Dr. Eric Dickson, president and CEO of UMass Memorial Health in Central Massachusetts told the The Boston Globe: “When health officials ordered an end to elective surgeries during Covid-19, it was understood to be temporary. The difference now is we don’t see the end. We’re not seeing the light at the end of the tunnel. This isn’t a surge we’re dealing with. This is the new reality.”

Boarding is wrecking emergency departments

One significant cause of the trouble is something called boarding which occurs when a patient is held in the emergency department after they have been admitted to the hospital because there are no inpatient beds available. In a letter written to President Joseph Biden by more than 30 medical academies and national associations, including the American College of Emergency Physicians (ACEP), the American Academy of Emergency Medicine (AAEM) and the Emergency Nurses Association, healthcare leaders implore the administration to recognize and address these most pressing issues. “Boarding has become its own public health emergency and our nation’s safety net is on the verge of breaking beyond repair.” 

The letter goes on to outline the underlying issues caused by boarding, “while the causes of ED boarding are multifactorial, unprecedented and rising staffing shortages throughout the healthcare system have recently brought this issue to a crisis point, further spiraling the stress and burnout driving the current exodus of excellent physicians, nurses and other healthcare professionals.” 

The winter months have brought this crisis to a head. In many parts of the United States, a “triple threat” of flu, Covid-19 surges and RSV or respiratory syncytial virus in the pediatric population is placing an insurmountable burden on the emergency departments across the country. The letter goes on to ask the President: “the  undersigned organizations hereby urge the Administration to convene a summit of stakeholders from across the healthcare system to identify immediate and long-term solutions to this urgent problem. The letter explains that the “breaking point” is completely outside the control of the workers and looks to the administration for help.

Since the Start of the Pandemic, Americans Are Drinking Too Much

Doctors, nurses and other healthcare workers burnout

Another issue compounding the present crisis is healthcare worker burnout. The American Medical Association (AMA) recently released a study revealing that almost 63% of physicians felt burned out in 2021. And these statistics aren’t reserved solely for doctors; nurses, physician assistants, technicians and other healthcare workers are reporting similar burnout numbers. Feelings of burnout and being overwhelmed are plaguing the American health workforce and reflect a systemic breakdown in healthcare. According to Chrisine Sinsky, MD, AMA vice president of professional satisfaction: “While burnout manifests in individuals, it originates in systems.” Burnout is not the result of a deficiency in resiliency among physicians, rather it is due to the systems in which physicians work.”

Looking for a Safe Place in Facebook’s Digital Universe

The rate of burnout is a major contributing factor to staffing shortages and needs to be addressed. The letter addressed to President Biden recognizes this issue and calls for solutions: “Overcrowding and boarding in the emergency department is a significant and ever-growing contributor to physician and nurse burnout, as they must watch patients unnecessarily decompensate or die despite their best efforts to keep up with the growing flood of sicker and sicker patients coming in.” 

Healthcare workers who experience burnout have a much higher rate of early retirement and/or leaving the practice of medicine altogether. It also directly contributes to the loss of skilled healthcare professionals, adding more strain to those left behind. The letter states: “It is critical that we end the burnout cycle in the emergency departments to ensure our nation’s health care workforce can meet the needs of its patient population.”

It is quite clear what problems are facing the healthcare system in the United States. And with this crisis looming over the heads of millions of Americans, it will be imperative for the government and its agencies to recognize the scope of the problem and to act accordingly. 

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

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“The drug class, GLP-1 (glucagon-like peptide) receptor agonists have been on the market for diabetes treatment for more than 15 years,” says Donna H. Ryan, MD Professor Emerita at Pennington Biomedical Research Center in Baton Rouge, Louisiana. “A similar compound, liraglutides was approved for obesity in 2012, but the semaglutides plus lifestyle changes are producing a 15-17% weight loss (or reductive change in body weight) on average.”

Since the Start of the Pandemic, Americans Are Drinking Too Much

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As a result of the dramatic weight loss, Ozempic and its cousins have taken Hollywood by storm. Suspected but not confirmed, Ozempic was the likely reason Kim Kardashian was able to fit into Marilyn Monroe’s dress for the 2022 Met Gala, after losing more than 15 pounds in three weeks. Other celebrities got the memo, and so did anyone who wanted to lose weight and who could afford it. The drugs are injectables and cost between $1200 and $1500 per month out of pocket. 

