(NEW YORK) — Researchers in Australia have found that for low back pain sufferers in their mid-40s, opioids don’t mitigate pain any better than a placebo. Among the study’s participants, the placebo gave slightly more positive results in helping manage pain.
Close to 350 participants – 51% male and 49% female, and with a median age of 44 – were enrolled in the study led by researchers at the University of Sydney, and shared by medical journal The Lancet. Recruited through primary care clinics and emergency departments, the study participants were randomly assigned either an opioid or placebo to treat lower back pain or neck pain.
Across the six-week treatment period, there was no difference in the pain levels reported by the participants. Although the scientists noted the disparity was not statistically significant, the placebo group reported a slightly lower pain intensity at 2.25, while the opioid group reported 2.75. Physical functioning and quality of life – other metrics used in the study – also trended in favor of the placebo group, but the difference was not significant, the study noted.
Participants recruited did not have medical problems of greater severity, such as a fracture, and they also did not previously suffer from back pain.
Both the placebo and opioid treatment groups were permitted to receive additional non-opioid treatments like non-prescription pain medicines during the study. However, only 58% of the participants adhered to taking the opiate or placebo.
Patients that did not provide adequate follow-up results were excluded from the analysis.
Professor Andrew McLachlan, dean of Sydney Pharmacy School and a co-author of the research, told ABC News that with opioids not recommended, other courses of treatment should be the focus.
“Managing low back pain requires careful assessment to check for serious causes and reassurance that most people will recover if they can stay active,” he said via email. “Treatments such as the application of heat and also anti-inflammatory medicines may be help[ful] in people who can take these medicines.”
He also advised that anyone currently using opioids for pain management should consult their doctor or pharmacist before abruptly stopping those medications.
“Stopping opioid medicines may require a gradual reduction in dose to avoid some of the harmful and unpleasant withdrawal effects of these medicines,” he added.
The findings of the study were particularly relevant in light of the continuing opioid crisis in the U.S., with the drugs becoming the leading cause of overdose deaths among all ages since 2016, according to the National Institute on Drug Abuse.
(WASHINGTON) — The White House revealed on Wednesday that President Joe Biden has begun using a CPAP machine to deal with longstanding sleep apnea.
“Since 2008, the President has disclosed his history with sleep apnea in thorough medical reports. He used a CPAP machine last night, which is common for people with that history,” deputy press secretary Andrew Bates said in a statement.
Here what the condition is and how it can be treated:
What is sleep apnea?
Sleep apnea is a sleep condition in which breathing suddenly stops and starts repeatedly while a person is sleeping.
There are two main types of sleep apnea. The first is obstructive sleep apnea (OSA), which is the most common form and occurs when throat muscles relax and block air flow to the lungs, according to the National Heart Lung and Blood Institute.
The second form, central sleep apnea (CSA), occurs when the brain doesn’t properly send signals to the muscles that control breathing.
Other symptoms include frequent loud snoring and gasping for air during sleep. While awake, a person may notice symptoms including fatigue, dry mouth and headaches, waking up to urinate at night and sexual dysfunction or lower libido.
How is sleep apnea diagnosed?
If a person is believed to be suffering from sleep apnea, their health care provider may refer them to a sleep disorder center to run tests and monitor patients overnight.
One test, known as a nocturnal polysomnography, involves hooking a patient up to equipment that monitors heart, lung and brain activity; blood oxygen levels; breathing patterns; and arm and leg movements during sleep, according to the Mayo Clinic.
Home sleep tests can also be performed, which involve measuring a patient’s heart rate, airflow, blood oxygen levels and breathing patterns during sleep but at home rather than at a clinic.
The American Medical Association estimates about 30 million people in the United States have sleep apnea, but only six million are diagnosed with the condition.
Is sleep apnea serious?
Millions of people may suffer from sleep apnea, making the condition seem harmless, but it can be serious.
Complications of OSA include heart issues, high blood pressure, type 2 diabetes or liver problems while CSA can lead to cardiovascular complications, the Mayo Clinic said.
Both types of sleep apnea can cause daytime drowsiness or tiredness, which can lead to trouble focusing or concentrating.
What is a CPAP machine?
A CPAP, or continuous positive airway pressure machine, is a common form of treatment for sleep apnea.
