fbpx
Connect with us

The Conversation

Louisiana set to reclassify abortion pills as controlled, dangerous substances − here’s what that means

Published

on

theconversation.com – Jamie Rowen, Associate Professor of Legal Studies and Political Science, UMass Amherst – 2024-05-24 13:39:36
Misoprostol has a long history of safe and effective use.
AP Photo/Allen G. Breed

Jamie Rowen, UMass Amherst and Tami S. Rowen, University of California, San Francisco

Louisiana's Legislature approved a bill on May 23, 2024, that would reclassify two abortion pills, mifepristone and misoprostol, as “controlled, dangerous substances.” Both pills have a long history of safe and effective use in medication abortions as well as for treatment of miscarriages and other conditions. The bill, which is expected to be signed into law by the state's governor, makes it illegal to possess either of the pills without a prescription. Surgical and medication abortions are already banned in Louisiana, with few exceptions.

U.S. asked twin sisters Jamie Rowen, a legal scholar, and Tami Rowen, an obstetrician and gynecologist, to explain the new law's implications – both for patients and providers.

What does Louisiana's law mean for these abortion pills?

Mifepristone and misoprostol have long been classified as noncontrolled substances. Though a prescription is required in order to obtain them, there have been no criminal consequences for possessing these medications.

Louisiana's new bill, once signed, would reclassify the pills as Schedule 4 drugs, which includes medications such as diazepam, more commonly known as valium, and tramadol, a commonly used opioid.

Advertisement

In the U.S., prescription medications are divided into two categories: not controlled and controlled. These are based on the drug's likelihood for mental and physical addiction. Louisiana just moved the two medications from not controlled to controlled.

Access to medication abortion already requires a prescription everywhere in the U.S. So people seeking abortions will still need to get a prescription to obtain the pills under Louisiana's new law, just as before.

What this law primarily does is make it a crime for people who are not seeking abortions to possess the pills. In Louisiana, it is against the law to provide a medical or surgical abortion absent the threat of a woman's death or “substantial and irreversible bodily impairment.” Louisiana residents seeking medication abortion must get the pills from out of state. Under this new law, if someone without a valid prescription transports or stores mifepristone or misoprostol in Louisiana, they may face a penalty of between one and five years in prison and up to US$5,000 in fines.

Controlled substances are further categorized by schedules. Under federal law, schedule designations are determined by a drug's potential for abuse, its risk to public and a few other factors.

Under Louisiana state law, there are five schedules that follow similar categorizations as federal law. A Schedule 4 classification means that the drug or other substance has a low potential for abuse, has a currently accepted medical use, and that abuse of the drug or other substance may lead to limited physical dependence or psychological dependence.

Advertisement

By classifying mifepristone and misoprostol as a controlled Schedule 4 drug, the legislature is asserting without evidence that there are dependence and abuse risks associated with taking the medication.

Hundreds of doctors in Louisiana say that the new bill could make it much harder for them to obtain the pills for maternal care in a state that already has some of the highest maternal mortality rates in the U.S.

What science, if any, did the Legislature rely on?

This is the first time that a state has classified abortion medication as a controlled substance, but it is not an unprecedented classification of abortion medication as a Schedule 4 drug.

Taiwan similarly classifies mifepristone this way.

The classification has no science behind it, however, as no studies suggest that the drug poses any risk of dependence or abuse. Mifepristone can be used for elective abortion, miscarriage management and even for labor induction, being more effective than traditional treatments with misoprostol alone.

In terms of safety, it is useful to compare the risks of mifepristone with another commonly used drug, Viagra. Though requiring a prescription, Viagra is not classified as a controlled substance. For mifepristone, there are rare reported cases of nonspecific fatal sepsis that could be related to women undergoing medical abortion in the U.S.

Advertisement

In contrast, Viagra was linked to 1,473 major adverse outcomes and 522 reported deaths in the U.S. during a 13-month period. The legislative history in Louisiana does not explain the science behind its classification scheme.

