Friday, August 18, 2023

White House won’t say if Biden family’s China biz is ‘security issue’

White House national security adviser Jake Sullivan refused to comment Friday about whether the Biden family’s business ventures in China posed a “national security issue,” as Republicans allege.

“Republicans on the House Oversight Committee are currently investigating the Biden family’s ties to foreign entities. They have specifically pointed to Hunter Biden’s financial ties to China,” began Daily Caller reporter Diana Glebova ahead of a Camp David summit with President Biden and the leaders of Japan and South Korea.

“Does the administration view this investigation as legitimate? And is the administration concerned that Hunter Biden’s ties to China pose a national security issue?”

“I don’t have any comment on that,” Sullivan replied.

President Biden, South Korean President Yoon Suk Yeol and Japanese Prime Minister Fumio Kishida were expected to focus largely on China during their Friday trilateral at the forested presidential retreat in western Maryland.

House Republicans accuse the president of abusing his prior position as vice president to advance his family’s business interests in countries where he led the Obama administration’s foreign policy, such as China, Russia and Ukraine.

The first family has had at least two major business relationships in China and Joe Biden allegedly was involved in both of them.

“We’re concerned that the president is compromised because of the millions of dollars that his family has received,” House Oversight Committee Chairman James Comer (R-Ky.) told CNN last week.

Hunter Biden. — Hunter Biden wrote in emails retrieved from his former laptop that he had to give “half” of his income to Joe Biden, according to reports.

Former President Donald Trump, who is seeking a rematch against Biden in next year’s election despite facing four criminal trials, claimed in a video published Tuesday that Biden “was bribed and now he’s being blackmailed.”

“He’s petrified of China because they know exactly how much money has been given to him and they know exactly where it is. China has paid him a fortune,” claimed the 77-year-old, blasting Biden for failing to do more to investigate the origins of COVID-19, which killed more than 1 million Americans after possibly leaking from a Chinese lab — a theory backed by the FBI and Energy Department.

“Just think of what China has gotten for all that money. Biden shut down my administration’s initiative targeting Chinese spies in the United States,” Trump said. “He let China off the hook for COVID. He shut down the investigation into the origins of the China virus.”

Press briefing by National Security Advisor Jake Sullivan. — When asked if the administration is concerned with Hunter Biden’s ties to China, Sullivan replied, “I don’t have any comment on that.”

Trump added, “He did nothing as China began setting up bases in Cuba, taking over South America and threatening Taiwan. They even took over the Panama Canal,” he added, referring to a series of Chinese investments in the formerly US-controlled canal zone.

The Chinese spy base in Cuba was set up in 2019 during Trump’s presidency, the Biden administration said.

“Russia and China are even doing military exercises near the Aleutian Islands right off the coast of Alaska and Biden sits back and his hands and does nothing,” Trump added.

Other Republicans have faulted Biden’s response to largely China-sourced fentanyl, which has caused a surge in US overdose deaths as the highly potent compound is increasingly mixed into non-opioid drugs and counterfeit prescriptions, killing unwitting users.

“Over the past few months, [Biden] sent three members of his administration to make nice with China and got nothing done on fentanyl.” Republican presidential candidate and former South Carolina Gov. Nikki Haley said earlier this month, referring to recent visits by Secretary of State Antony Blinken, Treasury Secretary Janet Yellen and climate envoy John Kerry.

Fentanyl killed an estimated nearly 76,000 Americans in 2022 — an all-time record — after killing about 72,000 in 2021.

The death toll from fentanyl under Biden is up dramatically.

During 2020, Trump’s final full year in office, roughly 58,000 Americans died from fentanyl, though that figure was up significantly from more than 37,000 in 2019 and about 32,000 in 2018.

Republicans also faulted Biden’s handling of a Chinese spy balloon that Biden ordered shot down in February off South Carolina’s coast after it traversed the continental US.

“When you look at the Biden balloon that came across the country for a week … how much has that been influenced by the Biden family’s corrupt business deals?” asked Rep. Bob Good (R-Va.) at the time.

