Health
After Roe, Pregnant Women With Cancer Diagnoses May Face Wrenching Choices
In April of final yr, Rachel Brown’s oncologist referred to as with unhealthy information — at age 36, she had an aggressive type of breast most cancers. The very subsequent day, she discovered she was pregnant after almost a yr of making an attempt together with her fiancé to have a child.
She had at all times stated she would by no means have an abortion. However the decisions she confronted have been wrenching. If she had the chemotherapy that she wanted to stop the unfold of her most cancers, she may hurt her child. If she didn’t have it, the most cancers may unfold and kill her. She had two kids, ages 2 and 11, who may lose their mom.
For Ms. Brown and others within the unfortunate sorority of ladies who obtain a most cancers prognosis when they’re pregnant, the Supreme Court docket determination in June, ending the constitutional proper to an abortion, can appear to be a slap within the face. If the lifetime of a fetus is paramount, a being pregnant can imply a lady can’t get efficient remedy for her most cancers. One in a thousand ladies who will get pregnant every year is recognized with most cancers, which means hundreds of ladies are going through a critical and probably deadly illness whereas they’re anticipating a child.
Earlier than the Supreme Court docket determination, a pregnant girl with most cancers was already “getting into a world with super unknowns,” stated Dr. Clifford Hudis, the chief government officer on the American Society of Scientific Oncology. Now, sufferers in addition to the docs and hospitals that deal with them, are caught up within the added issues of abortion bans.
“If a health care provider can’t give a drug with out worry of damaging a fetus, is that going to compromise outcomes?” Dr. Hudis requested. “It’s an entire new world.”
Most cancers medicine are harmful for fetuses within the first trimester. Though older chemotherapy medicine are secure within the second and third trimesters, the security of the newer and simpler medicine is unknown and docs are reluctant to provide them to pregnant ladies.
About 40 % of ladies who’re pregnant and have most cancers have breast most cancers. However different cancers additionally happen in pregnant ladies, together with blood cancers, cervical and ovarian most cancers, gastrointestinal most cancers, melanoma, mind most cancers, thyroid most cancers and pancreatic most cancers.
Girls with some sorts of most cancers, like acute leukemia, usually can’t proceed with a being pregnant if the most cancers is recognized within the first trimester. They must be handled instantly, inside days, and the mandatory medicine are poisonous to a fetus.
“For my part, the one medically acceptable possibility is termination of the being pregnant in order that lifesaving remedy might be administered to the mom,” stated Dr. Eric Winer, the director of the Yale Most cancers Heart.
Some oncologists say they aren’t certain what’s allowed if a lady lives in a state like Michigan, which has criminalized most abortions however allows them to save the lifetime of the mom. Does leukemia qualify as a cause for an abortion to avoid wasting her life?
“It’s so early we don’t know the reply,” stated Dr. N. Lynn Henry, an oncologist on the College of Michigan. “We will’t show that the medicine brought about an issue for the newborn, and we are able to’t show that withholding the medicine would have a unfavourable end result.”
In different phrases, docs say, issues from a being pregnant — a miscarriage, a untimely beginning, beginning defects or demise — can happen whether or not or not a lady with most cancers takes the medicine. If she just isn’t handled and her most cancers gallops right into a malignancy that kills her, that too may need occurred even when she had been given the most cancers medicine.
Directors of the College of Michigan’s medical system aren’t intervening in most cancers remedy selections about deal with cancers in pregnant ladies, saying “medical determination making and administration is between docs and sufferers.”
I. Glenn Cohen, a regulation professor and bioethicist at Harvard, is gravely involved.
“We’re placing physicians in a horrible place,” Mr. Cohen stated. “I don’t suppose signing as much as be a doctor ought to imply signing as much as do jail time,” he added.
Oncologists often are a part of a hospital system, Mr. Cohen stated, which provides an additional complication for docs who deal with cancers in states that ban abortions. “No matter their private emotions,” he requested, “what are the dangers the hospital system goes to face?”
“I don’t suppose oncologists ever thought at the present time was coming for them,” Mr. Cohen stated.
