A few weeks ago, the Alabama Supreme Court ruled that embryos created in the IVF process had the same rights as children. The ruling was a warning of just how far the anti-abortion might go. Abdul reflects on the hypocrisy at the core of the ruling. Then he sits down with Elisabeth Smith, Director for State Policy and Advocacy at the Center for Reproductive Rights to discuss the broader implications of the ruling and what it means for people in Alabama and beyond.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: The CDC changes Covid isolation protocols. A ransomware attack on a healthcare IT company disrupts pharmacies across the country. A billion dollar donation makes tuition free at a Bronx medical school. And Adeline Hambley, our guest from a few weeks back, officially keeps her job as Ottawa County health officer. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] When I ponder the Alabama Supreme Court’s ruling granting embryos generated in the IVF process the rights of children, I actually can’t believe that grown, educated people, let alone grown educated people who’ve somehow been elevated to the highest court in their state, can actually believe that. IVF embryos are usually frozen at the blastocyst stage, meaning 200 or 300 cells at most, sometimes even fewer. The idea that blastocysts are the same as humans isn’t just an aggrandizement of what an embryo is, but it’s an insult to what a human is. 200 to 300 cells, I just want to put that in perspective. One milliliter of human saliva has about 430,000 cells, literally more than a thousand times as many. Is that human? As regular listeners know, I’ve got two kids, one of them, Serene just turn one. As I watch her delight in crawling around our house, picking up toys, laughing with her sister, or cuddling with Sarah and I, I can’t help but ponder what she’s thinking, what she’s feeling. She’s actually human and need I say this, but she’s a lot more than 1/1000 of the cells inside a milliliter of spit. You know who else is human? The thousands of would be parents in Alabama who’ve just been denied the right to have a child by this ruling. Thousands of would be parents who wanted other humans in their lives who were told that some jurist, ostensibly quote, “pro-life” views meant that they couldn’t bring life into the world. And then there are the humans at the center of this. The ones whose humanity is actively being targeted by claiming that a 200 cell blastocyst is an actual human. There are the pregnant folks whose bodies are intended to be controlled through these jurists pretzel shaped logic. So make no mistake, this is about claiming that a 200 cell embryo frozen at -321 degrees is a human, so that you could ignore the rights of actual breathing, eating, sleeping, feeling people who you reduce to a vessel for non breathing, non sleeping, non feeling fetuses inside their bodies or now outside their bodies. And all of this should remind us just how absurd the logic designed to end abortion rights in this country really are. Our guest today has been saying so for a long time. Elisabeth Smith is the director of state policy and advocacy at the center for Reproductive Rights. She joined me to explain more about the implications of the Alabama ruling, what it means for the fight for reproductive rights, and what it means for our future. Here’s my conversation with Elisabeth Smith. 

Dr. Abdul El-Sayed: All right, let’s get going. Can you introduce yourself for the tape? 

Elisabeth Smith: Absolutely. My name is Elisabeth Smith. I use she/her pronouns. And I’m the director of state policy and advocacy at the center for Reproductive Rights. 

Dr. Abdul El-Sayed: Elisabeth, thank you so much for taking the time to join us today. I honestly, I’ve thought a lot about this and put out some content on this, but the more I think about this situation that has been posed to us by the Supreme Court of the state of Alabama, putting in jeopardy, really one of the most um cherished uh pieces of of of health care access when it comes to reproduction and reproductive rights. For so many families who um who’ve relied on it for for having kids, it actually really boggles the mind. So I just want to ask you, when you heard about this ruling, where were you and what were you thinking? 

Elisabeth Smith: Um, I was at work [laugh] thinking about um abortion rights and bodily autonomy and reproductive freedom like I get to do most days. But for me, this opinion and this decision is really connected to the issues of, of reproductive autonomy and control. And, um this is all part and parcel of anti-abortion legislators and advocates who for 50 years have had a coordinated campaign to try to stop people from, you know, determining the course of their reproductive lives for themselves. 

