DYING, ILLNESS, AND AGING WITH GRACE

Was UnitedHealthcare CEO Brian Thompson shot and killed for supporting a change in our approach to health care?

 

"At an investor meeting last year, he outlined his company's shift to "value-based care," paying doctors and other caregivers to keep patients healthy rather than focusing on treating them once sick.

 

"Health care should be easier for people," Thompson said at the time. "We are cognizant of the challenges. But navigating a future through value-based care unlocks a situation where the … family doesn't have to make the decisions on their own."

 

Thompson also drew attention in 2021 when the insurer, like its competitors, was widely criticized for a plan to start denying payment for what it deemed non-critical visits to hospital emergency rooms.

 

"The University of Iowa graduate began his career as a certified public accountant at PwC and had little name recognition beyond the health care industry. Even to investors who own its stock, the parent company's face belonged to CEO Andrew Witty, a knighted British triathlete who has testified before Congress.
 

"When Thompson did occasionally draw attention, it was because of his role in shaping the way Americans get health care."

                 ~Excerpt from the story UnitedHealthcare CEO kept a low public profile. Then he was shot to death in New York (Adam Geller and Tom Murphy, AP, 12-4-24)

 

      — — —

 

'The words "deny," "defend" and "depose" were scrawled on the ammunition, Kenny said. The messages mirror the phrase "delay, deny, defend," which is commonly used by lawyers and critics about insurers that delay payments, deny claims and defend their actions.' ~ WTOP

 

        — — —

 

 

As I read about the shooting, wondering what might have made someone angry enough to shoot a CEO.

In a section on Understanding the issues health care reform should address (on my own website), this was the first article I had linked to:

 

How UnitedHealth harnesses its physician empire to squeeze profits out of patients (Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence, Physicians for a National Health Program, PNHP, reprinted from STAT News, Investigation: Health Care’s Colossus, 7-25-24)

 

     "UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. A STAT investigation reveals the untold story of how the company has gobbled up multiple pieces of the health care industry and exploited its growing power to milk the system for profit. UnitedHealth’s tactics have transformed medicine in communities across the country into an assembly line that treats millions of patients as products to be monetized."

 

     "Doctors said the company had a fixation with medical coding to generate more revenue — encouraging clinicians through bonuses and performance reviews to identify more health problems in patients, even if those conditions seemed dubious. By controlling doctors, UnitedHealth can lean on them to practice in ways that benefit the insurer, and use its insurance arm to funnel cash back to its clinicians — similar to how Standard Oil amassed power as both the buyer and seller in oil refining.

     "Doctors interviewed by STAT said they were initially seduced by the company's sales pitch that it would be hands-off and help them provide high-quality care, but they quickly became disillusioned. Patients, meanwhile, are wondering why their doctors are rushing through their appointments — if they can get seen at all — and have expressed alarm when concerning diagnoses pop up in their medical records, many of which were never mentioned by their physicians.

 

     "While UnitedHealth expanded in patient care, it also grew its dominance in Medicare Advantage, the alternative to traditional Medicare that is run by private insurers and now covers more than half of all Medicare beneficiaries. Medicare Advantage insurers have gamed the system by excessively coding their members, resulting in massive overpayments to the companies. Overpayments based on coding alone are expected to total $50 billion this year..."

• Killing of UnitedHealthcare CEO brings resentment of the health care system to the fore Anger toward health insurers reflects people’s ‘pent-up pain’ ( Bob Herman and Tara Bannow, STAT, 12-6-24) "Now, Americans are grappling with two heavy subjects at once: the callousness of a slaying, and an undercurrent of deep-seated anger at a health care industry that makes a lot of money by exploiting Americans."

 

 

 

More on:          

What is "value-based care"?
Better health at lower costs: Why we need Value-Based Care now (Aetna, an insurance provider)

     "Value-Based Care (VBC) is a health care delivery model under which providers — hospitals, labs, doctors, nurses and others — are paid based on the health outcomes of their patients and the quality of services rendered. Under some value-based contracts, providers share in financial risk with health insurance companies. In addition to negotiated payments, they can earn incentives for providing high-quality, efficient care. VBC differs from the traditional fee-for-service model where providers are paid separately for each medical service. While quality care can be provided under both models, it’s the difference in how providers are paid, paired with the way patient care is managed, that provides the opportunity for health improvements and savings in a VBC environment."

 

"We spend too much and we get too little."

"The U.S. spends the most on health care, but has the worst outcomes and highest disease burden among developed nations."

• The Gilded Age of Medicine Is Here (Dhruv Khullar, New Yorker, 12-12-24) Health insurers and hospitals increasingly treat patients less as humans in need of care than consumers who generate profit. This year, the health-news site STAT revealed that UnitedHealth, the country’s largest private insurer, had set up dashboards for practices to compete on how many conditions they could diagnose in patients.

Killing of UnitedHealthcare CEO brings resentment of the health care system to the fore Anger toward health insurers reflects people’s ‘pent-up pain’ ( Bob Herman and Tara Bannow, STAT, 12-6-24) "Now, Americans are grappling with two heavy subjects at once: the callousness of a slaying, and an undercurrent of deep-seated anger at a health care industry that makes a lot of money by exploiting Americans." https://www.statnews.com/2024/12/06/unitedhealthcare-ceo-killing-outrage-pain-resentment-reaction-brian-thompson/

....

What are the value-based programs? (Centers for Medicare & Medicaid Services)
       https://www.cms.gov/medicare/quality/value-based-programs
"Our value-based programs are important because they’re helping us move toward paying providers based on the quality, rather than the quantity of care they give patients.

"What are CMS’ original value-based programs?
There are 5 original value-based programs; their goal is to link provider performance of quality measures to provider payment:
    End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
    Hospital Value-Based Purchasing (VBP) Program
    Hospital Readmission Reduction Program (HRRP)
    Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
    Hospital Acquired Conditions(HAC) Reduction Program

Other value-based programs:
    Skilled Nursing Facility Value-Based Purchasing (SNFVBP)
    Home Health Value Based Purchasing (HHVBP)"

              

 Here's a link to a 2023 list of recommended changes in health care:
NEWS: Sanders and Marshall Announce Bipartisan Legislation on Primary Care (US Senate Committee on Health, Education, Labor & Pensions, 9-14-23)

https://www.help.senate.gov/chair/newsroom/press/news-sanders-and-marshall-announce-bipartisan-legislation-on-primary-care

"According to the most recent estimates, over the next decade the United States faces a shortage of over 120,000 doctors — including a huge shortage of primary care doctors -- and the nursing shortage may be even worse. Over the next two years alone, it is estimated that we will need between 200,000 and 450,000 more nurses.

    "The Sanders-Marshall agreement answers this crisis by providing over $26 billion in funding to expand primary care in America and address the health care workforce shortage:

 

Provides $5.8 billion a year over the next three years in mandatory funding for community health centers which provide high-quality primary health care to more than 30 million Americans.

Within those funds there is a $245 million per year set aside to expand hours of operation at community health centers and $55 million per year for school-based health services.

Health centers will be newly required to provide nutrition services.

Provides $3 billion in capital funding primarily to enable community health centers to expand dental care and mental health care in their facilities.

Increases funding for the National Health Service Corps from $310 million to $950 million per year over the next three years to provide 2,100 scholarships and debt forgiveness for some 20,000 doctors, nurses, dentists, mental health providers, and other health care professionals who commit to working in our nation's most underserved areas.

Provides $1.5 billion over the next five years in the Teaching Health Center Graduate Medical Education program to create more than 700 new primary care residency slots, which would result in up to 2,800 additional doctors by 2031. This program increases the number of primary care physicians and dental residents trained in community-based settings. In Academic Year 2021-2022, the program funded more than 930 individual primary care medical and dental residents, who provided more than 1.1 million hours of patient care to more than 800,000 patients in medically underserved and rural areas.

Addresses the nursing shortage in America by investing $1.2 billion in grants to community colleges and state universities to increase the number of students enrolled in accredited, two-year registered nursing programs. The schools receiving these awards must use them to expand their class sizes and grow the number of two-year nurses trained across the country. This provision would allow schools to train up to 60,000 additional two-year nurses.

Provides $300 million to produce an additional 2,000 primary care doctors by 2032. The bill will also increase residency programs in rural America through an investment in the Rural Residency Planning and Development program and invests in training and workforce programs for dentists and dental assistants.

 

The legislation will be fully paid for by combatting the enormous waste, fraud and abuse in the health care system, making it easier for patients to access low-cost generic drugs and holding pharmacy benefit managers accountable, among other provisions.

 

 

Sandors Payfors

(Bipartisan Primary Care and Health Workforce Act Bipartisan Offsets)

Possibly for 2011, but clearly about funding, and the ideas listed make sense:

My guess anyone searching for articles and research on these topics would find research gold. Clearly pharmacy benefit managers were a big part of the health care funding problem in 2011 (rather than a solution).

