Marihuana legal es más potente que nunca pero no está bien regulada
La marihuana y otros productos que contienen THC, el principal ingrediente psicoactivo de la planta, se han vuelto más potentes y peligrosos a medida que la legalización los ha vuelto más accesibles.
Décadas atrás, el contenido de THC de la hierba solía ser inferior al 1,5%. Hoy, algunos productos tienen más de un 90%.
La marihuana y otros productos que contienen THC, el principal ingrediente psicoactivo de la planta, se han vuelto más potentes y peligrosos a medida que la legalización los ha vuelto más accesibles.
Décadas atrás, el contenido de THC de la hierba solía ser inferior al 1,5%. Hoy, algunos productos tienen más de un 90%.
La euforia de antaño ha dado paso a algo más alarmante. Cientos de miles de personas llegan a salas de emergencias por crisis relacionadas con la marihuana, y millones sufren trastornos psicológicos vinculados al consumo de cannabis, según investigaciones federales.
Pero los organismos reguladores no están a la altura.
En los estados que permiten la venta y el consumo de la marihuana y sus derivados, la protección al consumidor no es consistente.
“En muchos estados, los productos tienen una etiqueta de advertencia y poco más por parte de las entidades reguladoras”, dijo Cassin Coleman, vicepresidente del comité de asesoramiento científico de la Asociación Nacional de la Industria del Cannabis.
En general, el gobierno federal no ha intervenido. Sigue prohibiendo la marihuana como sustancia catalogada en la Lista 1 —como droga sin uso médico aceptado y con un alto riesgo de abuso— en virtud de la Ley de Sustancias Controladas (CSA). Pero en lo que respecta a la venta de cannabis, que muchos estados han legalizado, no regula características como la pureza o la potencia.
La Administración de Drogas y Alimentos (FDA) “básicamente se ha cruzado de brazos y no ha cumplido con su deber de proteger la salud pública”, afirmó Eric Lindblom, de la Facultad de Derecho de la Universidad de Georgetown que anteriormente trabajó en el Centro para Productos del Tabaco de la FDA.
La marihuana se ha transformado profundamente desde que generaciones de estadounidenses la usaron por primera vez.
El cannabis se cultiva para suministrar dosis mucho más altas de THC. En 1980, el contenido de THC de la marihuana confiscada era inferior al 1,5%. Hoy en día, muchas variedades de flores de cannabis —la materia vegetal que se puede fumar en un porro— tienen más de un 30% de THC.
Recientemente, en un dispensario de California el menú incluía una variedad con un 41% de THC.
La legalización también ha abierto la puerta a productos que se extraen de la marihuana pero que no siquiera parecidos: concentrados de THC aceitosos, cerosos o cristalinos que se calientan e inhalan mediante el vapeo o el dab, utilizando dispositivos parecidos a un soplete.
Los concentrados actuales pueden tener más de un 90% de THC. Algunos se anuncian como THC casi puro.
Pocos personifican la expansión de la marihuana de forma tan clara como John Boehner, ex presidente de la Cámara de Representantes de Estados Unidos. El republicano de Ohio se opuso durante mucho tiempo a la marihuana y, en 2011, se declaró “inalterablemente contrario” a su legalización.
Ahora forma parte del consejo directivo de Acreage Holdings, un productor de derivados de la marihuana.
Y Acreage Holdings ilustra la evolución del sector. Su marca Superflux comercializa un producto para vapear —”resina pura en un formato cómodo e instantáneo”— y concentrados como “budder”, “sugar”, “shatter” y “wax”. La empresa anuncia su concentrado de “THCa cristalino” como “lo último en potencia”.
Según el Instituto Nacional sobre el Abuso de Drogas, las concentraciones más elevadas entrañan mayores riesgos. “Los riesgos de dependencia física y adicción aumentan con la exposición a altas concentraciones de THC, y las dosis más altas de THC tienen más probabilidades de producir ansiedad, agitación, paranoia y psicosis”, se explica en su sitio web.
En 2021, 16,3 millones de personas en Estados Unidos —el 5,8% de las personas de 12 años en adelante— habían sufrido un trastorno por consumo de marihuana en el último año, según una encuesta publicada en enero por el Departamento de Salud y Servicios Humanos (HHS).
Esta cifra es muy superior a la suma de los trastornos por consumo de cocaína, heroína, metanfetamina, estimulantes de venta bajo receta, como Adderall, o analgésicos recetados, como fentanilo y OxyContin.
Otras drogas son más peligrosas que la marihuana, y la mayoría de las personas afectadas por su consumo padecieron un caso leve. Pero aproximadamente 1 de cada 7 —más de 2,6 millones de personas— padecieron un caso grave, según la encuesta federal.
La mayoría de los médicos equiparan el término “trastorno grave por consumo de sustancias” con la adicción, señaló Wilson Compton, subdirector del Instituto Nacional sobre el Abuso de Drogas.
El trastorno por consumo de cannabis “puede ser devastador”, afirmó Smita Das, psiquiatra de Stanford y presidenta de un consejo sobre adicciones de la Asociación Americana de Psiquiatría.
Das dijo que ha visto vidas destrozadas por el cannabis: personas de éxito que han perdido familias y trabajos. “Se encuentran en una situación en la que no saben cómo han llegado, porque sólo era un porro, sólo era cannabis, y no se suponía que el cannabis les creara adicción”, explicó Das.
Entre los diagnósticos médicos atribuidos a la marihuana figuran la “dependencia del cannabis con trastorno psicótico con delirios” y el síndrome de hiperémesis cannabinoide, una forma de vómito persistente.
Se estima que unas 800,000 personas realizaron visitas a emergencias relacionadas con la marihuana en 2021, según un estudio del gobierno publicado en diciembre de 2022.
Derecho a desintoxicación.
Un padre de Colorado pensó que era cuestión de tiempo para que el cannabis matara a su hijo.
En la primavera de 2021, el adolescente pasó un semáforo en rojo, chocó contra otro auto —resultando heridos él y el otro conductor— y huyó del lugar, según recordó el padre en una entrevista.
En los restos del accidente, el padre encontró porros, envases vacíos de un concentrado de THC de alta potencia conocido como “wax” y un vaporizador de THC.
En el teléfono móvil de su hijo descubrió mensajes de texto y decenas de referencias al “dabbing” y a la hierba. El adolescente dijo que había estado fumando antes del accidente y que intentó suicidarse.
Semanas después, la policía ordenó su ingreso involuntario en un hospital para una evaluación psiquiátrica. Según un informe policial, creía que lo perseguían francotiradores de un cártel de drogas.
El médico que evaluó al adolescente le diagnosticó “abuso de cannabis”.
“Deja de consumir dabs o wax, ya que pueden volverte extremadamente paranoico”, escribió el médico. “Vete directamente al programa de desintoxicación que elijas”.
Según el relato del padre, en los dos últimos años el adolescente sufrió varias retenciones involuntarias, docenas de encuentros con la policía, repetidos encarcelamientos y una serie de estadías en centros de tratamiento hospitalario.
A veces parecía fuera de la realidad, y enviaba mensajes de texto diciendo que Dios le hablaba y le daba superpoderes.
Los daños también fueron económicos. Los reclamos al seguro médico por su tratamiento ascendieron a casi $600,000 y los gastos de la familia llegaron a casi $40,000 hasta febrero.
En las entrevistas para este artículo, el padre habló bajo condición de anonimato para no perjudicar la recuperación de su hijo.
Está convencido de que la enfermedad mental de su hijo fue el resultado del consumo de drogas. Dijo que los síntomas remitían cuando su hijo dejaba de consumir THC y volvían cuando usaba de nuevo.
Su hijo tiene ahora 20 años, ha dejado la marihuana y le va bien, dijo el padre, y añadió: "No me cabe la menor duda de que el consumo de cannabis fue lo que le causó la psicosis, los delirios y la paranoia".
Regulación estatal desigual
Ahora, el uso médico de la marihuana es legal en 40 estados y el Distrito de Columbia, y el uso recreativo o para adultos es legal en 22 estados más el Distrito de Columbia, según MJBizDaily, una publicación especializada.
Al principio de la pandemia de covid-19, mientras gran parte de Estados Unidos cerró sus negocios, los dispensarios de marihuana siguieron abiertos. Muchos estados los declararon negocios esenciales.
Pero sólo dos estados que permiten el uso para adultos, Vermont y Connecticut, han puesto límites al contenido de THC —30% para la flor de cannabis y 60% para los concentrados de THC— y eximen de los límites a los cartuchos precargados, dijo Gillian Schauer de la Asociación de Reguladores de Cannabis, un grupo de reguladores estatales.
Algunos estados limitan el número de onzas o gramos que los consumidores pueden comprar. Sin embargo, incluso un poco de marihuana puede equivaler a mucho THC, apuntó Rosalie Liccardo Pacula, profesora de políticas de salud, economía y derecho en la Universidad del Sur de California.
Algunos estados sólo permiten el uso médico de productos con bajo contenido de THC; por ejemplo, en Texas, las sustancias que no contienen más de un 0,5% de THC en peso. Y algunos estados exigen etiquetas de advertencia. En Nueva Jersey, los productos de cannabis con más de un 40% de THC deben declarar: "Este es un producto de alta potencia y puede aumentar el riesgo de psicosis".
La normativa sobre marihuana de Colorado tiene más de 500 páginas. Sin embargo, se enfatizan los límites de las protecciones al consumidor: "Este producto se ha producido sin supervisión reglamentaria en materia de salud, seguridad o eficacia".
Determinar las normas adecuadas puede no ser sencillo. Por ejemplo, las etiquetas de advertencia podrían proteger a la industria de la marihuana de su responsabilidad, al igual que hicieron con las empresas tabacaleras durante años. Poner un tope a la potencia podría limitar las opciones de las personas que toman dosis elevadas para aliviar problemas médicos.
En general, en el ámbito estatal, la industria del cannabis ha frenado los esfuerzos reguladores argumentando que unas normas onerosas dificultarían la competencia entre las empresas legítimas y las ilícitas, explicó Pacula.
Pacula y otros investigadores han pedido al gobierno federal que intervenga.
Meses después de terminar su mandato como comisionado de la FDA, Scott Gottlieb hizo un llamamiento similar.
Al quejarse de que los estados habían llegado "muy lejos mientras el gobierno federal permanecía al margen", Gottlieb pidió "un esquema nacional uniforme para el THC que proteja a los consumidores."
Eso fue en 2019 y poco ha cambiado desde entonces.
¿Dónde está la FDA?
La FDA supervisa los alimentos, los medicamentos recetados, los de venta libre y los dispositivos médicos. Regula el tabaco, la nicotina y los vapes de nicotina. Supervisa las etiquetas de advertencia del tabaco. En interés de la salud y la seguridad públicas, también regula los productos botánicos, productos médicos que pueden incluir material vegetal.
Sin embargo, cuando se trata de la marihuana para fumar, los concentrados de THC derivados del cannabis que se vapean o dabean y los comestibles infundidos con THC, la FDA parece estar muy al margen.
La marihuana medicinal que se vende en los dispensarios no está aprobada por la FDA. La agencia no ha avalado su seguridad o eficacia ni ha determinado la dosis adecuada. No inspecciona las instalaciones donde se producen los productos ni evalúa el control de calidad.
La agencia sí invita a los fabricantes a someter los productos del cannabis a ensayos clínicos y a su proceso de aprobación de medicamentos.
El sitio web de la FDA señala que el THC es el ingrediente activo de dos medicamentos aprobados por la FDA para el tratamiento del cáncer. Aparentemente, sólo por eso la sustancia está bajo la jurisdicción de la FDA.
La FDA tiene "todo el poder que necesita para regular de forma mucho más eficaz los productos de cannabis legalizados por los estados", afirmó Lindblom, ex funcionario de la agencia.
Al menos públicamente, la FDA no le ha prestado atención a los concentrados de THC derivados del cannabis o la hierba fumada en porros, sino más bien en otras sustancias: una variante del THC derivada del cáñamo, que el gobierno federal ha legalizado, y un derivado diferente del cannabis llamado cannabidiol o CBD, que se ha comercializado como terapéutico.
"La FDA se ha comprometido a vigilar el mercado, identificar los productos de cannabis que plantean riesgos y actuar, dentro de nuestras competencias, para proteger al público", declaró Courtney Rhodes, vocera de la FDA.
"Muchos, la mayoría de los productos con THC se ajustan a la definición de marihuana, que es una sustancia controlada. La Drug Enforcement Administration (DEA) regula la marihuana en virtud de la Ley de Sustancias Controladas (CSA). Le remitimos a la DEA para preguntas sobre la regulación y aplicación de las disposiciones de la CSA", escribió Rhodes en un correo electrónico.
La DEA, dependiente del Departamento de Justicia, no respondió a las preguntas formuladas para este artículo.
En cuanto al Congreso, quizá su medida más importante haya sido limitar la aplicación de la prohibición federal.
"Hasta ahora, la respuesta federal a las acciones estatales para legalizar la marihuana ha consistido, sobre todo, en permitir que los estados apliquen sus propias leyes sobre la droga", señaló un informe de 2022 del Servicio de Investigación del Congreso.
En octubre, el presidente Joe Biden ordenó al secretario de Salud y Servicios Humanos y al fiscal general que revisaran la postura del gobierno federal respecto a la marihuana: si debería seguir clasificada entre las sustancias más peligrosas y estrictamente controladas.
En diciembre, Biden firmó un proyecto de ley que ampliaba la investigación sobre la marihuana y obligaba a las agencias federales a estudiar sus efectos. La ley dice que las agencias tienen un año para publicar sus conclusiones.
Algunos defensores de la marihuana dicen que el gobierno federal podría desempeñar un papel más constructivo.
"La NORML no opina que el cannabis sea inocuo, sino que la mejor forma de mitigar sus riesgos potenciales es mediante la legalización, la regulación y la educación pública", afirmó Paul Armentano, subdirector del grupo antes conocido como Organización Nacional para la Reforma de las Leyes sobre la Marihuana (NORML).
"Los productos tienen que someterse a pruebas de pureza y potencia", añadió, y "el gobierno federal podría ejercer cierta supervisión en la concesión de licencias a los laboratorios que prueban esos productos".
Mientras tanto, según Coleman, asesor de la Asociación Nacional de la Industria del Cannabis, los estados se quedan "teniendo que actuar como si fueran USDA + FDA + DEA, todo al mismo tiempo".
¿Y dónde deja eso a los consumidores? Algunos, como Wendy E., jubilada en sus 60 años, luchan contra los efectos de la marihuana.
Wendy, que habló con la condición de que no se revelara su nombre, empezó a fumar marihuana en la secundaria en los años 70 y la convirtió en su estilo de vida durante décadas.
Luego, cuando su estado la legalizó, la compró en dispensarios "y enseguida me di cuenta de que la potencia era mucho mayor que la que yo había consumido tradicionalmente", contó. "Parecía haber aumentado de manera exponencial".
En 2020, explicó, la marihuana legal —mucho más fuerte que la hierba ilícita de su juventud— la llevó a obsesionarse con el suicidio.
Antes, la mujer que se define como "hippie de la madre tierra" encontraba camaradería pasando un porro con sus amigos. Ahora asiste a reuniones de Marihuana Anónimos, con otras personas que se recuperan de esta adicción.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
2 years 2 months ago
Health Industry, Mental Health, Noticias En Español, Colorado, Connecticut, FDA, Latinos, Legislation, marijuana, New Jersey, Substance Misuse, texas, Vermont
Pregúntale a chatbot: ¿qué hay para cenar?
Olivia Scholes, de 28 años, de Vancouver, British Columbia, tiene síndrome de ovario poliquístico o SOP. Es una de cada 10 mujeres a nivel mundial a las que se les diagnostica esta afección hormonal, que puede causar múltiples quistes ováricos, infertilidad, aumento de peso y otros problemas.
Olivia Scholes, de 28 años, de Vancouver, British Columbia, tiene síndrome de ovario poliquístico o SOP. Es una de cada 10 mujeres a nivel mundial a las que se les diagnostica esta afección hormonal, que puede causar múltiples quistes ováricos, infertilidad, aumento de peso y otros problemas.
Después de su diagnóstico hace 10 años, Scholes controló su afección en parte tratando de consumir, o evitar, ciertos alimentos y bebidas. Pero a veces, transferir lo que sabía que tenía que hacer a sus platillos diarios era complicado y requería de tiempo.
“El hecho de tener esa información no significa que planee mis comidas con esa información todo el tiempo”, dijo Scholes.
Scholes estaba navegando por TikTok cuando vio un video que explicaba cómo se usaba ChatGPT para crear un plan detallado de nutrición y entrenamiento.
Ese video la interesó a ver si chatbot, un programa de inteligencia artificial entrenado para ofrecer respuestas detalladas, podría brindarle opciones de comidas adaptadas al SOP.
El control del peso y de la insulina puede ayudar a reducir el impacto de la afección. Debido a que muchas personas con SOP experimentan resistencia a la insulina, controlar sus niveles a través de la dieta es uno de los mejores pasos que se puede tomar.
Scholes comenzó preguntando a ChatGPT si sabía cuáles eran los mejores alimentos para las personas con síndrome de ovario poliquístico y resistencia a la insulina, y el chatbot le proporcionó una lista. Luego preguntó si el sistema podría darle un plan de dos semanas, con tres comidas al día, dos refrigerios y postres sin edulcorantes artificiales.
En cuestión de segundos, Scholes tenía una lista de alimentos, que luego le pidió a ChatGPT que la convirtiera en una lista de compras.
Scholes dijo que, al transformar la información en comidas planificadas, el chatbot le facilitó la compra de ingredientes para una variedad de menús.
“La gran ayuda de ChatGPT no solo fue que tomó la información que ya conocía; puso esa información en un espacio tangible para mí”, dijo Scholes.
ChatGPT, desarrollada por la empresa OpenAI, se lanzó públicamente en noviembre y llegó a 100 millones de usuarios activos en enero, lo que la convirtió en la aplicación para consumidores de más rápido crecimiento en la historia.
ChatGPT está entrenada en una gran cantidad de texto de una variedad de fuentes, como Wikipedia, libros, artículos de noticias y revistas científicas. El chatbot avanzado de inteligencia artificial (IA) permite a los usuarios ingresar un mensaje de texto y recibir un resultado generado de manera inteligente, que además, permite iniciar una conversación.
Otros chatbots, como el chat de Google Bard y Bing AI, también de Microsoft, son similares a ChatGPT y pueden planificar comidas.
Algunos profesionales de salud y bienestar dicen que la capacidad de ChatGPT para tener conversaciones puede ser útil para generar planes de comidas e ideas para personas que tienen objetivos de salud y necesidades nutricionales específicas.
Scholes compartió su experiencia usando ChatGPT en un video de TikTok. Ese video ahora tiene más de 1.3 millones de visitas y una sección de comentarios colmada de preguntas sobre su experiencia.
En febrero, Jamie Askey, de Lufkin, Texas, hizo un video de TikTok explicando cómo usar ChatGPT para generar planes gratis de comidas y listas de compras que cumplan con los objetivos de calorías y macronutrientes: los nutrientes que el cuerpo necesita, como grasas, carbohidratos y proteínas.
Askey ha hecho muchos videos desde principios de 2021 dando consejos de salud, desde recetas fáciles para preparar comidas hasta consejos sobre cómo dejar de comer compulsivamente.
Su video ahora tiene más de 13,000 visitas en TikTok, con gente agradecida por los consejos.
“Lo mejor de este sitio web es que es muy conversacional”, dijo Askey sobre ChatGPT.
A diferencia de Google y otros motores de búsqueda, los usuarios no tienen que buscar un tema a la vez. El formato de diálogo hace posible que ChatGPT siga una instrucción, brinde una respuesta detallada y responda a preguntas de seguimiento.
Los usuarios interesados en generar opciones de comidas pueden decirle a ChatGPT “Quiero que actúes como nutricionista” o “Quiero que me hagas un plan de nutrición saludable”. El chatbot luego responderá con preguntas aclaratorias para ayudar a generar un plan de comidas apropiado. Es posible que el usuario deba proporcionar información adicional, como su altura, peso, restricciones dietéticas y objetivos.
Askey, quien es enfermera y entrenadora certificada en macronutrición, advierte que las personas con enfermedades crónicas deben ser evaluadas por un profesional antes de usar un chatbot para planificar comidas.
“Las posibilidades son infinitas cuando le preguntas a esta máquina”, dijo Askey. “Pero tienes que pensar que no siempre es blanco y negro. Hay áreas grises y ahí es donde entra en juego el historial de salud. Ahí es donde entra en juego el historial de dietas”.
Los usuarios de ChatGPT están entusiasmados con las capacidades del programa y con la idea de que podría simplificar las tareas cotidianas.
Pero el chatbot no está exento de fallas. Un problema: los datos de entrenamiento de ChatGPT están actualizados hasta 2021, lo que significa que parte de la información que proporciona puede estar desactualizada. Para la planificación de comidas y la nutrición, el programa no puede obtener las últimas pautas de salud y bienestar, lo que puede ser particularmente problemático para las personas con ciertas afecciones de salud.
El modelo también puede generar información incorrecta, proporcionando respuestas incorrectas o malinterpretando lo que pregunta el usuario. Cuando Scholes le pidió al chatbot las comidas para dos semanas, el chatbot se detuvo en el día ocho.
Algunos usuarios también han expresado su preocupación por fallas y sesgos dentro de la tecnología que pueden afectar negativamente los tipos de respuestas que genera. En diciembre de 2022, Steven T. Piantadosi, profesor asociado de Psicología en la Universidad de California-Berkeley, publicó una cadena de Twitter que destacaba los sesgos.
OpenAI, la empresa de investigación de inteligencia artificial detrás de ChatGPT, ha reconocido el potencial de sesgo dentro de la IA. Dijo en un blog en febrero que muchas personas están ” preocupadas por los sesgos en el diseño y el impacto de los sistemas de IA”.
En esa publicación, la compañía también describió algunos de los pasos que está tomando para eliminarlos.
Scholes se pregunta si los prejuicios existentes contra ciertos tipos de personas podrían afectar sus resultados.
“Si ChatGPT se basa en algún tipo de material fóbico contra las personas con sobrepeso, y yo busco material dirigido a mujeres gordas que lidian con problemas de gordura y SOP, ¿qué tipo de sesgos ya están integrados en ese sistema?”
Para cualquiera que esté considerando usar ChatGPT para generar un plan de comidas con metas de salud, Askey recomendó siempre verificar. “La IA no es una persona”, dijo. “Entonces, siempre tienes que verificar”.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
2 years 3 months ago
Noticias En Español, Health IT, Nutrition, texas, wellness, Women's Health
El dolor, la esperanza y la ciencia chocan cuando los atletas recurren a los hongos mágicos
WAKEFIELD, Jamaica — El boxeador se sentía destrozado. Todos los días, se despertaba con dolor. A veces eran dolores de cabeza debilitantes. Otros, era su espalda. O sus puños. Sus costillas. Su nariz. Además, sufría de cambios de humor. Depresión. Ansiedad.
Mike Lee no se arrepintió de su carrera. Había sido uno de los mejores boxeadores profesionales del mundo en su categoría. Tenía marca de 21-1, y peleó en el Madison Square Garden y frente a millones en la televisión.
Pero habían pasado más de dos años desde que pisó un ring, y cada día era un recordatorio del costo. En un momento, Lee estaba tomando ocho medicamentos recetados, todos para tratar de sobrellevar la situación.
Contó que, en su momento más bajo, en una noche en que estaba en lo más profundo de una adicción a los analgésicos, pensó en chocar su auto contra la valla de una autopista de Chicago a 140 mph.
Estaba dispuesto a hacer cualquier cosa para escapar del infierno en el que se sentía atrapado.
El impulso se desvaneció, pero el dolor permaneció.
Estaba perdido.
“Cuando tienes dolor y estás atrapado, harás cualquier cosa para salir de eso”, dijo Lee.
Ahora, había llegado a una jungla verde al final de un camino de tierra en la mitad de una montaña.
Esperaba que los hongos psicodélicos pudieran cambiar su vida.
Lee era parte de un pequeño grupo, muchos de ellos atletas retirados, que viajaron a Jamaica en marzo de 2022 para un retiro que costó hasta $5500. Cada uno de ellos había venido a Good Hope Estate, una plantación de azúcar convertida en centro turístico exclusivo, con la esperanza de librarse de la depresión, la ansiedad y el dolor crónico que habían experimentado durante años.
Dos ceremonias con hongos psicodélicos y dos sesiones de terapia les esperaban en el retiro dirigido por una empresa canadiense llamada Wake Network. Los participantes estaban nerviosos, pero también esperanzados.
Junto con Lee, había un jugador profesional de fútbol americano que estaba considerando retirarse y una ex estrella de hockey que tenía múltiples conmociones cerebrales.
Venían de todas partes de América del Norte, de diferentes orígenes y diferentes deportes, pero tenían algunas cosas en común: eran vulnerables y sentían que los medicamentos recetados les habían fallado. No sabían qué esperar, si el tratamiento funcionaría, si regresarían a casa con una solución o simplemente con otra decepción.
Lee se enteró del retiro por un amigo de la infancia que trabaja como médico en Wake. Otros habían sido reclutados por Riley Cote, un ex ejecutor de los Philadelphia Flyers y ahora un evangelista psicodélico que es asesor de Wake con una participación accionaria.
Alguna vez, Cote fue como Lee. Le encantaba golpear a la gente en la cara. Amaba la forma en que su mano aterrizaba con un ruido sordo cuando sus nudillos se conectaban con la carne y el hueso a una velocidad violenta. Romper la cabeza de alguien hacía que Cote se sintiera vivo.
“Luché contra todos. Escogía al tipo más grande que pudiera encontrar y lo desafiaba. Así fue como sobreviví, cómo me hice un nombre. Me estaba infligiendo todo este dolor e inflamación, siempre recibiendo puñetazos en la cara, y tenía que mantener este tipo de personalidad machista, como, ‘Oh, no puedes lastimarme. No puedes lastimarme’”.
Ya no era esa persona. Le daba escalofríos pensar en el hombre que alguna vez fue, alguien que bebía en exceso y usaba analgésicos para adormecer su cerebro. Hubo un tiempo en que él, como Lee, estaba en un lugar oscuro, pero con el transcurso de varios años, los hongos psicodélicos, cree Cote, lo ayudaron a regresar a la luz.
“El mundo está en una crisis, una crisis de salud mental, una crisis espiritual”, dijo Cote. “Y creo que estas son medicinas espirituales, y siento que es el camino correcto para mí. No lo considero más que mi deber, mi propósito en este planeta es compartir la verdad sobre la medicina natural”.
Durante años, han circulado rumores sobre una red clandestina de atletas, principalmente ex atletas, que usan psilocibina, el compuesto de los hongos mágicos, para tratar lesiones cerebrales traumáticas, ansiedad y depresión.
Muchos de ellos, como Cote, ven a los psicodélicos como una cura milagrosa, lo único que pudieron encontrar que podría ayudar a romper un ciclo de analgésicos y abuso de sustancias. Se reunían en pequeños grupos para ingerir hongos en privado o viajaban a países como Jamaica donde los hongos psicodélicos no están prohibidos.
Ahora, el uso de hongos psicodélicos está ganando terreno en los Estados Unidos. Varias ciudades han despenalizado la posesión de psilocibina, y los votantes de Oregon y Colorado aprobaron medidas electorales para legalizar los hongos mágicos bajo uso supervisado. Muchos investigadores predicen que la Administración de Drogas y Alimentos (FDA) aprobará un tratamiento psicodélico en los próximos cinco años.
Pero muchos de esos mismos investigadores advierten que la intensa promoción de los psicodélicos está superando a la ciencia, y que el tratamiento conlleva riesgos significativos para algunos pacientes. Temen que, a menos que la investigación se lleve a cabo de forma metódica y ética, el uso generalizado de la psilocibina podría resultar en una reacción negativa del público, como sucedió en la década de 1960, relegando un tratamiento prometedor al basurero de las sustancias prohibidas.
Están instando a las entidades corporativas como Wake, que ya se están posicionando para aprovechar la posible legalización de los psicodélicos, a que avancen lentamente, se aseguren de que la investigación se realice de la manera correcta y permitan que la ciencia se ponga al día.
“Si no haces esto de manera segura, la gente saldrá lastimada”, dijo Matthew Johnson, profesor de psiquiatría e investigador de psicodélicos en la Universidad Johns Hopkins.
Pero muchos, incluidos los ex atletas profesionales con cuerpos y cerebros maltratados, no quieren esperar el lento avance de la investigación clínica. Necesitan ayuda ahora.
Los analgésicos, los antidepresivos, las innumerables píldoras diferentes que les recetaron a lo largo de los años no han ayudado. En sus mentes, las historias de sus compañeros atletas que dicen que se han beneficiado de los psicodélicos superan cualquier incertidumbre científica.
“Cuando piensas en hongos mágicos, piensas en los hippies de Woodstock bailando al ritmo de la música”, dijo Lee. “Pensar que tienes algunos de los mejores atletas del mundo aquí que están lidiando con algunas cosas y las están tomando, te hace sentir más cómodo. Me hace sentir como, ‘Está bien, tal vez estoy haciendo lo correcto’. Es una medicina curativa; no es solo una droga de fiesta”.
***
Cote, ahora de 41 años, era un patinador de hockey decente que creció en Winnipeg, Manitoba, tenaz de punta a punta y un trabajador incansable, pero bastante promedio en el manejo del disco.
No anotó suficientes goles para ascender en el hockey junior como lo hicieron algunos prospectos. Sin embargo, a medida que crecía, a los entrenadores no les importaba tanto. Tenía hombros anchos y un largo alcance. En una era del hockey en la cual la violencia todavía era moneda corriente, había encontrado su boleto dorado para la NHL: Cote golpeaba a la gente y recibía golpes a cambio.
Como miembro de los Flyers, vio que era su deber mantener las tradiciones de los Broad Street Bullies, un grupo de jugadores de la década de 1970 que fueron celebrados por la prensa por jugar y festejar fuerte.
Se abrió camino a través de la NHL durante partes de cuatro temporadas, acumulando más de 400 minutos de penalización en su carrera y anotando solo un gol. La mayoría de sus peleas fueron situaciones brutales, bárbaras. Sus destacados muestran a un gigante corpulento, con los ojos llenos de violencia, el tipo de matón que podría romperte la mandíbula y reír como un maníaco después, la sangre goteando de su rostro y cayendo al hielo.
“Fue algo que disfruté hacer, y creo que era solo un elemento de competencia para mí”, dijo Cote. “Y probablemente también era algo que estaba haciendo por miedo: miedo de no vivir mi sueño de la infancia o de decepcionar a mis padres o a la gente”.
Dijo que se medicaba por su dolor casi todos los días con alcohol. Las cervezas eran un aperitivo de camino a los shots en la barra. Después, venían drogas duras. Él y sus compañeros de equipo se quedaban fuera hasta las 3 am, a veces más tarde, y luego intentaban sudar el veneno al día siguiente durante la práctica.
