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Abortions in South Carolina are banned after six weeks of pregnancy. Local nonprofits are working to help patients anyway

While abortion continues to divide voters along party lines, reproductive justice leaders in the state of South Carolina share why their work remains personally, rather than politically, relevant.

Memories of pandemic wane but long COVID-19 continues for many

The Centers for Disease Control and Prevention reduced the recommended COVID-19 isolation period from five days to one.

Sanders and stakeholders press lawmakers to reauthorize and increase funding for the Older Americans Act

Reauthorization of the law will help decrease poverty among seniors, Sanders says.

How Biden made health care access, affordability priorities in State of Union address

The president contrasted his health care record with that of his political opponent, Donald Trump, during his State of the Union address.

People with disabilities at high risk of unemployment

Senators voiced concern over the workforce exclusion of individuals with disabilities and discussed eliminating subminimum pay.

Pharma CEOs defend high drug prices before Senate hearing

WASHINGTON — Lawmakers on Thursday grilled the CEOs of three major pharmaceutical companies on why the U.S. pays the highest prices in the world for prescription drugs, demanding that they find ways to lower medication costs. 

“The outrageous cost of prescription drugs in America means that one out of four of our people go to the doctor, get a prescription, and cannot afford to fill that prescription,”  said Sen. Bernie Sanders (I-Vt.), chair of the Senate Committee on Health, Education, Labor and Pensions.  He also slammed the industry for huge windfalls, noting that “10 of the top pharmaceutical companies in America made over $110 billion in profits in 2022.”

A report released by HELP majority staff on Tuesday found that the median launch price of innovative prescription drugs sold by Johnson & Johnson, Merck and Bristol Myers Squibb — the three pharmaceutical companies represented during the hearing — have exponentially increased their initial prices of new drugs over the past four years when compared with the  2004-2008 period.

That same report also revealed that the three companies set their drug prices considerably higher in the United States than in comparable developed nations. Merck, for example, sells cancer drug Keytruda for $191,000 a year in the United States but only for $112,000 in Canada and $44,000 in Japan.

Chris Boerner, the CEO of Bristol Myers Squibb, admitted that consumers pay more for their drugs in the United States than those in other countries but blamed high drug costs on pharmacy benefit managers — the intermediaries between insurance providers and pharmaceutical manufacturers — who push drug prices higher. 

“We set the list price, but that list price for Eliquis is driven up by the incentives of intermediaries,” Boerner said. “We would love to work with Congress to bring that down.” 

In an interview with Medill News Service, Robin Feldman, a professor of law at UC Law San Francisco, said she “heartily agrees” with Boerner that PBMs play a major role in pushing drug prices higher. But she added that the system benefits the pharmaceutical industry overall. 

“The drug companies will point to PBMs as the bad guys, but the system can also work in favor of the drug companies,” Feldman said. “PBMs are able to siphon off a significant amount of money in the supply chain process, but in exchange for that, pharmaceutical companies get preferred positions in the insurance claim.”

During the hearing, Boerner also touted Bristol Myers Squibb’s investment of more than $65 million in research and development over the past decade, arguing that it has bolstered innovation and allowed Americans to gain access to life-saving treatment before the rest of the world. 

However, many lawmakers including Sen. Chris Murphy (D-Conn.) pointed out that Johnson & Johnson and Bristol Myers Squibb spent more in 2022 on stock buybacks, dividends and executive compensation than they did on R&D. 

“When you say you’re in the business of saving lives, you have to think about putting patients over profits,” Sen. Patty Murray (D-Wash.) added. “Sky high drug costs are forcing many people, including in my home state of Washington, to choose between filling their prescription and paying for other things they need — essentials like groceries or rent.”

Sen. Maggie Hassan (D-N.H) also called out the CEOs for making minor modifications to existing patented drugs to prolong exclusivity over the market, stifling competition and preventing lower drug prices from coming into the market. 

Bristol Myers Squibb has sued to block two approved generics of the blood thinner Eliquis from entering the U.S. market until 2028 even though the original patents on the medications have already expired. Merck has already filed 168 patents for its cancer drug Keytruda. 

“Merck is using patent gimmicks and loopholes to delay other companies from selling lower cost versions of this medication, all while raising the price of Keytruda in the U.S. year after year,” Hassan said.

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Experts urge Congress to combat U.S. drug shortage by requiring more information from manufacturers

WASHINGTON — Lawmakers on the House Committee for Ways and Means on Tuesday called on manufacturers to improve transparency as the U.S. experiences a nationwide drug shortage.   

Active shortages are at their highest levels since 2014, according to the American Medical Association. A survey from the American Society of Health-System Pharmacists Resource Center found that over 300 drugs, especially chemotherapy treatments, were in short supply by the end of the second quarter of 2023.

“Patients are living in fear that they may be unable to get the treatments they need when they need them,” Ways and Means Chairman Jason Smith (R-Mo.) said. “I hope today’s hearing can help us zero in on bipartisan solutions that will get more, and better, medications into the hands of the patients who need them.”

Dr. Stephen Schleicher, chief medical officer of Tennessee Oncology, told the committee that many cancer patients were hit hard last year by the shortage of two chemotherapy medicines: carboplatin and cisplatin. 

Schleicher testified that Tennessee Oncology went 10 days without a single shipment of either drug. At the peak of the shortage, the oncology practice was unable to treat 90% of patients who were scheduled to receive carboplatin and 50% who needed cisplatin. 

“As oncologists, we were suddenly faced with the near impossible task of determining which of our patients could receive our very limited drug supply,” Schleicher said. “We were put in a situation that a decade of medical training did not prepare us for.”