CPAP machines keep the airways open so people can receive oxygen while they’re sleeping. They can not only improve sleep quality but reduce the risk of health issues including heart attack and stroke, according to the Cleveland Clinic.
Different types of masks are available including one that just covers the nostril area, one that covers the nose, and a full mask that covers the nose and mouth.
(NEW YORK) — A Montana judge permanently struck down a law making it more difficult for transgender people to change their sex on their birth certificate and held the state health department in contempt for disregarding court orders.
The 2021 bill — which was signed into law at the time by Gov. Greg Gianforte — required a transgender person to have gender-confirmation surgery and a court order before their sex could be changed on their birth certificate by the Montana Department of Health and Human Services.
Prior to the law, residents were allowed to amend the sex designation of their birth certificate either by submitting a gender-designation form confirming their gender transition, a government ID with the correct sex designation or a court order indicating the change.
In the Monday order, 13th Judicial District Court Judge Michael Moses wrote that the law was permanently enjoined because it is unconstitutional and the health department showed a “flagrant disregard” after previous orders temporarily banned the law.
In April 2022, the judicial court issued an order preliminarily enjoining the law and instructed the state to return to the previous rule for changing sex designation.
“Defendants, instead, engaged in temporary rulemaking and promulgated a temporary rule whereby DPHHS removed the procedure for changing the sex designation of birth certificates altogether,” Moses wrote.
Although the state eventually did drop the change, they took the case to the Montana Supreme Court, which agreed with the lower court’s decision and said the state had to go back to the previous rule.
Despite the state Supreme Court’s order, DPHHS stopped providing a method for people to change the sex designation on birth certificates.
Although the state had new counsel representing it at a hearing last month, Moses said the lawyers were unable to provide an explanation for why Montana continued to disobey court orders.
“The state here did not act in good faith or in accordance with constitutional and statutory mandates,” Moses wrote. “This court determined that it was in contempt of court for a significant portion of this litigation.”
He continued, “Weighing the equities, this is not a garden variety case. The defendants spent considerable time and effort defending a statute that they knew was unconstitutional. They ignored orders from this court and an order from the Supreme Court.”
Moses ordered the state to pay plaintiffs “reasonable” attorney fees and costs related to the contempt of court action between January 2023 and June 2023.
(NEW YORK) — A new analysis from Consumer Reports found that some heavy metals in baby food have been on the decline but the report argues more can be done to make baby food safer overall.
Through random testing of baby food products, Consumer Reports found levels of some heavy metals such as arsenic, cadmium and lead in baby food have fallen since 2018.
Low exposure to heavy metals is not considered harmful but advocates have pushed for more regulation in baby food. A 2021 report from a House oversight committee warned of “dangerous levels of toxic heavy metals in even more baby foods” and the Food and Drug Administration launched a “Closer to Zero” initiative that aimed to reduce contaminants like heavy metals in baby food.
Consumer Reports noted that some foods still contain higher levels of heavy metals, including rice, sweet potatoes and snack foods like rice-based puffs and teething wafers.
Toxicologist Stephanie Widmer told ABC News the presence of heavy metals in baby food shouldn’t be a surprise since they are present in the soil used to grow crops.
“We have to remember that heavy metals are in the soil where crops grow; they are part of the Earth,” Widmer said. “Heavy metals are and always have been present in tons of different foods we consume and feed to our children.”
Widmer added, “Variety in our diets is key in limiting exposure to harmful heavy metals. It doesn’t mean we have to eliminate certain baby foods entirely — long-term effects from heavy metals come from repetitive exposure over very long periods of time. Parents should not be alarmed and should simply continue to ensure variety in the diet.”
(NEW YORK) — For Emma Goidel and Ilana Caplan, building a family using assisted reproductive technology was never going to be easy, but the couple says they never imagined the financial costs they’d face simply because of who they are.
“We looked really closely at our insurance and we saw, oh my God, Aetna covers fertility procedures. But then when we read the fine print, we saw – wait a minute, this coverage is only for people having heterosexual sex,” said Goidel, who lives in New York City.
As a growing number of same-sex couples turn to intrauterine insemination (IUI) and in vitro fertilization (IVF) to have children, many say they’re encountering entrenched inequality in how benefits are provided by health insurers and employers.
