01/06/2023

FDA Expands Pharmacy Options For Abortion Pills

12:12 minutes

outside the main fda building, the sign is in the foreground
Credit: Shutterstock

This week, the FDA finalized rules that would allow more retail pharmacies to stock and fill prescriptions for the abortion drug mifepristone. Previously, the medication had been available only via certain specialty pharmacies or via mail order. Now, major retail pharmacies such as CVS and Walgreens can apply for permission to fill prescriptions for the medications, which now account for about half of all abortions performed in the United States.

The immediate effects of the rule change are not entirely clear, however—a patchwork of state and local laws govern the availability of these medications, and may prevent their availability in some areas. Around half of the states have some restriction on abortion pills. 

Katherine Wu, science writer at The Atlantic, joins Ira to unpack the rule change and  other stories from the week in science, including news of a new surging COVID variant called XBB.1.5, the injury to NFL player Damar Hamlin, a stray snowy owl visiting southern California, a likely farewell to the Mars InSight lander, and a study looking at how an island rat population can affect offshore coral reefs.


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Segment Guests

Katherine J. Wu

Katherine Wu is a staff writer at The Atlantic based in New Haven, Connecticut.

Segment Transcript

IRA FLATOW: This is Science Friday. I am Ira Flatow. A bit later in the hour, standup comics talking science. But first, some serious business. This week, the FDA finalized a rule that would allow more retail pharmacies– and we’re talking big chains like Walgreens and CVS– to stock and fill prescriptions for the abortion drug, mifepristone. The medication has been available only via certain specialty pharmacies or mail order. Joining me to talk about this and other science stories of the week is Katherine Wu, staff writer for The Atlantic, based in New Haven, Connecticut. Welcome back to Science Friday.

KATHERINE WU: Hello. Good to be here, as always.

IRA FLATOW: Thank you. Please explain the new rules for us about abortion pills.

KATHERINE WU: Right, so earlier this week, the FDA gave the green light to big chain pharmacies like CVS and Walgreens, as you mentioned, to dispense these very important abortion pills. The move is expected to really expand access to these pills with the catch that some states’ restrictions around abortion pills may somewhat limit it. But for people who are pregnant and don’t want to be in about half of states, at least, this should make a massive difference.

IRA FLATOW: And how much of a role do these pills play in the medical landscape?

KATHERINE WU: So before Roe versus Wade was overturned, we were already seeing that about half of abortions were performed with medication, with these pills, mifepristone and misoprostol. And that percentage has been widely expected to increase now that surgical abortions are far less available.

IRA FLATOW: So to be clear, this is not the morning after pill like Plan B, correct?

KATHERINE WU: That’s right. So these are two pills that people can take through about the 10th or 12th week of pregnancy, so still early on, really, the first trimester. And the idea is to end an early stage pregnancy. The morning after pill is to prevent that pregnancy from even really taking hold in the first place.

IRA FLATOW: Mm-hmm, and as you said before, these pills are accessible in about half the states?

KATHERINE WU: So the tricky part here is, for instance, if CVS and Walgreens move forward with certification to be able to dispense these pills, which both have said that they’re planning to do, that sort of should give blanket approval to any CVS or Walgreens to dispense these pills, fill these prescriptions. Just a note here that prescriptions are still required so that has not been removed. These are not available over the counter.

But the tricky thing is, things may look very different in, say, Massachusetts versus Texas. We know about at this point about half of states have at least some restrictions around abortion pills. For instance, some basically make it impossible to use the pills via telemedicine because you basically have to take them in the physical presence of a clinician. And some states like Texas have actually outright banned the use of the pills past the seventh week of pregnancy. So it’s a little tricky. Basically, the TLDR here is mileage may somewhat vary depending on what state you’re in.

IRA FLATOW: You say that restrictions are going to be different in different states. Are we going to see people leaving their own state and traveling to other states to get the pill?

KATHERINE WU: It will be interesting to see if people start crossing state lines to access these pills. I mean, I believe that has already been happening to some degree because there have been restrictions around the pills, even before this ruling. But and we also know that is happening with surgical abortions, so I wouldn’t be surprised if there is some travel to access this. But certainly not everyone has the resources to drive 8, 10, 20 hours to access abortion pills, which the big plus there is convenience.

IRA FLATOW: Yeah. Let’s move on to some other medical news. Of course, we’re still in the midst of the COVID pandemic. And now there’s a new variant, right? Tell us about that variant.

KATHERINE WU: Right, so this newcomer is XBB 1.5, and it’s actually been around for a few months. I think it was first detected around these parts actually in October. But after brewing sort of quietly in this big variant soup that we’ve been dealing with for quite some time, it really started to take off in December. In the last week of 2022, it went from 20% of estimated infections in the US to 40%. And I think once the new numbers come out any minute from the CDC, we’re going to see it taking over quite a bit more. It’s already the vast majority of infections in the Northeast.

IRA FLATOW: Hm. Do we know if this is really something new to worry about? Is it making people any sicker?

KATHERINE WU: So, so far, there’s no evidence to suggest that this is more inherently severe or likely to cause severe disease than previous variants, though I will caveat that by saying that it takes a while to sort of figure that out. We also know that some people’s antibodies may be waning if they haven’t gotten a recent bivalent shot. And people were mingling a lot over the holidays, so kind of a TBD on that front. But it is spreading remarkably fast. The WHO has already said that this is probably one of the most transmissible omicron variants we’ve seen yet.

IRA FLATOW: Wow. Do we know why this is taking over so easily?

KATHERINE WU: Yeah, so it’s kind of familiar stories that we’ve heard a few times now. It seems like two factors are driving this. One is that it is very good at evading antibodies that vaccines and previous variants have laid down in people. And also, it seems really, really good at latching on to the surfaces of our airway cells. And so that might make it easier for this variant to spread really quickly between people.

