21 August 2022: Medical advisory for anti-abortion states

Medical advisory for anti-abortion states 

21 August 2022

 

Pregnant women and girls may want to avoid traveling to anti-abortion states because of adverse health outcomes if they have a medical emergency. See https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html to determine the current status of each state, but note that this changes frequently due to litigation. Prior to the Dobbs v. Jackson Women's Health Organization decision of the U.S. Supreme Court (see https://en.wikipedia.org/wiki/Dobbs_v._Jackson_Women%27s_Health_Organization), female patients could rely on a  standard of care that prioritized their health in medical decision making. However, in anti-abortion states, physicians, nurses, pharmacists and other health care personnel now have to consider whether their actions will subject them to criminal prosecution under the anti-abortion laws.

This threat of criminal prosecution is real. In Indiana, its Attorney General threatened an ob-gyn who performed an abortion on a 10 year old from Ohio, even though it was clearly legal at the time (https://thehill.com/homenews/state-watch/3559347-indiana-ag-threatens-license-of-doctor-who-provided-abortion-to-10-year-old-rape-victim/). There is no doubt that some other prosecutors, who are typically elected officials, will use cases to attempt to advance their political careers.

 

How does the threat of prosecution alter care of pregnant patients? Some physicians are delaying or altering treatment for ectopic (tubal) pregnancy (https://www.washingtonpost.com/health/2022/07/16/abortion-miscarriage-ectopic-pregnancy-care/?pwapi_token=eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWJpZCI6IjMzMjkyOTg1Ii),  infections (https://www.npr.org/sections/health-shots/2022/07/26/1111280165/because-of-texas-abortion-law-her-wanted-pregnancy-became-a-medical-nightmare), miscarriages (https://apnews.com/article/abortion-science-health-medication-lupus-e4042947e4cc0c45e38837d394199033), lethal fetal conditions (https://www.wafb.com/2022/08/15/mother-claims-she-was-denied-an-abortion-despite-babys-condition/), maternal cancer (https://www.nbcnews.com/news/latino/mom-abortion-ban-daughter-death-dominican-republic-rcna43600) or other life threatening maternal conditions (https://www.nytimes.com/2022/08/01/us/abortion-journey-crossing-states.html). It is difficult to predict how this will affect any specific patient because (a) health care personnel may be reluctant to talk about their changing practice patterns, (b) the Dobbs decision is recent and behavioral changes are still ongoing, (c) research studies typically take years to publish. However, it seems likely that care will often be delayed and occasionally altered as health care personnel grapple with their fear of prosecution.

I suspect that, over time, to minimize the risk of prosecution, some health care personnel in these anti-abortion states will presume all women and girls to be pregnant unless proven otherwise and that they will administer pregnancy tests more commonly before starting or continuing treatments that may be dangerous to the unborn. These treatments include immunosuppressive drugs for autoimmune diseases (rheumatoid arthritis, lupus, multiple sclerosis), cancer treatments (radiation, chemotherapy, other drugs), as well as drugs for more common diseases (acne, bacterial infections, coagulation disorders, high blood pressure, manic-depressive disorder, seizures, see https://www.rxlist.com/teratogenic_drugs/definition.htm, https://www.ncbi.nlm.nih.gov/books/NBK553086/).  Some physicians may refuse to treat women or girls for these conditions unless it is clear that they cannot become pregnant in the future because they want to eliminate even the possibility of treatment being given during pregnancy and they cannot test every day.

What do you think? I welcome your opinion on how these state anti-abortion laws may affect medical care to women and girls, pregnant or not.

5 July 2022: Every pregnancy in an anti-abortion state is now a potential felony charge

https://www.freep.com/story/opinion/contributors/2022/06/26/supreme-court-abortion-ruling-roe/7724609001/

In anti-abortion states, every pregnancy is now a potential felony charge for all involved, including the pregnant woman, her physicians, friends and family if the pregnancy does not result in a healthy child. For example, a miscarriage is now a potential murder charge for anyone who encouraged or perhaps even tolerated any dangerous activity by or near the pregnant woman, including smoking, drinking, illegal drugs, car accidents, other accidents or any activity that may harm an embryo or fetus. This is particularly true in Texas, which has a bounty system to encourage reporting of abortions and possibly any actions encouraging or facilitating them, https://www.nytimes.com/2021/09/10/us/politics/texas-abortion-law-facts.html.

In addition, every female from puberty to menopause in an anti-abortion state should consider herself to be under surveillance because anti-abortion fanatics may consider that she is hiding a pregnancy and considering ways to end it.  

Pregnant women who get sick are at greater risk of death or bad outcomes because their physicians will be hesitant to take any action that may hurt the baby and risk a felony charge for themselves. This may be particularly true at Catholic hospitals, which may be much more sensitive to this issue.

Females in anti-abortion states have three choices: (a) do nothing and take your chances that there will be no criminal charges or threats to your health when pregnant, (b) fight to change the laws in your state or (c) move to a pro-choice state. Leaving is hard, but remember that many of our distant relatives left oppressive conditions to come here - moving to another state is much easier than what they went through.

