A STAT Investigation: Pain, loss, and coercive care

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Good morning! It’s 11/11. At 11:11, make a wish!

But actually: What can Trump & RFK Jr. realistically do?

After years of being sidelined by a Democratic majority, Republicans and President-elect Donald Trump have a long list of changes they want to make to public health agencies. My colleagues assessed how much change will be possible on some of the party’s key priorities. Here’s a preview:

• On vaccines: Robert F. Kennedy Jr. and others in Trump’s orbit have long publicly questioned vaccines. But what could the government actually do? Agencies could be leveraged to slow approvals and advisory committee slots could be filled with fellow skeptics. The simplest thing a Trump-empowered RFK Jr. could do is continue to cast unfounded doubt over the safety and efficacy of vaccines, STAT reporters write.

• On health and science agencies: If Republicans take control of both the House and the Senate, pathways open up for reforms they pushed earlier this year, like restructuring NIH, slashing CDC funds and eliminating “duplicative” programs.
• On pandemic preparedness: Trump has promised he would disband the White House Office of Pandemic Preparedness and Response, but that would take congressional action. Still, there are informal ways to undermine the office, like sending officials on loan from other departments back to their regular positions.

Read more on what’s possible around pharma drug ads, fluoride, reproductive care, and addiction.

Two new reproductive care studies

JAMA Network Open published two studies on reproductive care that caught my eye Friday. Here’s a rundown:

• Pregnant women and those in the first year after pregnancy are killed at higher rates when state laws prohibit finalizing a divorce during pregnancy, according to a study of the CDC’s National Violent Death Reporting System from 2018 to 2021. (Three states — TX, MO, and AR — currently have these divorce laws.) That increase in deaths was statistically significant for intimate partner homicides.
• An estimated 42% of people seeking abortions incurred “catastrophic health expenditures” because of it, according to a study of 675 patients from before Roe v. Wade was overturned. “Catastrophic” here means that the expenses hindered a person’s ability to meet their basic needs. When people had to go out of state to get an abortion, 65% were dogged by these high costs — a challenge that’s especially relevant now as more states issue abortion bans.

LA hospital tests AI to translate discharge notes into Spanish

When a patient is ready to leave the hospital, their discharge notes are the important instructions they take home on how to care for themselves and when to follow up with a doctor. These are issued in English — for most hospitals, it can take hours or even days to translate these notes. Now, Children’s Hospital Los Angeles is beginning to pilot a program using generative AI to translate them in seconds for Spanish-speaking patients.

The hospital’s language and cultural services team, which had long had reservations about machine translation performance, tested the Spanish translations on de-identified discharge notes. “I’ve seen atrocious translations before,” said Troy McGuire, CHLA’s chief health information officer. “This really is, I think, the first time that I would have been on board with the quality” of a machine translation tool.

Read more in the exclusive story from STAT’s Katie Palmer.

Sickle cell, loss, and survival in America

Tammy Clemons was in the hospital again, a place where she’d spent too much of her life already. This time, when a nurse asked her what level her pain was, Clemons said eight — like her insides no longer wanted to be a part of her and were trying to get out.

The pain had started while she was at work, at the beauty supply store. A customer had asked for some extensions, but when Clemons had reached up with the grabber, a sharpness in her belly made her gasp. She’d been living with sickle cell disease for decades at that point, and the pain it caused her was just one of life’s heartbreaks. She’d never have kids thanks to a tubal ligation she got as a teenager on a doctor’s recommendation. But there was also the death of her brother, her grandmother.

Read more about Clemons and her experience with sickle cell disease in Part 5 of Eric Boodman’s Coercive Care series. And if you haven’t read the first four parts, please do. Eric writes vividly about how doctors push sickle cell patients into unwanted sterilizations and reports on new data showing how prevalent sterilizations are among these patients; about how, when they do get pregnant, patients can be pushed toward or against abortions; and about the federal rule that fails to protect patients.

911 operators could eliminate bystander CPR disparities

Bad news: When a woman’s heart suddenly stops beating, she is less likely to receive CPR from a bystander than a man is. Good news: The disparity is eliminated when a 911 operator guides a caller through the steps.

That’s according to new research being presented today at the American Heart Association’s Resuscitation Science Symposium. Researchers at Duke University School of Medicine analyzed nearly 2,400 emergency calls for cardiac arrest in North Carolina. CPR was administered in about half of all calls. When it was, 911 operators assisted 81% of the time.

Previous research has shown that the fear of being perceived as touching someone inappropriately and concerns about harming someone frail contribute to hesitancy to do CPR on women. But when bystanders are guided by 911 operators, both men and women receive CPR much more often. The study authors hope that their findings offer insight to improve the low rate of people who survive cardiac arrest when it occurs outside a hospital, per a press release.

More puzzling heart health disparities

STAT’s Liz Cooney highlights four new papers that reiterate how people in different socioeconomic groups have differing health outcomes.

Here’s what researchers found: Cardiac care before delivery helped white but not Black mothers with preeclampsia. Black veterans were less likely to be prescribed weight loss drugs than white ones. Social needs keep heart failure patients from getting the benefits of “quadruple therapy,” meaning all four forms of guideline-directed medical therapy. And cardiology fellows have mixed reviews on their programs’ DEI efforts.

Read more from Liz about those studies, which will also be presented at AHA scientific sessions later this week.

What we’re reading

• Study maps how nonprofit religious groups set up facilities near abortion clinics, NBC News

• Clinicians who provide trans health care brace for the Trump era, STAT

• For older, unmarried couples, caregiving obligations can be murky, New York Times

• 12 states promised to open the books on their opioid settlement funds. We checked up on them, KFF Health News
• RFK Jr. is crowdsourcing reams of nominees for Trump’s health administration, STAT