Harassment and Violence Against Health Professionals Who Provide Reproductive

ntroduction

The National Academies Standing Committee on Reproductive Health, Equity, and Society and the Committee on Human Rights co-hosted a webinar on December 11, 2023, during which expert panelists discussed long-standing concerns regarding harassment, threats, and physical attacks against health care professionals working to provide essential sexual and reproductive health care. This webinar, supported by the National Academy of Sciences W.K. Kellogg Foundation Fund, was part of a series on reproductive health topics.

Violence and Harassment Against Health Professionals Providing Reproductive Care

• Clinicians around the world have been harassed, arrested, surveilled, demoted, and fired for providing abortion care and advocating for patients’ rights. (Shah)
• Violence by anti-abortion extremists has often intersected with a legacy of racism, antisemitism, and white supremacy in the United States. (Davidson)
• Since 1977 in the United States, there have been 11 murders, 42 bombings, 200 arsons, 531 assaults, 492 clinic invasions, 375 burglaries, and thousands of other incidents of criminal activities directed at patients, providers, and volunteers. (Davidson)
• The Internet has become the newest battleground for anti-abortion violence, with online death threats, doxing, and other threats of harm having skyrocketed in the past decade. (Cohen)
• Following the Dobbs decision and subsequent state-level abortion bans, many anti-abortion extremists have traveled to states where abortion remains legal to target clinics there. (Davidson)
• In 2022, increases in major incidents like arsons, burglaries, death threats, and invasions were reported overall, with a sharp increase in states that are protective of abortion rights. (Davidson)

• Insights on the Legal Framework

  • Laws restricting access to abortion and the harassment providers face can impact their ability to practice medicine and create long-term impacts on health care, exacerbating disparities in health care. (Shah)
  • While most countries are amending their laws, in recognition of the harm caused by the criminalization of abortion, the United States is one of only four countries that has recently moved to restrict abortion. (Shah)
  • Some states have steep criminal laws governing abortion, provisions that can include significant monetary penalties and lengthy prison sentences. (Beasley)
  • The FACE Act has successfully prevented most large clinic blockades but not other forms of harassment, largely due to enforcement issues and fear that the police will be taking sides in a political debate if they enforce this law. (Cohen)
  • California, Colorado, Massachusetts, New Jersey, New York, Oregon, and Vermont have expanded Safe at Home laws to include abortion providers and seekers. (Cohen)

  • Effects of Violence on the Health and Well-Being of Providers

  • A key strategy against abortion access around the world is fear, including utilizing the law and harsh criminal penalties to implicitly impose bans on abortion, even where the law allows for life-saving care. (Shah)
  • Trauma and a climate of fear have led to system level burnout and health care deserts. (Harris)
  • The targeted harassment of health professionals providing reproductive care at home and at work sends a clear message that providers have to be constantly vigilant about their personal safety and privacy. (Cohen)
  • Relatives, neighbors, and colleagues can also become targets of this harassment in order to intimidate and indirectly harass the provider. (Cohen)
  • Clinicians are being put in an untenable situation of dual loyalty, in which they are unable to both avoid grave legal risk and adhere to medical standards of care and medical ethics. (Shah)

  • Mitigating and Preventing Violence and Harassment

    • The National Abortion Federation provides resources to abortion providers and facilities to help keep staff and their patients safe, including staff preparedness trainings, facility and residential security assessments, and law enforcement assistance. (Davidson)
    • Research highlights the importance of health professionals’ voices in breaking stigma- silence cycles and depolarizing abortion, which can lead to more support for abortion access. (Harris)
    • Institutions need to support and facilitate the voice of health professionals in their employment and not discourage them from speaking out on access to abortion. (Harris)
    • Careful audience research needs to be conducted to develop evidence-based communication recommendations, so providers understand the impact of their voice. (Harris)
    • Enhanced training for law enforcement would be beneficial; in many cases when an incident occurs, the burden is on providers to identify the ordinance that has been violated and push law enforcement to investigate. (Davidson)
    • There is a lot to learn from dialogue with other clinicians from around the world who have, for decades, faced violence and harassment for providing abortion care. (Shah)
    • By using a maternal mortality and health equity framework, along with an outcomes-based approach, the message can be amplified that abortion care is health care. (Lappen)

     

    • 

      Michelle Davidson
      Director, Security, National Abortion Federation

      PLAY VIDEO

      “For severe acts of violence, we [National Abortion Federation] respond in person to assist with threat, mitigation, law enforcement liaison, and ensure that anyone affected has the resources they need to not only be safe in that moment but to assist with recovery support, like psychological ...