It should be noted that there is no risk of dependence from either misoprostol or mifepristone. Misoprostol was approved by the Food and Drug Administration for its ability to lessen the symptoms of gastric ulcers but is widely used throughout obstetrics and gynecology for inducing labor and stopping postpartum hemorrhage. Side effects for those using misoprostol for ulcers or gynecological care are rare, particularly compared with other Schedule 4 drugs.

a woman holds a sign supporting access to abortion pills at a protest rally
Abortion rights activists have been protesting efforts at the state and federal level to restrict access to abortion pills like mifepristone.
AP Photo/Jose Luis Magana

How could the new law affect access for nonabortion procedures?

According to the new law, the criminal penalties of up to five years in prison can be imposed regardless of whether the pills are designated for a person electing abortion or trying to complete a miscarriage. In addition, the law does not distinguish between the possession of misoprostol for the treatment of gastric ulcers or gynecological care.

By punishing people who are transporting or storing the medications for others, the law may create new barriers to access for a variety of people, even if it doesn't criminalize pregnant people who consume the pills.

What are the implications of the laws for other states?

The Supreme Court has interpreted the Constitution as allowing both the federal government and the states to regulate controlled substances. This means there can be variations in access to medications state to state.

However, states typically follow federal scheduling guidelines and practices when making their own drug classifications. A well-known but rare exception to this common practice is cannabis, which many states have decriminalized or legalized contrary to federal law.

Advertisement

The immediate impacts will be on clinical studies on the two drugs in other states that have patients in Louisiana. Clinical trials with medications that are not controlled substances may be conducted in any state with little or no added state regulation. Clinical trials of controlled substances have additional regulatory requirements that can add costs and delay development.

The most likely long-term outcome is that other states may make similar legislative attempts to curb access to medication abortion, particularly in states that have unsuccessfully tried to stop access to medical abortion in other ways.The Conversation

Jamie Rowen, Associate Professor of Legal Studies and Political Science, UMass Amherst and Tami S. Rowen, Associate Professor of Obstetrics, Gynecology and Gynecologic Surgery, University of California, San Francisco

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation

A microbiologist explains how to avoid getting sick at the barbecue, in the pool or on the trail

Published

on

theconversation.com – Bill Sullivan, Professor of Pharmacology and Toxicology, Indiana University – 2024-06-11 07:35:19

Taking precautions against outdoor pathogens can keep you from getting sidelined over the summer.

galitskaya/iStock via Getty Images Plus

Bill Sullivan, Indiana University

As flowers bloom and temperatures climb, many are eager to get back outside. But while the Sun may be shining, there is a dark side that can make the great outdoors not so great.

Gangs of germs are lurking in the woods, in the soil, in the water and in your food, ready to rain on your summer parade.

Advertisement

I'm a professor of microbiology at the Indiana University School of Medicine, where I study and teach about infectious disease. Here are some things to keep in mind to help you and your loved ones stay free of illness while enjoying summer activities.

Germs in the backyard

There's nothing like the smell of a good barbecue and fresh goodies from your own garden. To make sure people leave your party with only good memories, be aware of germs commonly linked to food poisoning, which can result in diarrhea, cramps, nausea, vomiting and fever.

Meats, including fish and poultry, often house harmful bacteria such as Salmonella, E. coli or Listeria. Raw meat can contaminate anything it touches, so be sure to wash your hands and disinfect surfaces and utensils. To avoid cross contamination, do not keep uncooked meat near prepared foods. Meat products must be cooked to proper temperatures to ensure harmful germs are destroyed before consuming.

Person washing a cutting board in the kitchen sink

Washing cooking utensils that touch raw meat can reduce cross contamination.

Catherine Falls Commercial/Moment via Getty Images

In addition to bacteria, a parasite called Toxoplasma gondii can cause acute food poisoning. Toxoplasma parasites are shed as microscopic oocysts in the feces of infected cats. Oocysts persist in the environment for a year or more, and other animals, including people, can inadvertently ingest them.

Advertisement

Upon infection, Toxoplasma forms tissue cysts in the flesh of food animals – another reason to cook your meats thoroughly. Pregnant people need to take special care in avoiding Toxoplasma, since the parasite can cross the placenta and cause miscarriage or birth defects.

