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"Welcome to a regular Tuesday at school in America"

About That Dead CEO

I won't celebrate the destruction of any human being - not even a blood-sucker like Brian Thompson.

I'd much rather just tax these individual pricks out of existence, and starve their rent-seeking middleman companies into oblivion.

That said, it's really easy to hear a musical quality in the righteous vitriol raining down on the whole fucked up system.

BKjr

Nerves. A neurological disorder called spasmodic dysphonia.

And yes - it's easy to suspect it ties in with the brain worm thing (prob'ly not), but BKjr has had it for quite a while now, and apparently, one of the things that doesn't help is a strict regimen of diet and exercise, which kinda puts the lie to the guy's insistence that all anybody needs is a better diet, more exercise, and no drugs.

And this is the dude they want to put in charge of America's public health policy?

RFK Jr. says he has spasmodic dysphonia, a voice disorder. What is it?

A neurological movement disorder, it causes difficulty in speaking, and a voice that often breaks and sounds strained or strangled.

Robert F. Kennedy Jr., president-elect Donald Trump’s choice to lead the Department of Health and Human Services, has said he has spasmodic dysphonia. It is a voice disorder characterized by involuntary spasms in the muscles that control the vocal cords, or folds. This causes difficulty in speaking, and a voice that often breaks and sounds strained or strangled.

It is known as a focal dystonia, a neurological movement disorder that affects one specific part of the body. Writer’s cramp, where there are spasms in the hands or fingers, or persistent eye spasms or eye closure are others in the same category.

Spasmodic dysphonia most often develops at midlife — in one’s 30s or 40s — and can be life altering, particularly for those whose careers depend on speech.

“Most people take their voice for granted until they don’t have it,” said Pryor Brenner, a otolaryngologist in D.C. “It can be very discouraging. People don’t feel comfortable speaking, or don’t want to speak. They are embarrassed. It has a huge impact because they aren’t able to express themselves.”

Moreover, “it’s an invisible condition, meaning others can’t see it,” said Michael M. Johns, professor of clinical otolaryngology at the Keck School of Medicine of the University of Southern California and director of the USC Voice Center. “It’s not associated with any cognitive impairment, and these people look normal to the eye.”

Scientists agree that the disorder is neurological but don’t know its exact cause, according to Dysphonia International. Researchers are still trying to identify which part of the brain is involved and whether there may be a genetic component, according to the organization.

Some cases also may be triggered by a viral illness such as a cold or influenza, or a traumatic life event such as the death of a loved one, Brenner said. “An incredibly stressful event in life can turn it on,” he said.

Andrew Tritter, a laryngologist at UTHealth Houston, said such cases are rare, but they do occur. “I’ve seen them from a traumatic experience to going in for routine surgery,” he said. “I had one patient who woke up with it after she had a hysterectomy. Her voice was terrible, and it became chronic.”

Tritter said for people with spasmodic dysphonia, it “can be frustrating and upsetting to not be understood or heard, or be asked to constantly repeat yourself.”

There also are idiopathic cases, which occur spontaneously with no obvious cause. “It just happens,” Brenner said.

There are three kinds of spasmodic dysphonia.

Adductor spasmodic dysphonia is the most common type, which accounts for 80 percent of cases, including Kennedy’s, experts said. It causes sudden involuntary spasms that trigger the vocal cords to stiffen and close. The spasms disrupt the vibration of the vocal cords and the ability to make sounds.

Abductor spasmodic dysphonia is less common — accounting for about 20 percent of cases, experts said. It results in involuntary spasms that trigger the vocal cords to open, making vibration impossible and forming words difficult. Also, the open position lets air escape during speech, making the person sound weak, quiet and breathy.

Mixed spasmodic dysphonia is very rare and has symptoms common to the other two types.

How is spasmodic dysphonia diagnosed?

An otolaryngologist and speech-language pathologist will evaluate a patient’s symptoms and medical history and visualize their vocal cord movement through a stroboscopy exam, which is an endoscopy through the nose or mouth with a special camera and light that provides a detailed visual of vocal cord vibration to diagnose the condition.

They also will rate voice quality, record the voice to obtain acoustic measures and may palpate the neck to determine the presence of tension in and around the larynx. They may also ask the patient to read or repeat several specific sentences.

At times, the condition can be confused with other vocal issues such as a vocal tremor, Brenner said. But there is a distinction.

“Someone who has a vocal tremor can’t hold a pitch.” he said, describing a wavering that occurs when the person tries. Someone with spasmodic dysphonia, on the other hand, “can usually hold a single pitch but has trouble forming and articulating words.

How is spasmodic dysphonia treated?

Spasmodic dysphonia can’t be cured, experts said. Usually, once someone has it, “it doesn’t fluctuate over time,” Brenner said. “It levels off fairly quickly, with not a lot of variation over the years.”

Also, “I’ve never seen a child with it,” he added.

But there are several treatments, including surgery and voice therapy, though injections with botulinum toxin (Botox) is the gold standard in providing temporary relief, usually for several months, experts said.

It’s an office-based procedure using local anesthesia. Needles are passed into the neck and through the vocal cords, Johns said, and “it helps the vast majority of people become more functional in their lives.”

Botox works by blocking nerve impulses at the muscle receptor site, which normally signal the muscle to contract, and must be repeated periodically. The response varies, but the average relief lasts for about three to four months, according to Dysphonia International.

There can be some side effects, including breathiness, difficulty swallowing and pain at the injection site. Still, “it is a great treatment for most people,” Brenner said.

There also are at least two surgeries available, experts said. “Both are operations on the larynx and vocal cords to try to separate and relax them,” Johns said. “But they are fraught with complications and not considered standard treatment for the condition.”

The Bamboozlement Of Innocents

She was bargaining on Facebook.

She asked friends with dead relatives.

She scored some in parking lots.

Why We Can't Have Nice Things

At the upper levels, "American entrepreneurship" is plain old ordinary bullshit.