    • 

      Lisa Harris, MD, PhD
      F. Wallace and Janet Jeffries Professor of Obstetrics and Gynecology and Professor of Women’s and Gender Studies, University of Michigan

      PLAY VIDEO

      “When I testified in a case last summer to prevent our ban [in Michigan] from going into effect, literally, the vice president of the university and the Office of General Counsel folks accompanied me because they knew ...

    • 

      Lisa Harris, MD, PhD
      F. Wallace and Janet Jeffries Professor of Obstetrics and Gynecology and Professor of Women’s and Gender Studies, University of Michigan

      PLAY VIDEO

      “When abortion caregivers do decide to have a voice, it needs to be in ways that recognize complexity, show compassion for audiences, and help people hold any ambivalences they have about abortion and recognize that ...
    Many of the panelists emphasized the importance of connecting the dots on why abortion care is health care and, by denying or limiting that care, what the long-term impact will be on health care and health disparities (Harris, Beasley, Cohen, Lappen, Shah). Furthermore, some panelists stressed the need to push back on the normalization of violence by telling providers’ stories (Harris, Shah) and highlighting the implications of being forced to deny an abortion from the perspective of professional ethics and the principle of do no harm (Beasley, Shah). Dr. Harris stressed the need for empathy for people who have internal conflict or ambivalence about abortion to help depolarize this issue and mitigate and prevent violence against health professionals providing reproductive care.  Harassment and Violence Against Health Professionals Who Provide Reproductive
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The Future is Telehealth

Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures

Women surgeons have lower health care costs, Why?

 This analysis found lower 30-day, 90-day, and 1-year health care costs for patients treated by female surgeons compared with those treated by male surgeons. These data further underscore the importance of creating inclusive policies and environments supportive of women surgeons to improve recruitment and retention of a more diverse and representative workforce. 

Are women surgeons more cost conscious, or do male surgeons order more tests?

Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures | Surgery | JAMA Surgery | JAMA Network

Taking Z-drugs for Insomnia? Know the Risks | FDA

ZZZZZ. Remember sleeping through the night? Not lately?

If you’re lying awake night after night, unable to sleep, you may want to talk to your health care professional about it. They may prescribe insomnia medicines approved by the U.S. Food and Drug Administration, such as eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). Sometimes known as “Z-drugs,” they might help you get a good night’s sleep. But as with any medicine, there are risks.

Prescription Z-drugs work by slowing activity in the brain. Used properly, they can help you sleep. Quality sleep can have a positive impact on physical and mental health. But the treatments also carry the risk – though rare – of serious injuries, and even death. Be aware of these risks.

In 2019, the FDA required the addition of the risks for complex sleep behaviors resulting in serious injuries or death to the labeling and Patient Medication Guides for all prescription Z-drugs.

What Are Complex Sleep Behaviors?

Complex sleep behaviors occur while you are not fully awake. Examples include sleepwalking, sleep driving, sleep cooking, or taking other medicines.

The FDA has received reports of people taking these insomnia medicines and accidentally overdosing, falling, being burned, shooting themselves, and wandering outside in extremely cold weather, among other incidents.

People might not remember these behaviors when they wake up the next morning. Moreover, they may experience these types of behaviors after their first dose of one of these Z-drugs, or after continued use.

Tips for Taking Medicines for Insomnia

If your health care professional prescribes a Z-drug to help you sleep, discuss with them the benefits and risks.

Be sure to read the Patient Medication Guide as soon as you get the prescription filled and before you start taking the medicine. If you have any questions or don’t understand something, ask your health care professional.

After taking the medicine, if you experience a complex sleep behavior, stop taking the drug and contact your health care professional immediately.

