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More COVID shots are coming. Will a weary public be more interested this year?

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More COVID shots are coming. Will a weary public be more interested this year?

A new coronavirus shot will be available starting this week, but the big question is how many people will get one.

Attitudes about COVID-19 are clearly shifting, as is to be expected since it long ceased to be the sort of suffocating public health threat that ground the globe to a halt. But health officials note that vaccines are a major driver of that progress, and continued inoculations — much like a typical flu shot — can help keep the coronavirus confined.

It’s clear that vaccines, once so desired that hopefuls endured hours-long waits or even hit the road in hopes of securing the shots, have become a harder sell as the pandemic eased and people moved on with their lives. Deaths and serious illnesses are down.

That’s not to say there’s no appetite for the latest targeted batch of shots, however.

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Attitudes about vaccination

According to survey results released this week, Americans appear more inclined to get the latest COVID-19 vaccination than they were last year. The U.S. Centers for Disease Control and Prevention this week recommended that virtually all Americans — ages 6 months and up — get a fresh vaccine dose this autumn using a new formula designed against an Omicron subvariant that was dominant earlier this year.

Just 21% of adults nationwide received the last updated COVID-19 shot that was introduced a year ago. But a survey of adults taken in August, the results of which were presented by the CDC this week, suggest that about 43% of adults plan to either probably or definitely get this latest COVID-19 vaccine.

Such uptake would be more in line with that of the annual flu shot. Survey results suggest 47% of U.S. adults got the flu shot during the 2022–23 flu season.

Doctors say it remains important that people stay up to date on their vaccinations. While the risk of dying from COVID-19 has fallen since the early months of the pandemic — thanks to vaccinations, anti-COVID drugs like Paxlovid, years of natural immunity and a slower evolving virus — deaths can still happen.

“In those with and without underlying conditions, there was no group that clearly had no risk of severe illness,” Megan Wallace, a CDC epidemiologist, said during Tuesday’s meeting of the agency’s Advisory Committee on Immunization Practices.

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There is some hope that as COVID-19 vaccinations become more routine, like the flu shot, there will be less fatigue. Large majorities of Americans have completed their primary COVID-19 vaccination series, including 94% of U.S. seniors and 79% of adults.

For most, that primary series entailed a two-dose regimen of either the Moderna or Pfizer-BioNTech vaccines. However, uptake on subsequent booster or additional doses has lagged behind those more robust top-line figures.

Today, most people who have never been vaccinated no longer need to get a two-dose primary series to be considered inoculated. Now, an unvaccinated person who is at least 5 years old needs to get only one shot to be considered current on their vaccination.

Only unvaccinated babies and young children, ages 6 months to 4 years, will need either two doses of the updated Moderna vaccine or three doses of the updated offering from Pfizer-BioNTech.

Officials also no longer use the term “boosters” to describe the latest vaccination, instead calling it an updated COVID-19 vaccine.

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In a Kaiser Family Foundation poll published in April, 32% of adult respondents said they were “very” likely to get a COVID-19 vaccine offered annually, like the flu shot; while another 21% said they were “somewhat” likely.

Vaccine trust

Despite a robust safety record, Americans are less confident in the safety of COVID-19 vaccines than they are other routine adult vaccines and the flu shot.

About 66% of adults think routine adult vaccines as either completely or very safe, and 27% say they are somewhat safe. For the flu shot, 64% consider it completely or very safe, and 26% consider it somewhat safe, according to a survey conducted in August whose results were presented by the CDC.

But for the COVID-19 shot, 49% of adults consider it completely or very safe, and 30% consider it somewhat safe.

Among those who didn’t get last year’s updated COVID-19 shot, the possibility of unknown serious side effects was cited as a key reason.

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The CDC says the COVID-19 vaccines are safe and effective. More than 670 million doses had been administered through March 1, the CDC said, “under the most intense safety monitoring in U.S. history.”

“The benefits of COVID-19 vaccination outweigh the known and potential risks,” the CDC says.

Notably, healthcare providers are slightly more likely to recommend other routine vaccinations to adults than they do for COVID-19. Among adults, 72% said their healthcare provider suggested they get the flu shot, but just 56% mentioned the COVID-19 vaccination.

