Health

(NEW YORK) — More than 40,000 graduating medical students learned Friday where they will spend the next three to seven years of their medical training.

With the United States grappling with a simultaneous shortage of primary care physicians and a rural health care crisis, many of the graduating students are set to enter the front lines of the country’s health care shortage.

At least 136 rural hospitals and health systems closed between 2010 and 2021, and over 40% of rural hospitals operate with negative profit margins. Despite billions of dollars in investment in health care, hospitals throughout the United States face the possibility of shutting down.

“I would say it is probably the worst time for health care that we ever experienced,” Joanne Conroy, the chief executive officer and president of Dartmouth Health, told ABC News. She noted that increased costs, inflation, limited housing, and workforce shortages have made running rural hospitals more challenging.

“We know what to do if we face another pandemic,” Conroy said. “The question is whether or not we have the financial resilience in order to survive it.”

Many hospitals that remain open have cut costs to survive, offering fewer services and beds.

In 2020, 47% of rural community hospitals did not provide obstetric services, with 89 obstetric units closing between 2015 and 2019. Seven million women reside in counties with limited or no access to maternity care, impacting half a million newborns annually.

According to Conroy, patients can already feel the impact of the crisis, noting that some women in New Hampshire need to drive two hours to deliver their babies. Other effects include fewer available beds in emergency rooms, delays for elective surgery and longer wait times for prescriptions or ambulance pickups.

For new medical professionals entering their residency, especially those joining rural systems, the circumstances of the struggling health systems are out of their control.

“It is not my job to fix all of the problems for an entire community, that’s impossible. When you feel like that’s your responsibility, burnout is basically inevitable,” said Katie Stevenson, a Tufts medical student. “When you feel like your goal is to do the best you can with the resources you have, you are able to right-size your expectations a bit.”

An increasing number of students are entering medical school programs that focus on rural medicine. In 2019, the Health Resources and Services Administration issued grants to create 32 newly accredited rural residency programs, supplementing the preexisting programs.

This year, Tufts School of Medicine will graduate its tenth class of students from its Maine Track MD program – a partnership with Maine Medical Center that allows students to pursue a community-based curriculum and gain financial incentives to encourage primary-care specialties.

Graduating roughly 40 students annually, 27% of Maine Track students have been matched to programs in Maine and 47% have been matched into primary care programs, according to Dena Whitesell, an assistant dean for students at Tufts and psychiatrist at Maine Medical Center.

“We know that students and residents who live in an area [and] who train in an area are more likely to practice in that area in the future,” Whitesell said.

Liv Fauver, a Tufts student who matched with a University of Vermont residency program, grew up in rural New Hampshire and said she felt motivated to work in a similar community where she could positively impact the local residents.

“I think for me, my goal is to live and work in the community that I serve,” she said. “So I’m really in a place where I go home or go to the grocery store and see my patients all the time, because that’s the world that I live in and work in.”

While rural hospitals have closed in record numbers, PCPs – medical professionals who patients regularly use for checkups and other routine care – face additional challenges, especially in rural areas, according to experts.

Greg Sawin, a PCP who has practiced in Massachusetts and Maine as well as Duke University School of Medicine professor, said he worries that the goals of primary and long-term preventative care can sometimes be at odds with larger health care systems.

“We get paid to do things to people. We don’t get paid to keep populations healthy,” he said.

Moreover, he believes the costs associated with medical schools – including the high cost, the likelihood of incurring debt and substantially higher pay to pursue competitive specialties like orthopedic surgery or dermatology, for example – disincentivize primary care options like family or internal medicine.

“It can be very appealing to want to go into a specialty where you’re guaranteed to make more money and pay that debt off more easily,” Stevenson said.

Owen Foster lives in rural Vermont and has felt the impact of the decreased number of available PCPs, spending six months to book an appointment with a doctor. Living in a rural area, Foster shares his dilemma with millions of Americans in rural areas impacted by the shortage of PCPs.

“You need basic things at certain intervals in your life,” he told ABC News. “If you don’t have a primary care provider, you can’t get that and you can’t get the referrals you need, so it’s really, really difficult.”