Después de unos años, su cerebro comenzó a empañarse. Se hizo más grande y más fuerte a través del levantamiento de pesas, y parecía un monstruo en el hielo, pero cada una de sus habilidades de hockey se deterioró, salvo las peleas. A medida que su carrera terminaba, dijo, se sentía como si la oscuridad se acercara sigilosamente. Se deprimió. Tenía miedo de en lo que se había convertido.
Hoy, Cote se parece poco a aquel ejecutor de los videos. Más delgado y tranquilo, imparte clases de yoga en un estudio de Delaware tres veces por semana. Con el pelo hasta los hombros, tatuajes en los brazos y el pecho, habla con una suave voz de barítono. Parece más un monje que un monstruo.
“Miro hacia atrás y tal vez solo muestra lo confundido que estaba y la realidad que estaba buscando, que supuestamente era la felicidad y la satisfacción de perseguir el sueño de mi infancia”, dijo Cote. “Pero es difícil para mí entender que estoy haciendo eso ahora, simplemente sabiendo quién soy ahora y dándome cuenta de que se necesita mucha oscuridad para hacer lo que hice”.
Cote dijo que tomó hongos de forma recreativa durante sus 20 años, pero nunca en un entorno terapéutico o con el entendimiento de que podrían ayudarlo a procesar su trauma físico y emocional. “Era solo parte de la escena o parte de la fiesta”, dijo.
Pero cuando se jubiló en 2010, sintió que estaba enfrentando una crisis de identidad. Había sido un luchador durante tanto tiempo que pensó que eso era todo lo que era. ¿Cómo podría un ejecutor fracasado criar a dos hijas?
Empezó a leer. Lo que aprendió lo sorprendió.
Los investigadores habían revivido silenciosamente el estudio sobre los hongos psicodélicos como tratamiento médico en el año 2000, y los primeros hallazgos sugirieron que la psilocibina a menudo tenía beneficios notables para las personas diagnosticadas con ansiedad y depresión. Ayudó a algunos pacientes a deshacerse de sus adicciones a las drogas o al alcohol.
Otra investigación sugirió que la psilocibina en realidad puede ser capaz de remodelar la anatomía del cerebro, restaurar las vías neurológicas y ayudar a curar lesiones cerebrales traumáticas.
Para Cote, a quien le diagnosticaron al menos tres conmociones cerebrales en su carrera de hockey y probablemente sufrió muchas más, fue transformador.
Cote ahora recluta clientes para Wake, que organiza retiros inmersivos de psilocibina fuera de los Estados Unidos.
“Algunas personas vienen a estos eventos y están al borde del suicidio”, dijo Tyler Macleod, cofundador de Wake y su director de experiencia. “No se arreglan después de una ceremonia, pero ya no están atascados en la oscuridad. Se despiertan y dicen: ‘Oh, puedo navegar de nuevo una relación con mis hijos'”.
Todos los ex atletas que asisten a estos retiros están luchando con algo, dijo Cote. Necesitan ayuda. En muchos casos, sienten que han probado todo lo demás. Les pregunta por qué tienen que esperar cuando tantos estudios y anécdotas indican resultados positivos.
“Es como con el cannabis: ¿cuántas historias tuvimos que contarnos antes de tener un programa médico?”, apuntó Cote. “Simplemente ha estado bloqueado durante tanto tiempo”.
***
En 1970, el presidente Richard Nixon promulgó la Ley de Sustancias Controladas, legislación que dividía las drogas en cinco niveles, clasificándolas en gran medida según su potencial de abuso. Los hongos mágicos se clasificaron como sustancias de la Lista 1, junto con la heroína y la marihuana, lo que significa que el gobierno creía que no tenían ningún beneficio médico y que tenían un alto potencial de generar adicción. (La cocaína, la oxicodona y la metanfetamina se clasificaron como drogas de la Lista 2).
Esas decisiones, que el asesor de Nixon, John Ehrlichman, dijo más tarde que tenían motivaciones políticas, continúan teniendo un efecto dominó en la actualidad. La investigación sobre tratamientos psicodélicos se suspendió durante 30 años.
Si bien los estudios recientes han tenido un alcance pequeño, han mostrado efectos notables. Los medicamentos recetados aprobados para afecciones como la ansiedad o la depresión ayudan, en el mejor de los casos, a entre el 40% y el 60% de los pacientes. En los primeros ensayos, los psicodélicos han alcanzado tasas de eficacia de más del 70%.
Y, a diferencia de la mayoría de los medicamentos recetados, que dejan de funcionar poco después de que los pacientes dejan de tomarlos, uno o dos tratamientos de psilocibina pueden tener efectos terapéuticos por seis meses, un año o incluso más, según un estudio de Johns Hopkins.
Con un riesgo mínimo de adicción o sobredosis y siglos de uso por parte de las culturas indígenas, muchos investigadores consideran que la psilocibina es un tratamiento innovador potencial con grandes beneficios y pocos riesgos.
Scott Aaronson, director de programas de investigación clínica en Sheppard Pratt, un hospital psiquiátrico sin fines de lucro en las afueras de Baltimore, ha estado estudiando los trastornos del estado de ánimo difíciles de tratar durante 40 años, comenzando con algunos de los primeros estudios sobre Prozac.
“Soy un ser humano cínico, escéptico y sarcástico”, dijo Aaronson. “Y te diré, nunca he visto algo así en todos mis años”.
Pero la psilocibina no está exenta de riesgos. Puede exacerbar problemas cardíacos y desencadenar esquizofrenia en personas con una predisposición genética, y la combinación de psilocibina y litio puede causar convulsiones.
Los ensayos clínicos generalmente han descartado a los pacientes en riesgo de tales complicaciones. Aún así, una parte significativa de quienes consumen psilocibina, incluso sin ninguna de esas preocupaciones, tienen una experiencia negativa.
“En una dosis alta, alrededor de un tercio de las personas en nuestros estudios, incluso en estas condiciones ideales, pueden tener lo que se llamaría un mal viaje, algún grado de ansiedad o miedo sustancial”, dijo Johnson, investigador de Johns Hopkins. “Una persona puede ser muy vulnerable psicológicamente. Puede sentirse como si estuvieran muriendo”.
Sin embargo, a veces, incluso esos “malos viajes” pueden conducir a la ayuda con la depresión u otros problemas, según han descubierto investigadores, especialmente con la ayuda de seguimiento de un terapeuta para procesar la experiencia.
Los efectos psicodélicos de la psilocibina también pueden desconectar a una persona de la realidad, lo que puede llevar a las personas a hacer cosas peligrosas, como correr hacia el tráfico o saltar por una ventana.
“La percepción misma de la realidad y de ellos mismos en la realidad, como quiénes son, estas cosas pueden cambiar profundamente y no es una buena receta para interactuar en público”, dijo Johnson.
Los investigadores también describen casos en los que la psilocibina pone a las personas con problemas psicológicos no resueltos en estado de angustia a largo plazo.
Es por eso que los investigadores insisten en que la psilocibina debe administrarse en un entorno clínico con terapeutas capacitados que puedan guiar a las personas a través de la experiencia, lidiar con los resultados negativos cuando surjan, y ayudarlas a procesar e integrar sus experiencias.
Los ensayos clínicos de psilocibina se han basado en protocolos estrictos, que incluyen una o más sesiones antes del tratamiento para ayudar a los participantes a comprender qué esperar. El consumo de los hongos se hace a menudo en un solo día, con uno o dos terapeutas disponibles.
En los días siguientes, la persona regresa para lo que se conoce como integración, generalmente una sesión de terapia individual para ayudar a procesar la experiencia y comenzar el camino hacia la curación. Algunos ensayos agregan un día adicional de terapia entre dos tratamientos.
A diferencia de un medicamento típico, nose envía a los pacientes a casa con un frasco de píldoras. Todo el protocolo se parece más a un procedimiento médico.
Pero es un error pensar que es la medicina psicodélica la que hace todo el trabajo, no la terapia que viene después, dijo Jeffrey LaPratt, psicólogo e investigador de psilocibina con Sheppard Pratt. “Es un trabajo muy duro y requiere vulnerabilidad. Se necesita coraje. Puede ser realmente doloroso”.
***
El ex jugador de la NHL Steve Downie sintió como si algo en él se hubiera roto cuando lo invitaron al retiro de Wake en Jamaica. Sus días estaban llenos de niebla. Vivía con depresión, a menudo incapaz de salir de su casa.
“Me cansé de ir a esos médicos y me cansé de hablar con ellos”, dijo Downie. “No me malinterpreten, no digo que los médicos sean malos. Solo digo que, en mi experiencia personal, lo que viví no fue positivo. Y llega un punto en el que tienes que probar algo nuevo, y es por eso que estoy aquí”.
También tuvo un trauma en su vida que nunca había enfrentado realmente. Cuando Downie tenía 8 años, su padre murió en un accidente automovilístico que lo llevó a practicar hockey. Lanzarse profundamente en el deporte fue su única forma de sobrellevar la muerte de su padre. Al igual que Cote, su compañero de equipo en los Flyers durante dos años, jugó de manera imprudente imprudente, lanzándose a colisiones violentas que lo dejaban a él y a sus oponentes ensangrentados.
Después de una carrera juvenil empañada por una controversia de novatos, Downie comenzó su primera temporada en la NHL, en 2007, con una suspensión de 20 juegos por un brutal control en las tablas en un competencia de pretemporada que envió a su oponente fuera del hielo en camilla.
Sigue siendo una de las suspensiones más largas jamás emitidas por la liga. En la prensa de hockey, fue etiquetado como un villano, un matón y un psicótico extremo. Las palabras le dolieron un poco, incluso cuando trató de reírse de ellas.
“No tengo dientes y soy pequeño, así que no pueden estar tan equivocados”, dijo Downie. “¿Bien? Al final del día, era un trabajo. Hice lo que me pidieron”.
Durante sus nueve temporadas jugando para cinco equipos de la NHL, sufrió más conmociones cerebrales de las que podía recordar. Sordo de un oído, al borde de las lágrimas todos los días y bastante seguro de que estaba bebiendo demasiado, Downie, que ahora tiene 36 años, se miraba en el espejo algunos días y se preguntaba si estaría muerto en seis meses.
No sabía nada sobre psicodélicos, solo que Cote le había dicho que lo ayudaría cuando Downie estuviera listo.
“Llamé a Riley y le dije: ‘Necesito algo, hombre’. Me cansé de ir a los médicos y hablar con ellos”, dijo Downie. “Muchas de las pastillas que te dan, te comen el cerebro. Realmente no te ayudan”.
Justin Renfrow, un jugador de línea de 33 años que jugó en la NFL y en Canadá, llegó en busca de claridad. Estaba considerando retirarse del fútbol profesional, algo que lo asustaba y lo emocionaba. Había estado jugando durante la mitad de su vida, y el juego era una gran parte de su identidad. Fue la última conexión que tuvo con su abuela, una de las personas más importantes de su vida. Ella fue la que iba a los viajes de reclutamiento con él. Después de su muerte en 2021, Renfrow sintió que una parte de ella todavía estaba con él mientras jugara.
Pero después de una década de jugar profesionalmente, el cuerpo de Renfrow estaba maltratado. Le dolía una de las rodillas. Había llegado a odiar las drogas farmacéuticas. Dijo que los médicos del equipo le habían recetado tantos medicamentos diferentes, incluidos los que cubren el estómago y los bloqueadores de los nervios para que pudiera tomar más analgésicos, que su cuerpo comenzó a experimentar terribles efectos secundarios.
Dijo que una vez tuvo una reacción tan mala a una combinación de analgésicos que le habían dado que necesitó atención médica después de sudar a través de su ropa y tener problemas para respirar.
“Es solo, ‘Necesitamos llegar a los playoffs, así que toma esto'”, dijo Renfrow. “Lanzó mi cuerpo en picada”.
Había usado hongos psicodélicos en numerosas ocasiones, principalmente como una forma de lidiar con el dolor provocado por el fútbol americano, pero nunca los había usado como parte de una ceremonia o para meditar. En este viaje, buscó claridad. ¿Era hora de alejarse del fútbol? Le apasionaba la cocina y estaba pensando en iniciar su propio programa en YouTube. Tal vez era hora de cambiar su enfoque y dejar que el fútbol se desvaneciera.
“Tengo muchas personas que dependen de mí todos los días”, dijo Renfrow.
Los atletas esperaban que la ceremonia los ayudara a obtener respuestas.
La investigación sobre psicodélicos es prometedora y emocionante, pero la efectividad de los hongos como tratamiento no está del todo establecida. Pero incluso si la psilocibina y otros psicodélicos resultan ser nada más que un placebo, lo que algunos investigadores dicen que es posible, muchos atletas juran que están encontrando un alivio real de la ansiedad, la depresión y otros traumas persistentes de sus días de juego.
Con un mercado global potencial multimillonario, también hay un gran incentivo financiero. Wake es solo una de un número creciente de nuevas empresas con fines de lucro respaldadas por dinero de inversión privada que buscan una parte del tratamiento psicodélico.
Eventualmente, ellos y otros esperan abrir centros de tratamiento o vender las drogas en los Estados Unidos y Canadá. En Canadá, la producción, venta o posesión de hongos psicodélicos son ilegales.
Durante el retiro de Jamaica, los líderes de Wake dieron una presentación a los participantes sobre cómo podrían invertir en la empresa.
Macleod dijo que se interesó en la terapia psicodélica no como una oportunidad comercial, sino después de que perdió a su hermana, Heather, hace seis años por suicidio.
Perderla lo llevó a buscar respuestas. Su hermana había sido esquiadora competitiva en Canadá, pero una serie de caídas le provocaron múltiples conmociones cerebrales y durante su vida adulta tuvo ansiedad y depresión. La medicina tradicional le falló repetidamente, dijo Macleod. Cada semana, se encuentra deseando haber sabido lo que sabe ahora y haberlo usado para intentar salvarla.
“No puedo decirte cuántas personas vienen a mí que están luchando como mi hermana”, dijo. “Dios, desearía que ella pudiera estar aquí. Sé que ella nos estaría animando. La veo a veces mirándonos desde arriba y diciendo: ‘Ayuda a otras personas que estaban atrapadas donde yo estaba'”.
Ansiosas por llevar los tratamientos psicodélicos a los consumidores, las empresas corporativas a menudo extrapolan los resultados de la investigación de ensayos clínicos estrictamente controlados con pacientes cuidadosamente seleccionados para promover un uso más amplio por parte de la población general en casi cualquier entorno.
“La presión por los psicodélicos generalmente está siendo impulsada por personas que quieren ganar dinero, mucho más que por científicos”, dijo Kevin Sabet, ex asesor principal de la Oficina de Política Nacional de Control de Drogas de la Casa Blanca, y ahora presidente y director ejecutivo de Smart Approaches to Marijuana, un grupo político que se opone a la legalización de la marihuana.
“¿Por qué dejaríamos que los inversionistas de Wall Street, que son realmente los que están aquí tratando de ganar dinero, lideren la conversación?”, agregó.
La comercialización podría ser tanto buena como mala para los psicodélicos. Por un lado, podría proporcionar financiación para la investigación; por otro, el deseo de rentabilizar esa inversión podría influir indebidamente en los resultados y poner en riesgo a los pacientes.
“Tu modelo de negocio no va a funcionar bien cuando alguien salta por la ventana y aparece en la portada de The New York Times”, dijo Johnson, el investigador de Johns Hopkins.
La investigación clínica también debe superar la imagen del hongo como una droga de fiesta, algo que los hippies comparten en bolsas de plástico en las últimas filas de los conciertos.
Para cambiar esa narrativa, dicen Wake y otras compañías, se están inclinando mucho hacia la ciencia. Esto no es una búsqueda de emociones, dicen, sino una medicina legítima que trata condiciones psiquiátricas reales.
Es el mismo argumento que hicieron los defensores de la legalización de la marihuana, ya sea que lo creyeran o lo estuvieran usando como un medio para un fin: presionar para legalizar el cannabis como medicina antes de abrir las puertas al uso recreativo sin restricciones.
Los líderes de Wake, como la mayoría de los ejecutivos en el universo psicodélico, han dicho que están comprometidos a ayudar en la investigación para demostrar a los reguladores federales que la psilocibina es segura y efectiva. Las muestras de sangre y saliva que recolectó un médico en el retiro de Wake, dijeron, se usarían para identificar marcadores genéticos que podrían predecir quién responderá al tratamiento con psilocibina.
El equipo de Wake hizo que los participantes usaran un casco que contenía tecnología de imágenes experimentales que se había utilizado en ensayos clínicos para rastrear la actividad cerebral antes, durante y después de las experiencias psicodélicas. Como parte de la investigación, los participantes usaron el casco mientras jugaban juegos de palabras.
Muchos investigadores académicos se preguntan si algunas empresas simplemente están aplicando un barniz de ciencia a un esfuerzo por hacer dinero, lo que muchos escépticos denominan “teatro placebo”.
De hecho, Aaronson teme que el campo pronto pueda estar “lleno de vendedores ambulantes”.
“El problema que tienes es que, como era de esperar, las redes sociales y las comunicaciones funcionan mucho más rápido que la ciencia”, dijo. “Entonces, todos están tratando de tener en sus manos estas cosas porque creen que será increíble”.
Aaronson ha diseñado protocolos de ensayos clínicos para Compass Pathways, una empresa competidora con fines de lucro que busca comercializar tratamientos con psilocibina, y ha rechazado a otras empresas que buscan crear una huella en el espacio psicodélico. (Aaronson recibe fondos de Compass para respaldar su investigación, pero dijo que no tiene ningún interés financiero directo en la empresa).
“Me preocupa quién respalda el juego de algunas de estas compañías y trato de averiguar qué es lo que realmente busca alguien”, dijo. “Hablas con la gente y ves si hay un plan real para investigar o si hay un plan real para vender algo”.
***
Un murmullo de tensión nerviosa perduraba en el aire mientras los atletas se preparaban para la ceremonia. En el desayuno, no hubo muchas conversaciones triviales. Los asistentes se arremolinaron y se registraron con el personal médico de Wake para ofrecer sus muestras de sangre y saliva. Algunos participaron en una clase de yoga en un estudio al aire libre con vista a la jungla.
Wake había contratado a una chamán jamaicana, una mujer llamada Sherece Cowan, una empresaria de comida vegana que fue finalista de Miss Universe Jamaica 2012, para dirigir a los atletas en la ceremonia. Pidió que la llamaran Sita y se refirió a sí misma como facilitadora de medicina natural.
Habló lenta y deliberadamente, agitando el humo de una urna mientras instaba a los participantes a reunirse en círculo en el césped de la finca. Después de beber una dosis de 3 a 5 gramos de psilocibina, que había sido molida en polvo y mezclada con jugo de naranja, los atletas cayeron en un estado de sueño durante las próximas cuatro a seis horas.
“Espero que obtengas todo lo que necesitas. Puede que no sea todo lo que estás pidiendo, pero espero que recibas todo lo que necesitas”, dijo Cowan. “Bendiciones en tu viaje”.
Un músico local comenzó a tocar, sus tambores y campanas pretendían realzar el viaje. La mayoría de los atletas yacían sobre colchonetas, como si durmieran. Cote se sentó en una pose de yoga. Nick Murray, director ejecutivo de Wake, le había pedido a Cote que usara un casco especial, un dispositivo de electroencefalografía más pequeño que el otro casco, para medir su actividad cerebral.
Excepto por los tambores y las campanas del músico, todo estaba en silencio. De vez en cuando, el viento agitaba las hojas de los árboles en el límite de la propiedad, pero durante las siguientes seis horas, dentro del círculo, el tiempo casi se detuvo.
Dos horas después de la ceremonia, después de que el psicodélico había hecho efecto, lo que estaba ocurriendo pasaba dentro de las cabezas de los atletas. Cote, sorprendentemente, seguía manteniendo su postura de yoga.
El silencio se rompió cuando Renfrow se levantó de su estera después de tres horas. Llevaba una sudadera en la ceremonia con sus iniciales, JR, estampadas en el pecho. Se quitó la camisa de su cuerpo con frustración y la arrojó a un lado.
Las lágrimas se derramaron por su rostro.
Cuando la ceremonia terminó, los atletas comenzaron a sentarse y algunos charlaron en voz baja.
La mayoría no estaba seguro de cómo describir la experiencia. Para algunos, se sintió como un descenso a los rincones de la mente, con colores y emociones mezclándose. Otros dijeron que enfrentaron traumas que pensaron que habían enterrado o emociones que querían reprimir. Dijeron sentir una conexión con las otras personas en el círculo.
“Es el último asesino del ego porque, al menos para mí, te da una empatía increíble que nunca antes habías sentido”, dijo Lee. “Cuando estás haciendo un viaje con otras personas, te ves a tí mismo en ellos. Es casi como si estuvieras caminando frente a un espejo, diferentes espejos. Ves partes de tí mismo en todos y te das cuenta de que todos estamos conectados y todos estamos pasando por algo, todos tenemos algún tipo de dolor, y eso te vuelve humilde”.
La mayoría de los atletas se quedaron solos para poder anotar sus pensamientos en un diario, siguiendo las instrucciones del personal de Wake. Habría una sesión de terapia comunitaria a la mañana siguiente.
A cada uno se le pediría que compartiera algo de su viaje.
***
Al final, la mayoría de los curiosos sobre la psilocibina simplemente quieren saber: ¿Funciona? Y, ¿cómo funciona? Los científicos dicen que esas son preguntas difíciles de responder en este momento.
Investigadores han descubierto que los psicodélicos clásicos, como la psilocibina y el LSD, actúan sobre el receptor de serotonina 2A, el mismo receptor al que se apuntan los antidepresivos más comunes del mercado. Pero más allá de eso, la comprensión de cómo funcionan para ayudar a las personas es, en este punto, más teoría o conjetura que hecho científico.
Johnson, el investigador de Johns Hopkins, dijo que la psilocibina ayuda a aumentar la apertura en las personas, permitiéndoles salir de su visión de quiénes son. Alguien que se resigna a ser un fumador que no puede dejar de fumar o una persona con depresión que no puede encontrar la felicidad puede, bajo la influencia de los psicodélicos, verse a sí mismo de una manera diferente, explicó.
“Una vez que están fuera de la trampa mental, se vuelve tan obvio para las personas con estos diferentes trastornos que, ‘¿Sabes qué? Puedo simplemente decidir dejar de fumar. Puedo dejar de lado mi tristeza’”, dijo Johnson.
Estudios con ratas muestran que los psicodélicos también parecen aumentar la conectividad neuronal en el cerebro, incluso después de una sola dosis. Eso podría ayudar al cerebro a recuperarse de lesiones traumáticas o conmociones cerebrales, encontrando nuevos caminos alrededor de las áreas dañadas.
La teoría predominante de cómo la psilocibina y otros psicodélicos podrían ayudar a tratar la salud mental es que reprimen la actividad en la red de modo predeterminado del cerebro. Es un conjunto de regiones del cerebro que se activan cuando las personas reflexionan sobre algo, y una de las pocas partes que está hiperactiva en las personas con depresión.
A menudo revisan los errores que cometieron una y otra vez o se castigan continuamente por ellos, dijo LaPratt, el investigador de Sheppard Pratt. Esa hiperactividad en la red de modo predeterminado conduce a patrones repetitivos de pensamientos negativos. ¿Qué me pasa? ¿Por qué soy tan infeliz? De los cuales la persona no puede escapar.
Las personas con depresión suelen reflexionar sobre el pasado; personas con ansiedad, sobre el futuro.
“Es posible que surja algo y luego el cerebro comience a pensar, y nuevamente, como ese disco rayado”, dijo LaPratt. “Puede ser muy fácil comenzar a pensar en cómo todo podría salir mal y comenzar a dramatizar”.
Ese pensamiento repetitivo también prevalece en personas con otras afecciones, incluido el trastorno obsesivo compulsivo y el trastorno por estrés postraumático. Comienza a afectar el sentido de quiénes son; se definen a sí mismos por su condición.
Pero los psicodélicos parecen ayudar a las personas a examinar viejos traumas sin volver a caer en el mismo ciclo destructivo. Pueden ayudar a las personas a sentirse más conectadas con los demás. La depresión y la ansiedad no se borran simplemente, dijo LaPratt, sino que las personas pueden obtener una nueva perspectiva de sus problemas y comenzar a sentir, tal vez por primera vez, que pueden deshacerse de ellos.
“Vemos una mayor apertura y cierta motivación para cambiar los comportamientos”, dijo.
La mayoría de los psicodélicos están fuera del sistema de una persona a la mañana siguiente, pero, según los investigadores, esa mayor apertura puede durar semanas o meses sin dosis adicionales, lo que brinda una ventana durante la cual pueden comenzar a abordar sus problemas.
“Quizás estemos ayudando a las personas a llegar al punto de poder aceptar las cosas que no pueden cambiar y cambiar las cosas que sí pueden”, dijo Aaronson, haciéndose eco de la Oración de la serenidad, que a menudo se usa en los ejercicios de 12 pasos de los programas de recuperación. “Se les quita autonomía personal a las personas con depresión. No sienten que puedan operar en su mejor interés. Se ven atrapados en un conflicto interno. Y creo que esto les ayuda a ir más allá de eso”.
Por la mañana, los atletas se reunieron en un patio para una forma de terapia de grupo llamada integración. Estaba previsto que durara al menos dos horas. Macleod explicó que era una parte esencial para comprender el viaje de la psilocibina. Todos los asistentes tuvieron la oportunidad de compartir algo de su experiencia, ya fuera esclarecedor, confuso, edificante o una mezcla de muchas emociones.
Lee habló sobre su ansiedad, sobre tratar de entender cuál sería su identidad ahora que no era boxeador. Al alejarse del ring, temía estar decepcionando a todas las personas que lo apoyaron cuando eligió una carrera de boxeo en lugar de un trabajo en finanzas después de graduarse de Notre Dame.
Pero ahora había llegado a comprender que esas eran sus propias inseguridades. Podía seguir su propio camino. Podría ayudar a las personas que experimentan un dolor físico y emocional similar.
Renfrow respiró hondo varias veces mientras buscaba las palabras. Durante la mayor parte de su vida, se había visto a sí mismo como un jugador de fútbol americano. Pero en su viaje de psilocibina, sintió como si los miembros de su familia le dijeran que estaba bien dejarlo ir. Cuando se puso de pie durante la ceremonia y se quitó la camisa con sus iniciales, dijo que, simbólicamente, estaba soltando algo.
“Está bien dejar de perseguir el viaje del fútbol”, dijo Renfrow. “No voy a vestirme bien este año y eso está bien para mí. Seré capaz de resolverlo.
Al decir adiós al fútbol, dijo, se estaba despidiendo de su abuela.
“El fútbol era ella”, dijo Renfrow, y comenzó a llorar. “Fuimos a todos mis viajes de reclutamiento. Así que tuve que dejarla ir dejando ir al fútbol. Y ese fue un gran momento cuando me puse de pie. Tuve que dejarla ir. Así que fue difícil, pero tenía que hacerlo”.
Cuando fue el turno de Downie, trató de calmar la tensión bromeando, diciendo que era hora de ir a comer. No quería abrirse al grupo, dijo. Había escrito algunas notas en una hoja de papel. Sus manos temblaban mientras trataba de leerlas.
“No estaba bebiendo y no estaba consumiendo drogas por diversión”, dijo Downie con voz temblorosa. “Estaba adormeciendo mi cerebro porque estaba jodido. No pude salir de mi camino de entrada durante un año. Me senté en cuartos oscuros y recurrí a las drogas y el alcohol”.
Pero dijo que en el viaje psicodélico pudo conectarse con su pasado. “Estoy sentado allí y estoy repasando mi cerebro, estoy hablando con mi papá, estoy hablando con los miembros de mi familia. He pedido perdón a todos los que podría pedir perdón”, dijo. “Me hizo llorar. Me hizo sentir bien”.
Se dio cuenta, a través del viaje, que quería ser un mejor hombre. Su voz temblaba mientras trataba de pronunciar las palabras.
“Al final de todo esto, creo que lo que he aprendido es cómo controlar lo que sucede. yo tengo el control. Puedo controlar esto”, dijo. “Me iré a casa y me identificaré y ejecutaré y seré un mejor padre y me quedaré para mis hijos, lidiaré con mis conmociones cerebrales lo mejor que pueda”.
Se giró para mirar directamente a Cote, las lágrimas corrían por sus mejillas detrás de sus gafas de sol.
“Quiero decir esto, hermano, cuando digo que me salvaste la vida”.
Cuando las palabras de Downie dieron paso al silencio, Lee se levantó de su silla. Cruzó el círculo, se acercó a Downie y abrió los brazos. Los dos luchadores, que llegaron a Jamaica tristes y destrozados, se abrazaron.
***
Si bien los estudios han encontrado que la psilocibina junto con la terapia es más efectiva que la terapia sola, no está claro si la psilocibina sola, sin el trabajo preparatorio o la integración posterior, tiene algún efecto.
“Hay una razón por la cual las personas que van a raves y toman psilocibina no se curan”, dijo Aaronson. “La psilocibina no es un antidepresivo”.
Incluso dentro de los estrictos protocolos de ensayos clínicos, la pregunta sigue siendo si la terapia asistida por psilocibina funciona. Los estudios preliminares han sido prometedores, pero el número de sujetos de prueba ha sido pequeño. Se necesitan estudios mucho más amplios para determinar tanto la seguridad como la eficacia.
Aún así, eso no ha impedido que los defensores de la psilocibina promocionen la investigación hasta la fecha, lo que implica que es más definitiva de lo que es. Además, muchos evangelistas de los hongos atribuyen los efectos positivos de los ensayos clínicos al consumo de psilocibina en general, descartando los protocolos utilizados en los estudios.
En el retiro de Wake en Jamaica, por ejemplo, los atletas tomaron psilocibina en ceremonias grupales guiadas por Cowan, la chamán local, mientras que las sesiones de integración grupal fueron dirigidas por un médico osteópata. Ninguno de los dos era un psicoterapeuta autorizado, dijo Murray. No está claro si los beneficios de la terapia con psilocibina sugeridos por la investigación clínica se aplicarían a un entorno grupal, para la dosificación o la integración.
Murray, director ejecutivo de Wake, dijo que si bien la investigación clínica se esfuerza por eliminar cualquier variable, como las interacciones entre los participantes, los líderes de Wake sienten que el entorno grupal ofrece beneficios a sus clientes.
“Es ese grupo que siente que, ‘Estamos juntos en esto. Mi divorcio es como tu divorcio. Perdí a un hermano’”, dijo. “Eso es difícil de poner en un ensayo clínico”.
Wake se había registrado para realizar un ensayo clínico en Jamaica, pero Murray dijo que la compañía finalmente decidió no continuar, centrándose, en cambio, en ofrecer tratamiento.
Aún así, Murray dijo que Wake está contribuyendo a la investigación científica: recolectaron muestras de sangre y saliva, y se les pidió a los participantes que completaran cuestionarios antes y después del retiro para ayudar a evaluar si el tratamiento había funcionado.
Murray dijo que Wake usa los mismos cuestionarios validados clínicamente que se usan en el consultorio de un psiquiatra.
