Category: Health

(NEW YORK) — Two years after the launch of the 988 Suicide & Crisis Lifeline, 10 million contacts have been answered, according to the Substance Abuse and Mental Health Services Administration.

“That’s 10 million people who, often on the worst day of their life, had a resource to reach out to,” Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, told ABC News.

Prior to the launch of the three-digit number, the services provided by 988 were available through the 10-digit National Suicide Prevention Lifeline, which had been active since 2005.

“In its first year, [the 10-digit Lifeline] served about 45,000 people, and to think that we serve that many people in less than a week now is sort of mind-boggling,” Dr. Tia Dole, chief 988 Suicide & Crisis Lifeline officer for the lifeline’s administrator, Vibrant Emotional Health, told ABC News.

In the months leading up to the launch of the new number in 2022, advocates were concerned that funding and staffing issues would hamper the lifeline’s ability to serve what was expected to be a dramatic increase in call volume.

The latest available data from SAMHSA shows nationwide answer rates of 88% for calls, 83% of chats and 97% of texts for the month of May.

“The average call is 14 minutes. To me, that type of impact is so significant,” Dole said. “[With 988,] you don’t need insurance, you don’t need to say who you are — and the person on the other end of the line instantly has empathy for you.”

Funding helps meet demands

Despite still imperfect answer rates, some advocates tell ABC News that robust levels of federal and state funding have helped increase capacity to largely meet demand.

“We’re two years into a system that needed massive infrastructure investment, new ways of thinking, new ways of partnering with other systems,” Wesolowski said. “We always knew that [building out crisis care] was going to take many years, and if we waited for it to be perfect, we never would have gotten it off the ground.”

The Biden administration funneled $1.5 billion into standing up the 988 Lifeline network, much of that ahead of the launch in 2022, to help address capacity concerns.

“It’s been just such a priority for the administration to really invest heavily in the [988] Suicide & Crisis Lifeline,” SAMHSA Administrator Dr. Miriam Delphin-Rittmon told ABC News. “There’s been $1.5 billion that has been invested into 988, as part of this comprehensive strategy to address the nation’s overall behavioral health.”

Building a sustainable funding future

In the midst of a contentious political cycle, Wesolowski said she’s “hopeful” that the outcome of the presidential election won’t substantially impact federal investment in the service — noting that former President Donald Trump was the one who signed the bill that designated 988 as the lifeline in 2020.

“We have seen even in the change of control of the House, [a] split Congress, that there’s still a pretty strong interest in funding this resource. We saw a modest increase [in funding] this past fiscal year, about $18 million more to 988, but in an environment where a lot of programs are being cut, that’s pretty good,” she said. “There’s strong bipartisan support.”

Delphin-Rittmon said that many states have been working with the federal government on building out the crisis care system, making state-level investments to help fund 988 and related services.

So far, nine states have enacted a 988 lifeline cell phone tax, similar to the tax in place to fund 911 call centers, according to the National Alliance on Mental Illness, or NAMI, and several others have allocated appropriations to fund the service.

In Washington, one of the states with a 988 tax, Levi Van Dyke is the chief behavioral health officer for Volunteers of America Western Washington, which fields 988 calls, chats and texts across the state.

“Sustainable funding for 988 in Washington state is, maybe, different from other states. We are seemingly in a really good place with having that 988 fee and support,” Van Dyke told ABC News. “In talking with colleagues at centers around the country, I always feel very fortunate because we are in a good position as far as those resources.”

Subnetworks providing specialized services

Amid the buildout of the 988 system, the lifeline has also bolstered specialized services for veterans, Spanish speakers, LGBTQ youth, and people who are deaf and hard of hearing.

Dole said there aren’t currently plans to add another national subnetwork, saying that extending the interactive voice response at the beginning of a 988 call poses a challenge.

“The challenging part is extending the IVR [Interactive Voice Response] — press one, press two, press three, press four,” she said. “When you add additional wording to the message, you delay access to care. And what that does is increase the chance of abandonment, which is people clicking out.”

Back in Washington, the Native and Strong Lifeline enables callers to speak with Indigenous counselors who can offer culturally specific care to Indigenous people. The state-specific line was created in response to disproportionate rates of suicide among Native American communities.