What makes Foster’s experience unique is his position as the state of Vermont’s top health care regulator. As chair of Vermont’s Green Mountain Care Board, he oversees the quality and cost of the state’s health care system.

Learning about the shortage of primary-care physicians in Vermont, Foster decided to use the opportunity to find a PCP as a chance to examine the market as a “secret shopper.”

“What I found was I was completely incapable of getting a doctor,” he said. “I called eight places and the best I got was on an indefinite wait list, which never came to fruition.”

Rural areas comprise about two-thirds of the primary care health professional shortage areas nationwide, even though only 20% of Americans live in rural areas.

The problem is also likely to worsen over time. Projections indicate that the United States will likely suffer a shortage of between 17,800 and 48,000 PCPs by 2034.

Moreover, health care professionals believe that the shortage of PCPs can make other elements of health care more expensive and worsen overall patient outcomes. Sawin gave the example of a person getting strep throat. Without a PCP, the person might go to a local hospital emergency room, which is significantly more expensive than other treatment options.

“In terms of mismatch of resources, you know, a kid with strep throat showing up in the ER is like cutting butter with a chainsaw,” Sawin said.

Foster added that primary care providers are “critical to controlling the costs of a health care system” due to their role in the early identification of issues, their ability to diagnose mental health issues, and their approach to preventative medicine.

According to Foster, PCPs in rural areas, however, struggle to find and retain staff, negotiate with insurance companies and prevent burnout. The shortage of PCPs, combined with the increased health care needs of the older population in rural areas, creates a concerning combination.

Despite these issues, Foster said he was optimistic about some approaches to make primary care more financially feasible, including adding a floor for PCP spending within health plans and government involvement in rate setting.

A new generation of students graduating from rural track programs also has the potential to reverse the tide of the PCP shortage in rural areas, with 571 additional primary care matches this year. Stevenson, for example, matched with the Swedish Cherry Hill rural program in Washington state.

“I think we have an opportunity in this country to do a much better job of taking care of our patients if we do a better job of funding primary care and preventative care and creating healthy environments,” Stevenson said.

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(NEW YORK) — A new report suggests the virus that causes COVID-19 may be linked to raccoon dogs that were illegally being sold at a wet seafood market in China.

First reported in The Atlantic, a team of scientists from around the world announced Thursday they believe the virus, SARS-CoV-2, originated at the Huanan Seafood Wholesale Market in Wuhan, where the outbreak began.

It comes amid swirling debate about the origins of the pandemic, after a report from the U.S. Department of Energy concluded with “low confidence” that it was the result of a lab leak.

According to the report, researchers at the Chinese Center for Disease Control and Prevention uploaded new data from swab samples collected in January 2020 at the market — including of the floors, walls and cages containing animals — to the open global genome sequencing database GISAID.

From there, the international team, which included virologists and biologists, downloaded the samples and analyzed them.

The samples that came back positive for the virus also contained genetic material of several animals, particularly large amounts matching the common raccoon dog.

Although this doesn’t definitively prove that the virus definitely jumped from raccoon dogs to humans, the team said it is the strongest evidence to date of the natural transmission theory.

“This is a really strong indication that animals at the market were infected,” Dr. Angela Rasmussen, one of the virologists involved in the new report, told The Atlantic. “There’s really no other explanation that makes any sense.”

Members of the research team, who have not yet published their findings, did not immediately return ABC News’ request for comment.

The findings also support other scientific research indicating that the virus likely spilled over from animals into people in and around the Huanan Seafood Wholesale Market.

Raccoon dogs are known to harbor other viruses that jump from animals to humans. For example, a October 2003 report found a virus very similar to SARS-CoV-1, which is a cousin of the new coronavirus, in a raccoon dog and among humans at a live animal market in Guangdong, China.

Although most experts now believe the SARS outbreak in 2002-03 in China was linked to bats, raccoon dogs are believed to have been brief accidental hosts of the virus.

Currently, four U.S. agencies and the National Intelligence Council say the virus was the result of natural transmission that jumped from animals to humans.

Late last month, the Department of Energy changed its stance from “undecided” to “low confidence” that the COVID-19 pandemic “most likely” was the result of a laboratory leak, becoming the second agency, after the FBI, to believe a lab accident resulted in the global health emergency.