Biden has steadfastly denied any knowledge of or involvement in his son Hunter and brother James Biden’s foreign business dealings — despite mounting evidence to the contrary.

Biden claimed “that’s not true” in March when asked about three relatives — Hunter, James and daughter-in-law Hallie — receiving $1 million from a Chinese energy company in early 2017, according to subpoenaed bank records released by the Oversight Committee.

The president grumbled, “Give me a break, man,” in February when asked if his ability to manage the US-China relationship was “compromised.”

First son Hunter Biden co-founded investment fund BHR Partners with Chinese state-owned entities in 2013 — just 12 days after Hunter joined VP Biden aboard Air Force Two for an official trip to Beijing, the Wall Street Journal reported.

US President Joe Biden, with son Hunter Biden, arrives at Hancock Field Air National Guard Base in Syracuse, New York, on February 4, 2023. — The CEFC relationship appears to have started around 2015 when Hunter connected with Vuk Jeremic, a former foreign minister of Serbia and president of the United Nations General Assembly.

Hunter introduced his dad to BHR CEO Jonathan Li during the trip to China’s capital and Joe Biden later wrote college recommendation letters for Li’s children.

Hunter’s former business partner Devon Archer told the Oversight Committee in a July 31 interview that Joe Biden had coffee with Li during the 2013 trip — rather than a mere handshake as previously reported — and that Hunter put his father on speakerphone with Li during a subsequent business trip to Beijing.

Hunter Biden held a 10% stake in BHR through at least part of his father’s first year in office, and the status of his alleged divestment in late 2021 remains unclear — with the White House refusing to provide any transparency following an assertion by Hunter’s legal team that he no longer holds the shares.

Purported leaked BHR documents suggest Hunter’s “sugar brother” Kevin Morris, a wealthy Hollywood lawyer whom he met at a 2019 fundraiser, may have assumed control of the stake.

First brother James Biden and first son Hunter later launched a second business venture in China with another government-linked company, CEFC China Energy, which formed part of Beijing’s foreign-influence “Belt and Road” campaign.

Months after leaving office as vice president, Joe Biden allegedly met twice with his son and brother’s CEFC partners and was referred to as the “big guy” penciled in for a 10% cut in a May 2017 email.

Two of Hunter Biden’s former associates in the venture, Tony Bobulinski and James Gilliar, identified the president as the “big guy.”

Bobulinski alleges that he discussed the CEFC deal with Joe Biden, and an October 2017 email from Hunter Biden’s laptop identifies Joe Biden as a participant in a call about CEFC’s attempt to purchase US natural gas.

The CEFC relationship appears to have started around 2015 when Hunter connected with former Serbian foreign minister Vuk Jeremic while his dad was vice president. Jeremic was running for United Nations secretary-general at the time.

IRS whistleblowers Gary Shapley and Joseph Ziegler, who investigated Hunter for three and five years, respectively, said in recent congressional testimony that Justice Department officials blocked them from investigating Joe Biden’s role in business dealings, despite communications directly mentioning him.

Shapley provided the panel with a July 30, 2017, WhatsApp message in which Hunter wrote that he was “sitting here with my father” and threatened retribution if a deal was aborted, immediately preceding the transfer of $5.1 million from CEFC to Biden-linked accounts — on top of more than $1 million transferred earlier in the year.

Hunter also received a 3.16-carat diamond from CEFC founder Ye Jianming in 2017.

Hunter Biden wrote in emails retrieved from his former laptop that he had to give “half” of his income to Joe Biden, and the House Oversight Committee in May identified nine Biden family members who allegedly received foreign revenue.

House Speaker Kevin McCarthy (R-Calif.) this month called on President Biden to “give us his bank records” to show he wasn’t involved and said Republicans are moving closer to launching an impeachment inquiry.

https://nypost.com/2023/08/18/white-house-wont-say-if-biden-familys-china-biz-is-security-issue/

Few Early Alzheimer's Patients Qualify for Lecanemab

Few people with early Alzheimer's disease met eligibility criteria for the new anti-amyloid monoclonal antibody treatments lecanemab (Leqembi) and aducanumab (Aduhelm), cross-sectional data from the Mayo Clinic Study of Aging showed.