“Entonces, no es teatro. Estas son las herramientas reales que se utilizan”, dijo. Sin embargo, sería difícil con el enfoque de Wake analizar si los hongos y la integración ayudaron a los participantes u otras influencias, como estar de vacaciones en Jamaica, estar entre un grupo de compañeros de apoyo o la marihuana que muchos de ellos fumaban regularmente durante el retiro.
“Al menos tienes que escuchar y tomarlo en serio. Hay anécdotas de personas que dicen que se habrían suicidado”, dijo Johnson. “A veces ves solo la experiencia de ‘full monty’, donde esta persona está allí en una trayectoria oscura, oscura y toda su vida cambia. Sospecho que esto es real. Algo está pasando con estos atletas que hacen estos informes”.
Las anécdotas brillantes, particularmente cuando provienen de atletas o celebridades de alto perfil, tienen peso entre el público y ayudan a impulsar medidas como las de Oregon y Colorado que están estableciendo vías para el tratamiento con psilocibina, independientemente de lo que piensen los investigadores o los reguladores.
“Cuando las personas están molestas y no satisfacemos sus necesidades, van a probar cosas”, dijo Atheir Abbas, profesor asistente de neurociencia del comportamiento en la Oregon Health & Science University. “Con suerte, los científicos pueden ponerse al día para comprender por qué las personas piensan que esto es realmente útil. Y tal vez sea útil, pero tratemos de averiguar si lo es y cómo”.
Pero existe el peligro de tomar estas historias, sin importar cuán convincentes sean, y extrapolar su seguridad o eficacia.
“La parte difícil es que el plural de anécdota no son datos”, dijo Sabet, el CEO de Smart Approaches to Marijuana. “Y los datos aún no están allí”.
***
Un año después del retiro, Downie, Renfrow y Lee dijeron que creían que su viaje con la psilocibina los había ayudado. No solucionó mágicamente todos sus problemas, pero cada uno lo consideró una experiencia positiva.
Downie ya no siente que está atrapado en un lugar oscuro. Dijo que cuando regresó a Ontario, su familia notó una diferencia de inmediato.
“Ese viaje me dio mucha claridad”, dijo Downie. “Te da direcciones. Te da respuestas internamente. Es algo único que experimenté. Mi año fue definitivamente mejor que el año anterior, eso es seguro… ¿Creo que podría ayudar a otras personas? Yo diría que sí. ¿Me ayudó? Absolutamente”.
Sin sentirse más como un prisionero en su casa, Downie comenzó un campamento de motos de nieve que lleva a los adultos en aventuras guiadas por Moosonee, cerca de James Bay. Es algo que solía hacer con su familia antes de que despegara su carrera en el hockey.
“No es mucho de lo que presumir, pero es lo más al norte al que puedes ir en una moto de nieve en Ontario”, dijo Downie. “Vienen muchos adultos de todas partes. Es una experiencia genial. Siempre ha sido una de mis pasiones”.
Todavía tiene problemas persistentes por sus conmociones cerebrales y sospecha que siempre los tendrá.
“Es lo que es”, dijo. “¿Diría que está mejorando? Es un proceso”.
El resultado más positivo ha sido la alegría que ha encontrado en ser padre.
“Mi pequeño está empezando a enamorarse del hockey, que es algo que he estado esperando”, dijo Downie.
Aunque Downie no ha realizado otro viaje con psilocibina, dijo que estaría abierto a hacerlo.
Renfrow salió de la ceremonia con la intención de retirarse del fútbol profesional, pero tres meses después volvió a firmar con Edmonton Elks de la Canadian Football League. Este año, se unió a los Jacksonville Sharks de la National Arena League, en parte para estar más cerca de su hijo.
“En ese momento, pensé que iba a dejar el fútbol”, dijo.
Pero se siente cómodo donde está y dice que está cumpliendo sus objetivos, incluido presentar ese programa de cocina en YouTube que esperaba hacer. Y dijo que se está divirtiendo de nuevo. Ahora recurre a los hongos cada vez que tiene que tomar una gran decisión.
“Creo de todo corazón en eso y en todo el tipo de orientación que me ha dado”, dijo. “No podrías pedir algo mejor, haber seguido la guía de un viaje con hongos”.
Lee se mudó de California a Austin, Texas, y ahora dirige un negocio de CBD con su hermana. Encontrar su identidad posterior al boxeo sigue siendo un proceso. En sus viajes psicodélicos en el retiro de Wake, dijo Lee, nunca pensó en deportes o boxeo. Sus visiones eran todas sobre la familia, Dios, el universo.
“Simplemente me hace darme cuenta de la importancia que le estoy dando a algo que a mi subconsciente ni siquiera le importa”, dijo. “A mi subconsciente no le importa que sea boxeador, que fui luchador e hice esto y aquello. Es todo tipo de ego”.
La experiencia, dijo, lo ayudó a comprender cuán poderosa puede ser la mente, que puede ser un amigo o un enemigo.
“Salí de eso dándome cuenta de que tengo todas las herramientas para curarme a mí mismo”, dijo. “Eso es enorme. Porque, especialmente para los muchachos que han tenido conmociones cerebrales o atletas o lo que sea, te sientes un poco aislado, te sientes solo, te sientes sin esperanza. Así que te da un sentido de esperanza”.
Le permitió ir más allá de la necesidad de probarse a sí mismo, en el ring o fuera de él, para dejar de medir su valor por sus logros. Se ha obsesionado con actividades mucho más tranquilas y no violentas: el surf y el pickleball.
“Puedo apagar mi cerebro como en el boxeo”, dijo. “Pero al mismo tiempo, es más fácil para mi cuerpo y simplemente, no sé, más satisfactorio. No tengo que probar nada”.
El viaje a Jamaica le está permitiendo salir adelante, hacer el trabajo necesario para sanar.
“Una parte de mí entró con la esperanza de que todos mis problemas se resolvieran, pero poner esas expectativas puede ser difícil”, dijo. “¿Estoy curado? No. ¿Pero realmente ayudó? ¿Y fue como una de las experiencias más profundas de mi vida?
“Yo diría que sí”.
Este artículo fue producido y escrito por Markian Hawryluk de KFF Health News y Kevin Van Valkenburg de ESPN. El investigador John Mastroberardino colaboró con la historia.
Si tu mismo o alguien que conoces puede estar experimentando una crisis de salud mental, llama o envía un mensaje de texto a la Línea de vida de crisis y suicidio al 988 o a la Línea de texto de crisis enviando un mensaje de texto con “HOME” al 741741. En Canadá, llama a Talk Suicide Canada al 1-833- 456-4566 o envía un mensaje de texto al 45645 de 4 pm a medianoche ET.
[Nota del editor: como parte del reportaje de este artículo, algunos miembros del equipo de reporteros de ESPN, bajo la guía del personal de Wake Network, usaron psilocibina. Wake Network fue compensado, pero no por ESPN.]
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
2 years 3 months ago
Health Industry, Mental Health, Noticias En Español, Pharmaceuticals, States, Colorado, Oregon, texas
Pain, Hope, and Science Collide as Athletes Turn to Magic Mushrooms
If you or someone you know may be experiencing a mental health crisis, call or text the 988 Suicide & Crisis Lifeline at 988 or the Crisis Text Line by texting “HOME” to 741741. In Canada, call Talk Suicide Canada at 1-833-456-4566 or text 45645 from 4 p.m.-midnight ET.
WAKEFIELD, Jamaica — The boxer felt broken. Every day, he was waking up in pain. Some days, it was debilitating headaches. Other times, it was his back. Or his fists. His ribs. His nose. On top of that, he had mood swings. Depression. Anxiety.
Mike Lee didn’t regret his career. He had been one of the best professional fighters in the world in his weight class. He’d gone 21-1 professionally and fought in Madison Square Garden and in front of millions on TV.
But it had been more than two years since he’d been inside a ring, and every day was a reminder of the cost. At one point, Lee was taking eight prescription medications, all of them trying to help him cope. In his lowest moment, on a night when he was in the depths of an addiction to painkillers, he said, he contemplated driving his car into the median of a Chicago freeway at 140 mph. He was willing to do anything to escape the hell he felt trapped in.
The impulse faded, but the pain remained.
He was lost.
“When you’re in pain and you’re stuck in a corner, you’ll do anything to get out of it,” Lee said.
Now, he had come to a verdant jungle at the end of a dirt road halfway up a mountain.
Psychedelic mushrooms, he hoped, could change his life.
Lee was part of a small group — many of them retired athletes — who’d traveled to Jamaica in March 2022 for a retreat costing as much as $5,500. They each had come to the Good Hope Estate, a sugar plantation turned exclusive resort, hoping to rid themselves of depression, anxiety, and chronic pain they had experienced for years.
Two psychedelic mushroom ceremonies and two therapy sessions awaited them at the retreat run by a Canadian company called Wake Network. The participants were nervous, but also hopeful.
Along with Lee, there was a professional football player considering retirement and a former hockey star who had multiple concussions. They’d come from all over North America, from different backgrounds and different sports, but they had a few things in common: They were vulnerable, and they felt that prescription medications had failed them. They didn’t know what to expect, whether the treatment would work, whether they’d return home with a solution or just more disappointment.
Lee had learned about the retreat from a childhood friend who works as a doctor for Wake. Others had been recruited by Riley Cote, a former enforcer with the Philadelphia Flyers and now a psychedelics evangelist who is an adviser to Wake with an equity stake.
Cote was once just like Lee. He used to love punching people in the face. He loved the way his hand landed with a thud when his knuckles connected with flesh and bone at a violent speed. Snapping someone’s head back made Cote feel alive.
“I fought everyone and their brother in my career,” Cote said. “I would pick out the biggest guy I could find and challenge him. It was how I survived, how I made a name for myself. I was inflicting all this pain and inflammation on myself, always getting punched in the face, and I had to keep up with this macho type of personality, like, ‘Oh, you can’t hurt me. You can’t hurt me.’”
He was no longer that person. It made him cringe to think about the man he once was, someone who drank excessively and used painkillers to numb his brain. There was a time when he, like Lee, was in a dark place, but over the course of several years, psychedelic mushrooms, Cote believes, helped bring him back into the light.
“The world is in a crisis, a mental health crisis, a spiritual crisis,” Cote said. “And I think these are spiritual medicines, and I just feel like it’s the right path for me. I don’t think of it as anything more than my duty, my purpose on this planet is to be sharing the truth around natural medicine.”
For years, whispers have circulated about an underground network of athletes — primarily ex-athletes — using psilocybin, the compound in magic mushrooms, to treat traumatic brain injuries, anxiety, and depression. Many of them, like Cote, view psychedelics as a miracle cure, the one thing they’d been able to find that could help break a cycle of pharmaceutical painkillers and substance abuse. They gathered in small groups to ingest mushrooms in private or traveled to countries such as Jamaica where psychedelic mushrooms aren’t prohibited.
Now the use of psychedelic mushrooms is gaining traction in the United States. A number of cities have decriminalized possession of psilocybin, and Oregon and Colorado voters passed ballot measures to legalize magic mushrooms under supervised use. Many researchers predict FDA approval of a psychedelic treatment will come within the next five years.
But many of those same researchers warn the hype over psychedelics is outpacing the science — and that the treatment comes with significant risks for some patients. They fear that, unless research is conducted methodically and ethically, widespread use of psilocybin could result in a public backlash, as it did in the 1960s, relegating a promising treatment to the dustheap of banned substances.
They are urging corporate entities like Wake, which are already positioning themselves to take advantage of the potential legalization of psychedelics, to go slowly, ensure the research is done the right way, and allow the science to catch up.
“If you don’t do this safely, people are going to get hurt,” said Matthew Johnson, a psychiatry professor and psychedelics researcher at Johns Hopkins University.
But many — including former pro athletes with battered bodies and brains — don’t want to wait for the slow grind of clinical research. They need help now. The painkillers, the antidepressants, the countless different pills they were prescribed over the years haven’t helped. In their minds, the stories told by fellow athletes who say they have benefited from psychedelics outweigh any scientific uncertainty.
“When you think of magic mushrooms, you think of hippies at Woodstock dancing around to music,” Lee said. “To think about you’ve got some of the best athletes in the world here that are dealing with some stuff and they’re taking it, it makes you feel more comfortable. It makes me feel like, ‘OK, maybe I’m doing the right thing.’ It’s a healing medicine; it’s not just a party drug.”
***
Cote, now 41, was a decent hockey skater growing up in Winnipeg, Manitoba, tenacious as hell from end to end and a tireless worker, but fairly average at handling the puck. He didn’t score enough goals to rise through junior hockey the way some prospects did. Yet as he got older, coaches didn’t mind as much. He had broad shoulders and a long reach. In an era of hockey where violence was still currency, he had found his golden ticket to the NHL: Cote would beat on people and get beat on in return. As a member of the Flyers, he saw it as his duty to uphold the traditions of the Broad Street Bullies, a group of players from the 1970s who were celebrated by the press for playing — and partying — hard.
He fought his way through the NHL for portions of four seasons, accumulating more than 400 career penalty minutes while scoring just one goal. Most of his fights were brutal, barbaric affairs. His highlight reel shows a hulking giant, his eyes filled with violence, the kind of goon who could break your jaw and laugh maniacally in the aftermath, blood dripping from his face down onto the ice.
“It was something I enjoyed doing, and I think it was just an element of competition for me,” Cote said. “And it was also probably something I was doing out of fear — fear of not living my childhood dream or letting my parents down or people down.”
He said he medicated his pain nearly every day with booze. Beers were an appetizer on the way to doing shots at the bar. Shots often led to harder drugs. He and his teammates would stay out until 3 a.m., sometimes later, then try to sweat out the poison the next day during practice.
After a few years, his brain started to fog. He got bigger and stronger through weightlifting, and he looked like a monster on the ice, but every hockey skill except his fighting deteriorated. As his career wound down, he said, it felt as if darkness was creeping in. He grew depressed. He was afraid of what he’d become.
Today, Cote bears little resemblance to that enforcer in the videos. Thinner and calmer, he teaches yoga classes in a Delaware studio three times a week. With shoulder-length hair, tattoos on his arms and chest, he speaks with a soft baritone voice. He seems more monk than monster.
“I look back and it just shows maybe how confused I was and what reality I was seeking, which was supposedly happiness and fulfillment within chasing my childhood dream,” Cote said. “But it’s hard for me to wrap my head around me doing that now, just knowing who I am now, and realizing it takes a lot of darkness to do what I did.”
Cote said he took mushrooms recreationally throughout his 20s, but never in a therapeutic setting or with the understanding they might help him process both his physical and emotional trauma. “It was just part of the scene or part of the party,” he said.
But when he retired in 2010, he felt like he was facing an identity crisis. He had been a fighter for so long, he thought that’s all he was. How could a washed-up enforcer raise two daughters?
He started reading. What he learned shocked him.
Researchers had quietly revived the study of psychedelics as a medical treatment in 2000, and early findings suggested psilocybin often had noticeable benefits for people diagnosed with anxiety and depression. It helped some patients shed their addictions to drugs or alcohol. Other research suggested that psilocybin may actually be capable of reshaping the anatomy of the brain, restoring neuropathways, and helping heal traumatic brain injuries.
For Cote, who was diagnosed with at least three concussions in his hockey career and probably incurred many more, it was transformative.
Cote now recruits clients for Wake, which hosts immersive psilocybin retreats outside the U.S.
“Some people come to these events and they’re borderline suicidal,” said Tyler Macleod, a Wake co-founder and its chief experience officer. “They’re not fixed after one ceremony, but they’re not stuck in the dark anymore. They wake up and they’re like, ‘Oh, I can navigate a relationship with my kids again.’”
The ex-athletes who attend these retreats are all struggling with something, Cote said. They need help. In many cases, they feel as if they have tried everything else. He asks why they need to wait when so many studies and anecdotes indicate positive results?
“It’s like with cannabis: How many stories did we have to be told before we had a medical program?” Cote said. “It’s just been roadblocked for so long.”
***
In 1970, President Richard Nixon signed into law the Controlled Substances Act, legislation that divided drugs into five levels, ranking them based largely on their potential for abuse. Magic mushrooms were categorized as Schedule 1 substances, alongside heroin and marijuana, meaning the government believed they had no medical benefit as well as high potential for abuse. (Cocaine, oxycodone, and methamphetamine were all classified as Schedule 2 drugs.)
Those decisions — which Nixon adviser John Ehrlichman later said were politically motivated — continue to have a ripple effect today. Research into psychedelic treatments was put on hold for 30 years.
While the recent studies have been small in scope, they have shown remarkable effects. Prescription drugs approved for conditions such as anxiety or depression help at best 40% to 60% of patients. In early trials, psychedelics have reached efficacy rates of more than 70%.
And unlike most prescribed medications, which stop working soon after patients quit taking them, one or two treatments of psilocybin can have lasting effects of six months, a year, or even longer, according to one Johns Hopkins study. With minimal risk of addiction or overdose and centuries of use by Indigenous cultures, psilocybin is seen by many researchers as a potential breakthrough treatment with great benefits and few risks.
Scott Aaronson, director of clinical research programs at Sheppard Pratt, a nonprofit psychiatric hospital outside Baltimore, has been studying difficult-to-treat mood disorders for 40 years, starting with some of the early studies on Prozac.
“I’m a cynical, skeptical, sarcastic human being,” Aaronson said. “And I will tell you, I have never seen anything like it in all my years.”
But psilocybin is not without risks. It can exacerbate heart problems and trigger schizophrenia in those with a genetic predisposition, and the combination of psilocybin and lithium may cause seizures. Clinical trials have generally screened out patients at risk for such complications. Still, a significant portion of those who consume psilocybin, even without any of those concerns, have a negative experience.
“At a high dose, about a third of people in our studies, even under these ideal conditions, can have what would be called a bad trip, some degree of substantial anxiety or fear,” said Johnson, the Johns Hopkins researcher. “A person can be very psychologically vulnerable. It can feel like they’re dying.”
Sometimes, though, even those “bad trips” can lead to help with depression or other issues, researchers have found, especially with follow-up help from a therapist to process the experience.
The psychedelic effects of psilocybin can also disconnect a person from reality, which can lead people to do dangerous things, like running out into traffic or jumping out a window.
“The very conception of reality and themselves in reality, like who they are — these things can be profoundly changed and it’s not a good recipe for interacting in public,” Johnson said.
Researchers also describe cases where psilocybin puts people with unresolved psychological issues into long-term distress.
That’s why researchers are adamant that psilocybin should be administered in a clinical setting with trained therapists who can guide people through the experience, deal with negative outcomes when they emerge, and help people process and integrate their experiences.
Clinical trials of psilocybin have relied on strict protocols, involving one or more sessions before the treatment to help the test subjects understand what to expect. The ingestion of the mushrooms is often done in a single day, with one or two therapists on hand. In the following days, the person returns for what’s known as integration, typically a one-on-one therapy session to help process the experience and to begin the journey toward healing. Some trials add an extra day of therapy in between two treatments.
Unlike with a typical medication, patients aren’t sent home with a bottle of pills.The entire protocol is more like a medical procedure.
But it’s a misconception that it’s the psychedelic medicine doing all the work, not the therapy that comes afterward, said Jeffrey LaPratt, a psychologist and psilocybin researcher with Sheppard Pratt. “It’s really hard work and it takes vulnerability. It takes courage. It can be really painful.”
***
Former NHL player Steve Downie felt as if something in him was broken when he was invited to the Wake retreat in Jamaica. His days were filled with fog. He was living with depression, often unable to leave his home.
“I got tired of going to those doctors and tired of talking to them,” Downie said. “Don’t get me wrong — I’m not saying doctors are bad. I’m just saying, in my personal experience, what I went through, it wasn’t positive. And it just comes to a point where you got to try something new, and that’s why I’m here.”
He also had trauma in his life he’d never truly confronted. When Downie was 8 years old, his father died in a car crash driving him to hockey practice. Throwing himself deep into the sport was his only way of coping with his father’s death. Like Cote, his teammate on the Flyers for two years, he played the game with reckless abandon, launching himself into violent collisions that left both him and his opponents bloodied.
After a junior career marred by a hazing controversy, Downie started his first NHL season, in 2007, with a 20-game suspension for a brutal check into the boards in a preseason contest that sent his opponent off the ice on a stretcher. It remains one of the longest suspensions ever issued by the league. In the hockey press, he was labeled a villain, a thug, a goon, and borderline psychotic. The words stung a little, even when he tried to laugh them off.
“I got no teeth, and I am small, so they can’t be all that wrong,” Downie said. “Right? End of the day, it was a job. I did what I was asked.”
Over his nine seasons playing for five NHL teams, he endured more concussions than he could remember. Deaf in one ear, on the verge of tears every day, and fairly certain he was drinking too much, Downie, now 36, would look in the mirror some days and wonder if he would be dead in six months. He didn’t know anything about psychedelics, just that Cote had told him he would help when Downie was ready.
“I called Riley and I said, ‘I need something, man.’ I got tired of going to doctors and talking to them,” Downie said. “A lot of the pills they give you, they eat at your brain. They don’t really help you.”
Justin Renfrow, a 33-year-old lineman who played in the NFL and in Canada, came seeking clarity. He was considering retiring from professional football, something that both scared and excited him. He’d been playing for half his life, and the game was a huge part of his identity. It was the last connection he had to his grandmother, one of the most important people in his life. She was the one who went on recruiting trips with him. After she died in 2021, Renfrow felt that a part of her was still with him as long as he played the game.
But after a decade of playing professionally, Renfrow’s body was battered. One of his knees was aching. He had come to loathe pharmaceutical drugs. He said he’d been prescribed so many different drugs by team doctors — including stomach coaters and nerve blockers so he could take more painkillers — that his body started to experience terrible side effects. Once, he said, he had such a bad reaction to a combination of painkillers he’d been given, he needed medical attention after he sweated through his clothes and began to have trouble breathing.
“It’s just, ‘We need to make the playoffs, so take this,’” Renfrow said. “It threw my body into a tailspin.”
He’d used psychedelic mushrooms numerous times, mainly as a way to cope with the pain brought on by football, but he’d never used them as part of a ceremony or to be meditative. On this trip, he sought clarity. Was it time to walk away from football? He was passionate about cooking and thinking of starting his own show on YouTube. Maybe it was time to shift his focus and let football fade away.
“I’ve got a lot of people who depend on me every day,” Renfrow said.
The ceremony, the athletes hoped, would guide them toward some answers.
***
The research into psychedelics is promising and exciting, but the effectiveness of mushrooms as a treatment isn’t fully settled. But even if psilocybin and other psychedelics prove to be nothing more than a placebo — which some researchers say is possible — many athletes swear they are finding real relief from the anxiety, depression, and other traumas lingering from their playing days.
With a potential multibillion-dollar global market, there’s also a huge financial incentive. Wake is just one of a growing number of for-profit startups backed by private investment money staking a claim in the psychedelic treatment space. They and others hope to open treatment centers or sell the drugs in the U.S. and Canada eventually. Magic mushrooms are illegal to produce, sell, or possess in Canada.
During the Jamaica retreat, Wake leaders gave a presentation to participants on how they could invest in the company.
Macleod said he grew interested in psychedelic therapy not as a business opportunity but after he lost his sister, Heather, six years ago to suicide. Losing her drove him to search for answers. His sister had been a competitive skier in Canada, but a series of falls led to multiple concussions, and throughout her adult life she had anxiety and depression. Traditional medicine repeatedly failed her, Macleod said. Every week, he finds himself wishing he’d known then what he knows now and used it to try to save her.
“I can’t tell you how many people come to me who are struggling like my sister was,” he said. “God, I wish she could be here. I know that she’d be cheering us on. I see her sometimes looking down on us and saying, ‘Help other people who were stuck where I was.’”
Eager to bring psychedelic treatments to consumers, corporate firms often extrapolate research findings from tightly controlled clinical trials with carefully selected patients to promote broader use by the general population in almost any setting.
“The push for psychedelics generally is being driven by people that want to make money, much more than it is about scientists,” said Kevin Sabet, a former White House Office of National Drug Control Policy senior adviser who’s now president and CEO of Smart Approaches to Marijuana, a political group opposed to marijuana legalization. “Why would we let the Wall Street investors, who are really the ones here trying to make money, be driving the conversation?”
Commercialization could be both good and bad for psychedelics. On the one hand, it could provide funding for research; on the other, the desire for a return on that investment could improperly influence the results and put patients at risk.
“Your business model isn’t going to work well when someone’s jumped out of a window and it’s on the front page of The New York Times,” said Johnson, the Johns Hopkins researcher.
Clinical research must also overcome the mushroom’s image as a party drug, something hippies share out of plastic baggies in the back rows of concerts. To change that narrative, Wake and other companies say, they are leaning hard into the science. This isn’t thrill-seeking, they say, but legitimate medicine treating real psychiatric conditions. It’s the same argument proponents of marijuana legalization made, whether they believed it or were using it as a means to an end — pushing to legalize cannabis as medicine before opening the floodgates to unfettered recreational use.
Wake leaders, like most executives in the psychedelic space, have said they are committed to assisting research to prove to federal regulators that psilocybin is safe and effective. Blood and saliva samples a doctor collected at the Wake retreat, they said, would be used to identify genetic markers that could predict who will respond to psilocybin treatment.
Wake’s team had participants use a helmet containing experimental imaging technology that had been used in clinical trials to track brain activity before, during, and after psychedelic experiences. As part of the research, participants wore the helmet while playing games of Wordle.
Many academic researchers wonder whether some companies are simply applying a veneer of science to a moneymaking endeavor, what many skeptics refer to as “placebo theater.”
Indeed, Aaronson fears the field could soon be “full of hucksters.”
“The problem you’ve got is that, not surprisingly, social media and communications works much faster than science does,” he said. “So everybody’s trying to get their hands on this stuff because they think it’s going to be incredible.”
Aaronson has designed clinical trial protocols for Compass Pathways, a competing for-profit company seeking to market psilocybin treatments, and has turned down other firms looking to create a footprint in the psychedelic space. (Aaronson receives funding from Compass to support his research but said he has no direct financial interest in the company.)
“I worry about who’s backing the play from some of these companies and try to figure out what somebody is really after,” he said. “You talk to people and you see whether there’s a real plan to do research or there’s a real plan to sell something.”
***
A hum of nervous tension lingered in the air as the athletes prepared for the ceremony. At breakfast, there wasn’t a lot of small talk. The attendees milled about, checking in with Wake’s medical personnel to offer up their blood and saliva samples. Some participated in a yoga class in an outdoor studio that overlooked the jungle.
Wake had hired a Jamaican shaman — a woman named Sherece Cowan, a vegan food entrepreneur who was a 2012 Miss Universe Jamaica runner-up — to lead the athletes in the ceremony. She asked to be called Sita and referred to herself as a plant medicine facilitator.
She spoke slowly and deliberately, waving smoke from an urn as she urged participants to gather in a circle on the lawn of the estate. After drinking a 3- to 5-gram dose of psilocybin, which had been ground into a powder and mixed with orange juice, the athletes would slip into a dream state for the next four to six hours.
“I hope that you get all that you need. It may not be all that you’re asking for, but I hope you receive all that you need,” Cowan said. “Blessings on your journey.”
A local musician began to play, his drums and chimes intended to enhance the journey. Most of the athletes lay on mats, as if sleeping. Cote sat in a yoga pose. Nick Murray, Wake’s CEO, had asked Cote to wear special headgear — an electroencephalography device smaller than the other helmet — to measure his brain activity. Except for the musician’s drums and chimes, it was quiet. The wind occasionally rustled the leaves on the trees at the edge of the property, but for the next six hours, inside the circle, time mostly stood still.
Two hours into the ceremony, after the psychedelic had kicked in, whatever was taking place was occurring inside the athletes’ heads. Cote, remarkably, was still holding his yoga pose.
The stillness was broken when Renfrow stood up from his mat after three hours. He’d worn a sweatshirt to the ceremony with his initials, JR, emblazoned across the chest. He peeled the shirt off his body in frustration and tossed it aside.
Tears spilled down his face.
As the ceremony wound down, the athletes began sitting up, and a few chatted quietly.
Most weren’t sure how to describe the experience. For some, it felt like a descent into the recesses of the mind, with colors and emotions swirling together. Others said they confronted traumas they thought they’d buried, or emotions they wanted to suppress. They expressed feeling a connection to the other people in the circle.
“It’s the ultimate ego killer because, for me at least, it gives you incredible empathy that you’ve never felt before,” Lee said. “When you’re doing a journey with other people, you see yourself in them. It’s almost like you’re walking past a mirror, different mirrors. You see parts of yourself in everybody and you realize that we’re all connected and we’re all going through something, we’re all in some sort of pain, and it humbles you.”
Most of the athletes drifted off to be alone so they could scribble down their thoughts in a journal, per instructions from Wake staffers. There would be a communal therapy session the next morning.
Each would be asked to share something from their journey.
***
In the end, most of those curious about psilocybin simply want to know: Does it work? And how does it work? Scientists say those are difficult questions to answer right now.
Researchers have discovered that classic psychedelics, like psilocybin and LSD, act on the serotonin 2A receptor, the same receptor targeted by the most common antidepressants on the market. But beyond that, the understanding of how they work to help people is, at this point, more theory or conjecture than scientific fact.
Johnson, the Johns Hopkins researcher, said psilocybin helps increase openness in people, allowing them to step outside of their vision of who they are. Someone who is resigned to being a smoker who can’t quit or a person with depression who can’t find happiness can, under the influence of psychedelics, view themselves in a different way, he said.
“Once they’re outside of the mental trap, it just becomes so obvious to people with these different disorders that, ‘You know what? I can just decide to quit smoking. I can cast aside my sadness,’” Johnson said.
Studies with rats show that psychedelics also appear to increase neuronal connectivity in the brain, even after a single dose. That could help the brain recover from traumatic injuries or concussions, finding new pathways around damaged areas.
The prevailing theory of how psilocybin and other psychedelics might help treat mental health is that they tamp down activity in the brain’s default mode network. It’s a set of regions in the brain that are engaged when people are ruminating about something and one of the few parts that is overactive in people with depression.
They often revisit mistakes they’ve made over and over again or continually beat themselves up about them, said LaPratt, the Sheppard Pratt researcher. That overactivity in the default mode network leads to repetitive patterns of negative thoughts — What’s wrong with me? Why am I so unhappy? — from which the person cannot escape.
People with depression often ruminate about the past; people with anxiety, about the future.
“You may have something coming up and then the brain starts thinking, and again, like that broken record,” LaPratt said. “It can be very easy to start thinking about how everything might go wrong and start catastrophizing.”
That repetitive thinking prevails in people with other conditions, too, including obsessive compulsive disorder and post-traumatic stress disorder. It begins to affect their sense of who they are; they define themselves as their condition.
But psychedelics seem to help people examine old traumas without falling back into the same kind of destructive loop. They can help people feel more connected to others. Depression and anxiety aren’t simply erased, LaPratt said, but people can gain a new perspective on their problems and start to feel, maybe for the first time, that they can shake them off.
“We see increased openness and some motivation for changing behaviors,” he said.
Psychedelics are mostly out of a person’s system by the next morning, but, according to researchers, that increased openness can last for weeks or months without additional doses, providing a window during which they can begin to address their problems.