Dr. Abdul El-Sayed: And, you know that, I think for a lot of us even before the fall of Roe and the disastrous Dobbs decision, we understood that there was a concerted effort to take away abortion rights in this country. And, you know, this has been a clearer line of debate since the ’70s and ’80s. And, you know that there was a obviously with with the fall of Roe, a clear movement in that, in that direction, against, uh the right to uh determine when, where, and with whom. Um. You you would have a, a baby, but the this, I think, came out of nowhere for a lot of folks and that you know I, connecting the dots, I can see it. But as somebody who spends your days thinking about reproduction and reproductive rights, how long have you seen this on the horizon? And, you know, what were the first inklings? 

Elisabeth Smith: So I think the the seeds of this, um this decision were planted a long time ago. Right. Um. I, I’m 43. Um. I grew up in San Antonio, Texas. I worked for um the Planned Parenthood affiliate in San Antonio as a teenager, and I went with other teens um to do kind of, like, safe sex talks, um to for other teens in San Antonio. Um. And I was in high school at a time where young people in Texas could get access to abortion and contraception without parental involvement. And since, you know, the late ’90s, um that access has been just completely taken away. Right? And we now live in a country where 14 states have criminalized abortion. And along the way, we saw, you know, anti-abortion factions make a whole host of arguments about women’s health. And then they talked about fetal pain, and then they talked about fetal dignity, and then they talked about the rights of the quote unquote, “unborn.” And so all of that was coordinated across various states, across the federal government. And these arguments were seated in various places throughout kind of our our, you know, national public, you know, conversation on on reproductive health rights and justice. And so when we look at this Alabama decision, the majority, you know, depended on language from the Alabama Constitution. And that language was added in a ballot initiative that was on the ballot in November 2018. So before Dobbs, before um uh even before the law in Mississippi, that was at issue in Dobbs was enacted. And at that point, the state of Alabama was working to challenge Roe. But they knew that they couldn’t enforce the laws that they were enacting because Roe still stood. So that was part of the campaign to create, to enact, to create and then enact unenforceable laws and the challenges to those laws would then get to the Supreme Court. Which part of the campaign right, was to remake the Supreme Court, so that there would be a court that was receptive to arguments about Roe needing to be overturned. So when that language was put into the Constitution, people were hoping for the fall of Roe, but they didn’t ah this will be my opinion, but I don’t think they really thought through what that language could mean if it were to be enforced. And so, you know, since February 16th, we’ve seen folks in Alabama and across the country really grapple with what does this mean? Right? What does this language in the Constitution mean? And how could it be used to stop people from accessing fertility care to, you know, form families of their own. 

Dr. Abdul El-Sayed: You know? I guess. I mean, part of me is almost incredulous. I guess I shouldn’t be. I’ve been around long enough that things shouldn’t surprise me anymore, but that you can call yourself pro-life and oppose access to a health care intervention that can empower people to make lives. Like I just that that to me, I just can’t understand it now. Has there been like, is is there really a tradition of people who are so absolutist about this idea that life begins when sperm touches egg, that they’ve been going after IVF? Or is this just a rogue set of judges who have now seen this writing in the Constitution as an opportunity to further reinforce opposition to abortion? Like, is this a long held idea that people actually believe in? 

Elisabeth Smith: So I’m not going to. I’m not going to claim to, to understand, you know, the minds of um anti-abortion folks. But I will say, you know, I think prior to prior to Dobbs and prior to the overturning of Roe, we saw an anti-abortion movement that was completely, um completely linked, completely uniform. Right? And what we’re seeing today are some of the differences between folks who identify as anti-abortion, right? Some some people who identify as anti-abortion were horrified by this ruling and have expressed that horror. And then you read the words of the majority opinion and the expression that um and again quoting from the opinion that extra uterine children are children. I think I was struck by the fact that some people do clearly, you know, believe this idea, um which has so many wild and incredible potential outcomes, but kind of going back to, you know, how you started this question. I think we have to ask what the purpose ultimately of decisions like this is. Right? And s um when we think about the rights of the quote unquote “unborn” or the rights of embryos or the rights of fetuses, that is a way to change the conversation and turn towards someone or something other than the pregnant person. Right? Because when we think about bodily autonomy and reproductive autonomy, that idea is that a pregnant person decides for themselves, potentially with their partner, with their family, um you know, with their community if, when and how to form a family. But if anti’s can change the conversation away from the pregnant person, then they can start to do other things right. They can start to criminalize pregnant people, which is a wildly unpopular idea in this country. And which is why, you know, most abortion bans have an exception for pregnant people. But if we then instead of focusing on pregnant people, but we instead say we’re going to pass criminal laws on the idea that an embryo or fetus is a person and we’re focused on their rights, it’s a way to to obfuscate, to change the conversation, to not focus on the living, breathing person who’s pregnant and what they want and need. 