Delphin-Rittmon told ABC News that SAMHSA has received interest from other states about creating a similar line and that those conversations are ongoing.

Van Dyke said the process to create the line in Washington was years long, requiring specialized staff and training, but that he would love to see it offered in other states.

“We’ve seen how impactful and how important it is to have this dedicated service, and we would love to see that service grow and expand outside of Washington state,” Van Dyke said.

Building awareness — and when to call

Dole said that while the service is called the 988 Suicide & Crisis Lifeline, “I actually think of 988 as preventative,” noting that you don’t have to be in active crisis to call.

“If you’re in a mental health emergency, absolutely call us,” Dole said. “But if you are really struggling, if you call us — the earlier you call us, the more likely that you can be connected to services that will prevent something that is an emergency.”

She said that 988 staff can connect callers to resources to help them deal with nonemergency mental health issues, and that they hope to help prevent crises, as well as respond to them.

“988 is certainly for people in crisis, and it is certainly for people before they get into crisis, and their loved ones and their family,” she said.

Delphin-Rittmon echoed the sentiment, telling ABC News, “If people are struggling, it’s important for them to know that they’re not alone, that we are here to help. There’s compassionate, trained counselors available, 24 hours a day, seven days a week, to help them with any type of mental health, substance use or suicide-related crisis.”

Looking ahead, the advocates say they want 988 to be widely known as the number to call for people struggling with mental health issues.

“I want 988 to be as ubiquitous in our culture as 911,” Wesolowski said. “I want every young person to not even hesitate, to not even think — if they are struggling, if their friend is struggling, if their parent or sibling is struggling — to feel like 988 is a natural place for them to reach out to and to know what they’re going to get when they reach out.”

If you are experiencing suicidal, substance use or other mental health crises, or are worried about a friend or loved one, please call or text the 988 Suicide & Crisis Lifeline. You will reach a trained crisis counselor for free, 24 hours a day, seven days a week. You can also go to 988lifeline.org.

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(PHOENIX) — A 4-month-old baby died in Arizona last week after suffering a heat-related illness while on a boat, according to police.

The infant’s death comes amid an ongoing heat wave in the U.S. affecting tens of millions of people across multiple states.

The infant, who was not identified by police, was rescued from a boat on Lake Havasu on July 5 and transported to a local hospital, according to authorities.

From there, the infant was taken to Phoenix Children’s Hospital, where they “succumbed to their injuries,” the Mohave County Sheriff’s Office said in a statement released Monday.

The sheriff’s office said the investigation into the child’s death is “ongoing.”

A sheriff spokesperson told ABC News Wednesday the office is not releasing any further information.

On Wednesday, a spokesperson for the medical examiner’s office in Maricopa County, where Phoenix Children’s Hospital is located, identified the infant as Tanna Rae Wroblewski and said her cause of death has not yet been determined.

A GoFundMe page established for the Wroblewski family states that they were enjoying a “family day on the lake” when the infant “lost consciousness” and family members started performing CPR.

“Lake Havasu City Fire Department quickly arrived to take over life-saving procedures. Tanna was rushed to Havasu Regional Medical Center where they continued to work on her to get a pulse,” the fundraiser states. “She was then airlifted to Phoenix Children’s Hospital where they did everything in their power to revive her, but God had other plans, and took Tanna to heaven that night.”

Attempts to reach members of the Wroblewski family by ABC News were not successful.

In the Lake Havasu area, temperatures over the past week have hit triple digits, reaching as high as 120 degrees Fahrenheit, according to the National Weather Service.

As of Tuesday, more than 70 million people were under heat alerts in the West amid a scorching heat wave enveloping much of the U.S., but particularly the West Coast.

How to protect kids from heat

According to the American Academy of Pediatrics, children are more susceptible than adults to the health effects of extreme temperatures, including extreme heat, because they cannot regulate their body temperature as well as adults.

When it comes to extreme heat, children may suffer health effects including heat exhaustion, heat cramps and heat stroke, according to the AAP.

Parents and caregivers should do their best to keep kids in indoor, air-conditioned areas in periods of extreme heat, and make sure kids are well-rested and hydrated.