“It is maybe that we’re helping people get to the point of being able to accept the things they can’t change and to change the things that they can,” Aaronson said, echoing the Serenity Prayer, often used in 12-step recovery programs. “Personal autonomy is taken away from people with depression. They don’t feel like they can operate in their own best interest. They get caught in internal conflict. And I think this helps them get beyond that.”
***
In the morning, the athletes gathered on a patio for a form of group therapy called integration. It was scheduled to last at least two hours. Macleod explained it was an essential part of understanding a psilocybin journey. Every attendee had an opportunity to share something from their experience, whether it was enlightening, confusing, uplifting, or a mixture of many emotions.
Lee spoke about his anxiety, about trying to understand what his identity would be now that he wasn’t a boxer. By walking away from the ring, he feared he was letting down all the people who supported him when he chose a boxing career instead of a job in finance after he graduated from Notre Dame. But now he’d come to understand those were his own insecurities. He could walk his own path. He could help people experiencing similar physical and emotional pain.
Renfrow took several deep breaths as he searched for words. For most of his life, he’d viewed himself as a football player. But on his psilocybin journey, he felt as if members of his family told him it was OK to let go. When he stood up during the ceremony and peeled off his shirt with his initials, he said, he was symbolically letting go of something.
“It’s OK to stop chasing the football journey,” Renfrow said. “I’m not going to suit up this year and that’s cool with me. I’ll be able to figure it out.”
In saying goodbye to football, he said, he was saying goodbye to his grandmother.
“Football was her,” Renfrow said, and he began crying. “We went on all my recruiting trips. So I had to let her go with letting football go. And that was a big moment when I stood up. I had to let her go. So it was tough, but I had to do it.”
When it was Downie’s turn, he tried to defuse the tension by joking that it was time to go eat. He didn’t want to open up to the group, he said. He’d written some notes on a sheet of paper. His hands shook as he tried to read them.
“I wasn’t drinking and I wasn’t doing drugs for fun,” Downie said, his voice trembling. “I was numbing my brain because it was f—ed. I couldn’t turn out of my driveway for a year. I sat in dark rooms and I turned to drugs and alcohol.”
But on the psychedelic trip, he said, he was able to connect with his past. “I’m sitting there and I’m going through my brain, I’m talking to my dad, I’m talking to my family members. I’ve said sorry to everyone I could possibly say sorry to,” he said. “It made me cry. It made me feel good.”
He realized, through the journey, he wanted to be a better man. His voice was shaking as he tried to get the words out.
“At the end of all this, I think what I’ve learned is how to control what goes on. I do have control. I can control this,” he said. “I’m going to go home and I’m going to identify and execute and be a better father and stay around for my kids, deal with my concussion problems as best I can.”
He turned to look directly at Cote, tears streaming down his cheeks from behind his sunglasses.
“I mean this, bro, when I say you saved my life.”
As Downie’s words gave way to silence, Lee stood up from his chair. He crossed the circle, walked over to Downie, and opened his arms wide. The two fighters, who came to Jamaica sad and broken, embraced.
***
While studies have found that psilocybin plus therapy is more effective than therapy alone, it’s unclear whether psilocybin alone, without the preparatory work or the integration afterward, has any effect.
“There’s a reason why people who go to raves and take psilocybin don’t get cured,” Aaronson said. “Psilocybin is not an antidepressant.”
Even within strict clinical trial protocols, the question remains whether psilocybin-assisted therapy works. Preliminary studies have been promising, but the numbers of test subjects have been small. Much larger studies are needed to determine both safety and efficacy.
Still, that hasn’t stopped psilocybin advocates from touting the research to date, implying it is more definitive than it is. Moreover, many mushroom evangelists attribute the positive effects from clinical trials to taking psilocybin in general, discounting the protocols used in the studies.
The Wake retreat in Jamaica, for example, had the athletes take psilocybin in group ceremonies guided by Cowan, the local shaman, while the group integration sessions were led by an osteopathic physician. Neither was a licensed psychotherapist, Murray said. It’s unclear whether the benefits of psilocybin therapy suggested by clinical research would apply to a group setting — for the dosing or the integration.
Murray, Wake’s CEO, said that while clinical research strives to remove any variables, such as interactions between test subjects, Wake leaders feel the group setting offers benefits to its clients.
“It’s that group feeling that, ‘We’re in this together. My divorce is like your divorce. I lost a brother,’” he said. “That’s tough to put into a clinical trial.”
Wake had registered to hold a clinical trial in Jamaica, but Murray said the company ultimately decided not to pursue it, focusing on offering treatment instead.
Still, Murray said Wake is contributing to scientific research: They collected the blood and saliva samples, and participants were asked to fill out questionnaires before and after the retreat to help assess whether the treatment worked.
Murray said Wake uses the same clinically validated questionnaires used in a psychiatrist’s office. “So, it’s not theater. These are the actual tools that are used,” he said. It would be hard with Wake’s approach, however, to parse whether participants were helped by the mushrooms and integration or by other influences, such as being on vacation in Jamaica, being among a supportive peer group, or the marijuana many of them smoked regularly during the retreat.
“You’ve got to at least listen and take it seriously. There’s anecdotes of people saying they would have killed themselves,” Johnson said. “Sometimes you do see just the ‘full monty’ experience, where this person is just there on a dark, dark trajectory and their whole life changes. I suspect this is real. Something’s happening with these athletes making these reports.”
Glowing anecdotes, particularly when they come from high-profile athletes or celebrities, carry weight with the public and help spur measures like those in Oregon and Colorado that are establishing pathways to psilocybin treatment regardless of what researchers or regulators think.
“When people are upset and we’re not meeting their needs, they’re going to try things out,” said Atheir Abbas, an assistant professor of behavioral neuroscience at Oregon Health & Science University. “Hopefully, scientists can catch up to understanding why people think this is really helpful. And maybe it is helpful, but let’s try to figure out if it is and how.”
But there’s a danger in taking these stories, no matter how compelling, and extrapolating safety or efficacy from them.
“The hard part is the plural of anecdote is not data,” said Sabet, the Smart Approaches to Marijuana CEO. “And the data isn’t there yet.”
***
A year after the retreat, Downie, Renfrow, and Lee said they believed their psilocybin journey had helped them. It did not magically fix all their issues, but each considered it a positive experience.
Downie no longer feels that he is stuck in a dark place. When he returned to Ontario, he said, his family noticed a difference right away.
“That trip gave me a lot of clarity,” Downie said. “It gives you directions. It kind of gives you answers internally. It’s a unique thing I experienced. My year was definitely better than the previous year, that’s for sure. … Do I think it could help other people? I would say yes. Did it help me? Absolutely.”
No longer feeling like a prisoner in his house, Downie started a snowmobile camp that takes adults on guided adventures around Moosonee, near James Bay. It’s something he used to do with his family before his hockey career took off.
“It’s not much to brag about, but it’s the most northern you can go in Ontario in a snowmobile,” Downie said. “A lot of adults come from all over. It’s a pretty cool experience. It’s always been a passion of mine.”
He still has lingering issues from his concussions and suspects he always will.
“It is what it is,” he said. “Would I say it’s getting better? It’s a process.”
The most positive outcome has been the joy he’s found in being a father.
“My little guy is starting to fall in love with hockey, which is something I’ve been waiting for,” Downie said.
Although Downie hasn’t taken another psilocybin journey, he said he would be open to it.
Renfrow emerged from the ceremony intent on retiring from professional football but three months later re-signed with the Canadian Football League’s Edmonton Elks. This year, he joined the National Arena League’s Jacksonville Sharks, in part to be closer to his son.
“At that time, I thought I was going to quit football,” he said.
But he feels comfortable where he is and says he’s fulfilling his goals, including hosting that cooking show on YouTube he’d hoped to do. And he said he’s having fun again. He now turns to mushrooms whenever he has a big decision to make.
“I wholehearted believe in that and all the kind of guidance it’s given me,” he said. “You couldn’t ask for a better thing, to have followed guidance from a mushroom journey.”
Lee moved from California to Austin, Texas, and now runs a CBD business with his sister. Finding his post-boxing identity has remained a process. In his psychedelic journeys at the Wake retreat, Lee said, he was never thinking about sports or boxing. His visions were all about family, God, the universe.
“It kind of just makes me realize how much importance I’m putting on something that my subconscious doesn’t even care about,” he said. “My subconscious doesn’t care that I’m a boxer, that I was a fighter and did this and did that. It’s all kind of ego.”
The experience, he said, helped him understand how powerful the mind can be — that it can be a friend or a foe.
“I came away from it kind of realizing that I have all the tools to heal myself,” he said. “That’s huge. Because, especially for guys who have had concussions or athletes or what have you, you feel kind of isolated, you feel alone, you feel hopeless. So it kind of gives you a sense of hope.”
It allowed him to move beyond the need to prove himself, in the ring or outside it, to stop measuring his worth by his accomplishments. He’s become obsessed with much calmer, nonviolent pursuits: surfing and pickleball.
“I can turn my brain off just like in boxing,” he said. “But at the same time, it’s easier on my body and just, I don’t know, more fulfilling. I don’t have to prove anything.”
The Jamaican trip is allowing him to move forward, to do the work necessary to heal.
“Part of me went into it hoping that all my problems would be solved, but putting those expectations on it can be difficult,” he said. “Am I cured? No. But did it really help? And was it, like, one of the most profound experiences of my life?
“I’d say yes.”
This article was reported and written by KFF Health News’ Markian Hawryluk and ESPN’s Kevin Van Valkenburg. Researcher John Mastroberardino contributed to this report.
[Editor’s note: As part of the reporting of this article, some members of ESPN’s reporting team, under the guidance of Wake Network staff, used psilocybin. Wake Network was compensated, but not by ESPN.]
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
2 years 3 months ago
Health Industry, Mental Health, Pharmaceuticals, States, Colorado, Oregon, texas
A Doctor’s Love Letter to ‘The People’s Hospital’
Could a charity hospital founded by a crusading Dutch playwright, a group of Quakers, and a judge working undercover become a model for the U.S. health care system? In this episode of the podcast “An Arm and a Leg,” host Dan Weissmann speaks with Dr. Ricardo Nuila to find out.
Nuila’s new book, The People’s Hospital: Hope and Peril in American Medicine, uses the innovative model of the Ben Taub Hospital in Houston, where he practices, to argue for a publicly funded health system in the U.S. that’s available to everybody, with or without insurance.
Dan Weissmann
Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.
Credits
Emily Pisacreta
Producer
Adam Raymonda
Audio Wizard
Afi Yellow-Duke
Editor
Click to open the Transcript
Transcript: A Doctor’s Love Letter to ‘The People’s Hospital’
Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.
Dan: Ben Taub Hospital is a publicly funded safety net hospital in Houston, Texas. The majority of patients don’t have insurance of any kind.
Dr. Ricardo Nuila has been working at Ben Taub since he was an intern, a medical student. He took me on a tour.
Ricardo Nuila: I started here and, you know, literally I just did not want to leave here cuz I just, just really enjoyed my job here
Dan: He’s just published a book called “The People’s Hospital” that’s not just a love letter to the place, it’s a pitch:
Not only is this place way, way cheaper than what we’re used to, in many ways it’s better. And it’s a model, a real alternative to what-we’re-used-to.
So, I ask him to pick ONE patient’s story from the book to tell, he picks a patient he calls Stephen. A restaurant manager, a Republican. A guy who did not expect to end up here.
But he had a giant lump on the side of his throat, and his insurance didn’t cover much. He paid cash, upfront, to get seen in a local ER.
Ricardo Nuila: finally there was a doctor who had seen a CAT scan and said, you have tonsillar cancer, cancer, however, you don’t have, uh, insurance
Dan: Tonsillar cancer. Cancer of the tonsils. That landed hard. So did the “however.”
Ricardo Nuila: He felt shitty you know, that somebody could tell you cancer, but there’s nothing that we are gonna do about it because of, of how much and…
Dan: It’s like it’s too painful — or too obvious — to finish the sentence: Because of your insurance. Somebody tells Steven to try the public hospital, Ben Taub. He expects the worst. But that’s not what he finds.
Ricardo Nuila: He comes to love this place. He gives, this is like so Steven, but he, he gives gift cards to the people greeting at the door because they’re nice and they do their job well cuz they make his day,
Dan: And it’s not just that he likes the people at the door.
Ricardo Nuila: He feels like he got really good healthcare and that he also, um, thought that the price was extremely reason.
Dan: Stephen lost his insurance when he got too sick to work, and he doesn’t qualify for Medicaid. He owns a house, he’s got savings, Texas has really stringent Medicaid restrictions– so he’s paying out of pocket.
Ricardo Nuila: But his final bill is pennies of what he thought he would pay.
Dan: Stephen’s dad had gotten radiation treatment for cancer, and the sticker price was 700 thousand dollars. Stephen had gotten radiation AND chemo AND surgery — and had been hospitalized for a good while.
His bill was 32 thousand, three hundred and seventy-eight bucks. Real money for sure, but he can pay it. And it’s less than five percent of his dad’s bill for much less extensive treatment.
Ricardo Nuila: And the healthcare is really good. And so he’s almost proud that he’s had this experience
Dan: Steven’s become a convert. And as Ricardo Nuila walks me into a conference room, it’s clear: He hopes his book will create more converts.
Ricardo Nuila: you start to see this model and it makes you think, can things be different in healthcare? I think that that’s an option. But we as a country haven’t thought about that. Seriously. You know?
Dan: And if it seems politically unimaginable that we could have anything like this around the country– an effective, efficient, CHEAP, publicly-funded health system–
Well, the idea that Houston could have one, that was pretty unlikely too.
In fact, the story of how Ben Taub got here may be the most surprising story in Ricardo Nuila’s whole book.
This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter, and I like a challenge. So our job on this show is to take one of the most enraging, terrifying, depressing parts of American life and to bring you a show that’s entertaining, empowering and useful.
Ben Taub Hospital sits at the edge of the Texas Medical Center– that’s a giant neighborhood full of hospitals and medical schools, including some of the best in the country, like the M.D. Anderson cancer center.
In his book, Ricardo Nuila writes about how some patients at Ben Taub can see from their rooms the gleaming buildings of Ben Taub’s neighbors.
So when I visit, I make him show me the view. We look out from a stairwell at a glass tower, M.D. Anderson’s Sheikh Zayed building.
Ricardo Nuila: that’s glamorous. Right? you get a glimpse into the rest of the medical center here. Ben Taub sticks out, I feel like, because it’s, it’s brick versus glass.
Dan: But as Ricardo Nuila makes clear in his book: This unglamorous brick building gets the job done.
In addition to Steven, there’s Ebonie, whose complicated pregnancy — there’s a lot of vaginal bleeding– gets tracked more precisely than it would elsewhere:
At other hospitals, nurses eyeball the pads that absorb that blood and note heavy, medium or light bleeding. At Ben Taub, they’ve adopted an innovative approach: weighing each pad to get an exact measurement.
Another patient, Christian, has bounced around other systems without anybody accurately diagnosing the dire kidney problems that have kept him in pain for years. Because he didn’t have good insurance, it wasn’t worth anybody’s time.
At Ben Taub, insurance isn’t an obstacle,
Ricardo Nuila: We organize things, which is basically, okay, we need to focus on your kidneys right now and we need to get you to see a geneticist. And both of those things happened.
Dan: they not only diagnose him, they get him on a form of dialysis that he can manage himself at home.
It’s cheaper, and delivers better quality of life for him.
Everything at Ben Taub is cheaper. The system spends about a third as much per patient as the national average. In part, that may be because nobody earns million-dollar salaries here.
But Ricardo Nuila makes the case over and over again that they take the time– because they have it– to make wise use of resources.
They don’t have as many MRI machines as other hospitals. But guess what? A lot of patients don’t need MRIs.
But Ben Taub can’t meet every need: One patient, Geronimo, needs a liver transplant, and that requires resources the hospital just doesn’t have.
But Ricardo Nuila and his colleagues put a lot of time into wrenching him back onto Medicaid, so he can get the transplant somewhere else. They rope in a Congressman to get it done.
Geronimo tells his mom:”I feel so important. Everyone treats me like I’m rich.”
Ricardo Nuila: That’s what I think a lot of people really want is just the sense that the person who’s responsible for your care is thinking through the problem with you and aware that you are not having a great day and wants to deal with that situation with you. And I just felt like this environment allowed me to like, have those moments.
Dan: So who pays for this environment? It may be cheaper, but it isn’t free.
Some patients are on Medicaid. Some are on Medicare. Some have private insurance. But the majority don’t have any insurance at all.
Some, like Stephen, pay cash. And a lot of the rest — about a third of Ben Taub’s patients — are treated for free.
The bulk of Ben Taub’s funding comes from a special property tax in Harris County, where Houston is located. It funds a whole system called Harris Health– Ben Taub, a second hospital, and a bunch of clinics.
And of course, none of this has always existed.
In fact, it’s only here, like this, because of a really wild story, with two big characters. One of whom wasn’t even from Houston. He was a writer I’d never heard of, a Dutch guy named Jan de Hartog.
Ricardo Nuila: de Hartog was one of the most amazing people that you could read about. He was a Nazi resistance fighter, Dutch ship captain.
Dan: And while he was hiding out in Denmark during the war– in between saving a few Jewish babies and running war missions in his tugboat–
he wrote a romantic dramedy that — later became a broadway hit. And then got adapted into a Broadway musical called I Do, I Do– which, Broadway-musical nerds in the house– starred Mary Martin and Robert Preston– you know, The Music Man– and had a song that your mom might still remember.
(musical sounds)
Dan: Yeah. So, interesting guy. And in the early 1960s he came to Houston to teach playwriting at a local University. It was a big time for him. He’d just gotten married — for the third time, but this one was for keeps- and become a Quaker.
Ricardo Nuila: And when he and his wife Marjorie come to Houston, they find that there’s all these whisperings about this charity hospital in town in Houston about how, how awful the conditions are. That the children in the maternity ward would cry all night for the, for a lack of milk, and so as part of his faith, he decides that he needs to volunteer there
Dan: When de Hartog writes about the hospital later, he describes the experience of walking in for the first time as literally mind-boggling.
He’s like: I know what a hospital smells like. Disinfectant, maybe some fresh laundry. And I know what a slaughterhouse smells like: Blood, and shit. And the smell here is slaughterhouse.
As he looks around, the sights are something else.
Ricardo Nuila: He sees a cockroach crawling into the tracheostomy of like a patient. He sees like people sitting in their own filth.
Dan: He and Marjorie do not up and quit. They stick around. And then they recruit a dozen Quakers and a few society ladies to come volunteer with them, and get the Red Cross to train them.
And it’s nuts. This is a rich city. The ZOO is air conditioned. But not this hospital.
And he starts to catch on: Why it’s so horrible.
Number one is racism.
The hospital serves mostly Black and Brown patients. When Jan and Marjorie start volunteering, the other volunteers are all society ladies, and the whole program is set up so they don’t touch patients. DeHartog later says he asked why, and the volunteer coordinator says, Southern ladies can’t have physical contact with black people.
But she doesn’t say black people. She uses the n-word.
When he asks staff why public officials don’t do something about the rotten conditions, they say: What politician is going to stick up for black people? The n-word comes up again.
And– de Hartog doesn’t make this connection, but it seems pretty on the nose: The hospital itself is named after Jefferson Davis, who led the Confederacy in the Civil War.
But there’s also a political mechanism for institutionalizing this neglect, without ever having to acknowledge the role of racism:
No one particular political entity — no one particular political leader– is responsible for the public hospital, financially. The city of Houston and Harris County are each supposed to kick in HALF. So it doesn’t belong to either of them. Here’s de Hartog describing the city-county dynamic in a lecture he gave many years later.
Jan de Hartog: And they were continuously at each other’s throats. The one said, you don’t pay enough. The other said, but you don’t. And they went back and forth
Dan: The top official for Harris County actually has the title County Judge. At that time, this was a guy named Bill Elliott.
And you’ll hear in this clip from a local newscast, he wasn’t exactly reaching for the bill. Here he is, explaining why the some problem with the hospital is actually the CITY’s fault.
Judge Bill Elliott: it’s absolutely ridiculous, uh, to say that, uh, this is a responsibility and this is the fault of Harris County.
Dan: And the city? At least one.council member is calling for a budget cut.
Which really pisses de Hartog off.
And de Hartog actually loves the city. It’s an exciting place. It’s booming– growing super-fast. And it’s not just an oil town.
Ricardo Nuila: Houston at that time was the home of NASA.
NASA narrator: Future manned space flight missions to the moon and perhaps the planets will be commanded from this control room of the Mission Control Center at NASA’s Manned Spacecraft Center,
Ricardo Nuila: It had built this Astrodome, it was the city of the future.
Dan: The Astrodome– you know, a sports stadium WITH AIR CONDITIONING. .
Astrodome Narrator: A fully enclosed building, large enough for any sport convention show or conclave with constant temperature and humidity independent of outside weather,
Dan: CBS News does a report about the booming city: NASA, the oil wealth, the Astrodome. And de Hartog is a main character– talking about how much he loves the town.
Jan de Hartog: it is a city of, a city of unlimited opportunities. It’s an immensely exciting town, and you feel that anything is possible,
Dan: It wraps up with Walter Cronkite talking about how everybody in town is absolutely nuts about football.
Walter Cronkite: Their brand of football is like their brand of city and brand of life. Play wide open. Take a chance, try anything. Above all, do it with zest and do it big.
Dan: Oh, and there’s this OTHER thing Houston is really becoming known for.
Cutting edge medicine. For twenty years, the city’s been building the Texas Medical Center — that giant campus where more than a dozen hospitals and med schools now operate right on top of each other. Baylor College of Medicine actually moved from Dallas to Houston to be part of it.
Ricardo Nuila: Houston is a really deeply medical city. And at that time they’re all working on extraordinary things
Dan: Yeah, in 1964, while Jan de Hartog is witnessing the suffering at the charity hospital, Dr. Michael deBakey is performing the world’s first coronary artery bypass at a private hospital in town.
But the medical establishment were not allies. Jefferson Davis hospital, on the outskirts of town, was about to be replaced by a new building in the Texas Medical Center.
But the Medical Society– the local doctors’ association — hadn’t wanted the charity hospital as a neighbor. They’d actually put up a ballot initiative to keep the new building at the old site.
Medical Society Voice-Over: you the taxpayer, will pay the extra cost That’s why your doctor recommends you vote for the new hospital to remain at its present site.
Dan: It hadn’t worked, but along with the budget cuts, officials were now talking about DELAYING the charity hospital’s move to the new building, which had just been completed. De Hartog and his friends, smell a rat.
They think the powers that be are actually going to sell the new building in the Medical Center to some other hospital that wants in. This has been a public conversation.
Jan de Hartog: There had been offers to buy it and they wanted to wait for the highest bidder
Ricardo Nuila: He writes a series of op-eds for the Houston Chronicle that start to get press, not just in Houston, but around the country and in fact around the world.
Dan: He describes the awful things he’s seen. And he appeals to Houstonians’ sense of pride in their bustling, futuristic city. A city he loves, too. Here’s how his first op-ed ends…
Jan de Hartog: I cannot believe that it is the will of the citizens of Houston, that our growing medical center rightly becoming famous all over the. Shall be allowed to harbor the cancerous sore of man’s inhumanity to man. It would turn the entire center planned as Houston’s glory into Houston’s shame.
Dan: Even just that first op ed made a lot of noise.
Jan de Hartog: the bomb exploded and the national magazines and newspapers and TV zeroed in on the hospital to find out what was going on,
Dan: … and immediately, the hospital DOES move into its new home in the Medical Center. But the funding issue isn’t solved.
So de Hartog keeps pushing.
Ricardo Nuila: He writes a book called “The Hospital”
Dan: He goes to churches around town, synagogues, everywhere he can, recruiting hundreds of volunteers.
But there’s no political progress — and conditions at the hospital actually get worse. Key nurses get burned out and quit. Things go to hell.
In a harrowing diary entry, he writes about full bedpans left on tables next to trays of food. About a patient crying out for help, and hearing back “Shut up!”
Jan de Hartog: Never before had I realized to this extent, the depth of our damnation, and at that deepest moment of desperation, when we knew nothing could be done, nothing would change for the simple reason that
Jan de Hartog: those who had the fate of the hospital in their hands were not there. Mayor Welsh didn’t work there. Uh, commissioner Bill Elliot Judge, the county judge did not work there.
Dan: But THEN, there’s a turn. Somebody shows up. That’s right after this.
This episode of An Arm and a Leg is produced in partnership with Kaiser Health News. That’s a non-profit newsroom about health care in America. KHN is not affiliated with the giant health care player Kaiser Permanente. We’ll have more information about KHN at the end of this episode.
So, Jan de Hartog keeps slogging away.
He gives a talk at a Baptist church– he reads that diary entry, the one with the bedpans, and the absence of Judge Elliott and other leaders.
And at first he thinks he didn’t go over so big. Nobody even raises their hand to volunteer.
But then it happens.
Jan de Hartog: When, uh, we were about to leave, a man turned up with a baby on his hip who said, uh, do you train people at night?
Dan: And the guy seems to be looking around, trying to make sure nobody’s listening. De Hartog tells the guy, yeah, we could do that…
Jan de Hartog: He said, I mean, a dead of night without anybody seeing.
Dan: De Hartog’s like, “um, sure, I guess. Why, though?”
Jan de Hartog: He said, well, I am Judge Elliot,
Dan: Judge Elliott. The county judge. Probably the most powerful politician in town. That’s who wants to volunteer. In secret. Without anybody seeing. He says to de Hartog
Jan de Hartog: I cannot do it as a judge, but I must do it as a man. And that was the moment that the whole damn thing changed..
Dan: Because Judge Bill Elliott followed through.
Ricardo Nuila: He trains himself in a clandestine manner to be an orderly, at night, and he verifies everything that de Hartog has said.
Dan: de Hartog actually oversees the judge’s final practical exam, where Bill Elliott tends to an African-American man named Willie Small.
Jan de Hartog: the judge with his thermometer went and put his hand on Willie’s shoulder and said, Mr. Small, sir, I’d like to take your temperature to hear that, to hear a southern judge, , say “Mr. Small, sir”
Dan: It was a symbolic moment. The judge had to touch, had to defer to, a Black man. So not only had the judge now seen everything, he took responsibility for what he had seen.
There’s a proposal for a county-wide property tax, to fund what’s called a Hospital District. Now there’s a referendum, and Elliott backs it all the way.
Jan de Hartog: and we all waited with baited breaths for the outcome. And it was no
Dan: Yeah. The referendum fails. And as de Hartog tells it, once it does, a real backlash starts to build. It gets personal.
Jan de Hartog: those who had resented our presence from the very beginning became vocal. Margie and I, were called communists
Ricardo Nuila: De Hartog just would not flinch. I mean, he and his wife’s lives were threatened.
Dan: Also, somebody threw a bag of excrement at their door.
Eventually, de Hartog says the Red Cross, which was training and supervising volunteers at the hospital, came to him and Marjorie and said, “It might be better for us if you left town for a while.”
They did — went on to all kinds of adventures.
Meanwhile, Bill Elliott kept pushing, and keeps pulling in allies– including, eventually, the Medical Society.
Ricardo Nuila: he rallies them to get behind it.
Dan: He gets the question on the ballot AGAIN later that same year. And it passes in November 1965.
It’s a big moment.
Ricardo Nuila: What’s also interesting is that it’s forgotten. Something that I’ve gleaned from all this is that you know, people will forget and you have to remind them.
Dan: And while we’re remembering: In 1965, the whole country is making some big commitments to health care for a lot of people. President Lyndon Johnson signs Medicare and Medicaid into law in July of that year.
It’s probably also worth noting that Medicare and Medicaid help make Ben Taub possible: About a third of the hospital’s patients are on one or the other. It’s a minority of patients, but it’s many millions of dollars of funding.
The 1960s were a notoriously divisive time. And so is this.
Ricardo Nuila doesn’t ignore today’s political polarization — or how that polarization makes it hard to imagine a national conversation about creating a different health care system.
Or the role that doctors have historically played in resisting that conversation.
It’s part of his story. His family story. And in a book about a place where a lot of sad things do happen, this may be the toughest one.
Ricardo Nuila: I was born into a family of doctors and my dad in many ways was a hero to me. I saw how much pride he took in his work of being a doctor
Dan: But over time– as insurance companies got tougher to deal with– the business side of running a medical practice looked a lot less apealing.
Ricardo Nuila: . He had to hire more and more staff. He hired his mother, my grandmother, who is, uh, the type of person not to back down from Chicago, you know, . And so, her job was to be on the insurance companies to make sure that they wouldn’t, screw him out of money.
Dan: His dad turned away patients who didn’t have insurance. His dad growled and grumbled– about insurance companies, and about patients who didn’t have money to pay.
When Ricardo finished college and got into medical school, he put off starting for two years. What he sees as his dad’s life in the business of health care is not appealing.
Ricardo Nuila: the grind wears on him, you know? The fighting with the insurance companies
Dan: I mean in the book, your dad is a bit of a stand-in for . For doctors as a doctoring, as profession and the, and the way in which doctors get alienated from medicine.
Ricardo Nuila: yeah, he is a stand in a bit for doctors. And it’s gonna be, I think the doctors have a lot to say about how healthcare goes in America,
Ricardo Nuila: And unfortunately, the history shows that they haven’t been a great piece of that, at least as far as universal healthcare is concerned.
Dan: This becomes part of Ricardo’s story with his dad. Dad invites him to form a family practice. Ricardo chooses Ben Taub. And over the years, it becomes clear: They’re on opposite sides of a political divide. There are painful conversations, and then they go months without speaking.
Ricardo Nuila: that’s how deep politics run, you know, it’s really, it’s really difficult when you overlay like politics onto like a family dynamic,
Ricardo Nuila: It just felt like he was like totally on board with this idea that, you know, healthcare is something that is earned and healthcare is something that people, if you can’t afford it, you don’t deserve it. Is what I heard from what he was saying.
Dan: is your dad an ideal reader of the book? Is your dad kind of who the person you wanna make that case to?
Ricardo Nuila: That’s really interesting.
Ricardo Nuila: I would say this, that, I did not write this to preach to the choir for sure.
Dan: But he’s not sure his dad would actually pick up a book like this.
Ricardo Nuila: It’s just because I know my dad, he, my dad’s the type of person who reads John Grisham on a beach, you know? So I’m not a hundred percent sure if he would pick up this book, you know?
Dan: Unless, say, his son wrote it. Ricardo does expect his dad to read The People’s Hospital. And even if he doesn’t agree with everything his son has written, Ricardo thinks his dad will be proud.
Ricardo Nuila: I can tell you now as a, as a father, , it’s not clear that your kids are gonna come out Okay. . You know what I mean? I’m just saying that like he has reason to be proud just because I’m a, a living and breathing person right now, you know?
Ricardo Nuila: And I’m, I’m working in as a doctor. So I, I feel, I feel good for him.
Ricardo Nuila: And I think that he’s probably very happy that I wrote about medicine cuz he loves medicine.
Dan: The last chapter of “The People’s Hospital” is called “faith” And in it, Ricardo Nuila describes a daily ritual that he says keeps him grounded. It starts with passing a plaque on his way in. Of course I have him show it to me.