Despite the fact that many celebrities jumped on the bandwagon, the medication has merit and may be a game-changer for people who are overweight or obese struggling to lose weight. “People who are overweight, obese, diabetic or prediabetic have the same metabolic issues although the former are not called “diseases,” explains Nina Karol, MD an internal medicine specialist who trained at The Albert Einstein College of Medicine in New York and currently practices at Concierge Physicians of Westport in Connecticut. “They are just at different points on a trajectory of progression where the body may no longer be able to compensate as well and require drugs (prediabetes vs. diabetes).”

Without treating people who are overweight or obese, they can turn into prediabetics. And of course, many prediabetics will turn into diabetics. Semaglutides have the potential to stop this progression in its tracks and save people from going on and developing diabetes, lowering the risk of high blood pressure, nerve damage, cardiovascular disease and stroke. 

The Debate On Transgender Athletes Is Fundamentally About Fairness

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According to Dr. Ryan, if you go off of the drug, there is a good chance the weight could come back, “Just like with high blood pressure, if you stop the drug, the blood pressure goes up.  If you stop semaglutide, weight will be regained.” Short term use of the drug has not been demonstrated in a clinical trial, so it is likely semaglutide will be a long-term commitment.

And they are not without side effects. Like any medication, side effects are a reality: semaglutides can cause nausea, vomiting, diarrhea, kidney issues and potentially a thyroid tumor in susceptible people. But the demand is still there and for many, the pro’s strongly outweigh the con’s. “The company was unprepared for the demand,” says Dr. Ryan. And as a result, some Type 2 diabetics who have been on Ozempic are having a hard time getting them. “We can switch them to another GLP-1 Receptor agonist – dulaglutide, liraglutide, or exenatide – as a temporary measure.”

This drug class is definitely here to stay and when used as intended it has the potential to lessen and prevent serious morbidities and mortality among so many people who have struggled with being overweight, obese and prediabetic. “Doctors are allowed to prescribe off label,” says Dr. Karol, “but ethically this should be done for a good medical reason, not to help someone lose a few pounds to look good.”

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

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In 1967, Kathrine Switzer became the first woman to run the Boston Marathon. She was physically assaulted by numerous men, including the race director who tried to remove her bib number and throw her out of the race. Switzer’s courage became a symbol of the struggle for inclusiveness in sports. Her determination paved a path for so many other women athletes. Billie Jean King is viewed as one of the most iconic women in tennis. In 1973, she founded the Women’s Tennis Association and led the fight for equal prize money for women in tennis tournaments. In 2007, Venus Williams pressured Wimbledon to offer the same prize money to women as they do to men, actualizing the goal envisioned many years before. Simone Biles won a total of 25 world championship medals, the most global competition series medals out of any male or female gymnast ever.

Gender is controversial

Women have been fighting for equal footing in sports for decades, so it’s no surprise that the idea that gender is a choice is proving to be controversial. At the heart of the debate is Lia Thomas, a transgender woman who swam for the University of Pennsylvania (UPenn) located in the historic city of Philadelphia where the Founding Fathers of the US signed the declaration of independence in 1776. Thomas competed on UPenn’s men’s swim team from 2017 to 2020. Thomas then started competing on UPenn’s women’s team from 2021. In 2022, she became the first transgender athlete to win the National Collegiate Athletic Association’s (NCAA) Division 1 national championship in any intercollegiate sport. The event was the women’s 500-yard freestyle race.

Thomas began hormone replacement therapy in the spring of 2019. It was at this time that she came out as a transgender woman to her coaches and friends. She was required to swim for the men’s team during the time she was going through hormone treatment. Thomas swam for the women’s team in the 2021-22 season. The 2020-21 swimming season was canceled due to COVID-19. Thomas competed in intercollegiate swimming after adhering to all of the guidelines set forth by the NCAA to compete as a woman.

Nonetheless, Thomas found herself in the middle of a national firestorm. Her taking part in women’s swimming elicited criticism from her teammates, coaches and national and international competitors. Thomas also received support from current and former NCAA swimmers, Team USA and international swimmers across the globe. In December 2021, Thomas achieved the nation’s fastest times in the 200- and 500-yard freestyle races, smoking the competition. 

Thomas’s record-breaking success caused public uproar. Legislators introduced bills to restrict the participation of transgender athletes in women’s sporting events. Many were concerned that Thomas’ participation would destroy women’s sports and rob cisgender (denoting or relating to a person whose sense of personal identity and gender corresponds with their birth sex) women of achievements. The number of transgender athletes competing in women’s sports is probably very low and this data is not collected formally. Regardless, the argument on the transgender issue is fierce and many question the difference between assigned biological sex and gender identity.