Symptoms of heat-related illness to watch for in babies and kids include faintness, extreme tiredness, intense thirst, headaches, fever, nausea, vomiting, hyperventilation and skin numbness or tingling, according to the AAP.

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(NEW YORK) — Ashley Watts is getting ready to become a first-time mom.

“This pregnancy ride has been very fulfilling,” Watts, 32, told ABC News.

For Watts, this pregnancy journey is different. She has previously suffered five pregnancy losses, telling ABC News that she now suffers from hospital anxiety after feeling dismissed and unsupported by her doctors as she tried to navigate those losses and pursue motherhood.

When she learned of her most recent pregnancy, Watts decided she wanted to work with a midwife and dreamed of welcoming her baby into the world at a birthing center. The cost of midwifery care, however, was a barrier in allowing Watts access to the care she felt was better suited to her needs.

A 2021 study published in the International Journal of Environmental Research and Public Health found that midwife-assisted home births in the United States cost an average of $4,650. In many cases, insurance does not cover these births, according to the study.

After going to a consultation appointment with midwife Allegra Hill at Kindred Space LA, Watts learned of birthFUND, a new initiative by Elaine Welteroth, an author and former Teen Vogue editor-in-chief, that provides need-based grants to expectant mothers and families to use for holistic perinatal care and midwifery birth support services.

“I really don’t believe that quality, holistic, safe maternal health care should be seen as a luxury in one of the wealthiest countries in the world,” Welteroth told ABC News. “And there is something we can do about it.”

Welteroth launched birthFUND in April of this year during Black Maternal Health week, inspired by her own experience seeking care during her first pregnancy.

“I thought, how hard could it be to find a doctor? You know, I live in LA, I have resources, I have a great network,” Welteroth said. “And I just had bad experience after bad experience.”

Discouraged and nearing her third trimester, Welteroth found Kim Durdin, midwife and co-founder of Kindred Space LA.

“As a new mom, giving life in a country that’s in a surging maternal mortality crisis, I thought I should be able to ask questions about my health, about my body, about the kinds of decisions that I could make throughout the process, and midwives embrace that, they encourage that,” Welteroth said.

“I think I came out of my birth experience feeling this deep conviction to pay it forward,” she said. “I just felt like if there is anything I can do to help make sure that midwifery care is accessible to families who want this kind of care, then, like, that’s my calling.”

Dr. Laurie Zephyrin, a board-certified OB-GYN and the senior vice president for Advancing Health Equity at The Commonwealth Fund, told ABC News that there are a lot of misconceptions around midwifery care, adding that there needs to be a lot more education about the benefits and opportunities involved with using a midwife.

Midwives are also clinicians, trained to help guide people through the birthing process, she said. 

“There’s definitely data that shows that people that have a midwife during their care have improved outcomes,” Zephyrin said.

Zephyrin is one of the authors in a recent study by The Commonwealth Fund that analyzed maternal mortality data in the United States and 13 other high-income nations, finding that maternal mortality rates in the U.S. continue to far exceed that of other high-income nations.

According to the latest report by the Centers for Disease Control and Prevention (CDC), the maternal mortality rate in the U.S. fell in 2022 after three years of continuous increase. Findings by The Commonwealth Fund’s study suggest two-thirds of all maternal-related deaths in the United States happen postpartum and are frequently the result of high blood pressure, severe bleeding, infection and cardiomyopathy.

“One of the advantages of what we saw when we compared to other high-income countries is that there’s someone that comes to your home and sees you during the postpartum period, they check on you, they help answer questions,” Zephyrin said.

“And that continues throughout the postpartum period, and that leaves an opportunity so that things don’t fall through the cracks,” she continued.

For Black women like Watts, who are at a higher risk of dying from pregnancy-related complications in the United States, access to midwifery care can be even more critical.

Despite the decrease, the rate of maternal deaths for Black women in the United States remained significantly higher than other racial groups, the CDC report found. In 2022, an average of 19 white women died per 100,000 live births, while an average of 49 Black women died for every 100,000 live births.