Dr. Abdul El-Sayed: Hmm. You know, in the process, it’s we’re going to also rob a bunch of people who can’t get pregnant of of their right to have children as a function of our attempt to do this, to take away rights from pregnant people. I mean it, I I appreciate your point because it’s very clarifying. And if I can put it another way, if you take the the focus away from the rights you’re taking away from pregnant people and on to this idea of sort of like a positive set of rights you’re giving to a lump of cells, then that way it starts to open up the the avenue to continue to enforce this in a more absolutist sense. Is that correct? 

Elisabeth Smith: Absolutely. Absolutely. 

Dr. Abdul El-Sayed: And I guess you know, the thing that that I, I can’t understand and I, you know I as as a person of faith, I find it nuts when you start to try to read your faith into other people’s lives and then and then claim that somehow you’re on the right for doing this. But leave that aside. It’s also self-defeating from a position of how you think about theology. Because if you now start to say that you know, your faith dictates that there’s something hallowed about this lump of cells because of a level of, you know, claim dignity that you believe God gave it. In some respects, you’re saying this is about what we do out of our veneration of God. But here’s the here’s the here’s the rub to me. A lot of how how the, you know, the the Judeo Christian even Muslim tradition think about God is that God is omnipotent and God has monopoly on certain things, which includes creating life. But now if you’re saying that a, a a lump of cells created in vitro in a test tube by scientists has the same life as that that that human that is born at the end of a pregnancy. You’re basically you’re basically selling out the plot, right? Because you’re basically saying that like, actually, no, you can, you know, people can create life, but we’re going to give it this dignity as a function of what we believe about God. And and that just to me, it just like it like it blows the mind because you’re like, y’all, y’all lost the plot here. You you completely and 100% lost the plot. And in the meantime, you’ve now taken away huge rights from all kinds of people. People who are pregnant, people who can’t get pregnant. Uh. In your in your assumed veneration of of you know, your faith and your your attempt to arrogate your faith over um the rights of of people who don’t, who don’t believe or may believe but but interpret differently. Um. Has that, you know, I mean, I, I know we’re gonna talk a little bit more about the ruling, but like, has has that not come up in, in conversations like is are people not seeing the like the very clear hypocrisy implied in this?

Elisabeth Smith: Well, you know, we have partner organizations who advocate for reproductive health rights and justice from various, you know, religious traditions. Right. Um. Catholics for choice is an organization that we work closely with. The National Council of Jewish Women is an organization that we work closely with. And when we talk to to people from other faith traditions who say that it is their faith tradition that leads to their advocacy on this issue, then I think it becomes even clearer that we are not in a position where faith broadly demands some kind of reproductive oppression or control, but instead, faith broadly requires us to honor the decisions of, you know, pregnant people and their families and communities. And that is actually the way that um you know, our partner orgs from a faith tradition describe their advocacy. 

Dr. Abdul El-Sayed: Hmm. And I appreciate that perspective. And I, you know, I certainly agree with it. It’s just it’s so frustrating to watch folks who claim to do something in the name of, um in the name of God. And then in the process, sort of cell phone when it comes to what they believe about God, it’s just like, you know, it, I mean, it, I mean, it like you have to laugh so that you don’t cry. Um. I want to ask you a little bit more just about the the on the ground implications of the ruling. A lot has happened in Alabama since, and it’s affected thousands of people’s lives. Can you can you talk to us about some of the decisions that have been made and some of the ways that this this court ruling has forced the hands of health care providers, uh regarding their ability to deliver uh IVF services. 