• Start with your brilliant new idea
• Set it up as a "non-profit"
• Get government to pitch in
• Wire it so the tax-payer money being syphoned into your shell company is laundered and hidden, so it can be funneled into your very profitable subsidiaries
• Buy some politicians to cement your scheme in place, basically making it illegal not to do business with you

You pay a premium every month, but when you need care that shades even slightly away from the sweet spot on your insurance company's Favorites List, they'll deny you the care you need to live your bestest healthiest life.

50 million Americans are denied care in one way or another every year.

The big insurance companies have strangled healthcare providers to the point where they can own any given "private" practice, and have taken on the doctors as hired hands - subjecting them to all the shitty labor-fucking laws that they've paid their coin-operated legislators to put in place.

Corporate Plutocracy

is not coming.

It's already here.

Shit Rolls Downhill

Under some truly horrible decisions of some truly asinine Republican legislatures, restrictions on abortion and other healthcare services for women are greatly contributing to hospital organizations having to discontinue OB/GYN care, or close down some hospitals altogether.

And the downstream effects of these asshole GOP prigs getting their slimy hands on the levers of power are beginning to show up big.

The tragic, preventable reasons syphilis is surging among U.S. infants

A decade ago, the United States stood on the brink of eliminating the scourge of babies born with syphilis. Now, cases are surging, a phenomenon that is underscoring deep inequities in the nation’s health-care system and reviving concerns about a disease easily controlled with routine antibiotics.

The spike, driven in part by the nation’s drug and homelessness crisis, is especially apparent across the Sun Belt, according to public health experts and data from the Centers for Disease Control and Prevention.

The rate of syphilis is five times higher for babies born to Black mothers than to White mothers, reflecting racial disparities in access to maternal health care.

Syphilis, a bacterial infection that primarily spreads through sexual contact, can be passed from mother to child through the placenta. Congenital syphilis resulted in 188 stillbirths and 23 infant deaths in 2021, according to CDC data, and can cause organ damage, profound fetal anemia and long-term complications for surviving babies.

While the overall number of infected infants seems low — nearly 2,700 nationally in 2021, or 74 of every 100,000 live births — public health officials say no baby in developed nations should be born with syphilis because most cases are preventable with testing and penicillin treatment of the mother. The fact that cases have climbed, experts say, is an indictment of the U.S. health-care system.

Oman, Cuba and Sri Lanka are among the countries that have virtually eliminated mother-to-child transmission of syphilis in recent years, according to the World Health Organization.

After steadily declining since World War II, congenital syphilis roared back in the United States to about 4,000 cases a year in the early 1990s as syphilis surged in adults. The number of infected infants dwindled to several hundred a year in the 2000s, then started climbing again in 2013.

“People thought we had gotten rid of syphilis when it in fact came back and is significantly increasing,” said Robert McDonald, who focuses on STD prevention at the CDC.

To reverse the trends, public health authorities are striving to reach women at highest risk for passing syphilis to their babies — those who are homeless, exchange sex for money, or use drugs are more likely to be exposed to the disease and less likely to seek prenatal care.

STIs are rising, but public health is shifting away from condom promotion

In Portland, Ore., county workers paid for pregnant women without stable housing to stay in a hotel for three weeks to ensure they received the three-shot regimen needed to quash the bacterial infection.

In Atlanta, a clinic hailed an Uber to bring a pregnant woman with syphilis to her third appointment for a penicillin shot when she couldn’t secure a ride.

In Los Angeles, the county jail began syphilis screening for female inmates, and the health department is planning to hold events where women experiencing homelessness could receive STD screenings alongside clothes, showers and food.

“These things are all kind of converging and creating this social milieu in which we are seeing this preventable infectious disease end up with tragic outcomes,” said Sonali Kulkarni, who leads the STI prevention division of the Los Angeles County Department of Public Health.

Health officials say the pandemic made it harder to respond to sexually transmitted diseases as dwindling staff and money were redeployed to covid. Compared to the novel health threats that captivate public attention like the coronavirus, mpox and bird flu, syphilis can seem like old news.

The first step to saving a baby from being born with syphilis is identifying whether the mother is infected. But just a few states — Arizona, Texas and North Carolina — require the most comprehensive syphilis testing covering the first visit, third trimester and at delivery, according to a 2021 review of laws compiled by the CDC.

The CDC, in examining congenital syphilis cases from 2020 with medical histories available, found that 41 percent had no timely prenatal care or testing. Nearly as many were diagnosed with syphilis but did not receive adequate treatment.

When a pregnant woman tests positive for syphilis, the only recommended treatment to prevent a congenital case — Bicillin L-A — can be hard to come by. Pfizer is the only manufacturer, and there’s no generic version. It’s so expensive that pharmacies and private health providers often don’t stock it, making it difficult to immediately start providing treatment. Public health departments are the most likely to have the shots on hand.

Inside the Biden administration plan to address maternal mortality

In rare cases, patients who did receive timely testing and treatment still risk passing the infection to their babies.

In early March, a 32-year-old Houston mom held her newborn son with a full head of brown hair for mere minutes before doctors whisked him to the neonatal intensive care unit to begin treatment for congenital syphilis.

The mother, who spoke on the condition of anonymity to discuss her medical history, said she still tested positive for syphilis at delivery despite having already had two rounds of treatment during her pregnancy.

Doctors performed a lumbar puncture, or spinal tap, on the boy to test for neurosyphilis, which occurs in 60 percent of babies with symptoms. After 10 days in the NICU, during which her son received penicillin through a tiny intravenous line, the woman was able to bring him home. But much uncertainty lies ahead.

“You don’t want to lose somebody before you get to know him,” she said.

She must bring her son back to the hospital for follow-up visits every two months for a year because syphilis and its effect on babies is stubbornly hard to detect, said her doctor Irene A. Stafford, a maternal-fetal medicine physician at the University of Texas Health Science Center.

A newborn rests beside his mother Dailyn Fleite, left, 29, at the Ana Betancourt de Mora Hospital in Camaguey, Cuba, in 2015. The World Health Organization declared Cuba the first country in the world to eliminate the transmission of HIV and syphilis from mother to child. (Alexandre Meneghini/Reuters/Alamy)
Stafford said she sees the consequences of the syphilis resurgence in her patients every day. One in 555 babies in Texas is born with congenital syphilis, according to the Texas health department.