The American Psychological Association (APA) defines transgender as “an umbrella term for persons whose gender identity, gender expression or behavior does not conform to that typically associated with the sex to which they were assigned at birth.” The APA goes on to state that “gender identity refers to a person’s internal sense of being male, female or something else.”

Making Sense of the Controversial Transgender Debate

I am a women’s health doctor and a former collegiate athlete. It goes without saying that I am a feminist. I have and will always be a staunch supporter of women’s rights. I have fought for equality in women’s sports since I was in grade school. The boys lacrosse team at my high school would always compete on the best field with an electronic scoreboard while the girls team, of which I was the captain, was relegated to an inferior field at the back without a scoreboard. I was part of a very vocal group that fought for the girls team to be treated the same as the boys team. 

I believe in equality in sports and I fully support the right to transition to another gender. But we have to recognize the anatomic, physiologic advantages that a transitioned woman (XY) has over a biological woman (XX), regardless of hormone treatment. If we ignore that, it’s almost like we are partaking in a version of the Emperor’s New Clothes, ignoring what is obvious because we want to be politically correct, progressive and inclusive.  

Men and women have different bodies. We have recognized this from the beginning of time. We can try to distill the differences down to hormones, but that we would be oversimplifying and quite frankly, ignoring inherent differences that are on a variety of different levels.

Once a biological male body hits puberty, there are a host of physical changes that result in larger muscle mass, denser bones and higher fractions of lean body mass. It’s the reason why male athletes on average run faster, can lift more weight and throw farther than the average female athlete. And the differences can be seen on a microscopic level. Take skeletal muscle kinetics and muscle fiber composition for example. One of the many research studies on the subject tells us: “The identification of over 3,000 genes differentially regulated in male and female muscle highlights the complex differences that occur in skeletal muscle from both sexes.” 

This study reveals that gender differences are present across numerous species. It observes: “Sex-based differences in skeletal muscle fiber-type composition and function are apparent in numerous species and are present in specific anatomical locations. Here, we present findings on sexual dimorphisms present in the mammalian musculoskeletal system.” These scientifically observed differences simply cannot be wished away.

Many famous biological women athletes are against the inclusion of transgender women in competition. Three-time Olympic swimming gold medalist Nancy Hogshead-Makar told ESPN: “We need to prioritize fairness for biological women in sports. A category that is for half the world’s population is worth defending. Only then can we talk about ways to include transgender men and women, ways that respect everyone with all their differences and that don’t harm biological women.”

A cohort of swimmers from the University of Arizona, including several former Olympic athletes wrote a letter to the NCAA after Lia Thomas decisively won at a swim championship in Atlanta, GA. The letter blamed the NCAA Board of Governors for “successfully failing everyone by allowing Thomas who has distinct biological advantages, to compete against women to ‘appease everyone.”

In a recent interview with The New York Times, internationally recognized sports physiologist Ross Tucker pointed to peer-reviewed studies that highlight top transgender women athletes having a substantial edge over top biological women. Hormones aside, biologic men who transition have inherent advantages. He says, “Lia Thomas is the manifestation of scientific evidence. The reduction of testosterone did not remove her biological advantage.”

Not everyone in the scientific community agrees, Dr. Joshua Safer, an internist and executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York was quoted by the American Civil Liberties Union (ACLU) as saying, “A person’s genetic make-up and internal and external reproductive anatomy are not useful indicators of athletic performance. According to Safer, “For a trans woman athlete who meets NCAA standards there is no inherent reason why her physiological characteristics related to athletic performance should be treated differently from the physiological characteristics of a non-transgender woman.”

Genetic advantages may not be limited to assigned gender at birth, according to some experts. Discussing genetic advantages is a slippery slope, Alexi Kuska, assistant swimming and diving coach at University of Wisconsin, Milwaukee says. “Every elite swimmer has a genetic advantage.” Analysis of 23-time Olympic gold-medalist American swimmer Michael Phelps illustrates this point. Kuska says, “His measurements (height, wing-span, etc) are inches beyond of what the ‘perfect’ swimmer would be.” This raises the question: Should someone like Phelps be sidelined? 

An Issue of Fairness

But in my opinion, that’s not really the point. Everything can be distilled down to genetics and gender definitely plays a role in sports. It’s really about where you draw the line, and a line must be drawn in order to maintain fairness in women’s sports, an ideal that has been fought for, for decades. Assigned gender at birth is a rational and very reproducible method for delineation.