Complex sleep behaviors can occur at lower dosages, not just high doses. It’s important to carefully follow the dosing instructions as directed by your health care professional.

Don’t take these medicines with any other sleep drugs, including those you can buy over-the-counter without a prescription.

Don’t drink alcohol before or while taking these medicines; together they may be more likely to cause side effects.

You may still feel drowsy the day after taking one of these drugs. Keep in mind that all insomnia medicines can impair your ability to drive and activities that require alertness the morning after use.

For information on healthy sleep habits, visit Tips for Better Sleep and Insomnia: Relaxation techniques and sleeping habits.

 

Was this helpful?

Taking Z-drugs for Insomnia? Know the Risks | FDA

Credible Sources of Information on Health and Wellness

When seeking credible sources for health and wellness information to include on a website, it's essential to rely on reputable organizations and experts. Here are some sources that you can consider:

1. **Government Health Agencies:**

   - Centers for Disease Control and Prevention (CDC): Provides comprehensive information on a wide range of health topics.

   - World Health Organization (WHO): Offers global health information and guidelines.

2. **Medical Associations:**

   - American Heart Association (AHA): Trusted source for cardiovascular health information.

   - American Cancer Society (ACS): Provides reliable information on cancer prevention and treatment.

   - National Institutes of Health (NIH): Comprises various institutes, each focusing on specific health aspects.

3. **Educational Institutions:**

   - Mayo Clinic: Known for its expertise in medical research and patient care.

   - Harvard Health Blog: Offers insights and advice from Harvard Medical School experts.

4. **Nonprofit Organizations:**

   - WebMD: Provides health information with input from medical experts.

   - Mayo Clinic: Offers reliable health information and tools for self-care.

5. **Professional Health Journals:**

   - The New England Journal of Medicine: Publishes peer-reviewed articles on a wide range of medical topics.

   - JAMA (Journal of the American Medical Association): Covers various medical specialties.

6. **Nutrition and Diet:**

   - Academy of Nutrition and Dietetics: Offers evidence-based information on nutrition.

   - Nutrition.gov: A government resource providing information on healthy eating.

7. **Mental Health:**

   - National Institute of Mental Health (NIMH): Focuses on mental health research and education.

   - Mental Health America: Provides information and resources for mental health.

8. **Alternative Medicine:**

   - National Center for Complementary and Integrative Health (NCCIH): Focuses on complementary and alternative medicine.

9. **Fitness and Exercise:**

   - American Council on Exercise (ACE): Offers resources on fitness and exercise.

   - National Institute on Aging (Exercise and Physical Activity): Tailored for older adults, providing exercise guidelines.

When curating information, it's crucial to cross-reference from multiple sources to ensure accuracy. Additionally, be cautious of websites that lack clear authorship or those promoting unsubstantiated claims. Always prioritize peer-reviewed journals, established health organizations, and government agencies for the most reliable information.

Feel free to ask if you have specific health topics in mind, and I can provide more tailored recommendations.

OpenEvidence - NY Times finally reports some Truth

The prevalence of Long COVID, defined as the persistence of symptoms beyond 4 weeks from the onset of acute COVID-19, varies across different age groups. In the general adult population, estimates suggest that around 7.3% of all respondents reported long COVID.[1] However, the prevalence of long COVID was found to be higher among respondents who were female, had comorbidities, or were not vaccinated.[1]

In a nationwide population cohort study of Scottish adults, the adjusted prevalence of symptoms attributable to SARS-CoV-2 infection was 6.6%, 6.5%, and 10.4% at 6, 12, and 18 months respectively.[2]

In children and adolescents, the prevalence of long COVID is reported to be around 25.24%, with another study reporting a similar prevalence of 23.36%.[3-4] The most prevalent clinical manifestations in this age group were mood symptoms, fatigue, and sleep disorders.[3]

Risk factors for long COVID in children and adolescents include chronic conditions, obesity, and being in the adolescent age group.[5] In the general population, risk factors include increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, overweight/obesity, and asthma.[6]

It's important to note that these estimates may vary due to differences in study design, population characteristics, and definitions of long COVID. Further research is needed to better understand the prevalence and risk factors of long COVID across different age groups.