She said she’s haunted by a case of a teen mother who was being trafficked by a relative and had received little to no prenatal care. Although she visited the emergency room complaining of symptoms during her pregnancy, she was never screened for syphilis and birthed a baby with neurosyphilis. The baby is now 5 years old and still can’t swallow solid food. The child requires speech and physical therapy and care in multiple pediatric specialties.

The teenager got pregnant again after an incomplete treatment regimen and birthed a second child with syphilis. Today, she is homeless, and her mother cares for the children.

Studies show that about half of women with syphilis don’t report risk factors such as transactional sex, substance abuse, unstable housing and sexual violence because they may fear losing custody of their children, Stafford said; as a result, they don’t get the robust screening that could lead to treatment for them and their babies.

Most women do not know they have syphilis because it doesn’t hurt, doesn’t burn, doesn’t itch. Any symptoms that develop are often vague and can be missed by even the most astute physician, said Stafford, who has received a federal grant to develop a simpler syphilis test for moms and newborns.

In Phoenix, staffers at Hushabye Nursery, a nonprofit that provides care for babies suffering from opioid withdrawal, said the recent rise in infants born with syphilis is especially alarming because the babies who need a quiet, dark environment to mitigate the pain of withdrawal must instead spend 10 days in loud, bright neonatal intensive care units to receive treatment for syphilis. After partnering with health departments in the fall to increase syphilis screening, the nursery was able to prevent three potential cases of congenital syphilis by getting the mothers into treatment, said nursery co-founder Tara Sundem.

The University of Chicago Medical Center started screening emergency room patients for syphilis in 2019, bringing testing and treatment to the place where high-risk women experiencing homelessness and addiction tend to seek medical care. This kind of universal syphilis screening at hospitals remains rare even though it can prevent congenital syphilis.

In Multnomah County, Oregon, which includes Portland, public health workers are conducting more outreach in homeless encampments and shelters as they saw a rise in syphilis infections in people who reported using drugs, often while living on the streets. In one instance, a pregnant woman who lived in a tent under a bridge received her syphilis diagnosis and first penicillin shot at an emergency room but resisted coming back. A county nurse came to her tent to bring the next two shots.

Some experts attributed the uptick in cases to varying state policies on screening. Eleven states, mostly in the Southeast, have yet to expand Medicaid to all low-income adults, which would cover the costs of syphilis testing and treatment. That leaves pregnant people, whose medical care is supposed to be covered by Medicaid, susceptible to reinfection if their partners remain untreated.

“It’s frustrating because if timely interventions are deployed, you can totally turn this condition around,” said Mark Turrentine, a professor of obstetrics and gynecology at Baylor College of Medicine in Houston.

Sarah Nadia Ali, director of infectious diseases at Mary’s Center, said the D.C. community health center has tried to remove barriers to screening at its walk-in sexual health center that accepts people without insurance. (Bonnie Jo Mount/The Washington Post)
A challenge for anti-abortion states: Doctors reluctant to work there

Several states, including Mississippi in March, have strengthened their screening requirements in recent years in response to the rise of congenital syphilis.

But the closure of rural hospitals and OB/GYN services has created “monumental” geographical gaps in accessing prenatal care, said Thomas Dobbs, Mississippi’s former public health director. “If you are a working mom who maybe doesn’t get much sick time — or any sick time — and you have a 100-mile drive just to get to a prenatal care visit, that’s a huge impediment,” Dobbs said.

Even if care were readily accessible, public health experts say many expectant Black mothers don’t believe doctors have their best interests at heart because of the medical establishment’s long history of mistreating Black patients.

Joseph Kanter, Louisiana’s top health official, says he has treated patients who had cases of congenital syphilis in their family because of the infamous Tuskegee experiments, in which hundreds of Black men were left untreated for syphilis to study the long-term effects of the disease. That has created a tragically ironic situation: The failure to treat syphilis in Black adults made their descendants more skeptical of a medical system that could provide treatment to prevent syphilis in Black babies.

“The issue of congenital syphilis is deeply intertwined with a history of institutional racism,” Kanter said, noting that 65 percent of congenital syphilis cases in Louisiana are among Black babies. “We are dealing with a lot of earned mistrust.”

Public health experts say the country has the capability to end congenital syphilis, often drawing parallels to transmission of HIV from mother to child — which declined from 1,760 in 1991 to fewer than 40 in 2019. That plunge was a result of a national public health campaign with sustained funding to adopt universal screening, put doctors on alert and ensure that pregnant people with HIV received antiretroviral therapy and did not breastfeed their children.

“The same focus has not been on congenital syphilis,” said Rebekah Horowitz, director of STI programs at the National Association of County and City Health Officials. “Without the focus and the funding, it won’t end.”

Here It Comes

We've heard warnings from "the lefties" and from women all over the spectrum about the shit we can expect once the pinch-faced blue-nosed puritans get their way. And the shit is not just coming - it's already here - and it's been here for a while.

Women taking it into their own hands could pose a whole set of dangers, but there's some possibility that it just might be the "good news" part of this whole fucked up mess.

NYT: (pay wall)

Some Women ‘Self-Manage’ Abortions as Access Recedes

Information and medications needed to end a pregnancy are increasingly available outside the health care system.

Hannah, a woman in Oklahoma, self-managed her abortion last year, when local clinics were overwhelmed with patients from Texas. 

In states that have banned abortion, some women with unwanted pregnancies are pursuing an unconventional workaround: They are “self-managing” their abortions, seeking out the necessary know-how online and obtaining the medications without the supervision of a clinic or a doctor.

At first glance, the practice may recall the days before Roe v. Wade, when women too often were forced to take risky measures to end an unwanted pregnancy. But the advent of medication abortion — accomplished with drugs, rather than in-office procedures — has transformed reproductive care, posing a significant challenge to anti-abortion legislation.

Even before the Supreme Court's decision to overturn Roe v. Wade, medication abortions accounted for more than half of abortions in the United States. Federal regulators made access to the pills even easier during the pandemic by dropping the requirement for an in-person visit and allowing the drugs to be mailed to patients after a virtual appointment.