IRA FLATOW: So, once again, be vigilant, get boosted, mask where appropriate.

KATHERINE WU: Right. I think the tricky thing is this is coinciding with the sort of post-holiday surge. We were already expecting a winter wave because of behavior and not enough people getting that bivalent shot. And this could make the impending surge worse.

IRA FLATOW: Hm. OK, let’s move on to some other news. Especially if you were watching Monday night football, you may have seen that really scary incident involving a 24-year-old, Damar Hamlin, who collapsed and went into cardiac arrest on the field. Today, he seems to be doing a bit better, right?

KATHERINE WU: Yeah, that’s wonderful news. As far as I know, he is still in the ICU, but he has massively improved since Monday. I think it’s going to be quite some time before he’s back up on his feet. But we are hearing hopeful news from the Buffalo Bills and definitely wishing him a speedy recovery.

IRA FLATOW: But we still don’t know medically what happened. It’s a bit of a mystery, right?

KATHERINE WU: Right, I mean, this was an incredibly healthy young athlete who collapsed on the field. The most plausible explanations that experts have been putting forward this week, basically, they’re thinking there may have been some sort of pre-existing condition that made his heart a little bit weaker. And of course, we do need to remember, there was a pretty big impact right before he collapsed. He had just tackled another player.

And it’s possible that a very rare incident in which the impact hit his chest at just the right moment in the cycle of his heart pumping might have sort of set his heart rhythm into flux and triggered a heart attack. It’s sort of unclear. It could be a mix of factors coming together. But I think it’s important to note here that a lot of misinformation has started to swirl around this because ambiguity just lets that stuff slide in. There is no evidence so far to suggest that vaccines have anything to do with it, but that hasn’t stopped people from suggesting it.

IRA FLATOW: Hm, yeah. That’ll always be there. Let’s turn to something else. Let’s turn to some space news. For the past four years, we’ve been hearing about Marsquakes, like seismic activity on Mars. And that comes from data taken by a Lander called Insight. But Insight may be coming to an end. Isn’t that correct?

KATHERINE WU: Yeah, I think NASA has, unfortunately, called time of death on Insight, this plucky Lander that was sending us news for more than four years. In mid-December, it sent its last communication to us here on Earth. And then NASA tried to contact it twice, didn’t hear back two consecutive times. And basically, near the end of the month, they said we think this is over. They declared the mission done. And that is it for Insight. So we are in mild mourning.

IRA FLATOW: So that’s sorry to hear that. It’s a story of dusty solar panels once again.

KATHERINE WU: That seems to be a big part of the issue, which is a little ironic because Insight got so dusty doing its hard work on Mars that it kicked up some dust onto its solar panels, and just battery life is also a thing. So at this point, it seems like it does not have enough power to keep on collecting data.

IRA FLATOW: And what have we learned from this mission?

KATHERINE WU: So much. I mean, before this, we really did not have good insight– well, ha-ha– into why Mars quakes were happening. And as you were saying, this is shaking and rumbling on the red planet, the rough equivalent of earthquakes here on Earth. The difference is this is not like plates shifting up and below each other, as they are here on Earth. Rather, it seems to be the outer crust of Mars shrinking and cooling.

And sort of picture an egg sort of drying out from the inside and maybe losing heat and creating some cracks. But really understanding how that process works might tell us how heat is seeping out of the planet’s interior and maybe even turn the clock back, give us a sense of what Mars looked like billions of years ago.

IRA FLATOW: So much to learn about that planet that’s really– it’s really cool. Let’s move on to an unusual wintertime visitor in southern California. I’m talking about the snowy owl. Please fill us in.

KATHERINE WU: Yes, finally, some cheery news. There was a snowy owl spotted in southern California right after Christmas. And locals absolutely flipped their lids. They were so excited because it is absolutely bizarre to see a snowy owl this far south. I mean, it is kind of cool in southern California right now, but it’s certainly nothing like the arctic, where they spend most of their time and have a lot of snow to camouflage them. But yeah, it’s bonkers. One local, I saw a quote that said it was like seeing Santa Claus on a beach, which I loved.

IRA FLATOW: So the owl’s totally out of its natural habitat, is what you’re saying.

KATHERINE WU: It is. Normally, they don’t fly any further south than the Canadian-US border. And this is way further south than that. This is kind of bonkers.

IRA FLATOW: Wow. Let’s move on possibly to our last story here. There’s new research into– this is crazy– an unusual connection between rats and reefs, showing the interconnectivity of nature.

KATHERINE WU: Right. So I think researchers have known for a while now that invasive rats taking over islands, even intuitively, we can get a sense that is not a good thing. But they’re really just starting to understand the full ripple effects of this kind of disruption. And they’re starting to see that invasive rats can actually affect the behavior of tropical fish that hang out around coral reefs. So let’s follow this sort of chain of events here. Rats–

IRA FLATOW: Please, please.

KATHERINE WU: Rats will eat the eggs and chicks of local seabirds, which means seabirds can’t fly over the shore and deposit their feces into the soil to fertilize it, which means corals don’t get enough nutrients to grow healthy and allow algal growth that feeds these damselfish. So these local damselfish are no longer protecting their territories as aggressively because they’re thinking, oh, these corals suck. I don’t want to guard this real estate anymore. And it’s all the rat’s fault.

IRA FLATOW: So this is the ripple effect of invasive species.

KATHERINE WU: Yeah. Rats are ruining everything, is the tagline here.

IRA FLATOW: [LAUGHS] And there you have it. Thank you very much for taking time to be with us, Katherine.

KATHERINE WU: Always glad to do it.

IRA FLATOW: Katherine Wu, staff writer for The Atlantic, based in New Haven, Connecticut.

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