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A STAT investigation: HHS considers changes to sterilization consent

June 18, 2024
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Morning Rounds Writer and Podcast Producer

Happy pub day to Anthony Fauci — did you know that basically all new books are released on Tuesdays? I worked in book publishing for three years and never actually found out why, but it's true. Which, by the way: There's still time for you to share your favorite health and science reads (and listens!) for our summer list.

Also, you won't see me in your inbox tomorrow. It's Juneteenth! Talk to you on Thursday.

reproductive health

A federal rule was supposed to stop coercive sterilization — it didn't

Since the late 1970s, a federal rule has required any patient on Medicare or Medicaid to sign a consent form at least 30 days before a tubal ligation or vasectomy. The idea is to give people time to make a careful, fully-informed decision. It's necessary protection — a previous investigation by STAT's Eric Boodman found that, for decades, some women with sickle cell disease have felt pressured into getting sterilizations they didn't want or didn't fully understand.

But for some people, the waiting period can do more harm than good. For example: If you're hoping for a tubal ligation during your C-section, but don't know to ask for it far enough in advance, you might be out of luck. Or simply: A misplaced piece of paper could lead to, in the most extreme scenario, an unwanted pregnancy. 

Now, 45 years after the rules came into effect, the federal government is quietly considering shortening the waiting period and clarifying the form. Read the latest story in Eric Boodman's Coercive Care series, which asks the daunting ethical question of how to ensure true consent for a medical procedure as weighty as sterilization.


addiction

Not enough people are getting medicine after an overdose, study says

About 17% of people on Medicare who survived a drug overdose in 2020 experienced another one within a year, according to a new study in JAMA Internal Medicine. But a much smaller percentage — just 4% — received medication for opioid use disorder in the year after an overdose. These drugs, including methadone or buprenorphine, are effective, cheap, and easy-to-distribute treatments that can help people recover from addiction. Of the study's 136,762 Medicare beneficiaries who survived an overdose, 1,323 died within a year.

Researchers from a collection of federal agencies including CDC, CMS, and NIH found that receiving addiction medication, filling a prescription for naloxone (an emergency medicine that can reverse overdose), and receiving a behavioral health assessment or crisis services all reduced a person's odds of dying from an overdose in the year after surviving one. The results point to a continued need to improve access to these medications and services, the authors write. But you already know that if you read reporting from STAT's Lev Facher on overdose deaths in the U.S., federal research on treatment, and how private equity got into the recovery business.   


climate change

Sun's out, statistics out: The news you need for this week's heat wave

It's going to be very, very hot this week in many parts of the country. If you need evidence to convince any stubborn family members that, no, they aren't immune to extreme heat and, yes, we should put the AC in the window, then STAT has you covered. 

What can the heat do to you? Last summer was the hottest in 2,000 years here in the northern hemisphere. Heat waves are associated with an increased risk of preterm birth; they can put your heart into 'oxygen debt,' in addition to triggering heart attacks and strokes.

Maybe someday we'll get prescriptions for AC, but today is not that day. Not enough people currently have access to air conditioning, and this is just one of the factors experts are considering when looking toward a future of even more extreme heat. Another already-in-use option: rapid cooling body bags



first opinion

'Long Covid feels like a gun to my head'

Andrew Harnik/AP 

Rachel Hall-Clifford has spent her career studying neglected tropical diseases. But in 2022, she got Covid for the first time, and now she has her own neglected disease: long Covid. Hall-Clifford is not easily intimidated — she once talked a Guatemalan street gang out of harming her research team as someone held an assault rifle to their heads during a robbery. But in a new First Opinion essay, she admits that long Covid scares her like nothing else.

"This is not a funny story I will tell colleagues over drinks later," she writes. "I spend a lot of my time lying in the dark (I'm here now, even as I type this) negotiating with god and science to make me — and all of us suffering with long Covid and other post-viral illnesses — better." Read the essay, and watch out for an interview with Hall-Clifford on the First Opinion Podcast tomorrow.


technology

Do you have a landline phone? If so, you may be healthier than me

In the second half of last year, 76% of adults and 87% of children lived in homes that did not have a landline telephone, but did have at least one cell phone. For 17 years, the National Center for Health Statistics has regularly released data on the proportion of people with landline phones versus wireless phones — a ratio that has practically flipped on its head over the decades. And in case you were wondering, this is relevant to health. As recently as 2018, NCHS data has shown that people who live in wireless-only homes are less likely to have health insurance or a regular place to go for medical care, and are more likely to face financial barriers to care. 

It's another sign that health is inexplicably linked to access to technology. Earlier this month, a federal program to provide people with a discount on a computer and monthly internet expenses ended because funding ran out. In anticipation of this exact scenario, STAT published a First Opinion essay last year from three clinicians and researchers about the real life effects that a lack of internet access can have on patients.


smoking

Should people actually try vaping if they want to quit smoking?

It turns out that e-cigarettes might be just as effective at helping people quit smoking as the gold-standard pharmaceutical drug, varenicline, according to a clinical trial published yesterday in JAMA Internal Medicine. People in the study received either a nicotine-containing e-cigarette and placebo tablets, varenicline and an e-cigarette without nicotine, or a placebo tablet and a nicotine-free e-cigarette for 12 weeks. All three groups were also given intensive tobacco cessation counseling.

There was no statistically significant difference between them in the study, which is the first published randomized controlled trial to compare the two, STAT's Nicholas Florko reports. The trial is likely to cause a stir within the tobacco-control community, which has been bitterly divided over the question of whether e-cigarettes are a help or hindrance for adults who smoke cigarettes, and whether they should be recommended by doctors as a way to kick a smoking habit. Read more on the study from Nick.


More around STAT
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What we're reading

  • Inside the world of gender-affirming vocal care, Marketplace

  • Why the FDA will have a hard time properly regulating cannabis, STAT
  • Bird flu is infecting cats (and the occassional dog.) Here's what to know, New York Times
  • With sweeping NIH reform on the table, GOP previews new era of research scrutiny, STAT

Thanks for reading! More tomorrow,


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