One victim of rationing was a 61-year-old woman with stage 4 lung cancer who required carboplatin, Schleicher said. After having to stop treatment due to the drug shortage, her condition deteriorated rapidly, and she died soon afterward.

“Imagine being a patient with a hope for a cure or wanting to live longer with family (and) suddenly being told that you don’t have the optimal treatment anymore,” Schleicher said. “I implore Congress to act to stop these drug shortages.”

Allan Coukell, a panelist who testified to the committee, called on Congress to evaluate manufacturing quality and consider policies that encourage suppliers to maintain additional buffer inventory beyond immediate demand. 

“After a dozen years, (drug shortages) must now be understood as a built in and permanent outcome of the current system,” said Coukell, the senior vice president for public policy at Civica Rx, a non-profit pharmaceutical company. “The U.S. system is designed so that purchasers of drugs are incentivized to choose the lowest price, setting pennies on already low cost products instead of purchasing in a way that makes shortages less likely. Without changes, shortages will get worse.”

However, according to a University of Utah Drug Information Service investigation, manufacturers reported that poor quality manufacturing issues were only responsible for 12%, with supply issues accounting for 14%. The cause of 60% of shortages was reported to be unknown. 

Many lawmakers, including Rep. Judy Chu (D-Calif.), called for standardization of reporting, noting that manufacturers are not obligated to give detailed information on the causes of drug shortages.

“It’s shocking there is so little concrete information on why (most shortages) occur,” Chu said. “It’s clear that increasing transparency over the supply chains is necessary to address the root cause of shortages and ultimately solve this crisis.” 

The United States is heavily dependent on foreign manufacturers for active ingredients and finished medications, according to Stephen Schondelmeyer, director of the PRIME Institute at the University of Minnesota’s College of Pharmacy. About 80% of all doses Americans take everyday come from foreign sources. China and India are responsible for 45% and 60% of doses respectively. 

“I think we’ve got a disaster on our hands,” said Rep. Vern Buchanan (R-Fla.). “We’ve got to find a way for American companies to get back in the game.”

According to Schondelmeyer, there are over 600 active pharmaceutical ingredients that do not exist in the United States. The country could set up companies to produce those ingredients but it would take a considerable amount of time and investment, Schondelmeyer said.  

Dr. Julie Gralow, the chief medical officer of American Society of Clinical Oncology, added that the U.S. should invest in advanced technology, such as continuous manufacturing for critical drugs and active pharmaceutical ingredients. 

“Patients and their families deserve to know that they will get the care they need without delay,” Gralow said. “Providers should not have to make heartbreaking choices about patient care. We must act now.”

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Medicare drug price negotiations start, a potential help in Berkshire County where 16.5% are insured by Medicare

WASHINGTON — In an effort to lower drug costs, Medicare will begin price negotiations with drug manufacturers on Thursday for the 10 most costly prescriptions covered by Medicare. 

It marks the first step in historic negotiations under the Medicare Drug Price Negotiation Program. In August 2022, President Joe Biden signed the Inflation Reduction Act into law, allowing Medicare to directly negotiate prices of certain high-expenditure drugs lacking generic competition with drug companies for the first time in U.S. history.

“Today is another milestone on the march to ensure people with Medicare get fair prices for prescription drugs,” said Xavier Becerra, the secretary for the Department of Health and Human Services, in a statement. “I am confident that this process will lead to lower prices, putting an end to exorbitant price gouging by pharmaceutical companies.”

Between June 2022 and May 2023 the 10 drugs cost the federal government $50.5 billion. During a call with reporters on Wednesday evening, Biden administration officials did not disclose the amount of savings that the initial price offers would generate.

The price negotiations are expected to continue until Aug. 1, with the final prices announced on Sept. 1. The negotiated prices for these drugs will become effective beginning in 2026. 

The ten drugs currently subject to negotiation include Eliquis, a blood thinner from Bristol Myers Squibb and Pfizer; Jardiance, a drug for Type 2 diabetes and heart failure from Boehringer Ingelheim and Eli Lilly; and Xarelto, a blood thinner from Johnson & Johnson.

Locally, 16.5% of Berkshire County residents are insured by Medicare, according to Data USA. However, a JAMA Network Open study found that nearly 1 in 5 adults ages 65 and older didn’t take their medications fully as prescribed in 2022 because of cost concerns. 

“We have the world’s best medicine, but the prices are too high,” said Jeromie Ballreich, an associate research professor at the Johns Hopkins Bloomberg School of Public Health. 

Ballreich acknowledged that negotiating prices could potentially limit innovation in medicine but said that the Inflation Reduction Act negotiations are worth the trade-off to ensure that Americans have increased access to these drugs. 

“Innovative medicines are not beneficial to society if patients don’t have access to them, and access is conditional on cost,” Ballreich said. 

In a Data for Progress survey released in August 2023, 84% of voters expressed support for Medicare drug price negotiation — including 75% of Republicans and 92% of Democrats. 

In future years, the Centers for Medicare and Medicaid Services will select 15 more drugs for negotiation in 2027 and 2028, and up to 20 more drugs each year after that. 

Stacie B. Dusetzina, a professor in the Department of Health Policy at Vanderbilt University School of Medicine, said it is unclear how much relief patients will get from the drug negotiations in 2026 but that patients should see reduced costs in the future as more and more drugs are negotiated. 

In addition to negotiating costs with pharmaceutical companies, the Inflation Reduction Act also made several changes to the Medicare Part D drug benefit. This includes a cap on out-of-pocket yearly maximum prescription drug costs. Part D enrollees will pay no more than $3,300 in annual drug costs in 2024. By 2025, out-of-pocket costs will not exceed $2,000. 