Ricardo Nuila: I park like right over there, .
Ricardo Nuila: I come in here and I just look at, look at this every time.
Dan: So, and describe what we’re seeing here.
Ricardo Nuila: Well, we’re seeing, a plaque that, talks about when this hospital was founded, and the people who constructed the building. And there’s also the, I forgot this is, this is bad of me, but I forgot the name.
Dan: the snake around the stick?
Ricardo Nuila: I’m in big trouble now because I’m on the Caduceus Caduceus. I, it’s the Cadus. Yeah.
Ricardo Nuila: And it’s just a reminder, you know, that we have this structure in place to help care for people who don’t have, uh, the means and that, and
Dan: that people decided to put this building here. Yeah.
Ricardo Nuila: Exactly. It’s a community effort.
Dan: Ricardo Nuila writes that he sees that community as he walks from that plaque to his desk– all the co-workers, in every kind of job, doing their best.
And this is the faith that he says gets affirmed— reading from the book here:
If someone is suffering and there is the capacity within the community to help, in a way that doesn’t harm anyone else, then we not only owe it to that person, we owe it to ourselves to help.
Whatever your politics are, I think that’s pretty great.
Dr. Ricardo Nuila practices at Ben Taub Hospital. He’s associate professor of Medicine, Medical Ethics and Health Policy at Baylor College of Medicine. His book is called “The People’s Hospital.”
Honestly there’s a lot in this book, — more patient stories, more family stories, a very deft summary of a hundred years of health care economics and politics.
I’ll tell you: reading this book, I was reminded of an idea I’ve had before. That it might be cool someday to convene a kind of “Arm and a Leg” book club. Because I’d like to have someone to talk with about a book like this– like maybe you.
Right now, that’s just an idea. The how would take a LOT of figuring out.
But I’m curious how that idea sounds to you. You can let me know at Arm and a Leg show dot com, slash contact.
I mean, that’s always a good place to send ideas and stories and questions— so many of our best episodes come from you.
And I’m curious what you think about this virtual book club idea. If you’ve taken part in something like this, or helped to organize it, I’d love to hear how it went.
That’s arm and a leg show dot com, slash contact.
Next time on An Arm and a Leg: A woman named Lisa French asked her hospital what her surgery would cost her. They said, with your insurance, about thirteen hundred bucks.
They expected about 55 thousand more from insurance.
They got 75 thousand. But then they wanted more. 229 thousand more. They wanted it from Lisa French, and they sued her for it.
After eight years, the case finally got resolved last June. Lisa French won!
The case has a LOT to teach us about our legal rights.
That’s next time on An Arm and a Leg.
Till then, take care of yourself.
This episode of An Arm and a Leg was produced by me, Dan Weissmann, with help from Emily Pisacreta, and edited by Afi Yellow-Duke.
The recording of Jan de Hartog’s lecture is courtesy of the Baylor College of Medicine Archives.
The audio of Bill Elliott is from a KHOU-TV newscast, thanks to the Texas Archive of the Moving Image.
Big thanks to the archivists who helped us find some of the tape for this episode!
That includes Emily Vinson at the University of Houston library
Matt Richardson and Sandra Yates at the Texas Medical Center Archives
And David Olmos at the Baylor College of Medicine archives.
Daisy Rosario is our consulting managing producer. Adam Raymonda is our audio wizard. Our music is by Dave Winer and Blue Dot Sessions.
Gabrielle Healy is our managing editor for audience. She edits the First Aid Kit Newsletter.
Bea Bosco is our consulting director of operations. Sarah Ballema is our operations manager.
This season of an arm and a leg is a co production with Kaiser health news. That’s a nonprofit news service about healthcare in America, an editorially-independent program of the Kaiser family foundation.
KHN is not affiliated with Kaiser Permanente, the big healthcare outfit. They share an ancestor: The 20th century industrialist Henry J Kaiser. When he died, he left half his money to the foundation that later created Kaiser health news.
You can learn more about him and Kaiser health news at arm and a leg show dot com slash Kaiser.
Zach Dyer is senior audio producer at KHN. He is editorial liaison to this show.
Thanks to Public Narrative — That’s a Chicago-based group that helps journalists and non-profits tell better stories– for serving as our fiscal sponsor, allowing us to accept tax-exempt donations. You can learn more about Public Narrative at www dot public narrative dot org.
And thanks to everybody who supports this show financially.
If you haven’t yet, we’d love for you to join us. The place for that is arm and a leg show dot com, slash support.
Thank you!
“An Arm and a Leg” is a co-production of KHN and Public Road Productions.
To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.
To hear all KHN podcasts, click here.
And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
USE OUR CONTENT
This story can be republished for free (details).
2 years 4 months ago
Health Care Costs, Insurance, Multimedia, An Arm and a Leg, Hospitals, Podcasts, texas
In Texas, Medicaid Coverage Ends Soon After Childbirth. Will Lawmakers Allow More Time?
Victoria Ferrell Ortiz learned she was pregnant during summer 2017. The Dallas resident was finishing up an AmeriCorps job with a local nonprofit, which offered her a small stipend to live on but no health coverage. She applied for Medicaid so she could be insured during the pregnancy.
“It was a time of a lot of learning, turnaround, and pivoting for me, because we weren’t necessarily expecting that kind of life change,” she said.
Ferrell Ortiz would have liked a little more guidance to navigate the application process for Medicaid. She was inundated with forms. She spent days on end on the phone trying to figure out what was covered and where she could go to get care.
“Sometimes the representative that I would speak to wouldn’t know the answer,” she said. “I would have to wait for a follow-up and hope that they actually did follow up with me. More than 476,000 pregnant Texans are currently navigating that fragmented, bureaucratic system to find care. Medicaid provides coverage for about half of all births in the state — but many people lose eligibility not long after giving birth.
Many pregnant people rely on Medicaid coverage to get access to anything from prenatal appointments to prenatal vitamins, and then postpartum follow-up. Pregnancy-related Medicaid in Texas is available to individuals who make under $2,243 a month. But that coverage ends two months after childbirth — and advocates and researchers say that strict cutoff contributes to rates of maternal mortality and morbidity in the state that are higher than the national average.
They support a bill moving through the Texas legislature that would extend pregnancy Medicaid coverage for a full 12 months postpartum.
Texas is one of 11 states that has chosen not to expand Medicaid to its population of uninsured adults — a benefit offered under the Affordable Care Act, with 90% of the cost paid for by the federal government. That leaves more than 770,000 Texans in a coverage gap — they don’t have job-based insurance nor do they qualify for subsidized coverage on healthcare.gov, the federal insurance marketplace. In 2021, 23% of women ages 19-64 were uninsured in Texas.
Pregnancy Medicaid helps fill the gap, temporarily. Of the nearly half a million Texans currently enrolled in the program, the majority are Hispanic women ages 19-29.
Texans living in the state without legal permission and lawfully present immigrants are not eligible, though they can get different coverage that ends immediately when a pregnancy does. In states where the Medicaid expansion has been adopted, coverage is available to all adults with incomes below 138% of the federal poverty level. For a family of three, that means an income of about $34,300 a year.
In Texas, childless adults don’t qualify for Medicaid at all. Parents can be eligible for Medicaid if they’re taking care of a child who receives Medicaid, but the income limits are low. To qualify, a three-person household with two parents can’t make more than $251 a month.
For Ferrell Ortiz, the hospitals and clinics that accepted Medicaid near her Dallas neighborhood felt “uncomfortable, uninviting,” she said. “A space that wasn’t meant for me” is how she described those facilities.
Later she learned that Medicaid would pay for her to give birth at an enrolled birthing center.
“I went to Lovers Lane Birth Center in Richardson,” she said. “I’m so grateful that I found them because they were able to connect me to other resources that the Medicaid office wasn’t.”
Ferrell Ortiz found a welcoming and supportive birth team, but the Medicaid coverage ended two months after her daughter arrived. She said losing insurance when her baby was so young was stressful. “The two-months window just puts more pressure on women to wrap up things in a messy and not necessarily beneficial way,” she said.
In the 2021 legislative session, Republican Gov. Greg Abbott signed a bill extending pregnancy Medicaid coverage from two months to six months postpartum, pending federal approval.
Last August, The Texas Tribune reported that extension request had initially failed to get federal approval, but that the Centers for Medicare & Medicaid Services had followed up the next day with a statement saying the request was still under review. The Tribune reported at the time that some state legislators believed the initial application was not approved “because of language that could be construed to exclude pregnant women who have abortions, including medically necessary abortions.”The state’s application to extend postpartum coverage to a total of six months is still under review.
The state’s Maternal Mortality and Morbidity Review Committee is tasked with producing statewide data reports on causes of maternal deaths and intervention strategies. Members of that committee, along with advocates and legislators, are hoping this year’s legislative session extends pregnancy Medicaid to 12 months postpartum.
Kari White, an associate professor at the University of Texas-Austin, said the bureaucratic challenges Ferrell Ortiz experienced are common for pregnant Texans on Medicaid.
“People are either having to wait until their condition gets worse, they forgo care, or they may have to pay out-of-pocket,” White said. “There are people who are dying following their pregnancy for reasons that are related to having been pregnant, and almost all of them are preventable.”
In Texas, maternal health care and Pregnancy Medicaid coverage “is a big patchwork with some big missing holes in the quilt,” White said. She is also lead investigator with the Texas Policy Evaluation Project (TxPEP), a group that evaluates the effects of reproductive health policies in the state. A March 2022 TxPEP study surveyed close to 1,500 pregnant Texans on public insurance. It found that “insurance churn” — when people lose health insurance in the months after giving birth — led to worse health outcomes and problems accessing postpartum care.
Chronic disease accounted for almost 20% of pregnancy-related deaths in Texas in 2019, according to a partial cohort review from the Texas Maternal Mortality and Morbidity Review Committee’s report. Chronic disease includes conditions such as high blood pressure and diabetes. The report determined at least 52 deaths were related to pregnancy in Texas during 2019. Serious bleeding (obstetric hemorrhage) and mental health issues were leading causes of death.
“This is one of the more extreme consequences of the lack of health care,” White said.
Black Texans, who make up close to 20% of pregnancy Medicaid recipients, are also more than twice as likely to die from a pregnancy-related cause than their white counterparts, a statistic that has held true for close to 10 years with little change, according to the MMMRC report.
Stark disparities such as that can be traced to systemic issues, including the lack of diversity in medical providers; socioeconomic barriers for Black women such as cost, transportation, lack of child care and poor communication with providers; and shortcomings in medical education and providers’ implicit biases — which can “impact clinicians’ ability to listen to Black people’s experiences and treat them as equal partners in decision-making about their own care and treatment options,” according to a recent survey.
Diana Forester, director of health policy for the statewide organization Texans Care for Children, said Medicaid coverage for pregnant people is a “golden window” to get care.
“It’s the chance to have access to health care to address issues that maybe have been building for a while, those kinds of things that left unaddressed build into something that would need surgery or more intensive intervention later on,” she said. “It just feels like that should be something that’s accessible to everyone when they need it.”
Extending health coverage for pregnant people, she said, is “the difference between having a chance at a healthy pregnancy versus not.”
As of February, 30 states have adopted a 12-month postpartum coverage extension so far, according to a KFF report, with eight states planning to implement an extension.
“We’re behind,” Forester said of Texas. “We’re so behind at this point.”
Many versions of bills that would extend pregnancy Medicaid coverage to 12 months have been filed in the legislature this year, including House Bill 12 and Senate Bill 73. Forester said she feels “cautiously optimistic.”
“I think there’s still going to be a few little legislative issues or land mines that we have to navigate,” she said. “But I feel like the momentum is there.”
Ferrell Ortiz’s daughter turns 5 this year. Amelie is artistic, bright, and vocal in her beliefs. When Ferrell Ortiz thinks back on being pregnant, she remembers how hard a year it was, but also how much she learned about herself.
“Giving birth was the hardest experience that my body has physically ever been through,” she said. “It was a really profound moment in my health history — just knowing that I was able to make it through that time, and that it could even be enjoyable — and so special, obviously, because look what the world has for it.”
She just wishes people, especially people of color giving birth, could get the health support they need during a vulnerable time.
“If I was able to talk to people in the legislature about extending Medicaid coverage, I would say to do that,” she said. “It’s an investment in the people who are raising our future and completely worth it.”
This story is part of a partnership that includes KERA, NPR, and KHN.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
USE OUR CONTENT
This story can be republished for free (details).
2 years 4 months ago
Health Care Costs, Insurance, Medicaid, Multimedia, States, Audio, Legislation, Pregnancy, texas, Women's Health
A Judicial Body Blow to the ACA
The Host
Julie Rovner
KHN
Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
Opponents of the Affordable Care Act may have stopped trying to overturn the entire law in court, but they have not stopped challenging pieces of it — and they have found an ally in Fort Worth, Texas: U.S. District Judge Reed O’Connor. In 2018, O’Connor held that the entire ACA was unconstitutional — a ruling eventually overturned by the Supreme Court. Now the judge has found that part of the law’s requirement for insurers to cover preventive care without copays violates a federal religious freedom law.
In a boost for the health law, though, North Carolina has become the 40th state to expand the Medicaid program to lower-income people who were previously ineligible. Even though the federal government will pay 90% of the cost of expansion, a broad swath of states — mostly in the South — have resisted widening eligibility for the program.
This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat, and Sandhya Raman of CQ Roll Call.
Panelists
Rachel Cohrs
Stat News
Alice Miranda Ollstein
Politico
Sandhya Raman
CQ Roll Call
Among the takeaways from this week’s episode:
- Thursday’s decision out of Texas affects health plans nationwide and is expected to disrupt the health insurance market, which for years has provided preventive care without cost sharing under the ACA. Even if the decision survives a likely appeal, insurers could continue offering the popular, generally not-so-costly benefits, but they would no longer be required to do so.
- The decision, which found that the U.S. Preventive Services Task Force cannot mandate coverage requirements, hinges on religious freedom objections to plans covering PrEP, the HIV medication, alongside other preventive care.
- Speaking of the ACA, this week North Carolina became the latest state to expand Medicaid coverage under the health law, which will render an estimated 600,000 residents newly eligible for the program. The development comes amid reports about hospitals struggling to cover uncompensated care, particularly in the 10 states that have resisted expanding Medicaid.
- Pushback against Medicaid expansion has contributed over the years to a yawning coverage divide between politically “blue” and “red” states, with liberal-leaning states pushing to cover more services and people, while conservative-leaning states home in on policies that limit coverage, like work requirements.
- On the abortion front, state attorneys general are challenging the FDA’s authority on the abortion pill — not only in Texas, but also in Washington state, where Democratic state officials are fighting the FDA’s existing restrictions on prescribing and dispensing the drug. The Biden administration has adopted a similar argument as it has in the Texas case challenging the agency’s original approval of the abortion pill: Let the FDA do its job and impose restrictions it deems appropriate, the administration says.
- The FDA is poised to make a long-awaited decision on an over-the-counter birth control pill, an option already available in other countries. One key unknown, though, is whether the agency would impose age restrictions on access to it.
- And as of this week, 160 Defense Department promotions have stalled over one Republican senator’s objections to a Pentagon policy regarding federal payments to service members traveling to obtain abortions.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: New York Magazine/The Cut’s “Abortion Wins Elections: The Fight to Make Reproductive Rights the Centerpiece of the Democratic Party’s 2024 Agenda,” by Rebecca Traister.
Alice Miranda Ollstein: Stat’s “How the Drug Industry Uses Fear of Fentanyl to Extract More Profit From Naloxone,” by Lev Facher.
Rachel Cohrs: The Washington Post’s “These Women Survived Combat. Then They Had to Fight for Health Care,” by Hope Hodge Seck.
Sandhya Raman: Capital B’s “What the Covid-19 Pandemic and Mpox Outbreak Taught Us About Reducing Health Disparities,” by Margo Snipe and Kenya Hunter.
Also mentioned in this week’s podcast:
- The New York Times’ “‘We’re Going Away’: A State’s Choice to Forgo Medicaid Funds Is Killing Hospitals,” by Sharon LaFraniere.
- KHN’s “Fresh Produce Is an Increasingly Popular Prescription for Chronically Ill Patients,” by Carly Graf.
- California Healthline’s “Prescription for Housing? California Wants Medicaid to Cover 6 Months of Rent,” by Angela Hart.
click to open the transcript
Transcript: A Judicial Body Blow to the ACA
KHN’s ‘What the Health?’Episode Title: A Judicial Body Blow to the ACAEpisode Number: 291Published: March 30, 2023
[Editor’s note: This transcript, generated using transcription software, has been edited for style and clarity.]
Julie Rovner: Hello and welcome back to KHN’s “What the Health?” I’m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, March 30, at 11 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Good morning.
Rovner: Sandhya Raman of CQ Roll Call.
Sandhya Raman: Good morning.
Rovner: And happy birthday to you.
Raman: Thank you.
Rovner: And Rachel Cohrs of Stat News.
Rachel Cohrs: Hi, everybody.
Rovner: We’ve got breaking news, so we will get right to it. In Texas, we’ve got a major decision from a federal judge with national implications. No, not the abortion pill case — that is still out there. This time, Judge Reed O’Connor has ruled that the Affordable Care Act can’t require coverage of preventive services recommended by the [U.S.] Preventive Services Task Force because the PSTF, as an independent advisory board, can’t legally mandate anything. This case was specifically — although it was about a lot of things — but it was mostly about employers who didn’t want to cover preexposure prophylaxis [PrEP] for people at high risk of HIV because it violated their religious beliefs. And if the name Reed O’Connor sounds familiar, that’s because he’s the same judge who ruled in 2018 that the entire Affordable Care Act was unconstitutional, a finding that wasn’t formally overturned until it got to the Supreme Court. Alice, you’ve been following this case. What happens now?
Ollstein: I’m expecting the Biden administration to appeal at lightning speed, although that appeal will go to the 5th Circuit, which is very right-leaning. It’s ruled to chip away at the Affordable Care Act in the past. So who really knows what will happen there? But yeah, this is really huge. This is saying that this board that has decided what services insurance companies have to cover for free, with no cost sharing, going all the way back to 2010 is not constitutional, and thus what they say can’t be enforced. And so this throws the insurance market into a bit of chaos.
Rovner: Yeah, although one would think that it wouldn’t affect this year’s policies — I mean, for people who are going to be worried that all of a sudden, you know, oh my God, I scheduled my mammogram and now my insurer might not pay for it. It’s not going to be that immediate, right?
Ollstein: We’re not expecting that. I mean, we’re expecting the Biden administration to ask for courts to stay the impact of the ruling until further arguments and appeals can be made. But we really don’t know at this point. And I will say, you know, I’ve seen some misinformation out there about how the ruling deals with contraception. They do not block the contraception mandate. That is related to this case, but the court did not accept that part of the challengers’ claims.
Rovner: Yeah, we should say there are a bunch of different claims and the judge only accepted a couple of them. It could have been even broader. But, you know, unlike the previous Affordable Care Act cases, this one doesn’t threaten the entire law, but it does threaten one of the law’s most popular pieces, those requirements that plans cover preventive care that’s been shown to be cost-effective. This could be an uncomfortable case for the Supreme Court, assuming it gets there, couldn’t it?
Cohrs: It could be an uncomfortable case for the Supreme Court, but it’s also uncomfortable for insurers, too, who’ve promised this. People have come to expect it. And if it is cost-effective, I mean, certainly there may be plans that, you know, make choices to restrict coverage or impose some cost sharing. If this stands, if this is applied nationwide — again, very big ifs at this point — but if these really are cost-effective, then it’s kind of an open question what insurers will choose to do, because obviously they want people to enroll in their plans as well.
Rovner: Yeah, I was going to say, I could see insurers sort of deciding as a group that we’re going to keep providing this stuff, as you say, Rachel, because they want, you know, they want to attract customers, because for the most part it’s not that expensive. I mean, obviously, you know, things like colonoscopies can run into the thousands of dollars, but a lot of these things are, if not de minimis, then just not very expensive. And, as I mentioned, they’re very popular. So it’s possible that, even though they may strike down the mandate, there won’t be as much of an impact from this as some people are saying. But, as Alice points out, we don’t really know anything at this point.
Ollstein: And I think some of the concern is the kind of risk-pool sorting we used to see, you know. So the challengers said that their right to purchase insurance that doesn’t cover certain things was being infringed upon. And so if insurers start to create separate plans, some of which cover all kinds of preventive care, including sexual health care, and separate ones that don’t, and people who don’t think they need a lot of stuff, you know, sort themselves into some plans and not others, you can see that reflected in premiums that could lead to some of the major pre-ACA problems we used to see.
Rovner: If the idea that somebody doesn’t like something and therefore can’t buy something without it, you can see that leading to all kinds of problems down the line about people saying, well, “I don’t like that drugstores sell condoms, so therefore I should be able to go to a drugstore that doesn’t sell condoms,” although that’s not a mandate. But you can see that this could stretch very far with people’s religious beliefs. And indeed, the basis of this claim is that this violated the Religious Freedom Restoration Act. That’s one of the things that Judge O’Connor found, and that could be taken to quite the extreme, I imagine.
Ollstein: Right. I mean, they weren’t required to actually purchase PrEP. They weren’t required to use it. They weren’t required to prescribe it. Just the insurance company was required to cover it along with everything else they cover. And the folks said even purchasing insurance that had that as one of the things it could conceivably cover violated their religious rights.
Rovner: Yes. And this goes back to the contraceptive cases, where the religious organization said that, you know, by having birth control in their plans, it made them complicit in something that they thought was a sin. And that’s exactly what’s being stressed here, even among the individual plaintiffs: that having to buy insurance that has these benefits, even if they don’t use them, makes them complicit in, basically, sex outside of marriage. I mean, that’s what’s in the decision. It’s quite a reach. I’ll be interested to see, as this goes up, what people think of it. So, before we got Judge O’Connor’s opinion, what I thought would be the biggest news of the week comes from North Carolina, which on Monday became the 40th state to expand Medicaid under the Affordable Care Act, to cover people with incomes up to 138% of poverty. That’s about $20,000 in 2023. Well, it’s almost there. The newly eligible 600,000 people won’t be able to sign up until the legislature approves a budget, which is likely later this spring. North Carolina expanding the program leaves only a swath of states across the South, including Florida, Georgia, and Texas, and a couple in the Great Plains as still holding out on a 90% federal match. Is anyone else on the horizon or is this going to be it for a while?
Raman: I think one thing to note about how this is happening is that North Carolina was able to do this finally through the legislature after like a yearslong process. And it has been increasingly rare for this to happen through the legislature. The last time was Virginia, in 2018, but every other state that has done it in recent years has all been through ballot initiative and going that route. And the 10 holdouts that we have, you know, we have Republican-controlled legislatures who’ve been pretty against doing this. So I think if any of those states were to be able to do that at this point that haven’t been tempted by, you know, any of the incentives … [unintelligible] … get a higher match rate or anything like that, it would have to be through the ballot, which is already a difficult process, can take years. There have been various roadblocks to push back and even some of the states in the past that have been able to get it through ballot initiative — some of the legislatures afterwards have tried to like push back on it — when we saw with Utah a few years ago, where even if the voters had voted that they wanted to expand, they wanted to kind of pull it back.
Rovner: We thought in Maine, where the governor blocked it until basically he was out of office.
Raman: Yeah.
Ollstein: And in Missouri, where they just refused to fund it.
Raman: Yeah, so I think that’ll be definitely something to watch with how the budget goes in the next few months. But I guess, at least with North Carolina, this was something that was bipartisan. It was spearheaded in the legislature by Republicans, so I think they might not have the same issues there than Missouri, but it’s a tough haul to get the remaining 10 at this point after this many years.
Rovner: Yeah, I feel like North Carolina is much more like Virginia, which is that, finally, after a lot of wearing down, the Republican legislature and the Democratic governor were able to come to some kind of agreement. That’s what happened in Virginia. And that seems to be what’s happened here in North Carolina. Meanwhile, in those 10 states, hospitals which end up providing free care to people who can’t pay aren’t doing so well. In Florida, the state’s hospital association has been all but begging the state government to expand Medicaid pretty much since it was available to them, which is now going on 13 years. According to the American Hospital Association, 74% of rural hospital closures around the country took place in states that have not expanded Medicaid or where expansion had been in place for less than a year. And the New York Times has a story this week about the toll that that lack of insurance is taking — I’m sorry — and the New York Times has a story this week about the toll that lack of insurance for the working poor is taking there, not just on the state’s hospitals, but on the health of the state’s population. Lawmakers in these states are very happy to take federal money for all manner of things. What is it about this Medicaid expansion that’s making them say, “No, no, no”?
Raman: This was something that came up this week in the House. Appropriations’ Labor, HHS, Education Subcommittee had a hearing this week specifically on rural communities and some of the issues they face. And Medicaid expansion obviously did come up with some of the witnesses and some of the lawmakers as something that would be helpful given the number of hospital closures they’ve seen, and there might only be one health care facility for miles or in a county, and just how it would be helping them to kind of relieve paying for the uncompensated care that they’re already dealing with, you know, highlighted a number of the issues there. So it’s something that comes up, but I think one of the pushbacks that we saw was, you know, again, that it is a) tied to the Affordable Care Act, which has been such a partisan back-and-forth since its inception, and then b) just the messaging has always been about the cost. I mean, even if the general consensus is that it does save money over time for taking care of that care, something that came up was why states get more of a reimbursement for expansion than they do for traditional Medicaid. That was brought up a couple times, things like that. And so I think it’s hard to get some of those folks on board just because of how partisan it has become.
Rovner: Yeah, I remember I watched the hearing in Wyoming on this last year. They didn’t want to do it, it seemed, more for ideology. I mean, a lot of states that are doing this, you know, you can levy a tax on hospitals and nursing homes, who are happy to pay the tax because they’re now getting paid for these patients who couldn’t pay. And the state’s really not out-of-pocket, as it were, at all. But and yet, as we point out, these last 10 states, including some of the really big ones, have yet to actually succumb to this. Well, while we are talking about Medicaid, there have been a couple of interesting stories from my KHN colleagues in the past few weeks about so-called social determinants of health, those not strictly medical interventions that have a big impact on how sick or healthy people are. In California, Democratic Gov. Gavin Newsom wants to use Medicaid to pay for six months of rent or temporary housing for homeless people. And in Montana, health professionals can now prescribe vouchers for fruit and vegetables for patients with little access to fresh food. Is this the wave of the future, or will those who want to shrink rather than expand the welfare state and government in general roll programs like these back?
Cohrs: I think there certainly is a trend, a lot of momentum behind the idea of food as medicine and, you know, moving away and exploring some of these non-medication treatments or some of these underlying reasons why people do have health issues. I think certainly support for the Medicaid program is going to be a hot-button issue in D.C. over the next few months, but there is a lot that states can do on their own as well. And I know states have, you know, programs to kind of cover people that fall between the cracks of traditional insurance programs. California has a robust program for that, the local levels as well. So I think there may be ways to get around that, even if we do see some more restrictions. And again, the administration is Democratic at this point, so I think they may be friendlier to some of these innovations than prior ones, and that could change at any time. But this certainly isn’t something that’s going to go away.
Rovner: I wonder if we’re going to end up with blue states having all of these more robust pro — I mean, we already have blue states with more robust programs, but blue states having these more inclusive programs and red states not. Alice, you’re nodding.
Ollstein: Absolutely. And that’s been the trend for a while, but it could even accelerate now, I think, and you’re seeing that on both sides, with blue states looking to cover more and more things; also looking to cover more and more people, including undocumented people. That’s another trend in Medicaid. At the same time, you have red states that have long explored how to cover fewer and fewer, you know, trying to change the income eligibility threshold for expanded Medicaid, trying to do work requirements, trying to do, like, other restrictions. And so I think the patchwork and the divide is only going to continue.
Rovner: Well, moving on to abortion this week, we are still waiting, as I said, for that other decision out of Texas that could impact the future of the abortion pill mifepristone. But Alice, there’s another case at the other end of the country that could have something to say about the Texas case. What’s going on in Washington state?
Ollstein: This one has really flown under the radar. So this is an interesting situation where the same — a lot of the same Democratic attorneys general who were siding with the Biden administration in the Texas case are challenging the Biden administration in a different case in Washington state, basically saying that the remaining federal restrictions on abortion pills — mainly that providers have to get certified in order to prescribe the drugs or dispense them — saying that that should be tossed out, that it’s not supported by medicine and science. And so it’s interesting because you have the Biden administration fighting back against an effort to make the pills more accessible, which is not what a lot of people expect. It goes sort of against their rhetoric in recent months; they’ve talked about wanting to make the pills more accessible and they’re opposing an effort that would do that. But it is somewhat consistent with their position in the Texas case, which is, they’re saying, “Look, this is the FDA’s job. Let the FDA do its job. The FDA has a process, came up with these rules, got rid of some, kept others, and you outside folks don’t have the right to challenge and overturn it.”
Rovner: So what happens if the judges in both of these cases find for the plaintiffs, which would be kind of, but not completely, conflicting?
Ollstein: Yeah, so the Washington state case could just apply to the dozen states that are part of the challenge. And so you could have, again, more of a patchwork in which the abortion pills become even more accessible in those blue states and even less accessible in other states. You could also have these competing rulings that ultimately trigger Supreme Court review.
Rovner: Yeah, it’s not exactly a circuit split because it wouldn’t be opposite decisions on the same case; they’re different cases here. But as you point out, it’s really a case challenging the authority of the FDA to do what the FDA does. So it’s going to be really interesting to watch how this all plays out. While the future of mifepristone remains in doubt, the FDA is going to consider making at least one birth control pill over the counter. We know that morning-after pills, which are high doses of regular birth control pills, are already available without a prescription. So why hasn’t there been an over-the-counter birth control pill until now?
Ollstein: Everything concerning birth control, emergency contraception, abortion, it just — these fights drag on for years and years and years. So finally, we seem to be on the cusp of having a decision on this. It’s expected, from most people I’ve talked to, that they will approve this over-the-counter birth control. There’s a lot of data from around the world. A lot of other countries already have this. And one key unknown is whether the FDA will maintain an age restriction on it. A lot of progressive advocates do not want an age restriction because they think that this is important to help teens prevent unwanted pregnancies. And I think that’s going to be a big piece of the fight that I’m watching.
Rovner: And oh, my goodness, it was that age restriction that held up the over-the-counter morning-after pill for years. That was like a 13-year process to get that over the counter. It went on and on and on, and I covered it. All right. Well, there is abortion-related action on Capitol Hill too this week. We’ve got a potential abortion standoff brewing in the Senate over reproductive health policy at the Department of Defense. Who wants to talk about that one?
Raman: This one has been, I think, really interesting, since we’re all health reporters. And it’s been really something that I think my defense colleagues have been following so closely. But we have Senator Tuberville, who’s been holding up military nominations because the Pentagon has a policy that allows, you know, service members leave for reproductive care and it covers travel to seek an abortion. And so —
Rovner: Although it still doesn’t pay for the abortion.
