�������ýҕ�l

Nine years ago, Dr. Gordon Schiff, a physician at Brigham and Women’s Hospital, offered a patient a medicine that his textbooks had never mentioned: $30 in cash. Schiff had learned that his patient could not afford the out-of-pocket cost to fill his prescription and didn’t have the time to deal with insurance. So Schiff figured cash from his own pocket would help his patient find quicker relief. But the trainee shadowing Schiff disagreed, and reported him for being “unprofessional.” (Julia Hotz, 3/24)

Often, the fate of Roe v. Wade looms over the confirmation hearing of any prospective Supreme Court justice. This time feels different. This week, Ketanji Brown Jackson takes questions from the Senate Judiciary Committee as the Supreme Court continues to deliberate whether it will undermine the fundamental right to abortion when it rules on a Mississippi statute that bans abortions after 15 weeks of pregnancy. (Mary Ziegler and Aziza Ahmed, 3/23)

Before prescribing medication abortion, clinicians have been compelled to perform a pelvic examination or ultrasonography for gestational dating to adhere to the requirements of the US Food and Drug Administration (FDA) Risk Evaluation and Mitigation System (REMS) program for dispensing mifepristone. These examinations require an in-person clinic visit, which can be logistically burdensome and limit access to care. In this issue of JAMA Internal Medicine, Upadhyay et al1 provide evidence that medication abortion using mifepristone and misoprostol is safe and effective for pregnancy termination without requiring an in-person clinical evaluation. These data should reassure clinicians and FDA evaluators that allowing history-based screening in lieu of in-person examinations is appropriate and evidence based. (Jennifer Karlin, MD, PhD and Jamila Perritt, MD, MPH, 3/21)

Most people would agree that a well-trained physician — or nurse, patient care tech or any other healthcare professional — should be prepared to give people effective care regardless of gender, race or age. That’s Inclusivity 101. But for too many in healthcare, Inclusivity 101 leaves out a very large group: people with disabilities. With between 20% and 25% of Americans living with a disability, it’s time for medical education to become fully inclusive. (Kara Ayers, Karen Kostelac and Susan Havercamp, 3/23)

In his State of the Union address, President Biden expressed concern with the growing — and troubling — trend of private equity ownership and operation of nursing homes and the inherent risk it presents to care of their residents. Between 2010 and 2019, such equity deals in health care nearly tripled in value, from $42 billion to $120 billion, totaling $750 billion over the last decade. That staggering number represents thousands of hospitals, nursing homes, travel nurse companies, behavioral health programs, and other health care settings in every state. The profit-making goals of private equity are, in many ways, at odds with the needs of patients and the rules of government-financed health care programs. In fact, since 2013, private equity-owned health care companies have paid more than $500 million to settle claims of overcharging government health care programs. (Jeanne A. Markey and Raymond M. Sarola, 3/24)