“If you compare that to even last year where the same drug could have cost you upwards of $10,000 or $15,000 out of pocket, we’re really seeing substantial improvements,” Dusetzina said. “For Medicare beneficiaries, it is a really transformative change that can save people literally thousands of dollars out of pocket every year.

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Health care spending has become ‘unsustainable,’ McMorris Rodgers says, as Congress presses for clearer pricing

WASHINGTON – Health experts on Wednesday urged Congress to take more action to address the growing problem of unaffordable health care and deteriorating quality of care as spending is expected to continue to rise.

Health care spending rates grew 4.1% to reach $4.5 trillion in 2022, averaging to $13,500 per person, according to the Centers for Medicare and Medicaid Services. Conversely, spending on Medicare patients has slowed to the lowest level since 2005.

The problem stems from a “business model that allows industry to set prices that have little to do with the quality of the care they offer,” Sophia Tripoli, who serves as the senior director of health policy at Families USA, a health care nonprofit, said. Tripoli said she blames rising health care costs on rapid consolidation that has eliminated market competition. 

Medical price-gouging, Tripoli said, has allowed monopolistic pricing to “push our nation’s families to the brink of financial ruin.”

Rep. Cathy McMorris Rodgers (R-Wash.), chair of the Energy and Commerce Committee, agreed that improving the current health care system is an “important step,” especially with more than 60 percent of Americans living paycheck to paycheck.

“This trend is not sustainable,” McMorris Rodgers said during a hearing organized by the Subcommittee on Health. “We have to find a way to reverse it.”

To address the lack of clarity on costs, the House in December 2023 passed the Lower Costs, More Transparency Act, a bill aimed at increasing price transparency and lowering the cost of prescription drugs. 

This legislation “empowers patients to make informed decisions about their care,” said Anna Eshoo (D-Calif.), the ranking member of the Subcommittee on Health.

The bill has not yet been taken up by the Senate. Both McMorris Rodgers and Eshoo said that their work “would not be done” until the bill reaches President Joe Biden’s desk and is signed into law.

“Americans are in an affordability crisis,” Eshoo said. “This affects everyone – no one skates away from this. We’re human beings, [and] our bodies need care.”

McMorris Rodgers called price transparency a “standard” across the health care system, emphasizing its potential to “restore doctor-patient relationships and address what’s driving [health care] costs.”

Other witnesses echoed similar criticisms of the free market that prevents patients from receiving adequate care. Chapin White, director of health analysis at the Congressional Budget Office, urged lawmakers to implement government policies that reduce money paid to hospitals by commercial insurers, leading to cost cuts across the health care sector.

Kevin Lyons, plan administrator for the New Jersey State Policemen’s Benevolent Association, said that the American health care system one of the “least transparent aspects of our economy.”

“We, the everyday Americans, don’t have the deep pockets to lobby Washington,” Lyons told lawmakers. “Yet, our needs and voices are just as important.”

Tripoli also noted the importance of bipartisan cooperation to Congress implementing “common sense policies” that make health care more affordable for patients, employers and taxpayers alike.

“This work is urgently needed,” Tripoli said. “The journey to fully transform our health care system is long, but Congress holds the power to take the next critical steps.”

Published in conjunction with Spokane Spokesman-Review

Long-COVID patients, experts call on Congress to take action

WASHINGTON — In February 2020, Angela Meriquez Vázquez was an avid runner with nearly two decades of experience. A month later, she contracted COVID-19 and her life changed dramatically. 

What initially seemed like a mild infection developed into debilitating symptoms, including severe blood clots, a series of mini-strokes, and numbness in her face, hands, and legs, which has made even walking a challenge. Now, nearly four years later, she rarely leaves her home. 

“We are living through the largest mass disabling event in modern history,” Vázquez said. “Not since the emergency of AIDS has there been such an imperative for large-scale change and healthcare.”

Vázquez’s comments came before the Senate Health, Education, Labor and Pensions Committee on Thursday, which held a hearing to address the issue of long COVID-19. 

According to the Brookings Institute, an estimated 16 million Americans suffer from long COVID and experience a range of debilitating symptoms, including extreme fatigue, dizziness, insomnia, and chronic pain. As a result, as many as 4 million Americans are out of work. 

However, there are still no FDA-approved long-covid treatments.

“We hear what you’re experiencing,” Chairman Bernie Sanders (I-Vt.) told the panelists. “We have not as a Congress done anywhere near enough and we hope to turn that around.”

Vázquez told the committee that one of the biggest challenges is finding physicians who are knowledgeable about long COVID. 

“I had many clinical signs that something was wrong for weeks,” Vázquez said. “All were dismissed by doctors as anxiety,” an experience Vázquez said is all too common for women and people of color navigating the U.S. health care system. 

Nicole Heim, the mother of a 16-year-old long COVID patient who testified before the committee, emphasized the importance of physicians recognizing that long COVID affects not only high-risk adults but healthy youth as well. 

“Long COVID took my straight-A honors student, talented flautist, and member of the school’s marching band with an active friend group and stripped her of life as we knew it,” Heim said. “Because of the severity of her symptoms, she is no longer able to physically participate in the marching band and is now homeschooled full-time.”

Heim’s daughter is on Medicaid and has access to a wide network of specialty doctors. 

However, multiple panelists shared their challenges in navigating the Social Security Disability Insurance system. 

Rachel Beale, a long COVID patient from Southampton County, Va., shared that she was denied SSDI twice without any explanation, despite long-COVID being recognized as a disability by the ADA. As a result, she has had to pay an estimated $4,000 annually out of pocket and cut back on services that help her manage her chronic pain.