To avoid getting toxoplasmosis from oocysts, people should wear gloves while gardening, wash fruits and vegetables, and make sure the sandbox is free of cat poop and covered when not in use.

Germs in the water

Recreational water facilities, such as pools, water parks and fountains, are a great way to beat the summer heat. The smell of chlorine is a good sign that the water is being treated to kill many types of germs.

Unfortunately, some germs can remain infectious in chlorine for several minutes or days, which is plenty of time to spread from one person to another. These include viruses such as norovirus, bacteria such as E. coli, and parasites such as Cryptosporidium and Giardia.

Accidental ingestion of these germs can cause stomach problems, including diarrhea, which can become serious if it leads to dehydration. To avoid becoming infected, swim in well-maintained facilities and avoid swallowing the water. To avoid infecting others, stay out of public water for at least a week if you have diarrhea.

Advertisement

Hand holding pH and chlorine test kit above a swimming pool

While a well-chlorinated pool can kill most germs, some may still lurk in the water.

Antonio Hugo Photo/Moment via Getty Images

Bacteria in the water that get trapped in the ear can lead to a painful infection known as swimmer's ear, which can be prevented by wearing earplugs in the water.

Ponds, rivers and lakes can also be home to these diarrhea-causing germs. Warm fresh water may also contain Naegleria fowleri, the so-called “brain-eating amoeba.” While extremely rare, inhaling water containing Naegleria fowleri is almost always fatal. Wearing nose plugs can help prevent infection.

If you're going to reach for the beach, be sure to reach for waterproof bandages if you have an open wound, piercing or tattoo. Global warming has produced a rise in so-called “flesh-eating bacteria” that cause a dangerous condition called necrotizing fasciitis. These infections can be very difficult to treat and may result in surgical removal of affected tissue or limbs.

Shellfish such as oysters, clams and mussels filter ocean water as they eat, causing germs to get trapped inside their bodies. Consuming raw shellfish can lead to serious food poisoning due to infection with bacteria or Toxoplasma oocysts.

Advertisement

Germs on the trail

While hiking or camping, you may come across water that looks clean enough to drink, but don't be tempted.

Be sure to boil or properly filter water you drink to avoid bacteria such as E. coli and parasites such as Giardia and Cryptosporidium. These intestinal pathogens will produce cramps, nausea and diarrhea – especially unpleasant symptoms when you don't have access to indoor plumbing.

After a very mild winter, you can expect a lot of ticks and mosquitoes in the summer, both of which are carriers of serious diseases. As they feed on blood, ticks can inject bacteria that cause Lyme disease or Rocky Mountain spotted fever. They can also transmit a parasite that causes babesiosis. Symptoms of illness following a tick bite should be promptly evaluated by a physician.

Person applying bug spray on arm of child outdoors

Insect repellent can help protect you from diseases transmitted through bug bites.

SeventyFour/iStock via Getty Images Plus

Mosquitoes can carry numerous viruses that are injected into the bloodstream while they take a blood meal. Common mosquito-borne viruses in the U.S. include West Nile virus, eastern equine encephalitis and Zika. In most cases, these viruses produce flu-like symptoms that typically resolve on their own. Infection with Zika virus during pregnancy, however, can lead to birth defects, and West Nile virus can cause acute fever and neurological effects in some people.

Advertisement

To avoid tick and mosquito bites, wear insect repellent and keep your skin covered whenever possible. Wear light colors so the insects are more visible to you. Ticks like shade and high grass, so mow your lawn down to about 2 inches in height. Be sure to inspect your body and scalp for ticks after being outside.

It is important to pay attention to local reporting outbreaks of infectious agents in your area or travel destination. With these precautions in mind, you're sure to have a terrific time, uninterrupted by the germs of summer.The Conversation

Bill Sullivan, Professor of Pharmacology and Toxicology, Indiana University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Continue Reading

The Conversation

PFAS are toxic ‘forever chemicals’ that linger in our air, water, soil and bodies – here’s how to keep them out of your drinking water

Published

on

theconversation.com – Jessica Ray, Professor of Civil & Environmental Engineering, University of Washington – 2024-06-11 07:35:04

Exposure to PFAS during pregnancy can lead to a child's low birth weight and accelerated puberty.