Encouraging doctors to routinely suggest an updated COVID-19 vaccination — possibly made easier by a simpler, once-a-year time frame for most people — could help boost vaccination rates, experts say.

The CDC said that in one study, the risk of cardiac complications — including myocarditis, an inflammation of the heart muscle — was actually higher among adolescent males age 12 to 17 after a coronavirus infection than after getting a COVID-19 vaccination.

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COVID-19 impact remains

From last October through the end of April, there were more than 70,000 COVID-19 deaths nationally, about 200,000 fewer than during the same time period the prior year, but still twice the typical number of annual flu deaths.

So far this calendar year, about 25,000 people ages 65 and up have died from COVID-19, as have about 2,800 adults between the ages of 45 and 64, and about 450 people ages 20 to 44, according to the CDC. There have been 36 deaths among those ages 5 through 19; 18 deaths among those ages 1 to 4; and 26 deaths among those younger than 1.

“COVID-19 burden is currently lower than at previous points in the pandemic, however, the absolute number of hospitalizations and deaths is still high,” Wallace said.

Even people with no underlying health conditions can still die from COVID-19.

New analysis of recent COVID-19 data confirm that “there are deaths, including in children, including in those without chronic conditions,” said Dr. Matthew Daley, a pediatrician and research expert in vaccines who is also a member of the CDC Advisory Committee on Immunization Practices. “And my perception is that that those deaths are vaccine preventable.”

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Most people who are dying from COVID-19 are not current on their vaccinations.

There was some debate at this week’s CDC advisory committee meeting over the merits of how strong a recommendation the agency should make — whether the recommendation for new COVID-19 vaccinations should be for virtually all Americans age 6 months and up, or more limited to seniors and other higher-risk groups.

A strong majority, 13 out of 14 voting members, favored a universal recommendation.

A modeling scenario showed that a universal vaccine recommendation by the CDC, compared to just suggesting those ages 65 and older get vaccinated, “is projected to prevent about 200,000 more hospitalizations, and 15,000 more deaths, over the next two years,” Wallace said.

Public concerns lessen

People’s feelings about the pandemic have changed over time, with more Americans saying the coronavirus situation is getting better.

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In August, just 3 in 10 American adults reported being very or moderately concerned about getting COVID-19, according to a survey made public by the CDC this week. In a March survey from Monmouth University, half of respondents said they would be very or somewhat concerned about a family member getting COVID-19.

How people feel about COVID varies by race and ethnicity, according to survey data presented by the CDC. Among white adults, 38% said they were “not at all” concerned about getting COVID-19, the highest share of any racial or ethnic group. By comparison, 26% said they would be moderately or very concerned.

Black adults were the most worried about getting COVID-19, with 41% saying they would be very or moderately concerned, while 27% said they were “not at all” concerned.

Among Latino adults, one-third said they were “not at all” concerned about getting COVID-19, while a little over a third said they’d be moderately or very concerned.

“Those living in urban areas reported more concern over getting COVID-19 than those in suburban or rural areas,” Wallace said. Urban residents are more likely to believe in the vaccine’s safety — 51% believe it’s completely or very safe — compared to rural residents, 37% of whom think the same, the CDC survey found.

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Income also matters. Concerns about getting COVID-19 decrease as income increases, Wallace said. It is wealthier people who have the most confidence in vaccine safety, with about 57% of people making $75,000 or more saying the COVID-19 vaccines are very or completely safe, while 35% of people making under $25,000 said the same.

Vaccine distribution refinements should make administering vaccinations easier. There will be smaller minimum order quantities and single doses in vials. This “is likely to reduce wastage, eases logistics and helps with storage capacity limitations,” Wallace said.

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Column: A cancer survivor's advice: research, persistence and second opinions

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Column: A cancer survivor's advice: research, persistence and second opinions

In the fall of 2022, Robin Clough and Dr. Gene Dorio were going about their lives as they had for many years, serving older adults in the Santa Clarita Valley. Clough was busy with her work as an administrator at the local senior center while Dorio, a house-call geriatrician, crisscrossed the valley visiting his patients.