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(NEW YORK) — The number of new cases of babesiosis, a tick-borne illness, increased significantly between 2011 and 2019 in the United States, a new CDC report found. It’s also spreading consistently in three new states — now, the disease is endemic in 10 states in the Northeast and Midwest.

The increase isn’t surprising, said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, in an email to ABC News. It’s consistent with what experts are seeing with other tick-borne diseases, like Lyme disease.

There are likely multiple factors behind the increases, including human behavior and warmer weather. More people are moving to areas with ticks and are interacting with animals (like deer and mice) that the ticks feed on, Chin-Hong said. Climate change may also be playing a role, he says. “A warmer climate may increase tick survival, shorten the life cycle of ticks (so many more cycles possible in a season) and increase the duration of tick season.”

Usually, the parasite infects humans after being bitten by certain ticks. These ticks are commonly found in wooded, bushy or grassy areas. They are most likely to bite during the spring, summer and fall, though adult ticks may still bite during the winter if temperatures are above freezing. While there is no vaccine available, the disease can be prevented by limiting tick exposure.

Once infected, symptoms can vary. Symptoms can range from none at all to fevers, headaches, kidney failure, and even death. In 2019, there were a total of eight deaths reported. According to the CDC, patients with symptoms can be treated with a combination of antibiotics and antiparasitic drugs.

Before this new report, the CDC only considered seven U.S. states to have consistent number of babesiosis. This included Connecticut, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, and Wisconsin. However, the newly released data shows that Maine, New Hampshire and Vermont have similar or higher number of new cases.

Between 2011 and 2019, 16,456 cases of babesiosis were reported in 37 states, according to the report. Most cases overall were reported in New York (4,738). The highest incidence was reported in Rhode Island (18 cases per 100,000 people in 2015). Vermont, Maine and New Hampshire had the largest increase in the number of new cases. Rates of new cases increased in Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island and Vermont.

In addition to changes in human behavior and climate, there has also been increased awareness of babesiosis in the past decade, said Dr. Amesh Adalja, an infectious disease expert at Johns Hopkins Center for Health and Security, in an email to ABC News. That may also contribute to the increased number of cases. “More clinicians are ordering tests,” he said. With testing, doctors started to find cases in new areas.

Preventing babesiosis and other tick-borne illnesses

People should be aware of their risk of contracting babesiosis when traveling or living in areas where the illness is more common. The best way to prevent tick-borne illnesses is avoiding ticks. People can minimize tick exposure by covering exposed skin, using repellants and walking on cleared paths in wooded areas, the CDC says.

Anyone spending time outside in areas where there might be ticks should check their body, clothing, and pets for ticks after coming inside, the CDC says. Showering within 2 hours of being outdoors and putting clothes in the dryer on high heat can also prevent tick bites.

If you do find a tick, pull it straight out with tweezers.

Babesiosis isn’t the only disease ticks can carry — they can also spread Lyme disease, Rocky Mountain spotted fever, and anaplasmosis.

People should seek medical attention if they happen to fall ill after a tick bite, Chin-Hong says.

Lauren M. Cuénant, D.O., is a Physical Medicine and Rehabilitation resident at the University of Miami/Jackson Memorial Hospital and a contributor to the ABC News Medical Unit.

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(NEW YORK) — A new double lung transplant technique was successful for two patients with lung cancer, Northwestern Medicine announced. The hospital said it’s leveraging that success into a new clinical program that will offer transplants to patients with end-stage lung cancer.

“Every morning when I open my eyes, like, I just can’t believe it, and life has different meaning now,” said Tannaz Ameli, the second person with lung cancer to receive the transplant, during a press briefing.

Lung cancer is currently the third most common type of cancer in the United States after skin cancer first, and breast cancer in women and prostate cancer in men second, according to the CDC. Yet more people die from lung cancer than any other type of cancer.

Treatment for lung cancer mostly depends on how much that cancer has spread. Patients may be treated with targeted medications, chemotherapy, radiation or surgery to remove the tumor. But those treatments don’t always work, and for some people, a lung transplant is their only option.

