthcare providers can perform abortions, the kind of counseling required and which procedures are allowed.

But now, more than half of abortions are taking place with pills.

According to data released by Guttmacher earlier this year, abortion pills – not surgical procedures – accounted for 54 percent of abortions in 2020. That makes medication abortion the dominant choice in the United States for the first time since the Food and Drug Administration approved an abortion pill, mifepristone, more than 20 years ago. It’s part of a two-drug protocol approved to terminate pregnancies up to 10 weeks gestation. That protocol also is prescribed to manage some miscarriages.

During the pandemic, the FDA relaxed rules so that the tightly regulated drug mifepristone could be obtained through telehealth appointments and mail-order pharmacies, rather than in person. That made it easier for patients in some states to get a medication abortion at home. The Biden administration recently made those changes permanent.

Now, Republican lawmakers in several states are pushing back. In South Dakota, Gov. Kristi Noem recently signed legislation designed to restrict access to the drugs.

Already, more than a dozen states restrict limit the use of telemedicine to provide abortion pills. And this year, Planned Parenthood says new restrictions have been introduced in two dozen states, some of which would ban the pills altogether if Roe v Wade is overturned.

In Georgia, Republican state Sen. Bruce Thompson sponsored SB 456, a bill banning abortion pill delivery by mail and requiring doctors to examine patients in person before prescribing them. During floor debate, Thompson said his bill was intended “to protect the cherished doctor-patient relationship.”

But that position is at odds with that of major medical groups, including the American College of Obstetricians and Gynecologists and the American Medical Association, who’ve long supported easing access to the pills and called for lifting the in-person dispensing requirement.

Thompson opposes abortion rights, but he claims this bill is all about patient safety.

“Why would we not do everything within our power to protect women’s health and safety during this difficult time in their lives?” he said.

But opponents say the bill would make patients less safe. Several lawmakers noted that Georgia is among the states with the highest rates of maternal mortality – and that those death rates are dramatically higher for Black women.

State Sen. Kim Jackson, a Democrat, noted that many people, particularly in rural areas, lack access to pregnancy care.

“What’s really cruel about this bill is that those who are already the most vulnerable are the ones who are most likely to be burned by this injustice,” Jackson said. “People who are poor, people who live in rural communities. People with disabilities, and people of color.”

The bill passed Georgia’s state senate on March 1 and is awaiting a vote in the House.

“As soon as the FDA made medication abortion more accessible, Georgia pretty much turned around and was like, ‘No, we actually want to make it really difficult for people to get one,'” said K. Agbebiyi, a Georgia-based advocate with the reproductive rights group URGE, which is fighting the bill.

Agbebiyi said medication abortion could become the only option for a growing number of people in states where clinics are few and far between because of abortion restrictions.

“We know, and our opponents know, that medication abortion is going to grow in popularity if Roe is overturned,” Agbebiyi said. “And that’s precisely why they’re trying to put as many barriers in place as possible.”

It’s more difficult to put up barriers on the internet, where abortion pills are available through mail-order pharmacies and other groups.

Ushma Upadhyay, a reproductive health researcher at the University of California, San Francisco, warned that if states try to block access to abortion pills, patients will find them online without a doctor’s help.

“That is what I’m concerned about,” she said. “It is extremely safe, but all patients should have the access to clinical support if they need it, if they have questions about how to take it, or whether what’s happening is normal.”

Meanwhile, some states are trying to make access to medication abortion easier. A bill moving forward in Delaware would allow a wider array of healthcare providers to prescribe the pills to their patients.

By:

Source: Republican state lawmakers are working to restrict access to abortion pills. : NPR

.

Critics:

By: Shefali Luthra

“Medication abortion is the existential threat of the anti-abortion movement,” said Greer Donley, an assistant professor at the University of Pittsburgh Law School who specializes in laws surrounding medication abortion access. When they’re on the precipice of getting the Supreme Court to overturn Roe v. Wade, there’s a technological advance that has made it impossible to control abortions.” 