 

Require honest billing by hospitals

Prohibit facility fees for telehealth and evaluation and management services

Prohibit anticompetitive contract clauses in commercial insurance

Pharmacy Benefit Managers/Generic Drug Package --- a suite of bipartisan bills addressing drug prices through reforms to pharmacy benefit managers (PBMs) and the generic drug market

Delinking PBM service fees

Prevention and Public Health Fund (reduce funding)

 

Other funding considerations: Up to $22.2 billion.

Medicaid improvement fund: Use these savings primarily to pay for increased funding for community health centers, the National Health Service Corps, and Teaching Health Centers Graduate Medical Education.

Expand program integrity for unemployment insurance

Extend the Sequester, but exclude Medicare (2011)

This series ran in 2022 but I am linking to stories that many of you won't have read, and should. 

• Patients for Profit: How Private Equity Hijacked Health Care (KFF Health News) Private equity investors are rapidly scooping up thousands of health care businesses, taking over emergency rooms or entire hospitals, and becoming major players in physician practices and patient care, from cradle to grave. But these acquisitions are often invisible to federal regulators. And their profit motives raise concerns about rising prices and the quality of treatment.

 

• Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties (Fred Schulte, KFF Health News, 11-14-22) Private equity firms have shelled out almost $1 trillion to acquire nearly 8000 health care businesses, in deals almost always hidden from federal regulators. The result: higher prices and complaints about care. Government should require 'added scrutiny' of private equity companies whose holdings run afoul of the law.

• Baby, That Bill Is High: Private Equity ‘Gambit’ Squeezes Excessive ER Charges From Routine Births (Rae Ellen Bichell, KFF Health News, 10-13-22) Routine births are turning into moneymaking ‘emergency’ events at hospitals that work with private equity-backed staffing companies. Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar. KHN found that more than 90% of private equity takeovers or investments fall below the $101 million threshold that triggers an antitrust review by the Federal Trade Commission and the U.S. Justice Department. In the health care sphere, private equity has tended to find legal ways to bill more for medical services: trimming services that don’t turn a profit, cutting staff, or employing personnel with less training to perform skilled jobs — actions that may put patients at risk, critics say.

• Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties (Fred Schulte, KFF Health News, 11-14-22) As private equity extends its reach into health care, evidence is mounting that the penetration has led to higher prices and diminished quality of care, a KHN investigation has found. KHN found that companies owned or managed by private equity firms have agreed to pay fines of more than $500 million since 2014 to settle at least 34 lawsuits filed under the False Claims Act, a federal law that punishes false billing submissions to the federal government with fines. Most of the time, the private equity owners have avoided liability.

• Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care (Markian Hawryluk, KFF Health News, 7-29-22) With the U.S. population rapidly aging, hospice has become a boom industry. And with limited oversight and generous payment, the industry is at high risk for exploitation. Agencies are paid a daily rate for each patient, which encourages for-profit hospices to limit spending to boost their bottom lines. For-profit hospices had Medicare profit margins of 19% in 2019, compared with 6% for nonprofit hospices. For-profit hospices tend to hire fewer employees than nonprofits and expect them to see more patients. If patients become too costly, requiring expensive care or medicines, hospice providers can discharge them, and take them to a hospital emergency room to get services the agencies don’t want to pay for themselves.

• Infections and falls increased in private equity-owned hospitals (National Institutes of Health, 1-23-24) Local hospitals might be owned by the university next door, by a non-profit organization, or by a for-profit company. Over the last decade, more and more hospitals have been purchased by private equity firms.The private equity model involves using investor money—and additional debt—to purchase an asset like a hospital. The firm typically then cuts operating costs, often sells the real estate portion, and attempts to re-sell the entity for a profit after several years. Hospitals saw a 25% increase in hospital-acquired conditions after acquisition by private equity firms relative to the control group. This increase was mainly driven by a spike in infections after the placement of a central line (a type of IV inserted near the heart to deliver drugs, fluids, or other substances) and an increase in falls. Private equity acquisitions led to higher charges, prices, and societal spending and a decline in the clinical quality of care delivered to hospital patients.

 

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk.

 

“The trauma caused by childhood neglect, sexual or domestic abuse and war wreaks havoc in our bodies, says Bessel van der Kolk in The Body Keeps the Score. . . . Van der Kolk draws on thirty years of experience to argue powerfully that trauma is one of the West’s most urgent public health issues. . . . Packed with science and human stories, the book is an intense read. . . . [T]he struggle and resilience of his patients is very moving.”
—Shaoni Bhattacharya, New Scientist

“War zones may be nearer than you think, as the 25 percent of US citizens raised with alcoholic relatives might attest. Psychiatrist Bessel van der Kolk argues, moreover, that severe trauma is ‘encoded in the viscera’ and demands tailored approaches that enable people to experience deep relief from rage and helplessness. In a narrative packed with decades of findings and case studies, he traces the evolution of treatments from the ‘chemical coshes’ of the 1970s to neurofeedback, mindfulness and other nuanced techniques.”
—Nature

“An astonishing amount of information on almost every aspect of trauma experience, research, interventions, and theories is brought together in this book, which . . . has a distinctly holistic feel to it. The title suggests that what will be explored is how the body retains the imprints of trauma. However, it delivers much more than this, delving into how the brain is impacted by overwhelming traumatic events, and is studded with sections on neuroscience which draw on the author’s own numerous studies as well as that of his peers. In addition, it investigates the effects of adverse childhood attachment patterns, child abuse, and chronic and long-term abuse. . . . [T]his book is a veritable goldmine of information.”
—European Journal of Psychotraumatology

“Dr. van der Kolk . . . has written a fascinating and empowering book about trauma and its effects. He uses modern neuroscience to demonstrate that trauma physically affects the brain and the body, causing anxiety, rage, and the inability to concentrate. Victims have problems remembering, trusting, and forming relationships. They have lost control. Although news reports and discussions tend to focus on war veterans, abused children, domestic violence victims, and victims of violent crime suffer as well. Using a combination of traditional therapy techniques and alternative treatments such as EMDR, yoga, neurofeedback, and theater, patients can regain control of their bodies and rewire their brains so that they can rebuild their lives. The author uses case histories to demonstrate the process. He includes a resource list, bibliography, and extensive notes. This accessible book offers hope and inspiration to those who suffer from trauma and those who care for them. It is an outstanding addition to all library collections.
—Medical Library Association, Consumer Connections

Updated from original entry 10-8-18

Sites geared to helping you prepare for poisoning, pandemics, hurricanes, earthquakes, tornadoes, flood and flash floods, fires, and disasters and emergencies generally. Let me know in comments of additional useful websites and online information. See also Weather and weather-related events (Search engines, Writers and Editors)

 

PREPARING FOR DISASTERS AND EMERGENCIES, GENERALLY
• A preparation & safety awareness guide for travellers (Postcard Travel)

• Disaster Distress Helpline (SAMHSA, Substance Abuse & Mental Health Services Administration) The Disaster Distress Helpline, 1-800-985-5990, is a 24/7, 365-day-a-year, national hotline dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. Stress, anxiety, and other depression-like symptoms are common reactions after a disaster. Call or text 1-800-985-5990 to connect with a trained crisis counselor. This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories. SAMHSA’s Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters.
• DisasterAssistance.gov Do you need help after a disaster? We can help you apply for FEMA disaster assistance and guide you to other resources to help you recover. Links for Red Cross and other emergency shelters, state emergency management offices, SBA disaster assistance
• Find Open Shelters and Disaster Relief Services (Red Cross)
• How to Pack an Emergency Kit for Any Disaster (Kenneth R. Rosen, NY Times, 7-3-17) The Life Straw "is Mr. Smyth’s choice for purification straws you can drink water through." If you have a container to drink from, iodine water purification tablets

 Read More 

A headings-only version of a helpful document (see links for more info below)

A to-do list for organizing all the essential information and important documents in and of your life.

   

Essentials:

Put these together in one place, for those taking care of your estate after you die.

---***Will ("last will and testament," specifying who will inherit your assets if there is no joint ownership, or beneficiaries whose names are not filed at an institution)

---***Durable financial power-of-attorney form (without which no one can make decisions and act for you if you are incapacitated)

---Revocable trust (in addition to, and privater than, a will; changeable anytime during your lifetime; and harder to dispute in court)
---Letter of instruction (for important final instructions, such as where you want your ashes scattered, who you want notified of your death, or how you want your funeral or memorial service to be performed).
 

Bank accounts:
---List of all bank accounts & online log-in info.

---List of safe deposit boxes (and locations)
  

Health care confidential:

---***Durable health care proxy/power-of-attorney form

     (so your designee can make health-care decisions on your behalf if you are incapacitated)

---***Living will (how you want to be treated in specific medical circumstances)

---Alternative: An Advance Health Care Directive, combining your Living Will and naming a Health Care Proxy/Power of Attorney with authority to make medical decisions for you.