What will you do?

27 June 2022: Curing cancer - Curative cancer treatment based on complexity theory (revised)

I have revised my prior post on Curing cancer - Curative cancer treatment based on complexity theory, see https://www.pathologyoutlines.com/ccnblog/curativecancertreatment.html 

It begins: This essay summarizes my recommendations on how to substantially reduce cancer deaths. In general, we should view cancer as primarily a disorder of a complex biological system that is composed of interacting networks and not as a modular system with faulty parts. I also believe that substantially reducing cancer deaths is primarily a management problem to be solved by identifying and implementing a series of appropriate public policy, medical and scientific tasks, and not by trying to discover a miracle treatment. 

Entire document: https://www.pathologyoutlines.com/ccnblog/curativecancertreatment.html Let me know of any comments or questions (but I cannot answer patient specific or treatment questions).

17 May 2022: Mental Health Awareness Month

May is mental health awareness month. This message is from the Michigan Dept of Health & Human Services:

If we’ve learned anything from the pandemic, it’s that our mental health and physical health go hand-in-hand. We’ve learned, as outlined in Governor Whitmer’s Mental Health Awareness Month proclamation at https://www.michigan.gov/whitmer/news/proclamations/2022/04/29/may-2022-mental-health-awareness-month?utm_campaign=&utm_medium=email&utm_source=govdelivery, that mental health affects how we think, feel and act; how we handle stress; and how we relate to others and make choices. Dr. Debra Pinals, MDHHS Medical Director for Behavioral Health and Forensic Programs, recorded a short video message encouraging us to stop and think about that—and know that help is available if needed.

https://www.youtube.com/watch?v=ymHvJZm_jh0

One source of help is the MDHHS Stay Well program, which was created in the early days of the pandemic and still offers services and resources to help you manage emotional distress. Here are a few:

* The Stay Well counseling line still provides emotional support 24 hours a day, seven days a week. Dial 1-888-535-6136 and wait for the prompt to press “8”. Counseling is free and confidential.

* “Cultivating Joy” video series. Visit Michigan.gov/StayWell and click the black button that says Video Resources. You’ll find a collection of short, animated videos designed to help you rediscover optimism and hope.

* The “Be Kind to Your Mind” discussion group meets weekly on Zoom. Anyone can join for a chance to connect with other Michiganders who’ve been weathering the proverbial COVID storms. Register at https://bit.ly/3PilXrV.

Remember, there’s no shame in seeking help if you’re struggling emotionally. In fact, it can keep serious mental health issues at bay. So, here’s to your health – both mental and physical.

16 May 2022: Another threat to the health of women and girls

I find these articles to be disturbing:

* Abortion foes push to narrow ‘life of mother’ exceptions,
https://www.washingtonpost.com/health/2022/05/13/abortion-ban-exceptions-mothers-life/

* What the “Life of the Mother” Might Mean in a Post-Roe America, https://www.newyorker.com/science/annals-of-medicine/what-the-life-of-the-mother-might-mean-in-a-post-roe-america

We want our physicians to be focused on what is in the best interest of the patient. Health care becomes more dangerous to patients when physicians must also consider possible criminal prosecution, loss of their medical license or loss of hospital privileges for providing optimal care to their patients.

For those of us who place primary importance on the health of the women and girls in our life or in society, I think we need to get more involved politically, in some way. I am circulating the petition for the Michigan Right to Reproductive Freedom Initiative, https://mireproductivefreedom.org/, and urge all who care about this issue to get more involved, in some way. What are you doing?

@NatPpolitics

30 April 2022: Adult versus childhood cancer

I have revised "Curing cancer - Adult versus childhood cancer', see https://www.pathologyoutlines.com/.../adultvschildhoodcan.... This brief article compares cancer in adults to cancer in children and adolescents focusing on numbers of deaths, clinical (microscopic) types, survival rates, etiology (how they arise) and curative treatment. Click at https://lp.constantcontactpages.com/su/onz6IND to sign up for our monthly newsletter.

12 April 2022: Curing cancer - reductionism versus complexity

 I have updated my article: Curing cancer - Reductionism versus complexity. It begins:

In 1971, President Richard M. Nixon announced the beginning of the "war on cancer" in the United States. Fifty years later, despite massive government expenditures and testimonials that the war on cancer "did everything it was supposed to do", cancer is still a leading cause of death with high mortality from cancer of the lung, colon, pancreas and breast.

Our war on cancer has failed because our basic approach to biology is wrong. Biologic thinking has traditionally relied on reductionism, the theory that the behavior of the whole is equal to the sum of the behavior of the parts. Based on this theory, sophisticated systems are presumed to be combinations of simpler systems that can be reduced to simpler parts; this implies that disease is due to flawed parts and treatment merely needs to identify and repair or destroy the damaged parts. Although logical and rational, reductionism does not accurately describe the functioning of complex systems, including human biology.

Rest of article, https://www.pathologyoutlines.com/ccnblog/reductionismvscomplexity.html