The debate continues to rage on. Fédération internationale de natation (FINA), the world’s swimming governing body, recently banned transgender women from competing in women’s events. It has decided to permit only those tansgender swimmers to compete in women’s events who transition before the advent of puberty, which they have set as 12. FINA has also proposed an “open competition category,” for trans swimmers to compete in. This ruling makes sense to me but clearly not to everyone involved.

We are living in a time where people are afraid to offer their opinion, where facts don’t seem to matter as much as they should. The transgender issue is one where people are afraid of expressing themselves lest they be damned like the noted Scottish writer JK Rowling. In 2020, she took a strong view about the current debate.

Rowling argued:

“We’re living through the most misogynistic period I’ve experienced. Back in the 80s, I imagined that my future daughters, should I have any, would have it far better than I ever did, but between the backlash against feminism and a porn-saturated online culture, I believe things have got significantly worse for girls.

She went on to make the case that there was indeed a difference between trans women and women. She found the demand that “women must accept and admit that there is no material difference between trans women and themselves” unacceptable. In her memorable words:

“But, as many women have said before me, ‘woman’ is not a costume. ‘Woman’ is not an idea in a man’s head. ‘Woman’ is not a pink brain, a liking for Jimmy Choos or any of the other sexist ideas now somehow touted as progressive. Moreover, the ‘inclusive’ language that calls female people ‘menstruators’ and ‘people with vulvas’ strikes many women as dehumanising and demeaning. I understand why trans activists consider this language to be appropriate and kind, but for those of us who’ve had degrading slurs spat at us by violent men, it’s not neutral, it’s hostile and alienating.”

Rowling has a right to raise these issues as do I. If we are afraid to speak out aloud about the issues that matter most to us, everyone is bound to lose out.

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

The post The Debate on Transgender Athletes Is Fundamentally About Fairness appeared first on Fair Observer.

There is a multitude of factors that contributed to the increase in alcohol consumption during the COVID-19 pandemic. According to statistics from the Centers for Disease Control and Prevention, anxiety and depression rose dramatically among the general population, and alcohol consumption often increases for those who use it as a way to cope. “Stress and boredom likely were main drivers for a substantial increase in alcohol intake,” explains Dr. Jagpreet Chhatwal, associate director of the Massachusetts General Hospital’s Institute for Technology Assessment and assistant professor at Harvard Medical School.

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Measures that were designed to help businesses stay afloat during the pandemic may have also affected drinking habits. According to Chhatwal, “cocktails-to-go laws that allowed customers to pick up mixed cocktails at local bars and direct-to-consumer laws that allowed liquor stores to deliver alcohol directly to homes” point to a potential link between access and consumption. 

Regardless of the reason, these numbers are going to translate to significant morbidity and mortality rates for Americans in the future. According to new a study by researchers at Harvard’s Massachusetts General Hospital published in Hepatology, due to the pandemic uptick in alcohol use, there will be close to 20,000 cases of liver failure, 1,000 cases of liver cancer and 8,000 deaths over the next two decades. 

Addressing this pressing issue will be complicated in a country that has long glamorized the use of alcohol among its population. From Super Bowl advertisements to film and music references, alcohol has long been associated with celebration, letting loose and having a good time. Consuming alcohol, even excessively, is normalized to the point that it is integrated into daily life on a regular basis: after-work happy hours, relaxing at home, birthdays, weddings, sporting events, etc. Alcohol has become so fused into the fabric of American society that in 2019, the industry was already worth over $250 billion.

Putting a positive spin on alcohol is dangerous because it creates the mirage that there are no negative consequences on a person’s physical or mental health, which is both untrue and potentially harmful. “Not everyone is aware of the safe drinking limits or realizes when to stop,” says Chhatwal. Excessive drinking can cause a myriad of health problems including high blood pressure, heart attacks, stroke, increase the risk for cancer, liver and GI problems, a weakened immune system, depression and anxiety as well as socialization issues and job loss.

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In a country where more than 14 million American adults 18 years and older had a clinical alcohol use disorder, according to statistics from National Institute for Alcohol Abuse and Alcoholism, the challenge will be raising awareness, confronting a booming business model and reevaluating new laws that made alcohol more accessible during the pandemic.

In Chhatwal’s opinion, “One of the foremost steps is to create awareness about the risk of an increase in alcohol consumption, especially high-risk drinking among women and minority populations who are more vulnerable.” He also stressed the importance of enlisting primary care providers to do more extensive screening for alcohol consumption patterns. There is also an obligation to take a hard look at new laws: “We need to evaluate the effect of cocktail-to-go and direct-to-consumer laws — if such laws contribute to increased drinking then there is a need to make policy-level changes.”