Behind the confusion and concern from docs are the tales of ladies like Ms. Brown.
She had a big tumor in her left breast and most cancers cells in her underarm lymph nodes. The most cancers was HER2 optimistic. Such cancers can unfold rapidly with out remedy. About 15 years in the past, the prognosis for girls with HER2 optimistic cancers was among the many worst breast most cancers prognosis. Then a focused remedy, trastuzumab, or Herceptin, utterly modified the image. Now ladies with HER2 tumors have among the many greatest prognoses in contrast with different breast cancers.
However trastuzumab can’t be given throughout being pregnant.
Ms. Brown’s first go to was with a surgical oncologist who, she stated, “made it clear that my life can be in peril if I stored my being pregnant as a result of I wouldn’t be capable to be handled till the second trimester.” He instructed her that if she waited for these months handed, her most cancers may unfold to distant organs and would change into deadly.
Her remedy within the second trimester can be a mastectomy with removing of all the lymph nodes in her left armpit, which might have raised her threat of lymphedema, an incurable fluid buildup in her arm. She may begin chemotherapy in her second trimester however couldn’t have trastuzumab or radiation remedy.
Her subsequent seek the advice of was with Dr. Lisa Carey, a breast most cancers specialist on the College of North Carolina, who instructed her that whereas she may have a mastectomy within the first trimester, earlier than chemotherapy, it was not optimum. Ordinarily, oncologists would give most cancers medicine earlier than a mastectomy to shrink the tumor, permitting for a much less invasive surgical procedure. If the remedy didn’t eradicate the tumor, oncologists would attempt a extra aggressive drug remedy after the operation.
But when she had a mastectomy earlier than having chemotherapy, it might be unimaginable to know if the remedy was serving to. And what if the medicine weren’t working? She nervous that her most cancers may change into deadly with out her realizing it.
She feared that if she tried to maintain her being pregnant, she would possibly sacrifice her personal life and destroy the lives of her kids. And if she delayed making her determination after which had an abortion later within the being pregnant, she feared that the fetus would possibly really feel ache.
She and her fiancé mentioned her choices. This being pregnant can be his first organic little one.
With monumental unhappiness, they made their determination — she would have a medicine abortion. She took the drugs one morning when she was six weeks and at some point pregnant, and cried all day. She wrote a eulogy for the newborn who may need been. She was satisfied the newborn was going to be a woman, and had named her Hope. She saved the ultrasound of Hope’s heartbeat.
“I don’t take that little life flippantly,” Ms. Brown stated.
After she terminated her being pregnant, Ms. Brown was capable of begin remedy with trastuzumab, together with a cocktail of chemotherapy medicine and radiation. She had a mastectomy, and there was no proof of most cancers on the time of her surgical procedure — an amazing prognostic signal, Dr. Carey stated. She didn’t have to have all of her lymph nodes eliminated and didn’t develop lymphedema.
“I really feel prefer it has taken lots of braveness to do what I did,” Ms. Brown stated. “As a mom your first intuition is to guard the newborn.”
However having gone by way of that grueling remedy, she additionally questioned how she may ever have dealt with having a new child child and her two different kids to take care of.
“My bones ached. I couldn’t stroll quite a lot of steps with out being out of breath. It was laborious to get vitamins due to the nausea and vomiting,” she stated.
The Supreme Court docket determination hit her laborious.
“I felt like the explanation I did what I did didn’t matter,” she stated. “My life didn’t matter, and my kids’s lives didn’t matter.”
“It didn’t matter if I misplaced my life as a result of I used to be being pressured to be pregnant,” she stated.
A federal prosecutor in Washington has contacted The New England Journal of Medicine, considered the world’s most prestigious medical journal, with questions that suggested without evidence that it was biased against certain views and influenced by external pressures.
Dr. Eric Rubin, the editor in chief of N.E.J.M., described the letter as “vaguely threatening” in an interview with The New York Times.
At least three other journals have received similar letters from Edward Martin Jr., a Republican activist serving as interim U.S. attorney in Washington. Mr. Martin has been criticized for using his office to target opponents of the administration.