Sen. Sanders said that Congress needs to hold insurance companies accountable for denying patients care.

“We have a health care system… (whose) function is to make huge profits for the insurance companies,” Sanders said. “We need a fundamental overhaul of our healthcare system.”

Many lawmakers, including Sen. Marshall (R-Kan.) also called for greater oversight of the NIH, which he accused of wasting $1 billion in long COVID funding.

“I would think that if you give somebody a billion dollars, we could have some treatment,” Sen. Marshall said. 

Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis, testified that the U.S. has made a lot of progress in understanding the biology of long COVID, but clinical trials are moving slowly.

“We’ve devised vaccines at rapid speed… (but) we’re doing trials for long COVID at snail speed,” Dr. Al-Aly told the committee. “The research effort of long COVID must match the urgency and scale of the problem.”

Sita Zarcufsky is one of the organizers of Long COVID Moonshot, a grassroots advocacy group that is calling on the government to fund $1 billion in annual research funding for long COVID. 

“We still have no federal commitment to fund any kind of clinical treatments, and we need those immediately,” Zarcufsky told Medill News Service after the hearing. “This is not a problem that can be ignored anymore.”

In an interview with Medill News Service, Sen. Hickenlooper (D-Colo.) said he “absolutely thinks” Congress can work together to pass funding. “The one hundred senators are all just people like you and me,” Hickenlooper said. “That means they listen and can be persuaded.”

Rural veterans face too many hardships in getting health services, lawmakers say

WASHINGTON – Only 5% of the new enrollees in the Veterans Health Administration over the past 18 months lived in rural areas. 

Such statistics are disconcerting to lawmakers like Rep. Mike Bost (R-Ill.), who called on the Department of Veterans Affairs to do better.

“While VA has an entire office dedicated to serving rural and remote veterans, I am concerned that this office has not kept pace with the changing veteran population,” Bost, chair of the House Committee on Veterans’ Affairs, said Thursday.

Rural veterans frequently encounter longer travel distances to VA facilities, struggle with unreliable internet connections, and have less information about the benefits available, acknowledged Dr. Shereef Elnahal, a department undersecretary.

The VA under the Biden administration has aimed to address long-traveling distances by expanding access to telehealth services, Elnahall said. In 2023, over 770,000 rural veterans received telehealth services, and nearly half identified telehealth as their preferred method of care, he said. 

However, 27% of rural veterans do not have internet access at home, according to the VA’s website. John Mikelson, a veteran advocate who testified Thursday, cautioned that telehealth is not a viable option for veterans who are “not tech-savvy.”

The challenge of reaching faraway facilities is particularly difficult for Navajo veterans, testified Buu Nygren, president of the Navajo Nation.

The Navajo Nation only has three VA clinics, and the nearest VA clinics are often hundreds of miles away in Phoenix, Albuquerque, N.M., and Salt Lake City. Nygren noted that a Navajo veteran living in Shiprock, N.M., would need to travel approximately 428 miles round trip — approximately 8 hours — to reach the nearest VA medical center in Albuquerque. Nygren suggested that lawmakers build a VA clinic on Navajo land to help ease such burdens.

Rep. Mark Takano (D-Calif.), the ranking Democrat on the committee, said he would be interested in working with fellow lawmakers to do so.

“We want to make sure that our veterans are provided for no matter where they live,” Bost added, saying he appreciated  “members of the committee for standing shoulder to shoulder with me in a bipartisan manner to do that.” 

Many committee members also voiced frustration with the VA’s system for veterans to seek reimbursement for travel. The VA has replaced in-house kiosks at VA facilities with an online portal known as the Beneficiary Travel Self-Service System. 

Rep. Mariannette Miller-Meeks (D-Iowa) said she has heard from many rural veterans who say the electronic portal is difficult to navigate. She expressed frustration with the VA for using its money to train staff rather than work with veterans to improve their care.

“I don’t care to increase the bureaucracy of the VA with people who aren’t delivering care,”  Miller-Meeks said. “What I want is for people to receive care.”

In an interview with Medill News Service, Marisa Schultz, a veteran from Illinois who testified on Thursday, said she thinks care for rural veterans is moving in the right direction. 

“I feel like I was heard today,” Schultz said. “I thought it was a very good committee hearing and I feel confident that the VA is taking concerns seriously.”

Recording artist urges lawmakers to pass bipartisan fentanyl bill

WASHINGTON – Country music artist and rapper Jason “Jelly Roll” DeFord urged lawmakers on Thursday to pass legislation to help combat the fentanyl crisis that is gripping the country.

The Grammy nominee was arrested at 14 years old and spent the following years moving through juvenile centers and prisons after being charged with possession with intent to sell and aggravated robbery. Now, he’s using his experience to call attention to the addiction crisis.

“I was a part of the problem. I am here now standing as a man that wants to be part of the solution,” DeFord said. 

Jelly Roll’s comments came during a hearing held by the U.S. Banking, Housing, and Urban Affairs Committee where they discussed current drug policy, the spread of fentanyl and the FEND Off Fentanyl Act, a bipartisan policy. It aims to address the fentanyl crisis by implementing anti-money laundering measures and monitoring fentanyl-related suspicious transactions. 

According to the U.S. State Department, fentanyl and other synthetic opioids led to more than 107,000 overdose deaths in 2022. Of those, sixty-eight percent involved fentanyl, according to the CDC.

Sen. Sherrod Brown (D-Ohio), chairman of the committee and co-author of the act, said that it is the committee’s “chance to show the people we serve that we can work together, we can put partisanship aside, we can take action on things that actually matter to their lives.”

In his opening remarks, Sen. Tim Scott (R-S.C.) blamed the fentanyl crisis on a “wide open” southern border. 