Single lung transplants have been successfully performed since the 1980s, and now, more than 1500 single lung transplants happen each year, according to the CDC. But lung transplants for lung cancer aren’t common.

That’s because there’s a high risk that cancer cells will spread from the lung into the rest of the body during the procedure — making it more likely the cancer will come back, said Dr. Ankit Bharat, chief of thoracic surgery and director of Northwestern Medicine Canning Thoracic Institute, in a press release.

When a patient needs both lungs replaced, the lungs are usually removed one after the other, Bharat said. If the first lung is transplanted while the other cancerous lung is still in the body, there’s a risk of the cancer spreading from that lung to the rest of the body, he said.

But Northwestern Medicine’s surgery team found a way to minimize that risk. Their approach allows surgeons to remove the cancerous lung from the body while the patient is hooked up to a bypass machine, which diverts their blood away from the heart and lungs. If blood doesn’t flow through the cancer during the surgery, the risk of the cancer spreading is less.

“We feel quite confident that we’ll be able to help some patients with no other options,” said Bharat. He said that the surgery involves “delicately taking both cancer-ridden lungs out at the same time along with the lymph nodes, washing the airways and the chest cavity to clear the cancer, and then putting new lungs in.”

He added, “These patients can have billions of cancer cells in the lungs, so we must be extremely meticulous to not let a single cell spill into the patient’s chest cavity or blood stream.”

The team at Northwestern Medicine first used the technique on Albert Khoury, a man from Chicago who came to them in 2021 after chemotherapy failed to treat his stage 4 lung cancer. His condition continued to worsen, and he ended up in the intensive care unit, according to a press release.

His doctor at Northwestern Medicine, oncologist Dr. Young Chae, said that a double lung transplant may be his only hope. Without one, Chae said Khoury wasn’t expected to live more than a year.

So, on Sept. 25, 2021, after 2 weeks on the transplant list, Khoury became the first person with lung cancer to have a successful double lung transplant.

One year later, Ameli, who lived in Minnesota, was also diagnosed with stage 4 lung cancer. She said that she tried chemotherapy, but just like for Albert Khoury, it wasn’t enough. Her husband had seen a video about Khoury’s procedure, she said, and he scheduled an appointment with a surgeon at Northwestern Medicine. She was a candidate — and received the second successful double lung transplant in July 2022.

“We’re so happy,” Ameli said at the press briefing. “I’m back. I did it. I made it.”

Because of those successes, Northwestern Medicine is launching a first-of-its-kind clinical program for people with end-stage lung disease.

The program plans to follow the outcomes of its first 75 patients who receive double lung transplants for lung cancer in a new research registry called DREAM (Double Lung Transplant Registry Aimed for Lung-limited Malignancies). While patients can receive a double lung transplant as a part of the clinical program without enrolling in the voluntary DREAM research registry, researchers hope to use the data to follow overall survival, disease-free survival and transplant rejection rates.

“I hope that all cancer patients can be as lucky as me and Albert were,” Ameli said. “Every day we wake up and we’re thankful for it.”

Aerial Petty, DO, is a family medicine resident at New York-Presbyterian/Columbia University Irving Medical Center and a contributor to the ABC News Medical Unit.

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(SALT LAKE CITY) — Utah Gov. Spencer Cox has signed a bill into law banning abortion clinics in the state, making it the latest to restrict the procedure since the Supreme Court overturned Roe v. Wade.

Cox, a Republican, signed H.B. 467 after it passed the state Senate on March 2 and state House on March 3, both along party lines.

Abortion clinics will be required to close either by the end of the year or when their licensee expires, whichever comes first.

Additionally, after May 2 of this year, the Utah Department of Health and Human Services will not be allowed to grant or renew a license of an abortion clinic.

Under the legislation, all abortions will be required to take place in a hospital, which is defined as “a general hospital licensed by the state.”

Currently, Utah bans abortion after 18 weeks. The ban was passed in 2019 but didn’t go into effect until the Supreme Court overturned Roe. H.B. 467 also removes the rape and incest exemption from this law.

Cox previously told reporters he would sign the bill, which also defined the term “abortion” to remove any confusion surrounding the law.

