The Supreme Court Overturns Roe v. Wade. What next?
And an update on pig heart implants
Editor’s Letter
2 days ago, the FDA officially decreased the scope of the J&J vaccines. They specifically cited the rare, but serious risk of blood clots as the reason to not recommend it to anyone anymore, unless Pfizer and Moderna are inaccessible or improper for a patient, or a patient specially requests it.
Answering Your Questions about Roe v. Wade
“We hold that Roe and Casey must be overruled. The Constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision....” - Justice Samuel Alito in an initial draft majority opinion
Roe v. Wade will be overturned. On May 2, 2022, Politico released a leaked draft of the majority opinion for Dobbs v. Jackson Women’s Health Organization. The draft, written by Justice Samuel Alito, calls the Roe decision “egregiously wrong from the start”. By overturning Roe v. Wade, the decision the Supreme Court makes in Dobbs v. Jackson will allow states the unfettered right to place abortion restrictions for the first time since 1973. Since the leak, Chief Justice John Roberts has confirmed the authenticity of the draft.
In the United States, the issue of abortion is inseparable from existing political fractures. As a result, much of the conversation about this Supreme Court decision has separated from Roe v. Wade itself and has centered around the political implications of an unprecedented Supreme Court draft leak or on the upcoming midterm elections. While these are undoubtedly important repercussions of this decision, but we at Unmasking Medicine are going to try to focus on the issue from a healthcare perspective. We’re also not going to discuss in detail the legal reasoning behind each decision, which is better outlined in other sources (like this one).
What is Roe v. Wade?
In 1973, the U.S. Supreme Court ruled in Roe v. Wade that a pregnant women had the right to an abortion any time in the first trimester of pregnancy. The landmark decision struck down many existing US state abortion laws and radically changed access to abortive healthcare for American women.
The Supreme Court revisited the Roe v. Wade decision in 1992 with Planned Parenthood v. Casey. Although the Casey decision revised some of Roe v. Wade’s legal rulings, the Supreme Court reaffirmed the constitutional protection of a women’s right to abortion. Since the Supreme Court relies heavily on precedent in its decision making, the Casey decision was thought to be an important step in making Roe v. Wade “settled law”.
At the time of its passing, Roe v. Wade was not particularly popular. Abortion had only just been legalized in 1970 in the states of Hawaii, New York, Alaska and Washington. But in the years since its passing, Roe v. Wade has grown in popularity, becoming a symbol representing the right to abortion. Now, Roe v. Wade is relatively popular, with a poll showing that nearly 2/3 of Americans think the Supreme Court should keep the decision in place.
What’s Gonna Happen?
A final decision on Dobbs v. Jackson Women’s Health Organization is expected by late June or early July of this year. Technically, the justices’ opinions are not yet final, but all signs point to the leaked decision being made in essentially its current state.
There are 26 states are certain or likely to ban abortion if Roe v. Wade is overturned. 22 of these states already have laws in place that make it near-certain that they will ban abortion, including trigger laws, pre-Roe bans on abortion, laws that ban abortion after six weeks (before many people know they are pregnant) and constitutional amendments that prohibit abortion rights (LiveScience). These states include: Alabama, Arizona, Arkansas, Georgia, Idaho, Iowa, Kentucky, Louisiana, Michigan, Mississippi, Missouri, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin and Wyoming. Four additional states - Florida, Indiana, Montana, and Nebraska - also appear likely to restrict abortion.
The extent to which each of these states will actually restrict abortion will vary. But if these states push their abortion bans to the 6-week threshold, it will be a significant change from the 20-week threshold that is the current national standard. At six weeks, most women still do not know that they are pregnant and, if they are, are unable to arrange an abortion in that time frame.
What are some other health implications?
The legal implications of the Dobbs v. Jackson’s Women’s Health Organization decision are still in flux, but many are still worried about his this decision extends to other important constitutional rights surrounding health.
The Roe v. Wade decision heavily relies on an implied constitutional right to privacy. If the Dobbs decision disregards this right to privacy, then other decisions based on this standard are also at risk of being overturned. The Griswold v. Connecticut decision in 1953 guaranteed the right to buy and use contraceptives. While no states have laws lined up to ban contraceptive use, the loss of the constitutional right leaves states to place future restrictions. This decision could even have implications on decisions regarding marriage, like the Obergefell v. Hodges decision in 2015 that legalized gay marriage nationwide (The Guardian).
New restrictions on abortion could also have unexpected consequences on other health issues. IVF, for example, creates many nonviable embryos. If new laws on abortion specify life as beginning at fertilization, these procedures may come under legal fire (SacBee).
Read more:
Politico article, and full draft of the decision
NYT opinion article on the implications of the decision
A Pig Virus May Have Led To The Death Of The First Patient Ever To Receive A Pig Heart
A few months ago we talked about how a genetically modified pig’s heart was used in a human heart transplant and how that was a landmark in medicine. It showed that we could make organs in other animals for transplant to humans thus potentially addressing the organ shortage.
This pig was genetically modified to reduce the chances that the human body would launch an immune reaction against a foreign heart leading to organ rejection. It was grown in a laboratory and closely monitored, however, two months after the patient was transplanted with the heart, the patient died from what is not thought to be a viral infection. Turns out a virus hitched a ride on the heart which later on led to the infection. This virus, called porcine CMV, does not infect human cells but causes inflammation, respiratory distress, and eventually death in pigs. It is believed that this virus caused inflammation and eventually heart failure which led to the death of the patient.
Doctors did see very low levels of porcine CMV post surgery but they were so low that it was dismissed as an error. Since the pig was grown in a sterile lab and had been previously tested, scientists were not expecting it to carry any viruses. So, when they saw a really small level of porcine CMV, they ignored it since it was not expected to be there in the first place. This is actually common practice because laboratory assays have a very difficult time distinguishing between near-zero and true-zero levels of virus.
While this is a set back for animal-to-human organ transplantation, if this death was caused due to an infection, it is something that can be prevented in the future by more rigorously testing these organs. The bright side here is that this was unlikely to be a result of immune rejection which was the primary concern for this field and the doctors. While a failed experiment, it still led to some important findings and pointed out some things that we need to be more aware of before popularizing these transplants.
Source:
The Guardian
Featured Fake News
So this has been circulating lately:
It’s actually not an edited photo, which means someone did make this statement. However, it is old, outdated, and missing a lot of context. For one, this isn’t a statement made by Pfizer.
The screenshot is actually from Britain’s Medicines and Healthcare Products Regulatory Agency (MHRA) and it’s not recent. It’s from 2020 when the vaccines were still in their nascent stages and when everyone was being very cautious with them. Everyone was waiting on more data.
Today, the MHRA still doesn’t fully recommend the vaccine to pregnant women either, but they are not as against it as they were in this screenshot. The vaccine is now recommended when the potential benefits outweigh the risks. Animal study data has indicated that the use of vaccines in pregnant women is mostly risk-free. When even more data rolls out, they will likely update their opinions.
That shouldn’t be too far away either, as recently a spokesperson for the MHRA wrote the following to Reuters by email:
“Since then new data which has come to light (both non-clinical and post-authorisation ‘real world’ data) supports the updated advice on vaccinating those who are pregnant and breastfeeding.
Over 104,000 pregnant people have received at least one dose of COVID-19 vaccine in England and Scotland and no concerns of the safety of the vaccines have been raised.”
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