Of 237 people with mild cognitive impairment or mild dementia and increased brain amyloid on PET, clinical trial inclusion and exclusion criteria narrowed the number who would qualify for a lecanemab trial to 19, or 8% of the cohort, reported Maria Vassilaki, MD, PhD, of the Mayo Clinic in Rochester, Minnesota, and co-authors.

Modifying the lecanemab exclusion criteria by not applying additional cognitive criteria led to 17.4% of participants with mild cognitive impairment being eligible for trial, the researchers wrote in Neurology

opens in a new tab or window.

Likewise, trial inclusion and exclusion criteria for aducanumab reduced the number of qualified candidates to 12 people, or 5.1% of the cohort.

"Our study results show only a small percentage of people with early Alzheimer's disease may be eligible to receive treatment, mostly due to chronic health conditions and brain scan abnormalities common in older adults," Vassilaki said in a statement.

"In general, clinical trial participants are healthier than the general population," she pointed out. "Additional research is needed to examine the safety and efficacy of monoclonal antibodies targeting amyloid-beta plaques in larger, more diverse populations, as well as in less healthy populations, before these therapies may be more widely available to people with Alzheimer's disease."

Lecanemab received full approvalopens in a new tab or window to treat Alzheimer's disease in July 2023 following accelerated approval in January. Full approval expanded lecanemab's Medicare coverageopens in a new tab or window, giving more Alzheimer's patients access to the drug. Aducanumab received accelerated approvalopens in a new tab or window to treat Alzheimer's in 2021.

"At first glance, applying clinical trial criteria to real-world practice may seem overly conservative," noted Stephen Salloway, MD, of Brown University in Providence, Rhode Island, and co-authors, in an accompanying editorial

opens in a new tab or window.

"However, appropriate use recommendations for lecanemabopens in a new tab or window and aducanumabopens in a new tab or window defined by experts closely mirror the rigorous trial inclusion/exclusion criteria due to the resource-intensive nature of the monoclonal antibody therapies and their potential for adverse events, restricting initial use to those who are most likely to benefit and least likely to be harmed," the editorialists observed.

While anti-amyloid drugs may have positive clinical benefits, they can cause amyloid-related imaging abnormalities (ARIA) -- either effusions and edema (ARIA-E) or bleeding (ARIA-H, including microhemorrhage, macrohemorrhage, or superficial siderosis).

"ARIA is typically transient and asymptomatic, but it can be serious and even fatal," Salloway and co-authors pointed out. "Patients who carry one or two copies of the APOE4 allele and those with significant underlying cerebral amyloid angiopathy are at increased risk for cerebral edema and microhemorrhage, and those taking anticoagulants and lecanemab have a higher rate of macrohemorrhage."

Lecanemab's prescribing information was updated in July after full approval and contains a black box warning

opens in a new tab or window about ARIA, recommending caution when treating patients on anticoagulants. Because anticoagulation increases hemorrhage risk, the appropriate use recommendations are more restrictive, stating patients who require anticoagulants should not receive lecanemab until more data are available.

The Mayo Clinic Study of Agingopens in a new tab or window was established in 2004 in Olmsted County, Minnesota. Participants undergo baseline and follow-up visits about every 15 months using the same evaluation protocol. Some also have neuroimaging studies.

Among the 237 participants included in the analysis, the mean age was 80.9. Nearly all (97.5%) were white and 54.9% were male. All were diagnosed with mild cognitive impairment (222 people) or mild dementia (15 people). All showed increased brain amyloid burden on PET. Inclusion and exclusion criteria came from the phase III trials of lecanemab (CLARITY-ADopens in a new tab or window) and aducanumab (EMERGE and ENGAGEopens in a new tab or window).

