番茄社区

The following is a transcript of the podcast episode:

Rachael Robertson: Hey everybody! Welcome to MedPod Today, the podcast series where 番茄社区 reporters share deeper insight into the week's biggest healthcare stories. I'm your host, Rachael Robertson.

Today, Kristina Fiore will share the results of a survey that 番茄社区 conducted among ob/gyns in abortion-restrictive states. Then, I'm going to talk about my reporting on a controversial BMJ paper that got an expression of concern after public outcry. After that, Jennifer Henderson will tell us about a Texas doctor accused of illegally accessing child health records.

First up, though, let's talk about the exclusive 番茄社区 survey.

Two years ago, the Dobbs decision overturned Roe v. Wade, upending federal protections for abortion. To understand how that decision has impacted care since then, 番茄社区 conducted a survey of ob/gyns in states with abortion bans. Kristina Fiore and I worked on this project together, and today we're going to chat a bit about the results.

First, a little background. We received responses from 50 ob/gyns in 18 states that have either a total abortion ban or gestational limits between 6 and 12 weeks. One of the most interesting findings is that the majority of clinicians have found workarounds to get patients the care they need. Kristina, do you want to go into that a bit?

Kristina Fiore: Yeah, so about 60% said that they've come up with other ways to help patients get access to the full spectrum of reproductive care. This was a multiple choice survey, so we don't have a whole lot of specific details on those workarounds, but Dan Grossman at UCSF, who is also studying the effects of Dobbs, said that even in states with abortion bans, some facilities have taken the lead in terms of caring for patients who have conditions that will put them at risk of serious complications. That includes things like preterm premature rupture of membranes, or PPROM, bleeding in the second trimester, and preterm labor.

Grossman said that about 2 years in, "people have figured out where those places are, and they can funnel patients to those places." But he also warned that even with the workarounds, it's "still challenging and it's different from how it used to be. You still either have to jump through hoops at your own institution, or more commonly, send people to another institution."

Robertson: Right. We saw some of those hoops in the survey, too. About 30% of respondents said that they had to face an abortion panel at their facility. How often were their requests approved?

Fiore: When clinicians faced an abortion panel to get permission to deliver care in certain instances, only 8% said that they always got to deliver the care that they needed. 10% got it three-quarters of the time, and 2% got it only a quarter of the time. But a pretty substantial 12% said they were always denied.

Also, about a third reported that they actually had to turn away a patient seeking an abortion at some point. Now, there's concern that this is all starting to show up in patient outcomes. 42% of our clinicians said that delays in care have put a pregnant patient's life or health at risk, and 50% said that care has gotten worse since bans went into effect.

Robertson: That's sad, but not necessarily surprising. Last year, when we wrote about the first anniversary of Dobbs, doctors told us that they were feeling the impact "every single day." We thought this might push more clinicians to leave ban states, but that's not what we found.

Fiore: Right. So only one in five ob/gyns said that they had seriously considered leaving their state because of an abortion ban. David Hackney, a maternal-fetal medicine specialist in Ohio, said that most ob/gyns can actually remain pretty distant from abortion, and that a surprising number just don't care about what's going on from a legal perspective. He said that most general ob/gyns can refer out if they have a major complication, so they don't have to follow the issues so closely. And indeed, we found only about half were ever given legal guidance on abortion from their hospital or their employer.

Robertson: So in some ways, perhaps state laws are a little less intrusive on everyday ob/gyn practice, even in those ban states. But still, patients are the ones bearing the brunt of this impact. I guess now we start planning our story for the third anniversary, huh?

Fiore: That's it, yeah.

Robertson: Thanks. Kristina.

Fiore: Thanks, Rachael. Let's swap seats for this next segment.

Earlier this month, BMJ Public Health published a paper that concluded that COVID vaccines were linked to excess deaths. Several news outlets reported on that paper, but after an outcry from the research community, the BMJ has placed an expression of concern on it. Rachael will tell us what happened.

So Rachael, what did the expression of concern say?