But many states never allowed telehealth abortion, and new laws prohibiting abortion apply to all forms of the procedure, including medications. So women in increasingly restrictive parts of the country are procuring the pills any way they can, often online, despite state prohibitions.

There are no reliable estimates of the number of women who undertake their own medication abortions, according to the Guttmacher Institute, which researches and supports abortion access.

With the overturning of Roe v. Wade, abortion is now banned in at least 10 states, according to a database maintained by The New York Times. Voters in Kansas on Tuesday rejected a ballot measure that would have removed abortion rights protections from the state constitution.

Limits of one sort or another are nonetheless expected in at least half of U.S. states, and so both sides of the divide are bracing for an increase in self-managed abortions.

Critics of abortion in any form insist that medication abortions are riskier than claimed, and even more so without medical supervision. The procedure should not be undertaken beyond 10 weeks gestation, they note, or performed without a doctor’s visit, because dating a pregnancy accurately is not always possible.

Other medical complications can be missed, they say — including ectopic pregnancy, in which the fertilized egg implants outside the uterus.

Claims that medication abortion is safe “are based on flawed and incomplete data, which prioritize convenience and cost over the health and safety of patients,” said Dr. Christina Francis, chair of the American Association of Pro-Life Obstetricians and Gynecologists, which opposes all abortions except to prevent permanent harm or death to the mother.

Physicians who support abortion tell a different story: There is plentiful evidence that medication abortion is safe, and women already carry out the procedure almost entirely alone at home, even if they do see a doctor to obtain the drugs. Self-management is not so different, supporters argue.

“It’s quite safe and effective based on studies we’ve done, national data provided by the states and the Guttmacher Institute, and the experience of other countries,” said Dr. Beverly Winikoff, the founder of Gynuity Health Projects, who performed much of the research on medication abortion that led to its approval in the United States more than 20 years ago.

The procedure typically involves taking two drugs: mifepristone, which stops the pregnancy by blocking a hormone called progesterone, followed a day or two later by misoprostol, which causes the uterus to contract.

More than half a million women had medication abortions in 2020 in the United States, and fewer than half of 1 percent experience serious complications, studies show. Medical interventions like hospitalizations or blood transfusions were needed by fewer than 0.4 percent of patients, according to a 2013 review of dozens of studies involving tens of thousands of patients.

A 2018 review by the National Academies of Sciences, Engineering and Medicine found that abortion medication ended pregnancies 96.7 percent of the time in gestations of up to nine weeks. The World Health Organization endorses self-managed abortion and says it can be used up to 12 weeks gestation.

Bags of medical abortion medication and follow-up instructions for patients were readied at the Trust Women clinic in Oklahoma City in December.Credit...Evelyn Hockstein/Reuters

Medication abortion “is noninvasive, doesn’t cause sepsis and doesn’t cause ruptures of internal organs,” like the illegal abortions of the pre-Roe era, Dr. Winikoff said.

“It doesn’t mean people can’t have excessive bleeding and need to get care occasionally, but those are not the dire circumstances of people from 50 years ago,” she added.

The drugs are regulated by the Food and Drug Administration, however, and are intended to be taken under a doctor’s supervision. The agency discourages internet purchases of mifepristone because patients will be “bypassing important safeguards,” officials said in a statement.

But the F.D.A. does not advise against online purchases of misoprostol (brand name Cytotec), which is used to treat a number of medical conditions. Misoprostol can terminate pregnancies by itself, recent studies have shown.

While no treatment is 100 percent safe, taking the pills “on your own at home does not affect your risk of complications,” said Dr. Carolyn Westhoff, an obstetrician gynecologist and professor at Columbia University and the editor in chief of the journal Contraception.

But self-management also means a woman does not have a familiar health care professional nearby to call in case of an emergency or complications. Dr. Westhoff and other experts fear that women performing their own abortions may be reluctant to seek medical help in states that have criminalized abortion.

Cassie, 20, who uses the pronouns they and them and asked that only a first name be used because they reside in Texas, where most abortions are banned after about six weeks of pregnancy, managed their own abortion in January.

Cassie, who already had a child and was struggling financially, filled out an online request form for abortion pills from Aid Access, which is based in Europe. The drugs took longer to arrive than expected, and when they did, Cassie’s pregnancy was already 12 weeks along.

“I just took them and prayed for the best,” Cassie said. They experienced heavy bleeding, nausea and “the worst cramps I’ve had in my entire life.”

“I was crying, curled up in a ball of pain in the middle of my bed,” they said.

When the bleeding did not subside, Cassie’s partner drove them to the hospital, where the remaining tissue was removed.

“That was its own horrifying experience of praying that they wouldn’t know or suspect I’d caused it myself,” Cassie said.

Both the know-how and the tools to perform an abortion are increasingly easy to access.

Women who live in states where abortion is legal can turn to U.S.-based telehealth providers like Abortion on Demand and Hey Jane, which offer detailed information to women seeking abortions and provide pills by mail after a video visit in states where these services are legal.

MYA Network provides physicians who answer questions about self-managed abortion, and Abortion Pill Info offers tips on keeping online research private.

For women in states with abortion bans, Plan C offers a number of workarounds, including a list of online pharmacies selling abortion drugs that the organization has tested and tutorials on setting up mail forwarding in another state to receive the drugs.

The site also refers people to Aid Access, which screens women online and orders abortion pills from overseas pharmacies that are sent in envelopes without return addresses, even to states where abortion is illegal. The group charges $150 or less, depending on income.

Hannah, a 26-year-old in Oklahoma, said she managed her own abortion with pills from Aid Access late last year, when local clinics, overwhelmed with patients from Texas, could not accommodate her.

Hannah, who asked to not be identified because abortion is now banned in her state, said she suffered from depression at times before she became pregnant, but had plummeted to a new low and was suicidal.

“I couldn’t afford a pregnancy and was not well enough, physically or mentally, to carry a pregnancy,” she said. Her self-managed abortion was “no worse than a normal period for me.”

A medication abortion cannot be distinguished from a miscarriage, and traces of the pills cannot be discovered if they are taken orally, said Dr. Rebecca Gomperts, a Dutch physician who founded Aid Access.