Lecanemab inclusion criteria reduced the study population to 112 participants; exclusion criteria further trimmed it to 19. These included cardiopulmonary contraindications (41 people), central nervous system-related exclusions such as Parkinson's disease or epilepsy, (37 people), imaging exclusions (42 people) and history of malignancy (20 people).

A total of 104 participants fulfilled the aducanumab clinical trial's inclusion criteria. Exclusion criteria lowered the number of eligible participants to 12, for many of the same reasons as lecanemab.

The study had several limitations, the researchers noted. Not all inclusion or exclusion criteria could be defined as they were in the trials. Importantly, the sample was not racially and ethnically diverse, and it's unclear how the findings apply to underrepresented populations. Real-world data about the eligibility, safety, and efficacy of anti-amyloid monoclonal antibodies should be collected in registries like ALZ-NETopens in a new tab or window, they added.

Disclosures

This study was supported by the NIH, the Alexander Family Alzheimer's Disease Research Professorship of the Mayo Clinic, the Mayo Foundation for Medical Education and Research, the Liston Award, the GHR Foundation, and the Schuler Foundation.

Vassilaki has consulted for F. Hoffmann-La Roche. She receives research funding from NIH, has equity ownership in Abbott Laboratories, Johnson and Johnson, Medtronic, Merck, and Amgen, and her spouse receives research funding from Avobis Bio, Co-authors also reported relationships with industry and nonprofit organizations.

Salloway has consulted for Biogen, Eisai, Avid, Lilly, Genentech, and Roche. He was a site principal investigator for trials of aducanumab, lecanemab, and donanemab, and a safety monitor for gantenerumab, and an author on the appropriate use recommendations for aducanumab and lecanemab. Co-editorialists also reported relationships with industry and nonprofit organizations.

Primary Source

Neurology

Source Reference: opens in a new tab or windowPittock RR, et al "Eligibility for anti-amyloid treatment in a population-based study of cognitive aging" Neurology 2023; DOI: 10.1212/WNL.0000000000207770.

Secondary Source

Neurology

Source Reference: opens in a new tab or windowHowe MD, et al "Untangling eligibility: real-world application of anti-beta amyloid monoclonal antibodies" Neurology 2023; DOI: 10.1212/WNL.0000000000207873.

https://www.medpagetoday.com/neurology/alzheimersdisease/105922

Warnings on Mixing New Alzheimer's Drug and Antidepressants

Mixing lecanemab (Leqembi) and certain antidepressants may signal caution, Swiss researchers said.

Some patients have a higher risk of intracerebral hemorrhage in the first 30 days after introducing selective serotonin reuptake inhibitors (SSRIs), reported Beatriz Pozuelo Moyano, MD, of the University of Lausanne, and co-authors.

"Our recommendations are to pay special attention to patients on SSRIs, particularly if they already have microhemorrhages," Pozuelo Moyano and colleagues wrote in a letter published in Alzheimer's & Dementiaopens in a new tab or window.

"The introduction of lecanemab treatment during the first 30 days after the introduction of SSRIs should be avoided," they continued. "Patients on concomitant antiplatelet treatment may need additional monitoring because bleeding risk is increased by the concurrent use of these drugs."

Monoclonal antibodies like lecanemab that target aggregated forms of beta amyloid can cause amyloid-related imaging abnormalities (ARIA) -- either edema or effusion (ARIA-E) or ARIA with hemosiderin deposition (ARIA-H), which can include microhemorrhage, macrohemorrhage, or superficial siderosis.

Lecanemab received full FDA approval to treat Alzheimer's diseaseopens in a new tab or window in July 2023. Its prescribing information contains a box warning about ARIA and recommends cautionopens in a new tab or window when treating patients with an increased risk for intracerebral hemorrhage and who are on anticoagulants.