While insurance companies in more than a dozen states offer no-cost fertility treatments for straight couples who struggle to get pregnant, they often refuse to cover those same services for lesbian or gay couples until they’ve paid out of pocket for up to a year.
Goidel and Caplan spent nearly $50,000 of savings to have their son Avi, who is a year old. None of the expenses for IUI or IVF were reimbursed by the insurer, Aetna, they say.
“How is it OK to say if you’re straight and your partner can’t get you pregnant, you come into the doctor and we’ll cover your treatment, but if you’re a queer and your partner can’t get you pregnant, too bad you’re going to pay?” said Goidel.
One-in-three American adults say they’ve used fertility treatments, like IUI or IVF, to grow their families or know someone who has, according to Pew Research Center, and many have spent thousands of dollars out of pocket in the process.
In places where fertility benefits are offered or required, LGBTQ people can be disadvantaged.
“Only 14 states provide coverage on private insurance plans for fertility health care, [but] only three states have fertility insurance laws that inclusively cover LGBTQ people,” said Polly Crozier, director of family advocacy, GLBTQ Legal Advocates & Defenders (GLAD).
“When there’s not access to fertility health care in your state, it particularly hits LGBTQ people hard, and then even in the states that do have access to fertility health care, LGBTQ people there face different standards. There are different rules for those families. It’s just not equal,” Crozier said.
Advocates say the fight for “fertility equality” is emerging as a key legal battleground. More than 100,000 same-sex couples are raising children in this country, according to government data, and increasing numbers are looking to grow their families, advocates say.
“We’ve always wanted to have kids. We knew when we got married that we wanted to have a family,” said Goidel, 33, who wed Caplan, 33, in 2017.
After having their first child through self-funded intrauterine insemination using donor sperm, in 2020 the couple consulted with their newly acquired Aetna health plan about fertility coverage for a second pregnancy.
The plan stipulated a diagnosis of infertility in order to qualify, they said. For Goidel and Caplan, that meant having to first attempt at least 12 months of IUI treatment — paid out of pocket — before any insurance coverage would kick in.
They got pregnant using IUI after five prior attempts, one of which resulted in a miscarriage, and one cycle of IVF, which also resulted in a miscarriage.
“My partner can’t get me pregnant. Whether that’s because she doesn’t have the gametes or something’s going on internally with me. No one makes that distinction when you’re a straight couple,” Goidel said.
Goidel brought a federal class-action lawsuit against Aetna in 2021, accusing the insurance company of sex discrimination for denying equal access to fertility treatment.
In court documents, the company denies the claims, saying Goidel did not meet requirements for fertility coverage under her health plan.
“Aetna is committed to equal access to reproductive health coverage for all members,” the company told ABC News in a statement on the Goidel case. “We offer infertility coverage for our plan sponsors, which aligns with our publicly available guidelines, individual benefit plans, and regulations. We have a history of strong support for the LGBTQ+ community, which we continue to build on. We continually evolve our benefit coverage guidelines based on evidence-based clinical information and member safety as a top priority.”
The case is currently pending in federal district court.
For gay men who want their own kids through surrogacy, it can be even more complicated and costly.
Corey Briskin, 34, and Nicholas Maggipinto, 37, of Brooklyn, New York, say neither their health insurance nor Briskin’s employer, the City of New York, would cover any costs of fertility treatment needed to get a surrogate pregnant.
“There’s just no way that that’s not some form of discrimination,” Maggipinto said in an interview.
Both men are attorneys.
“The No. 1 hurdle that every same-sex couple faces is that they can never meet the definition of infertility, which is the threshold qualifier for covered IVF,” he said.
Briskin and Maggipinto filed a class-action discrimination complaint in April 2022 with the Equal Employment Opportunity Commission (EEOC), seeking a nationwide order that employers must extend fertility benefits to LGBTQ employees.
The City of New York provides IVF benefits for heterosexual employees who have faced difficulty getting pregnant and are deemed infertile but does not cover LGBTQ employees because they cannot meet the infertility criteria.
The City, which declined an interview with ABC, argues the charge should be dismissed, telling the EEOC in a legal filing that “practically all” employer-provided health insurance nationwide does not cover IVF for surrogate pregnancies, “consistent with the law” and is “not discriminatory.”