Elisabeth Smith: Well, yes. And I want to start actually with um one justice on the Alabama Supreme Court dissented from the opinion and in the dissent, um that justice actually said that this would this would harm people in Alabama who are dependent on IVF and um, and actually says, you know, I’m quoting, “no court anywhere in the country has reached the conclusion, the main opinion reaches” and “the main opinion’s holding almost certainly ends the creation of frozen embryos through in vitro finalization in Alabama.” And so it was known justices in the court knew what this um, what this opinion would do. And we saw immediately some of the biggest um, or the largest medical providers of IVF in Alabama immediately cease, you know, offering the service. And so I think then we heard sort of really heart wrenching tales of people who had appointments cancelled, who had planned transfers that did not go forward. And that is why, you know, we saw a couple hundred people at the Alabama legislature um saying, you need to fix this. And many of them brought children who were conceived through IVF to to put a human face on you know what this what this opinion would entail. And so, you know, we we saw legislators in Alabama um say that they were going to fix the situation. And so they very quickly moved a bill, um Alabama House Bill 237, which purports to um, provide immunity, both civil and criminal, to providers of IVF um except for acts or omissions that were intentional and not related to IVF. And the bill also um purports to be retroactive on its face. So it was passed the bill was passed by both chambers. Um. And it is meant to be a quote unquote “fix”. Um. But in analyzing the legislation, um it it definitely falls short of what Alabamians need and want in order to access fertility care in their state, you know, without without fear. Um. And so it remains to be seen whether this legislation, um when it goes into effect, will one be effective and two, whether it may be challenged. Um. And it could potentially reach the Alabama Supreme Court again. If that were to happen, what would this majority do? Would they find that this is an effective carve out, or would they say, no. You know, based on our opinion in the in the prior case, we have said again, quote unquote, “extra uterine children are children” and this fix is ineffective and unconstitutional under the Alabama Constitution. Again, we don’t know, you know, whether any of those things will occur. But reading the text of the majority opinion, I am not sure that any law passed by the legislature would meet the bar that they have set. 

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Dr. Abdul El-Sayed: So in Alabama, there really may not be a way past this, except for that it’s almost like a law would have to be reversed. Would have to be would have to be heard by the Supreme Court, who would then have to reverse their precedent that that is based in this in this case, which you would assume given the you know, eh overt nature of the way this this ruling is written, uh wouldn’t happen until you had new justices. 

Elisabeth Smith: Well, even even kind of beyond that, the language the justices depended on is from that amendment to the Alabama Constitution. 

Dr. Abdul El-Sayed: Mmm. 

Elisabeth Smith: And so and let me just read you that language, because I think [laugh] this is the piece that again, as someone who works um on legislation across the country eh you know, amending statutes is easy. Amending a Constitution is much more difficult. So this is the language that is currently in the Alabama Constitution. The state, quote “acknowledges, declares, and affirms that it is the public policy of this state to recognize and support the sanctity of unborn life and the rights of unborn children, including the right to life.”. 

Dr. Abdul El-Sayed: Hmm. 

Elisabeth Smith: So as long as that language is in the Alabama Constitution, it is the Alabama Supreme Court that um has the role of deciding what the Constitution requires. So, you know, some legislators this week in Alabama have said we have to tackle that language in the Constitution. And until they do that, there’s the possibility of a state supreme court, you know, determining what that language means and following the logic of this recent decision. 

Dr. Abdul El-Sayed: Wow. So so they would, in effect, have to amend their state constitution, and that could be done by a vote of the people?

Elisabeth Smith: So every state is different in terms of how you amend a constitution. Um. In all states the legislature can put constitutional, can pass a bill and put legislation on the um on you know the next ballot to amend the Constitution. In some states, the people are able to initiate constitutional amendments and and gather signatures and put a constitutional amendment on the ballot themselves. However, that is not possible in Alabama. There are two ways to amend the Alabama Constitution. One is, like I said, the legislature passes a bill. Um. And then the secretary of state puts it on the ballot or two, a majority in each legislative chamber can call for a constitutional convention. So in both of those options, it is the legislature that has to act. So remember, it was the legislature that wrote the language and put the 2018 ballot constitutional amendment on the ballot. So in order to address the language, the legislature would again likely have to write legislation, pass it, and put that up for the vote of the people.

Dr. Abdul El-Sayed: Wow. So you’re, it’s really tough to unring this bell, at least within Alabama. Can you walk us through some of the federal efforts, uh to preempt this, um this the implications of this opinion? 