In November of that year, Clough saw a lump on her neck and had it checked out. The early indication was that she had papillary thyroid cancer.

“I was somewhat worried,” said Clough, but not overly so, because she knew that type of cancer was treatable and highly survivable. “So in the back of my mind it was like, ‘Oh, I’m so lucky. … It’s the easiest type of cancer to take care of.’”

California is about to be hit by an aging population wave, and Steve Lopez is riding it. His column focuses on the blessings and burdens of advancing age — and how some folks are challenging the stigma associated with older adults.

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Then things took a sharp turn for the worse. “I noticed it growing a lot,” Clough, 70, said of the lump. “I was having trouble speaking.”

Surgery was scheduled. Dorio, 72, said it was expected to take about three hours to remove the tumor and half of Clough’s thyroid gland. But the procedure dragged on. When the surgeon updated Dorio nine hours later, the news was grim. The tumor had spread through the thyroid gland, onto the carotid artery and into the tracheal rings.

“He told me it was all over the place,” Dorio said.

Tests revealed that Clough had anaplastic thyroid cancer, a far more aggressive form than papillary.

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We all know our fortunes can turn without much warning, especially as we age and the odds stack against us, raising the threat of our bodies gradually failing and our minds fading. But in just a couple of weeks, Clough and Dorio had gone from cruising through life to confronting death.

A man kisses his partner in the kitchen of their home.

Dr. Gene Dorio kisses Robin Clough in the kitchen of their home. Dorio, a house-call geriatrician, has been spending much of his time caring for Clough.

(Genaro Molina / Los Angeles Times)

With her type of cancer, life expectancy is often measured in months rather than years. “It was so hard to process, and I think my mind stopped me from processing it because it’s just too overwhelming,” Clough said.

They’d fallen for each other about 20 years ago after each had been married and divorced. Dorio has a daughter named Janene. Clough has two daughters, Catie and Amy. The Dorio-Clough courtship and blending of the two families began with him giving her a flu shot at her senior center; then he had her on his local radio show, “The Senior Hour.”

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They never married, and still don’t see the need.

“We’re compatible and we love each other … and have the same interests — fighting for people’s rights,” said Dorio, who, along with Clough, pushed for legislation — signed by Gov. Gavin Newsom — giving families more authority to determine medical decisions for loved ones even in the absence of an advance directive. Dorio had also served on the L.A. County Commission for Older Adults.

Robin Clough recalls how difficult the weeks of cancer treatment have been.

Robin Clough recalls how difficult the weeks of cancer treatment have been.

(Genaro Molina / Los Angeles Times)

Facing her grim diagnosis, Clough and Dorio leaned on each other and on Janene, Catie and Amy. There were weekly Zoom meetings to bolster spirits and share information about emerging therapies.

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I’d gotten to know Dorio a little bit over the years, having tagged along on his house calls, so I was copied on the periodic updates on Clough’s status that he mailed to friends and family. She beat the three-to-six-month prediction, and in July of 2023 Dorio wrote to say she was better, “but still has a ways to go.”

By then, she’d undergone seven consecutive weeks of chemotherapy and radiation, suffering skin burns on her neck from the latter. A metastatic lesion was surgically removed from her leg. Dorio took Clough to MD Anderson Cancer Center in Houston on a recommendation from Cedars-Sinai.

“To all our friends and family,” Dorio wrote in that July update, “seeking a second opinion and being persistent in researching and asking questions of your doctor team is very important, no matter what the diagnosis might be. It is physically and emotionally a roller coaster. But we have been given wonderful support from our family and many of you in the community. We will provide help and guidance in the future should you need it.”

In Houston, medical staff queried Clough about her family history. “This cancer is mostly caused by radiation exposure,” Clough said, “and one of the first things they asked me … was where did you grow up?”

Her answer was Arizona, downwind from nuclear weapons testing in nearby Nevada in the 1940s and ’50s that contaminated water, soil and food sources for years.

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I asked Clough if she had seen the Oscar-winning movie “Oppenheimer,” about the creation of the first nuclear weapons.