---A personal & family medical history (including your list of medications)

---A HIPAA Authorization that grants permission to release protected health information about you to designated parties
---Do Not Resuscitate Orders (DNR), IF and when you wish to be resuscitated (review regularly)

---Personal & family medical history (including your list of medications)
   

Proof of ownership (and debts), with dates:

---Documentation of housing and land ownership.

---Documentation of cemetery plots (cemetery deeds)

---Documentation of vehicles owned.

---Documentation of stock certificates and savings bonds.

---List of brokerage and escrow mortgage accounts.

---Any partnership or corporate operating agreements.

---List and proof and loans made to others and debts owed to others

    (what has been paid and what is still owed)

---Tax returns--last 3 years (some say 6).

    "Helps your personal representative file a final income-tax and estate return, and if necessary, a revocable-trust return."
   

Retirement and life insurance:

---Copies of life insurance policies (name of carrier, policy number and agent associated with the policy)

     "Be especially careful with life-insurance policies granted by an employer upon your retirement."

---List of (and details about) pensions, annuities, IRA’s, and retirement plans.

    ("An IRA is considered dormant or unclaimed if no withdrawal has been made by age 70.")
   

Marriage and divorce:

---Marriage license.

---Divorce judgment and decree.

---Copies of most recent child support payment order.

---Copies of life-insurance papers benefitting or covering children.

---Qualified domestic relations order.

 
Financial and legal information, a checklist:

[This general list repeats items listed above, in a different order:]

• Names, phone numbers, and email addresses of lawyers and financial advisors
• Names, addresses (especially of your legal residence), phone numbers, email addresses, date and place of birth, and Social Security numbers of everyone named in your will and other documents, and everyone important in your life, for your executors and guardians of minor children.
• Location of all vital and legal documents (including birth and death certificates, adoption records, prenuptial agreements, marriage certificates, divorce decrees, military records, immigration and citizenship documents, property deeds, recent tax returns, wills).
• Location of all vital and legal documents (including birth and death certificates, adoption records, prenuptial agreements, marriage certificates, divorce decrees, military records, immigration and citizenship documents, property (housing, land, and cemetery) deeds, vehicle titles, recent tax returns, do-not-resuscitate orders (DNRs), wills and living wills and related documents).
• List of property you own, with values (include real estate, vehicles, jewelry, furniture, other assets)
• A list of all financial assets and accounts, with bank account numbers and branch locations.
• A master list of all your accounts (savings, checking, credit card, stocks, bonds, mutual fund shares, other investments, escrow mortgage, insurance, frequent flier accounts, etc). List each institution, type of account (checking? savings? money market?), owner or policyholder (you? you and spouse? you and child?), account number, contact information for institution, where certificates are.
• Details about principal income and about your retirement savings accounts and other assets, including names, addresses, phone numbers, and social security numbers of principal beneficiaries.
• Details about your debts (especially to whom and how much). Include mortgages, loans, other debts. And proof on debts paid. For family history:
• List of employers and dates of employment.
• Education and military records.
• List of jointly owned property, and names of co-owners.
• A list of where you keep all pension documents, and folders on IRAs and 401(k) accounts
• Proof of loans made and debts owed (plus details on who and where)
• A list of computer user names, access codes, and passwords, or instructions on how to find them.
• Details on all forms of insurance (life, health, dwelling, car, etc.).
• A list of safe-deposit boxes, with an inventory of the contents. List all irreplaceable valuables (jewelry, heirlooms, photo negatives) and critical documents (marriage license, birth certificate, divorce papers, stock and bond certificates) that are stored under lock and key and photocopy the documents for your home office files.

Also helpful:
• Essential Document Locator Checklist (A Place for Mom)

SOURCES:
• The 25 Documents You Need (CAPTRUST Financial Advisors, 4208 Six Forks Road, Suite 1700, Raleigh, NC 27609.

    CAPSTONE'S list provides helpful explanations.
• The 25 Documents You Need Before You Die (Forge Financial Advisors, Fairport, New York).

"According to the National Association of Unclaimed Property Administrators, state treasurers currently hold $32.9 billion in unclaimed bank accounts and other assets. (You can search for unclaimed assets at MissingMoney.com)."

• The 25 Documents You Need Before You Die (Marc R. Gillespie, Financial Planner)

A similar list, organized by similar categories: Marriage & Divorce, Bank Accounts, Life Insurance and Retirement, Proof of Ownership, Health Care Confidential, The Essentials.
• The 25 Documents You Need Before You Die (Rachel Donnelly, Lantern Co.)

• Gender-affirming surgeries in the US nearly tripled before pandemic dip, study finds (Carla K. Johnson, AP News, 8-23-23) The increase likely reflects expanded insurance coverage for transgender care after the Obama administration and some states actively discouraged discrimination based on gender identity. The dip in 2020 can be attributed to the pandemic.

• What is gender-affirming care? Your questions answered (Patrick Boyle, Association of American Medical Colleges, AAMC, 4-12-22)

    As states move to restrict certain treatments for transgender youth, experts explain the many types of care, the need for them, and their impact.

    "Katherine Imborek, MD, has seen the gender-affirming care provided at UI Health Care’s LGBTQ Clinic in Iowa City change the lives of transgender youths and adults. “It decreases depression, anxiety, and suicide attempts,” says Imborek, co-director of the clinic. To her, that care is “a medical necessity, like providing insulin to a person with diabetes.”

   "But a growing number of lawmakers, including in Iowa, view some gender-affirming care as medically unsound for youths and even a form of child abuse. Iowa is among 15 states that have enacted or are considering laws to prohibit certain gender-affirming treatments for youths and to impose penalties on health care professionals who provide it, according to the Williams Institute at the UCLA School of Law in California.

    "Gender-affirming care, as defined by the World Health Organization, encompasses a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity” when it conflicts with the gender they were assigned at birth. The interventions help transgender people align various aspects of their lives — emotional, interpersonal, and biological — with their gender identity. As noted by the American Psychiatric Association (APA), that identity can run anywhere along a continuum that includes man, woman, a combination of those, neither of those, and fluid.

    "The interventions fall along a continuum as well, from counseling to changes in social expression to medications (such as hormone therapy). For children in particular, the timing of the interventions is based on several factors, including cognitive and physical development as well as parental consent. Surgery, including to reduce a person’s Adam’s Apple, or to align their chest or genitalia with their gender identity, is rarely provided to people under 18."

    This long article and explanation is worth reading. It includes several "fictional case vignettes," composite cases written to illustrate certain diagnostic characteristics and to instruct on treatment techniques

• Gender Affirmation Surgery (Cleveland Clinic) A clear explanation of various surgical and other options. "Gender affirmation surgery refers to procedures that help people transition to their gender. Gender-affirming options may include facial surgery, top surgery or bottom surgery. Most people who choose gender affirmation surgeries report satisfaction with results, including the way their body looks and works and improved quality of life." Clear explanations of nonsurgical gender-affirming options and surgical gender-affirming options, as well as what those options involve.

• Gender Affirmation Surgeries (Fan Liang MD, Johns Hopkins Medicine) Surgeries are not required for gender affirmation, but many patients choose to undergo one or more surgical procedures.  Liang presents an excellent overview and explanation of various options for gender affirmation surgery.

• Tim Walz's Policy for Transgender Minors Explained (Mandy Taheri, Newsweek, 8-11-24) Minnesota Governor Tim Walz, named as Vice President Kamala Harris' running mate, has a legislative history of supporting the rights of transgender minors and gender-affirming care, which has come under fire from top Republicans, including former President Donald Trump and his running mate Ohio Senator JD Vance.

• States that protect transgender health care now try to absorb demand (Jeff McMillan and Hannah Schoenbaum, AP News, 8-15-23)

    "States that declared themselves refuges for transgender people have essentially issued an invitation: Get your gender-affirming health care here without fearing prosecution at home.
    "Now that bans on such care for minors are taking effect around the country — Texas could be next, depending on the outcome of a court hearing this week — patients and their families are testing clinics’ capacity. Already-long waiting lists are growing, yet there are only so many providers of gender-affirming care and only so many patients they can see in a day.
    "For those refuge states — so far, California, Connecticut, Colorado, Illinois, Massachusetts, Maryland, Minnesota, New Jersey, New Mexico, New York, Washington and Vermont, plus Washington, D.C. — the question is how to move beyond promises of legal protection and build a network to serve more patients."

---State actions on gender-affirming care for minors (AP News interactive) Several Republican-led states have taken steps to bar access to gender-affirming care for transgender minors, which for people under 18 typically involves puberty blockers or other hormone treatments. Some Democratic-led states are instituting protections. Chart shows the status of gender-affirming care for minors in the states.
    Restricted
    Restrictions not in effect
    Restrictions struck down by court
    Gender-affirming care protected.
Apparently no stand has been taken in states represented in grey.