Elisabeth Smith: So there have been some federal some federal efforts. Um. Senator Tim Duckworth had a piece of legislation. Um. But so far they have failed. And again, when we look at the majorities in, in Congress, in the Senate and in the House there, you know, are strong numbers of reproductive health rights and justice supporters, but they are not in the majority. Right? They don’t have the majority needed to pass federal legislation at this point. And so I think there will be continued um conversation in Congress, whether they will have the the needed votes to actually pass federal protection is a big question mark. 

Dr. Abdul El-Sayed: How likely do you feel like this is to spread? You know, considering what you just shared about the challenges, uh that that we’ll face getting federal preemption and protecting the right to IVF. How likely do you see this spreading into other anti-abortion, uh majority types of states? 

Elisabeth Smith: Um. Maybe for the first time in our conversation, I’m going to I’m going to give some good news. Um. You know, we have we’ve been having a public conversation on reproductive health rights and justice, on abortion, on pregnancy like never before in the almost two years since Dobbs was issued. The conversation in the country in the second half of February after this Alabama decision has been really similar and is pushing that conversation, you know, even more forward because it has really, I think let people know that the danger of overturning Roe and the danger of the of the, you know, radical anti-abortion position is this, that IVF could be could be in danger. So the good news is that um, you know, there was a bill that had been introduced in Missouri, a state that um, you know, passes lots of, anti-abortion bans and restrictions and restrictions on reproductive health. And the bill would um would have, could have, um if it had been enacted, could have prevent presented serious limitations on IVF access. But the legislature legislator who introduced it, um withdrew it. And the the thought the the tea is that he withdrew it because of the public conversation about Alabama. In Florida, there was a bill that would have amended Florida’s wrongful death statute, but it wasn’t [?]. And so advocates in Florida um, have been, you know, advocating strongly and talking to legislators about how that Florida bill would also um limit or end access to IVF. And prior to the Alabama opinion, the conversation in the Florida legislature was, no, no, this bill has nothing to do with abortion. Don’t [laugh] don’t turn this rock over. Don’t worry about it. It won’t harm IVF access. You know, nothing to see here. But in the you know, in the last week, that bill has also been um put on pause and we are hearing that the bill is dead and the Florida legislature is going to um adjourn [?] next week. So efforts that, you know, had a likelihood of passage in other states before the Alabama opinion now have not gone forward. And that is great news for the folks in those states. It doesn’t help anybody in Alabama, but people are seeing with more clarity uh the stakes. 

Dr. Abdul El-Sayed: That is, um really hopeful news. Uh. I want to I want to ask. You know, the other the other space that this opens is it demonstrates in a, in a bald faced way just how self-defeating and dangerous a lot of the arguments upon which the anti-abortion position is based, and the risk of following them to their logical conclusion, because you got to hand it to the justices on this one. They followed a lot of the arguments that are made to oppose abortion rights to their logical conclusion, as as you laid out earlier. And I think when people look that in the eye, they don’t like it because they realize that this is a ideological uh attempt to rob a lot of people of their rights in ways that you can’t always control or see coming. And I’m wondering, you know, as you think about where this discussion goes, is there a potential that there is a backfire of this overreach here where it starts to win more people over, uh against the anti-abortion position or uh for the protection of abortion rights who otherwise might not have been, um uh might not have been open to listening, uh to the alternative view. 