“America is facing the worst border crisis in our nation’s history,” Scott said. 

Sen. John Kennedy (R-La.) agreed but said that, although the border is an issue, fentanyl-related policy should be equally focused on drug dealers. Kennedy displayed a chart comparing the amount of fentanyl needed to be charged with a federal crime compared to the amount that is necessary to get charged for other drugs. “We punish other drugs less severely than we do the most powerful drug, fentanyl,” he said. “What you allow, gentleman, is what will continue.” 

To launder their money, drug dealers and manufacturers have started using Chinese Money Laundering Organizations (CMLOs) and cryptocurrency, according to Christopher J. Urban, a former DEA agent.

Urban told the committee that CMLOs are independent money launderers in the U.S. who sell laundered U.S. dollars to brokers overseas whose clients want to use the U.S. dollar in America. This model, Urban said, allows cartels and drug manufacturers to launder money faster and with less risk compared to other forms of laundering. 

The FEND Act has the potential to hinder this form of money laundering. CMLOs and other laundering organizations keep detailed transaction data that can be breached by law enforcement with the aid of the FEND Act, Urban said. 

Cryptocurrency also plays a major role in laundering money from the sale of fentanyl. The DEA’s 2018 threat assessment states that cryptocurrency “offers a relatively secure method for moving illicit proceeds.”

“Crypto has changed the game by allowing criminals to move boatloads of money instantaneously and nearly anonymously,” said Sen. Elizabeth Warren (D-Mass.). “Holes in our anti-money laundering laws have given drug dealers a backdoor to move their dirty fentanyl money around and that back door is wide open.”

DeFord said he wanted to use his platform to remind committee members that fentanyl isn’t just a policy issue. Unable to vote because of his felon status, he felt that his perspective was fitting because fentanyl should be a nonpartisan issue.

“Fentanyl transcends partisanship and ideology,” DeFord said, “I encourage y’all to not only pass this bill, but I encourage you to bring it up where it matters– at the kitchen table.”

Pregnant cancer patients often have to terminate. Abortion pill restrictions could make that choice even harder

WASHINGTON — The patient had already made the agonizing decision to start chemotherapy to address her colon cancer, even though she was 30 weeks pregnant. Within a day, the decisions got harder: her colon perforated, and the pain was excruciating. She would need urgent surgery — and she would have to undergo an emergency C-section immediately.

“She looked me in the eye, and she said, ‘I have two children that need me, and if you have to make a decision, I need you to remember that. That my little girls need me, the two kids I already have need me,’” said her oncologist, Dr. Katherine Van Loon, who specializes in treating gastrointestinal cancers at the University of California, San Francisco.

Pregnant cancer patients like Van Loon’s have always faced near-impossible choices between their life-saving cancer treatments and their unborn children. But in a post-Dobbs America, restrictions on abortion access threaten to take the choice out of the patients’ hands, or those of their doctors.

Right now, one in 1,000 pregnancies is affected by a concurrent cancer diagnosis each year, a number that could rise as the mean age for pregnancy in the U.S. continues to trend upward. Many chemo, radiation, and hormone therapies can cause fetal harm, particularly during the first trimester. This can include congenital birth defects, higher stillbirth rates, and low birth weight and blood counts. Severe complications from the disease, such as those experienced by Van Loon’s colon cancer patient, may also force decisions on whether to prioritize the mother or the fetus.

The vast majority of pregnant cancer patients who choose to terminate their pregnancies do so in the first trimester, which is when the fetus is considered not viable, Van Loon said. That early, medication abortion, the most commonly used abortion method in the United States, can be used effectively. But the Supreme Court — which holds a 6-3 conservative majority — announced last week it will hear a controversial case threatening to limit access to the widely used abortion pill mifepristone, following competing lower court rulings and pressure from the Biden administration to review a Texas judge’s attempt to ban the drug. The Court’s decision in that and other abortion-related cases could also one day threaten fertility preservation efforts cancer patients rely on, experts said.

“Pregnancy is a joyful time in most women’s lives. When it is catastrophized by a cancer diagnosis, these are some of the worst moments that I have shared with patients,” Van Loon said.

Leading cancer groups have been outspoken about how continued abortion restrictions, including a potential mifepristone ban, will disrupt patient-first disease care. They say it will strip patients’ ability to prioritize life-saving treatment and interfere with physicians’ role in providing that care.

“The way that the states can regulate it would interfere with the doctor-patient relationship,” said Mary Rouvelas, Managing Counsel and Legal Advocacy Director at the American Cancer Society Cancer Action Network.

In May, the American Society of Clinical Oncology released ethical guidance for cancer physicians practicing in states where abortion access is limited.

“Oncologists have a critical role in upholding their patients’ moral agency,” the paper reads. “This includes presenting patients with options to terminate a pregnancy to treat the patient’s cancer.”

In the clinic, physicians are worried about the immediate impact a ruling would have on their ability to put their patients first. Stripping cancer patients of their reproductive choices would harm the quality of care they could provide.

“We are being limited in terms of our ability to do our best job in caring for our patients,” Van Loon said. “We know that results in worse outcomes for patients, but we also know that the moral distress that clinicians are carrying around not being able to deliver the best possible care is tremendous.”

Patient advocates, too, are worried about the impact that further restrictions on abortion access will have on patient trust.

“We need to preserve that privacy and that intimacy that happens in the doctor’s office, because a lot of these conversations are sensitive conversations or they’re scary conversations, and when there are other voices in the room, it really diminishes a patient’s ability to speak up,” Alison Silberman, CEO of patient advocacy organization Stupid Cancer, said.