His letters accused the publications of being “partisans in various scientific debates” and asked a series of accusatory questions about bias and the selection of research articles.
Do they accept submissions from scientists with “competing viewpoints”? What do they do if the authors whose work they published “may have misled their readers”? Are they transparent about influence from “supporters, funders, advertisers and others”?
News of the letter to N.E.J.M. was reported earlier by STAT, a health news outlet.
Mr. Martin also asked about the role of the National Institutes of Health, which funds some of the research the journals publish, and the agency’s role “in the development of submitted articles.”
Amanda Shanor, a First Amendment expert at the University of Pennsylvania, said the information published in reputable medical journals like N.E.J.M. is broadly protected by the Constitution.
In most cases, journals have the same robust rights that apply to newspapers — the strongest the Constitution provides, she added.
“There is no basis to say that anything other than the most stringent First Amendment protections apply to medical journals,” she said. “It appears aimed at creating a type of fear and chill that will have effects on people’s expression — that’s a constitutional concern.”
It’s unclear how many journals have received these letters or the criteria that Mr. Martin used to decide which publications to target. The U.S. attorney’s office in Washington did not respond to a request for comment.
“Our job is to evaluate science and evaluate it in an unbiased fashion,” Dr. Rubin said. “That’s what we do and I think we do it well. The questions seem to suggest that there’s some bias in what we do — that’s where the vaguely threatening part comes in.”
Jeremy Berg, the former editor in chief of the journal Science, said he thought the letters were designed to “intimidate journals to bend over backward” to publish papers that align with the administration’s beliefs — on climate change and vaccines, for example — even if the quality of the research is poor.
Robert F. Kennedy Jr., the nation’s health secretary, singled out N.E.J.M in an interview with the “Dr. Hyman Show” podcast last year as an example of a medical journal that has participated in “lying to the public” and “retracting the real science.”
Andrew Nixon, a spokesman for the Health and Human Services Department, declined to comment on whether Mr. Kennedy had any involvement with the letters.
In the interview, Mr. Kennedy said he would seek to prosecute medical journals under federal anti-corruption laws.
“I’m going to litigate against you under the racketeering laws, under the general tort laws,” he said. “I’m going to find a way to sue you unless you come up with a plan right now to show how you’re going to start publishing real science.”
Dr. Jay Bhattacharya, the new director of N.I.H., has vigorously criticized the leadership of scientific journals. Recently he co-founded a new journal as an alternative to traditional scientific publishing. It has published contrarian views on Covid.
Other prominent journals said they had not received the letter. On Friday, The Lancet, which is based in Britain, published a scathing editorial in solidarity, calling the letters “an obvious ruse to strike fear into journals and impinge on their right to independent editorial oversight.”
“Science and medicine in the U.S.A. are being violently dismembered while the world watches,” the editorial said.
One of Mr. Martin’s letters was sent to the journal Chest, a low-profile publication that publishes highly technical studies on topics like lung cancer and pneumonia. The New York Times reported last week that at least two other publishers had received nearly identically worded letters.
They declined to speak publicly for fear of retribution from the Trump administration.
Dr. Rubin said he, too, was worried about political backlash. Scientific journals rely on public funds in several indirect ways — for example, universities often use federal grants to pay for subscriptions.
“Are we concerned? Of course we are,” he said. “But we want to do the right thing.”
Mr. Martin gave the journals until May 2 to respond to his questions. N.E.J.M. has already responded to Mr. Martin with a statement that pushes back against his characterization of the journal.
“We use rigorous peer review and editorial processes to ensure the objectivity and reliability of the research we publish,” the statement read. “We support the editorial independence of medical journals and their First Amendment rights to free expression.”
This is not the N.E.J.M’s first brush with a Trump administration.
In 2020, the journal published an editorial condemning the president’s response to the pandemic — the first time the journal had supported or condemned a political candidate in its 208-year history.