• Gender-affirming Care for Transgender Patients (Nita Bhatt, Jesse Cannella, and Julie P. Gentile, Innovations in Clinical Neuroscience, NIH, National Library of Medicine, April-June 2022) "It has been well established that gender is a social construct, not an inborn reality of biology, nor is it binary. This is contrasted with sex, which is generally defined as the biological characteristics (i.e., reproductive, chromosomal, hormonal) of a person established at birth, and is in fact also nonbinary, although it is most often characterized as male or female. Even after “checking under the diaper” and with karyotyping, the sex defined at birth may be established as male or female, but it also may be established as intersex or be within other nonbinary variations.Gender, however, is a social construct that may be cisgender male or female, but individuals may alternatively be identified as nonbinary, genderfluid, genderqueer, or transgender male or female, among other identities (Table 1). Indeed, the binary construct of gender is one of Western context and is not absolute.

     "Fundamentally, it must be emphasized that the gender of a person cannot be externally read or assumed. Gender identity is an internal self-identity and may or may not correspond to how a person dresses, how a person grooms their hair or facial hair, what a person calls themselves, or how they speak. How a person externally represents themselves, such as through apparel, hair style, voice, or behavior, is known as their gender expression.4 For various reasons, including but not limited to comfort, safety, self-realization, laws, institutional guidelines, and conformity to social norms, the gender expression of a person may not necessarily correlate to their gender identity. For this reason, the only way to know the gender of a person is by asking them, and even when asked, gender and gender identity is subject to change and is not necessarily a permanent quality. 

 

This lengthy and important article "discusses some of the most significant health disparities faced by transgender patients, common challenges they experience, and how providers, regardless of specialty, can positively intervene to better provide an inclusive environment with gender-affirming care."

• Families with transgender kids are increasingly forced to travel out of state for the care they need (Arleigh Rodgers and MIchael Goldberg, AP News, 7-10-23)   

"At least 20 states have enacted laws restricting or banning gender-affirming care for trans minors, though several are embroiled in legal challenges. For more than a decade prior, such treatments were available to children and teens across the U.S. and have been endorsed by major medical associations.
    "Opponents of gender-affirming care say there’s no solid proof of purported benefits, cite widely discredited research and say children shouldn’t make life-altering decisions they might regret. Advocates and families impacted by the recent laws say such care is vital for trans kids.
    "The perceptions of most parents, Marx said, don’t align neatly with the extremes of full support or rejection of their kids’ identities.
    “Most parents exist in a kind of gray area,” Marx said. “Most parents are going through some kind of developmental process themselves as they come to understand their child’s gender.”

• Indiana lawmakers advance ban on all gender-affirming care (Arleigh Rodgers, AP News, 2-22-234)
     "Krisztina and Ken Inskeep’s son came out as transgender when he was a teenager, a transition they told an Indiana Senate public health committee on Wednesday that offered a remedy to years of his mental health struggles.
     "Still, an Indiana Senate bill that the couple called “cruel and arrogant” — banning gender-affirming transition treatments for those 18 and under, the very care they said kept their son alive — passed the committee 8-3.
     “If it weren’t for the support of doctors and health care professionals, we’re convinced that our child may not have survived,” Krisztina said.

 

• State of Homelessness (map, National Alliance to End Homelessness) Click on your state to view detailed information on homeless statistics, bed inventory, and system capacity. Read the report, including Key Facts. 

 

• Key Findings from the Point-in-Time Counts (Fact Sheet: 2023 Annual Homelessness Assessment Report, U.S. Dept. of Housing and Urban Development, 12-1-23)

   "At a point in time at the end of January 2023, 653,104 people – or about 20 of every 10,000 people in the United States – experienced homelessness across the United States. This is the highest number of people counted and reported as experiencing homelessness on a single night since reporting began in 2007. Unlike in the past where a single population drove the change, this year’s increases were across all populations. While the upward trend in unsheltered homelessness began several years ago, these increases were exacerbated in recent years as the COVID-19 pandemic, an opioid epidemic, and a nationwide affordable housing crisis conspired to make attaining and maintaining housing increasingly difficult for many low-income households. Increases in sheltered homelessness, particularly increases among families, reflect recent contextual issues such as the expiration of pandemic-era eviction moratoria and income protections, expansion of shelter capacity based on new pandemic-related resources and the easing of pandemic-related restrictions on shelter capacity."

• Why it’s so hard to end homelessness in America (Alvin Powell, Harvard Gazette, 1-24-24) Experts cite complexity of problem, which is rooted in poverty, lack of affordable housing but includes medical, psychiatric, substance-use issues.

• Which States Have The Best Homelessness Assistance Programs (Nick VinZant, QuoteWizard, Insurance News)
"Key findings in 2021:
~Colorado ranked the top state in the nation for housing assistance from 2018 to 2019.
~Connecticut saw a 23.6% decline in homelessness from 2018 to 2019.
~In 2019, it was estimated that nearly 568,000 were experiencing homelessness.
~As of November 2020, 10.74 million Americans are unemployed.
~Mississippi, Louisiana and Alabama all had the lowest counts of total homeless per 10K in 2019.
~New York, Hawaii and California have the most homeless per 10K."

• Housing crisis is the 'canary in the coal mine' (Eleanor Black, Newsroom, New Zealand, 4-21-21)New Zealand needs to change its approach to housing completely, and treat it as a public right, like health and education, says property developer Mark Todd. Sitting with a coffee at Mt Albert’s Taco Loco, he gestures towards Ockham’s Modal building across the road – 32 thoughtfully-designed rental apartments on just 680 square metres, with a shared residents’ lounge and balcony, indoor bike storage, easy access to public transport, efficient hot water system and a music room.

 

• Homelessness Statistics (National Alliance to End Homelessness)
• National Coalition for the Homeless
• Healthcare for the Homeless Suitcase Clinic (Facebook page)
---Suitcase Clinic, James Madison University (Harrisonburg, Virginia 22807)
---Homelessness is a Healthcare Issue: New Medical Group Will Treat Southern California Homeless Seniors

• NEXT: Next Generation Military and Veterans Healthcare Systems (America Conference Institute press release, 2023) 

    ‘This is street medicine wrapped in the framework of managed care’     "With the population of unhoused individuals in California soaring to more than 161,000, SCAN Group, whose holdings include SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans, is launching Healthcare in Action, a new medical group that will provide healthcare and other services to individuals experiencing homelessness."
• Homeless encampment cleanups do little to change numbers of people on the street, study finds (Doug Smith,LA Times, 7-24-24) Homeless encampment cleanups including Mayor Karen Bass’ Inside Safe program that moves people into motels and hotels have no long-term effect on the number of people living on the streets, a new study by RAND Center on Housing and Homelessness has found
• Supreme Court rules cities may enforce laws against homeless encampments (David G. Savage, LA Times, 6-28-24) The Supreme Court ruled Friday that cities in California and the West may enforce laws restricting homeless encampments on sidewalks and other public property. In a 6-3 decision, the justices disagreed with the 9th Circuit Court in San Francisco and ruled that it is not “cruel and unusual” punishment for city officials to forbid homeless people from sleeping on the streets or in parks.
---Will the Grants Pass ruling on homelessness spur smaller cities to shoo people into L.A.? (David Zahniser and Doug Smith, LA Times, 7-7-24) When the U.S. Supreme Court issued its landmark ruling on anti-camping laws last month, Pasadena Mayor Victor Gordo was one of the local political leaders who welcomed it. The high court concluded that laws penalizing homeless people for sleeping or pitching tents in public spaces do not constitute cruel and unusual punishment. That means cities can clear homeless encampments from parks, sidewalks and other areas even when they lack sufficient shelter beds.
• “Hollywood 2.0” An innovative treatment team approach combining outpatient and intensive field services, in partnership with the community that center around an individual’s needs. "It starts with connection and ends with a neighbor living a safer, more meaningful life.