If a woman needs care after taking the pills, “we always tell people to say they had a miscarriage,” she said. “It’s exactly the same symptoms, and the treatment is exactly the same.”

A study of thousands of women in the United States who received abortion pills from a provider without an in-person visit during the pandemic found that the practice was safe.

Complications are the rare exception. Another recent study looked at self-managed abortions in Argentina and Nigeria, where abortion is banned except to save the life of the mother (and, in Argentina, in cases of rape).

Twenty percent of the nearly 1,000 women who participated in the study sought care at hospitals after the procedure, but most only wanted to confirm the abortion was complete. About 4 percent reported ongoing pain, fever or bleeding. Seventeen required procedures to complete the abortion, 12 stayed in the hospital overnight, and six needed blood transfusions, according to the study, which was published in The Lancet Global Health in late 2021.

The surprise finding was that while some of the women took the mifepristone-misoprostol combination, the success rate for those taking misoprostol alone — a widely used drug that can be purchased in countries like Mexico without a prescription and is fairly inexpensive — was higher than that of the two-drug combination.

Most state laws that restrict abortion make performing an abortion a crime for doctors, not patients. Only three states — South Carolina, Oklahoma and Nevada — have laws that explicitly make it a crime to end one’s own pregnancy.

Other states, however, have wielded child endangerment statutes or other laws against women suspected of terminating their pregnancies.

In Indiana, Purvi Patel was sentenced to 20 years in prison in 2015 for inducing a self-managed abortion; her conviction was overturned in 2016. In Texas, murder charges were brought against Lizelle Herrera earlier this year in relation to a self-managed abortion, but prosecutors said they would not pursue the case.

At least six states have introduced legislation establishing a fetus as a person, which will make it easier to prosecute women who terminate their own pregnancies, said Dana Sussman, the deputy executive director of National Advocates for Pregnant Women.

Both the American Medical Association and the American College of Obstetricians and Gynecologists, which support abortion as an essential component of health care, oppose criminalizing self-managed abortion, as they say doing so will deter women from seeking medical attention.

At the moment, health care providers are not legally required by any state to report patients they suspect of self-managing an abortion, according to If/When/How, an abortion-rights advocacy group. But laws are in flux.

“We’re operating in an area of complete uncertainty,” Ms. Sussman said.
Abortion Access in the United States

• Indiana Governor Signs First Post-Roe Abortion Ban, With Limited Exceptions
• Republicans Begin Adjusting to a Fierce Abortion Backlash
• Biden Issues Executive Order on Abortion Access, Calling for More Study
• Kansas Votes to Preserve Abortion Rights Protections in Its Constitution
• They Had Miscarriages, and New Abortion Laws Obstructed Treatment
• Tracking the States Where Abortion Is Now Banned

The Implications of Overturning Roe v. Wade

Medication Abortions:

Demand for abortion pills is surging, setting the stage for new legal battles. For now, it is still legal in most states to receive abortion medication by mail and pharmacies risk violating federal civil rights law if they refuse to fill a prescription for abortion pills.

Plan B:

In the wake of the Supreme Court’s ruling, many women are stocking up on so-called morning-after pills. Here’s how these differ from abortion pills.

I.V.F.:

Legal experts say the end of Roe could make it easier to place restrictions on genetic testing, storage and disposal of the embryos created outside the womb.

Contraceptive Pills:

The Food and Drug Administration’s first application for a birth control pill that would not require a prescription has taken on new meaning after the Supreme Court decision.

Women Will Die

...unnecessarily.

 And so will some of their children.

The federal government has said

the United States needs 9,000 more OB/GYNs,

and that the shortage will reach 22,000 by 2050.

WaPo: (pay wall)

A challenge for antiabortion states: Doctors reluctant to work there

Recruiters say OB/GYNs are turning down offers, a warning for conservative-dominated states already experiencing shortages

In a few years, Olgert Bardhi’s skills will be in high demand. A first-year resident in internal medicine at the University of Texas Southwestern Medical Center in Dallas, he’ll be a full-fledged physician by 2025 in a nation facing a shortage of primary care doctors.

The trouble for Texas: Because of the state’s strict antiabortion laws, Bardhi’s not sure he will remain there.

Although he doesn’t provide abortion care right now, laws limiting the procedure have created confusion and uncertainty over what treatments are legal for miscarriage and keep him from even advising pregnant patients on the option of abortion, he said. Aiding and abetting an abortion in Texas also exposes doctors to civil lawsuits and criminal prosecution.

The top courts in Texas and Ohio on July 1 allowed the Republican-led states to enforce abortion bans and restrictions after the Supreme Court overturned Roe. (Video: Reuters, Photo: Eric Gay/AP/Reuters)

“It definitely does bother me,” Bardhi said. “If a patient comes in, and you can’t provide them the care that you are supposed to for their well-being, maybe I shouldn’t practice here. The thought has crossed my mind.”

He is balancing his concern with his sense that he can do more good by staying, including counseling patients on obtaining contraception.

Bardhi’s uncertainty reflects a broader hesitancy among some doctors and medical students who are reconsidering career prospects in red states where laws governing abortion have changed rapidly since the Supreme Court struck down Roe v. Wade, according to interviews with health-care professionals and reproductive health advocates.

One large medical recruiting firm said it recently had 20 obstetrician-gynecologists turn down positions in red states because of abortion laws. The reluctance extends beyond those interested in providing abortion care, as laws meant to protect a fetus could open doctors up to new liabilities or limit their ability to practice.

It remains unclear how thoroughly career decisions being made amid the upheaval and confusion since the Supreme Court’s decision on Dobbs v. Jackson Women’s Health Organization will translate to a lasting geographic shift. But amid a national shortage of reproductive health practitioners, the early evidence indicates that red states have, at minimum, put themselves at a disadvantage in the competition for crucial front-line providers, experts said.

One large health-care staffing firm, AMN Healthcare, said clients in states with abortion bans are having greater trouble filling vacancies because some prospective OB/GYN candidates won’t even consider opportunities in states with new or pending abortion bans.


Tom Florence, president of Merritt Hawkins, an AMN Healthcare company, cited 20 instances since the Supreme Court ruling where prospects specifically refused to relocate to states where reproductive rights are being targeted by lawmakers.