Raman: It does not pay for the abortions. It’s for the travel. And so I know that my colleagues have looked at this and how this point, like, both sides have been getting a little frustrated, you know, with even some senators saying, “Hey, I agree that I don’t like this policy, but you need to find another way,” because as of earlier this week 160 promotions have been stalled. And so it’s just been kind of ramping up and holding up a lot of folks for kind of an unusual method.
Rovner: Yeah, and the defense secretary saying, I mean, this threatens national security because these are promotions — are important promotions. Flag officers, these are not, you know, just sort of — they’re routine, but they’re, you know, but if they don’t happen, if they get stalled, it’s a problem. In all of my years of seeing anti-abortion senators hold up things, this is not one I have seen before. It’s at least — it’s sort of new and imaginative, and I guess we will see how that plays out. Back in the states, though, it seems that the efforts to restrict reproductive rights are getting very extreme, very fast. Yes, the Oklahoma Supreme Court ruled earlier this month that a pregnant woman does have a right to an abortion when continuing the pregnancy threatens her life. But four of the nine justices there didn’t even want to go that far, suggesting that the legislature has the right to basically require saving the fetus even at the cost of the pregnant person’s life. In Texas, a lawsuit in which the ex-husband is suing the friend of his ex-wife for the wrongful death of his child for helping her get abortion medication is setting the stage for the so-called personhood debate: the idea that a new person with full legal right is created upon fertilization of an egg by sperm. Over the past few decades, several states have rejected personhood ballot measures as a bridge too far. But it feels like all bets are off now. I mean, it’s sort of like a race to see who can be the most extreme state.
Ollstein: I think the trends are revealing some interesting things. I mean, one, anti-abortion folks are well aware that people are still getting abortions, mainly in one of two ways: either traveling out of state or ordering pills online and taking them at home, both of which are very difficult to enforce and stop. And so there’s just a lot of, like, throwing spaghetti against the wall and seeing what sticks, in terms of, can we actually criminalize either of those things? If so, how is it enforced, or does it even need to be enforced? Or is just the fear and the chilling effect enough? I mean, we definitely see that. We definitely see medical providers holding off on doing even perfectly legal things because of fear and the chilling effect. And so there’s just a lot of experimentation at the state level right now.
Rovner: Yeah, I forgot to mention Idaho, where the legislature introduced a bill that would make it a crime — that creates abortion trafficking as a crime — for someone to take a minor, it’s not really across state lines, because the state can’t do that, so it’s like taking the minor to the border in an effort to cross state lines to get an abortion. There was, for many years in the late 1990s and early 2000s, something called the Child Custody Protection Act in Congress, because they needed that for the interstate part of it, that would make it a crime to take a minor across state lines in violation of the home state’s parental involvement laws. It passed both the House and the Senate at various times. It never became law. It’s been introduced recently, but nobody’s tried to take it up recently. I wouldn’t be surprised to see that come back up, too. But it really does seem that every day there’s another bill in another state legislature that says — after all the claims of the anti-abortion movement for decades, that we don’t want to punish the women, we only want to punish the providers — that’s gone out the window, right?
Raman: I guess I would add that, you know, we’re seeing a lot of this activity now. But something that I keep in mind is that a) it’s gotten a lot harder to know what’s going to, you know, using the spaghetti metaphor that Alice did, like what will stick. So there’s just a lot more flurry of action. And then I feel like I see increasingly, you know, people, since they don’t know that, just like fixating a lot on various things, just because you don’t know. I think, you know, even a few years ago, there were a lot of things that would have one sponsor or two sponsors and have no chance of going anywhere, as most bills introduced anywhere do. But now, a) a lot of these things are moving very, very quickly in the legislature, and b) since we don’t know, it’s hard to know where to kind of focus, even to some of the experts that I’ve talked to, where it’s just, “We’re not sure.” So just be aware of all of these things in various places because of kind of that uncertainty.
Rovner: Yeah, I know I’m generally loath to talk about bills that got introduced either in Congress or in state legislatures, because I think it unnecessarily creates expectations that for the most part don’t happen. But as both of you say, some of these things are happening so fast that, if you mention them one week, they’re law by the next week. So we will see as this continues to move quickly. All right. That’s the news for this week. Now it is time for our extra credit segment. That’s when we each recommend a story we read this week we think you should read too. As always, don’t worry if you miss it. We will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Rachel, why don’t you go first this week?
Cohrs: All right. So my story is from the Washington Post, and the headline is “These Women Survived Combat. Then They Had to Fight for Health Care,” by Hope Hodge Seck. And I thought it was just a really great feature on this very niche issue. And I think veterans’ kind of health care overall just doesn’t get as much coverage as it should, and —
Rovner: Particularly women’s veteran’s health care.
Cohrs: Exactly. Yes. And so these women were essentially going into combat situations to help relations with women in very conservative cultures, and they were exposed to the grenade blasts and a lot of these combat situations. But then their health care coverage upon returning wasn’t covered. And there is kind of a new bill with some momentum behind it that is trying to plug that loophole. So, yeah, I thought it was a very great feature on an issue that’s undercovered.
Rovner: Yeah, this was something I knew nothing about until I read this story. Alice?
Ollstein: I chose a piece by Rachel’s colleague at Stat, Lev Facher, called “How the Drug Industry Uses Fear of Fentanyl to Extract More Profit From Naloxone.” And this is really timely, with the approval this week of over-the-counter opioid-overdose-reverse medication. And basically it’s about how these drug companies are coming up with new forms of the drug, really huge doses, new delivery forms, injectables, and nasal sprays, and stuff that are not really justified by science and are sort of just an opportunity for more profit because the basic form of the drug that works extremely well and is very affordable, they are basically hyping the fear of fentanyl to try to push these stronger products they’re coming up with. And the fear is that municipal governments that have limited resources are going to spend their money on those not really justified new forms and get fewer medication for everyone than just using the basic stuff that we know works.
Rovner: Indeed. Sandhya?
Raman: My extra credit is from Margo Snipe and Kenya Hunter at Capital B, and it’s called “What the Covid-19 Pandemic and Mpox Outbreak Taught Us About Reducing Health Disparities.” And I thought this was an interesting look that they did, highlighting how, you know, there’s been a lot more talk about the various health inequities among, you know, racial and ethnic and sexual minority communities after these two pandemics have started. And they look at how some of the targeted efforts have narrowed some of the gaps in things like vaccines, but just how some of these lessons can be used to address other health disparities, you know, things like community outreach and expanding types of screenings and how many languages public health information is translated into and things like that. So, it’s a good read.
Rovner: Well, my extra credit this week is a long read, a very long read, by Rebecca Traister in New York Magazine, called “Abortion Wins Elections: The Fight to Make Reproductive Rights the Centerpiece of the Democratic Party’s 2024 Agenda.” And while I’m not sure I’m buying everything that she’s selling here, this is an incredibly thorough and interesting look at the past, present, and possibly future of the abortion rights movement at the national, state, and local levels. If you are truly interested in this subject, it’s well worth the half hour or so of your time that it takes to get through the entire thing. It’s a really, really good piece. OK, that is our show for this week. As always, if you enjoyed the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us too. Special thanks, as always, to our ever-patient producer, Francis Ying. Also, as always, you can email us your comments or questions. We’re at whatthehealth@kff.org. Or you can tweet me still. I’m @jrovner. Alice?
Ollstein: @AliceOllstein.
Rovner: Rachel?
Cohrs: @rachelcohrs.
Rovner: Sandhya?
Raman: @SandhyaWrites.
Rovner: We will be back in your feed next week. Until then, be healthy.
Credits
Francis Ying
Audio producer
Emmarie Huetteman
Editor
To hear all our podcasts, click here.
And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
USE OUR CONTENT
This story can be republished for free (details).
2 years 4 months ago
Health Care Costs, Insurance, Medicaid, Multimedia, Public Health, States, Abortion, Contraception, FDA, KHN's 'What The Health?', North Carolina, Obamacare Plans, Podcasts, texas, Women's Health
Biden Budget Touches All the Bases
The Host
Julie Rovner
KHN
Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
President Joe Biden’s fiscal 2024 budget proposal includes new policies and funding boosts for many of the Democratic Party’s important constituencies, including advocates for people with disabilities and reproductive rights. It also proposes ways to shore up Medicare’s dwindling Hospital Insurance Trust Fund without cutting benefits, basically daring Republicans to match him on the politically potent issue.
Meanwhile, five women in Texas who were denied abortions when their pregnancies threatened their lives or the viability of the fetuses they were carrying are suing the state. They charge that the language of Texas’ abortion ban makes it impossible for doctors to provide needed care without fear of enormous fines or prison sentences.
This week’s panelists are Julie Rovner of KHN, Shefali Luthra of The 19th, Victoria Knight of Axios, and Margot Sanger-Katz of The New York Times.
Panelists
Victoria Knight
Axios
Shefali Luthra
The 19th
Margot Sanger-Katz
The New York Times
Among the takeaways from this week’s episode:
- Biden’s budget manages to toe the line between preserving Medicare and keeping the Medicare trust fund solvent while advancing progressive policies. Republicans have yet to propose a budget, but it seems likely any GOP plan would lean heavily on cuts to Medicaid and subsidies provided under the Affordable Care Act. Democrats will fight both of those.
- Even though the president’s budget includes something of a Democratic “wish list” of social policy priorities, the proposals are less sweeping than those made last year. Rather, many — such as extending to private insurance the $35 monthly Medicare cost cap for insulin — build on achievements already realized. That puts new focus on things the president has accomplished.
- Walgreens, the nation’s second-largest pharmacy chain, is caught up in the abortion wars. In January, the chain said it would apply for certification from the FDA to sell the abortion pill mifepristone in states where abortion is legal. However, last week, under threats from Republican attorneys general in states where abortion is still legal, the chain wavered on whether it would seek to sell the pill there or not, which caused a backlash from both abortion rights proponents and opponents.
- The five women suing Texas after being denied abortions amid dangerous pregnancy complications are not asking for the state’s ban to be lifted. Rather, they’re seeking clarification about who qualifies for exceptions to the ban, so doctors and hospitals can provide needed care without fear of prosecution.
- Although anti-abortion groups have for decades insisted that those who have abortions should not be prosecuted, bills introduced in several state legislatures would do exactly that. In South Carolina, those who have abortions could even be subject to the death penalty. So far none of these bills have passed, but the wave of measures could herald a major policy change.
Also this week, Rovner interviews Harris Meyer, who reported and wrote the two latest KHN-NPR “Bill of the Month” features. Both were about families facing unexpected bills after childbirth. If you have an outrageous or exorbitant medical bill you want to share with us, you can do that here.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: KHN’s “Girls in Texas Could Get Birth Control at Federal Clinics, Until a Christian Father Objected,” by Sarah Varney
Shefali Luthra: The 19th’s “Language for Treating Childhood Obesity Carries Its Own Health Risks to Kids, Experts Say,” by Jennifer Gerson
Victoria Knight: KHN’s “After People on Medicaid Die, Some States Aggressively Seek Repayment From Their Estates,” by Tony Leys
Margot Sanger-Katz: ProPublica’s “How Obamacare Enabled a Multibillion-Dollar Christian Health Care Cash Grab,” by J. David McSwane and Ryan Gabrielson
Also mentioned in this week’s podcast:
- The New York Times’ “The Programs You’d Have to Cut to Balance the Budget,” by Alicia Parlapiano, Margot Sanger-Katz, and Josh Katz
Click to open the transcript
Transcript: Biden Budget Touches All the Bases
KHN’s “What the Health?”Episode Title: Biden Budget Touches All the BasesEpisode Number: 288Published: March 10, 2023
[Editor’s note: This transcript, generated using transcription software, has been lightly edited for style and clarity.]
Julie Rovner: Hello and welcome back to KHN’s “What the Health?” I’m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I’m joined by some of the best and smartest health reporters in Washington. We are taping this week on Friday, March 10, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Shefali Luthra of The 19th.
Shefali Luthra: Hello.
Rovner: Victoria Knight of Axios News.
Victoria Knight: Hi. Good morning.
Rovner: And Margot Sanger Katz of The New York Times.
Margot Sanger Katz: Hello, everybody.
Rovner: Later in this episode we’ll have my “Bill of the Month” interview with Harris Meyer. It’s a twofer this time: two successive bills from two different families related to having a baby. But first, this week’s news. We are taping on Friday this week because President [Joe] Biden released his budget Thursday afternoon, and it felt weird to have a news podcast without talking about the budget. And yes, like most presidential budgets since the 1980s, this one is, quote-unquote, “dead on arrival” on Capitol Hill. But one thing the president’s budget does is provide a pretty-detailed look at the administration’s priorities and policy initiatives. Which health program stuck out to you as getting a publicity, if not an actual funding, boost in this document? Victoria, you were looking at the budget.
Knight: Yeah. My colleagues at Axios and I spent several hours yesterday morning going through the budget. I think it was really interesting because I think he was trying to toe the line between “we want to save Medicare, make sure it stays solvent,” but also “we want to push some more progressive ideas as well.” So there’s kind of both things in there. Some obvious things: He wants to permanently extend the enhanced tax credits for the ACA [Affordable Care Act] — so, make permanent those subsidies. Those expire, currently, at the end of 2025. He also wanted to do something called Medicaid-like coverage for eligible people in states that haven’t expanded Medicaid. And then he also wants to expand the number of drugs to be negotiated under the IRA [Inflation Reduction Act] and also move up the timeline a little bit. So, just an example: It’s supposed to be 10 drugs to be negotiated in 2026. And now he wants to do 20. Something also really interesting: [He] wants to do like a Netflix-like subscription service for hepatitis C to basically eradicate hepatitis C within the U.S.
Rovner: I thought that was maybe the most interesting thing in this budget because it’s something that we just hadn’t heard of before.
Knight: Yeah.
Rovner: That, basically, I mean, these hepatitis C drugs were really expensive when they first came out and there was concern that Medicaid programs, in particular, were going to have trouble paying for them because many of the people who have hepatitis C are intravenous drug users, and they’re more likely to get hepatitis C — or people in prison. Lots of people on Medicaid who have hepatitis C. And this would basically be a way to pay in advance for the drugs. Is that essentially what they would do?
Knight: Yeah. And I think it’s also interesting that it at least has one Republican senator — Bill Cassidy is super into this idea. He did something similar in Louisiana. I’m not sure there’s other Republicans that are on board for that, but I thought that was really interesting. You know, of course, he was talking about extending the $35 insulin cap to the commercial market. There’s some other stuff about behavioral health, pandemic preparedness. One other thing Shefali will appreciate also, he proposed increasing Title X family planning funding by almost 80% from 2023 levels, which I think — Shefali, maybe you know — [is] one of the highest increases they’ve ever proposed, in a while at least.
Luthra: Yeah, the family planning clinics, interest groups, etc., were very, very happy about this proposal, even if they know it will not become reality. I think their sense was this was a commitment that would be really transformative for them, especially now, when they are so tightly funded.
Rovner: I did notice that for a president who has not technically said that he’s running again, some of these targeted increases were for some of the very important interest groups who have been kind of, I won’t say whining, but complaining. You know, Title X had not gotten big increases since Biden became president. There’s an initiative for more money for home- and community-based care in Medicaid, which is something, again, there’s an active constituency for in the Democratic Party; the “Cancer Moonshot,” you know, which has obviously been something near and dear to President Biden’s heart; also more money … also, the [American] Cancer Society sent out a lot of emails yesterday saying, yay, thanks for proposing this big budget increase. So there does certainly seem to be a lot of touching of the important constituencies, perhaps in anticipation of reelection campaign?
[Three panelists chime in at once.]
Luthra: Julie, you forgot …
Sanger-Katz: I would say …
Knight: And I think he did … Go, Margot!
Rovner: One at a time! [laughing all around] Margot, you go first.
Sanger-Katz: I would say so. And I would also just point out that the Medicare policies in the bill were previewed by the White House a couple of days before the budget release, and they were, like, the main thing. This is what they were leading with. The president had an op-ed in The New York Times describing his Medicare policies, and they put out a fact sheet with a lot of the Medicare policies. And I think it really reflects this notion that improving the solvency of Medicare and also committing to not really cutting the core services of Medicare, that this is a very key political message that the president cares about, that the president wants to run on, and that he thinks is a very useful contrast with what some Republicans have proposed in the past and what he imagines they might want to propose as House Republicans get ready to release their own budget, which faces some difficult constraints because Speaker [Kevin] McCarthy has promised certain members that the budget that they will pass will be a balanced budget. And that’s quite hard to do without touching the big health care programs.
Rovner: Yeah. Republicans have not promised not to touch Medicaid, which now the president has been very careful to say, “It’s not just Medicare and Social Security. I’m not going to let you cut Medicare, the Affordable Care Act either.” All right, Victoria, you wanted to say something?
Knight: I think — it was also interesting that, I do think, the president did want to push forward some of the more progressive policies that … the progressive base care about, such as doing more negotiating of drugs; something Sen. Bernie Sanders (I-Vt.) has talked a lot about is the community health centers program; expanding Medicaid, home- and community-based services; … and the insulin price cap — things that I think the progressive base cares about as well. So I feel like, as you’re saying, that interest groups, but also the different bases and also the groups that care about reproductive health care, they want him to do something after Roe v. Wade. So it definitely was, like, this huge list of trying to cater to everyone.
Rovner: It’s kind of a Democratic wish list.
Sanger-Katz: At the same time, though, I think he did leave out some of the things that were part of the Build Back Better package. In the previous budgets, the president had gone even bigger on things that the progressive base wanted. And you can see a lot of things in this budget where he’s ticking those boxes, as you say. And I think a lot of policies that he has proposed in the past that he wasn’t able to get through the last Congress — but not all. It does seem like this budget is a little more focused on being able to reduce the deficit a little bit less on this very expansive notion of a robust federal government that is spending money to improve people’s lives in quite as many ways as the message that he has been proposing in his previous budgets. You can see, again, I think this is a pivot towards campaign mode, towards his assessment of the current political moment, growing concerns about the deficit and about inflation.
Rovner: But also, as you mentioned, Margot, they put out the Medicare part of this in advance, mainly because I feel like the Medicare part of the budget is not so much a part of, you know, the statement of the budget as it is a negotiating position for this whole fight we’re going to have over the debt ceiling in a couple of months, where the Republicans are going to want to demand cuts to programs basically in exchange for not letting the U.S. default on its debts. And what the president has managed to do here is say, “We’re going to lower the price of prescription drugs more, we’re going to tax the rich more. And those two things are going to a) reduce the deficit some and b) shore up the Medicare trust fund. So you can’t accuse me of not dealing with the impending problem of Medicare.” How much of a box does that actually put Republicans in when we start to get to these negotiations?
Sanger-Katz: I don’t know how much of a box it really puts them in for a couple of reasons. One is that some of what he’s proposing is really kind of an accounting gimmick. He’s taking money that is already flowing into the federal budget, that is already part of the dollars and cents of our deficit, and he’s just redirecting them from the general fund into the Medicare trust fund. So it is true that these proposals would extend the solvency of the Medicare Hospital Insurance Trust Fund, which is projected to run into some financial trouble in the coming decade. But it is not true that, like, all of the things that he’s proposing are actually new money. Some of it just comes out of other parts of the budget. It doesn’t change the deficit.
Rovner: So I will point out that that is a time honored way of extending the solvency of trusts.
Sanger-Katz: Oh, sure. I’m not saying that Biden is alone in doing that. But I just think there’s kind of three things he’s doing in this proposal. One of them is not deficit reduction. It’s just kind of moving money around. One is this drug price reduction proposal where he’s trying to get more savings by going more aggressively after more drugs. I think that is a place where he can put Republicans in a box a little bit. They’ve come out in opposition to the drug price negotiation provisions that were part of the Inflation Reduction Act that they passed last year. But those policies are super popular. The public really supports them. They feel like the pharmaceutical companies make too much money. They think that Medicare should be able to negotiate. So I think that’s a very politically shrewd decision that I think does demand potentially a response from Republicans as a possibility for deficit reduction. But then the third thing that he did is he really just raised taxes. You know, these are taxes on the rich; as Biden has been promising all along, he’s not going to raise taxes for people earning under $400,000 a year. So they’ve increased these payroll taxes, they’ve increased some investment taxes. There was kind of a loophole, a category of businesses that were not subject to that tax in the past. And, you know, I think those are basically nonstarters with Republicans. And when Republicans talk about deficit reduction, they often are very, very focused on cutting spending that the federal government does. They are much less interested in increasing taxes. And I do think that the fact that Biden led with this proposal, that he’s so comfortable talking about raising taxes as a core part of his platform, is a sign that the politics of tax cuts have changed a little bit, that that is … if you’re just taxing the rich, it seems like the public will accept that. Democrats seem actually excited about that in certain cases. But I still think tax increases are a hard political row to hoe. I think that it is not something that probably appeals to many Republican politicians. And I also think it’s probably not something that appeals to many Republican voters, either. So I don’t know that it really puts Republicans in a box in a meaningful way because they don’t feel any tension where their supporters will want them to do this thing.
Rovner: Obviously, this is a big fight yet to come. Victoria, you wanted to say something.
Knight: Yeah. I just want to add one thing. We did have, like, the first indicator: The House Freedom Caucus had a press conference this morning, and they didn’t give a lot of details, but they did say they want to restore Clinton-era work requirements for welfare programs. So they didn’t specify Medicaid, but it seems pretty likely that’s probably what they’re talking about. My colleagues and I did talk to some Republicans last week that were indicating they did want work requirements for Medicaid. So I think that seems like the very first. There’s going to be three different groups within the House Republican caucus that are going to release budgets: the Budget Committee, the House Freedom Caucus, the Republican Study Committee. So I think we are going to start seeing the outlines of what they want to do very soon. But that was kind of the first one coming out this morning, so …
Rovner: Yes, underscoring the fact that the Republicans don’t agree on what they want to do …
Knight: No.
Rovner: … which is why we haven’t seen their budget yet.
Knight: Exactly.
Rovner: Although I will point out President Biden’s budget was a month late, too.
Sanger-Katz: Can I just say one thing about the Republican budget? Because I actually spent a lot of time looking at various budget proposals and trying to examine this goal that the Republicans have of balancing the budget. Just like: How hard is it to balance the budget? And it turns out that it’s extremely hard. It’s sort of hard in a normal year. But in this post-covid era, when spending has been so elevated for so long, balancing the budget within a decade is just really, really, really hard. If you do it without raising taxes, which Republicans say they don’t want to raise taxes; if you do it without cutting defense spending, which Republicans say they don’t want to cut defense spending; if you do it without cutting Medicare or Social Security, which recently McCarthy has said he does not want to do — you end up just … this is just the basic math … having to cut everything else by 70%. That’s 7-0%. That is not the kind of cut that you can achieve even by imposing a work requirement on Medicaid, a work requirement on food stamps, and other kinds of policies that Republicans have proposed in the past. That is like deeply, deeply reducing the role of the federal government, you know, cutting Medicaid in more than half. Larry Levitt [KFF’s executive vice president for health policy] pointed out earlier this week reducing Medicaid spending by 70% probably means 50 million fewer people would have Medicaid coverage. And that’s just Medicaid. You’re talking about basically everything that the government does — environmental protection, law enforcement, military pensions, just about any program that you can think about in the government that’s not Medicare, Social Security, or direct defense spending. Seventy percent cut is quite hard to do. And so I am very curious to see what these budgets look like. I can tell you, having looked at some of the previous Republican proposals, that those all relied on some reductions to Medicare and Social Security because those programs represent such a large percentage of federal spending that if you don’t cut those at all, there’s just not a lot of dollars left. And in my reporting on this question, it does seem like one thing that the Republican Budget Committee is very likely to do is to use very aggressive assumptions about the economic growth that their policies will unleash. And so the idea is that if the economy grows by so much, then tax revenue, what increase all by itself, because people will be earning more money, and so that will enable them to balance the budget in 10 years without having to actually reduce the deficit by as much as independent scorekeepers like the Congressional Budget Office think would be necessary.
Rovner: Although I would point out that every time we’ve had one of these big tax cuts that Republicans say it’s going to grow the economy enough to pay for it, it has not grown the economy enough to pay for it.
Sanger-Katz: Indeed! You know, cutting everything that the government does by 70% probably actually would have a negative impact on the economy. People would be losing money. They would be losing their government jobs. These would be very large economic impacts that probably most economists do not think would lead to economic growth.
Rovner: Yeah, well, we will see. I will put, Margot, the nice story you did with your colleagues demonstrating all of this in chart form in the show notes. OK. Let us turn to abortion. We will start with Walgreens, poor Walgreens, caught in the maw of the abortion wars. In January, the FDA said that brick-and-mortar pharmacies for the first time could start dispensing the abortion pill, mifepristone, whose distribution had been tightly regulated since it was first approved more than 20 years ago. Almost immediately, both CVS and Walgreens, the country’s largest and second-largest pharmacy chains, announced they would apply for FDA certification to distribute the pills in states where abortion is still legal. Then, last month, 20 Republican state attorneys general, including at least four in states where abortion is still legal, warned CVS and Walgreens that if they send the pills by mail, they could be in violation of the 1873 Comstock Act, which we have talked about here before, which prohibited the mailing of items considered, air quotes, “obscene,” which at the time included information about birth control. Cut to last week when Walgreens appeared to cave to the pressure and the threat of legal action, saying it would not sell the pill in states where it’s illegal, not actually naming those states. Then, after a huge backlash, it tried to walk back its position a little, mostly leaving lots of questions. Shefali, what is your take on what Walgreens is and isn’t going to do now vis-a-vis mifepristone? They’ve kind of said both things.
Luthra: I think there’s a lot of layers here, but I want to go back to January for a moment, when we got that news from Walgreens and CVS so quickly that they would participate in providing mifepristone. Frankly, a lot of these folks that I spoke to were very surprised that [the pharmacies] reacted so quickly because carrying mifepristone in stock opens you up to really intense harassment, boycotts, protests from the anti-abortion movement. And we did see right away many of the premier anti-abortion movements calling for boycotts of Walgreens and CVS, for protests, etc. They have been organizing protests outside pharmacies right now. And there has been pressure from the beginning from governors like [Florida] Gov. Ron DeSantis instructing pharmacies not to stock the press down. The fact that Walgreens ultimately has caved in these states with hostile governments wasn’t surprising. If anything, it was surprising that it took quite so long. I am incredibly curious to see what happens with CVS and Rite Aid, the other two pharmacies that are now getting caught in the crosshairs, facing really intense pressure from lawmakers and politicians who support abortion access and also those who don’t. We saw in New York this week, the governor and the attorney general called on pharmacies to continue carrying mifepristone. Frankly, I’m skeptical that that really matters because there is no reason not to carry mifepristone in New York, a state where the government is very friendly to abortion.
Rovner: And we should point out, because this is my biggest frustration: Nobody’s actually doing it yet because nobody’s gotten certified yet.
Luthra: Correct.
Rovner: They’re not — all these headlines that said, “Walgreens is going to stop doing this.” It’s like, no, they’re going to not start doing this. Sorry.
Luthra: And we have no idea when they will get certified how long it would take. We have no idea, frankly, if mifepristone will still be able to be distributed in the country at that point, because we are still waiting on the ruling from this judge in Texas. We simply have so many open questions. And at this point, this really is more of an avenue for people to make statements about how they feel about abortion access, than it is actually affecting people’s ability to get care. The other statement grandstanding that I have been really struck by is what we’ve seen from the California governor, Gavin Newsom, who really does love to talk a lot about his pro-abortion rights bona fides, even if those statements don’t translate much into actual impact or policy. And what we saw this week was his promise that California wouldn’t do business with Walgreens if they wouldn’t stock mifepristone.
Rovner: And this is not just an idle threat in California, right? There’s a huge contract that he now says he’s not going to renew.
Luthra: So there is a contract. But friend of the podcast and former KHNer Sydney Lumpkin found the contract that Newsom was referring to. You would think it would be a significant amount of money, given how much attention it has gotten. It is a $54 million contract over five years. When you look at the overall market cap of Walgreens, a $30 billion company, it’s not clear exactly how meaningful that actually is compared to the pressure they are facing from lawsuits and the very powerful anti-abortion movement.
Rovner: So, and what … I mean, you referred to this, but what are we thinking that CVS and Rite Aid are going to do — having seen Walgreens literally put through the wringer here on this issue?
Luthra: I think that’s a really good question. I — I mean, coming into this week — had assumed that they would follow the path of Walgreens and do the exact same thing, right? Stock mifepristone, provide it with a doctor’s prescription in states where they are protected and face no legal risks, but perhaps not do so in those states where a) mifepristone is banned, as they have said they would not do. And also in states where, like Kansas, for instance, abortion is legal, but you have a very anti-abortion attorney general. It is quite interesting that they have not said either way what they will do beyond just, well we won’t do it in states where it’s illegal.
Rovner: Yeah, if I was advising CVS at this point, I would tell them to not say a word to anybody until some of this shakes out.
Luthra: Exactly.
Rovner: All right. Well, let us move on to Texas, where there is always abortion news. As Shefali mentioned, we have not had the decision yet on that abortion pill case out of Amarillo, but both sides are still going at it on other issues. Remember all those stories we’ve been chronicling about women with wanted pregnancies gone wrong who couldn’t get medical care until they were literally at death’s door or they went to another state? Well, five of them are suing the state of Texas, saying they should have been allowed to terminate their pregnancies under existing exceptions to the abortion bans, except that doctors and hospitals have been unwilling to risk giant fines and even jail time. The five women — some of whom are still pregnant, some of whom are not — want the state, whose officials continue to claim that these women were eligible for abortions in Texas if their lives were truly at risk, they want the state to clarify those exceptions even more. Is there any chance this happens? They’re not asking for the bans to be lifted. I mean, this is a kind of a unique lawsuit that we’ve not seen before because we’ve not seen that many women in this situation before.
Luthra: I think this is a pretty smart approach. I wouldn’t be surprised if it has better odds of success than, as you mentioned, a request to fully overturn Texas’ abortion bans because the exceptions are really unclear. Doctors do not feel safe talking about abortion, even in cases where it is likely that it would be very beneficial for the pregnant person, for a fetus that has really minimal chance of survival upon birth. One thing that Nancy Northup, the head of CRR [the Center for Reproductive Rights], said to me when I asked her is, depending on how this case goes, it is not at all unlikely that we see similar lawsuits filed in other states with abortion bans with similarly vague “life of the parent” exceptions that are, in reality, impossible to enforce. I think this is going to be the beginning of a very robust series of legal challenges to state abortion bans. And we’ll see better success for abortion rights lawyers in some states than in others — really depending on the makeup of these different states’ supreme courts.
Rovner: Yeah, I mean, it’s funny because over the years I’ve heard obviously lots of warning about this possibility, both from the Center for Reproductive Rights, which, as you say, is pushing this case, and other groups. But nobody could sue because nobody had standing, because it hadn’t happened. It was all theoretical. Well, now it’s happened and we have people to whom it is not theoretical, who are able to go to court and say, hey, this happened to us and it violated our rights and you need to do something about it.