Dr. Rubin said he doubted Mr. Martin’s letter was related to the editorial. The journal Chest didn’t write about Trump’s first term yet received a letter, he noted.
Social media can be a great source of fitness, nutrition and wellness tips — but it also has some potentially harmful content.
Enter “SkinnyTok,” a popular weight-loss trend making the rounds on TikTok.
Creators are pairing the hashtag with videos that share various ways to lose weight, many of them based on the goal of getting as thin as possible in a short amount of time.
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As of April 26, there were more than 60,000 videos from creators talking about SkinnyTok. One of those is Mandana Zarghami, 25, a business owner and influencer in Miami, Florida.
“What you eat in private will show in public,” Zarghami told her followers in a recent video.
The influencer spoke with Fox News Digital about her perception of the worldwide SkinnyTok trend.
“There’s an emphasis on portion control, prioritizing daily movement and knowing what foods will make you feel better from the inside out and more,” she said.
The creator acknowledged, however, that some of the content could be triggering for those who have battled disordered eating.
Mandana Zarghami, a TikTok creator, acknowledged that some of the SkinnyTok content could be triggering for those who have battled disordered eating. (Mandana Zarghami/TikTok)
“While some content under the SkinnyTok trend can promote motivation around health and wellness, it can also unintentionally glamorize unhealthy habits or unrealistic body standards if you’re following the wrong influencer or content creator,” Zarghami cautioned.
At the same time, she said, “you control what you consume.”
“What you eat in private will show in public.”
“It’s a little hard to be sensitive to each group, because a lot of the people who talk about SkinnyTok on their platforms also battled disordered eating and overcame it with healthy lifestyle choices,” Zarghami added.
Dr. Brett Osborn, a Florida neurosurgeon and longevity expert, said he has witnessed the “devastating consequences” of extreme thinness firsthand, including women with fractured bones caused by malnutrition.
“This is a growing crisis, and it is being dangerously celebrated on social media under hashtags like #SkinnyTok,” he told Fox News Digital.
“It’s a little hard to be sensitive to each group, because a lot of the people who talk about SkinnyTok on their platforms also battled disordered eating and overcame it with healthy lifestyle choices,” said influencer Mandana Zarghami (right). (iStock/TikTok-Mandana Zarghami)
“When young people chase after extreme thinness through starvation diets, they invite frailty into their lives. The body, deprived of caloric energy, becomes extremely fragile.”
In teenagers and young adults, malnutrition disrupts hormones, weakens immunity, impairs cognitive function and can cause lasting damage to their still-developing brains, according to Osborn.
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Physical effects of malnutrition can include hair loss, reduced bone density and, in severe cases, irreversible structural damage, he added.
Low body weight or minimal body fat does not equate to good health, the doctor said.
“Starvation is not a virtue – it is an abandonment of the body’s nutritional needs,” he said. “The SkinnyTok trend preys on impressionable youth, particularly young women, encouraging them to shrink rather than thrive.”
Low body weight or minimal body fat does not equate to good health, one doctor told Fox News Digital. (iStock)
Rather than focusing on “extreme thinness,” Osborn called for a focus on building muscle, which he described as the “cornerstone of vitality.”
“In older adults, muscle loss — or sarcopenia — is a medical warning sign linked to increased risks of falls, fractures, hospitalizations, cognitive decline and even mortality,” he cautioned.
“Muscle loss doesn’t just weaken the body — it erodes the mind, hastening the onset and progression of dementia. The body and the brain are interconnected, and when one suffers, so does the other.”
“Muscles are your shield against disease and decline. Being lean and strong, not thin and frail, is the true measure of health,” one doctor said. (iStock)
To those embracing the SkinnyTok trend, Osborn recommends that they shift the focus to building muscle.
“Muscles are your shield against disease and decline. Being lean and strong, not thin and frail, is the true measure of health,” he said.
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“Instead of glorifying starvation, we should teach our youth to nourish their bodies and minds, build resilience through muscle gained by strength training, and prioritize bodily function over any short-lived trend.”
Dr. Jillian Lampert, vice president of The Emily Program, an eating disorder treatment center based in Minnesota, also called out the potential risks of the SkinnyTok trend.