The complaint remains pending at EEOC.
“I think there’s a fair argument that that’s sex discrimination, sexual orientation discrimination, and frankly, just bad business,” Crozier said.
A small growing number of companies are providing benefits for family building outside of insurance plans, some chipping in for IVF and others offering to help cover the cost of adoption.
Both couples — Briskin and Maggipinto, and Goidel and Caplan — said they respect adoption as an option for same-sex couples to build families but not one that should be imposed on them.
“There’s nothing wrong with adoption, and for many people, that is a really wonderful option and maybe even their preference,” said Briskin. “But at the same token, no one should tell us that we should build our family that way.”
As the legal cases play out, both families hope change is on the horizon.
“We are hopeful that whatever becomes of this, there will be a change for the better for people who are similarly situated to us,” Briskin said.
(NEW YORK) — Drugs used for diabetes and weight loss like Ozempic and Wegovy were found to be effective for weight loss when taken as a pill, according to research published over the weekend.
Rybelsus is the pill version of semaglutide — the active ingredient that helps patients lose weight — and is already approved for those with Type 2 diabetes.
A new study published in The Lancet highlighted that a higher dose of the pill also worked for weight loss in those without diabetes. Researchers looked at nearly 700 patients with overweight or obesity for over a year and found that the drug lowered body weight by an average of 15%.
Nearly 70% of those who took the pill achieved a 10% reduction in body weight. Additionally, over three times the number of people taking the drug achieved a 5% reduction, a generally accepted baseline for clinically meaningful weight loss.
Ozempic and Wegovy are typically injected once a week. Researchers noted that a once-daily pill would increase the options for those struggling with obesity.
Although studies were not designed to directly compare, the injectable form of the drug appears more effective than the pills. Both versions of the drug have similar safety profiles but come with a relatively high proportion of patients reporting side effects like nausea and constipation.
“This is not just for cosmetic or vanity’s sake. This is to change health risks and outcomes,” Dr. Jennifer Ashton, ABC News chief medical correspondent and a board-certified obesity medicine specialist, said on Good Morning America.
Those with obesity may struggle to manage long-term weight loss with changes in diet and exercise alone. While doctors can prescribe the pills off-label, additional research may help open doors to getting semaglutide pills used more widely for weight loss, rather than just for those with diabetes.
The results come on the heels of new research estimating that the number of people living with diabetes will double by 2050, exceeding 1.3 billion worldwide.
Around half of this increase may be attributable to obesity fueled by the widespread availability of ultra-processed and relatively cheap food options.
“Remember, when you talk about the bad news of these increasing Type 2 diabetes rates, the good news is that Type 2 diabetes is largely reversible and preventable, but that does not mean it’s easy to do that,” Ashton said.
Those who are overweight or obese are often at a higher risk of developing Type 2 diabetes. Over 70% of American adults are considered to be overweight or obese, and more than 37 million people in the U.S. have diabetes, according to the Centers for Disease Control and Prevention.
(SARASOTA, Fla.) — Five people caught malaria locally in the U.S. for the first time since 2003, according to health officials.
Four people in Sarasota County, Florida, and one person in Cameron County, Texas, reported cases of the mosquito-borne illness, state officials said. Cameron County is the southernmost county in Texas, about 1,300 miles away from Sarasota, Florida.
All four Florida patients “have been treated and have recovered,” according to a statewide mosquito-borne illness advisory from the Florida Department of Health released Monday. Residents have been advised to “take precautions by applying bug spray, avoiding areas with high mosquito populations, and wearing long pants and shirts when possible — especially during sunrise and sunset when mosquitos are most active,” the health department said.
The last locally acquired Texas cases occurred in 1994 and 2003 in Palm Beach, Florida, according to the Centers for Disease Control and Prevention.
The illness is caused when a person is bitten by a mosquito carrying malaria parasites, the CDC said. Malaria isn’t contagious and can’t be spread person-to-person.
Symptoms include fever, chills, muscle aches, nausea headache and anemia, and can sometimes be fatal if not treated, according to the CDC.