Cancer groups have also noted that the post-Dobbs era poses reproductive concerns for cancer patients beyond just abortion. For those able to get pregnant, chemo and radiation can contribute to infertility, and medical experts recommend embryo preservation as one of the best fertility services for such individuals. But if states start describing personhood as beginning at fertilization, that could mean more restrictions on embryo preservation, the organizations said.

Currently, there are no laws banning egg freezing or embryo preservation, but Republicans in multiple states have introduced bills that would define personhood at fertilization. Without explicit exemptions for services such as in vitro fertilization, or IVF, there remains a legal and medical gray area. In their dissent against the Dobbs decision, Supreme Court Justices Sonia Sotomayor, Elena Kagan, and now retired Stephen Breyer explicitly named IVF as an anticipated concern.

“The Court may face questions about the application of abortion regulations to medical care most people view as quite different from abortion,” they wrote.

The Supreme Court will hear oral arguments for the mifepristone case in early 2024 and is expected to issue a ruling by the end of June.

A growing number of doctors on Capitol Hill may be the latest prescription for Congress

WASHINGTON – Stethoscope in one hand and a legislative pen in the other, these doctors are bringing their life-saving skills to Congress.

“My job is to take care of the patient that’s in front of me, and as a member of Congress, my job is to take care of the constituents that I represent,” said Rep. Ami Bera (D-Calif.), an internal medicine doctor who served as Sacramento County’s Chief Medical Officer before running for office.

Bera is one of 19 physician members in the current Congress. These doctors-turned-legislators said their experiences in the medical industry inspire their legislative efforts. 

“In the end, we’re a service industry. It’s about the people. Nobody cares about anything other than how much you care about them,” said emergency medicine physician Rep. Rich McCormick (R-Ga.). 

“That’s the same as the attitude I have as an ER doc.” McCormick, who attended medical school after serving as a pilot in the Marine Corps, eventually became head of the Emergency Medicine Department for the Navy in Kandahar, Afghanistan after his residency.

With issues like Covid-19, abortion care and transgender rights coming to the fore, doctors have become increasingly involved in the political sphere.

“Health care remains a hot topic. Medications are too expensive. The Supreme Court has overturned a woman’s right to make our own health care decisions,” said Rep. Kim Schrier (D-Wash.), the first pediatrician and one of just three female physicians in Congress. Schrier said systemic issues affecting children like hunger and access to public education motivated her transition to politics. 

Out of all doctors in Congress, 15 members are in the House and only four are Democrats. Rep. Andy Harris (R-Md.), who served as co-chair of the GOP Doctors Caucus from 2018-2022, said that many Republican physicians were inspired to run after the Affordable Care Act was passed, fearful of governmental influence on clinicians’ practices.

“When I was elected in 2010, I was one of six physicians elected that year, all Republicans. It was a kind of a pushback against Obamacare,” Harris said. Harris is an anesthesiologist by trade, having served in the Naval Reserve. 

Since the beginning of the pandemic, the number of Americans who say they have not too much or no confidence in scientists to act in the best interests of the public has grown from 12 percent to 27 percent, according to Pew Research. Confidence in medical scientists has also decreased. Members noted how the presence of medical perspectives in Congress is more important than ever.  

“It’s been a critical missing voice,” Schrier said. 

Some note that the presence of doctors in Congress has been a mainstay since the nation’s founding. 

“I often go back to the framers of the Constitution, and there were farmers and bankers and businessmen. And there were also doctors. Benjamin Rush, who was there from the very beginning the father of American psychiatry,” said Rep. John Joyce (R-Pa.), a board-certified internal medicine physician and dermatologist who said the impact of physician shortages on rural communities like his own influenced his run. 

While medicine is a taxing profession, legislators said it remains their passion, and there are parts of the job they miss.  

“The thing I miss most is actually teaching the medical students,” Bera, who taught as a professor of medicine at the University of California, Davis, said. 

“It’s not easy. You see a lot of physician burnout, but I think it’s incredibly important.”

Schrier says that seeing her former patients in the supermarket reminds her how she misses the “relationships that you build with families.”

Some even see a future where they return to seeing patients after their time on the Hill. 

“I could easily see going back to it,” Harris said. “I’ve, you know, practiced for over 30 years. I think I can still share that with patients.”

Lawmakers investigate breakdowns of Georgia’s foster care system after independent inquiry revealed problems

WASHINGTON – A Senate bipartisan inquiry into the failures of the foster care system heard  first-hand accounts of the neglect and abuse, with experts providing lawmakers with recommendations for changes on Oct. 25.

The inquiry came on the heels of an independent investigation into widespread neglect and child abuse in Georgia’s foster care system, which oversees about 11,000 children. In February, Sen. Jon Ossoff (D-Ga.) and Sen. Marsha Blackburn (R-Tenn.)  sent a letter to Georgia’s Department of Human Services, demanding answers. As chairman of the Senate Human Rights Subcommittee, Ossoff convened the first hearing on Wednesday on the treatment of children in the foster care system.  

“Ultimately, this is not about statistics and bureaucracies,” Ossoff told reporters. “It’s about human beings. It’s about the most vulnerable human being in our state — foster children.”

Rachel Aldridge, a parent from Georgia, testified about the murder of her two-year-old daughter Brooklynn, whose case was managed by the state’s Division of Family & Children Services. 

In July 2022, Georgia Office of the Child Advocate, an independent oversight group, found that caseworkers were “no longer adequately responding to child abuse cases.”  

Aldridge had uncontested custody of her daughter. But she told lawmakers that after she was wrongfully arrested, DFCS placed the child with Brooklynn’s father, who was not a certified foster parent. His live-in girlfriend would later be convicted of killing Brooklynn. 

