Abortion pill can be sold at drugstores, FDA says

(alex hogan/stat)

Late yesterday the FDA expanded access to abortion medication by allowing retail pharmacies to offer mifepristone, the first of two drugs used in the two-part process, expanding availability beyond a few mail-order pharmacies or specially certified doctors or clinics. The regulatory change, first reported by the New York Times, still requires patients to have a prescription from a certified health care provider and to fill out a consent form. More than half of pregnancy terminations come from abortion pills as people feel the effects of the Dobbs decision.

Mifespristone blocks a hormone needed for pregnancy to develop and is typically taken in the first 10 to 13 weeks of pregnancy. The second drug is the less-restricted misoprostol, taken 24 to 48 hours after mifepristone to cause contractions that expel tissue. In December 2021, the FDA ended the requirement that patients get mifespristone in person, enabling consultations and prescriptions by telemedicine.

What’s on the horizon for infectious disease

Three years into a confounding pandemic, making predictions puts you on a path to folly. But there are developments to watch in infectious disease, broadly speaking. And they are cause for concern. All those “seasonal” respiratory illnesses like flu and RSV are back, appearing at odd times and hammering overstretched hospitals, not to mention mpox, vaccine-derived polio, Ebola, cholera. Also on the horizon: Covid in China. With too many unprotected people traveling for Lunar New Year there, it could get ugly, STAT’s Helen Branswell tells us.

Here’s what’s more worrying: “We think everyone — policymakers and people who rely on health care — should give some thought to the fact that nurses and doctors and EMTs and hospital staff and laboratory technicians and public health officials at every level are simply tapped out,” she writes. Read more.

Paying people the right amount might improve diversity in clinical trial participation

Paying people to participate in medical research has a long history. In 1900, STAT’s Usha Lee McFarling reminds us, military surgeon Walter Reed paid people willing to be bitten by yellow fever-infected mosquitoes $100 in gold (roughly $3,500 today) to take part in studies, and $100 more if they became infected. Now researchers are exploring whether paying volunteers could help narrow racial and ethnic gaps in who takes part in clinical trials. A new study found that how much people are offered matters.

Offering $100 to join a survey to detect Covid antibodies enticed affluent and white people while doing little to increase the participation of people from low-income or non-white households. A $500 incentive closed the gap completely. “I think it speaks to some real discomfort in responding to these surveys, which is not equally spread across populations,” co-author Michael Greenstone of the University of Chicago told Usha. Read more.

Closer look: People with disabilities face barriers to reproductive health

(MARIA FABRIZIO FOR STAT)

For people with chronic conditions and other disabilities, pregnancy can introduce additional barriers, stigma, and risks. Disabled people in the U.S. are less likely to receive comprehensive sexual education and access to contraceptives, so they’re more likely to have unintended pregnancies. During pregnancy, disabled women are more likely to have adverse birth outcomes and to experience pregnancy complications, in part because they often are on medications that interact negatively with pregnancy.

STAT’s Isabella Cueto and contributor Lacey Lyons spoke with seven people about their experiences. For Leigh Krauss, who was diagnosed with multiple sclerosis nearly a decade ago, a second attempt at pregnancy via IVF and a surrogate was successful after a painful loss the first time. “We wanted this so badly and especially with what we went through, I just came from a place of gratitude — that I’d really wished for this so much,” she said. Read their stories.

When doctors know each other, patients benefit, study suggests

Sometimes, it’s who you know that makes a difference. A new study in JAMA Internal Medicine found that when primary care physicians’ patients were referred to specialists with whom they trained in medical school or later programs, patient reviews of the specialist were higher than when there was no such bond — even if the PCP didn’t make the referral. In evaluations at one large health system, patients said these specialists treated them with more concern, gave clearer explanations, engaged them in more shared decision-making, and spent more time with them compared to patients who saw specialists without ties to their PCPs.

The researchers suspect specialists knew PCPs would read their clinical notes or hear from their patients. As opposed to incentives that involve money, “this study suggests potentially large gains in quality from encouraging and harnessing physician-peer relationships,” the authors write.

Opinion: Emergency rooms — and a federal law — can't get around state abortion bans

The Dobbs decision overturning Roe v. Wade is being adjudicated in hospital emergency rooms, long thought of as the last chance for people desperately seeking reproductive care. But now, emergency medicine physicians Jennifer Tsai and Hazar Khidi write in a STAT First Opinion, getting treatment for pregnancy-related medical emergencies is complicated by state abortion bans that introduced complex legislative restrictions around what counts as a medical emergency. Even the Emergency Medical Treatment and Labor Act can't help.

“Pregnant people experiencing worrisome pain and bleeding can’t be expected to know whether or not they are facing a medical emergency,” they say. Practicing emergency physicians can’t know without examination and diagnostic tests if something is a medical emergency, nor predict with certainty when a medically urgent issue might become life-threatening. “This means state legislators, lawyers, and insurance administrators don’t have the ability to do so either. The fact that we let them is harming people.” Read more.

What we're reading

Arizona inducing the labor of pregnant prisoners against their will, AZcentral
Antibody drugs could target infectious diseases — if costs come down, Washington Post
Telehealth brings expert sexual assault exams to rural patients, Kaiser Health News
3 drug pricing issues to watch in 2023, STAT
Why do you get sick in the winter? Blame your nose, Wired
Opinion: NIH advances landmark recommendations on disability inclusion and anti-ableism, STAT