“To talk to approximately 20 candidates that state they would decline to practice in those restrictive states, that is certainly a trend we are seeing,” Florence said. “It is certainly going to impact things moving forward.”

Three candidates turned down one of the firm’s recruiters, who was working to fill a single job in maternal fetal medicine in Texas, he said: “All three expressed fear they could be fined or lose their license for doing their jobs.”

In another example, a physician contacted by phone by an AMN Healthcare recruiter trying to fill a post in an antiabortion state “simply said, ‘Roe versus Wade,’ and hung up,” Florence said.

Florence said the shift has especially serious implications for small, rural hospitals, which can afford just a small number of maternal specialists or, in some cases, only one.

“They can deliver hundreds of babies each year and see several thousand patients,” he said. “The potential absence of one OB/GYN that might be in their community, if not for the Supreme Court decision, is highly significant. The burden will be borne by the patients.”

Tellingly, Florence added, none of the recruiters had encountered a single physician seeking to practice in a state because it had banned abortion.

In a 2021 Kaiser Family Foundation survey, 75 percent of OB/GYNs said their practices do not provide abortions for the purposes of terminating a pregnancy.

Yet broadly written abortion bans across the United States have cast a chill across the broader practice of reproductive health, say mainstream physician leaders who support abortion rights. In states without exceptions for the life and health of the woman, they say, routine standards of care are being scrapped.

They worry that limits on training for new doctors will undermine recruitment of young talent. They are concerned about restrictions on fertility treatment. They anticipate that conservative legislatures will seek to impose bans on certain types of contraception, including IUDs and Plan B medication. Most Republicans in the U.S. House voted last month against a measure protecting the right to contraception.

Additionally, many OB/GYN doctors, even if they don’t perform abortions themselves, believe strongly in patient autonomy and decision-making, said academic and clinical leaders.

“Even physicians in restrictive states have never had to deal with this kind of political interference and legislative oversight,” said Eve Espey, chair of the department of obstetrics and gynecology at the University of New Mexico and a physician at the UNM Center for Reproductive Health. “It’s an incredible intrusion into a wide swath of reproductive health care.”

A third-year OB/GYN resident at U-N. M., Alana Carstens Yalom attended medical school at Tulane University, in New Orleans. She had entertained the idea of going back to Louisiana for her medical practice. Not anymore. She wants abortion care to be a part of her OB/GYN practice, and Louisiana has a ban.

“Now I don’t think that is even an option for me,” she said.

Physicians, medical residents and medical students said in interviews they are worried about the impact on the profession. How to navigate careers in the new landscape is a major topic of discussion among both doctors and trainees, they said.

Mayrose Porter, an Austin native who is a student at Baylor College of Medicine in Houston, said she will apply to residencies in her home state but that the rest of the choices on her list will only be in states where abortion is legal. In the long term, Porter, a member of Medical Students for Choice, does not expect to practice medicine in Texas.

“The idea that myself and other future doctors are just not going to be here is sad for me personally and sad for the community,” she said, emphasizing she was speaking for herself only, not Baylor. “There’s some guilt that I’m abandoning the community I grew up in.”

In Nebraska, Methodist Health System in Omaha has just two specialists with expertise in high-risk pregnancies who also can perform dilation and evacuation procedures to remove a fetus. The hospital permits abortions only in situations that threaten the health and life of the woman. A group of OB/GYNs from Nebraska, including Methodist maternal fetal specialist Emily Patel, have formed a local political action committee to urge the legislature not to pass an abortion ban.

They are warning about “downstream effects” of an abortion ban on reproductive health more broadly.

A common example is for a woman whose water has broken around 18 or 19 weeks. The risks of continuing that pregnancy to the health of the woman and the fetus include developmental problems for the fetus and the risk of infection for the woman.

But under the proposed abortion ban in Nebraska, Patel said, it is not clear whether even explaining termination options in such a circumstance would be legal.

“Imagine we are in a state with a ban, and that fetus has a heart rate, and the patient sitting in front of me is not ill. This is going to be a tough situation for a physician to be in,” Patel said. “A physician is not going to want to be in a position where they are going to be criminally prosecuted for providing routine care and counseling.”

It’s the sort of legal uncertainty and danger that top doctors will seek to avoid, she added: “These states where bans are going into effect are going to have trouble recruiting for the next generation of OB/GYNs.”

Opponents of abortion said worries about legal jeopardy and restrictions beyond elective abortions are overblown.

“There’s a lot of mythology and misconception about what this means for reproductive health,” said Sandy Christiansen, an OB/GYN who is medical director of a Maryland Care Net pregnancy center, which encourages women to continue pregnancies. “There shouldn’t be any problems” treating a miscarriage with medication or surgical intervention, she said.

“They shouldn’t have to worry about their licenses if they are practicing a standard of care,” said Christiansen, who is a member of the American Association of Pro-Life Obstetricians and Gynecologists.

She did acknowledge some confusion: “Hopefully, the laws that will come along will clarify some of these things.”

Another member of the antiabortion physicians’ group, associate professor Susan Bane, at Barton College, a small Christian-affiliated institution in North Carolina, said she believes reluctance to move to states with abortion bans will be limited to the small percentage of OB/GYN doctors who want to perform elective abortions.

“If you’re going to be in medical school and you want to be an obstetrician and want to do abortions, you will choose a state where it’s legal,” she said.

Hospital systems in states with abortion restrictions, including Utah, Texas, Mississippi, Alabama and Ohio, did not respond to requests for comment or declined to respond to questions about how they are approaching potential retention and recruiting challenges.

A large health system based in Utah, Intermountain Healthcare, lists 10 OB/GYN physician vacancies on its website, the most of any specialty for which it is recruiting. A spokeswoman at Intermountain, apparently inadvertently, included a Post reporter on an email to the public relations team after The Post asked about challenges filling those vacancies in light of Utah’s abortion law: “We need to strategize a response to politely decline so that we can stay away from this issue.”

Doctors said they are grappling with the fallout from broadly worded legislation written by politicians without detailed medical knowledge. The environment creates a high degree of legal and professional risk for specialists, said David Turok, an associate professor of OB/GYN at the University of Utah who is also a board member of Physicians for Reproductive Health, which supports abortion rights.