Leading up to the murder, Aldridge reported to caseworkers at DFCS warning signs, like a bruise on Brooklynn’s leg and drug use in the home. Still, the agency did not remove the child, Aldridge recalled tearfully. 

“Brooklynn would still be alive if anyone at DFCS had just been willing to listen to me — her own mother,” Aldridge said. “The system meant to protect children failed Brooklynn at every level.”

Ossoff, a father himself, told Aldridge that she had gone through “every parent’s absolute worst nightmare.”

According to an audit, DFCS failed 84 percent of the time when it came to risk assessment and safety management. Aldridge’s story illustrates that failure, said Melissa Carter, an attorney specializing in child law. 

“Safety assessment is both an art and a technique,” Carter said. “Once the child is placed there, there’s this ongoing responsibility to check in, to just make contact with that child.”

Georgia DFCS receives upward of 120,000 reports of suspected child mistreatment annually. Many case managers lack the resources to solve problems that are presented to them, Carter said. 

Carter added that Georgia has not invested enough in preventative measures to avoid forcing children into the child welfare system. The state has not used federal funds efficiently either, she said. 

“This is about systemic failures,” Carter said. “Georgia lacks the operational capacity, policy, infrastructure and practice tools to support effective case management.”

OCA, the independent oversight body, also determined DFCS provided “inadequate” services for children who underwent human trafficking, sexual abuse and physical abuse. Foster children, especially Black, brown and LGBTQ+ youth, are “treated more like adults,” Emma Hetherington, a lawyer who works with survivors of child sexual abuse, told the Senate panel. 

In DFCS documents and communications, the agency used phrases, like “promiscuous,” “sex addict” and “prostitute,” to describe youth in their care.

“Let me make it clear: There is no such thing as a child prostitute,” Hetherington said. “The foster care system in Georgia has always struggled with systemic challenges and barriers, but I’ve never seen it this dismal as it is today.”

In the past year, Georgia has spent $28 million to house foster children in hotels because DFCS could not find a home for them. The state came under fire for this practice, called “hoteling,” as some say it deprives youth of a stable environment and treatment. 

When Mon’a Houston, a former foster child from Georgia, was in DFCS’ care, she cycled through 18 placements, including group homes and hotels, she testified. 

Houston emphasized the need for good case managers. Of three case managers who were assigned to her from 2017 to 2022, only one visited her and answered her phone calls, she said. 

“I felt alone,” Houston said. “I’m doing this, so other people know they can come out on the other side.”

Blackburn presented a hypothetical to Houston, asking her to rewrite the job description of a caseworker. 

“Listen to the children,” Houston said. “Make them feel loved. Make them feel like they have a family.”

Ossoff emphasized that the Senate’s investigation is “ongoing.” Once the inquiry period ends, Ossoff expects lawmakers will have necessary information to draft legislation. 

“We have an obligation to understand why and how (foster children) are being harmed, abused, neglected — and to change that system,” Ossoff said. “Reform is absolutely the ultimate goal.”

SCOTUS split on future of opioid recovery funds as Purdue Pharma bankruptcy, Sackler legal immunity at stake

WASHINGTON – Supreme Court justices appeared torn on whether Purdue Pharma’s bankruptcy settlement plan, which would protect the Sackler family ownership from civil liability in exchange for $6 billion in opioid relief funds, has legal standing during oral arguments on Monday. 

Over 95% of the victims who brought lawsuits against Purdue, the developer of the highly addictive painkiller OxyContin, voted on the settlement to support the plan as it stands. Since OxyContin came on the market in 1996, over 645,000 people have died from opioid overdose. 

“The billions of dollars that the plan allocates for opioid abatement and compensation will evaporate, creditors and victims will be left with nothing and lives literally will be lost,” warned Purdue’s lawyer Gregory Garre if the high court rules against the company.

Purdue, often credited with starting the lethal opioid epidemic, filed for bankruptcy in 2019 following thousands of civil lawsuits against the company and the Sacklers from states, hospitals and individuals affected by their addictive wonder pill. The lawsuits collectively sought over $40 trillion in damages. More than 130,000 plaintiffs, including individual victims and family members, have filed claims against Purdue and the Sacklers. 

A bankruptcy court put lawsuits against Purdue and the Sacklers on hold and approved the company’s settlement in 2021. The plan would require the Sacklers to relinquish ownership of the company and contribute $6 billion of their own assets towards opioid recovery efforts.

The Department of Justice’s bankruptcy watchdog, the U.S. Trustee, asked the Supreme Court to take up the case. The federal government expressed concern that approval of Purdue’s plan would empower bankruptcy courts to issue blanket relief to responsible individuals via bankruptcy settlements.

At the core of Monday’s two-hour debate was whether the Bankruptcy Code, the federal law governing all bankruptcy cases, authorizes non-bankrupt individuals tied to a bankrupt party to escape legal liability via a bankruptcy settlement, as Purdue has outlined for the Sacklers. 

Justices highlighted the “catchall” section of the Bankruptcy Code when probing both Purdue’s counsel and the trustee, which allows “any other appropriate provision” to be included in a settlement. Justices debated whether the term “appropriate” grants the broad authority to offer legal protections to the non-debtor Sacklers.

“It conflicts with the basic nuts and bolts of the Bankruptcy Code’s comprehensive scheme. It permits the Sacklers to decide how much they’re going to contribute,” said Curtis Gannon, a lawyer representing the U.S. Trustee.

Despite the vast majority of victims supporting the deal, Gannon and some justices expressed concern that without full consent, the liability release included in the current bankruptcy plan would infringe on the rights of victims who oppose the plan to sue the Sacklers.