“One of the concerns with the trigger bill that medical providers had across the state was there a lack of clarity that would have made it hard for them to perform legal abortions,” Cox said at the time.

The governor’s office referred ABC News to Cox’s press conference on PBS Thursday when reached for comment.

Anti-abortion groups, such as Pro-Life Utah, applauded the decision.

“Thank you, Governor Cox for signing this bill into law!” the group said in a statement. “We value your commitment to protect the pre-born.”

However, abortion rights advocates, slammed the bill and said it basically eliminates access in the state.

“HB 467 is nothing but shameful procedural and political maneuvering intended to get around a valid court decision and prevent Utahns from accessing abortion,” Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, said in a statement when the bill first passed the state House. “Today’s passage is just one part of a nationwide campaign by anti-abortion extremists to end legal abortion throughout the United States, and it will have devastating impacts on Utah communities.”

Utah lawmakers also passed a law in 2020 banning all abortions except if the mother’s health is in danger or in cases of rape and incest reported to the police.

However, the ban was blocked from going into effect after the 3rd District Court issued an injunction, which was upheld by the state Supreme Court.

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(NEW YORK) — Maternal mortality rates in the United States continue to rise and Black women continue to be most affected, new data shows.

Deaths of women during and just after pregnancy have been steadily increasing over the past few years, according to a report published Thursday by the National Vital Statistics System.

Rates jumped from 23.8 deaths per 100,000 live births in 2020 to 32.9 in 2021, the new report found. Rates went up from 2019 to 2020 as well.

“It was a continuation of what we saw from 2019 to 2020,” Donna Hoyert, author of the report and a statistician at the Centers for Disease Control and Prevention, told ABC News. “But it was a bigger increase than in previous years.”

Mortality rates were highest in non-Hispanic Black women.

According to the report, non-Hispanic Black women died during and just after pregnancy at a rate 2.6 times that of non-Hispanic white women. That gap is consistent with previous reports.

“The maternal mortality rates in black women certainly reflects the systemic racism and discrimination in health care,” Dr. Joanne Stone, professor and system chair of obstetrics, gynecology and reproductive science at the Icahn School of Medicine, told ABC News. “Black women are at a higher risk for complications like preeclampsia and hemorrhage, as well as chronic health conditions.”

People of color often face discrimination or other gaps in care when receiving health care, and that is linked to poorer treatment, according to a study published in the American Journal of Public Health.

Black women often do not receive adequate health care, so pregnancy complications like high blood pressure are not properly treated, which can lead to death, according to another study published in the American Journal of Public Health.

“There are certain things that are happening for some groups that aren’t happening for others,” said Martha Wingate, professor and chair of the Department of Health Policy and Organization at the University of Alabama at Birmingham School of Public Health.

Thursday’s National Vital Statistics System report also found that women 40 years and older had higher rates of death during pregnancy.

That may be because as women get older, they have a higher risk for chronic conditions like hypertension and diabetes, which may complicate childbirth, said Stone. These women are also more likely to need fertility treatments to get pregnant, she said, which can lead to carrying multiple fetuses at the same time and can lead to greater mortality rates as well.

Pregnant people can take some steps to lower their mortality risk. The CDC says that women of reproductive age should maintain a healthy weight and diet, stop use of all substances and take care of health problems before becoming pregnant.

While more research is needed to identify ways to reduce mortality rates and close the gap between inequities in healthcare, Westgate said women should listen to their bodies and seek out care if something feels wrong. Reducing those rates does not just help pregnant people — it helps everyone around them, she said.

“We’re talking about families,” Westgate said. “It’s not just the mom.”

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(NEW YORK) — A U.S. Food and Drug Administration analysis did not find a clear association between the COVID-19 antiviral drug Paxlovid and illness rebound, the FDA said in a new report.

Rebound rates are around the same in people who took the drug and those who didn’t, the study said. It’s the first time the FDA has weighed in on COVID-19 rebound.

“Virologic and/or symptomatic rebound may occur as part of the natural progression and resolution of COVID-19 disease, irrespective of PAXLOVID treatment,” the FDA wrote. Around 10 to 16% of people with COVID-19 had rebound symptoms, according to the FDA’s analysis.