“I won’t watch it,” she said firmly.

It’s impossible to directly link Clough’s cancer to weapons testing, but the federal Centers for Disease Control and Prevention reports that people exposed to radiation fallout, “especially during childhood, may have an increased risk of thyroid disease, including thyroid cancer many years later.”

Oncologists Alain Mita at Cedars-Sinai and Maria Cabanillas at MD Anderson, who had collaborated previously on patients with anaplastic thyroid cancer, determined that Clough’s form of cancer warranted treatment with Keytruda, a drug that stimulates the immune system.

But after a few months of treatment that had showed some promise, the cancer was growing again. In late December, Clough’s doctors switched to a drug called Retevmo, a targeted therapy that blocks the driver of tumor growth.

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A man using a cane sits at a desk in his home.

Dr. Gene Dorio put off hip surgery to take care of his partner, Robin Clough, and uses a cane for support.

(Genaro Molina / Los Angeles Times)

A hopeful Dorio recalled that in a 2017 blog post, he had written that “genetic engineering research is on the verge of finding the DNA ‘stop button’ ” for cancer cell growth. He added, “Hopefully one day our great-grandkids will ask … ‘What was cancer?’”

One month into Retevmo medication, Clough had to stop because of adverse side effects to her liver. But a new scan revealed what seemed to her like a miracle.

The cancer was gone.

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Two months later, she had another test.

No cancer.

“Her cancer is, at this moment, undetectable and in remission. For anaplastic cancer that’s very unusual,” Dr. Mita told me.

That doesn’t mean the cancer won’t return, he said. But for the time being, there’s cause for optimism.

Mita said that 10 years ago he could not have predicted this measure of success against such an aggressive cancer, and he’s hopeful medical science will see more advances in the coming years. With some cancers, he said, doctors are now able to skip chemotherapy and radiation in favor of meds like those used to treat Clough.

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Cabanillas shared his optimism, saying survival rates at MD Anderson have improved with some forms of anaplastic thyroid cancer by using “immunotherapy in combination with targeted therapy.”

In her kitchen a few days ago, with the girls’ college diplomas and family photos hanging on the walls, Clough said it’s all been overwhelming at times, and Dorio chimed in on his own worries and determination to remain strong for her sake. Clough’s life has been consumed by doctor visits, surgical procedures, continued unpleasant side effects from treatment and the constant anxiety of awaiting the next test results.

“I never felt like it was too much,” Clough said. “There are times when I think, I’m so tired of this. But it’s never been too much, and I think that’s because of my loved ones.”

Dorio, meanwhile, put his practice on hold to focus on the house-call patient who lives in his own home. He’s been putting off hip replacement surgery, too, and uses a cane.

It’s more than a little helpful, Clough said, when, in the midst of a life-threatening medical crisis, the person you live with is a doctor. She said she never felt that she could beat cancer entirely, “but that I could keep it under control. And I still have that hope.” Each day, she said, is a bonus.

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Clough shed a few tears as she told her story, but also flashed a radiant smile.

“I was supposed to be gone, but I’m not. So every day is ‘Wow,’ you know? I get to see my daughters, and in the process of this I had my first grandchild.”

The baby boy is now 11 months old.

His name is Robin.

steve.lopez@latimes.com

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Abortion pill usage surged post-Roe. These numbers show the dramatic rise

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Abortion pill usage surged post-Roe. These numbers show the dramatic rise

Less than a quarter of a century ago, abortion pills could not be legally obtained from a U.S.-based medical provider.

Now, they are the most common method of terminating a pregnancy — used by 3 out of 5 abortion patients in the U.S.

Americans’ use of medication abortion has rapidly expanded since 2000, when the FDA approved the use of mifepristone, one of the two drugs used in the most common medication abortion regimen.

Over the last eight years, the U.S. Food and Drug Administration has steadily relaxed its rules to allow patients to take mifepristone up to 10 weeks into pregnancy and receive it by mail after a telemedicine appointment.