Malaria used to be common in the U.S., but a 1947 campaign by southeastern states to spray insecticides and drain breeding grounds eliminated transmission, according to the CDC.
There are around 2,000 malaria cases a year, the CDC said, but they’re most often diagnosed in people who caught the disease while abroad.
The risk to most people of locally acquired malaria is currently extremely low, the CDC said in a statement regarding one of the Florida cases.
Climate change could reverse progress made in fighting the illness, with warmer temperatures possibly expanding the range for mosquitoes that carry diseases like malaria, research published in the Lancet Planetary Health indicates.
“The presence of competent mosquitoes and warmer temperatures in the Southeast will likely lead to additional cases in the coming months and years,” Dr. John Brownstein, an infectious disease epidemiologist and chief innovation officer at Boston Children’s Hospital, told ABC News. “Future invasion of new mosquitoes, coupled with potential climate change effects, could significantly expand the malaria risk.”
“While the permanent return of malaria is still unlikely, these cases represent a broader warning of mosquito-borne diseases in the region,” he said.
People can protect against mosquito bites by draining standing water in gutters and flowerpots, wearing long sleeves and long pants, wearing insect repellent and using screens on windows, according to the CDC.
(SARASOTA, Fla.) — Five people caught malaria locally in the U.S. for the first time since 2003, according to health officials.
Four people in Sarasota County, Florida, and one person in Cameron County, Texas, reported cases of the mosquito-borne illness, state officials said. Cameron County is the southernmost county in Texas, about 1,300 miles away from Sarasota, Florida.
All four Florida patients “have been treated and have recovered,” according to a statewide mosquito-borne illness advisory from the Florida Department of Health released Monday. Residents have been advised to “take precautions by applying bug spray, avoiding areas with high mosquito populations, and wearing long pants and shirts when possible — especially during sunrise and sunset when mosquitos are most active,” the health department said.
The last locally acquired Texas cases occurred in 1994 and 2003 in Palm Beach, Florida, according to the Centers for Disease Control and Prevention.
This is a developing story. Please check back for updates.
(NEW YORK) — As a pediatrician, Dr. Kristina Lehman knows the ins and outs of the evidence around breastfeeding better than most.
But as a mother, she also knows that breastfeeding is hard and that following evidence-based guidelines isn’t possible or the choice for everyone.
“I’m more proud of my breastfeeding relationship than even my [medical degree],” Lehman, who is also a breastfeeding medicine specialist, internal medicine physician and associate professor at the Ohio State University Wexner Medical Center, told ABC News.
The American Academy of Pediatrics (AAP) recommends that infants be exclusively breastfeed for the first six months of life and continue breastfeeding along with other food until two years of age.
Research shows breastfeeding has many benefits, including decreased infant infections and childhood cancers as well as a decreased risk of diabetes, high blood pressure, breast, ovarian and endometrial cancer in the mother.
But only about a quarter of women meet those recommendations, according to data shared by the U.S. Centers for Disease Control and Prevention. Experts said that’s partly because health care and social systems aren’t set up to support breastfeeding.
The gap may mean groups like the AAP should consider adjusting their recommendations to remove the emphasis on exclusivity regarding breastfeeding and amend the two-year time frame due to the unattainable standard for so many, argued Seattle physician Dr. Amy Kennedy in a recent editorial in the New England Journal of Medicine.
“I encourage the AAP and other national health organizations to consider how their statements on exclusive breast-feeding are perceived by the public,” Kennedy wrote. “Everyone’s journey is different.”
But other experts said increasing support is the best way to close the gap — not changing the guidelines. Last week, Lehman and Dr. April Castillo, a preventive medicine physician and breastfeeding specialist, published an article in response on the physician-facing website KevinMD.
They argued that the health care system — including doctors themselves — needs to improve the support of women in their infant feeding choices.
The lack of social support, limited education for physicians around breastfeeding, and marketing from the formula industry adds to the stress, anxiety and isolation during an already fraught time, according to Dr. Anne Eglash, a family medicine physician and president of the North American Board of Breastfeeding and Lactation Medicine.
Postpartum depression and anxiety — which affect 1 in 8 people after delivery, according to the CDC — can make the process even more challenging.
The current system makes it difficult for parents to actually make a choice either way, according to Eglash, who told ABC News that “no one is supporting” parents.
