#5SmartReads - February 16, 2023

Hitha on the safety of mifepristone, on what amnesty in Iran actually means, and Nia Long

February 16, 2023

Mifepristone has one of the best safety profiles in widely used medications authorized by FDA.

“Newsy analyzed the death rate of erectile dysfunction drugs because they are generally given to healthy people and deal with reproductive health, just like Mifeprex.

Data from one study shows erectile dysfunction drugs have a mortality rate about four times greater than Mifeprex. But unlike the abortion pill, erectile dysfunction drugs are sold at pharmacies with a prescription. Yet despite its own data, the FDA maintains Mifeprex is so risky it must be placed in a special program for its riskiest drugs called REMS, or Risk Evaluation and Mitigation Strategies.”

And until the FDA changed the rule for mifepristone to allow it to be dispensed over the counter and by mail pharmacy (a change that was supported by data, not politics), it was one of the most restricted drugs to access.

The Texas lawsuit and GOP attorneys general injunction to remove authorization for mifepristone has nothing to do with safety of patients, but to control the lives of birthing people. And this sets a dangerous, terrifying precedent that could see misoprostol (the other medication used in abortions, also used to treat miscarriages), fertility drugs, birth control…

Frankly, I hope to see the Democratic attorneys general fighting this injunction to file their own to revoke FDA’s authorization of Viagra, if only to demonstrate the absurdity of the GOP’s legal actions.

Not to mention the danger they pose to the health of over 50% of the population.

Nia Long is an icon. Fellow millennials will remember her from Fresh Prince of Bel-Air or The Best Man. My younger friends likely recognize her from You People.

Frankly, I think her cropped cut was a more iconic hairstyle than The Jennifer long bob (though I didn’t dare try to pull off either).

Nia’s lived a big life, professionally and personally, and carries herself with immense grace while dispensing all the wisdom on aging, living with gratitude, and navigating single motherhood in this interview. I’ve copied and pasted so many quotes from this piece in my inspiration note, but I’ll leave you with the one that feels most aligned to how I’m living right now:

“I had a long span of burnout where I felt like I was on this hamster wheel going nowhere. When you have that level of exhaustion, it becomes bigger in your mind than it is. I started having more gratitude. If you wake up and you’re like, Oh my gosh, I have 20 things to do, you’re already making yourself tired. I started seeing so many people pass away. I lost my dad. I thought, One day, we won’t be here. And I started reexamining what was necessary to keep in my life and what to walk away from. I found myself to be a lot more peaceful. Making a list at the top of the week is also very helpful. Not, I have to do, but, I’m inspired to do these things this week. So that if I don’t finish it, I can always push it to the next week. But it feels more like a choice than a demand.”

I really value NPR’s reporting everyday, but especially on the women-led revolution in Iran and how they highlight the vast difference between Khamenei’s words and the reality in the country.

The latest example is the Ayatollah’s reported amnesty and reduced sentencing for tens of thousands of protestors. The reality is that amnesty announcements are usually made on Shia holidays, and the people who go free are usually debtors, elderly, ill, or require medical treatment.

Those who have protested for freedom will likely continue to be jailed. In the rare chance they’re released, they are likely to still be under house arrest after signing a “letter of regret”, and have their passports confiscated so they cannot leave Iran.

Make no mistake - the protests continue, though they have and will continue to change. Keep paying attention and keep supporting their fight for freedom. It’s too important to ignore.

Social media is designed to be addictive. Every like, comment, or new post triggers the release of dopamine and makes you feel good…so you continue to scroll and comment and like and engage. And before you realize it, you’ve been scrolling for over an hour without realizing it, and feeling jittery whenever you put your phone down to try and do something else.

It’s not you. It’s the apps. And they have only gotten better at grabbing and holding onto your attention.

“Rather than giving us pleasure itself, as is commonly thought, dopamine motivates us to do things we think will bring pleasure. As the brain’s major reward and pleasure neurotransmitter, it’s what drives us to seek pizza when we’re hungry and sex when we’re aroused. Scientists use dopamine to measure “the addictive potential of any experience,” writes Lembke. The higher the dopamine release, the more addictive the thing.”

If you want to dig deeper into the science and psychology of dopamine, I highly recommend the book Dopamine Nation. But if you want the summary and the action steps to observe your own dopamine spikes and to balance them out better, this article is a great piece and worth your time.

One of my healthcare policy ideas has been to establish an essential drugs registry, where the Health and Human Services department would be the biggest procurer of the most commonly prescribed medicines and distribute them to any American who needs them (much how we did with the COVID vaccines).

One of the pilot programs CMS (Centers for Medicare and Medicaid, a division within HHS) is launching comes very close to this, reducing the out-of-pocket cost for commonly used drugs to $2/month for those on Medicare. And while the details will determine its success, it’s something I hope will be successful and be built upon in the future.

There are two other programs focused on expanding access and affordability of higher cost therapies and affordability of drugs approved under the accelerated approval pathway. These programs are significant shifts from how coverage and payment has traditionally been offered, but the first program is an expansion of Medicare Part D and easier to implement and bears a higher probability of success. I’ll be keeping my eye on all 3, but the first stands to make a significant impact quickly, if it’s successful.

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