Curious Bioethics March 6-11, 2023
International Women's Day, Transgender history, Walgreens abortion pill fallout
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In today’s curated collection, you’ll find:
Bioethics in the News: Covid is still here, International Women’s Day, Walgreen’s abortion pill fallout, insulin prices finally drop
What I’m Reading: transgender history, environmental health ethics
Educational Opportunities: liberation education for us all, an update on ProPublica abortion webinar
COVID-19
Hard to believe yesterday was the 3rd anniversary of the World Health Organization first calling the outbreak a pandemic on March 11, 2020. Globally, nearly 7 million people have died. On Friday, Johns Hopkins University stopped adding data to its trusted tracking website. While lots of governments, organizations, and people have moved on, the virus is here to stay.
Bioethics in the News:
Healthcare workers and law enforcement
This week, after a woman was arrested for a self-managed abortion, probably reported by healthcare workers, I wrote, “We are not cops” on Twitter. Early next week, be on the look out for my deeper dive into the issue of healthcare workers and patient confidentiality in your inbox.
International Women’s Day
The first International Women's Day was observed in Europe in March 1911. More than 1 million people attended rallies calling for women to have the right to regular stuff like work, vote, and hold public office. It’s been over 100 years, and we still have a lot of work to do toward basic equity for women.
If we’re not fighting for all women, we are fighting for no women. Yes, it’s been a very rough year for women worldwide, including here in the US.
In Afghanistan, the Taliban continues to impose further restrictions on women’s societal roles. Women are no longer allowed to attend universities or work with international groups.
In the U.S., since the fall of Roe, abortion has been severely restricted or banned in 15 states. The Guttmacher Institute is my go-to source for up-to-date info used to make maps like this one:
This week alone has been painful:
Florida intends to ban abortion at 6-weeks
Tennessee doesn’t want to have to give marriage licenses to people it doesn’t like
Iowa and Arkansas join way too many other states in preventing transgender children from access to safe, evidence-based care.
Walgreens
Last week, I told you about Walgreen’s move to not sell abortion pills after legal threats from 21 Republican attorneys general, even in states where the treatment is still legal. On Monday, Governor Newsom said California would no longer do business with Walgreens. California's $54 million contract may be effective in getting Walgreens and other chain pharmacies to rethink their relationship to abortion care gatekeeping.
Eli Lilly finally cuts insulin prices
Skyrocketing insulin prices have been killing patients for years as patients have been forced to ration the drug against other costs (like rent and food).
But that’s not why Lilly is lowering the price of Humalog by 70% toward the end of 2023.
The 1990 Medicaid Drug Rebate Program requires drugmakers to pay a rebate to state and federal governments. This offsets the cost of outpatient prescription drugs for low-income patients. In the past, the rebate was capped at 100% of the average price for the drug. But the 2021 American Rescue Plan removes the cap in 2024 - this means manufacturers like Lilly might be forced to pay rebates for drugs that cost more than what states pay for them.
So, Eli Lilly's decision to cut insulin prices now will allow it to avoid paying large Medicaid rebates next year.
If you’re interested in understanding the history of insulin (discovered way back in the 1920s) and how the cost enormous cost makes abso-tutin-lutly no sense, check out Michael Bliss’ book The Discovery of Insulin. An ICU attending gave me a copy of the book as a birthday present in my last month as an intern. It’s an easy read, and forever shaped my understanding of the business of medicine.
What I’m reading this week
Transgender History
How is hatred born? How does it grow? What does it look like when we still have time to stop it’s death march?
The answer is sobering. It looks like now. And we are running out of time.
- Brandy L Schillace
I highly recommend
's essay on the growing attacks on transgender people's ability to exist, and her 2021 Scientific American piece on the rise and fall of the first transgender clinic. (Brandy’s upcoming book on the history, present, and future of transgender care can’t come out soon enough, but alas, we have to wait.)
Environmental Ethics
Caroline Chen and colleagues at Politico wrote that “the next deadly pandemic is just a forest clearing away. But we’re not even trying to prevent it.” The essay outlines how deforestation impacts disease spread, especially spillover diseases from infected animals. I found it through reading Chen’s Twitter thread ⤵️
Environmental politics significantly impact health. Amee Vanderpool at
wrote about toxic forever chemicals and the lobbying that keeps these poisons in our food and water.This year the Environmental Protection Agency (EPA) determined that virtually no minimum level of exposure to two types of PFAS compounds in drinking water is safe, and public health advocates say the entire chemical class is toxic and dangerous. The chemical industry records billions of dollars in PFAS sales annually, so the direct opposition to establishing protectionist laws that would curtail sales for companies like Dupont and 3M, has been high.
Grief Work
If you enjoyed my review of Laurel Braitman’s new book What Looks Like Bravery, you will love Anne Helen Petersen’s
interview with my darling friend. While not an ethics book per se, Laurel captures the intersection of healthcare, death, and grief with urgent honesty. With the world eager to forget about Covid and it’s millions of tragedies, we are all at risk of our unmitigated trauma coming to bite us in the butt over and over. Her words are a call to action to heal ourselves and each other as best we can.Educational Opportunities
Embodied Social Justice Certificate Program
“Without inner change there can be no outer change.
Without collective change, no change matters.”
— REV ANGEL KYODO WILLIAMS
A one-of-a-kind, 3-month certificate program committed to collective liberation, increasing awareness and unlearning of oppressive social structures, and repairing belonging. I discovered this on the fabulous
newsletter (definitely worth a subscription - Kerri's resources are incredible every single week).3-Month Online Certificate Program, April 3 - June 30, 2023
Learn more and enroll here.
ProPublica Post-Roe: Today’s Abortion Landscape
This event was rescheduled to March 21 - sign up here for access.
That’s it!
As always, thanks for being curious!
Hit reply and let me know what ethics issues you are most curious about this week—I’d love to hear from you!
See you next week!
Be Well & Be Curious,
Alyssa