*[The Wider Lens provides commentary on trending stories in the world of health, covering a wide variety of topics in medicine and health care.]

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

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A new study published by JAMA Network reveals that the number of hospitalizations for eating disorders including anorexia, bulimia and binge-eating disorders, among others, increased dramatically during the pandemic. According to Dr. Kelly Allison, one of the researchers on the study and the director of the Center for Weight and Eating Disorders at the Perelman School of Medicine at the University of Pennsylvania, the results “suggest that disordered eating became more severe in disorders of extreme restriction, as well as in those with loss of control eating.” What’s even more troubling is that the average age of the patients has decreased over time. 

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Eating disorders are mental health conditions typified by significant and persistent disturbances in eating behaviors, accompanied by distressing emotions. People who suffer from eating disorders often display a preoccupation with body weight and food intake. These disorders can affect people of all ages, racial and ethnic backgrounds as well as genders, although they are more common in girls and women. People are particularly vulnerable during the adolescence and teen years and are most often diagnosed between the ages of 12 and 35.  

There are many reasons why the COVID-19 pandemic created a breeding ground for eating disorders. For many people, eating habits changed significantly. Shopping at a grocery store was already incredibly stressful for the general population; for people with disordered eating behavioral patterns, it was most likely worse.

Those who restrict food intake may have limited their shopping excursions or curtailed their purchases; for those who binged, they may have the added temptation of bulk purchases of processed foods. “They were then in close proximity to that food all day while working or schooling from home, so the temptation to eat those foods was likely increased during this time,” says Allison.

Obesity is often cited as a risk factor for severe COVID disease and poor outcomes even in younger people. This news may have triggered disordered eating patterns in vulnerable people. Excess weight is often a modifiable risk factor and could have been the impetus for extreme dieting. “I have been overweight for a long time, hearing that extra pounds could land me on a ventilator in the hospital was enough for me to diet,” says Shaunda F., a 27-year-old mom from New York state. “I lost more than 12 pounds in two months at the beginning of the pandemic fearing for my life. I basically starved myself.”

There are other considerations with regard to an increase in the diagnosis of eating disorders and subsequent hospitalizations. Family members were able to pick up on pathological behaviors because they were together more frequently than normal. According to Allison, “Middle school, high school and college-aged individuals were home all day, and their eating behaviors and weight changes were more evident.” Under normal circumstances, these behaviors may have gone unnoticed but were more difficult to hide during the pandemic.  

Access to care was likely another factor responsible for the uptick in hospitalizations for eating disorders. “In the beginning of the pandemic, access was limited as providers were transitioning to virtual outpatient care,” says Allison. “This could have led to a time delay that progressed the severity of symptoms to a state where hospitalization was needed.”

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It is imperative that parents and loved ones have this issue on their radar screen, as treating disordered eating patterns often requires clinical intervention. Keeping an eye out for warning signs can be life-saving. “If someone you care about starts avoiding eating with family and friends, along with noticing changes in weight (sudden increases or decreases), these should be considered concerning,” Allison points out. Using a bathroom directly after a meal could be a red flag for vomiting or laxative use. Other warning signs include hoarding food, a preoccupation with body weight, food or calories, wearing baggy clothes to hide weight loss, frequent checking in the mirror, skipping meals, etc.

Regardless of the reason, the pandemic has driven a rise in eating disorders and, like with COVID-19, a lot depends on everyone doing their bit to make sure those at risk are protected.

*[The Wider Lens provides commentary on trending stories in the world of health, covering a wide variety of topics in medicine and health care.]

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

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Instagram, a photo-sharing app that is owned by Facebook, Inc., is popular among school-aged children and teenagers worldwide. Studies have shown that young people spend up to nine hours on social media and digital technology, posting pictures, streaming videos, listening to music and engaging socially.

Return of Jane: Would Stricter Rules Bring Back Illegal Abortion?

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The Wall Street Journal investigation into the leaked internal Facebook documents confirmed that studies commissioned by the social media giant found that its subsidiary, Instagram, has negatively impacted the mental health of its users, particularly teenage girls. In addition, the company failed to act to remedy the potential harm that it is directly and knowingly causing.

Leaked documents reveal that more than 30% of teenage girls using Instagram feel worse about their bodies after accessing the app. Another document outlined how Instagram can contribute to and exacerbate anxiety and depression in users. 