• A California Medical Group Treats Only Homeless Patients — And Makes Money Doing It (Angela Hart, KFF Health News and Orange County Register, 7-19-24) Doctors, nurses, and social workers are fanning out on the streets of Los Angeles to provide health care and social services to homeless people — foot soldiers of a new business model taking root in communities around California.
   Their strategy: Build trust with homeless people to deliver medicine wherever they are — and make money doing it.
   They distribute GPS devices so they can track their homeless patients. They stock their street kits with glass pipes used to smoke meth, crack, or fentanyl. They keep company credit cards on hand in case a patient needs emergency food or water, or an Uber ride to the doctor.
   Healthcare in Action and SCAN’s Medicare Advantage insurance plan generate revenue by serving homeless patients in multiple ways:
---Both are tapping into billions of dollars in Medicaid money that states and the federal government are spending to treat homeless people in the field and to provide new social services like housing and food assistance.
---For instance, Healthcare in Action has received $3.8 million from Newsom’s $12 billion Medicaid initiative called CalAIM, which allows it to hire social workers, doctors, and providers for street medicine teams, according to the state.
---It also contracts with health insurers, including L.A. Care and Molina Healthcare in Southern California, to identify housing for homeless patients, negotiate with landlords, and provide financial help such as covering security deposits.
---Healthcare in Action collects charitable donations from some hospitals and insurers, including CalOptima in Orange County and its own Medicare Advantage plan, SCAN Health Plan.
---Healthcare in Action partners with cities and hospitals to provide treatment and services. In 2022, it kicked off a contract with Cedars-Sinai to care for patients milling outside the hospital.
---It also enrolls eligible homeless patients into SCAN Health Plan because many low-income, older people qualify for both Medicaid and Medicare coverage. The plan had revenue of $4.9 billion in 2023, up from $3.5 billion in 2021. "#1 in Member Satisfaction among Medicare Advantage Plans in California"

• United States Interagency Council on Homelessness
• Geriatrics and Extended Care (Veterans Administration)
---Community Resources, Geriatrics and Extended Care (Veterans Administration's useful links).

 

More to come, I'm sure. -- Pat McNees

• Secrets, death and a police interrogation: Women recall illegal abortions before Roe v. Wade (Nina Shapiro, Seattle Times, 5-22-22)

• The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion by Diana Greene Foster debunks most anti-abortion arguments.
• We asked readers how Roe v. Wade has affected their lives; Here are their stories (Ryan Nguyen, Seattle Times, 5-22-22)

• Tracking the States Where Abortion Is Now Banned (NY Times Interactive)
• Interactive Map: US Abortion Policies and Access After Roe (Guttmacher Institute) "The abortion landscape is fragmented and increasingly polarized. Many states have abortion restrictions or bans in place that make it difficult, if not impossible, for people to get care. Other states have taken steps to protect abortion rights and access. Our interactive map groups states into one of seven categories based on abortion policies they currently have in effect." Note: You may need to clear your browser’s cache or open this page in an incognito window to ensure you are viewing the most recent version.
• Is Abortion Still Accessible in My State Now That Roe v. Wade Was Overturned? (Planned Parenthood)
• Key facts about the abortion debate in America (Carrie Blazina, Pew Research Center, 7-15-22) Quoting headlines only:

1. A majority of the U.S. public disapproves of the Supreme Court’s decision to overturn Roe.

2. About six-in-ten Americans (62%) say abortion should be legal in all or most cases, according to the summer survey...

3. While Republicans’ and Democrats’ views on the legality of abortion have long differed, the 46 percentage point partisan gap today is considerably larger than it was in the recent past...

4. There are wide religious divides in views of whether abortion should be legal, the summer survey found. "An overwhelming share of religiously unaffiliated adults (83%) say abortion should be legal in all or most cases, as do six-in-ten Catholics. Protestants are divided in their views: 48% say it should be legal in all or most cases, while 50% say it should be illegal in all or most cases. Majorities of Black Protestants (71%) and White non-evangelical Protestants (61%) take the position that abortion should be legal in all or most cases, while about three-quarters of White evangelicals (73%) say it should be illegal in all (20%) or most cases (53%)."

5. Women (66%) are more likely than men (57%) to say abortion should be legal in most or all cases...

6. Relatively few Americans view the morality of abortion in stark terms...

• How abortion rights advocates say midterm elections could impact access in Arizona (Kyla Guilfoil, ABC News, 11-7-22) Abortion providers in Arizona have been living in "legal limbo" since the Supreme Court overturned Roe v. Wade. A near-total abortion ban in the state with language dating back to 1864 was never technically repealed after the 1973 ruling of Roe. Who's elected may determine what rights women have to abortions in Arizona.
• Post-‘Roe,’ Contraceptive Failures Carry Bigger Stakes (Sarah Varney, KHN, 11-7-22) With most abortions outlawed in at least 13 states and legal battles underway in others, contraceptive failures now carry bigger stakes for tens of millions of Americans.

• Supreme Court's decision on abortion could open the door to overturn same-sex marriage, contraception and other major rulings (Tierney Sneed, CNN, 6-26-22) Friday's decision in Dobbs v. Jackson Women's Health Organization, which overturned nearly a half-century of precedent, will be a seminal case in the annals of law and learning. It will be paired with the 1973 Roe v. Wade landmark that had declared a constitutional right to end a pregnancy, just as the 1954 Brown v. Board of Education, which ended the "separate but equal" doctrine and began desegregation of schools, has long been tethered to Plessy v. Ferguson, the 1896 decision that permitted separate but equal accommodations for Black and White people.
• Is Abortion Sacred? (Jia Tolentino, New Yorker, 7-16-22) Abortion is often talked about as a grave act. But bringing a new life into the world can feel like the decision that more clearly risks being a moral mistake. Important historical insights into attitudes about abortion. For example, "A third of parents in one of the richest countries in the world struggle to afford diapers; in the first few months of the pandemic, as Jeff Bezos’s net worth rose by forty-eight billion dollars, sixteen per cent of households with children did not have enough to eat."
• What the End of Roe v. Wade Will Mean for the Next Generation of Obstetricians (Emma Green, New Yorker, 5-31-22) An aspiring ob-gyn’s views on abortion might determine what training she seeks out, which specialities she pursues, and where she chooses to live. In a post-Roe world, that self-sorting process would grow even more intense.
• What’s Next if ‘Roe v. Wade’ Falls? More Than Half of States Expected to Ban or Restrict Abortion (Sarah Varney, KHN, 5-3-22)

• Letters from an American (Heather Cox Richardson. 9-26-22) "Republicans have managed to keep voters behind their economic program by downplaying it and emphasizing cultural issues, primarily abortion, which reliably turned out anti-abortion voters. Now that the Supreme Court has overturned the 1973 Roe v. Wade decision legalizing abortion, Republicans have a demographic problem: a majority of voters support reproductive rights and are turning out to vote, and there is no longer a reason for anti-abortion voters to show up.
    "So Republican leaders are downplaying abortion....They are also inventing new cultural crises, most notably an attack on LGBTQIA folks but also a renewed attack on immigrants. Trump has gone further, jumping aboard the QAnon train..."
• “We Need to Defend This Law”: Inside an Anti-Abortion Meeting With Tennessee’s GOP Lawmakers (Kavitha Surana, ProPublica, 11-15-22) Anti-abortion groups helped write and pass laws that kicked in to ban abortion when Roe v. Wade was overturned. The groups see Tennessee’s ban as the country’s strongest — and they want to keep it that way, according to audio reviewed by ProPublica.

      "The way that many state laws work is they’ll say, ‘Abortion, elective abortion, is generally illegal except in these situations.’ … What y’all did is you said, ‘Elective abortion is illegal all the time.’”

      "There has to be medical judgment … [or] you’ve got the legislature practicing medicine, which they have no business at all doing." —Tennessee state Sen. Richard Briggs. His position seems to more closely reflect the attitudes of the majority of Tennesseeans: While 50% identify as "pro-life," 80% believe abortion should be either completely legal or legal under some conditions. To Briggs, the anti-abortion lobbyists were asking lawmakers to respond to legitimate questions from voters with answers that weren't based in science.

    The American Cancer Society says scientific evidence does not support the theory that abortions raise the risk of breast cancer. The National Academies of Sciences, Engineering and Medicine reviewed existing research and found the risk of death after a legal abortion is a small fraction of the risk of carrying a pregnancy to term.

    A large body of peer-reviewed work finds that having a wanted abortion is not associated with worse health or mental health outcomes. Instead, denying a woman a wanted abortion is linked to worse economic and health outcomes and can strengthen a woman's ties to a violent partner.
• Supreme Court Overturns Roe v. Wade: What You Need to Know Planned Parenthood answers frequently asked questions.
• State legislation tracker (Guttmacher Institute) Major developments in sexual & reproductive health. which states require insurance coverage for abortion.

• Midwest Abortion Providers Scramble to Prepare for a Post-Roe World (Peter Slevin, New Yorker, 5-7-22) With federal protections imperilled, advocates expect a dramatic influx of interstate “refugees” seeking care.vc cccc
• God Help My Friendship With White Evangelicals After Dobbs (Brittney Cooper, The Cut, 6-24-22) When you grow up in a world where your body, because it is not white, is not treated as sacred, you learn to value every protection, personal and political, against your violation. When the first enslaved Black women arrived in this country, their womanhood became defined solely through their forced reproduction of enslaved, unfree offspring. Forced reproduction cannot mean anything other than slavery to Black women.