“It is a vicious cycle that quickly spirals from external messaging to internal criticism.”
“This content dangerously glorifies content that encourages people to take drastic measures to change their bodies,” she told Fox News Digital. “It also further ensnares people already struggling with their body image and thoughts of size and shape, reinforcing the notion that being thin at all costs is the norm.”
The behaviors in many of the videos are “often extreme” and highly limit foods or food groups, Lampert noted.
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The algorithms used by social media platforms make the content even more dangerous by amplifying the messages, according to the expert.
“Looking at one TikTok with even some less toxic body image content will teach the algorithms to send you more and more and more until your feed has become an avalanche of toxic content,” Lampert warned.
As people scroll through countless videos of “ideal” bodies and lifestyles, this often leads them to conclude that they’re not thin enough or attractive enough.
“This content dangerously glorifies content that encourages people to take drastic measures to change their bodies,” one expert told Fox News Digital. (iStock)
“Continual assessment of appearance and eating habits can make a person hypercritical and hyper-fixated on perceived flaws, thus fueling the cycle of eating less, which often leads to overeating and overexercising, which often leads to fatigue and loss of control around food,” said Lampert.
“It is a vicious cycle that quickly spirals from external messaging to internal criticism.”
Dr. Anastasia Rairigh, a Tennessee-based family physician and obesity medicine specialist at the virtual health platform PlushCare, warned that extreme weight-loss behaviors can be deadly.
“As a person severely limits their caloric intake, the body struggles to maintain the correct electrolyte balance,” she shared with Fox News Digital.
“When a person’s electrolytes are severely unbalanced, they can experience heart arrythmias or, in severe cases, cardiac arrest. Even if a person does not experience this, severe food deprivation can lead to damage to the heart, bones and brain.”
“Many of us that promote SkinnyTok focus on proper nutrition, walking over 10,000 steps a day and promoting a healthy and active lifestyle,” a creator told Fox News Digital. (iStock)
People who deprive themselves of food may also notice effects on cognition, mood and sleep, Rairigh warned.
“Modeling a healthy attitude toward food is critically important to combating the negative influence of toxic diet culture,” she said, recommending that people focus on food as a source of energy rather than an enemy.
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“Supporting young people to focus on activities and interests outside social media has been shown to be helpful as well,” she said.
“Encourage and facilitate positive activities in the real world as a counter to time spent on social media.”
“Modeling a healthy attitude toward food is critically important to combating the negative influence of toxic diet culture.”
Those who are showing signs of disordered eating should see a doctor, Rairigh advised.
“While disordered eating is deadly, there is hope and treatment. Do not be afraid to reach out for help.”
Zarghami, the TikTok creator, reiterated the importance of setting positive examples on social media.
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“Many of us that promote SkinnyTok focus on proper nutrition, walking over 10,000 steps a day and promoting a healthy and active lifestyle,” she told Fox News Digital.
“It’s so important to approach these trends with balance, focus on overall well-being rather than appearance, and encourage sustainable, nourishing choices that support both physical and mental health.”
The opioid overdose reversal medication commercially known as Narcan saves hundreds of thousands of lives a year and is routinely praised by public health experts for contributing to the continuing drop in opioid-related deaths. But the Trump administration plans to terminate a $56 million annual grant program that distributes doses and trains emergency responders in communities across the country to administer them, according to a draft budget proposal.
In the document, which outlines details of the drastic reorganization and shrinking planned for the Department of Health and Human Services, the grant is among many addiction prevention and treatment programs to be zeroed out.
States and local governments have other resources for obtaining doses of Narcan, which is also known by its generic name, naloxone. One of the main sources, a program of block grants for states to use to pay for various measures to combat opioid addiction, does not appear to have been cut.
But addiction specialists are worried about the symbolic as well as practical implications of shutting down a federal grant designated specifically for naloxone training and distribution.