According to the World Health Organization, including midwifery in family planning could help avert more than 80% of all maternal deaths, stillbirths and neonatal deaths. Zephyrin’s team found that the U.S. has the second lowest number of midwives for every 1,000 births, and that most countries with the lowest mortality rates rely heavily on midwives.

According to data projections by the National Center for Health Workforce Analysis, the United States is predicted to face an OB-GYN shortage, with an estimated 5,000 obstetricians expected to leave the workforce in the next 12 years. Making midwifery care more accessible can help alleviate the need for OB-GYN care providers while allowing expectant families access to holistic, perinatal care.

While approximately 3.66 million live births happen in the United States annually, there are currently about 12,650 registered midwives, according to data by the CDC and the National Center for Health Workforce Analysis.

“I really believe that people need to be educated more about what midwives can do and the opportunities for midwifery care in this country,” Zephyrin said. “Midwives are clinical providers, and they can provide this holistic aspect of care that’s really critical in what people want in our maternal health care system.”

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(NEW YORK) — Pfizer announced early Thursday morning that it has selected its preferred once-daily modified release formulation of danuglipron, a move that it said was a significant milestone in the obesity drug’s development.

Danuglipron, an oral glucagon-like peptide-1 (GLP-1) receptor agonist, will undergo dose optimization studies in the second half of 2024 as Pfizer seeks to evaluate multiple doses of the formulation which they hope will inform the registration-enabling studies.

“Obesity is a key therapeutic area for Pfizer, and the company has a robust pipeline of three clinical and several pre-clinical candidates. The most advanced of them, danuglipron, has demonstrated good efficacy in a twice-daily formulation, and we believe a once-daily formulation has the potential to have a competitive profile in the oral GLP-1 space,” said Mikael Dolsten, MD., PhD., chief scientific officer & president, Pfizer Research and Development. “Following a thorough analysis of our previous Phase 2b data and trial design, we believe that with the preferred modified release formulation and future trial design optimization, we can advance a competitive oral GLP-1 molecule into registration enabling studies, with the goal of addressing the present and persistent medical needs of people living with obesity.”

Participants in the study so far have included healthy adults aged 18 years or older and the results thus far have shown a profile that supports once-daily dosing, which is consistent with previous danuglipron studies. Notably, there have been no liver enzyme elevations observed among the more than 1,400 study participants.

Danuglipron is an investigational medicine that is taken as a tablet by mouth and is currently not approved for use by health authorities.

Current popular FDA approved weight loss medications Wegovy and Zepbound are weekly injections.

Pfizer will still need to do large scale clinical trials to produce the data necessary to show it’s safe, effective and tolerable and then submit to FDA — a process which is still likely much further down the line.

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(NEW YORK) — Nearly 200 people have been infected with dengue in the states of New York and New Jersey so far this year, according to data from the Centers for Disease Control and Prevention.

New York has reported 143 cases and New Jersey has reported 41.

Dengue transmission is typically common in tropical and subtropical areas of the world, according to the CDC.

Over 2,500 people have been infected in the U.S. so far this year, about five times higher than the same time last year. Puerto Rico currently makes up the bulk of those cases — with over 1,700 reported. The U.S. territory declared a public health emergency back in March.

The CDC issued a health alert last month warning health care providers of an increased risk of dengue virus infection this year. Globally, new cases of dengue have been the highest on record, according to the CDC.

Dengue viruses spread through mosquito bites. The most common symptom is a fever with aches and pains, nausea, vomiting and rash. Symptoms usually begin within two weeks after being bitten by an infected mosquito and last 2-7 days. Most people recover after about a week.

The best way to prevent dengue is to avoid mosquito bites, according to the CDC.

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(NEW YORK) — A new study that detected variable levels of heavy metals, including lead, in tampons currently on the market is being reviewed by the U.S. Food and Drug Administration, a spokesperson for the agency told ABC News.

The study published in Environmental International by researchers at the University of California, Berkeley, evaluated the levels of 16 types of metals, including lead as well as mercury, arsenic and iron, in 30 tampons from 14 different brands obtained in the U.S., Greece and England.

Differing levels of metals were found on materials of all 30 tampons, which included both organic and non-organic brands, according to the study, published July 3.