Elisabeth Smith: You know, look, I have been, as I said, um an abortion proponent for decades now. And prior to Dobbs, everybody who did abortion work could see the writing on the wall. Right. We saw this in the 2016 election. We knew what the stakes for the 2020 election were. And we we yelled and screamed and tried to convince people that their rights were at stake. And, you know, polling and research showed us that people didn’t believe us. And I don’t blame them for that. Right. Like, I I’m going to go off on a bit of a tangent, but um, my pet, my hobby horse, I have a lot of people say, why didn’t young people realize x, y, z? Why didn’t young people vote? Why didn’t young people? And to that I say listen. Roe was decided in 1973. I want people to, you know, depend on the rights that the Supreme Court has articulated and move on, right, and move on to the next fight and move on to the next the next clause and the next issue that needs to be addressed. But that being said, as soon as Dobbs was issued, we saw people start to stand up and proclaim their support for abortion rights. In the state of Kansas the um the restrictive constitutional amendment that was on the ballot in early August 2022 was um was a campaign that, you know, really depended on everybody in Kansas standing up for their rights in the Kansas Constitution. The center was part of that campaign. And we we thought that we would win, but we didn’t know what what um we didn’t know what percentage by what percentage we might win. And then we saw Kansans go to the polls and resoundingly, um vote against that amendment. And since then, abortion has won every time it’s been on the ballot. So I think that as people start to understand more and more the the chaos and the horror and the pain that can be tied directly to the Dobbs decision. They become more vocal and more staunch kind of in their positions, um in support of abortion rights, and support of access to reproductive health care. And to conclude this soliloquy [laugh] I think there’s, you know, in 50 years when someone writes the definitive history of the Dobbs decision, they are going to be able to chart terrible outcomes that we are not yet aware of. Right? We we now see the effects on the potential effects on IVF. We know that providers in states that have banned abortion are leaving those states. We know that medical residents and medical fellows aren’t accepting positions in states that have banned abortion. We’re seeing those things now pretty clearly. But the effects of Dobbs on people in this country will continue to, you know, become clear both to abortion rights advocates but also to the rest of the country as issues like this continue to be uncovered. 

Dr. Abdul El-Sayed: Hmm. Yeah, I, I appreciate that note because I think you’re you’re entirely right. Right. Is that this was the unraveling of a stitch that had held for nearly half a century in our country, and you just don’t know what else in the fabric is going to start to to be unraveled. You can imagine that three weeks ago, there were families awaiting implantation for babies that they were hoping for that they may never be able to actually have where you know, it’s going to cost them tens of thousands of dollars more and a whole lot of travel to figure out how to have ostensibly because some, quote, “pro-life” people took away their right to make life that they were so excited to have and to welcome into their home. And, you know, on the same boat, we we think about how many people are burned in situations where they’re forced to carry a pregnancy that they did not want to have as a function of this same ideology. And um, there is so much that uh, that, that we need to continue to do to affirm uh those rights and those basic human rights to control your own autonomy and your own body. And I want to ask you, you know, for those folks in Alabama who are, you know, were were midway through a long, protracted IVF course. What recourse do they have? What are the circumstances that they’re facing now? 

Elisabeth Smith: Immediately I think they’re they are in a wait and see position. Right? Um. What will happen with this uh, this legislation that the legislature, the legislature passed? Um. When it gets enacted, will, you know, their IVF providers resume providing care? You know, will they feel like this is this is enough? Um. And they can reschedule appointments or will those providers, um you know, not not resume care. And if that happens, then, as you alluded to, there are the really awful and incredibly expensive questions about um, you know, moving embryos to another state and trying to get care in that other state. Um. Folks in Alabama also have the dubious pleasure of living right next door to Louisiana. And Louisiana is the only state in the country with a law that says that IVF embryos created through IVF can never be destroyed, and in fact, those embryos have the right to sue and be sued. And so [laugh] we likely don’t have time but there are really um, just mind boggling stories of litigation over control of embryos that are in Louisiana because of that Louisiana law. So folks in Alabama aren’t going to be looking in that direction. But, you know, if providers don’t resume services, will maybe be looking to other states if they can manage, you know, the logistics and the cost. 

Dr. Abdul El-Sayed: And all of this just highlights just how, how many intellectual pretzels are being created by folks who are choosing to abrogate other people’s rights in favor of arrogating their own belief system over others. In a in a country where we ostensibly believe in the separation of church and state. And I just um, I’m really glad that there are folks like you who are out there who are um fighting the good fight for uh reproductive rights and freedom and uh doing so in a way that reminds us of the dignity that’s lost uh when we fail to do that. And um just how critical this can be for people’s lives. Our guest today was Elisabeth Smith. She’s the director of state policy and advocacy at the center for Reproductive Rights. Elisabeth, we really appreciate you joining us, um sharing your work and your perspective with us. And being out there, um fighting the good fight. So thank you so much for taking the time to join us today. 

