Health
Supreme Court Weighs South Carolina’s Bid to Defund Planned Parenthood
The Supreme Court heard arguments on Wednesday in a case arising from South Carolina’s attempt to deny funding to Planned Parenthood. But the question the justices grappled with was a relatively narrow one, focused on whether individuals may sue the state to obtain medical services from Planned Parenthood unrelated to abortion.
In 2018, Gov. Henry McMaster of South Carolina, a Republican, ordered state officials to deny Medicaid funds to Planned Parenthood, saying that “payment of taxpayer funds to abortion clinics, for any purpose, results in the subsidy of abortion and the denial of the right to life.”
Medicaid gives federal money to states to provide medical care for poor people, but it sets some conditions. One is that eligible participants may receive assistance from any provider qualified to perform the required services.
Abortions are banned in South Carolina after six weeks of pregnancy, and, even then, federal law prohibits the use of Medicaid funding except in life-threatening circumstances or in cases of rape or incest. But Planned Parenthood clinics in Charleston and Columbia provide services unrelated to abortion, including counseling, physical exams, contraception and screenings for cancer and sexually transmitted infections.
Planned Parenthood and a patient who sought contraception sued under a federal civil rights law, and a federal trial judge blocked the South Carolina directive, saying that it ran afoul of Medicaid’s requirement that patients may choose any qualified provider.
The litigation that followed was convoluted and circuitous, focusing largely on whether that provision created a right that individuals could enforce by filing lawsuits. The Supreme Court has said that federal laws like Medicaid, which give money to states but only if they accept certain conditions, must “unambiguously confer individual federal rights” to give affected individuals the right to sue.
That is a hard test to meet, and the court has ruled that it has been satisfied only rarely, most recently in 2023 in Health and Hospital Corporation of Marion County v. Talevski, a case concerning nursing homes. The statute at issue in that case repeatedly referred to “rights” as such, while the Medicaid provision in the new case used different language.
It said people seeking medical services “may obtain such assistance from any institution” that is “qualified to perform the service or services required.”
Nicole A. Saharsky, a lawyer for Planned Parenthood, acknowledged that the standard was strict.
“It is a high bar to find that Congress put in place an individually enforceable right,” she said. “What we’re saying is that this provision meets the bar.”
Kyle D. Hawkins, a lawyer for the Trump administration, disagreed, saying the Medicaid provision lacked the required “unmistakable rights-creating language.”
Under the Biden administration, the government had taken the opposite position, which Mr. Hawkins acknowledged.
“With the change in administration,” he said, “the federal government re-evaluated its position in this case, and we believe that the view we’re advancing today is the best reading of the statute.”
The justices discussed at length whether Congress had to use “magic words” to allow people to sue. John J. Bursch, a lawyer with the Alliance Defending Freedom, a conservative Christian group that represents South Carolina, proposed a series of words Congress could use to grant an unambiguous right to sue.
“The list I would give you is rights, entitlement, privilege and immunities,” he said, adding that they did not amount to magic words.
In response, Justice Brett M. Kavanaugh said, “I’m not allergic to magic words because magic words, if they represent the principle, will provide the clarity that will avoid the litigation that is a huge waste of resources for states, courts, providers, beneficiaries and Congress.”
Justice Elena Kagan said the language in the Medicaid law could hardly be plainer. “The state has to ensure that individuals have a right to choose their doctor,” she said. “That’s what this provision is.”
Last year, a unanimous three-judge panel of the U.S. Court of Appeals for the Fourth Circuit, in Richmond, Va., ruled that the suit could proceed.
“This case is, and always has been, about whether Congress conferred an individually enforceable right for Medicaid beneficiaries to freely choose their health care provider,” Judge J. Harvie Wilkinson III wrote for the panel. “Preserving access to Planned Parenthood and other providers means preserving an affordable choice and quality care for an untold number of mothers and infants in South Carolina.”
He added that “this decision is not about funding or providing abortions.”