OpenEvidence - What's the prevalence of Long COVID in different age groups?

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$15 billion win for physicians on prior authorization | American Medical Association

The time-consuming process for prior authorization to be incorporated into Electronic Health Record.

$15 billion win for physicians on prior authorization | American Medical Association

What’s at stake

Prior authorization is a health plan cost-control process that AMA survey research shows leads to delayed and abandoned care, negatively affecting patient outcomes. The average physician practice completes 45 prior authorizations per physician, per week, and doctors and their staff spend nearly two business days a week completing such authorizations.

More than nine in 10 physicians (94%) report care delays while waiting for insurers to authorize necessary care, and 80% say prior authorization can lead to treatment abandonment. 

One-third (33%) of physicians report that prior authorization has led to a serious adverse event. This includes hospitalization (25%) or disability or even death (9%) for a patient in their care.  

Meanwhile, 31% of physicians report that prior authorization criteria are rarely or never evidence-based, with 89% saying prior authorization harms patients’ clinical outcomes.

Prior authorization is overused, costly, inefficient, opaque, and responsible for patient care delays. That’s why we’re standing up to insurance companies to eliminate care delays, patient harm and practice hassles, and why fixing prior authorization is a critical component of the AMA Recovery Plan for America’s Physicians. 

Prior authorization is overused, costly, inefficient, opaque, and responsible for patient care delays. That’s why we’re standing up to insurance companies to eliminate care delays, patient harm, and practice hassles, and why fixing prior authorization is a critical component of the AMA Recovery Plan for America’s Physicians. 

Centers for Medicare & Medicaid Services (CMS) has released a final rule making important reforms to prior authorization to cut patient care delays and electronically streamline the process for physicians. Together, the changes will save physician practices an estimated $15 billion over 10 years, according to the U.S. Department of Health and Human Services (HHS).

The rule addresses prior authorization for medical services in these government-regulated health plans:

Medicare Advantage.

State Medicaid and Children’s Health Insurance Program (CHIP) fee-for-service programs.

Medicaid-managed care plans and CHIP-managed care entities.

Qualified health plan issuers on the federally facilitated exchanges.

In addition, CMS is mandating shortened processing time frames and also requiring that payers give physicians and patients more prior authorization-related information. Notably, the $15 billion savings estimate does not account for lower patient costs attributable to timelier delivery of physician-ordered care.

Enforcement of these policies, particularly around Medicare Advantage payers, can include CMS sanctions and civil monetary penalties. Starting in 2026, affected payers will have to send prior authorization decisions within 72 hours for urgent requests and within a week for nonurgent requests. For some payers, CMS noted, that would represent a 50% improvement. The AMA strongly advocated faster time frames (PDF) of 24 hours for urgent requests and 48 hours for standard requests. CMS said it will consider updating its policies in future rulemaking.

Why it’s important: While payers claim that prior authorization requirements are used for cost and quality control, a vast majority of physicians report that the protocols lead to unnecessary waste and avoidable patient harm. One-third of the 1,001 physicians surveyed (PDF) by the AMA reported that prior authorization has led to a serious adverse event for a patient in their care.

More specifically, the AMA survey found that these shares of the physician respondents reported that prior authorization led to:

A patient’s hospitalization—25%.

A life-threatening event or one that required intervention to prevent permanent impairment or damage—19%.

A patient’s disability or permanent bodily damage, congenital anomaly or birth defect, or death—9%.

Change Healthcare cyberattack outage could last weeks

If your health payer is United Health Group your ddoctor may not be able to send a prescription with his electronic health recordl

He will need to fax the prescription or you may need to bering it in in person.

Change Healthcare cyberattack outage could last weeks

We here at Health Train Express use credible sources for information. These are our guiding principles.

Identifying Credible Sources of Health Information in Social Media: Principles and Attributes

By Raynard S. Kington, Stacey Arnesen, Wen-Ying Sylvia Chou, Susan J. Curry, David Lazer, and Antonia M. Villarruel

Background

In March 2021, the National Academy of Medicine (NAM) launched a project to help identify principles for identifying credible sources of health information in social media, of which this paper is the principal output. Sponsored by YouTube’s Healthcare and Public Health Partnerships arm [c], the project was inspired by the goal of enhancing public access to evidence-based health information during the COVID-19 pandemic, although the issue has relevance beyond the current crisis.