Eglash described a situation in which medical providers tell the public people should breastfeed, but then send new parents, “out to run that marathon and there’s a desert and no one’s offering any water.”
Changes that could help might include improving doctors’ education around breastfeeding, putting resources towards systems that can help parents find infant feeding experts like lactation consultants, and increasing awareness around postpartum depression, according to Eglash and Castillo.
There also need to be more resources around mixed feeding, which combines breastfeeding and formula feeding, Castillo told ABC News.
But even with improvements in support, meeting guidelines still might still not be feasible for some parents, according to Kennedy.
She said she had many resources at her disposal and a supportive partner, but breastfeeding was difficult for her. She said she wasn’t able to exclusively breastfeed for six months, much less breastfeed for two years.
Still, all the experts agreed that people feeding infants need compassion, regardless of the way they navigate the journey.
“I think a lot of women think that it is all or nothing. And so when they try all and it’s too hard, they totally quit instead of backing off a little bit. But that’s where you need that individualized support to be able to say, what are your goals?” Lehman said. “It’s a conversation and it has to be individualized.”
Eglash noted that the goals aren’t the problem — the system needs to change to help people have the best possible experience.
“I think the big thing is that we all want babies fed, right? And we want parents to meet their intentions, to have the right to feed their babies the way they intend,” Eglash said.
Danielle Craigg, MD, is a senior general preventive medicine and public health resident at Renaissance School of Medicine at Stony Brook University and a member of the ABC News Medical Unit.
(NEW YORK) — Shortly after a Tennessee trigger ban on abortion went into effect last September, a group of maternal fetal medicine specialists, family planning physicians, bioethicists, neonatologists and a lawyer gathered to form a panel tasked with determining whether the facility could provide medically necessary abortion care in line with state law.
Physicians decided it was best to evaluate and gain a consensus in situations where patients were requesting abortion care or doctors are recommending it.
“It really came about from the fact that many of us are very concerned and nervous for our own safety, and felt that some of these would be decisions that are better made in a group setting,” Dr. Sarah Osmundson, a maternal fetal medicine specialist in Tennessee, told ABC News.
“Usually these are time-sensitive issues,” Osmundson said. “So, even though we have meetings every other month, when a case arises, it usually means that we have to either ad hoc meet or talk or communicate over email and explain the patient’s situation. And then we ask for three physicians to review the chart and to weigh in on whether they think an abortion would meet the standards set by the current laws.”
Tennessee’s law only makes exceptions for cases where it is necessary to prevent death or serious and permanent bodily injury to the mother.
“We are basically looking at these cases individually and trying to guess whether we think a reasonable group of other Tennesseans would look at these individual cases and agree that an ongoing pregnancy represents a risk of death to the patient or serious medical impairment,” Osmundson said.
Physicians in several states told ABC News that facilities are using termination boards or medical ethics boards to navigate whether they can provide patients with medically necessary abortions in line with exceptions allowed in their states.
Dr. Nicole Teal, a maternal fetal medicine specialist, told ABC News that abortions past 20 weeks of pregnancy in the hospital where she works in North Carolina require two physicians to sign off in cases where the mother’s life is at risk. In most cases, both physicians are specialists. In July, North Carolina will start enforcing a ban that prohibits abortions past 12 weeks of pregnancy, with an up to 20-week exception for rape or incest and 24 weeks for fatal fetal anomalies.
If physicians feel the case is a gray area and they are unsure whether the abortion would be permitted under the ban, they get the hospital’s legal and ethics teams involved before providing care.
“Logistically speaking, what happens when someone comes in and they’re sick and it’s Saturday night? The ethics committee is not going to convene Saturday night at midnight to come up with an answer,” Teal said.
Some common pregnancy complications could be deadly if left untreated, but patients may not be showing signs of illness or an imminent threat to their life when they first show up at a hospital. This leaves doctors’ hands tied.
Teal told the story of one patient who came in who came in with “very severe preeclampsia,” a serious and sometimes fatal pregnancy complication that occurs after 20 weeks, but physicians had to wait until her health got worse before they could help her because the state’s 20-week ban was in effect.