Texas, which is so far the only state that has ended access to abortions after six weeks of pregnancy, provides some insight. The number of Texans receiving abortions has only fallen somewhat — a far larger number of people are now making journeys out of state or ordering medication abortion pills online from the European nonprofit Aid Access, which operates outside the U.S. health care system but has worked to provide Americans with telemedicine-based medication abortions since 2018.

In a post-Roe world, the options would likely look different. With more states banning or severely restricting abortion access, travel likely poses a greater burden, especially for people who live where neighboring states also have legislatures that have restricted access. But health care providers in states where abortion rights are protected could, under the new FDA guidance, could potentially prescribe pills through a phone call or video-chat and mail them to people in other states.

There are accessibility questions. Not everyone has sufficient internet access to find a virtual provider, noted Abigail Aiken, an associate professor at the University of Texas at Austin who has studied the Texas law’s impact on medication abortion requests. And not everyone knows about services like Aid Access or other ways to navigate the health care system and find an out-of-state provider.

.

The Coronavirus Crisis

More Patients Seek Abortion Pills Online During Pandemic, But Face Restrictions

Consider This from NPR

The New Texas Abortion Law Is Putting Some Patients In Danger

National

With Abortion Restrictions On The Rise, Some Women Induce Their Own

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Stool Tests Might Help Spot Early Pancreatic Cancer

Stool tests might provide a useful way to help doctors spot early pancreatic cancer, say researchers.

They have been trialling the concept in a study with 136 volunteers.

The findings, described in the journal Gut, suggest detectable changes involving gut bugs could provide a warning sign that a tumour is present.

Pancreatic cancer often doesn’t cause symptoms in the early stages. That means it is usually more advanced and harder to treat when it is found.

As the cancer grows it may cause vague symptoms, such as indigestion, changes to bowel habit and some tummy or back pain. Some people see their GP several times before being diagnosed.

Currently, fewer than one in 20 of those with the most common form – ductal adenocarcinoma – will survive for five years or more. Earlier detection could improve those odds.

The Spanish team behind the work recruited patients from two hospitals – one in Madrid and the other in Barcelona. Only some of the patients had pancreatic ductal adenocarcinoma, while the others were selected as controls for comparison.

The researchers collected and analysed spit and stool samples from the volunteers to see if there was any discernible difference between the groups.

While the saliva samples drew a blank, the stool ones did show a difference that the team believe could be useful for helping to diagnose pancreatic cancer.

It was a distinct pattern or genomic profile of gut bacteria, fungi and other microbes.

This consistently identified patients with the disease, irrespective of how far it had progressed, suggesting that characteristic microbiome signatures emerge early on and that the stool microbiome might pick up early stage disease, say the researchers.

They recommend more studies – and some are already taking place.

Independent researchers in Germany have validated the findings in a small number of patients, and the test is also being trialled in Japan.

Source: Stool tests might help spot early pancreatic cancer – BBC News

.

Critics: By: Samuel Lovett

Stool samples could soon be analyzed to help detect pancreatic cancer after scientists identified microorganisms that appear to place individuals at greater risk of developing the illness. In a study of 136 people, scientists found that 27 different microbes were abundant in the stool samples of those diagnosed with the most common form of pancreatic cancer.

This “microbial profile” consistently identified patients with the disease, irrespective of how far it had progressed, raising hope that a new screening test could be developed to diagnose pancreatic cancer.

Pancreatic cancer is deadly and can be very difficult to treat, with only around one in four people surviving one year or more after diagnosis. Dr Helen Rippon, chief executive of Worldwide Cancer Research, which helped fund the study, said: “This new breakthrough builds on the growing evidence that the microbiome – the collection of microorganisms that live side by side with the cells inside our body – is linked to the development of cancer.

References

“Can pancreatic cancer be prevented?”. American Cancer Society. 11 June 2014. Archived from the original on 13 November 2014. Retrieved 13 November 2014.

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