Abortion care has begun to shift from in-person visits to the mailbox. Just four years ago, there were no online-only U.S. abortion clinics dispensing abortion pills. But during the COVID-19 pandemic — and after the Supreme Court’s 2022 overturning of the constitutional right to an abortion — virtual abortion clinics began to take on an increasingly significant role.

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If the Supreme Court decides to order a reversal of recent FDA rules, limiting patients from obtaining mifepristone at pharmacies or through the mail without an in-person visit, abortion services could be restricted even in blue states like California.

Here are some of the numbers on abortion pill usage in the U.S.:

How many medication abortions take place each year in the U.S.?

About 642,700 medication abortions took place in 2023 within the formal healthcare system, according to the Monthly Abortion Provision Study from the Guttmacher Institute, a Washington based nonprofit research group committed to advancing sexual and reproductive health in the U.S.

This number is likely an undercount, as it does not include self-managed medication abortions outside of the formal healthcare system or abortion pills mailed to anyone in the 14 states where abortion is banned.

What percentage of abortion patients in the U.S. use medication abortion?

According to Guttmacher, medication abortions accounted for 63% of abortions in 2023 — a massive jump from zero in 2000 to 53% in 2020.

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This percentage does not include self-managed abortions or abortion pills mailed to anyone in a state where abortion is banned.

Guttmacher does not have state-level medication abortion data.

How many states limit the mailing of abortion pills?

Twelve states — other than the 14 states where abortion is banned — have passed laws mandating at least one in-person clinic visit, according to the health news service Kaiser Family Foundation.

Twenty-four states, including California, have no telehealth medication abortion restrictions.

Still, the legal landscape is hazy. Some online-only abortion clinics, such as Europe-based Aid Access, allow U.S. doctors in blue states with “shield laws,” legislation designed to protect them from prosecution, to prescribe and mail pills to patients in restricted states.

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How many Americans get medication abortion by mail?

There’s no complete national data on the number of self-managed medication abortions. But research suggests more American women began to access abortion pills via mail in recent years as they experienced limited clinic access during the COVID-19 pandemic, states imposed abortion restrictions, and abortion pills became more readily accessible.

Data from Aid Access, a service run by European doctor Rebecca Gomperts that began shipping abortion pills to Americans in 2018, shows that requests for self-managed abortion through online telemedicine nearly tripled after the Supreme Court overturned Roe vs. Wade.

In 2022, requests from U.S. patients to Aid Access for self-managed medication abortions jumped from an average of 83 a day before the Supreme Court’s abortion decision was leaked to 214 a day after the court decision was formally announced, according to research led by Abigail Aiken, associate professor of public affairs at the University of Texas at Austin. Demand increased in all states, but the largest increases were in states that have enacted total or near-total abortion bans: Louisiana, Mississippi, Arkansas, Alabama and Oklahoma.

The Society of Family Planning, a global nonprofit group that specializes in “abortion and contraception science,” recently estimated that 16% of abortions in the U.S. were provided via telehealth in September 2023, with 13,770 telehealth abortions resulting in medications being dispensed via mail from online-only and brick-and-mortar clinics.

This data includes abortion pills mailed to people in states with bans or restrictions on telehealth abortion.

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How many U.S. clinics offer medication abortion?

About 789 facilities in the U.S. offered medication abortion in 2022, according to data from Advancing New Standards in Reproductive Health, a research program at UC San Francisco.

The number of facilities providing telehealth abortion care and mailing abortion pills soared from 52 in 2020 to 243 in 2022.

How have telehealth abortion services expanded since the COVID-19 pandemic?

In 2020, there were zero online-only clinics providing medication abortion.

By 2022, 69 virtual clinics provided care via telehealth in 23 states and D.C., according to ANSRH’s Abortion Facility Database. Most of the new clinics are concentrated in the Northeast and West.

How many Californians get medication abortion by mail from virtual-only clinics?

According to the Society for Family Planning’s October 2023 #WeCount report, 7,510 telehealth abortions in California were provided by virtual-only clinics in the first six months of 2023.

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This figure does not include telehealth abortions from brick-and-mortar clinics.