RUNSMART/Digital Vision via Getty Images

Jessica Ray, University of Washington

Close to half of America's tap water contains PFAS, or perfluoroalkyl and polyfluoroalkyl substances. These “forever chemicals” are in thousands of products, from clothing and cosmetics to cleaning products, and are linked to cancers, liver damage, high cholesterol and asthma.

Dr. Jessica Ray, assistant professor of civil and environmental engineering at the University of Washington, explains what PFAS are, how scientists are trying to remove them from the environment, and what you can do to reduce the impact of PFAS on your own .

Advertisement

Dr. Jessica Ray discusses PFAS in our water supply.

has collaborated with SciLine to bring you highlights from the discussion, which have been edited for brevity and clarity.

What are PFAS, and how are they used?

Jessica Ray: PFAS are a class of thousands of synthetic chemicals originally manufactured and heavily used in the 1950s. They were the active ingredient in fire suppressant foams that were used at military bases on aircraft fires.

Since then, they've been used in many applications and consumer products – shampoos, dental floss, nail polish. They've been used in waxy coatings found in food containers. They have also been applied as nonstick coatings; for example, in cookware. They've been used in outerwear to help with rain protection.

Why are PFAS called “forever chemicals”?

Advertisement

Jessica Ray: It is difficult for PFAS to degrade naturally in the environment or even during processes like water treatment.

How do PFAS move through the environment?

Jessica Ray: Unfortunately, PFAS like to stick to solid surfaces like soils. They can dissolve in water and enter the Earth's atmosphere. And because PFAS can permeate air, water and soil, humans and animals can be exposed to them in a multitude of ways.

For example, if PFAS are present in ocean water, and then the fish ingest and become contaminated with PFAS, and then we consume those fish, then we are exposed to PFAS. And unfortunately, researchers have detected PFAS in many, many different drinking water sources worldwide. Not just surface water and groundwater, but bottled water as well.

What are the health impacts of PFAS?

Advertisement

Jessica Ray: PFAS have been linked to liver tissue damage and kidney cancer. If a fetus is exposed to PFAS during pregnancy, that can lead to low birth weight and accelerated puberty. PFAS have also been linked to impairments of the immune system.

How can we reduce personal exposure to PFAS?

Jessica Ray: You can do a number of things. If you're cooking, you could purchase and use stainless steel or cast iron cookware, very tried and true cookware that should not contain PFAS.

Also look for products that explicitly state they are PFAS-free. And you could buy organic products, those should have lower PFAS loads. Finding ways to reduce PFAS loads to the environment and to drinking water will be important given the Environmental Protection Agency ruling in April 2024 to regulate several PFAS in drinking water.

The Environmental Protection Agency has targeted six chemicals for removal from drinking water.

How can we remove PFAS from our drinking water?

Advertisement

Jessica Ray: A handful of companies are selling essentially a version of a Brita water filter that are targeted for PFAS. Generally though, just using something like a Brita or Pur water filter at home should help reduce exposure to not only PFAS, but other contaminants that might persist even in drinking water that's distributed to your tap at home.

What about your research on removing PFAS from water?

Jessica Ray: My research group is exploring two different approaches for treating PFAS in water. One approach is to remove or separate PFAS from water. The other is to destroy PFAS in water.

For the separation approaches, we're looking at existing water treatment processes used in drinking water and wastewater treatment, and then trying to modify those processes to selectively target PFAS in water apart from other contaminants that might be in the water.

How is your group trying to improve PFAS filtration?

Advertisement

Jessica Ray: If you are filtering your water at home using a filtration cartridge, then that can help to remove a wide variety of contaminants. These contaminants can include heavy metals or other dissolved contaminants in water.

But often, PFAS in drinking water sources tend to exist in very, very low concentrations, while other contaminants exist at much higher ones. Filters only have so many adsorption sites available where contaminants are bound. And so there is a strong likelihood the adsorption sites will be occupied before the PFAS can be removed from the water.