This isn’t the first time a study has linked teenage depression, anxiety and other stress-related conditions to social media use. Studies conducted across the globe have sought to establish the notion of “digital age vulnerability” to mental health conditions in users.

The research has been conclusive. A 2018 British study published in The Lancet tied social media use to decreased, disrupted and delayed sleep, which is associated with depression, memory loss and poor academic performance. Another study in the Journal of Adolescent Health concluded that depression and eating disorders are higher in young people who use social media outlets on a regular basis.

It is the first time, however, that leaked documents have shown the company’s acknowledgment of the harms it may be causing and subsequently failing to act. Facebook places a lot of importance on Instagram in capturing a younger audience. Adolescents and teens across the United States spend much more time on Instagram than on Facebook, and with ever-evolving features, Instagram competes with other teen favorites like TikTok and Snapchat. 

Brooke T., a 17-year-old girl from New York, spends roughly six to seven hours per day on Instagram and other social media platforms. She was recently diagnosed with anorexia nervosa, an eating disorder characterized by very low body weight, a fear of gaining weight and a skewed perception of weight in general. “Every time I would go on Instagram, all I saw were pictures of perfect bodies everywhere,” she told me. “It made me feel pretty bad about myself.” When asked directly if her time on Instagram contributed to her recent diagnosis, she answered: “Definitely.”

Alarm bells have sounded before and organizations across the United States have conducted research that reflects this upsetting trend. Between 2010 and 2018, depression rates have doubled among teenage girls, according to data from the Department of Health and Human Services. The Centers for Disease Control and Prevention report that suicide rates among girls in the same period of time have nearly doubled as well.

Back in December 2017, Mark Zuckerberg, the founder, chairman and CEO of Facebook, was pressed in an interview to comment on the data linking an increased risk of mental health conditions tied directly to Facebook, he insisted that “protecting our community is more important than maximizing our profits.” Unfortunately, the leaked documents tell another story.

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If Facebook has full knowledge of the harm and risk it poses to people who use its platforms, the company has an ethical and moral obligation to acknowledge it publicly and work to make its products safer for children, teens and adults. This is particularly true in light of Facebook’s recent announcement of the plan to develop a metaverse platform, that will subsume consumers even more deeply into its digital world. Simply rebranding won’t effect the necessary change.

The COVID-19 pandemic has wreaked havoc on the mental health of men and women, boys and girls around the world. Social media has helped connect so many people when social distancing has kept them apart. But if the platforms are knowingly harming the mental health and well-being of its users, companies like Facebook need to be held accountable and measures must be taken to ensure the health and safety of users.

 *[The Wider Lens provides commentary on trending stories in the world of health, covering a wide variety of topics in medicine and health care.]

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

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According to the Guttmacher Institute, abortion was so dangerous that in 1965, roughly 17% of deaths relating to pregnancy and childbirth were the result of illegal abortions. The shocking statistic is unsurprising given that in the 1950s and 1960s, the number of illegal procedures ranged from 200,000 to 1.2 million per year.

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Women from lower socioeconomic backgrounds and women of color were disproportionately affected by strict regulations as many couldn’t afford to travel to places where they could obtain a legal abortion. The levels of morbidity and mortality among this demographic were astounding. While childbirth-related deaths among white women as a result of abortion stood at one in four in New York City in the early 1960s, the number was one in two for nonwhite and Puerto Rican women.

Born out of this predicament was the Abortion Counseling Service of Women’s Liberation, also known as the Jane Collective, founded by Heather Booth as an underground service headquartered in Chicago, Illinois. The main goal of the “Service,” as it became known, was to assist women in gaining access to safe and affordable abortions. Many women who were part of Jane were taught to perform abortions for others in need and did so successfully without a medical license. 

Laura Kaplan, a member of Jane and author of “The Story of Jane: The Legendary Underground Feminist Abortion Service,” was not surprised when Texas Governor Greg Abbott signed into law one of the country’s strictest abortion rules, banning the procedure from as early as six weeks into pregnancy, but she was angry: “I am outraged by this, but even more than Texas, I am the most angry at the Supreme Court’s decision to let this blatantly unconstitutional ruling stand.”

The six-week mark stipulated by the new legislation means that many women will be barred from accessing abortion services before they even realize they are pregnant. The legislators went a step further by incentivizing private citizens to report and sue providers or anyone helping a woman get an abortion for $10,000.