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Q&A: The FDA says the abortion pill mifepristone is safe. Here's the evidence

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Q&A: The FDA says the abortion pill mifepristone is safe. Here's the evidence

Abortion is back on the docket at the U.S. Supreme Court, with the justices hearing arguments Tuesday about whether a pill used to terminate early pregnancies was properly evaluated by the Food and Drug Administration.

The medication, mifepristone, has been used in the United States more than 5 million times since it was approved for use in 2000, according to Danco Laboratories, the company that sells it under the brand name Mifeprex. Fewer than 0.5% of women who take it experience “serious adverse reactions,” and deaths are exceedingly rare, the FDA says in its prescribing information for doctors.

Mifepristone debuted in France, its home country, and China in 1988. It is now approved in 96 countries, from Albania to Zimbabwe, according to Gynuity Health Projects, a nonprofit that advocates for women’s reproductive rights.

Here’s a closer look at the safety of mifepristone.

What is mifepristone?

Mifepristone is the generic name of a pill that makes up half of the two-drug regimen used in medication abortions in the United States. When used in conjunction with a drug called misoprostol, it can terminate a pregnancy that is in the first 10 weeks of gestation.

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The synthetic steroid was originally known as RU-486 (the “RU” stands for Roussel-Uclaf, the French company that developed the pill). It is also sold under the brand name Mifeprex.

How does mifepristone work?

It prevents a natural steroid hormone called progesterone from doing its job, which is to get the inner lining of the uterus ready for an embryo to implant about a week or so after an egg is fertilized.

Mifepristone gets in the way of this process by blocking the receptors that progesterone would normally bind with.

How do we know it is safe?

As with other medications, the Food and Drug Administration has monitored mifepristone’s safety profile in the decades since it went on the market. If problems cropped up that weren’t evident during clinical trials, the agency could have revoked its approval.

Instead, it has expanded access to mifepristone. For example, it was initially approved for use during the first seven weeks of pregnancy; in 2016, that window was extended to 10 weeks. Likewise, after the COVID-19 pandemic accelerated acceptance of telemedicine, the FDA in 2021 stopped requiring patients to see a healthcare provider in person in order to get a mifepristone prescription.

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Those two decisions are at issue in the cases going before the court Tuesday.

“Hundreds of medical studies and vast amounts of data have confirmed its safety and efficacy as part of this two-drug regimen,” the American College of Obstetricians & Gynecologists, the American Medical Assn., and other medical societies wrote in a friend-of-the court brief filed on behalf of the FDA and Danco. The brief noted that “major adverse events occur in less than 0.32% of patients” and that “the risk of death is almost non-existent.”

Another sign of the drug’s safety is the fact that medication abortions have overtaken surgical abortions in the United States. Last year, 63% of abortions nationwide were carried out with mifepristone, according to the Guttmacher Institute, a nonprofit research group that supports reproductive rights.

Are there side effects to taking mifepristone?

There can be. According to the FDA, the most common ones include headaches, weakness, dizziness, nausea, vomiting, diarrhea, fever and chills.

The serious side effects to watch out for after using both drugs in the regimen are heavy bleeding (which the FDA describes as “enough to soak through two thick full-size sanitary pads per hour for two consecutive hours”), abdominal pain, a fever above 100.4 degrees Fahrenheit that lasts for at least four hours, and “feeling sick” more than a day after taking misoprostol.

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Symptoms like these could be signs of a life-threatening infection, an ectopic pregnancy or another serious problem. Anyone experiencing them should contact a healthcare provider right away.

Can mifepristone be fatal?

The FDA says it is aware of 32 women who died after taking mifepristone between September 2000 (when it was first approved in the United States) and the end of 2022.

However, it’s not clear that mifepristone was responsible for any of these deaths. Two of them were definitely caused by ruptured ectopic pregnancies, several died of drug intoxication or overdoses, and at least two women who took the pill were victims of homicides, the FDA said. As for the remaining cases, patients were taking other medications or undergoing treatments at the same time, making it difficult to pin the blame on mifepristone, according to the agency.

In their legal brief, the medical groups said that in the worst-case scenario, the drug could have caused no more than 13 of the 32 deaths. That makes the drug less dangerous than using “Viagra or getting one’s wisdom teeth removed.”

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