Patients with cerebral amyloid angiopathy (CAA) may have an increased risk of ARIAs, Pozuelo Moyano and co-authors noted. According to the drug's appropriate use recommendationsopens in a new tab or window (AURs), lecanemab can be given to "patients with fewer than four microhemorrhages, which may still correspond to possible or probable CAA," they wrote. "Considering this, a parallel prescription with SSRIs deserves close monitoring, as antidepressant use is associated with an increased risk of developing microbleeds."

Depression prevalence ranges from 19% to 78% in dementia, they added, and apathy and depression are the most frequent behavioral and psychological symptoms of dementia in Alzheimer's disease.

In a retrospective observational study, the researchers evaluated the prevalence of antidepressant drugs in patients eligible for lecanemab (according to the AURs) at the Leenaards Memory Center of Lausanne University Hospital.

They identified 47 eligible patients among the 410 Alzheimer's patients evaluated in 2022; 32% were on antidepressant treatment. Most patients (80%) were on SSRIs.

"This prevalence is similar to those previously reported in Alzheimer's disease patients in general," Pozuelo Moyano and co-authors observed. "This high prevalence of Alzheimer's disease patients eligible for lecanemab on antidepressant drugs, especially SSRIs, raises the question of an appropriate clinical management of these patients."

"We estimate that in patients eligible for anti-amyloid drugs, the indication for antidepressant treatment and its dose should be periodically re-evaluated as the antiplatelet effect in antidepressants is dose dependent," they stated. "It is important to also consider alternative choices, such as antidepressants with lower bleeding risk for mood disorders and antiepileptics (pregabalin and gabapentin) for an anxiety disorder or anxiety-type [behavioral and psychological symptoms of dementia]."

That recommendation is "very reasonable and is the kind of guidance that could be integrated into the AURs," Jeffrey Cummings, MD, ScD, of the University of Nevada, Las Vegas, who led the workgroup that developed the lecanemab appropriate use recommendations, told MedPage Today.

While the observations in the study were not derived from patients on lecanemab, "this data set suggests that vigilance on larger data sets will inform future practice," Cummings said.

Disclosures

The authors reported no conflicts of interest.

Cummings has multiple relationships with pharmaceutical companies and nonprofit organizations.

Primary Source

Alzheimer's & Dementia

Source Reference: opens in a new tab or windowPozuelo Moyano B, et al "Antidepressants and the risk of bleeding in the era of anti-amyloid drugs" Alzheimers Dement 2023; DOI: 10.1002/alz.13435.

https://www.medpagetoday.com/neurology/alzheimersdisease/105944

Widespread Misdiagnosis of MDS

Discordant Pathologic Diagnoses of Myelodysplastic Neoplasms and Their Implications for Registries and Therapies

Key Points

Misdiagnosis of MDS can lead to suboptimal treatment decisions and errors in population-based estimates of MDS incidence and mortality
Accurate MDS diagnoses and prognosis depends on strong collaboration between clinicians and skilled pathologists

Myelodysplastic neoplasms (MDS) are a collection of hematopoietic disorders with widely variable prognoses and treatment options. Accurate pathologic diagnoses present challenges due to interobserver variability in interpreting morphology and quantifying dysplasia. We compared local clinical site diagnoses with central, adjudicated review from 918 participants enrolled in the ongoing National Heart, Lung, and Blood Institute National MDS Natural History Study (NCT02775383), a prospective observational cohort study of participants with suspected MDS or MDS/myeloproliferative neoplasms (MPNs). Locally, 264 (29%) were diagnosed as having MDS, 15 (2%) MDS/MPN overlap, 62 (7%) idiopathic cytopenia of undetermined significance (ICUS), 0 (0%) acute myeloid leukemia (AML) with <30% blasts, and 577 (63%) other. Approximately one-third of cases were reclassified following central review with 266 (29%) diagnosed as MDS, 45 (5%) MDS/MPN overlap, 49 (5%) ICUS, 15 (2%) AML <30%, and 543 (59%) other. Site miscoding errors accounted for over half (53%) of the local misdiagnoses, leaving a true misdiagnosis rate of 15% overall, 21% for MDS. Therapies were reported in 37% of patients, including 43% of patients with MDS, 49% of MDS/MPN, and 86% of AML <30% blasts. Treatment rates were lower (25%) in cases with true discordance in diagnosis compared to those where local and central diagnoses agreed (40%), and receipt of inappropriate therapy occurred in 7% of misdiagnosed cases. Discordant diagnoses were frequent, which has implications for the accuracy of study-related and national registries and can lead to inappropriate therapy.

