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Can pharmacists refuse to fill prescriptions for drugs that can be used in abortions?



Under this Supreme Court, patients could struggle to obtain lifesaving drugs like methotrexate

Methotrexate is a fairly common drug that treats a wide range of medical conditions. I take it to help control an autoimmune disorder. So do about 60 percent of rheumatoid arthritis patients. It is used to treat some cancers, such as non-Hodgkin lymphoma. It also has at least one other important medical use.

The drug is the most common pharmaceutical treatment for ectopic pregnancies, a life-threatening medical condition where a fertilized egg implants somewhere other than the uterus — typically a fallopian tube. If allowed to develop, this egg can eventually cause a rupture and massive internal bleeding. Methotrexate prevents embryonic cell growth, eventually terminating an ectopic pregnancy.

And so many patients who take methotrexate say they have become the latest victims of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization — the decision overruling Roe v. Wade.

It’s unclear how widespread this phenomenon is, though the problem is serious enough that the Arthritis Foundation put out a statement warning that “arthritis patients who rely on methotrexate are reporting difficulty accessing it,” and that “at least one state — Texas — allows pharmacists to refuse to fill prescriptions for misoprostol and methotrexate, which together can be used for medical abortions.”

In some cases, pharmacists are reportedly reluctant to fill methotrexate prescriptions in states where abortion is illegal, and doctors are similarly reluctant to prescribe it. In other cases, pharmacists may refuse to fill valid methotrexate prescriptions because they personally object to abortion, even in states where the procedure remains legal.

The phenomenon of patients struggling to obtain therapeutic drugs that can be used in abortion care appears to be severe enough that, on Wednesday, President Joe Biden’s administration released a four-page “Guidance to Nation’s Retail Pharmacies.” It informed them that federal laws prohibiting discrimination on the basis of disability or pregnancy may require pharmacists to fill prescriptions for drugs like methotrexate. (The question of whether a particular denial by a particular pharmacist violates federal law will depend on the specifics of the case.)

Ultimately, however, laws are only as good as the courts that interpret them. And disputes over whether states can ban mifepristone, or whether pharmacists can simply refuse to dispense certain drugs, are likely to be resolved by the same justices who gave us Dobbs.

At best, that means a lot of confusion for patients until the courts sort these issues out. And, given this Court’s hostility toward abortions and sympathy for religious conservatives, it is likely that many patients will be denied prescription drugs.

Federal civil rights law probably requires pharmacists to dispense lawful drugs, but this Supreme Court is likely to give an exemption to religious conservatives.

It is always dangerous to predict what kind of laws may emerge from the fever swamps of the Texas state legislature. But red states are probably less likely to enact a blanket ban on drugs like methotrexate, which have many therapeutic uses unrelated to abortion, than they are to ban drugs like mifepristone that are primarily used in abortion care.

Even if drugs like methotrexate remain legal in all 50 states, however, individual pharmacists may refuse to dispense them, and doctors may be reluctant to prescribe them — out of a misguided belief that the drug is illegal, a fear of being targeted by overzealous prosecutors, or a religious or moral objection to abortion.

In its Wednesday guidance, the Biden administration argues that federal civil rights laws prohibiting “discrimination on the basis of sex and disability” may require pharmacists to dispense certain drugs even after Dobbs. The primary anti-discrimination law governing health care, which was enacted as part of the Affordable Care Act, prohibits discrimination by “any health program or activity” that receives federal funding through a program like Medicare or Medicaid. So most doctors, hospitals, and pharmacies are covered by this law.

Suppose, for example, that “an individual experiences severe and chronic stomach ulcers, such that their condition meets the definition of a disability under civil rights laws.” If a doctor prescribes the drug misoprostol, which is used to prevent stomach ulcers but is also used in medication abortions, then a pharmacy “may be discriminating on the basis of disability” if it refuses to dispense this drug “because of its alternative uses.”

Similarly, the guidance argues that a pharmacist may violate federal sex discrimination laws, which also prohibit discrimination on the basis of pregnancy, if it refuses to dispense methotrexate to a patient with an ectopic pregnancy.