Under the new law, the government doesn’t enforce the bill — the private citizens of Texas do. This provision was designed to make the law harder to contest in court, but lawsuits are expected. The US Department of Justice has already mounted a legal challenge, positing that it stands “in open defiance of the Constitution.”

At the same time, several Latin American countries are loosening their restrictions on abortions. “Predominantly Catholic countries like Argentina and Mexico are making progress, while we are moving backwards,” says Kaplan. 

Could there be a return of Jane in Texas now that abortion rights are being curtailed? “Women are not going to let women suffer,” says Kaplan. “We didn’t back then.” Starting in 1969, Jane groups popped up all over the country, with women finding their way to one of the services when they were in need.

After New York state legalized abortion, it changed the landscape. White middle-class women could get on a plane and get to New York, but it meant that many young, poor and many women of color were left behind. Kaplan thinks history may repeat itself: “Women with the most need didn’t have access to abortion and that will happen again.”

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It’s important to note that after abortion was legalized, less than 0.3% of women, regardless of age, experienced serious complications post-procedure. If the real debate is about the preservation of life — and, indeed, the sanctity of life — we have to look beyond the life of the developing fetus and to the life of the mother as well. 

Any rational policy should look at promoting access to birth control and prioritizing the health of the mother by assuring that she has access to safe procedures. Outlawing abortion doesn’t work — the story of the Jane Collective has shown that. It won’t change people’s motivation to terminate an unwanted pregnancy.

As a democratic society, we don’t want to throw ourselves back to an underworld that offers subpar care, creates a greater public health problem and endangers the health of women.

*[The Wider Lens provides commentary on trending stories in the world of health, covering a wide variety of topics in medicine and health care.]

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So where does that leave public confidence in our health agencies? Not in a good place. According to a recent poll conducted by the Harvard T.H. Chan School of Public Health and the Robert Wood Johnson Foundation, 48% of those polled reported little to no trust in the CDC and even less for state and local health departments. 

These low numbers have dire consequences. Public health recommendations that include mask-wearing, proof of vaccination status and compliance are necessary for the United States to effectively combat the COVID-19 Delta variant and minimize morbidity and mortality. If the general public is skeptical and doesn’t have faith in these recommendations, containing the spread of new variants becomes nearly impossible.

The Elusive Importance of Sleep

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It is not hard to understand the reasons behind eroding trust in the United States. From the start, the COVID-19 pandemic has been highly politicized. “There are deep divisions in this country affecting how people look at public health institutions tied to political views and philosophy,” explains Dr. Robert Blendon, professor emeritus of health policy and political analysis at the Harvard T.H. Chan School of Public Health and co-director of the recent poll.

The CDC was once viewed as a neutral agency. Back in 2009, during the H1N1 (swine flu) pandemic, all of the messaging came directly out of the CDC headquarters in Atlanta, Georgia. The messaging was not politically charged. “The minute you start doing discussions out of the White House,” says Blendon, the message gets lost. “It’s no longer the CDC’s goals — it becomes the president’s goals.” In order to lower the political climate in this country, the White House should not be placed at the center of discussions.

In addition to the political climate, there has been mixed messaging from the scientific community. “Data has changed, data moves,” explains Dr. Arthur Caplan, professor and founding head of the Division of Medical Ethics at the NYU School of Medicine. “The public doesn’t fully understand or accept that.” There was a great deal of uncertainty with COVID-19, especially at the beginning of the pandemic. There was a wide expectation among many people that the scientific community would have immediate and definitive answers. It didn’t, and that bred feelings of anxiety, fear and distrust.

Convincing people to get the vaccine is critical at this point in the pandemic. But the tactics need to evolve. “We discovered in the data polling from the variety of unvaccinated people that they are not worried about the disease,” says Blendon. “If you look at other diseases from the past, parents first got worried about polio when they saw pictures of children disabled for their whole lives.” Pictures, personal stories that relay the importance of vaccination and what is at stake will work better than statistics.

“There was a critical care physician from Alabama who had two patients near dying, they wanted the vaccine but it was too late,” explains Blendon. According to both Blendon and the results from the poll that he oversaw, this is very powerful and this is what it will take to move the needle: “We need to convince people through iron lung pictures, not statistics.”

In addition, Blendon thinks that the public seems to trust their own health care provider: “We need to emphasize local physicians — those voices in Tennessee, Mississippi, Missouri, Alabama will move people over time.” The pandemic is being fought on the ground and has nothing to do with politicians and the presidential administration. 