The project involved an independent expert advisory group composed of multi-disciplinary experts in information governance, health information development, public health and health equity, social media and misinformation, and science communication (members of which also authored this paper), a public webinar, a public comment period, and other information-gathering activities. This paper does not constitute official recommendations from the NAM or the National Academies of Sciences, Engineering, and Medicine (NASEM), nor does it represent an endorsement of any actions taken by YouTube or other SMPs following its publication.

Foundational Principles

Based on their information gathering and deliberation, the authors developed the following foundational principles to guide the identification of credible sources of health information in social media.

 

Principle 1: Science-Based

Sources should provide information that is consistent with the best scientific evidence available at the time and meet standards for the creation, review, and presentation of scientific content.

This principle reflects the authors’ conviction that scientific evidence is the only reliable predictor of health outcomes and therefore should be the foundation of health information provided to consumers. There are a number of attributes (e.g., use of citations) that help to indicate whether a source is sharing information that is consistent with the best scientific evidence available at the time, described in the following section.

Principle 2: Objective

Sources should take steps to reduce the influence of financial and other forms of conflict of interest or bias that might compromise or be perceived to compromise the quality of the information they provide.

This principle acknowledges that all sources have COIs or inherent biases. However, in order to be considered credible, sources should strive to separate the presentation of health information from profit motives and other biases (e.g., political). Sources should also disclose conflicts, as noted in the next principle.

Principle 3: Transparent and Accountable

Sources should disclose the limitations of the information they provide, as well as conflicts of interest, content errors, or procedural missteps.

The final principle acknowledges the fallibility of both organizations—which cannot eliminate COI and errors—and science itself. At the frontiers of understanding, scientific knowledge changes over time as more evidence becomes available and as existing evidence is analyzed in new ways. Scientific evidence, no matter how rigorous, can never guarantee a certain outcome for every individual or every context. Furthermore, Black, Indigenous, and People of Color (BIPOC) and other groups, such as LGBTQIA+ individuals and people with disabilities, are underrepresented within organizations traditionally considered authorities in science, meaning that the best available science might not fully reflect their experiences (discussed further in “Structural Bias”).

To maintain credibility, sources must clearly acknowledge the limitations of the information they share so that consumers can reach fully informed conclusions. Fundamentally, this last principle reflects one of the key themes among the public comments the authors received—the importance of protecting the right of individuals to autonomy and independent evaluation of the information they consume and the sources they choose to trust. It also acknowledges sources’ right to freedom of speech [f], but at the same time, requires sources to be fully transparent and provide all the context necessary for consumers to reach an informed judgment. However, the protection of free speech and consumer autonomy must be balanced against the harms of misinformation and disinformation, as well as recent anti-science and “post-truth” trends in the media [16]. “Post-truth” refers to an environment in which scientific evidence is disregarded by some in favor of an alternative set of beliefs [17].

 Credibility Attributes

Using the foundational principles as a scaffold, the authors identified a set of attributes that generally describe credible sources of health information (see Table 1). Not every source can display every attribute, but this should not preclude a general assessment of credibility. For example, a professional association may have a lobbying arm, which is counter to one of the attributes under the “objective” principle. However, the same organization might have a research arm that nearly or fully aligns with the attributes under the “science-based” principle. Furthermore, this organization may clearly disclose its lobbying activities to the public and maintain a strict firewall between political messages and health information for the public, thereby aligning with attributes under the “transparent and accountable” principle. 

These guiding principles ensure what you read on Health Train Express is credible.

Identifying Credible Sources of Health Information in Social Media: Principles and Attributes - National Academy of Medicine

Research in the Era of AI - Microsoft Research. Will AI find Disruptive Science in Health Care

Will AI bring the truth out?  The truth will set you free. AI will be a disruptive technology in health care. It began with the electronic health record.