Abortion was mentioned only in passing in Wednesday’s argument in Medina v. Planned Parenthood South Atlantic, No. 23-1275, and the case did not turn on the state’s reason for trying to disqualify Planned Parenthood. But Ms. Saharsky said the dispute presented issues beyond a technical one about who can sue.
Congress, she said, had tried to send a message: “We want people on Medicaid who are insured through Medicaid to have the same right that people who have private insurance enjoy because it’s so foundational to individual dignity and individual autonomy.”
Health
Guava for Weight Loss Is a Real Thing—Here’s the Juicy Truth
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Health
Single workout cuts cravings, offering new hope for smokers trying to quit
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If you’re trying to quit smoking, try a brisk walk or bike ride to curb your craving for a cigarette.
Researchers found that just one workout can reduce the urge to light up. But the type of exercise you do and how you do it makes a big difference.
High-intensity, aerobic exercise is most effective at reducing people’s cigarette cravings, a review of 59 randomized controlled trials involving more than 9,000 adults found.
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“Single-bout exercise reduced acute cravings immediately and up to 30 minutes post-exercise, but not longer-term cravings,” the authors of the study, published in the Journal of Sport and Health Science, reported.
Aerobic exercise is the most effective form of exercise for reducing cravings for cigarettes, researchers found. (iStock)
The research team highlighted other key findings from their study of “exercise-based interventions for smoking cessation.”
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Exercise training made people between 15% and 21% more likely to abstain from smoking than those who didn’t exercise, the authors found.
Researchers found that exercise curbs people’s cigarette cravings for up to 30 minutes after they stop exercising. (iStock)
Regular exercise also caused smokers to cut back by an average of two cigarettes per day.
In addition to being a free and accessible method for reducing smoking, exercise is also effective at reducing anxiety and stress, which drive many people to smoke.
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The authors suggest that because exercise boosts feel-good hormones, such as dopamine, and reduces the stress hormone cortisol, smokers who work out feel less inclined to use nicotine as a brain reward.
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Exercise should be integrated into other smoking cessation programs to enhance quit success, the authors concluded.
Exercise releases similar feel-good brain chemicals that people get from cigarettes, researchers suggested. (iStock)
They also noted that none of the trials addressed vaping and recommended that future research target the use of electronic cigarettes.
Health
Hantavirus Vaccines and Treatments Are in the Pipeline
The deadly hantavirus outbreak aboard the cruise ship MV Hondius has put the spotlight on a rare pathogen that typically attracts relatively little attention, even from scientists.
There are no targeted treatments for hantaviruses, which are typically carried by rodents, and no widely available vaccines. So when passengers began falling ill in the middle of the Atlantic Ocean, doctors and public health experts were limited in what they could offer.
“It’s kind of a wake-up call,” said Dr. Vaithi Arumugaswami, an infectious disease researcher at the University of California, Los Angeles. “Our tool kit is almost empty.”
That’s not for lack of trying. A handful of scientific teams around the world have been working — for decades, in some cases — to develop hantavirus treatments and vaccines. But it has not been easy to find funding or nurture commercial interest in medical interventions for a type of pathogen that does not infect humans often and does not spread easily between people.
“It’s not an airborne, highly contagious viral threat, so it hasn’t been as high a priority for groups trying to prevent pandemics,” said Jay Hooper, a virologist at the United States Army Medical Research Institute of Infectious Diseases.
But there are promising vaccines and treatments in development. And some of them, experts said, could be moved through the pipeline rapidly if hantavirus interventions became a priority.
“I do think there are things that are sitting there on the bench that could be quickly developed,” said Dr. Ronald Nahass, the president of the Infectious Diseases Society of America. “But nothing is ready.”
Vaccine development
There are two main types of hantaviruses: Old World viruses, which circulate primarily in Asia and Europe, and New World viruses, which are found in the Americas. The cruise ship outbreak has been linked to a New World virus known as the Andes virus, which is endemic to South America and is the only hantavirus known to spread between people.