Even if federal civil rights law does require pharmacists to dispense these and similar drugs, however — and that question will need to be litigated — it is likely that this Supreme Court will permit pharmacists with religious objections to those drugs to ignore federal law.

In June 2016, the Supreme Court announced that it would not hear Stormans v. Wiesman — a case involving a pharmacy that refused to dispense emergency contraception, in violation of a state regulation, because the owners objected to this form of contraception on religious grounds. The timing of this refusal to hear the case was significant: Justice Antonin Scalia had died just a few months earlier, depriving the Court’s Republican appointees of the majority they’d enjoyed for many years.

Without the votes he needed to take up the case, Justice Samuel Alito wrote an absolutely livid dissent in Stormans, accusing the state of “hostility to pharmacists whose religious beliefs regarding abortion and contraception are out of step with prevailing opinion in the State.” Notably, Alito’s opinion was joined by Chief Justice John Roberts, the most moderate member of the Court’s current six-justice conservative majority.

It is exceedingly likely, in other words, that if a similar case were to arise today — perhaps a case involving a pharmacist who objects, on religious grounds, to dispensing drugs like methotrexate, mifepristone, or misoprostol — that this Supreme Court would side with the pharmacist. It’s also likely that this Supreme Court would show similar solicitude to a doctor or other health provider who refuses to prescribe a medication because of a religious objection.

In a densely populated city, that kind of decision is likely to inconvenience many patients, who might have to walk several blocks to a different pharmacy in order to get their prescription filled. But in rural areas where patients could have to drive to another town to find another pharmacist, one pharmacist’s refusal to fill their prescription could be a very serious imposition — and that’s assuming that the pharmacist in the next town doesn’t also have religious objections to certain drugs.

In sparsely populated areas, in other words, patients are not only likely to struggle to find abortion care. Patients with common conditions like rheumatoid arthritis or psoriasis may also struggle to fill their prescriptions, even if they take these drugs for reasons that have nothing to do with a pregnancy.

Culled from The Vox

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Houston Health care clinic and home health owners sentenced for fraud



Alatan was the owner of Colony Home Health Services, while Ekene was the owner of Milten Medical Clinic, both businesses located in Houston.

HOUSTON, TX — Two individuals have been ordered to federal prison following their convictions of conspiracy to commit and committing health care fraud, announced U.S. Attorney Jennifer B. Lowery.

A federal jury convicted Francis Ekene, 71, Sugar Land, on all counts following a three-day trial.

Today, U.S. District Judge Sim Lake imposed a 120-month-term of imprisonment to be immediately followed by three years of supervised release. In handing down the prison term, Judge Lake noted that despite his health issues, it was important for him to serve his punishment.

Also convicted at trial was Alfred Olotin Alatan, 63, formerly of Houston and now residing in Fulshear. He was previously sentenced to 120 months in prison.

Alatan was the owner of Colony Home Health Services, while Ekene was the owner of Milten Medical Clinic, both businesses located in Houston.

At trial, the jury heard that Alatan paid recruiters to bring patient information to be billed for home health services regardless of whether they needed it or not. Beneficiaries testified in trial and admitted they did not need home health services at the time the health care service providers billed them.

Additional testimony revealed a doctor had signed off on plan of care forms at the Milton Clinic when patients were not actually under his care.

Previous employees Susana Bermudez and Rita Kpotie Smith also testified. Bermudez admitted she and Smith operated both clinics and that Alatan was the leader of the scheme. Both Alatan and Ekene would consult Bermudez and Smith who directed them and provided assistance in carrying out the scheme within both offices.

At trial, the defense attempted to convince the jury they were not involved in the daily operations and did not know the provided services were unnecessary and fraudulent.

Alatan and Ekene were permitted to remain on bond and voluntarily surrender to a U.S. Bureau of Prisons facility to be determined in the near future.

Bermudez and Smith, both 55, and of Houston, previously pleaded guilty to their roles as co-conspirators in the scheme. Bermudez is currently serving 30 months in federal prison, while Smith is serving is serving a 60-month sentence.