• Doctors Struggle With State Abortion Restrictions at Odds With Federal Law (Melanie Evans, Wall Street Journal, 7-10-22) "Law requiring doctors to provide emergency treatment to stabilize certain patients may necessitate performing an abortion in some cases. Doctors and hospitals are rushing to reconcile laws in their states barring abortion with a federal law that may require the procedure as part of emergency treatment. How physicians and hospitals are addressing the mandates of the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 in the wake of the overturning of Roe v. Wade. That decision in Dobbs v. Jackson Women’s Health Organization stripped away an almost 50-year-old right to an abortion."
• SCOTUS strikes down Roe as expected; half of states likely to ban abortion (Kerry Dooley Young and Joseph Burns, AHCJ, Covering Health, 6-24-22)
• Irish Eyes Aren’t Smiling (Maureen Dowd, Opinion, NY Times, 7-16-22) "Once, Ireland seemed obsessed with punishing women. Now it’s America. Una Mullally, a columnist for The Irish Times, on Ireland and America swapping roles: Ireland growing less benighted; America more so. Ireland less influenced by the dictates of the Catholic Church; America more influenced, reflecting the views of the five right-wing Catholics on the Supreme Court and Neil Gorsuch, an Episcopalian who was raised Catholic. Ireland once had too much church in the state. Now America does."    “People thought there was this American dream but it’s clearly becoming more of an American nightmare.”

[Back to Top]

• Seeing Norma: The Conflicted Life of the Woman at the Center of Roe v. Wade (Joshua Prager, NY Times, 7-2-22) Norma McCorvey, the plaintiff in the case that made abortion legal, struggled with her role. Her personal papers offer insight into her life, her thinking — and her continued relevance. As McCorvey began to speak publicly about Roe and her life, she observed over and again, as in these notes from 1989, that access to abortion was often a matter of class.
• After Roe v. Wade: US researchers warn of what’s to come (Mariana Lenharo, Nature,4-24-22) Years of studies point to the negative economic and health effects of restricting access to abortions.
• America Before and After Roe (Fahima Haques NY Times, 6-27-22) Timeline, photos, and links to key stories about the effects of the Supreme Court decision, how far the Supreme Court will go, responses to key questions, abortion access, abortion travel, medication abortions, statehood battles where gerrymandering has given Republicans an advantage, what those who oppose and support abortion rights have to say.
• America Is About to See Just How Pro-life Republicans Actually Are (Elaine Godfrey, The Atlantic, 6-26-22) After the fall of Roe, some abortion opponents think it’s time to focus on expanding America’s social safety net. Will the rest of their movement join them?
• The Abortion Surge Engulfing Clinics in Pennsylvania (E. Tammy Kim, New Yorker, 7-22-22) Patients are travelling to the state from Ohio, Kentucky, and even Louisiana, but how long will that option last?

• The Dishonesty of the Abortion Debate (Caitlin Flanagan, The Atlantic, December 2019) "No matter what the law says, women will continue to get abortions. How do I know? Because in the relatively recent past, women would allow strangers to brutalize them, to poke knitting needles and wire hangers into their wombs, to thread catheters through their cervices and fill them with Lysol, or scalding-hot water, or lye. Women have been willing to risk death to get an abortion. When we made abortion legal, we decided we weren’t going to let that happen anymore."
• The Extremes Are Not Unusual (Jill Filipovic, 7-14-22) A 10-year-old in need of an abortion is shocking, but it's not isolated. In Ohio alone, an average of one girl aged 15 and under has an abortion every week — and you can bet that many of these girls are rape survivors. One in nine girls in the US experiences rape or sexual assault at the hands of an adult before she turns 18.

•Why I Provide Abortions (Christine Henneberg, Boston Review, 11-29-21) Why I provide abortions has nothing to do with “viability”—the standard that theoretically protects legal abortion up to about twenty-four weeks. When it comes to the definition, and even the value of life, context matters. If viability means “potential for survival,” we are talking about vastly uncertain potential within different contexts.
• Infertility Patients and Doctors Fear Abortion Bans Could Restrict I.V.F. (Jan Hoffman, Roe v. Wade Overturned, NY Times, 7-5-22) The new state bans don’t explicitly cover embryos created outside the womb, but legal experts say overturning Roe could make it easier to place controls on genetic testing, storage and disposal of them.
• Roe Was Flawed. Dobbs Is Worse (Tom Nichols, The Atlantic, 6-22)Yes, Roe was the product of an activist court. But then so was Dobbs v. Jackson Women’s Health Organization. Justice Samuel Alito and the other five conservatives on the Supreme Court were not handing back abortion to the states as if it were some open question for a debate; they knew exactly what was going to happen in states with “trigger” laws the minute they ruled. Despite their legal rationale, these justices were taking sides in a culture war on behalf of a minority of Americans with whom at least some of them happen to agree
      "Anti-abortion conservatives huff that the Court has regularly overturned hideous decisions, such as Dred Scott, Plessy, or Korematsu (which wasn’t really overruled but finally disavowed in a 2018 ruling). Roe, they argue, is just another bad case that was due for reversal....Roe, even if poorly decided, has been affirmed in that same court; again, a majority of Americans believe in a right to abortion in all or some cases, and have for a half century. Even now, if the goal was to remedy a Roe overreach, the majority could have found a way to do so while leaving abortion rights intact. This was apparently Roberts’s position, but he was brushed aside by the five other conservative justices.

     It's true that abortion is not in the Constitution. A lot of things aren't in the Constitution, including the "right to be left alone," but that hasn't stopped Americans from recognizing that such rights exist.

      Friday's decision in Dobbs v. Jackson Women's Health Organization, which overturned nearly a half-century of precedent, will be a seminal case in the annals of law and learning. It will be paired with the 1973 Roe v. Wade landmark that had declared a constitutional right to end a pregnancy, just as the 1954 Brown v. Board of Education, which ended the "separate but equal" doctrine and began desegregation of schools, has long been tethered to Plessy v. Ferguson, the 1896 decision that permitted separate but equal accommodations for Black and White people.
      "Yet where Brown ensured rights, of course, Dobbs eliminated them.
      "It was a sober, even humble Roberts who wrote -- alone -- as he separated himself both from the conservatives who dissolved a constitutional guarantee and from the liberal dissenters who expressed sorrow for American women and warned of further erosions on privacy. See also Chief Justice John Roberts lost the Supreme Court and the defining case of his generation (Joan Biskupic, CNN, 6-26-22)

[Back to Top] • Why the Defense of Abortion in Kansas Is So Powerful(Sarah Smarsh, NY Times, 8-3-22) "In a state where registered Republicans far outnumber Democrats, the results reveal that conservative politicians bent on controlling women and pregnant people with draconian abortion bans are out of step with their electorates, a majority of whom are capable of nuance often concealed by our two-party system.
      "This is not news to many red-state moderates and progressives, who live with excruciating awareness of the gulf between their decent communities and the far-right extremists gerrymandering, voter-suppressing and dark-moneying their way into state and local office.
      "Too often, election results say more about the conditions of the franchise — who manages to use it, and what information or misinformation they receive along the way — than they do about the character of a place."

• Abortion in the U.S. Dashboard (KFF) An ongoing research project (and visual mapping) tracking state abortion policies and litigation following the overturning of Roe v. Wade. Among key facts:

---79% of abortions occur before 10 weeks.
---As of the end of June 2022, medication abortion via telehealth was available in 22 states and DC
---A majority of states have at least one restriction on health insurance coverage for abortion services
---Most of the general public (73%) opposes making it a crime for doctors to perform abortions
---In 2021 the median cost of abortion services exceeded $500. Another map tracks states with numerous abortion restrictions.
• Abortion Access (Stateline) Covering state policy on abortion access across the 50 states. See, for example, Abortion opponents push state lawmakers to promote unproven ‘abortion reversal’ GOP-backed laws in more than a dozen states require health providers to tell patients they can change their minds.
• Why SCOTUS’ Abortion Ruling Is a Disaster for Free Expression (Summer Lopez and Nadine Farid Johnson, Daily Beast, 7-17-22) Providing information about abortion access is literally illegal in some states, and the chilling effect could even spread to states where abortion is still legal.

• Voters support abortion rights in five states with ballot measures (Brad Dress, The Hill, 11-9-22) "Voters in California, Vermont and Michigan on Tuesday approved ballot measures enshrining abortion rights into their state constitutions, while those in the traditionally red states of Montana and Kentucky rejected measures that would have restricted access to reproductive care. The votes signal support for abortion rights after the Supreme Court in June overturned the landmark 1973 case Roe v. Wade and the constitutional right to the procedure.
     "In August, Kansas voters also rejected a ballot measure that would have given the state legislature the authority to restrict abortion access through a state constitutional amendment.

