Good morning, I’m Mark Johnson, a science reporter at The Washington Post and someone who appreciates as short a trip as possible when it comes time to see the doctor. I never realized what a luxury my 15-minute drive was until I interviewed 72-year-old Lenore Tate, who lives in Sacramento and endures three hours in the car to visit her cardiologist at Stanford University, for a story on a national cardiologist shortage.
Today’s edition: Reproductive-care groups are bracing for a wave of patients from Iowa as the state’s new abortion ban takes effect. Federal regulators are warning patients about dosing risks associated with compounded versions of popular drugs like Ozempic and Wegovy. But first …
The United States needs more cardiologists
America has a supply-and-demand problem when it comes to heart disease. The illness is the country’s No. 1 killer, but almost half of all counties lack a single cardiologist.
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That’s what a research team from Brigham and Women’s Hospital in Boston found when they examined all 3,143 U.S. counties; over 46 percent had no cardiologist. Worse, the counties most likely to be without a cardiologist happen to be those most likely to need one. These are largely rural areas with high levels of smoking, diabetes, obesity and high blood pressure — the telltale signs of heart disease.
The cardiologist problem forms part of the larger, decades-old rural health-care crisis. Robert A. Harrington, dean of Weill Cornell Medicine, describes the disparity between health care in rural and urban areas this way: “Your Zip code tells more about your health outcomes than your genetic code,” he said. “And that’s certainly the case with rural America.”
Since January 2005, 192 rural hospitals nationwide have closed or converted to facilities that do not provide inpatient care. And in the 20-year period ending in 2019, the gap in the death rates in urban and rural areas almost tripled.
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In cardiology, the effects are acute, burdening both patients and doctors. Tate, who has congestive heart failure, said that even in Sacramento there are not enough cardiologists to meet the need. It can take months to get in to see a local doctor.
“It’s more than a hardship,” she said of the three-hour drive to see her doctor at Stanford. “There are times I’ve had other illnesses and injuries that have made it difficult for me to get in my car and drive.”
Stephen Sigal is one of two full-time cardiologists in Titus County, Tex., who serve a four-county area of about 3,000 square miles. It’s an area plagued by high levels of heart disease.
“It’s rare that I work less than 12 hours a day,” Sigal said. “It’s not uncommon that I work 16 to 18 hours in a day.”
Usman Salahuddin, a cardiologist for Ochsner Rush Health in Meridian, Miss., said surrounding Lauderdale County has 11 other cardiologists. But there are none in the adjacent counties.
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“We don’t have cardiothoracic surgery or electrophysiology, specialty fields within cardiology,” Salahuddin said. “So we do the first triage assessment and then we, in turn, have to refer them out,” as far as Hattiesburg an hour and a half away, or even New Orleans, about three hours away.
Attracting cardiologists to rural areas hasn’t been easy. Salahuddin, who went to medical school in his native Pakistan, said he received a special visa to train in the United States that required he spend three years working as a doctor in an underserved area. More such programs may help address the shortage of cardiologists.
The use of telemedicine to connect patients with their distant doctors may also help. But experts suggest health officials will probably need to find other innovative programs. Read my full story here.
Reproductive wars
Iowa abortion ban takes effect as residents flee state for care
Planned Parenthood will continue providing abortions in Iowa but only in the very limited circumstances allowed by the state’s new abortion ban, which took effect this morning, The Post’s Annie Gowen reports.
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Key context: The law restricts the procedure after fetal cardiac activity can be detected, typically about six weeks into pregnancy. There are exceptions for cases of rape, incest, a fetal abnormality “incompatible with life” or if the life of the mother is in danger.
Iowa had previously permitted abortions until 22 weeks of pregnancy. More than 4,000 procedures were performed in the state last year, a number that is expected to drop by at least 97 percent under the new ban, according to Ruth Richardson, president and CEO of Planned Parenthood North Central States.
Reproductive-care groups in neighboring states where the procedure remains legal are already seeing an influx of patients from Iowa. The Chicago Abortion Fund received more than 60 support requests from Iowa residents during the first three weeks of July, a 165 percent increase over previous months.
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Meanwhile, across the country:
- In Texas: Attorney General Ken Paxton (R) is suing the Biden administration over a policy that allows adolescents to access birth control without their guardians’ consent, arguing that the rule violates state law, our colleague Dan Rosenzweig-Ziff reports.
- In Nebraska: The state Supreme Court upheld a law banning abortion after 12 weeks of pregnancy and restricting gender-affirming care for minors, ruling that combining the issues doesn’t violate a state constitutional amendment requiring bills to address a single subject, the Nebraska Examiner’s Aaron Sanderford reports.
- In Arizona: A judge rejected an effort by Republican lawmakers to use the term “unborn human being” to describe a fetus in the summary of an abortion rights ballot measure, finding that the wording is “packed with emotion and partisan meaning,” Sejal Govindarao reports for the Associated Press.
Agency alert
FDA warns of dosing errors from compounded weight-loss drugs
The Food and Drug Administration is warning patients and doctors about dosing errors associated with compounded versions of semaglutide, the active ingredient in Novo Nordisk’s blockbuster weight-loss and diabetes drugs.
In an alert Friday, the federal regulator said it had received reports of adverse events, some requiring medical attention or hospitalization, that may be related to overdose. The agency cited instances of patients who were unfamiliar with how to measure doses with a syringe, and health-care providers calculating incorrect doses by mixing up metric conversions, resulting in patients taking five to 10 times more than intended.
Why it matters: Generic versions of Ozempic and Wegovy have skyrocketed in popularity due to ongoing shortages of the brand-name drugs. While the FDA exercises some oversight of compounding pharmacies, their drugs don’t undergo the agency’s premarket review for safety, effectiveness or quality.
In other health news
- The Justice Department alleged in new court documents that TikTok’s China-based owner built a search tool that allowed its employees to collect information on U.S. users’ views on divisive issues such as abortion, gun control and religion, The Post’s Victoria Bisset and Drew Harwell report.
- Drug manufacturer Indivior reached a $86 million settlement with 16 states over the company’s alleged role in fueling the nation’s opioid epidemic. The funds will be used to support addiction treatment, recovery and prevention programs.
- In just one month, California’s Medicaid program paid nearly $20 million for health-care services on behalf of beneficiaries who were concurrently enrolled in the safety net program in another state, according to an audit by the HHS inspector general.
Daybook
📅 Welcome back! The Senate is in session, while the House is out until September. Here’s what we’re watching.
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On tap this week: The Senate is expected to vote on a pair of bills that would boost online privacy and safety protections for children. If passed, the legislation would mark the most significant tech regulations to advance through a chamber of Congress in decades, per The Post’s Cristiano Lima-Strong.
On Wednesday: The Senate Health, Education, Labor and Pensions Committee will mark up legislation to reauthorize the Older Americans Act and two other bills; a Senate Judiciary subcommittee will examine birth behind bars.
On Thursday: The Senate Appropriations Committee will mark up legislation to fund the Department of Health and Human Services and other agencies for fiscal 2025; the Senate HELP Committee will consider Mark Eskenazi’s nomination to the Occupational Safety and Health Review Commission.
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On Friday: Independent advisers to the FDA will review Zevra Therapeutics’ new drug, arimoclomol, for treating Niemann-Pick disease type C, a rare genetic disorder.
Health reads
The unlikely alliance bringing the tech giants to heel (By Ruth Reader | Politico)
Sugar rush
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