The study’s authors noted that it is not clear whether the metal levels found in the tampons would contribute any negative health effects to users but called for more research to be done.

“Despite this large potential for public health concern, very little research has been done to measure chemicals in tampons,” the study’s lead author, Jenni A. Shearston, a postdoctoral scholar at the UC Berkeley School of Public Health and UC Berkeley’s Department of Environmental Science, Policy, & Management, said in a statement. “To our knowledge, this is the first paper to measure metals in tampons.”

Shearston added, “I really hope that manufacturers are required to test their products for metals, especially for toxic metals. It would be exciting to see the public call for this, or to ask for better labeling on tampons and other menstrual products.”

The FDA noted in a statement that the study has “limitations” but said the agency is reviewing its findings.

“The FDA is reviewing the study. All studies have limitations. While the chemical method used indicates these metals are present in the tampons tested in the laboratory, the study does not assess whether any metals are released from tampons when used in the body,” the agency said in a statement Tuesday. “It also does not address whether any metal, if released, can be absorbed into the vaginal lining or, subsequently into the bloodstream.”

The statement continued, “We plan to evaluate the study closely, and take any action warranted to safeguard the health of consumers who use these products.”

In their findings, the study’s authors acknowledged that the types of metals detected are commonly found in the environment and could come in contact with tampon materials in a variety of ways. Possibilities include through water, air or soil, by nearby contamination or during the manufacturing process but more research is needed to understand exactly how this is happening.

Experts say it is important to note that the study only measured the levels of metals in materials of the tampons. It did not measure any levels of these metals in the blood to correlate with human health.

Dr. Stephanie Widmer, an emergency medicine physician and medical toxicologist, echoed the study’s authors in saying more research needs to be done.

“We have no understanding of the absorption, if there is any, or if this has any impact on human health,” Widmer, who was not involved with the study, told ABC News. “More research needs to be done and this study fails to provide any evidence that women who use tampons are walking around with higher than normal, or even higher levels of heavy metals in their blood than women who do not use tampons.”

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(NEW YORK) — Colorado public health officials have confirmed a human case of plague in a Pueblo County resident, according to the Pueblo Department of Public Health and Environment.

Plague is very rare, with an average of seven human plague cases reported annually in the U.S., according to the Centers for Disease Control and Prevention.

While the disease killed millions of people in Europe during the Middle Ages, nowadays, it is a rare cause of illness in rural areas of the southwestern U.S., particularly in New Mexico, Arizona and Colorado, the agency said.

Certain regions of Africa and Asia have also reported cases over the past few years.

A potentially life-threatening disease, plague is caused by the bacterium Yersinia pestis. It is usually passed to humans through the bite of an infected rodent flea or by handling an infected animal, according to the Pueblo Department of Public Health.

Symptoms can include sudden fever, chills, severe headache, muscle aches, swollen lymph nodes, nausea and vomiting, per the CDC.

Plague can be cured with antibiotics, but they must be administered promptly to prevent serious illness or death.

Health officials urged anyone who develops symptoms of plague to seek medical care immediately.

In order to avoid infection, health officials suggest people take precautions, including avoiding contact with dead animals, regularly treating pets for fleas and eliminating places in and around the home where rodents can breed.

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(NEW YORK) — COVID-19 cases are rising in several regions of the United States as summer gets underway.

For the week ending June 29, the latest date for which data is available, COVID test positivity was 9% across the U.S., an increase of 0.8% from the previous week, according to data from the Centers for Disease Control and Prevention. This is higher than levels seen during early May 2024 but lower than several points during the pandemic.

Test positivity was highest in the Southwest and western U.S. with 15.7% positivity in the region comprised of Arizona, California and Nevada, CDC data showed.

Additionally, wastewater data from the CDC shows that COVID viral activity is low nationally but has been steadily rising over the last month-and-a-half. For the week ending June 22, levels were classified as “high” in the West and “moderate” in the South.

Wastewater tracking is often used as an early detection tool for monitoring potential future upticks, although it can be inconsistent.

Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University Medical Center, said the country has traditionally seen increases in COVID every summer, so a “bump” at this point in the year was to be expected, as experts had predicted.