One approach that we've been using is to develop new adsorbents that help target PFAS. My group has been developing this material for the last couple of years. And we've been talking to people who can help commercialize this technology so consumers can apply these kinds of point-of-use treatments to help protect them from PFAS. It's hard to say exactly how long it will be until the treatments will be commercially available – maybe in one or two years.

Are there alternatives to PFAS that are safer to use?

Jessica Ray: Researchers are looking into what's called green chemistry – designing chemicals that behave similarly to PFAS but aren't as toxic and will break down in the environment. So there is hope for the future.

Advertisement

Watch the full interview to hear more.

SciLine is a free service based at the nonprofit American Association for the Advancement of Science that helps journalists include scientific evidence and experts in their stories.The Conversation

Jessica Ray, Professor of Civil & Environmental Engineering, University of Washington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Continue Reading

The Conversation

Biden and Trump may forget names or personal details, but here is what really matters in assessing whether they’re cognitively up for the job

Published

on

theconversation.com – Leo Gugerty, Professor Emeritus in Psychology, Clemson University – 2024-06-10 11:43:28

This image of Trump and Biden was taken during the 2020 presidential debate in Nashville, Tenn.

Pavlo Conchar/SOPA Images/LightRocket via Getty Images

Leo Gugerty, Clemson University

Some Americans are questioning whether elderly people like Joe Biden and Donald Trump are cognitively competent to be president amid reports of the candidates mixing up names while speaking and having trouble recalling details of past personal events.

I believe these reports are clearly concerning. However, it's problematic to evaluate the candidates' cognition based only on the critiques that have gained traction in the popular press.

Advertisement

I'm a cognitive psychologist who studies decision-making and causal reasoning. I argue that it's just as important to assess candidates on the cognitive capacities that are actually required for performing a complex leadership job such as the presidency.

Research shows that these capacities mainly involve decision-making skills grounded in extensive job-related knowledge, and that the types of errors made by Biden and Trump do increase with age, but that doesn't mean either candidate is unfit for office.

Intuitive vs. deliberative decision-making

There are two types of decision-making: intuitive and deliberative.

In intuitive decision-making, people quickly and easily recognize a complex situation and recall an effective solution from memory. For example, physicians' knowledge of how diseases and symptoms are causally related allows them to quickly recognize a complex set of patient symptoms as matching a familiar disease stored in memory and then recall effective treatments.

A large body of research on fields from medicine to military leadership shows that it takes years – and often decades – of effortful deliberate practice in one's field to build up the knowledge that allows effective intuitive decisions.

Advertisement

In contrast to the ease and speed of intuitive decisions, the most complex decisions – often the kinds that confront a president – require conscious deliberation and mental effort at each stage of the decision-making process. These are the hallmarks of deliberative decision-making.

For example, a deliberative approach to creating an immigration bill might start with causal reasoning to understand the multiple factors influencing the current border surge and the positive and negative effects of immigration. Next, generating possible bills may involve negotiating among multiple groups of decision-makers and stakeholders who have divergent values and objectives, such as reducing the number of undocumented immigrants but also treating them humanely. Finally, making a choice requires forecasting how proposed solutions will affect each objective, dealing with value trade-offs and often further negotiation.

Psychological scientists who study these topics agree that people need three key thinking dispositions – referred to as “ actively open-minded thinking” or “wise reasoning” – for effective deliberative decision-making:

  • Open-mindedness: Being open-minded means considering all of the choices and objectives relevant to a decision, even if they conflict with one's own beliefs.

  • Calibrated confidence: This is the ability to express confidence in a given forecast or choice in terms of probabilities rather than as certainties. One should have high confidence only if evidence has been weighted based on its credibility and supportive evidence outweighs opposing evidence by a large margin.

  • Teamwork: This involves seeking alternative perspectives from within one's own advisory team and from stakeholders with conflicting interests.

A reporter addresses the difference between normal gaffes and mistakes that are a cause for concern.