Robertson: The BMJ said that the paper's messaging gave rise to widespread misreporting and misunderstanding of the work amid claims that it implies a direct causal link between COVID-19 vaccination and mortality, when the researchers "looked only at trends in excess mortality over time, not its causes."

So this notice was posted 2 weeks after the paper was published, which is a really fast turnaround for that kind of thing. I spoke with epidemiologist Gideon Meyerowitz-Katz, who analyzed the whole situation in his newsletter, and he told me this:

Gideon Meyerowitz-Katz: I think that they [the BMJ] are misrepresenting the paper, which does explicitly say vaccines caused excess deaths. I don't think it's fair to only blame the reporters in this case.

Fiore: So what's wrong with the paper? Why is it causing so much controversy?

Robertson: One huge issue is that it's based entirely on other research. This BMJ paper copied the methods from an influential paper by Ariel Karlinsky and Dmitry Kobak that was published in eLife back in 2021. That original paper has been cited by the CDC and the UN. And again, here's Meyerowitz-Katz on that:

Meyerowitz-Katz: They just took some of the data from that paper, they reanalyzed it badly, and then they published it as novel work, which is extremely problematic.

Robertson: The researchers of the original paper are calling for a retraction of the BMJ one. They also want a public apology and an investigation into how it was published.

Fiore: How did it get published?

Robertson: I was asking that same question. Meyerowitz-Katz said that bad research occasionally makes it through peer review. Becky Smullin Dawson, another epidemiologist I spoke to, told me that this whole situation was a failure of peer review. She also said that it's a good reminder on why it's so important to read the whole paper. In this case, the intro details the dangers of COVID vaccines, but the methods and the results don't have data to back those claims up. She said "the data did not connect those dots. Heck -- the data do not even exist." This kind of process is slow, so we'll see if further action is taken against the paper in the coming months.

Fiore: Okay, well, keep us posted. Thanks for the story.

Robertson: Thanks. Kristina.

A Texas physician has been accused of illegally obtaining children's health records. Now that case has been unsealed, according to federal prosecutors. Jennifer Henderson is here with more information.

Jennifer, what can you tell us about the details of this case?

Jennifer Henderson: We now know that Eithan Haim, the doctor in question, recently had a four-count indictment filed against him. He's been charged with allegedly violating HIPAA when he reportedly leaked information about Texas Children's Hospital continuing its gender-affirming care program after it said it had been halted.

Robertson: Okay, so what does the indictment against Haim allege?

Henderson: Basically, the indictment alleges that Haim obtained personal information, such as patient names, treatment codes, and the attending physician from the hospital's electronic health record system without authorization. It also alleges that he obtained the data under false pretenses, with intent to cause malicious harm to the hospital.

Haim was previously a resident at Baylor College of Medicine and had rotations at Texas Children's that had ended in 2021, according to the indictment. But 2 years later, in April 2023, Haim allegedly requested to reactivate his login at the hospital to access data for pediatric patients who were not under his care.

Robertson: Oof, so have other people weighed in on this unsealed indictment?

Henderson: Haim's legal counsel, Ryan Patrick of Haynes Boone, said in a statement that, "Dr. Haim maintains that he has done nothing wrong. The government's facts are wrong, and their timeline is wrong. Eithan looks forward to having his day in court."

A Baylor College of Medicine spokesperson confirmed via email that Haim had completed his residency there and referred any questions to Texas Children's Hospital, which did not immediately respond to a request for comment. If convicted, Haim faces up to 10 years in federal prison and a $250,000 maximum possible fine, according to federal prosecutors.

Robertson: Thanks for this update, Jennifer.

Henderson: Sure thing, Rachael.

Robertson: And that's it for today. If you like what you heard, please leave us a review wherever you listen to podcasts, and hit subscribe if you haven't already, we'll see you again soon.

This episode was hosted and produced by me, Rachael Robertson. Sound engineering by Greg Laub. Our guests were 番茄社区 reporters Kristina Fiore, Rachael Robertson, and Jennifer Henderson. Links to their stories are in the show notes.

MedPod Today is a production of 番茄社区. For more information about the show, check out medpagetoday.com/podcasts.

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