“We had anticipated that there would be something of a summer bump because we have seen that in the past … COVID hangs around during the summer and even gets a little more active, unlike influenza, which virtually disappears during the summertime,” he told ABC News. “Now this bump will go down, and then, of course, we’ll get the conventional winter surge later.”

Weekly hospitalizations are still near record lows but have been ticking up over the past few weeks, according to CDC data. The highest rates are among those aged 65 and older with a rate of 7.7 per 100,000 for the week ending June 15, the latest date for which data is complete.

Comparatively, adults between ages 18 to 49 and children aged 4 and under have a rate of 0.5 per 100,000, the data showed.

Schaffner said the groups making up hospitalizations are those with chronic illnesses — such as heart disease or lung disease — or those who are immunocompromised.

“Particularly older people … with chronic illnesses, the immune-compromised, particularly if they are not up to date in their vaccination, that’s the population we see now contributing to that bump in hospitalizations,” he said.

Meanwhile, deaths have been steadily dropping since January of this year and continue to remain low, CDC data indicate. For the week ending June 8 — the latest date for which complete data is available because deaths are subject to reporting delays — just 283 COVID deaths were reported, which is a record low.

Currently, KP.2 and KP.3, offshoots of the omicron variant, are the dominant COVID-19 variants in the U.S. making up nearly half of all cases.

CDC officials told ABC News in a statement on Monday that there is “no evidence that KP.2, KP.3, or any other recent variant, causes more severe disease.”

The CDC added that it is tracking all variants and recommended vaccination as the most effective way to prevent severe illness from COVID-19.

Schaffner agreed that the best way to prevent severe illness is to be up to date on vaccinations. High-risk groups that haven’t received a COVID-19 vaccine since last fall are currently eligible for another dose to carry them through the summer.

“Be sure this fall, when we have yet another updated vaccine, to get that vaccine along with your influenza vaccine,” he said. “We update both of them now on an annual basis, and that should be certainly a fall routine for all of us, but especially people in high-risk groups.”

He recommended those in high-risk groups, or people who will be around high-risk groups, to consider masking in indoor crowded areas, and — if they test positive — to receive early treatment with antiviral medication such as Paxlovid.

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(NEW YORK) — As the popularity of drugs used for weight loss continues to explode, a new study is shedding light on which drug is most effective for weight loss.

Mounjaro, a drug with the main active ingredient tirzepatide, was found to be more helpful in helping people lose weight and maintain their weight loss, according to a study published Monday in JAMA Internal Medicine.

Individuals taking Mounjaro were three times as likely to lose 15% or more of total body weight, 2.5 times as likely to experience 10% or more weight loss, and 1.8 times as likely to experience 5% or more weight loss compared to those taking semaglutide, the active ingredient found in Ozempic.

This finding was sustained at 12 months of follow-up, according to the study, which analyzed more than 18,000 patients with obesity, both with and without Type 2 diabetes.

The study found that patients without diabetes lost more weight than patients with diabetes.

According to the study’s authors, more research is needed to understand why Mounjaro, with the active ingredient tirzepatide, was found to be more effective for weight loss.

Tirzepatide targets both the GLP 1 and the GIP receptor agonist, while semaglutide mimics only the GLP-1 receptor agonist, a type of hormone in the body that impacts everything from the brain to muscle to the pancreas, stomach and liver.

Both Ozempic and Mounjaro are approved by the U.S. Food and Drug Administration to treat Type 2 diabetes, but some doctors prescribe the medication “off-label” for weight loss, as is permissible by the FDA.

When these drugs are used “off-label,” it is usually not covered by insurance and can be costly, running as much as $1,000 per month.

There are also now two drugs on the market that are FDA-approved for weight loss — Wegovy, a medication that contains the same main ingredient, semaglutide, as Ozempic, and Zepbound, a medication that contains the same main ingredient, tirzepatide, as Mounjaro.

The drugs, typically taken once weekly as injections, work by helping the pancreas increase the production of insulin to move sugar from the blood into body tissues.

They also slow down the movement of food through the stomach and curb appetite, thereby causing weight loss.

Past clinical studies have shown users of the medications can lose between 5% and 20% of their body weight on the medications over time.