“What we have is laws that are not representative of medical practice, that are not framed in ways that we think or speak as medical professionals,” Turok said, “and that makes it confusing.”

Officials in some states are working to clarify how abortion bans are going to be applied. The Louisiana Department of Health on Monday issued a list of 25 fetal conditions that can justify termination.

The legal uncertainty adds to the burdens on OB/GYNs. They must respond to deliver babies 24 hours a day, emergencies are emotionally stressful, and practitioners face some of the highest rates of malpractice lawsuits and accompanying insurance costs.

The federal government has said the United States needs 9,000 more OB/GYNs and that the shortage will reach 22,000 by 2050.

In Michigan, an old, pre-Roe abortion ban was renewed after the Supreme Court ruling. The looming ban has prompted Tim Johnson, a veteran of high-risk pregnancy care at Michigan Health, to consider moving out of the state. Although he is 73 and no longer provides elective abortions, he still treats patients and is not ready to retire. If Michigan’s abortion ban sticks, he may move to Maryland to practice, he said.

“I always said if (Roe were overturned) quickly like this, it would be terribly disruptive,” he said, “We are starting to understand how truly disruptive it is.”

The PACT Act

Senate Republicans actively blocked a piece of good legislation that would bring some relief to veterans.

(See post: Get it Straight)

Jon Stewart goes after 'em - "Senator Toomey won't sit down with this man - because he is a fucking coward."

Today's Today

Were you born OK?

Were you properly tended to thru your childhood - immunizations, growth charts, nutrition, etc?

Look up a few nurses and buy them some flowers and some candy and a sports car and a condo.

We go 50 or 60 or 80 years being looked after and comforted and cared for mostly by nurses, and it's the doctors who make all the money and get the fond remembrances written up in the local newspapers when they croak.

Don't get me wrong - docs are in there pullin' hard, and they deserve recognition and reward.

But it's the nurses who carry the heavy end of the boat. Without them, modern healthcare doesn't work for shit. The payoff for them is always more than a little short.

Florence Nightingale May 12, 1820 - August 12, 1910

Simon Whistler with a biography: 

Black American History #29

Dr Clint Smith - The Tuskegee Syphilis Experiment

Tuskegee was not something that happened centuries ago. It didn't end until a year after I had left high school - and I never heard one fucking thing about it for years after that.

Also, Smith makes a great point. ie: "Tuskegee" is invoked to explain how racism was built into the healthcare system here in USAmerica Inc, while inviting the inference that since we've recognized how horrifically unethical it all was, we can dismiss it now as being part of a troubled past, and avoid having to acknowledge the ongoing problems of a racial divide in healthcare delivery that should be apparent to anyone who cares to look.

This Thing Called Science

Smallpox killed an estimated 300,000,000 people just in the 20th century. A number almost the equivalent of the current total population of USAmerica, Inc.

300,000,000 dead - in just under 80 years.

Did you catch the part about the economics of it?

We put enormous amounts of time, energy and tax money into the effort to eradicate smallpox over a span of decades. And that cost is recouped here in USAmerica Inc every 6 days.

Every.

Six.

Days.

The extremely positive economic benefits of good public health policy should be obvious, and we should be shouting it to the heavens.

And good public health policy comes from good government.

Not more government - not necessarily bigger or smaller - but better.

I want a government that does good work for me at a reasonable price.

Modern Miracles

I've only done Ketamine twice. And I can say without fear of contradiction that they remain among my most pleasant memories of drug-induced euphoria - or they would be if I hadn't been blissfully asleep both times.

🎶 Deep and restful, sleep...sleep...sleep 🎶

PsyPost:

Ketamine may ease depression by restoring the brain’s sensitivity to prediction error, study suggests

New research suggests that electrophysiological brain signals associated with neural plasticity could help explain the rapid, antidepressant effects of the drug ketamine. The findings, European Neuropsychopharmacology, indicate that ketamine could reverse insensitivity to prediction error in depression.

In other words, the drug may help to alleviate depression by making it easier for patients to update their model of reality.

“Ketamine is exciting because of its potential to both treat, and better understand depression. This is largely because ketamine doesn’t work the way ordinary antidepressants do – its primary mechanism isn’t to increase monoamines in the brain like serotonin, and so ketamine gives us new insight into other potential mechanisms underlying depression,” said lead researcher Rachael Sumner, a postdoctoral research fellow at The University of Auckland School of Pharmacy.

“One of the major candidates for the mechanisms underlying ketamine’s antidepressant properties is how it increases neural plasticity. Neural plasticity is the brain’s ability to form new connections between neurons and ultimately underlies learning and memory in the brain.”

“Rodent studies have consistently shown that ketamine increases neural plasticity within 24 hours,” Sumner said. “However, there are major challenges when attempting to translate what we know occurs in rodents to determine if it occurs in humans. Sensory processing mechanisms of plasticity, like the auditory process we examined in this study, provide an important means to meet this challenge of translation.”

The double-blind, placebo-controlled study included 30 participants with major depressive disorder who had not responded to at least 2 recognized treatments for depression. Seven in 10 participants demonstrated a 50% or greater decrease in their depression symptoms one day after receiving ketamine.

“In this case we used what’s called an ‘auditory mismatch negativity’ task to assess short-term plasticity and predictive coding, or the brains adaptability and tendency to try to predict what’s coming next,” Sumner said.

The researchers used electroencephalogram (EEG) technology to measure brain activity as the participants listened to a sequence of auditory tones that occasionally included an unexpected noise. The brain automatically generates a particular pattern of electrical brain activity called mismatch negativity (MMN) upon hearing an unexpected noise.

Sumner and her colleagues found that ketamine increased the amplitude of the MMN several hours post-infusion, suggesting that the drug increased sensitivity to prediction error.

“We found that just 3 hours after receiving ketamine the brains of people with moderate to severe depression became more sensitive to detecting errors in its predictions of incoming sensory information,” she told PsyPost.