The Department of Health and Human Services – Office of Inspector General conducted the investigation with the assistance of the FBI. Assistant U.S. Attorneys Tina Ansari and Grace Murphy prosecuted the case along with paralegal Judith Cardona assisted with the case.

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Why Africans and Americans Africans Must Participate in Clinical Research Trials



Clinical research trial is a vital component of medical research, as it invests significant resources emphasizing on disease prevention, treatment comparisons, identifying people who are at risk for developing a type of disease, or testing a treatment for a rare/emerging disease.

Clinical Research has been known to improve clinical outcomes, giving birth to major medical and technological advancements that have tremendously improved our overall quality of life.

Clinical research trials test the effectiveness and safety of new medicines or treatments. Some breakthroughs and advancements through clinical research include the development of new medications and treatments options for diseases, new diagnostic approaches, and new ways of reducing disease risk factors.

In my recent journey into clinical research investigation, I have observed that African American immigrants are yet to embrace the essence of clinical research studies.

While several studies have shown that the most common barriers to African Americans’ involvement in clinical research included mistrust in the system due to lack of information, and a fear that history may repeat itself, personal stories abound as to the safety and potential benefits of including this population in research studies.

Some other barriers include societal, educational, cultural, and financial reasons.

Could this be different for the immigrant African American?

Immigrant African Americans are known to be some of the most educated immigrants in the United States, and part of the education centers around understanding the essence of research, and participating in it.

Immigrant African-Americans suffer significantly from diabetes, cancer, hypertension, and heart diseases when compared with their Caucasian or Asian counterparts, but they are frequently marginalized and underrepresented in clinical trials of these diseases.

What we must understand is that, it is impossible to generalize the results of any study, without considering samples from different populations that will potentially be affected by the results of such studies.

Efforts to improve enrollment of immigrant African-American subjects entail that we all recognize the numerous medical problems that require totally new treatment approaches, or a modification to existing modalities.

The incidence of heart disease, prostate cancer, ovarian cancer, diabetes and several other viral diseases in immigrant African-Americans necessitates that this population be specifically involved in clinical trials for medical and surgical research purposes.

I am therefore calling upon all immigrant African Americans, and Africans all over the world, to participate in clinical research trials happening around them, so as to be well represented, and considered in the medical advancements, and production of pharmaceutical products made for diseases that could potentially affect us.

♦ Edith Nkem Declan an Adjunct Nursing Professor and Clinical Research Nurse Practitioner, based in Houston Texas.

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Nigeria plans to set up a healthcare fund to cover up to 83 million poor people



Nigeria plans to set up a healthcare fund to cover up to 83 million poor people who cannot afford premiums for insurance schemes, President Muhammadu Buhari said at the signing of a universal health coverage law.

Nigeria, with its 200 million population, is struggling to reform its healthcare to improve the sector but funding has been a major constraint coupled with the COVID-19 pandemic that has stretched its inadequate workforce.

The West African country has 0.4 doctors per 1,000 people, as per World Bank’s latest data, less than the global average of 1.8 doctors. It also has a fledgling health insurance sector which has struggled to increase enrolees.

Buhari on Thursday signed a National Health Insurance Authority Bill into law seeking to provide universal healthcare access, his office said in a statement.

Analysts have questioned where funding for the new law will come from. Nigeria has struggled to fund its large deficit budget as spending ballooned with subsidies on imported petrol and debt service gulping up bulk of government revenue.

“For the large number of vulnerable individuals who are not able to pay health insurance premiums, a vulnerable group fund will be set up,” Buhari said.

The fund will have a basic healthcare provision fund, health insurance levy, special intervention fund, and any investment proceeds, donations and gifts to the health authority, Buhari added.

Africa’s most populous country faces a shrinking labour market, double-digit inflation and low growth in the face of mounting insecurity. So far, schemes have been funded mainly from contributions from millions working for the government or big companies.

But there are untapped opportunities in the informal sector, analysts say, adding that the schemes needed to overcome challenges associated with healthcare pricing and reimbursements to hospitals and patients to make a profit.

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