Medical specialists point out that using medication to lose weight also requires cardio and strength training and changing your diet to one that includes proteins and less processed foods with added sugars.

The most commonly reported side effects of medications used for weight loss are nausea and constipation, but gallbladder and pancreatic disease are also reported. Makers of these drugs recommend having a conversation about the side effect profile and personalized risks with a healthcare professional before starting.

Barbra Streisand publicly asks Melissa McCarthy about Ozempic, sparking debate on weight and shaming
The study found there was no difference in the number of adverse gastrointestinal effects between people with and without Type 2 diabetes in the study.

Prapti Chatterjee-Murphy, M.D., a member of the ABC News Medical Unit, contributed to this report.

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(NEW HAVEN, Conn.) — A new report released by Yale Law School and Yale School of Medicine criticizes the often-cited Cass Review on gender-affirming care for transgender youth, commissioned by the National Health Service (NHS) in the United Kingdom.

The review, released in April, was performed by Dr. Hillary Cass, a former president of the Royal College of Pediatrics and Child Health, amid a rise in referrals to NHS’ gender services. Her review – which calls for more research, more support, and more caution around gender-affirming care – has been cited in the NHS decision to restrict the prescribing of puberty-pausing medications, also known as puberty blockers, to children and young people under 18 years old in the U.K.

In the U.S., gender-affirming care remains a hot-button issue in the political and medical arenas. At least 25 states have enacted restrictions on care for transgender youth since 2022, according to the Human Rights Campaign.

The Cass review was cited in recent, successful legislative efforts in Indiana to uphold a 2023 law that prohibited physicians from providing “gender transition procedures” to anyone younger than 18 years old, with certain medical exceptions.

The Yale report – which states it was authored by a team of researchers and clinicians that has “86 years of experience working with 4,800 transgender youth,” and “has published 278 peer-reviewed studies, 168 of which are related to gender-affirming care” – takes issue with several aspects of the Cass Review in their critique, saying that it “obscures key findings, misrepresents its own data, and is rife with misapplications of the scientific method.” It also accuses the Review of speculating about data on transgender patients, and criticizes certain statements made in the Review about concern over gender care referrals, early medical intervention, and more.

Yet despite being cited in the NHS decision to restrict prescribing puberty blockers to minors, the Yale report notes that the Cass Review does not recommend a ban on trans youth care. It also notes that it consistently makes recommendations that are in line with international gender-affirming medical care guidelines by the World Professional Association for Transgender Health (WPATH) and the Endocrine Society, a professional medical organization that is “dedicated to providing the field of endocrinology with timely, evidence-based recommendations for clinical care and practice,” according to its website.

In response to an ABC News request for comment, the team that authored the Cass Review said in a statement that the research that “underpins” the Review’s findings “looked at 237 papers from 18 countries, providing information on a total of 113,269 children and adolescents,” and was subject to peer review.

“In making her recommendations, Dr. Cass had to rely on the currently available evidence and think about how the NHS can respond safely, effectively, and compassionately,” the Review team told ABC News.

The statement continued, “The body of research on gender care for children and young people was strikingly poor compared to other areas of child and adolescent healthcare where life changing interventions are given, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.”

Spike in gender service referrals

The Cass Review repeatedly claims that the increase of referrals for gender-affirming care in the U.K. was “exponential,” and that social acceptance of transgender identities is unlikely to be the sole explanation for the rise.

“While it certainly seems to be the case that there is much greater acceptance of trans identities, particularly among younger generations, which may account for some of the increase in numbers, the exponential change in referrals over a particularly short five-year timeframe is very much faster than would be expected for normal evolution of acceptance of a minority group,” Cass states.

In their report, Yale researchers counter that the increase in referrals to the U.K.’s Gender Identity Service is not exponential, and points to Cass’s own data on referrals, which they say actually shows the number of referrals plateaued, and then decreased starting in 2017. A graph included in the Cass Review that shows a spike from 2021 to 2022 in child and adolescent referrals for gender dysphoria is accompanied by a note that states there is “a strong possibility that there was double counting” of referrals during the time period.