“To provide context, the brain creates models or predictions about the world around it and what is most likely to come next. This is largely thought to be because it is an efficient way to deal with the massive amount of information hitting our senses every moment of the day. When something is constant and stable in the world these models can become very rigid. It has been suggested that these models can become too rigid and unchanging, underlying negative ruminations and self-belief that people with depression often report.”

“As an example of how this might look in depression — it is often easy for friends and family to point out to their loved one errors or the harm in their thought patterns,” Sumner explained. “A counsellor will often work with a person to change their harmful ruminations or beliefs, such as with cognitive behavioral therapy (CBT). However, the person experiencing depression may find this difficult to see, or to take on because of how rigid their models (belief about themselves, the world around them, their future) have become.”

The participants also completed a visual task to measure long-term potentiation (LTP), the ability of neurons to increase communication efficiency with other neurons. An analysis of that data, published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, found evidence that the antidepressant effects of ketamine were associated with enhanced LTP.

“Ketamine may be working by increasing plasticity (the ability to adapt and learn new things), as well as increasing the brain’s sensitivity to unexpected external input that is signaling errors in its own rigid expectations,” Sumner said.

The main limitations of the new research are the lack of a control group and relatively small sample size. But Sumner and her colleagues hope that their future research will shed more light on whether ketamine can help to defeat harmful cognitions.

“The task we used involves presenting beeps through some headphones, and while it provides a highly controlled way to measure plasticity and sensitivity to unexpected input, it is pretty far removed from the complexity of the experience of depression itself. The next study should replicate our finding, and aim target and relate the change in the mismatch response and connectivity to higher level brain functions,” Sumner told PsyPost.

“Building on this finding may help provide evidence for the use of ketamine to facilitate or enhance people’s ability to engage with and benefit from therapies like CBT, by putting the brain into a more plastic state, ready to update its models.”

The study, “Ketamine improves short-term plasticity in depression by enhancing sensitivity to prediction errors“, was authored by Rachael L. Sumner, Rebecca McMillan, Meg J. Spriggs, Doug Campbell, Gemma Malpas, Elizabeth Maxwell, Carolyn Deng, John Hay, Rhys Ponton, Frederick Sundram, and Suresh D. Muthukumaraswamy.

Maybe we should try putting this stuff in the public water supply - might could go a long way to fixing what's gone wrong with the MAGA QAnon bozos. Can you thinking of a more apt description of their moronic beliefs than "inaccurate models and predictions"?

I think it's worth a shot.

Wondering

Just wondering when the miracle cure that 45* got at Walter Reed will be available to the rest of us.

That would make for such a nice Christmas, dontcha think?

Confirming The Worry

While Republicans are in court trying to kill Obamacare - with its guarantee that insurance companies cover pre-existing conditions at no increased rate - there's a growing body of evidence that a very large contingent of the current 7 million Americans who've been diagnosed with COVID-19 will likely live with health complications for the rest of their lives. 

AKA: Pre-Existing Conditions

Reuters:

SEOUL (Reuters) - Nine in ten coronavirus patients reported experiencing side-effects such as fatigue, psychological after-effects and loss of smell and taste after they recovered from the disease, according to a preliminary study by South Korea.

The research comes as the global death toll from COVID-19 passed 1 million on Tuesday, a grim milestone in a pandemic that has devastated the global economy, overloaded health systems and changed the way people live.

In an online survey of 965 recovered COVID-19 patients, 879 people or 91.1% responded they were suffering at least one side-effect from the disease, the Korea Disease Control and Prevention Agency (KDCA) official Kwon Jun-wook told a briefing.

Fatigue was the most common side-effect with 26.2% reading, followed by difficulty in concentration which had 24.6%, Kwon said.

Other after-effects included psychological or mental side-effects and loss of taste or smell.

Kim Shin-woo, professor of internal medicine at Kyungpook National University School of Medicine in Daegu, sought comments from 5,762 recovered patients in South Korea and 16.7% of them participated in the survey, said Kwon.

Conclusion: 

Republicans are assholes

Long Term Shit

Making the COVID-19 tests free didn't make them any more accessible.

I'm still not able to get tested if I'm not symptomatic.

Turns out that for a whole bunch of my fellow humans here in USAmerica Inc, another effect of this whole thing is that we've been forced to see that too many folks won't go in for the test even if they are symptomatic for fear of finding out they're in need of hospitalization - which makes them even more fearful that they can't afford to be cared for.

(yeah, it's The Independent, but still) Independent:

Around one in seven Americans would not seek medical if they developed a fever or dry cough because of concerns over costs, a new poll has found.

It suggests that almost 35 million people might avoid seeing a doctor for the symptoms, which are known manifestations of Covid-19.

The new poll was conducted by Gallup and non-profit organisation West Health and published on Tuesday. It further found that 9 per cent of people would avoid healthcare even when the question was “framed explicitly as believing [they] have been infected by the novel coronavirus“.

GOP Fuckery

WaPo:

DETROIT — Poor people in Michigan with asthma and diabetes were admitted to the hospital less often after they joined Medicaid under the Affordable Care Act. More than 25,000 Ohio smokers got help through the state’s Medicaid expansion that led them to quit. And around the country, patients with advanced kidney disease who went on dialysis were more likely to be alive a year later if they lived in a Medicaid-expansion state.

Such findings are part of an emerging mosaic of evidence that, nearly a decade after it became one of the most polarizing health-care laws in U.S. history, the ACA is making some Americans healthier — and less likely to die.

The evidence is accumulating just as the ACA’s future is, once again, being cast into doubt. 

The most immediate threat arises from a federal lawsuit, brought by a group of Republican state attorneys general, that challenges the law’s constitutionality. A trial court judge in Texas ruled late last year that the entire law is invalid, and an opinion on the case is expected at any time from the U.S. Court of Appeals for the Fifth Circuit. The case could well put the ACA before the Supreme Court for a third time.

Today's Parable

"Hi, I'm here for an oil change and tire rotation - here's my membership card for the discount."

"OK - that'll be $863.00 please."

"Wait - what? I paid good money for this card, and it's still that much?"

"Without the card, it's $5,289.00 - you're lucky - you have the Silver Club Card."

"Damn. Well, better'n nothin' I guess."

THE AMERICAN HEALTHCARE SYSTEM