Luthra: And I do want to add just one thing. I mean, it’s — I think we can’t understate just what these people have been through, the women who are suing Texas. I was just really struck by one woman who flew from Texas to Colorado for an abortion that she couldn’t get in state, paid extra for a seat by the airplane in case she went into labor on the flight, and said that she still has PTSD to this day from having to travel while afraid that she might go into labor and could die from it. Like, what these people are going through right now is just … it’s really difficult for us to imagine. And I think we’re just going to hear so many more stories that are really troubling about people whose lives have been so deeply put at risk, and they’re unable to get the care their doctors want to provide.
Rovner: Right. And I say for the 11th time, these are not women who got pregnant by accident and don’t wish to be pregnant. Many of these are women who’ve been through infertility treatment and were desperately anxious to be pregnant, were thrilled when they got pregnant, but whose pregnancy took a bad turn either for the fetus or, in some cases, one of the fetuses of twins, or in some cases the pregnant person themselves. Well, meanwhile, the Texas Republican legislature has been busy proposing even more abortion restrictions. Last week, we talked about a bill that would ban websites that include information about how to get abortion pills and punish internet providers who don’t block those sites. This week, we have a bill giving state officials the upper hand in prosecuting abortion cases in parts of the state where local Democratic prosecutors have suggested they don’t plan to zealously pursue such cases. Another bill would create a special prosecutor whose job would be, among other things, to pursue violations of the state’s abortion bans. Why is Texas such a hotbed of this?
Luthra: It’s always Texas. Texas is the biggest state in the country to have banned abortion, right? Most of the people who are traveling out of state — well, maybe not most, but the plurality — are Texans, because just so many people live there. And if we think about it, Roe v. Wade, as a case, it came from Texas. SB 8, the first law that allowed a state to circumvent Roe and ban abortions [at] anything after six weeks, that was a Texas law. This is a place where lawmakers really believe that they can be a fertile testing ground for the future of abortion restrictions. Between them and Missouri, I think, that is where we will see the bulk of innovative new ways to further restrict access.
Rovner: Well, speaking of big states that are banning or thinking about banning abortion, you wrote about Florida this week, which already has a ban on abortions after 15 weeks [and is] now considering a ban after six weeks. Florida is kind of a pivotal state in all this, right?
Luthra: Florida, third-biggest state in the country. And if we look at the map of the U.S. South and particularly the Southeast, Florida is just critical. Between Florida and North Carolina, that is where people across the region are going for abortions. And Florida has more than 60 clinics compared to, you know, around a dozen in North Carolina. If abortion there is banned after six weeks, there will be thousands of people who are displaced. They will probably have to go to North Carolina, while abortion is legal there, to Virginia and then to Illinois. And that is just really too far for so many people to travel. There just aren’t realistic options once you take Florida off the map.
Rovner: Well, finally, a bill has been introduced in the South Carolina legislature that could potentially subject patients who get abortions to the death penalty. Now, I am old enough to remember last year, when anti-abortion groups insisted they didn’t want to punish women who had abortions, just those who provide or facilitate them. I guess that’s not the case anymore.
Luthra: And I think we need to see where this bill goes. It is not the only state, either, where we are seeing legislation proposed that would treat abortion as murder or as homicide. There was a bill in Louisiana just last summer that failed on that front. But we have seen bills introduced in Tennessee, in Georgia, in so many others that I cannot remember now. But it’s a long list. I think what’s interesting is, so far, none of these bills have actually moved forward. And it’s still obviously early in the session. But what I’m curious about is, is this chipping away at the resistance toward these kinds of really strict abortion bans? And is this the first step in a multiyear effort to redirect who is punished for getting an abortion to switch from the doctors, the health care providers, to the pregnant people themselves, which has always been sort of this Rubicon the movement has been afraid to cross.
Rovner: Yeah, I remember in 2016 Chris Matthews was interviewing then-candidate Donald Trump and sort of got Donald Trump to say, you know, yes, the woman should be punished. And the anti-abortion movement came at him, like, no, no, no, that’s not what we say. That’s not what we want. And now it’s, you know, seven, eight years later and that’s not necessarily what people are saying. So, we will see how that goes. OK. That’s the news for this week. Now, we will play my “Bill of the Month” interview with Harris Meyer and then we’ll come back and do her extra credits.
We are pleased to welcome to the podcast Harris Meyer, who reported and wrote the last two KHN-NPR “Bill of the Month” stories, which are kind of related. Harris, welcome to “What the Health?”
Harris Meyer: Thanks very much, Julie.
Rovner: So, both of these bills have to do with something very common and very treacherous to your financial health: having a baby. Let’s start with baby No. 1, a now-3-year-old named Joey Trumble. Where is she from? Why was she in the hospital for 36 days?
Meyer: Joey was born prematurely in December 2019. Her mother, Brenna Kearney, is a writer in Chicago, and she was diagnosed with preeclampsia, and her doctors ordered her hospitalized at Northwestern. And then she developed a worse form of preeclampsia called HELLP syndrome. But anyway, the baby was born healthy but premature. And the baby, Joey, was treated at Northwestern Prentice, but without the knowledge of the parents the doctors who were treating her came over from next door from Lurie Children’s, and her hospital, Northwestern, was in network for her health plan. But Lurie Children’s doctors were out of network. They did not know that. So after her baby was sent home — it had about a month, 36 days, of hospitalization — the family got a bill of about $12,000, which was unexpected.
Rovner: That’s right. And we should point out that the baby was covered, right, under the mother’s health insurance.
Meyer: Correct.
Rovner: And yet they still got a bill for $12,000.
Meyer: That’s right. The hospitalization was covered. And, to their surprise, the doctors, the neonatologist from Lurie who treated the baby, were not covered in network. And so Brenna spent the next year contesting these charges. And they were never told that the doctors were out of the network. But she had found out that there was a 2011 Illinois law, which was in effect, which prohibited this kind of out-of-network billing for neonatology services.
Rovner: That’s right. And we should point out that this was before the federal No Surprises Act took effect, because this was late 2019.
Meyer: Correct.
Rovner: But there was a state law that should have applied.
Meyer: There was a state law. Illinois was a pioneer in this. So she cited that law to Blue Cross Blue Shield Illinois and to Lurie Children’s, and they said they knew nothing about it. So the bill was sent to collections about a year later, and she was able to get Blue Cross, finally, and, a year after the birth, to cover the Lurie doctor charges fully. However, in December, three years after she gave birth, she finds out she’s being billed again, after she thought the whole ordeal was over — many years after. And she finds out that Blue Cross of Illinois had taken the money back and now Lurie was coming after her and her husband again for the out-of-network charges. And that’s when she came to Kaiser Health News, and I made calls to Lurie, to Blue Cross of Illinois, and to Northwestern. And after my calls, Lurie agreed to drop the charges. But now a state senator, the Illinois Department of Insurance, and the Illinois attorney general are looking into this to see if there was a long pattern of violations by Lurie of this 2011 state law. And Brenna actually has been contacted now by three other women who experienced similar out-of-network bills from Lurie. So we’ll see what happens with that.
Rovner: So sort of a happy ending to that one. Let’s move to baby No. 2, or, more accurately, his mother. Who is she and what happened to her?
Meyer: OK. This was last June. Danielle Laskey is a school nurse, an RN, in Seattle. She was on vacation with the family. And at 26 weeks pregnant she felt that her water broke. Her doctors in Seattle ordered her to come back and said, you’d better come in. And her doctors were at Swedish Maternal & Fetal Specialty Center in Seattle, which was in network for her Blue Shield health plan. And when she got there, they said, yes, your water broke. You were at risk for the same complication from your first pregnancy three years ago. We want you to go to Swedish Medical Center across the street immediately, and we want you to stay there until you give birth, and we’ll monitor you. So she was in the hospital for seven weeks until she gave birth in August of last year.
Rovner: Oh, so just for context, Swedish is one of the big hospitals in Seattle, right?
Meyer: Yes, absolutely. And it’s one of the specialty facilities for this particular uncommon complication, which is called placenta accreta. Anyway, she was there for seven weeks. And again, she and her husband were not told that the hospital was out of network. But it turns out that Swedish, even though her doctors were — her Swedish doctors were in network for her health plan, it turns out that Swedish Medical Center was out of network, and she found out. Then the baby was born. The baby was in the hospital, the baby boy, for about a month. And then, meanwhile, after the baby was born, she experienced symptoms again, and she was rehospitalized for a day to have this placenta condition treated. Both those hospitalizations — you know, she and her husband, who’s a psychiatrist, thought they were emergencies. The doctors regarded them as emergencies. But yet afterward, the Regence Blue Shield and Swedish decided they were not emergencies. And so, guess what? The family was hit with over $100,000 in out-of-network bills for the two Swedish hospitalizations.
Rovner: And this was after the federal law took effect, right? This was last year.
Meyer: The federal law and a Washington state law were both in effect at that point, which say that you cannot apply out-of-network charges in an emergency situation. So, at first, Blue Shield said that it was not an emergency and it didn’t come under the law. And Swedish Medical Center was going to take the family to collections. The family appealed to Regence Blue Shield. Regence in January granted the appeal for the first hospitalization, erasing $100,000 or so of the charges. But the second hospitalization, $15,000 bill, was still in effect. And then they contacted Kaiser Health News. I contacted Regence Blue Shield and Swedish, and then the charges were dropped for the second hospitalization.
Rovner: Amazing how that happens.
Meyer: Yeah, well, it’s not a solution. So the twist on this one is that Regence Blue Shield said we decided it was an emergency and that it wasn’t proper that the doctors were in network but the hospital wasn’t, so we’re going to consider this an in network and erase the charges. But they said Regence Blue Shield had a contract with Swedish, which made Swedish a quote-unquote “participating provider”; therefore, the federal and state laws do not apply to that situation, and the hospital was allowed to charge the out-of-network charge. We’re going to erase it for this case, but the law does not apply to that situation.
Rovner: I confess, if I’m in a hospital and they say they’re a participating provider, I’m going to assume that means they’re in network. And in this case, it doesn’t, right?
Meyer: Right. It’s a very strange twist that my experts had never encountered before. I took the issue to the federal agency CMS, which administers the No Surprises Act, and they said that they’re going to look into this and HHS, Treasury Department, and Department of Labor are all going to have to look into this to see if this could be fixed through an agency guidance or whether this would require a congressional action to fix this apparent loophole in the law.
Rovner: Creativity. So what’s the takeaway here for both women and particularly for pregnant women who know at some point they’re likely to be in the hospital? You can’t ask every single person who touches you whether they’re in your network. And isn’t that what state and the federal law are supposed to guard against? These are the exact things that we assumed would be taken care of. Right?
Meyer: Right. Well, first of all, the family, the patient, and their loved ones need to ask the hospital and the insurer to tell them their rights under the No Surprises Act and make sure that both the insurer and the provider are following the letter of those federal and state laws. Second, if they do get, God forbid, a out-of-network bill, they need to immediately appeal that to the insurance company, and there’s a two-level appeal process. The second level, they get an independent review. And then, at the same time, they need to file a report or a complaint with the state attorney general’s office, the state department of insurance, and maybe even contact state legislators. There also are private agencies or private companies with nurses and lawyers, etc., that will help families, for a fee, address issues like this. Hopefully it shouldn’t require that, but sometimes it may. And of course, then there’s Kaiser Health News. You can file your “Bill of the Month” complaint through the portal, which we can’t deal with hundreds of thousands of cases, obviously.
Rovner: But we can help at least a few. And Harris Meyer, you helped two. So thank you very much. And thank you for joining us.
Meyer: Thank you, Julie.
Rovner: OK, we’re back. And now it’s time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Victoria, why don’t you go first this week? You got one of my favorites.
Knight: My extra credit is called “They Could Lose the House — to Medicaid,” by Tony Leys, and it is published on NPR but is a KHN story. It’s about a family in Iowa who found out, after the mother in the family died, that they could lose their house because she was getting services through Medicaid. She had dementia, and so she needed really intensive at-home family care. Then after she died, they got a letter from the Iowa Department of Human Services — just a month after she died, so not long after — saying that the state was trying to recoup the money that they had spent on her care. So it was almost over $200,000 that they were asking for. And what was really upsetting is this family home was going to be the inheritance for the daughter. And so now they’re kind of like, what are we going to do? Thankfully, they don’t have to do anything with the house until something happens to the father. So it’s not gone immediately. But this is basically something that some states do. It’s called estate recovery programs. And if people use Medicaid in those states, the states have the ability to come back later … whether it’s, like, a house or they can ask for funds that these families used for Medicaid. So it’s really illuminating. I had no idea this was something that happened, and it varies by state to state. But in Iowa, this is something that they kind of pursue very aggressively.
Rovner: I remember when Congress made this a possibility, I think it was back in 1995. It’s been around, the possibility of states recouping Medicaid money for a long time. But as you point out, not all states do it. And it’s usually a surprise when states do do it. People still really don’t know about it. Shefali.
Luthra: So my story is from my 19th colleague, Jennifer Gerson. The headline is “Language for Treating Childhood Obesity Carries Its Own Health Risks to Kids, Experts Say.” And what Jen did, which I think is really smart and important, is she looked at the new clinical guidelines we got from the American Academy of Pediatrics. And those were meant to improve how we evaluate and treat obesity in children. And what she gets into is that there are a lot of children’s health experts, especially mental health experts, who are deeply concerned about what the impacts of these new guidelines could be, how they might exacerbate weight stigma, and how the long-term ramifications of some of the treatment guidelines could actually have worse outcomes for young people as a result, by building on weight stigma, which could lead to different kinds of unhealthy behaviors, could lead to mental health harms that could have much longer term repercussions, possibly more, in fact, dangerous than the actual problems that these guidelines are trying to treat. And one thing that Jen notes I think is really important is that the implications of weight stigma, in particular, are especially harmful for young girls who, as we know, are already facing so many mental health crises in general right now. I thought this was a really important look at a potentially really troubling unintended consequence, and I’m really glad Jen wrote about it.
Rovner: Yeah, I had no idea. It was a very counterintuitive but really interesting piece. Margot, what do you have this week?
Sanger-Katz: I wanted to suggest an article in ProPublica called “How Obamacare Enabled a Multibillion-Dollar Christian Health Care Cash Grab,” by J. David McSwane and Ryan Gabrielson which is just this wonderful historic dive into how the Affordable Care Act ended up allowing something called Christian health ministries to provide an alternative to health insurance. As we all know, the Affordable Care Act basically said, if you’re going to offer health insurance, it has to meet certain minimum guidelines in terms of what it covers and how it works. And these Christian health sharing ministries are just this huge, huge exception where basically it’s just, you know, groups of religiously affiliated people can get together and just pay for each other’s health care or not, depending on what they want to do. There has been a lot of reporting over the years about the degree to which these plans are kind of scammy or poorly run or are not paying for needed health care for their members who think that they are an alternative to insurance. And so this piece is just fun because it looked at the lobbying that generated this strange policy.
Rovner: Yeah. You know, I remember when they got the Christian sharing ministries exception into the ACA and not really knowing where it came from. Well, this story explains exactly where it came from. So it is quite an eye-popping read. Mine is from my KHN colleague Sarah Varney, and it’s called “Girls in Texas Could Get Birth Control at Federal Clinics, Until a Christian Father Objected. Now, for decades, underage girls have been able to get contraception from federally funded Title X family planning clinics without parental permission. An effort by the Reagan administration in the early 1980s, dubbed the “Squeal Rule,” which would have required that parents be notified after the fact, was struck down in federal court and the Reagan administration did not appeal it. And no, I was not there to cover that at that time. I did look it up. A couple of months ago, Judge Matthew Kacsmaryk — yes, that Judge Kacsmaryk, who will any day now rule on whether the FDA approval of the abortion pill should be revoked — ruled in favor of a father in Texas, not a father whose daughters did or said they wanted to obtain contraception from a Title X clinic. But the father complained that the very possibility that his daughters could get birth control without his consent rendered that portion of the law — which has been in effect since Title X, was signed by Richard Nixon in 1970 — unconstitutional. And of course, the judge agreed with him. So for now, the ruling only applies in Texas. But lest you think they’re not coming for your birth control, think again.
OK. That is our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review — that helps other people find us, too. Special thanks, as always, to our ever-patient producer, Francis Ying. Also, as always, you can email us your comments or questions. We’re at whatthehealth — all one word — @kff.org. Or you can tweet me. I’m @jrovner. Shefali?
Luthra: I’m @shefalil
Rovner: Victoria.
Knight: @victoriaregisk
Rovner: Margot.
Sanger-Katz: @sangerkatz
Rovner: We will be back in your feed next week. Until then, be healthy.
Credits
Francis Ying
Audio producer
Stephanie Stapleton
Editor
To hear all our podcasts, click here.
And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
USE OUR CONTENT
This story can be republished for free (details).
2 years 4 months ago
Health Care Costs, Medicare, Multimedia, Pharmaceuticals, States, Abortion, Biden Administration, Bill Of The Month, KHN's 'What The Health?', Podcasts, texas, Women's Health
March Medicaid Madness
The Host
Julie Rovner
KHN
Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
With Medicare and Social Security apparently off the table for federal budget cuts, the focus has turned to Medicaid, the federal-state health program for those with low incomes. President Joe Biden has made it clear he wants to protect the program, along with the Affordable Care Act, but Republicans will likely propose cuts to both when they present a proposed budget in the next several weeks.
Meanwhile, confusion over abortion restrictions continues, particularly at the FDA. One lawsuit in Texas calls for a federal judge to temporarily halt distribution of the abortion pill mifepristone. A separate suit, though, asks a different federal judge to temporarily make the drug easier to get, by removing some of the FDA’s safety restrictions.
This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Rachel Cohrs of STAT News, and Lauren Weber of The Washington Post.
Panelists
Rachel Cohrs
Stat News
Alice Miranda Ollstein
Politico
Lauren Weber
The Washington Post
Among the takeaways from this week’s episode:
- States are working to review Medicaid eligibility for millions of people as pandemic-era coverage rules lapse at the end of March, amid fears that many Americans kicked off Medicaid who are eligible for free or near-free coverage under the ACA won’t know their options and will go uninsured.
- Biden promised this week to stop Republicans from “gutting” Medicaid and the ACA. But not all Republicans are on board with cuts to Medicaid. Between the party’s narrow majority in the House and the fact that Medicaid pays for nursing homes for many seniors, cutting the program is a politically dicey move.
- A national group that pushed the use of ivermectin to treat covid-19 is now hyping the drug as a treatment for flu and RSV — despite a lack of clinical evidence to support their claims that it is effective against any of those illnesses. Nonetheless, there is a movement of people, many of them doctors, who believe ivermectin works.
- In reproductive health news, a federal judge recently ruled that a Texas law cannot be used to prosecute groups that help women travel out of state to obtain abortions. And the abortion issue has highlighted the role of attorneys general around the country — politicizing a formerly nonpartisan state post. –And Eli Lilly announced plans to cut the price of some insulin products and cap out-of-pocket costs, though their reasons may not be completely altruistic: An expert pointed out that a change to Medicaid rebates next year means drugmakers soon will have to pay the government every time a patient fills a prescription for insulin, meaning Eli Lilly’s plan could save the company money.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: The New York Times’ “A Drug Company Exploited a Safety Requirement to Make Money,” by Rebecca Robbins.
Alice Miranda Ollstein: The New York Times’ “Alone and Exploited, Migrant Children Work Brutal Jobs Across the U.S.,” by Hannah Dreier.
Rachel Cohrs: STAT News’ “Nonprofit Hospitals Are Failing Americans. Their Boards May Be a Reason Why,” by Sanjay Kishore and Suhas Gondi.
Lauren Weber: KHN and CBS News’ “This Dental Device Was Sold to Fix Patients’ Jaws. Lawsuits Claim It Wrecked Their Teeth,” by Brett Kelman and Anna Werner.
Also mentioned in this week’s podcast:
- Politico’s “Why One State’s Plan to Unwind a Covid-Era Medicaid Rule Is Raising Red Flags,” by Megan Messerly.
- The Washington Post’s “Doctors Who Touted Ivermectin as Covid Fix Now Pushing It for Flu, RSV,” by Lauren Weber.
- NPR’s “To Safeguard Healthy Twins in Utero, She Had to ‘Escape’ Texas for Abortion Procedure,” by Selena Simmons-Duffin.
- The Daily Beast’s “Tennessee Abortion Ban a ‘Nightmare’ for Woman With Doomed Pregnancy,” by Michael Daly.
click to open the transcript
Transcript: March Medicaid Madness
KHN’s ‘What the Health?’Episode Title: Medicaid March MadnessEpisode Number: 287Published: March 2, 2023
Julie Rovner: Hello and welcome back to KHN’s “What the Health?” I’m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I’m joined by some of the best and smartest health reporters in Washington. We are taping this week on Thursday, March 2, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So, here we go. We are joined today via video conference by Alice Miranda Ollstein of Politico.
Alice Miranda Ollstein: Good morning.
Rovner: Rachel Cohrs of Stat News.
Rachel Cohrs: Hi, everybody.
Rovner: And we officially welcome to the podcast panel this week Lauren Weber, ex of KHN and now at The Washington Post covering a cool new beat on health and science disinformation. Lauren, welcome back to the podcast.
Lauren Weber: Thanks for having me.
Rovner: So we’re going to get right to this week’s news. We’ve talked a lot about the political fight swirling around Medicare the past couple of weeks. So this week, I want to talk more about Medicaid. Our regular listeners will know, or should know, that states are beginning to re-determine eligibility for people who got on Medicaid during the covid pandemic and were allowed to stay on until now. In fact, Arkansas is vowing to re-determine eligibility for half a million people over the next six months. Alice, the last time Arkansas tried to do something bureaucratically complicated with Medicaid, it didn’t turn out so well, did it?
Ollstein: No. It was so much of a cautionary tale that no other state until now has gone down that path, although now at least a couple are attempting to. So Arkansas was the only state to actually move forward under the Trump administration with implementing Medicaid work requirements. And we covered it at the time, and just thousands and thousands of people lost coverage who should have qualified. They were working. They just couldn’t navigate the reporting system. Part of the problem was that you had to report your working hours online and a lot of people who are poor don’t have access to the internet. And, you know, the system was buggy and clunky and it was just a huge mess. But that is not stopping the state from trying again on several fronts. One, they want to do Medicaid work requirements again. The governor, Sarah Huckabee Sanders, has said that they plan to do that and also they plan to do their redeterminations for the end of the public health emergency in half the time the federal government would like states to take to do it. The federal government has incentives for states to go slow and take a full year to make sure people know how to prove whether or not they qualify for Medicaid and to learn what other insurance coverage options might be available to them. For instance, you know, Obamacare plans that are free or almost free.
Rovner: Yeah. Presumably most of the people who are no longer eligible for Medicaid but are still low-income will be eligible for Obamacare with hefty subsidies.
Ollstein: That’s right. So the fear is that history will repeat itself. A lot of people who should be covered will be dropped from coverage and won’t even know it because the state didn’t take the time to contact people and seek them out.
Rovner: This is something that we will certainly follow as it plays out over the next year. More broadly, though, there have been whispers — well, more than whispers, whines — over the past couple of weeks that President [Joe] Biden’s challenge to Republicans not to cut Social Security and Medicare, and Republicans’ apparent acceptance of that challenge, specifically leaves out Medicaid. Now, I never thought that was true, at least for the Democrats. But earlier this week, President Biden extended his promises to Medicaid and the Affordable Care Act. How much of a threat is there really to Medicaid in the coming budget battles? Rachel, you wrote about that today.
Cohrs: There is a lot of anxiety swirling around this on the Hill. I know there’s a former Trump White House official who’s circulated some documents that are making people a little bit nervous about Republicans’ position. But it is useful to look at existing documents out there. It is not reflective necessarily of the consensus Republican position. And it’s a very diverse party right now in the House. They have an incredibly narrow majority and Kevin McCarthy is really going to have to walk a tightrope here. And I think it is important to remember that when Medicaid has come up on steep ballot initiatives in red states, so many times it has passed overwhelmingly. So I think there is an argument to be made that Medicaid enjoys more political support among the GOP voting populace than maybe it does among members of Congress. So I think I am viewing it with caution. You know, obviously, it’s something that we’re going to have to be tracking and watching as these negotiations develop. But Democrats still hold the Senate and they still hold the presidency. So Republicans have more leverage than they did last Congress, but they’re still … Democrats still have a lot of sway here.
Rovner: Although I’ll just point out, as I think I pointed out before, that in 2017, when the Republicans tried to repeal the Affordable Care Act, one of the things they discovered is that Medicaid is actually kind of popular. I think … much to their surprise, they discovered that Medicaid is also kind of popular, maybe not as much as Medicare, but more than I think they thought. So I guess the budget wars really get started next week: We get President Biden’s budget, right?
Ollstein: And House Republicans are allegedly working on something. We don’t know when it will come or how much detail it will have, but it will be some sort of counter to Biden’s budget. But, you know, the real work will come later, in hashing it out in negotiations. And, really, a small number of people will be involved in that. And so just like Rachel said, you know, you’re going to see a lot of proposals thrown out over the next several months. Not all of them should necessarily be taken seriously or taken as determinative. Just one last interesting thing: This has been a really interesting education time, both for lawmakers and the public on just who is covered under these programs. I mean, the idea is that Medicare is so untouchable, is this third rail, because it is primarily seniors, and seniors vote. And seniors are more politically important to conservatives and Republicans. But people forget a lot of seniors are also on Medicaid. They get their nursing home coverage through there. And so I’ve heard a lot of Democratic lawmakers really hammering that argument lately and saying, look, you know, the stereotype for Medicaid is that it’s just poor adults, but …
Rovner: Yeah, moms and kids. That was how it started out.
Ollstein: Exactly.
Rovner: It was poor moms and kids.
Ollstein: Exactly. But it’s a lot more than that now. And it is more politically dicey to go after it than maybe people think.
Rovner: Yeah, I think Nancy Pelosi … in 2017 when, you know, if the threat with Medicare is throwing Granny off the cliff in her wheelchair, the threat of Medicaid is throwing Granny out of her nursing home, both of which have their political perils. All right. Well, we’ll definitely see this one play out for a while. I want to move to the public health beat. Lauren, you had a really cool story on the front page of The Washington Post this week about how the promise of ivermectin to treat infectious diseases in humans. And for those who forget, ivermectin is an anti-wormer drug that I give to my horse and both of my dogs. But the idea of using it for various infectious diseases just won’t die. What is the latest ivermectin craze?
Weber: Yes, and to be clear, there is an ivermectin that is a pill that can be given to humans, which is what these folks are talking about. But there’s this group called the Front Line COVID-19 Critical Care Alliance that really pushed ivermectin in the height of covid. As we all know on this podcast, scientific study after scientific study after clinical trial has disproved that there is any efficacy for that. But this group has continued to push it. And I discovered, looking at their website back this winter, that they’re now pushing it for the flu and RSV. And as I asked the CDC [Centers for Disease Control and Prevention] and medical experts, there’s no clinical data to support pushing that for the flu or RSV. And, you know, as one scientist said to me, they had data that … had antiviral properties in a test tube. But as one scientist said to me, well, if you put Coca-Cola in a test tube, it would show it had antiviral properties as well. So there’s a lot of pushback to these folks. But, that said, they told me that they have had their protocols downloaded over a million times. You know, they’re … absolutely have some prominence and have, you know, converted a share of the American population to the belief that this is a useful medical treatment for them. And one of the doctors that has left their group over their support of ivermectin said to me, “Look, I’m not surprised that they’re continuing to push this for something else. This is what they do now. They push this for other things.” And so it’s quite interesting to see this continue to play out as we continue into covid, to see them kind of expand, as these folks said to me, into other diseases.
Rovner: I know I mean, usually when we see these kinds of things, it’s because the people who are pushing them are also selling them and making money off of them. And I know that’s the case in some of this, but a lot of these are just doctors who are writing prescriptions for ivermectin. Right? I mean, this is an actual belief that they have.
Weber: Yeah, some of them do make money off of telehealth appointments. They can charge up to a couple hundred dollars for telehealth appointments. And one of the couple of co-founders had a lucrative Substack and book deal that talks about ivermectin and do get paid by this alliance. One of them made almost a quarter of a million dollars in salary from the alliance. But yeah, I mean, the average doctor that’s prescribing ivermectin, I mean — there were over 400,000 ivermectin prescriptions in, I think, it was August of 2021. So that’s a lot of prescriptions.
Rovner: They’re not all making money off of it.
Weber: They’re not all making money. And I mean, what’s wild to me is Merck has come out and said, which, in a very rare statement for a pharmaceutical company, you know, don’t prescribe our drug for this. And when I asked them about RSV and the flu, they said, yeah, our statement would still stand on that. So it’s a movement, to some extent. And the folks I talked to about it, they really believe …
Rovner: And I will say, for a while in 2021, you couldn’t get horse wormer, which is a very nasty-tasting paste, even the horses don’t really like it. Because it was hard to get ivermectin at all. So we’ll see where this goes next. Here’s one of those “in case you missed It” stories. The Tulsa World this week has an interview with former Republican Sen. James Inhofe, who said, in his blunt Inhofe way, that he retired last year not only because he’s 88, but because he’s still suffering the effects of long covid. And he’s not the only one — quote, “five or six others have [long covid], but I’m the only one who admits it,” he told the paper, referring to other members of the Senate, presumably other Republican members of the Senate. Now, mind you, the very conservative Inhofe voted against just about every covid funding bill. And my impression from not going to the Hill regularly in 2021 and 2022 is that while covid seemed to be floating around in the air, lots of people were getting it, very few people seemed to be getting very sick. But now we’re thinking that’s not really the case, right?
Ollstein: When I saw this, I immediately went back to a story I wrote about a year ago on Tim Kaine’s long covid diagnosis and his attempts to convince his colleagues to put more research funding or treatment funding, more basic covid prevention funding … you know, fewer people will get long covid if fewer people get covid in the first place. And there was just zero appetite on the Republican side for that. And that’s why a lot of it didn’t end up passing. Inhofe was one of the Republicans I talked to, and I said, you know, do you think you should do more about long covid? What do you think about this? And this is what he told me: “I have other priorities. We’re handling all we can right now.” And then he added that long covid is not that well defined. And he argued there’s no way to determine how many people are affected. Well.
Rovner: OK.
Ollstein: So that … in “Quotes That Aged Poorly Hall of Fame.”
Rovner: You know, obviously Tim Kaine came forward and talked about it. But now I’m wondering if there are people who are slowing down or looking like they’re not well, maybe they have long covid and don’t want to say.
Ollstein: Well, I mean, something that Tim Kaine’s case shows is that there’s no one thing it can look like and somebody can look completely healthy and normal on the outside and be suffering symptoms. And Tim Kaine has also said that members of Congress have quietly disclosed to him and thanked him for speaking up, but said they weren’t willing to do it themselves. And he, Tim Kaine, told me that he felt more comfortable speaking up because the kind of symptoms he had were less stigmatized. They weren’t anything in terms of impeding his mental capacity and function. And there’s just a lot of stigma and fear of people coming forward and admitting they’re having a problem.