Peter Lee's keynote address at the Microsoft Research Forum focused on three main points:

The significant advances in AI, particularly in the past year, and how these developments have fundamentally transformed the way Microsoft approaches research 1.

The comparison of the current state of AI and computer science research to the scientific disruption in biology in the 1700s. He highlighted how the discovery of cell division changed the infrastructure of research in biology and drew parallels to how machine learning and neural transformers are changing the infrastructure of computer science research today 1.

The impact of these changes on researchers, with many finding their previous work disrupted or even invalidated. Despite the challenges, he expressed excitement and joy at living through this rare and special period of disruption and transformation in the field of AI and computer science research 1.

Keynote: Research in the Era of AI - Microsoft Research

Transcript - Keynote address: Research in the Era of AI Peter Lee, Corporate Vice President, Microsoft Research and Incubations Peter Lee discusses how recent developments in AI have transformed the way Microsoft approaches research. Microsoft Research Forum, Jan. 30, 2024

PETER LEE: Hi. I'm really pleased and excited to be here for this first Microsoft Research Forum, a series that we have here out of Microsoft Research to carry out some important conversations with the research and scientific community. This past year has been quite a memorable one. Just some incredible advances, particularly in AI, and I'll spend a little bit of time talking about AI here to get us started. But before doing that, I thought I would try to at least share how I see what is happening in the broader context of scientific disruption. And to do that, I want to go all the way back to the 1700s and the emerging science of biology, the science of living things. Actually, in the 1700s, it was well understood by the end of that century that all living things were made up of cells —everything from trees and plants to bugs, animals, and human beings. But a fundamental scientific mystery that lingered for decades was, where do cells come from? And a prevailing theory of that was the concept of cell crystallization. It has been understood in other areas that sometimes hard materials would crystallize into existence from fluid materials. And so the thought was that out of living fluids, under just the right conditions, cells would crystallize into existence. And a lot of biological research of the time was centered around that theory. And in fact, quite a few important and useful things came out of that line of research, research that even has an impact medically today. Now, of course, there was an alternative theory, which I think is credited to Robert Remak, that in fact cells get created through a process of cell division. And we know that this is true today. But it was really considered an alternative theory until Rudolf Virchow was actually able to witness the mitosis of cells, the division of cells, and in fact, coined the aphorism that all cells come from other living cells. This had a very significant impact on Virchow’s research and his research into what is now known as pathology. Overnight, whole research legacies were rendered largely invalid because the whole concept of cell crystallization was then known to be invalid. But even the very foundational infrastructure of research at the time changed. In fact, after Virchow, to call yourself a researcher in biology, you had to have access to a new piece of research infrastructure called the microscope, and you had to be good at using it. And so while the researchers themselves of the time were not invalidated, they were disrupted in a really fundamental way. And of course, the discovery of mitosis really set biology research on the path ultimately to the discovery of DNA and the remarkable kinds of medical and biological advances we see in the field. Now I tell that story because when I think about that story —and I learned it first from the great biology researcher and medical scientist Sid Mukherjee at Columbia —I think about what we as computer scientists are going through today. We've now witnessed the incredible potential power

of machine learning systems at scale and of specific architectures like neural transformers. And there are many possibilities, there are many challenges, and there are many mysteries. Furthermore, the infrastructure of what we do as computer science researchers, particularly in areas related to artificial intelligence, has changed in the same way that biology researchers need access to new infrastructure like microscopes. At least that was the case in the mid-1800s when Virchow made his discovery. Today, for a large segment of the kinds of research that we do, we now realize we need new types of infrastructure, infrastructure such as large datasets, access to large-scale GPU computing, and even other training pipelines and foundations. And what we're seeing is that this is affecting virtually everything that we do today. And so as we work together as a research community in computer science, we are in this incredibly exciting stage, a stage of being disrupted personally as researchers —many of us as researchers finding large parts of what we had been working on being changed, disrupt ed, or even invalidated —and a whole new vista of possibilities in front of us. And we are just incredibly excited within Microsoft Research to be living through this. There are difficult moments, to be sure, but also a sense of joy, a joy that comes from the realization that we are now living through something very special and very rare.

Microsoft's Health Futures