https://ashpublications.org/bloodadvances/article/doi/10.1182/bloodadvances.2023010061/497120/Discordant-Pathologic-Diagnoses-of-Myelodysplastic

FDA Grants De Novo Request for Neuromodulatory System for Urge Incontinence

The FDA has granted a de novo marketing request for the Revi System for tibial neuromodulation to treat urinary incontinence with or without urinary urgency, BlueWind Medical announced

opens in a new tab or window on Thursday.

The de novo request allows for treatment of men and women with urge urinary incontinence (UUI). Clinicians should follow applicable clinical guidelines and use professional judgment to determine if the device can be used before failure or intolerance of more conservative therapy, the company said.

"UUI is a debilitating, life-altering condition that impacts every aspect of a patient's life," said Cindy L. Amundsen, MD, of Duke University Medical Center in Durham, North Carolina, in the announcement. Efficacy and safety data "support the Revi device as a new option for those living with the frustrations of UUI."

"Additionally, while patient management should be based on clinical guidelines, use of this therapy may be considered by a physician's assessment before patients fail or cannot tolerate more conservative therapy, which could make this single outpatient procedure available to a larger number of patients with UUI," she added.

The Revi implant includes a small, battery-free neuromodulator implanted near the ankle during an outpatient procedure with local anesthesia. A lightweight wireless wearable device placed around the ankle one or twice daily activates the implant to stimulate the posterior tibial nerve.

Support for the de novo grant came from the multicenter, single-arm OASIS trialopens in a new tab or window, which evaluated the device in 151 women with UUI, including urinary urgency. Three-fourths of patients had at least a 50% reduction in UUI episodes after 6 months, increasing to 82% of patients who completed 12 months of follow-up. Also at 12 months, half of the patients remained 100% dry during a 3-consecutive-day assessment.

The device had a favorable safety profile over the 12-month evaluation, and 95% of study participants expressed satisfaction with the treatment. Additionally, more than 90% of patients remained compliant at 12 months with once-daily use of the device.

https://www.medpagetoday.com/urology/urinaryincontinence/105955

'Planned Parenthood of New Mexico Limits Non-Abortion Care Due to Surge From Texas'

Planned Parenthood clinics in New Mexico are prioritizing abortion care amidst a continuing influx of patients from Texas -- where abortion is largely banned -- and continuing fallout from the COVID pandemic.

The overwhelming demand has prompted Planned Parenthood, which offers low to no-cost services, to refer patients out to surrounding clinics in New Mexico for family planning, wellness exams, and other reproductive health services, so as to keep wait times down for abortion care. Currently, the wait time is 14 days for an abortion appointment at one of their clinics.

Adrienne Mansanares, the president and CEO of Planned Parenthood of the Rocky Mountains, told MedPage Today that for the last 6 to 8 weeks, some clinics have modified their services because of a staff shortage, with not enough advanced practice practitioners to meet the demand.

"We are one of just a few organizations that do provide abortion care," Mansanares said. "So there just aren't enough providers that can help jump in, whereas they can for things like sexually transmitted infections [STIs] or birth control."

There are only a dozen advanced practice providers of family services available across the state, she added, though Planned Parenthood's media representative would not confirm this.

Of the five New Mexico Planned Parenthood locations, three were scheduling in-person appointments for STI testing and wellness exams; two were scheduling for birth control and pregnancy tests; and one was scheduling for post-exposure prophylaxis (PEP) drugs for HIV as of press time, though Mansanares said that appointment availability varies day-to-day, and some services are available via telehealth. One clinic is not staffed at all, she noted.