Multiple high-profile people experienced COVID-19 rebound after taking Paxlovid, including President Joe Biden and Dr. Anthony Fauci— it was a major talking point around the drug. This new report offers data to counterbalance those anecdotal reports.

Pfizer, which makes Paxlovid, said it’s running two additional studies to try and understand symptom rebound.

One will look at rebounds in immunocompromised patients who take Paxlovid for different amounts of time. The second will check if patients who take Paxlovid and then have symptom rebound should take another course of the drug.

The info was part of the FDA’s briefing document ahead of a meeting of the agency’s advisors Thursday, where they’ll discuss whether the FDA should fully approve Paxlovid. The drug is currently available because of the FDA’s emergency use authorization.

A February study showed COVID rebound is “common” for those who did not take antiviral treatments, “but the combination of symptom and viral rebound is rare.”

The FDA approved pharmacies to prescribe Paxlovid in July 2022.

“The FDA recognizes the important role pharmacists have played and continue to play in combatting this pandemic,” Dr. Patrizia Cavazzoni, director for the FDA’s Center for Drug Evaluation and Research, said in a statement last year. “Since Paxlovid must be taken within five days after symptoms begin, authorizing state-licensed pharmacists to prescribe Paxlovid could expand access to timely treatment for some patients who are eligible to receive this drug for the treatment of COVID-19.”

Overall, the drug has worked as promised, doctors said, by dramatically reducing the chances that an older or high-risk individual might wind up hospitalized or dead.

Doctors have said that Paxlovid is most effective when given as soon after a diagnosis of COVID-19 as possible. Taking it later during the course of the illness may result in the drug not being as effective.

What’s more is that it might help prevent long COVID.

A study released in November 2022 by the Veterans Administration looking at the medical records of 56,000 people found that taking Paxlovid early decreased the chances of experiencing “long COVID” by some 25%.

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(NEW YORK) — Google is expanding use of its health care artificial intelligence, including helping detect diseases, such as cancer, earlier and answering medical questions.

During the technology company’s annual The Check Up event on Tuesday, employees announced several new updates and partnerships that they claim will help expand access to care and make the field more equitable.

“The future of health is consumer-driven,” Dr. Karen DeSalvo, Google’s chief health officer, said at the event held in New York City. “People will expect a mobile-first experience with more personalized insights, services and care. That means enterprises, including Google, will need to evolve to meet consumers where they are.”

The company unveiled the latest version of its medical large language model, which is designed to provide answers to medical questions, called Med-PaLM 2.

Last year, when it was first introduced, Google said it was the first AI system to get a passing score — meaning more than 60% — when answering multiple choice and open-ended questions that appear on U.S. medical licensing exams.

Google said the latest iteration consistently answered medical exam questions on an “expert” level, scoring 85%.

During the event, Dr. Alan Karthikesalingam, a research lead at Google Health, showed examples of some of the questions Med-PaLM 2 might answer including “what are the first warning signs of pneumonia?” and “can incontinence be cured?”

Many times, the answers were similar to — and even more thorough than — the answers clinicians provided to the same questions.

However, the company admitted it’s not ready to be rolled out yet in the real world due to some gaps in answering some medical questions, including not be as detailed.

“You can see from this sort of work that we’re still learning,” Karthikesalingam said.

Google also announced new partnerships that will help detect diseases earlier and identify health information more quickly.

The first partnership, with Kenya-based Jacaranda Health — which focuses on the health of expectant mothers and newborns — is to use AI to replace traditional ultrasound machines.

AI could be implanted in low-income areas that don’t have the machines or have very few of them, which are costly and requires training workers, so more pregnant women can be monitored.

Another partnership with Chang Gung Memorial Hospital in Taiwan will explore using AI models using ultrasound for breast cancer detection rather than traditional mammograms, which can also be costly.

Google is also partnering with the Mayo Clinic to see how AI can help for patients receiving radiation, a common cancer treatment.

The company says its AI may help speed up a process called contour delineation, in which clinicians use CT scans to outline healthy organs and tissue at risk so the radiation can be directed towards the tumor.

Google is also expanding the ability of its search engine to provide information about affordable health care providers.