“Reducing the funding for naloxone and overdose prevention sends the message that we would rather people who use drugs die than get the support they need and deserve,” said Dr. Melody Glenn, an addiction medicine physician and assistant professor at the University of Arizona, who monitors such programs along the state’s southern border.
Neither the Department of Health and Human Services nor the White House’s drug policy office responded to requests for comment.
Although budget decisions are not finalized and could be adjusted, Dr. Glenn and others see the fact that the Trump administration has not even opened applications for new grants as another indication that the programs may be eliminated.
Other addiction-related grants on the chopping block include those offering treatment for pregnant and postpartum women; peer support programs typically run by people who are in recovery; a program called the “youth prevention and recovery initiative”; and programs that develop pain management protocols for emergency departments in lieu of opioids.
The federal health secretary, Robert F. Kennedy Jr., has long shown a passionate interest in addressing the drug crisis and has been outspoken about his own recovery from heroin addiction. The proposed elimination of addiction programs seems at odds with that goal. Last year, Mr. Kennedy’s presidential campaign produced a documentary that outlined federally supported pathways out of addiction.
The grants were awarded through the Substance Abuse and Mental Health Services Administration, an agency within the federal health department that would itself be eliminated under the draft budget proposal, though some of its programs would continue under a new entity, the Administration for a Healthy America.
In 2024, recipients of the naloxone grants, including cities, tribes and nonprofit groups, trained 66,000 police officers, fire fighters and emergency medical responders, and distributed over 282,500 naloxone kits, according to a spokesman for the substance abuse agency.
“Narcan has been kind of a godsend as far as opioid epidemics are concerned, and we certainly are in the middle of one now with fentanyl,” said Donald McNamara, who oversees naloxone procurement and training for the Los Angeles County Sheriff’s Department. “We need this funding source because it’s saving lives every day.”
Matthew Cushman, a fire department paramedic in Raytown, Mo., said that through the naloxone grant program, he had trained thousands of police officers, firefighters and emergency medical responders throughout Kansas City and western rural areas. The program provides trainees with pouches of naloxone to administer in the field plus “leave behind” kits with information about detox and treatment clinics.
In 2023, federal figures started to show that national opioid deaths were finally declining, progress that many public health experts attribute in some measure to wider availability of the drug, which the Food and Drug Administration approved for over-the-counter sales that year.
Tennessee reports that between 2017 and 2024, 103,000 lives saved were directly attributable to naloxone. In Kentucky, which trains and supplies emergency medical workers in 68 rural communities, a health department spokeswoman noted that in 2023, overdose fatalities dropped by nearly 10 percent.
And though the focus of the Trump administration’s Office of National Drug Control Policy is weighted toward border policing and drug prosecutions, its priorities, released in an official statement this month, include the goal of expanding access to “lifesaving opioid overdose reversal medications like naloxone.”
“They immediately reference how much they want to support first responders and naloxone distribution,” said Rachel Winograd, director of the addiction science team at the University of Missouri-St. Louis, who oversees the state’s federally funded naloxone program. “Juxtaposing those statements of support with the proposed eliminations is extremely confusing.”
Mr. Cushman, the paramedic in Missouri, said that ending the naloxone grant program would not only cut off a source of the medication to emergency responders but would also stop classes that do significantly more than teach how to administer it.
His cited the insights offered by his co-instructor, Ray Rath, who is in recovery from heroin and is a certified peer support counselor. In training sessions, Mr. Rath recounts how, after a nasal spray of Narcan yanked him back from a heroin overdose, he found himself on the ground, looking up at police officers and emergency medical responders. They were snickering.
“Ah this junkie again, he’s just going to kill himself; we’re out here for no reason,” he recalled them saying.
Mr. Rath said he speaks with trainees about how the individuals they revive are “people that have an illness.”
“And once we start treating them like people, they feel like people,” he continued. “They feel cared about, and they want to make a change.”
He estimated that during the years he used opioids, naloxone revived him from overdoses at least 10 times. He has been in recovery for five years, a training instructor for the last three. He also works in homeless encampments in Kansas, offering services to people who use drugs. The back of his T-shirt reads: “Hope Dealer.”
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