Elisabeth Smith: Thank you for having me. [music break]

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. The CDC has officially changed the isolation protocols for Covid 19. Rather than a five day isolation period, they’re now recommending that people stop isolating if they’re 24 hours fever free. As I’ve expressed in the past, I think this might be premature, but let me try to at least explain the CDC’s reasoning here. The change in policy is premised on two facts on the ground. First, 24 hours fever free is the recommended isolation period for other viruses. And second, it’s extremely rare these days that people are even testing themselves for Covid anymore. And that might be because of fact one. The cost of knowing you have Covid as opposed to any other respiratory virus that could be causing your symptoms. That cost is that you would need to spend five days isolating. So as to many people’s thinking goes, maybe not test? This change in policy is about addressing that by reducing the required isolation period down to what it would be for other viruses like flu and RSV, and meeting people where they already are. But like I’ve said in the past, Covid continues to persist at levels that flu and RSV simply aren’t. And I’d rather encourage more isolation than less. See, people just aren’t that fastidious at assessing their symptoms. And reducing the isolation period just increases the likelihood that people who are still infectious go on to spread it. I thought we might have learned our lesson that it’s better that people stay home when they’re sick. It’s better for them, it’s better for everyone around them. But hey, I guess here we are. This week, thousands of Americans tried to access their prescriptions at their local pharmacy, only to be told that they were delayed. The cause? Last week United Health confirmed that its subsidiary, Change Health Care, had been hit by a massive ransomware attack that possibly compromised thousands of patient records and delayed crucial medications. The company handles nearly one in every three patient health care transactions. Managing the back end for nearly 70,000 pharmacies nationwide. The Russia based cyber gang BlackCat, I can’t believe I just said that, claimed credit on the dark web. And according to the FBI, this may be signaling a turn toward targeting health care companies. I raise this story because it highlights the growing risks inherent in our increasingly tech enabled health care system and what that could mean for our data privacy, but even worse, our health care access. We’ll be talking more about this, in fact, in a few weeks we’ll be interviewing a medical school dean who wrote a whole novel about the risks of tech enabled health care malfeasance, stay tuned. Ruth Gottesman, a billionaire philanthropist, just donated a billion dollars to Albert Einstein Medical College in the Bronx to fund free tuition for its medical students into the future. First of all, Ruth, slow clap to you. Generations of future doctors thank you. But also, this should raise the question why does it take a billionaire to make medical school free? The average physician graduates medical school with over $200,000 in educational debt. And it’s not just that that imposes huge financial consequences on American doctors, but it shapes who goes to medical school in the first place and what kinds of specialties they pursue. We talk a lot about expanding the diversity of America’s physicians. But ask yourself, how does the insane cost of going to medical school change who’s willing to take on that kind of debt in the first place? About a decade ago, a few colleagues and I analyzed the medical debt burdens of medical students by race. And as you probably could guess, Black medical students graduated with the highest debt burdens. Given the way that structural racism has robbed generations of families of accumulated wealth. The probability that Black students can count on family members to chip in to cover some of the costs is just lower, and that means more debt by the end. But even beyond the completely unequitable burden of debt on Black medical graduates, think about how many would be Black doctors look at the price tag and think, you know what? I’m going to do something else. But then even when they graduate, the need to pay back that debt shapes the choice of specialties. A 2014 study of over 3000 medical students from over 100 schools found that higher debt predicted choosing a specialty with a higher average income. Think dermatology or plastic surgery instead of pediatrics or primary care. We shouldn’t be leaving it to philanthropic billionaires to solve what is a major discipline wide crisis. So, Ruth, thank you. Now it’s Uncle Sam’s turn. Finally, a few weeks ago, we brought you the story of Adeline Hambley and Marcia Mansaray, leaders of Ottawa County’s Health Department. This week, we learned that a court ordered panel of arbitrators had facilitated an agreement in which Hambley would be guaranteed her job through 2025. The county commission, who had started all this, bowed to their will and voted eleven to zero to keep her in the role. And just to make the story sweeter, in the same week, the county administrator who oversaw attempts to cut the public health budget resigned. Sometimes tough stories do have good endings. That’s it for today. On your way out, don’t forget to rate and review the show. It really does go a long way. And if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected merch. Don’t forget to follow us at @CrookedMedia and me at @abdulelsayed no dash on Instagram, TikTok, and Twitter. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher, our associate producers are Tara Terpstra, and Emma Illick-Frank. Charlotte Landes mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Gesimer, and me. Doctor Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice, and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human, and Veteran Services.