“We knew it was happening, her blood pressure was getting higher, her labs were starting to get off. But we basically waited until her labs got bad enough that we could say, ‘It’s an imminent threat to her life.’ Basically we had to wait until her labs started crashing before we could take care of her,” Teal said.
“Preeclampsia sometimes progresses really rapidly, like in a couple days, and sometimes it takes weeks and we couldn’t say for sure it would it be one day or seven days before it was an imminent threat to her life,” Teal said.
Teal said several friends who practice medicine in southern states — like Florida, Mississippi, Georgia, Tennessee and even Texas — have been reaching out about patients whose health is in danger asking if she could provide them with abortion care. That access could no longer be available when a 12-week abortion ban goes into effect in July.
One patient with pulmonary hypertension, a serious condition that has over a 50% maternal mortality rate if the mom remains pregnant, was denied an abortion in Mississippi by an ethics committee, according to Teal. She traveled to North Carolina to receive care, Teal said.
At a leading health care facility in Houston, medically necessary abortions have to be approved by at least 75% of a panel made up of about six multidisciplinary physicians and a lawyer, according to Dr. Alireza Shamshirsaz, a maternal fetal medicine specialist who moved from Texas to Massachusetts last year.
Shamshirsaz said this usually only happens when a mother is very sick. Physicians need lab work, vital signs and sometimes cultures that show her health deteriorating.
“You can act [without getting their approval] and [retroactively] submit this data to the board, but then you need to be a very brave physician, because now you put your credentials and your career on the line,” Shamshirsaz told ABC News.
Before he left the hospital where he worked in Texas, Shamshirsaz said he had a patient pregnant with twins who went into labor early. After delivering the first of the two babies, the umbilical cord was prolapsed in the vagina, a rare medical emergency, and because the fetus still had a heartbeat, the board denied abortion care.
After staying in the hospital for several days, the patient was sent home, Shamshirsaz said. She later came back in septic shock and lost one of her kidneys. Shamshirsaz said she will likely need a transplant or dialysis in the future.
At the Boston facility where he currently works, Shamshirsaz said physicians can provide abortions up to 26 weeks and six days without needing approval. In complex late-term abortions that go past that threshold, Shamshirsaz gets other physicians at the Boston facility to sign off on the care as a safety net for himself.
Dr. Kelly Mamelson, a second-year resident who has lived in Florida almost her entire life, told ABC News the facility she currently works at requires two physicians to sign off on a medically indicated abortion — the only abortions it provides — whether that be maternal or fetal indication, before it can be performed.
“There is certainly a lot of anxiety behind [the laws’ ambiguity] and it can lead to delays in care,” Mamelson said.
For patients with pre-viable rupture of membranes — a condition fatal for fetuses if they are not at a gestational age compatible with life that can also be dangerous for mothers — if there is still a fetal heartbeat, physicians at her hospital in Florida have to wait until the mother is showing signs of an infection before they provide abortion care, Mamelson said.
“By waiting until you’re in a very dire situation, or potentially fatal situation, you’re doing a lot of harm to the patient. So, waiting for a mom to become septic, to then perform a procedure is extremely problematic. And I think it really highlights the lack of medical knowledge that seems to be pretty common among the legislators making these decisions,” Mamelson said.
Even after Tennessee lawmakers added an exception allowing abortions for ectopic pregnancies, physicians fear abortion laws when it comes to providing lifesaving care, Osmundson said.
“I think we are also balancing our ethical obligations as physicians and the oath that we took, and many of us have just decided that we’re going to do what we think is right for patients to ensure that nobody dies or has serious morbidity as a result of not performing care,” Osmundson said.
“Most of us do this at great personal risk. Unfortunately, I don’t think that we feel super protected by the current laws,” Osmundson said.
Even though the hospital where she works has told physicians it would provide criminal defense coverage if it ever comes to that, Osmundson said the risk of prosecution is still a huge burden. She also said the risk is far greater for physicians who do not work in a large medical center that would be willing to support them.
“It’s a huge mental and emotional burden to experience some of these cases along with patients and to try to care for these patients. And I would love the state of Tennessee to be witness to how challenging that is. I think it would help them empathize with what our patients go through,” Osmundson said.
“I never thought I would have to entertain what the state of Tennessee thinks is right or wrong,” Osmundson said.