“It would raise serious due process concerns,” Justice Neil Gorsuch said. Protesters outside the court, many of whom said they, too, were victims of Purdue’s opioid products and opposed the settlement, chanted, “Sacklers lie, people die.”

The court also weighed the importance of the Sacklers’ funds, noting that absent the current settlement, the wealthy family would not be required to contribute any of their own assets towards opioid recovery efforts. 

“Your opening never mentioned the opioid victims. The opioid victims and their families overwhelmingly approve this plan because they think it will ensure prompt payment,” Justice Brett Kavanaugh said to Gannon. 

“When thinking about the term ‘appropriate,’ I’m not sure why we should cast aside that concern so readily,” the justice added.  

Justice Elena Kagan also expressed concern about how denying this settlement may contradict the basic purpose of bankruptcy law.

“You’re supposed to maximize the estate and you’re supposed to do things that will effectuate successful reorganizations,” Kagan said. “It seems as though the federal government is standing in the way of that.”

The ramifications of this case have heavy implications for both the opioid crisis and the future of such settlements.

“What I came to realize, throughout this whole process is that we’re not going to put the Sacklers in jail,” said Cheryl Juaire, who lost two of her children to opioid-related deaths and is a member of the trustee-appointed victims’ committee represented on Monday. The committee supports the Purdue settlement.

“And at this point in time in this epidemic, we need that $6 billion.”

Juaire founded Team Sharing, an organization that leads peer support groups for families who have lost loved ones to addiction. Juaire warned that without the settlement, individual victims and states will be pitted against each other to fight for remaining funds. 

From a legal perspective, experts say this is the most significant bankruptcy case to come before the Supreme Court in the past 30 years.

“Implicit in that is this extremely powerful grant of essentially the power to create your own little bankruptcy process for non-debtors,” said Ralph Brubaker, a law professor at the University of Illinois College of Law. Brubaker, who filed a brief in support of the government, said the ruling will have an impact on the “larger systemic issue” of using the bankruptcy process as a way to escape liability. 

Based on Monday’s discussion, experts note that the justices are grappling with the various intricacies and concerns surrounding both sides of a future decision. 

“There were those justices that were skeptical that statutory authority exists for this dramatic use of the Bankruptcy Code and even wondering if there might be constitutional problems. And on the other hand, you have justices who are aware that reversing this case and preventing the kind of settlement we see here could have devastating implications for the victims,” Edward Morrison, a professor of law at Columbia Law School, said.

The court is expected to rule on the case by the summer of 2024 while Purdue, the Sacklers and victims await their fate.

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CDC’s new director attempts to outline vision for modernizing agency data amid GOP opposition

WASHINGTON – Efforts to build trust between House Republicans and the new director of the Centers for Disease Control and Prevention, Dr. Mandy Cohen, fell short Thursday morning as GOP members continued to use the agency as a lightning rod for their criticism of the government’s response to the COVID-19 pandemic.“Your actions could move the CDC further away from public trust,” said Rep. Cathy McMorris Rodgers (R-Wash.), chair of the House Energy and Commerce Committee, which oversees the CDC. “Your predecessors took bad advice due to political pressure and misled the American people.”

Such hostility may prove challenging to overcome for Cohen, who has ambitious goals for the agency. The CDC director wants to turn “data into action” quickly but she says the agency is limited without more access to local health jurisdictions. The CDC rapidly improved its access to this type of data during the pandemic.

“At the beginning of the pandemic, we transmitted information electronically and only about 200 hospitals were able to transmit that data electronically to them; now we’re close to 30,000,” she said.

Greater communication between the local, state and national levels would allow the agency to give more accurate recommendations using more transparent information like through “respiratory disease forecasts,” Cohen told members of Congress.

Republicans are refusing to include a provision giving the CDC access to any such data in its budget. Instead, they have proposed a $1.6 billion cut from the CDC’s budget in one of their appropriations bills.

Rep. Frank Pallone (D-N.J.) criticized that move, saying it “undermines the CDC’s ability to perform its vital mission” and “would endanger public health and safety.”

Republicans also sought to attack Cohen about pandemic-era policies that are no longer in effect such as mask mandates, vaccine mandates and public-school closures. Cohen didn’t address those previous policies and suggested future crises might have different responses from health officials.

“We’re in a different place than we were before,” said Cohen. “We both have different tools and different mechanisms to respond… I do think we’ve learned a lot about how to approach.”

The CDC director previously served as secretary of the North Carolina Department of Health and Human Services during the COVID-19 pandemic. In that role, Cohen said she “worked across the aisle” in the purple state, where she defended allowing schools to reopen while also threatening to file suits against school districts that failed to continue contact tracing and quarantine processes.

Rep. Gary Palmer (R-Ala.) pressed Cohen on whether she would continue the CDC’s masking recommendations of children as young as two years.

“If there aren’t significant policy changes, it’s going to be very difficult going forward,” said Palmer, in reference to trust in her work at the CDC.

Cohen was appointed director earlier this summer, and she’s already had to confront high-risk public health situations. Those included a malaria outbreak in Florida and Texas this summer, the first U.S.-acquired cases in 20 years.

“Public health, when it’s a success it can often be invisible,” she said.

Despite the tough questioning on the pandemic policies, Cohen sought to raise awareness on the continued danger of COVID-19, stating 1,000 people are still dying a week from it and only 16% have received the updated vaccine.

“COVID is still the respiratory virus that is putting the most number of folks in the hospital and taking their lives,” she said. “Top reasons people don’t get vaccinated is because their doctor or their nurse practitioners don’t bring it up.”



Medill Today | March 14, 2024