Presidents need to use both intuitive and deliberative decision-making. The ability to make smaller decisions effectively using intuitive decision-making frees up time to concentrate on larger ones. However, the decisions that make or break a president are exceedingly complex and highly consequential, such as how to handle climate change or international conflicts. Here is where deliberative decision-making is most needed.

Effective intuitive and deliberative decisions both rely on extensive job-related knowledge. Especially during deliberative decision-making, people use conceptual knowledge of the world that is consciously accessible, commonly referred to as semantic memory. Knowledge of concepts such as tariffs, Middle East history and diplomatic strategies allows presidents to quickly grasp new developments and understand their nuances. It also helps them fulfill an important job requirement: explaining their decisions to political opponents and the public.

Advertisement

What to make of forgetfulness and word mix-ups

Biden has been criticized for not recalling details of his personal past. This is an error in episodic memory, which is responsible for our ability to consciously recollect personal experiences.

Neurologists agree, however, that Biden's episodic memory errors are within the range of normal healthy aging and that the details of one's personal life are not especially relevant to a president's job. That's because episodic memory is distinct from the semantic memories and intuitive knowledge that are critical to good decision-making.

Mixing up names, as Biden and Trump occasionally do, is also unlikely to affect job performance. Rather, it simply involves a momentary error in retrieving information from semantic memory. When people make this common error, they usually still understand the concepts underlying the mixed up names, so the semantic knowledge that helps them deal with life and work is intact.

president biden sits on a chair with other men in suits on couches in an oval room in the White House

Biden is known for thoroughly investigating and discussing a diverse range of viewpoints with his advisers before making an important decision.

AP Photo/Evan Vucci

Making complex decisions as you age

Because all of us use a myriad of concepts to navigate the world every day, our semantic knowledge typically does not decrease with age, lasting at least until age 90. This knowledge is stored in posterior brain regions that deteriorate relatively slowly with age.

Advertisement

Research shows that, since intuitive decision-making is learned by extensive practice, older experts are able to maintain high performance in their field as long as they keep using and practicing their skills. As with semantic memory, experts' intuitive decision-making is controlled by posterior brain regions that are less compromised by aging.

However, older experts must put in more practice than younger ones to maintain previous skill levels.

The thinking dispositions that are key to deliberative decision-making are influenced by early social learning, including education. Thus, they become habits, stable characteristics that capture how people typically make decisions.

Evidence is emerging that dispositions such as open-mindedness do not decline much and sometimes even increase with age. To investigate this, I looked at how well open-mindedness correlated with age, while controlling for education level, using data from 5,700 people in the 2016 British Election Study. A statistical analysis showed that individuals ages 26 to 88 had very similar levels of open-mindedness, while those with more education were more open-minded.

Applying this to the candidates

As for the 2024 presidential candidates, Biden has extensive knowledge and experience in politics from more than 44 years in political office and thoroughly investigates and discusses diverse viewpoints with his advisers before reaching a decision.

Advertisement

In contrast, Trump has considerably less experience in politics. He claims that he can make intuitive decisions in a field where he lacks knowledge by using “common sense” and still be more accurate than knowledgeable experts. This claim contradicts the research showing that extensive job-specific experience and knowledge is necessary for intuitive decisions to be consistently effective.

My overall interpretation from everything I've read about this is that both candidates show aspects of good and poor decision-making. However, I believe Biden regularly displays the deliberative dispositions that characterize good decision-making, while Trump does this less often.

So, if you're trying to assess how or whether the candidates' age should affect your vote, I believe you should mostly ignore the concerns about mixing up names and not recalling personal memories. Rather, ask yourself which candidate has the key cognitive capacities necessary to make complex decisions. That is, knowledge of political affairs as well as decision-making dispositions such as open-mindedness, calibrating confidence to evidence, and a willingness to have your thinking challenged by advisers and critics.

Science cannot make firm predictions about individuals. However, the research suggests that once a leader has developed these capacities, they typically do not decrease much even with advanced age, as long as they are actively used.The Conversation

Leo Gugerty, Professor Emeritus in Psychology, Clemson University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Advertisement
Continue Reading

News from the South

Trending