      [As one elder in Kansas observes, about votes on post-Dobbs issues: "Some of these were votes against constitutional or other changes that would have forbidden abortion; some were in favor of enshrining women’s bodily autonomy in state law or state constitutions. There will be more such votes."]
     "The ballot votes came amid high-profile Senate and House races, with some candidates running for office across the nation with hard-line views on abortion access. Already in post-Roe America, about half of all states have moved to restrict abortion access, even as polls show most Americans approve of the right to abortion."
• “The Alliance for Hippocratic Medicine — a coalition of anti-abortion medical groups that formed in Texas last year — challenged both the FDA’s original 2000 approval of mifepristone, arguing the agency didn’t adequately consider the drug’s safety risks, as well as later agency actions that loosened restrictions on the pills. The groups claim their physician members are harmed by the pills’ availability because they may at some point need to provide follow-up care for a patient who took them and had a complication." ~ (Alice Miranda, Ollstein, Politico, 8-17-23)
• Because of Texas abortion law, her wanted pregnancy became a medical nightmare (Carrie Feibel, Shots, NPR, Morning Edition, 7-26-22) New, untested abortion bans have made doctors unsure about treating some pregnancy complications, which has led to life-threatening delays and trapped families in a limbo of grief and helplessness. Today, abortion is also illegal in Texas under an old 1925 law that the state's Attorney General Ken Paxton declared to be in effect after Roe was overturned.

     See New Texas Trigger Law Makes Abortion a Felony (NPR 8-27-22) Texas's new trigger law criminalizes providing abortions. It comes with five years to life imprisonment, as well as civil penalties of $100,000 for abortion and administrative penalties in the form of mandatory revocation of a license to practice medicine, do nursing, pharmacy, so on.criminalizes providing abortions. It comes with five years to life imprisonment, as well as civil penalties of $100,000 for abortion and administrative penalties in the form of mandatory revocation of a license to practice medicine, do nursing, pharmacy, so on.

• Leaked draft of the Supreme Court’s decision in Dobbs v, Jackson Women’s Health that would overturn Roe v. Wade and Planned Parenthood v. Casey and eliminate the federal standard regarding abortion access (Feb. 2022)
---“This Was Not a Surprise”: How the Pro-Choice Movement Lost the Battle for Roe (Alexandra Zayas, ProPublica, 5-3-22) In the wake of a leaked draft opinion indicating the Supreme Court plans to overturn Roe v. Wade, Joshua Prager, author of The Family Roe, discusses the 50-year battle over abortion rights and the strategic decisions that led us here. 'NARAL’s executive director in 1973, when Roe was ruled upon, told her board after the ruling, “The court has spoken and the case is closed.” They saw this as, basically: It’s over. We’ve won. 'The very, very opposite is true of the pro-life, who said: OK, now we have to think about this strategically, how will we go about overturning Roe? As a result of that imbalance, the pro-choice were playing catch up really for 49 1/2 years, as the pro-life (movement has) over and over again come up with many different ways to chip away at Roe and has been remarkably successful.'
---Of Course the Constitution Has Nothing to Say About Abortion (Jill Lepore, New Yorker, 5-4-22) Depending on the official decision in Dobbs v, Jackson Women's Health, abortion is likely to become a crime in at least twenty states. That there is no mention of the procedure in a 4,000-word document crafted by 55 men in 1787 seems to be a surprise to Justice Alito, but there is nothing in that document about women at all. "At the time, women could neither hold office nor run for office, and, except in New Jersey, and then only fleetingly, women could not vote." That "women are missing from the Constitution" is "a problem to remedy, not a precedent to honor." Indeed, "hardly anything in the law books of the eighteen-sixties guaranteed women anything. Because, usually, they still weren’t persons. Nor, for that matter, were fetuses."
• Florida court blocks teen from getting abortion, must continue pregnancy (Oriana Gonzalez, Axios, 8-16-22) The teenager, who court documents say is "parentless," had sought court approval to bypass a Florida law that requires that a minor get parental consent in order to get an abortion. A lower Florida court had ruled that the teenager, who is unidentified, was not mature enough to decide to get an abortion. The teen then filed an appeal, and the appellate court upheld the previous decision.

• One Woman’s Abortion (Mrs. X, The Atlantic, 8-65) In 1965, eight years before Roe v. Wade, an anonymous woman described the steps she took to terminate an unwanted pregnancy.
• Policies to Roll Back Abortion Rights Will Hit Incarcerated People Particularly Hard (Carly Graf. KFF Health News, 8-22-22) After the Supreme Court removed Roe v. Wade’s constitutional protections for abortions, many reproductive services stand to be prohibited altogether, putting the health of incarcerated women who are pregnant at risk.
      That threat is particularly urgent in states where lawmakers have made clear their intentions to roll back abortion rights.
      “Previously there was at least some sliver of legal recourse there for an incarcerated person, but that no longer exists for people who live in states where abortion is or will be severely restricted or illegal,” said Dr. Carolyn Sufrin, an OB-GYN, a professor, and the director of the Advocacy and Research on Reproductive Wellness of Incarcerated People program at Johns Hopkins University.
      The Prison Policy Project, a nonprofit research organization, estimates about 58,000 people a year are pregnant when they enter prisons or jails, or about 4% of the total number of women in state and federal prisons and 3% of those in local jails.
• Murky Legal Landscape for Docs Advising Patients on Self-Managed Abortions ( Amanda D'Ambrosio, MedPage Today, 7-26-22) "As new abortion restrictions take effect across the U.S. in the wake of the Supreme Court's decision on Dobbs v. Jackson Women's Health Organization, obtaining an abortion has become nearly impossible in some states, leading many to attempt to terminate their pregnancies outside of the formal healthcare system. "Self-managed abortion methods have been around for decades, and have become increasingly safer due to the widespread availability of the medications mifepristone (Mifeprex) and misoprostol (Cytotec). 'No one can take away their right to dispense medical information'"

• To Protect a Mother’s Health: How Abortion Ban Exemptions Play Out in a Post-‘Roe’ World (Christopher O’Donnell, Tampa Bay Times and KFF Health News, 7-21-23) Every state that bans or restricts abortions has an exception to protect the health of the mother. But recent history in other states suggests that few women will be able to take advantage of such exceptions if Florida’s new law, on hold while tied up by legal challenges, is upheld by the state Supreme Court.

       "If Florida’s six-week ban moves forward, rape and incest victims would have to provide their doctor a copy of a restraining order, police report, medical record, court order, or other documentation to get an abortion after that window. However, two-thirds of sexual assault victims do not report the crime, studies show, meaning no police report would exist. An estimated 8 in 10 rapes are committed by someone known to the victim, often leaving victims afraid of reprisals if they report the crime.

       "Florida has a long-established law allowing abortions when a fetus has fatal abnormalities. But no exceptions exist for serious genetic defects, deformities, or abnormalities, which were cited as the reason for 578 abortions in the state last year....A June KFF poll found that 61% of OB-GYNs who practice in states with abortion restrictions are concerned about the legal risk when deciding whether to perform an abortion. “It doesn’t make any medical sense,” said Jennifer Griffin, a Tampa physician who provides abortions. “These politicians are not making policy based on science; they’re based on religion.”

• ‘Republicans Abandoned Me’: Meet the Dobbs Voters of Michigan (Alice Miranda Ollstein and Politico Magazine, 11-4-22) Nine Michiganders on why they’re energized (pro and against abortion) in this year’s midterms, and how this election cycle has changed their relationship to politics.

     Stay-at-home mother of three Jessica Leach, 37, thought of herself, for decades, as a textbook Republican. But when Roe fell, she thought back to her first pregnancy 17 years ago that she considered terminating out of concern she wouldn’t be a good mother. She ultimately decided to see it through. When she first discovered the unintended pregnancy, she recalled, she went to a church-run clinic with her boyfriend, where “they just started pushing scripture at us and telling me not to have an abortion.” Turned off by the pressure campaign, she then visited an abortion clinic, and said the staff there gave her “all the information I needed to make the best choice for me and my life.”

    “I love being a mom, but I wonder if I would love it so much if I hadn’t had a choice,” she said. (One of nine stories, both for and against choice.)

• How a Secretive Billionaire Handed His Fortune to the Architect of the Right-Wing Takeover of the Courts (Andrew Perez, The Lever, and Andy Kroll and Justin Elliott, ProPublica, 8-22-22) In the largest known political advocacy donation in U.S. history, industrialist Barre Seid funded a new group run by Federalist Society co-chair Leonard Leo, who guided Trump’s Supreme Court picks and helped end federal abortion rights. The elderly, ultra-secretive Chicago businessman has given the largest known donation to a political advocacy group in U.S. history — worth $1.6 billion — and the recipient is one of the prime architects of conservatives’ efforts to reshape the American judicial system, including the Supreme Court.

      An ectopic pregnancy in the fallopian tube is never viable. But following the June reversal of Roe by the Supreme Court, reproductive health experts say treatment may be dangerously delayed as some states move to limit abortion services. Understanding hospital charges can be a head-scratcher since they often don't appear to align with the actual cost of providing care. That's true in this case. 
• These male politicians are pushing for women who receive abortions to be punished with prison time (Blake Ellis and Melanie Hicken, CNN, 9-21-22) They were adamant that a woman who receives an abortion should receive the same criminal consequences as one who drowns her baby.