One location in Albuquerque offers procedural (sometimes known as "surgical") abortion care, and three locations (including the Albuquerque site) were taking in-person appointments for medication abortion at press time. Telehealth appointments for medication abortion are available, and appointments cannot be scheduled more than 4 weeks in advance.

Mansanares said that Colorado and Nevada, also part of Planned Parenthood of the Rocky Mountains, are navigating similar challenges with out-of-state patient volume.

Since the Dobbs v. Jackson Women's Health Organization decision, which effectively ended the right to abortion in more than 20 states, 56% of New Mexico's Planned Parenthood abortion patients are from Texas, according to data from Planned Parenthood. Texas was one of 13 states with a "trigger" law that took effect almost immediately when the Roe v. Wade decision was overturned.

In the 10 months following the Supreme Court decision, New Mexico saw more abortion patients from Texas than all of the state's abortion patients in the 10 months prior to the passage of Texas's SB8, the 6-week ban that dealt the first blow to abortion care in Texas and became effective in September 2021.

Of Texas's neighbors, New Mexico shares the largest border, and is the only bordering state that has not banned abortion post-Dobbs. New Mexico has long protected abortion and reproductive health care; during the pandemic, the state designated abortion as an essential service, while Texas did not. Following the Supreme Court decision, the state earmarked $10 million

opens in a new tab or window to open a new reproductive health center at the El Paso border.

"We have a long, long history and tradition of birth justice workers, of people fighting for reproductive health care, reproductive freedom, and doing it in a way that really articulates the importance of the whole family," said Mansanares.

She noted that the timing of SB8, combined with the pandemic's overwhelming effect on healthcare, have played an important role in Planned Parenthood's recent staff shortages and triage of services.

"The impact of the pandemic is deep and goes wide," she explained. "So we're still making up for patients who maybe didn't get in to get sexually transmitted infection testing or treatment because they weren't getting wellness exams, they weren't coming in every year."

The University of New Mexico's Center for Reproductive Health is one of the clinics that has shouldered some of the volume since SB8 and the Texas ban, said Lisa Hofler, MD, MPH, MBA, chief of the division of complex family planning at the University of New Mexico in Albuquerque.

"Often the first reason why people encounter delays when they think, 'I need an abortion,' is not knowing where to go, or how to get one," she told MedPage Today. "Just [that] knowledge of people sometimes creates delays ... If you live in Dallas, would you think to call the University of New Mexico first?"

"All that said, though, I think things are probably plateauing, because of the delays having gone down," she noted, adding that the Center for Reproductive Health has hired additional faculty and staff to accommodate all reproductive health services, and wait times at the clinic are short.

Another option is Whole Woman's Health, which operated four clinics in Texas before moving to New Mexico. President Amy Hagstrom Miller told MedPage Today that wait times are short -- less than 48 hours -- at their Albuquerque location for both abortion care and ob/gyn services, which include family planning and wellness visits.

Hagstrom Miller echoed Hofler, saying that New Mexico's independent reproductive health clinics are able to offer a full range of services at comparable costs, but may not be as visible to potential patients as Planned Parenthood.

"Most of the folks that I know have appointment availability within a week," she said, referring to other independent clinics in the state. "I think Planned Parenthood has been backed up more locally, and nationally as well, because their brand name is so known."

In any case, patients are forced to make the choice to drive further to access care, or live longer with discomfort or uncertainty regarding reproductive health concerns.

Meanwhile, a shift in the healthcare labor market, with veteran healthcare providers retiring and new graduates just barely beginning, "has exasperated the fatigue of providing services during the pandemic, and then you layer on top of that people traveling hundreds, sometimes over 1,000 miles for an abortion -- and those folks are scared," Mansanares said. "It's got so much shame and stigma. You put all that on the back of a healthcare provider, and then we're in a crisis, which is what we're seeing now."

https://www.medpagetoday.com/special-reports/exclusives/105962

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