Hema Budaraju, the senior director of product, health and social responsibility at Google Search, said the company had used Duplex to help users find community health centers that offer free and low-cost care and are adding more doctors with appointments that can be booked online.

“We also know how important it is when you’re searching for healthcare providers that the information you find is accurate, like the clinic’s phone number and address,” she said. “Duplex called hundreds of thousands of healthcare providers in the U.S. to verify their information on Google Search and we’ve used this technology to verify if providers accept certain Medicaid plans in their state.”

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(AMARILLO, Texas) — A ruling is expected to come down from a federal judge in Texas Wednesday that could see an abortion medication being taken off the market in the United States.

The lawsuit, filed by Alliance Defending Freedom – a Christian conservative legal advocacy group – has asked Judge Matthew Kacsmaryk of the Northern District of Texas to reverse the U.S. Food and Drug Administration’s approval of mifepristone.

If the judge rules in favor of the plaintiffs, there would be a nationwide injunction on mifepristone, affecting even states where the procedure is legal.

Another drug used in combination with mifepristone for abortions, called misoprostol, would still be available, but it’s not approved by the FDA to be used for abortions on its own.

According to a transcript of a closed-door meeting, Kacsmaryk told trial lawyers that he planned to wait until late Tuesday to make public the logistics of the hearing to avoid protests.

“This is not a gag order but just a request for courtesy given the death threats and harassing phone calls and voicemails that this division has received,” Kacsmaryk told attorneys in the case. “We want a fluid hearing with all parties being heard. I think less advertisement of this hearing is better.”

Organizers from the Women’s March said they intend to stage a “kangaroo court” outside the courthouse, where protestors will be dressed in costume to suggest the case is based entirely on fraudulent claims.

Kacsmaryk “says he doesn’t want a ‘circus-like’ atmosphere, all while behaving like a clown who treats our lives like a political game,” the organizers of the Women’s March wrote. “So, we will bring the circus to him. Come in your clown makeup, and we will show the world what the Federal Court is all about here in Amarillo, a kangaroo court!”

If Kacsmaryk rules in favor of ADF, mifepristone would, at least temporarily, be taken off the market. All states where abortion is legal would only be able to offer in-clinic procedures.

This means patients will not be able to access telehealth services to get abortion pills and clinics already experiencing a surge of patients from states where abortion is illegal could be even more inundated.

ABC News’ Anne Flaherty contributed to this report.

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(NEW YORK) — Social media users, online groups, and even celebrities like Martha Stewart, are touting CBD as a real aid for sleep, but some are beginning to wonder if the legal chemical found in marijuana really works.

Cannabidiol, known as CBD, is a compound found in marijuana but is not an intoxicant, meaning it does not cause a “high,” according to the Centers for Disease Control and Prevention.

Jessica Ater, a mother of two in Washington state, said she’s been struggling with sleep.

“I can’t sleep at night. Like that’s when my brain starts going crazy,” Ater told ABC News’ Good Morning America. “Nothing worked and, if it did work, not long term.”

After reading about CBD in an online mom’s group, Ater said she bought some CBD gummies at a dispensary that helped.

“My anxiety I mean I still have it at night, but it definitely helps shut my brain off so that I’m able to sleep,” said Ater.

However, Annie Guthrie, a college student who wanted to fall asleep earlier, said her experience with CBD chocolates didn’t work for her at all.

“I had the hardest time sleeping so I needed to try something that could help that,” Guthrie told GMA. “Nothing happened. It didn’t work. It didn’t work at all.”

Dr. Ryan Vandrey, one of the country’s preeminent scientific researchers on CBD, said CBD may have better results for people with anxiety or pain compared to those who have a hard time falling asleep.

“Someone who has insomnia might not benefit from it unless the insomnia is secondary to something else like anxiety, or pain condition,” Vandrey said to GMA.

The Food and Drug Administration has indicated that they want to create more regulations for CBD. So far they’ve only approved it for the treatment of some seizure disorders.

Vandrey said that studies that exist on CBD are small and some found that the chemical doesn’t always isolate from THC, the part of cannabis that makes you high.

“So we don’t have the large randomized controlled trials,” he said. “So we see a lot of promise but we still need more evidence.”

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