“While there certainly is an increase in referrals, describing this increase as ‘exponential’ is a serious error that fuels concern that the Review is too often more interested in subjective polemics than in scientific accuracy,” the Yale report says.

Research quality on gender-affirming care

The Cass Review also criticized the evidence supporting the need for gender-affirming care. It concluded that “while a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.”

Yale experts counter in their report that the Cass Review’s “recommendations are informed by a flawed concept of evidence.” It says the Review “fails to recognize the nuances of evidence quality measures”; that it “does not follow established standards for evaluating evidence and evidence quality”; that it “casually discusses evidence quality and does not define it, contravening standard practice in scientific evaluations of medical research”; and that it “fails to contextualize the evidence for gender-affirming care with the evidence base for other areas of pediatric medicine.”

“If high-quality evidence were a prerequisite for medical care, we would all be worse off,” the Yale report further states. “Moderate, low, and very low-quality evidence,” as defined by what the report says is “one of the most widely accepted frameworks for determining evidence quality,” and “informs necessary, high-value care at every stage of life.”

The Cass Review team states in an online FAQ that “the approach to the assessment of study quality was the same as would be applied to other areas of clinical practice – the bar was not set higher for this Review.”

A subsequent clarification in the FAQ further states: “The same level of rigor should be expected when looking at the best treatment approaches for this population as for any other population so as not to perpetuate the disadvantaged position this group have been placed in when looking for information on treatment options.”

Early intervention concerns

The Yale report also takes issue with what it calls “unfounded speculation” in the Cass Review that “social transition and puberty-pausing medications may cause harm by putting youth onto a medical path.” It further notes instances in which they assert the Cass Review “expresses concern that early supportive interventions, such as social transition and puberty-pausing medications, lock young people into irreversible care.”

For example, while stating that for some young patients, the “best outcome” will be gender transitioning, the Review also argues that “those who had socially transitioned at an earlier age and/or prior to being seen in clinic were more likely to proceed to a medical pathway,” and that “the vast majority of people started on puberty blockers proceed from puberty blockers to masculinizing/feminizing hormones” – an “altered trajectory, culminating in medical intervention which will have life-long implications.”

The Cass Review also cautions that young people who transition before they experience life as the gender with which they do not identify “may have no frame of reference to cause them to regret or detransition, but at the same time they may have had a different outcome without medical intervention and would not have needed to take life-long hormones.”

“It is completely unscientific and inappropriate to expect a young person, regardless of their gender identity, to ‘try out’ life as a gender they do not identify with – as the Review supposes transgender youth should,” the Yale report states. It further says that “The Review’s own data show that most referred patients are never subsequently referred to pediatric endocrinology and even fewer receive medical interventions.”

The Yale report argues that continuing care isn’t necessarily cause for alarm or concern, and that “The Review does not consider the most likely explanation for why most youth who receive early, supportive interventions continue onto gender-affirming hormone therapy: that they are indeed transgender.”

“It is not social transition and puberty-pausing medications that drive a persistent transgender identity,” the Yale report asserts. “It is a transgender identity that drives social transition and subsequent medical interventions.”

Detransitioning and regret

The Cass Review asserts that “the percentage of people treated with hormones who subsequently detransition remains unknown due to the lack of long-term follow-up studies, although there is suggestion that numbers are increasing.”

However, in the Review’s audit of 3,306 patients who were discharged from the U.K. Gender Identity Service (GIDS), fewer than 10 patients transitioned back to their birth-registered gender – which Yale researchers note is “a ‘detransition’ date of 0.3%.”

The Yale report also states that it is “exceedingly rare that an individual would later determine that they are not transgender” after receiving clinical transgender care and support. “A person who regrets receiving care may continue to identify as transgender; another who stops medications may not experience regret, and one who stops identifying as transgender may not regret receiving medical care,” the report says.

A report in JAMA Pediatrics noted by the Yale report found that 1% of youth who received gender-affirming medications in the study re-identified with their assigned sex at birth.

In another study noted in the Yale report, this one in the LGBT Health journal, 82.5% of those surveyed “reported familial pressure, social pressure, employment difficulty, inability to access care, and financial reasons” as the reason they presented themselves as their sex assigned at birth.

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