•The Future of Roe v. Wade: 3 Scenarios, Explained (4-minute video, by Adam Liptak, narrator, Robin Stein, Aaron Byrd, Natalie Reneau, Anjali Singhvi and Jonah M. Kessel, 9-6-18) Clear and interesting analysis for three broad approaches to getting rid of the Supreme Court decision that made abortion legal.

(1a) Nuclear options would flip Roe on its head, saying Constitution prohibits abortion in interest of protecting fetal life (abortion=murder).

(1b) Do away with right to privacy, which is basis for Roe v. Wade, and would flip the issue back to states, allow states to regulate abortion. (Right to privacy is the foundation for many other rights.) If right to privacy doesn't include the right to abortion; states could limit or do away with right to abortion.

(2) Overrule Roe v. Wade. Right to privacy no longer includes right to abortion. States free to limit or forbid abortion.

3) Chip away at abortion rights(most likely scenario). The Supreme Court has already upheld some limits on abortion. More severe restrictons are a perfectly imaginable scenario. States can reinterpret "undue burdens" and poor women in red states would no doubt have a hard time getting abortions.

 How the Worm Gets in Your Brain? (Dana G. Smith and Dani Blum, NY Times, 5-8-24). The title may creep you out, but once it's asked, don't you want to know? This led me to other postings about parasites, which I (anxiously) share below.

    For example, Robert F. Kennedy Jr.'s disclosure that a doctor apparently found a dead worm in his brain has sparked questions about what brain parasites are, the damage they can cause and how, exactly, they get there. How do parasites turn up in people? And what can they do to the brain? Warning: Many of the following pieces are from the New York Times, for which you need a subscription. If you're not a subscriber, see if you can get access to them in your public library.

 

See especially this excellent resource:
• Parasitic Diseases: A–Z Index: More information about specific parasites (CDC, or Centers for Disease Control and Prevention) After a few general articles there's a wonderful A to Z directory to information about specific parasites and diseases (in four alphabetic groups).

• About Parasites (CDC)

 

•  R.F.K. Jr. Says Doctors Found a Dead Worm in His Brain (Susanne Craig, NY Times, 5-8-24) In 2010, Robert F. Kennedy Jr. was experiencing memory loss and mental fogginess so severe that a friend grew concerned he might have a brain tumor. Mr. Kennedy said he consulted several of the country’s top neurologists, many of whom had either treated or spoken to his uncle, Senator Edward M. Kennedy, before his death the previous year of brain cancer. About the same time he learned of the parasite, he said, he was also diagnosed with mercury poisoning, most likely from ingesting too much fish containing the dangerous heavy metal, which can cause serious neurological issues....Doctors who have treated parasitic infections and mercury poisoning said both conditions can sometimes permanently damage brain function, but patients also can have temporary symptoms and mount a full recovery."
     "Hours after this article was published, Mr. Kennedy posted a comment on his X profile. “I offer to eat 5 more brain worms and still beat President Trump and President Biden in a debate,” the post read. “I feel confident in the result even with a six-worm handicap.”

    

• A Silver Bullet Against the Brain-Eating Amoeba? (Emily Baumgaertner, NY Times, 1-14-19) "Brain-eating monsters are real enough — they lurk in freshwater ponds in much of the United States. Now scientists may have discovered a new way to kill them. Minuscule silver particles coated with anti-seizure drugs one day may be adapted to halt Naegleria fowleri, an exceptionally lethal microbe that invades through the sinuses and feeds on human brain tissue."

---Brain-Eating Amoeba Caused Nebraska Child’s Death, Health Officials Say (Eduardo Medina, NY Times, 8-18-22) Such infections are rare. From 2012 to 2021, only 31 cases were reported in the U.S., according to federal data.

---Man Dies of ‘Brain-Eating’ Amoeba After Swimming in Lake ( Jacey Fortin, NY Times, 7-25-19) Naegleria fowleri, a single-celled organism found in warm freshwater, can be fatal if it enters the body through the nose. The amoeba is typically found in warm freshwater, and the majority of cases in the United States have occurred in Florida and Texas. According to the North Carolina health department, Naegleria fowleri “does not cause illness if swallowed but can be fatal if forced up the nose, as can occur during diving, water-skiing or other water activities.”

---A Man Died After Being Infected With a Brain-Eating Amoeba. Here Are the Facts. (Christine Hauser, NY Times, 10-1-18) Naegleria fowleri is a single-celled organism that can cause a rare infection of the brain called primary amoebic meningoencephalitis, also known as PAM, which is usually fatal. The CDC reports that in 123 known cases from 1962 to 2011 in the United States, only one person has survived.

• Rare Infection Prompts Neti Pot Warning (Tara Parker-Pope NY Times, 9-3-12)

     The water is the problem, not the pots.

     Neti pots — those odd teapotlike vessels used to wash out the nasal passage — have won legions of fans who rely on them for relief from allergies, congestion and colds. But now, after two cases of a deadly brain infection were linked to neti pots, government health officials have issued new warnings about using them safely: Use distilled or filtered water in a neti pot. You can use bottled water, or you can boil water and let it cool before using.

• Pork Tapeworm (taeniasis and cysticercosis) Taeniasis and cysticercosis are diseases of humans caused by a tapeworm (Taenia solium) that normally infects pigs. Taeniasis is an intestinal infection with the adult stage of the tapeworm. Cysticercosis is a tissue infection with the larval stage cysts of the tapeworm.
      "People get taeniasis [pork tapeworm] from eating raw or undercooked pork that contains larval cysts. Once in the person’s intestine, the larval cysts develop into adult tapeworms and produce a large number of eggs.
    "People and pigs develop cysticercosis from swallowing the tapeworm eggs in the feces from an infected human. The eggs hatch in the small intestine and larvae migrate throughout the body before forming cysts. Cysts can form in a variety of tissues, including the brain where the condition is called neurocysticercosis."  [This is one reason they invented housecleaning.]

---Taeniasis FAQs (CDC) Eating raw or undercooked contaminated beef or pork is the primary risk factor for acquiring taeniasis. Because of this, certain groups with dietary restrictions for these meats may have a lower risk of taeniasis. Cook to at least 145° F (63° C) as measured with a food thermometer placed in the thickest part of the meat, then allow the meat to rest* for three minutes before carving or consuming.
   According to USDA, “A ‘rest time’ is the amount of time the product remains at the final temperature, after it has been removed from a grill, oven, or other heat source. During the three minutes after meat is removed from the heat source, its temperature remains constant or continues to rise, which destroys pathogens.”

• How Fat Cells Help Kick Parasites Out of Mice: Study (Natalia Mesa, The Scientist, 10-14-22) Immune cells get a lot of shine when it comes to fighting infection, but it turns out that fat might be just as important for removing parasitic invaders.
• Lose the Fat and Curb Parasitic Infection (Mariella Bodemeier Loayza Careaga, The Scientist, 3-1-24) Trypanosoma brucei (T. brucei) enters its host’s body through the painful bite of infected tsetse flies, causing sleeping sickness, which can be fatal if left untreated. In her laboratory at the University of Lisbon, parasitologist Luísa Figueiredo studies the mechanisms underlying T. brucei infections.
     “It had often been thought that the wasting associated with these infections was a consequence of high parasitemia,” said Monica Mugnier, a T. brucei researcher at Johns Hopkins University who was not involved in the research. “This result shows that the fat loss may actually be a protective mechanism during the infection.”

• What other parasites are there?  Check out History of Human Parasitology (F. E. G. Cox, Clinical Microbiology Reviews, 10-15-02)

Long, detailed, academic, and not easy reading, but briefly covers Ascaris and Ascariasis (roundworms), Hookworms and Hookworm Disease, Trichinella and Trichinosis, Strongyloides and Strongyloidiasis, Dracunculus and Dracunculiasis (Guinea Worm Disease), Filarial Worms and Lymphatic Filariasis (Elephantiasis), Loa and Loiasis (Eye Worm) and Onchocerca and Onchocerciasis (River Blindness), Schistosomes and Schistosomiasis, Liver and Lung Fluke Diseases, Cestodiasis (Tapeworm Infections),

and

(for those requiring study under a microscope), THE PARASITIC PROTOZOA: Amoebae and Amoebiasis, Giardia and Giardiasis, African Trypanosomes and Sleeping Sickness, South American Trypanosomiasis: Chagas' Disease, Leishmania and Leishmaniasis, Malaria, Toxoplasma, Toxoplasmosis, and Infections Caused by Related Organisms, Microsporidians.

 

If you want to post a link to another article, please include the full URL

(such as https://www.cdc.gov/parasites/ for Parasitic Diseases: A–Z Index: More information about specific parasites).