There are vaccines that target some of the Old World viruses in Asia, but their efficacy is modest, experts said. And there are no licensed vaccines for the New World viruses, which include the Sin Nombre virus endemic to rodents in the western United States.
But there are some in development. Dr. Hooper and his colleagues have developed a DNA vaccine for the Andes virus, which proved promising in a small phase 1 trial. Under certain dosing regimens, the researchers found, more than 80 percent of participants produced neutralizing antibodies. “It’s pretty amazing,” said Dr. Hooper, who is an inventor on multiple hantavirus vaccine patents owned by the U.S. government. “Getting these kinds of neutralizing antibodies in humans is impressive.”
There were drawbacks, including that the vaccine seemed to require at least three doses. But the vaccine is ready for further development “if there’s a need,” Dr. Hooper said. “We’ve done the science. It’s just other forces that are required to move vaccines forward — markets, government demand.”
Other teams have potential vaccines in earlier stages of development. For instance, Bryce Warner, a hantavirus researcher at the University of Saskatchewan, and his colleagues are exploring a variety of approaches, including a nasal vaccine that they hope might spark a more robust immune response in the airway.
But the research, which is being conducted in hamsters, is still in early stages, and hantavirus vaccine candidates can be challenging to move forward. Scientists lack good large-animal models for hantaviruses, Dr. Warner said, and human cases are rare enough to make trials tricky. “It’s very difficult to conduct a clinical trial when you only have a limited number of cases annually,” he said. “You don’t have the numbers of people to really show a robust effect.”
Drug hunting
Currently, the primary treatment for hantavirus infection is supportive care, which may include supplemental oxygen or heart-lung bypass machines. Doctors also sometimes prescribe an existing antiviral drug, called ribavirin, but there is not strong evidence that it is effective for New World viruses, scientists said.
The hunt for new drugs is underway, though. At U.C.L.A., Dr. Arumugaswami and his colleagues found that favipiravir, an antiviral approved to treat influenza in Japan, inhibited the Andes virus in human cells. They also identified several compounds that had broad antiviral activity, blocking hantaviruses as well as other types of viruses, in human organoids, miniature clusters of tissue that mimic the function of organs.
Other teams have been working to develop therapeutic antibody treatments, often working from blood samples collected from hantavirus survivors. “We were able to isolate the natural antibodies that people are making and basically winnow them down and find one that was really good,” said Kartik Chandran, a virologist at the Albert Einstein College of Medicine in New York. “We actually found several.”
When Dr. Chandran and his colleagues tested these antibodies in hamsters, one produced especially encouraging results: It seemed to work against both Old and New World hantaviruses and was effective even when given relatively late in the course of infection, Dr. Chandran said.
(Dr. Chandran is listed as an inventor on patents for hantavirus antibodies.)
Several other teams have also produced antibodies that were broadly effective in small animals, but that is where a number of potential products have stalled, experts said.
“We have a lead drug, and now what we need is someone to pay the money, which would be something like $40 million, to go the next step,” said Dr. James Crowe, director of the Vanderbilt Center for Antibody Therapeutics. “We have neither government nor foundation nor company support to do that. So we’re just waiting to find a partner.”
(Vanderbilt University has applied for patents related to these antibodies; Dr. Crowe is listed as the inventor.)
Experts said that they hoped the current outbreak might help bring attention to a family of often-overlooked viruses.
“Certainly judging by just my inbox and text messages, there’s a renewed interest in these agents, and renewed interest in maybe at least revisiting where they are in the priority list,” Dr. Chandran said.
Whether that interest can be sustained after the virus fades from the headlines remains to be seen, experts acknowledged.
“Raising awareness never hurts,” Dr. Warner said. “We’ll see whether or not it leads to anything tangible, at least in terms of funding and resources for advancing some of these things that are lacking for hantavirus.”
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