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Looking back on the past year, it’s become clear that the US could have handled the flow of information better. Had there been more transparency at the beginning of the pandemic, with public health officials explaining that they are learning about the disease in real time and that the recommendations may change, the public may have had more tolerance for an evolving situation. 

We were isolated from each other, connected largely online, with social media serving as the ultimate connector. Everyone became an expert, and every account became a megaphone. Ethical issues emerged from diminishing trust in science. “As science erodes, it opens the door wide for cooks, nuts and bigots,” says Caplan. “If science doesn’t have control over the message, anybody and everybody can pile in,” he points out. There is a large platform of misinformation and, in some egregious cases, so-called experts profiting over the fallacies they espouse. 

American public health agencies have a tough job ahead of them of fixing the distrust among the people who used to rely heavily upon them for guidance and information. But they also need to streamline their messaging and strategize effective recommendations to become a central voice in the fight against this virus so that we can soon look at this pandemic in the rearview mirror. 

 
The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

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The significance of the problem is often overlooked by the general public, with attitudes ranging from indifference to the glorification of sleep deprivation. It isn’t uncommon for a medical resident or a new mother to brush off concerns of not getting a good night’s rest, as it is equally common for pop culture to glamorize all-nighters. As a result, sleep hygiene is not regularly discussed and often goes under-reported by patients.

Health Consequences

But the health consequences are real and should not be ignored. Deficient sleep is inextricably linked with a wide range of negative outcomes that affect a person’s physical and mental well-being and performance. In fact, the National Center for Health Statistics has shown that decreased sleep duration has been associated with seven out of the 15 top causes of mortality across the US. These include cardiovascular disease, stroke, cancer, accidents, diabetes, hypertension and septicemia. Clearly, the impact of insufficient sleep has sweeping effects across global societies and constitutes a major public health concern. 

The duration of sleep varies among people based on age. According to a state-based study by the Centers for Disease Control and Prevention (CDC), fewer than 65% of adults reported the necessary number of hours per night. The survey revealed that over 80 million American adults were sleeping under the recommended seven hours each day.

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The same pattern is pervasive among adolescents and young adults, and the consequences can be devastating. These years are especially formative, with the brain and body undergoing remarkable development. Although sleep is essential, research reveals that many teens and young adults get far less of it than their bodies require. As a result, mental health issues, a decline in academic performance, accidents and injuries, poor judgment, risk-taking and obesity are rampant among this demographic.

It’s no coincidence that long-term sleep deprivation has been historically used as a form of torture, resulting in both negative physical and mental side effects. While chronic sleep insufficiency does not equate with institutionalized torture, it does result in a significant burden to public health, the labor force and academic performance.

Making Change

This begs the question: What are we doing as a global society to address this widespread and pervasive public health epidemic? How can changes in individual behavior, actions by employers and public policy measures be implemented in a meaningful way to make long-term, substantial change? 

In the workplace, lack of sleep can put employees and other people at risk, especially if, for example, the duties include patient care, transportation or law enforcement. Sleep hygiene needs to be an integral part of every workplace program. Employers can utilize the CDC’s Workplace Health Resource Center, which contains education, training and assessment tools, in addition to strategies to modify the workplace to increase alertness, incorporate dedicated breaks and spot warning signs of fatigue and exhaustion. 

According to statistics from the Johns Hopkins School of Public Health, up to two-thirds of patients have not discussed their issues around sleep with their doctors, while a significant percentage of health care providers fail to ask. Sleep habits should be routinely discussed at yearly physicals and histories, and patients should be given ample tools to manage sleep difficulties. These must include more than just a prescription.

Colleges and universities should take measures to curtail the unnecessary glamorization of sleep deprivation. Students largely ignore sleep requirements as academic, social and extra-curricular pressures get in the way. Students of all ages are spending an inordinate amount of time on social media, and a study from the National Sleep Foundation revealed that nighttime social media use negatively correlates with a good night’s sleep.

Schools and universities alike need to address these concerns that are so pervasive on school grounds across the globe. The inclusion of sleep education in health classes should be universal, as should education materials that include guidelines as to when to turn off electronic devices before bed. 

The last 16 months have resulted in global upheaval, leaving policymakers struggling to catch their breath. The COVID-19 pandemic and the ensuing quarantine forced many of us to work from home. In doing so, it inadvertently helped many to reestablish a work-life balance that was off-kilter for a very long time. As we reexamine our world and our lives, a better balance for our collective health must include the prioritization of sleep. 

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.

The post The Elusive Importance of Sleep appeared first on Fair Observer.