Rovner: I find it kind of ironic that last week we talked about how, you know, members of Congress and politicians with mental health, you know, normally stigmatizing problems are more willing to talk about it. And yet here are people with long covid not willing to talk about it. So maybe we’ll see a little bit more after this or maybe not. I want to talk a little bit about artificial intelligence and health care. I’ve been wanting to talk about this for a while, but this week seems to be everyone is talking about AI. There have been a spate of stories about how different types of artificial intelligence are aiding in medical care, but also some cautionary tales, particularly about chat engines. They get all their information from the internet, good or bad. Now, we already have robots that do intricate surgeries and lots and lots of treatment algorithms. On the other hand, the little bit of AI that I already have that’s medical-oriented, my Fitbit, that sometimes accurately tracks my exercise and sometimes doesn’t, and the chat bot from my favorite chain drugstore that honestly cannot keep my medication straight. None of that makes me terribly optimistic about launching into health AI. Is this, like most tech, going to roll out a little before it’s ready and then we’ll work the bugs out? Or maybe are we going to be a little bit more careful with some of this stuff?
Cohrs: I think we’ve already seen some examples of things rolling out before they’re exactly ready. And I just thought of my colleague Casey Ross’ reporting on Epic’s algorithm that was supposed to help …
Rovner: Epic, the electronic medical records company.
Cohrs: Yes, yes. They had this algorithm that was supposed to help doctors treat sepsis patients, and it didn’t work. The problem with using AI in health care is that there are life-and-death consequences for some of these things. If you’re misdiagnosing someone, if you’re giving them medicine they don’t need, there are, like, those big consequences. But there are also the smaller ones too. And my colleague Brittany Trang wrote about how with doctor’s notes or transcripts of conversations between a physician and a patient sometimes AI has difficulty differentiating between an “mm-hm” or an “uh-huh” and telling whether that’s a yes or a no. And so I think that there’s just all of these really fascinating issues that we’re going to have to work through. And I think there is enormous potential, certainly, and I think there’s getting more experimentation. But like you said, I think in health care it’s just a very different beast when you’re rolling things out and making sure that they work.
Weber: Yeah, I wanted to add, I mean, one of the things that I found really interesting is that doctors’ offices are using some of it to reduce some of the administrative burden. As we all know, prior authorizations suck up a lot of time for doctors’ offices. And it seems like this has actually been really helpful for them. That said, I mean, that comes with the caveat of — my colleagues and I and much reporting has shown that — sometimes these things just make up references for studies. They just make it up. That level of “Is this just a made-up study that supports what I’m saying?” I think is really jarring. This isn’t quite like using Google. It cannot be trusted to the level … and I think people do have caution with it and they will have to continue to have caution with it. But I think we’re really only at the forefront of figuring out how this all plays out.
Rovner: I was talking before we started taping about how I got a text from my favorite chain drugstore saying that I was out of refills and that they would call my doctor, which is fine. And then they said, “Text ‘Yes’ if you would like us to call” … some other doctor. I’m like, “Who the heck is this other doctor?” And then I realize he’s the doctor I saw at urgent care last September when I burned myself. I’m like, “Why on earth would you even have him in your system?” So, you know, that’s the sort of thing … it’s like, we’re going to be really helpful and do something really stupid. I worry that Congress, in trying to regulate tech, and failing so far — I mean, we’ve seen how much they do and don’t know about, you know, Facebook and Instagram and the hand-wringing over TikTok because it’s owned by the Chinese — I can’t imagine any kind of serious, thoughtful regulation on this. We’re going to have to basically rely on the medical industry to decide how to roll this out, right? Or might somebody step in?
Ollstein: I mean, there could be agency, you know, rulemaking, potentially. But, yes, it’s the classic conundrum of technology evolving way faster than government can act to regulate it. I mean, we see that on so many fronts. I mean, look how long has gone without any kind of update. And, you know, the kinds of ways health information is shared are completely different from when that law was written, so …
Rovner: Indeed.
Weber: And as Rachel said, I mean, this is life-or-death consequences in some places. So the slowness with which the government regulates things could really have a problem here, because this is not something that is just little …
Rovner: Of the things that keep me awake at night, this is one of the things that keeps me awake at night. All right. Well, one of these weeks, we will not have a ton of reproductive health news. But this week isn’t it. As of this taping, we still have not gotten a decision in that Texas case challenging the FDA approval of the abortion pill, mifepristone, back in the year 2000. But there’s plenty of other abortion news happening in the Lone Star State. First, a federal judge in Texas who was not handpicked by the anti-abortion groups ruled that Texas officials cannot enforce the state’s abortion ban against groups who help women get abortion out of state, including abortion funds that help women get the money to go out of state to get an abortion. The judge also questioned whether the state’s pre-Roe ban is even in effect or has actually been repealed, although there are overlapping bans in the state that … so that wouldn’t make abortion legal. But still, this is a win for the abortion rights side, right, Alice?
Ollstein: Yeah, I think the right knows that there are two main ways that people are still getting abortions who live in ban states. They’re traveling out of state or they are ordering pills in the mail. And so they are moving to try to cut off both of those avenues. And, you know, running into some difficulty in doing so, both in the courts and just practically in terms of enforcing. This is part of that bigger battle to try to cut off, you know, people’s remaining avenues to access the procedure.
Rovner: Well, speaking exactly of that, Texas being Texas, this week, we saw a bill introduced in the state legislature that would ban the websites that include information about how to get abortion pills and would punish internet providers that fail to block those sites. It would also overturn the court ruling we just talked about by allowing criminal prosecution of anyone who helps someone get an abortion. Even a year ago, I would have said this is an obvious legislative overreach, but this is Texas. So now maybe not so much.
Ollstein: I mean, I think lots of states are just throwing things at the wall to see what sticks and to see what gets through the courts. You had states test the waters on banning certain kinds of out-of-state travel, and that hasn’t gone anywhere yet. But even things that don’t end up passing and being implemented can have a chilling effect. You have a lot of confusion right now. You have a lot of people not sure what’s legal, what’s not. And if you create this atmosphere of fear where people might be afraid to go out of state, might be afraid to ask for funding to go out of state, afraid to Google around and see what their options are that serves the intended impacts of these proposals, in terms of preventing people from exploring their options and seeing what they can do to terminate a pregnancy.
Rovner: Yeah. Well, meanwhile, a dozen states that are not named Texas are suing the FDA, trying to get it to roll back some of the prescribing requirements around the abortion pill. The states are arguing that not only are the risk-mitigation rules unnecessary, given the proven safety of mifepristone, but that some of the certification requirements could invade the privacy of patients and prescribers and subject them to harassment or worse. They’re asking the judge to halt enforcement of the restrictions while the case is being litigated. That could run right into [U.S. District] Judge [Matthew] Kacsmaryk’s possible injunction in Texas banning mifepristone nationwide. Then what happens? If you’ve got one judge saying, “OK, you can’t sell this nationwide,” and another judge saying … “Of course you can sell it, and you can’t use these safety restrictions that the FDA has put around it.” Then the FDA has two conflicting decisions in front of it.
Weber: Yeah, and I find the battles of the AGs and the abortion wars are really fascinating because, I mean, this is a lawsuit brought by states, which is attorneys general, Democratic attorneys general. And you’re seeing that play out. I mean, you see that in Texas, too, with [Ken] Paxton. You see it in Michigan with [Dana] Nessel. I mean, I would argue one of the things that attorney generals have been the most prominent on in the last several decades of American history and have actually had immediate effects on due to the fall of Roe v. Wade. So we’ll see what happens. But it is fascinating to see in real time this proxy battle, so to speak, between the two sides play out across the states and across the country.
Rovner: No, it’s funny. State AGs did do the tobacco settlement.
Weber: Yes.
Rovner: I mean, that would not have happened. But what was interesting about that is that it was very bipartisan.
Weber: Well, they were on the same side.
Rovner: And this is not.
Weber: Yeah, I mean, yeah, they were on the same side. This is a different deal. And I think to some extent, and I did some reporting on this last year, it speaks to the politicization of that office and what that office has become and how it’s become, frankly, a huge launching pad for people’s political careers. And the rhetoric there often is really notched up to the highest levels on both sides. So, you know, as we continue to see that play out, I think a lot of these folks will end up being folks you see on the national stage for quite some time.
Ollstein: I’ve been really interested in the states where the attorney general has clashed with other parts of their own state government. And so in North Carolina, for example, right now you have the current Democratic attorney general who is planning to run for governor. And he said, I’m not going to defend our state restrictions on abortion pills in court because I agree with the people challenging them. And then you have the Republican state legislatures saying, well, if he’s not going to defend these laws, we will. So that kind of clash has happened in Kentucky and other states where the attorney general is not always on the same side with other state officials.
Rovner: If that’s not confusing enough, we have a story out of Mississippi this week, one of the few states where voters technically have the ability to put a question on the ballot, except that process has been blocked for the moment by a technicality. Now, Republican legislators are proposing to restart the ballot initiative process. They would fix the technicality, but not for abortion questions. Reading from the AP story here, quote, “If the proposed new initiative process is adopted, state legislators would be the only people in Mississippi with the power to change abortion laws.” Really? I mean, it’s hard to conceive that they could say you can have a ballot question, but not on this.
Ollstein: This is, again, part of a national trend. There are several Republican-controlled states that are moving right now to attempt to limit the ability of people to put a measure on the ballot. And this, you know, comes as a direct result of last year. Six states had abortion-related referendums on their ballot. And in all six, the pro-abortion rights side won. Each one was a little different. We don’t need to get into it, but that’s the important thing. And so people voted pretty overwhelmingly, even in really red states like Kentucky and Montana. And so other states that fear that could happen there are now moving to make that process harder in different ways. You have Mississippi trying to do, like, a carve-out where nothing on abortion can make it through. Other states are just trying to raise, like, the signature threshold or the vote threshold people need to get these passed. There are a lot of different ways they’re going about it.
Rovner: I covered the Mississippi “personhood” amendment back in 2011. It was the first statewide vote on, you know, granting personhood to fetuses. And everybody assumed it was going to win, and it didn’t, even in Mississippi. So I think there’s reason for the legislators who are trying to re-stand up this ballot initiative process to worry about what might come up and how the voters might vote on it. Well, because I continue to hear people say that women trying to have babies are not being affected by state abortion bans and restrictions, this week we have not one but two stories of pregnant women who were very much impacted by abortion bans. One from NPR is the story of a Texas woman pregnant with twins — except one twin had genetic defects not only incompatible with life, but that threatened the life of both the other twin and the pregnant woman. She not only had to leave the state for a procedure to preserve her own life and that of the surviving twin, but doctors in Texas couldn’t even tell her explicitly what was going on for fear of being brought up on charges of violating the state’s ban. I think, Alice, you were the one talking about how, you know, women are afraid to Google. Doctors are afraid to say anything.
Ollstein: Yeah, absolutely. I mean, it’s a really chilling and litigious environment right now. And I think, as more and more of these stories start to come forward, I think that is spurring the debates you’re seeing in a lot of states right now about adding or clarifying or expanding the kind of exceptions that exist on these bans. So you have very heated debates going on right now in Utah and Tennessee and in several states around, you know, should we add more exceptions because there are some Republican lawmakers who are looking at these really tragic stories that are trickling out and saying, “This isn’t what we intended when we voted for this ban. Let’s go back and revisit.” Whether exceptions even work when they are on the books is another question that we can discuss. I mean, we have seen them not be effective in other states and people not able to navigate them.
Rovner: We’ve seen a lot of these stories about women whose water broke early and at what point is it threatening her life? How close to death does she have to be before doctors can step in? I mean, we’ve seen four or five of these. It’s not like they’re one-offs. The other story this week is from the Daily Beast. It’s about a 28-year-old Tennessee woman whose fetus had anomalies with its heart, brain, and kidneys. That woman also had to leave the state at her own expense to protect her own health. Is there a point where anti-abortion forces might realize they are actually deterring women who want babies from getting pregnant for fear of complications that they won’t be able to get treated?
Ollstein: Most of the pushback I’ve seen from anti-abortion groups, they claim that the state laws are fine and that doctors are misinterpreting them. And there is a semantic tug of war going on right now where anti-abortion groups are trying to argue that intervening in a medical emergency shouldn’t even count as an abortion. Doctors argue, no, it is an abortion. It’s the same procedure medically, and thus we are afraid to do it under the current law. And the anti-abortion groups are saying, “Oh, no, you’re saying that in bad faith; that doesn’t count as an abortion. An abortion is when it’s intended to kill the fetus.” So you’re having this challenging tug of war, and it’s not really clear what states are going to do. There’s a lot of state bills on this making their way through legislatures right now.
Rovner: And doctors and patients are caught in the middle. Well, finally this week, Eli Lilly announced it would lower, in some cases dramatically, the list prices for some of its insulin products. You may remember that, last year, Democrats in Congress passed a $35-per-month cap for Medicare beneficiaries but couldn’t get those last few votes to apply the cap to the rest of the population. Lilly is getting very good press. Its stock price went up, even though it’s not really capping all the out-of-pocket costs for insulin for everybody. But I’m guessing they’re not doing this out of the goodness of their drugmaking heart, right, Rachel?
Cohrs: Probably not. Even though there’s a quote from their CEO that implied that that was the case. I think there was one drug pricing expert at West Health Policy Center, Sean Dickson, who is very sharp on these issues, knows the programs well. And he pointed out that there’s a new policy going into effect in Medicaid next year, and it’s really, really wonky and complicated. But I’ll do my best to try to explain that, generally, in the Medicare program, rebates are capped, or they have been historically, at the price of the drug. So you can’t charge a drugmaker a rebate that’s higher than the cost. But …
Rovner: That would make sense.
Cohrs: Right. But that math can get kind of wonky when there are really high drug price increases and then that math gets really messed up. But Congress, I want to say it was in 2021, tweaked this policy to discourage those big price increases. And they said, you know what? We’re going to raise the rebate cap in Medicaid, which means that, drugmakers, if you are taking really big price increases, you may have to pay us every time someone on Medicaid fills those prescriptions. And I think people thought about insulin right away as a drug that has these really high rebates already and could be a candidate disproportionately impacted by this policy. So I thought that was an interesting point that Sean made about the timing of this. That change is supposed to go into effect early next year. So this could, in theory, save Lilly a lot of money in the Medicaid program because we don’t know exactly what their net prices were before.
Rovner: But this is very convenient.
Cohrs: It’s convenient. And there’s a chance that they’re not really losing any money right now, depending on how their contracts work with insurers. So I think, yeah, there is definitely a possibility for some ulterior motives here.
Rovner: And plus, the thing that I learned this week that I hadn’t known before is that there are starting to be some generic competition. The three big insulin makers, which are Lilly, Sanofi, and Novo Nordisk, may actually not become the, almost, the only insulin maker. So it’s probably in Lilly’s interest to step forward now. And, you know, they’re reducing the prices on their most popular insulins, but not necessarily their most expensive insulin. So I think there’s still money to be made in this segment. But they sure did get, you know, I watched all the stories come across. It’s, like, it’s all, oh, look at this great thing that Lilly has done and that everything’s going to be cheap. And it’s, like, not quite. But …
Cohrs: But it is different. It’s a big step. And I think …
Rovner: It is. It is.
Cohrs: Somebody has to go first in breaking this cycle. And I think it will be interesting to see how that plays out for them and whether the other two companies do follow suit. Sen. Bernie Sanders asked them to and said, you know, why don’t you just all do the same thing and lower prices on more products? So, yeah, we’ll see how it plays out.
Weber: Day to day, I mean, that’s a huge difference for people. I mean, that is a lot of money. That is a big deal. So, I mean, you know, no matter what the motivation, at the end of the day, I think the American public will be much happier with having to pay a lot less for insulin.
Rovner: Yeah, I’m just saying that not everybody who takes insulin is going to pay a lot less for insulin.
Weber: Right. Which is very fair, very fair.
Rovner: But many more people than before, which is, I think, why it got lauded by everybody. Although I will … I wrote in my notes, please, someone mention Josh Hawley taking credit and calling for legislation. Sen. Hawley from Missouri, who voted against extending the $35 cap, as all Republicans did, to the rest of the population, put out a tweet yesterday that was, like, this is a great thing and now we should have, you know, legislation to follow up. And I’m like: OK.
Cohrs: You’ll have to check on that. I actually think Hawley may have voted for it.
Rovner: Oh, a-ha. All right.
Cohrs: There were a few Republicans.
Rovner: Thank you.
Cohrs: It’s not enough, though.
Rovner: Yeah, I remember that they couldn’t get those last few votes. Yes, I think [Sen. Joe] Manchin voted against. He was the one, the last Democrat they couldn’t get right. That’s why they ended up dropping …
Cohrs: Uh, it had to be a 60-vote threshold, so …
Rovner: Oh, that’s right.
Cohrs: Yeah.
Rovner: All right. Good. Thank you. Good point, Rachel. All right. Well, that is the news for this week. Now it is time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Alice, why don’t you go first this week?
Ollstein: Yeah. So I did the incredible New York Times investigation by Hannah Dreier on child labor. This is about undocumented, unaccompanied migrant children who are coming to the U.S. And the reason I’m bringing it up on our podcast is there is a health angle. So HHS [the Department of Health and Human Services], their Office of Refugee Resettlement has jurisdiction over these kids’ welfare and making sure they are safe. And that is not happening right now. The system is so overwhelmed that they have been cutting corners in how they vet the sponsors that they release the kids to. Of course, we remember that there were tons of problems with these kids being detained and kept for way too long and that being a huge threat to their physical and mental health. But this is sort of the pendulum has swung too far in the opposite direction, and they’re being released to people who in some cases straight up trafficking them and in other cases just forcing them to work and drop out of school, even if it’s not a trafficking situation. And so this reporting has already had an impact. The HHS has announced all these new initiatives to try to stop this. So we’ll see if they are effective. But really moving, incredible reporting.
Rovner: Yeah, it was an incredible story. Lauren.
Weber: I’m going to shout out my former KHN colleague Brett Kelman. I loved his piece on, I guess you can’t call it a medical device because it wasn’t approved by the FDA, which is the point of the story. But this device that was supposed to fix your jaw so you didn’t have to have expensive jaw surgery. Well, what it ended up doing is it messed up all these people’s teeth and totally destroyed their mouths and left them with a bunch more medical and dental bills. And, you know, what I find interesting about the story, what I find interesting about the trend in general is the problem is, they never applied for anything with the FDA. So people were using this device, but they didn’t check, they didn’t know. And I think that speaks to the American public’s perception that devices and medical devices and things like this are safe to use. But a lot of times the FDA regulations are outdated or are not on top of this or the agency is so understaffed and not investigating that things like this slipped through the cracks. And then you have people — and it’s 10,000 patients, I believe, that have used this tool — that did not do what it is supposed to do and, in fact, injured them along the way. And I think that the FDA piece of that is really interesting. It’s something I’ve run into before looking at air cleaners and how they fit the gaps of that. And I think it’s something we’re going to continue to see as we examine how these agencies are really stacking up to the evolution of technology today.
Rovner: Yeah, capitalism is going to push everything. Rachel.
Cohrs: So my extra credit this week is actually an opinion piece, in Stat, and the headline is “Nonprofit Hospitals Are Failing Americans. Their Boards May Be a Reason Why.” It was written by Sanjay Kishore and Suhas Gondi. I think the part that really stood out to me is they analyzed the backgrounds and makeups of hospital boards, especially nonprofit hospitals. I think they analyzed like 20 large facilities. And the statistic that really surprised me was that, I think, 44% of those board members came from the financial sector representing investment funds, real estate, and other entities. Less than 15% were health care workers, 13% were physicians, and less than 1% were nurses. And, you know, I’ve spent a lot of time and we’ve spent a lot of time thinking about just how nonprofit hospitals are operating as businesses. And I think a lot of other publications have done great work as well making that point. But I think this is just a stark statistic that shows these boards that are supposed to be holding these organizations accountable are thinking about the bottom line, because that’s what the financial services sector is all about, and that there’s so much disproportionately less clinical representation. So obviously hospitals need admin sides to run, and they are businesses, and a lot of them don’t have very large margins. But the statistics just really surprised me as to the balance there.
Rovner: Yeah, I felt like this is one, you know, we’ve all been sort of enmeshed in this, you know, what are we going to do about the nonprofit hospitals that are not actually acting as charitable institutions? But I think the boards had been something that I had not seen anybody else look at until now. So it’s a really interesting piece. All right. Well, my story this week is the other big investigation from The New York Times. It’s called “A Drug Company Exploited a Safety Requirement to Make Money,” by Rebecca Robbins. And it’s about those same risk-mitigation rules from the FDA that are at the heart of those abortion drug lawsuits we talked about a few minutes ago. Except in this case, the drug company in question, Jazz Pharmaceuticals, somehow patented its risk-mitigation strategy as the distribution center — it’s actually called the REMS [Risk Evaluation and Mitigation Strategies] — which is managed to fend off generic competition for the company’s narcolepsy drug. It had also had a response already. It has produced a bipartisan bill in the Senate to close the loophole — but [I’ll] never underestimate the creativity of drugmakers when it comes to protecting their profit. It’s quite a story. OK. That’s our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us, too. Special thanks, as always, to our ever-patient producer, Francis Ying. Also, as always, you can email us your comments or questions. We’re at whatthehealth — all one word — at kff.org. Or you can tweet me. I’m @jrovner. Alice?
Ollstein: @AliceOllstein
Rovner: Rachel.
Cohrs: @rachelcohrs
Rovner: Lauren.
Weber: @LaurenWeberHP
Rovner: We will be back in your feed next week. In the meantime, be healthy.
Credits
Francis Ying
Audio producer
Emmarie Huetteman
Editor
To hear all our podcasts, click here.
And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
USE OUR CONTENT
This story can be republished for free (details).
2 years 5 months ago
COVID-19, Health Care Costs, Health Industry, Insurance, Medicaid, Medicare, Multimedia, Abortion, Biden Administration, Drug Costs, FDA, KHN's 'What The Health?', Obamacare Plans, Podcasts, Prescription Drugs, texas, Women's Health
Ante vacío federal, estados promueven leyes duras contra el uso de sustancias tóxicas en cosméticos
Washington se unió a más de una docena de estados en tomar medidas enérgicas contra las sustancias tóxicas en cosméticos después que un estudio financiado por el estado encontró plomo, arsénico y formaldehído en productos para maquillaje y alisado del cabello fabricados por CoverGirl y otras marcas.
Estados Unidos se estancó en las regulaciones químicas después de la década de 1970, según Bhavna Shamasunder, profesora asociada de política urbana y ambiental en el Occidental College. Y eso ha dejado un vacío regulatorio, ya que la blanda supervisión federal permite que productos potencialmente tóxicos que estarían prohibidos en Europa se vendan en las tiendas estadounidenses.
“Muchos productos en el mercado no son seguros”, dijo Shamasunder. “Es por eso que los estados están ayudando a generar una solución”.
La posible exposición a sustancias tóxicas en los cosméticos es especialmente preocupante para las mujeres de color, porque estudios muestran que las mujeres negras usan más productos para el cabello que otros grupos raciales, y que las hispanas y asiáticas han informado que usan más cosméticos en general que las mujeres negras y blancas no hispanas.
La legislación del estado de Washington es un segundo intento de aprobar la Ley de Cosméticos Libres de Tóxicos, luego que, en 2022, los legisladores aprobaran un proyecto de ley que eliminó la prohibición de ingredientes tóxicos en los cosméticos.
Este año, los legisladores tienen un contexto adicional después que un informe encargado por la Legislatura, y publicado en enero por el Departamento de Ecología del estado, encontró múltiples productos con niveles preocupantes de químicos peligrosos, incluyendo plomo y arsénico en la base CoverGirl Clean Fresh Pressed Powder de tinte oscuro.
El lápiz labial de color continuo CoverGirl y la base de maquillaje Black Radiance Pressed Powder de Markwins Beauty Brands se encuentran entre otros productos de varias marcas que contienen plomo, según el informe.
Los equipos de investigación preguntaron a mujeres hispanas, negras no hispanas y multirraciales qué productos de belleza usaban. Luego, probaron 50 cosméticos comprados en Walmart, Target y Dollar Tree, entre otras tiendas.
“Las empresas están agregando conservantes como el formaldehído a los productos cosméticos”, dijo Iris Deng, investigadora de tóxicos del Departamento de Ecología estatal. “El plomo y el arsénico son historias diferentes. Se detectan como contaminantes”.
Markwins Beauty Brands no respondió a las solicitudes de comentarios.
“Las trazas nominales de ciertos elementos a veces pueden estar presentes en las formulaciones de productos como consecuencia del origen mineral natural, según lo permitido por la ley que aplica”, dijo Miriam Mahlow, vocera de la empresa matriz de CoverGirl, Coty Inc., en un correo electrónico.
Los autores del informe de Washington dijeron que los países de la Unión Europea prohíben productos como la base CoverGirl de tinte oscuro. Esto se debe a que el arsénico y el plomo se han relacionado con el cáncer, y daño cerebral y del sistema nervioso. “No se conoce un nivel seguro de exposición al plomo”, dijo Marissa Smith, toxicóloga reguladora sénior del estado de Washington. Y el formaldehído también es carcinógeno.
“Cuando encontramos estos químicos en productos aplicados directamente a nuestros cuerpos, sabemos que las personas están expuestas”, agregó Smith. “Por lo tanto, podemos suponer que estas exposiciones están contribuyendo a los impactos en la salud”.
Aunque la mayoría del contenido de plomo de los productos era bajo, dijo Smith, las personas a menudo están expuestas durante años, lo que aumenta considerablemente el peligro.
Los hallazgos del departamento de ecología de Washington no fueron sorprendentes: otros organismos han detectado conservantes como formaldehído o, más a menudo, agentes liberadores de formaldehído como quaternium-15, DMDM hidantoína, imidazolidinil urea y diazolidinil urea en productos para alisar el cabello comercializados especialmente para las mujeres negras.
El formaldehído es uno de los productos químicos utilizados para embalsamar los cadáveres antes de los funerales.
Además de Washington, al menos 12 estados —Hawaii, Illinois, Massachusetts, Michigan, Nevada, Nueva Jersey, Nueva York, Carolina del Norte, Oregon, Rhode Island, Texas y Vermont— están considerando leyes para restringir o exigir la divulgación de sustancias químicas tóxicas en cosméticos y otros productos de cuidado personal.
Los estados están actuando porque el gobierno federal tiene una autoridad limitada, dijo Melanie Benesh, vicepresidenta de asuntos gubernamentales del Environmental Working Group, una organización sin fines de lucro que investiga qué hay en los productos para el hogar y para el consumidor.
“La FDA ha tenido recursos limitados para intentar la prohibición de ingredientes”, agregó Benesh.
El Congreso no ha otorgado a la Agencia de Protección Ambiental (EPA) una amplia autoridad para regular estos productos, a pesar de que los contaminantes y conservantes de los cosméticos terminan en el suministro de agua.
En 2021, un hombre de California solicitó a la EPA que prohibiera los químicos tóxicos en los cosméticos bajo la Ley de Control de Sustancias Tóxicas, pero la petición fue denegada, porque los cosméticos están fuera del alcance de la jurisdicción de la ley, dijo Lynn Bergeson, abogada en Washington, D.C.
Bergeson dijo que la regulación de los productos químicos está sujeta a la Ley Federal de Alimentos, Medicamentos y Cosméticos, pero la Administración de Medicamentos y Alimentos (FDA) regula solo los aditivos de color y los productos químicos en los protectores solares porque sostienen que disminuyen el riesgo de cáncer de piel.
Minnesota, por ejemplo, llena los vacíos regulatorios al realizar pruebas de mercurio, hidroquinona y esteroides en productos para aclarar la piel. También aprobó una ley en 2013 que prohíbe el formaldehído en productos para niños, como lociones y baños de burbujas.
California ha aprobado varias leyes que regulan los ingredientes y el etiquetado de los cosméticos, incluida la Ley de Cosméticos Seguros de California, en 2005. Una ley adoptada en 2022 prohíbe las sustancias de perfluoroalquilo y polifluoroalquilo agregadas intencionalmente, conocidas como PFAS, en cosméticos y prendas de vestir a partir de 2025.
El año pasado, Colorado también aprobó una prohibición de PFAS en maquillaje y otros productos.
Pero expertos en seguridad del consumidor dijeron que los estados no deberían tener que llenar el vacío dejado por las regulaciones federales, y que un enfoque más inteligente implicaría que el gobierno federal sometiera los ingredientes de los cosméticos a un proceso de aprobación.
Mientras tanto, los estados están librando una batalla cuesta arriba, porque miles de productos químicos están disponibles para los fabricantes. Como resultado, existe una brecha entre lo que los consumidores necesitan como protección y la capacidad de acción de los reguladores, dijo Laurie Valeriano, directora ejecutiva de Toxic-Free Future, una organización sin fines de lucro que investiga y defiende la salud ambiental.
“Los sistemas federales son inadecuados porque no requieren el uso de productos químicos más seguros”, dijo Valeriano. “En cambio, permiten productos químicos peligrosos en productos para el cuidado personal, como PFAS, ftalatos o incluso formaldehído”.
Además, el sistema de evaluación de riesgos del gobierno federal tiene fallas, dijo, “porque intenta determinar cuánto riesgo de exposiciones tóxicas es aceptable”. Por el contrario, el enfoque que el estado de Washington espera legislar evaluaría los peligros y preguntaría si los productos químicos son necesarios o si existen alternativas más seguras, es decir, evitar los ingredientes tóxicos en los cosméticos en primer lugar.
Es muy parecido al enfoque adoptado por la Unión Europea (UE).
“Ponemos límites y restricciones a estos productos químicos”, dijo Mike Rasenberg, director de evaluación de peligros de la Agencia Europea de Productos Químicos en Helsinki, Finlandia.
Rasenberg dijo que debido a que la investigación muestra que el formaldehído causa cáncer nasal, la UE lo ha prohibido en productos de belleza, además del plomo y el arsénico. Los 27 países de la UE también trabajan juntos para probar la seguridad de los productos.
En Alemania se examinan anualmente más de 10,000 productos cosméticos, dijo Florian Kuhlmey, vocero de la Oficina Federal de Protección al Consumidor y Seguridad Alimentaria de ese país. Y no termina ahí. Este año, Alemania examinará alrededor de 200 muestras de dentífrico para niños en busca de metales pesados y otros elementos prohibidos en la UE para cosméticos, agregó Kuhlmey.
La legislación en Washington se acercaría a la estrategia europea para la regulación de productos químicos. Si se aprueba, daría a los minoristas que venden productos con ingredientes prohibidos hasta 2026 para vender los productos existentes.
Mientras tanto, los clientes pueden protegerse buscando productos de belleza naturales, dijo la dermatóloga del área de Atlanta, Chynna Steele Johnson.
“Muchos productos tienen agentes liberadores de formaldehído”, dijo Steele Johnson. “Pero no es algo que los clientes puedan encontrar en una etiqueta. Mi sugerencia, y esto también se aplica a los alimentos, sería, cuanto menos ingredientes, mejor”.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
USE OUR CONTENT
This story can be republished for free (details).
2 years 5 months ago
Noticias En Español, Public Health, Race and Health, States, california, Colorado, Hawaii, Illinois, Latinos, Minnesota, Nevada, New Jersey, New York, North Carolina, Oregon, Rhode Island, texas, Vermont, Washington