MedPod Today: So-Called 'Abortion Reversal'; CMS Cuts; Tinnitus After COVID Vax

app reporters offer further insights on these recently covered topics


The following is a transcript of the podcast episode:

Rachael Robertson: Hey, everybody. Welcome to MedPod Today, the podcast series where app reporters share deeper insight into the week's biggest healthcare stories. I'm your host, Rachael Robertson.

First up, Sophie Putka will interview me about my reporting on a legal battle in Colorado over whether or not the state can ban so-called medication abortion reversal. After that, Joyce Frieden is back on the podcast to talk about a new CMS rule that not everybody is a fan of. Finally, Jennifer Henderson tells us about one doctor who got tinnitus shortly after a COVID vaccine.

Now, let me hand the host seat over to Sophie for this segment.

Sophie Putka: A fight is raging in Colorado over whether or not the state can ban medication abortion reversal, a procedure that mainstream medicine says isn't backed by science. Earlier this year, Colorado passed a law banishing medication abortion reversal.

However, a Catholic health clinic called Bella Health and Wellness sued the Colorado Attorney General and members of the nursing and medical boards over the law. A Trump-appointed judge ruled in the clinic's favor, blocking Colorado from enforcing the law. Rachael is going to tell us a little bit more about it.

So, Rachael, what is the so-called medication abortion reversal? That's a mouthful.

Robertson: From the jump, I just want to be clear that no reputable medical group considers medication abortion reversal a real thing backed by evidence or science. For instance, the American College of Obstetricians and Gynecologists says that the strategy is not science based, and that it's both unproven and unethical. However, some providers tell abortion patients that a dose of progesterone will reverse the effects of mifepristone and/or misoprostol. But we don't actually have evidence that this works.

A randomized controlled trial testing the strategy actually had to be stopped after enrolling just 12 patients for safety reasons. They couldn't even get through the whole trial to test whether progesterone can actually reverse medication abortion safely or effectively. The work was published in the journal in 2020.

Putka: Wow. Okay, so can you tell us a little bit more about the Bella Health and Wellness case?

Robertson: Bella Health and Wellness is located in Englewood, Colorado, and it describes itself as Catholic and as a "comprehensive, life-affirming ob/gyn practice." The clinic and several employees of it filed the lawsuit the same day the law banning abortion reversal was passed in Colorado.

They're represented by the Becket Fund for Religious Liberty. And when I reached out to Becket for comment, they pointed to their press release, which celebrated the recent Colorado ruling, particularly on behalf of women who they say were "tricked or forced" into taking the abortion pill. Fun fact: the doctor who is considered the pioneer of medication abortion reversal, George Delgado, is also one of the doctors who's separately suing the FDA over the agency's approval of mifepristone, which is used for medication abortions.

Putka: So could a case like this actually make it to the Supreme Court? What are the broader legal ramifications here?

Robertson: I spoke with Dr. Christine Ryan, who is the associate director for religion and reproductive rights at Columbia Law School in New York City. She says that it's not likely to make it to the Supreme Court, but the case still signals a green light for clinics like Bella Health and Wellness. Dr. Ryan told me this:

Christine Ryan: Religious liberty and free speech rights have become a mechanism for the right, particularly the Christian Evangelical right, to supersede ... reasonable government regulations that are designed to safeguard the health of women, reproduction, and ... LGBT people, and protect people from deceptive practices.

Robertson: Lawsuits like this, she says, puts those rights at risk. And the Bella Health and Wellness case gives them precedence to win.

Putka: Thank you, Rachael.

Robertson: Thank you, Sophie. I will take the rest from here.

The Centers for Medicare and Medicaid Services, aka CMS, just released the final rule on the Medicare Physician Fee Schedule payments for 2024. CMS has been revising the rule since the first draft was issued this past summer. Here to tell us about what is in the final rule is Washington Editor Joyce Frieden.

So, Joyce, what's in the rule? Are doctors gonna get a pay increase from Medicare?

Joyce Frieden: Sadly, Rachael, they're not, unless Congress decides to intervene. The final rule, similar to the proposed rule that CMS issued in July, includes a 3.4% cut in the fees paid to doctors who treat Medicare patients. CMS says the cut is "in accordance with update factors specified by law." But physician groups say that the cut is unbearable, given that the cost of running a medical practice continues to go up. They are also unhappy because this cut comes on top of a 2% cut last year, which would have been even more if Congress hadn't stepped in to reduce the size of the cut.

Steven Furr, president of the American Academy of Family Physicians, said in a statement that, "Practices across specialties report challenges meeting growing patient needs as practice costs rise and annual, compounding Medicare payment cuts undermine practice viability and patient access." He called for Congress to improve the system by requiring annual pay increases to account for inflation.

Robertson: So is this cut universal across the board? Is everyone getting the same 3.4% cut?

Frieden: No. Some specialties will see their pay decreased by more than that, while others will see less of a decrease. It depends on the specific services they provide. For example, the rule includes an additional 2% pay cut for radiation therapy. Jeff Michalski, chair of the board of directors at the American Society for Radiation Oncology, said in a statement that these continued cuts "threaten to undermine patients' access to vital cancer care across the country."

Robertson: I mean, it sounds like there's a lot of fair criticism of the rule. Is there anything in this final payment rule that health groups actually like?

Frieden: Well, the AARP is happy that the rule includes a payment for doctors who train patient caregivers, usually family members. The group says that these unpaid caregivers provide about $600 billion each year in care, but are given very little training on things like giving injections or dressing wounds. So the AARP says allowing doctors to get paid for providing that training is a move in the right direction.

The rule also includes a new payment code for doctors who manage patients with complex chronic conditions. The American College of Rheumatology says this will help doctors take better care of these patients. Another provision in the rule extends for another year the payments for telehealth that were made easier to get during the pandemic. A lot of healthcare groups were calling for this flexibility to be extended and it includes payments for telehealth visits made via the telephone, as well as the regular audio/video visits.

Robertson: Thank you so much for this update, Joyce.

Frieden: Thanks, Rachael.

Robertson: Last March, Dr. Gregory Poland was grappling with what he called unrelenting symptoms of tinnitus. He developed it shortly after receiving his second dose of an mRNA COVID vaccine in early 2021. About a year and a half later, Poland got COVID for the first time. He told app that his tinnitus worsened after that. Poland is the director of the Mayo Clinic's Vaccine Research Group and editor-in-chief of the journal, Vaccine. Jennifer Henderson is here to tell us more about Poland's case.

So, Jennifer, why is Poland sharing his story now? What would he like to see happen?

Jennifer Henderson: Poland continues to say that since speaking out about his own experience, he's received hundreds of emails from people all over the world, claiming they, too, have developed tinnitus shortly after receiving a COVID vaccine. And though he is pro-vaccine himself, Poland says he would like to see more research looking into whether there may be any potential link.

I searched the Vaccine Adverse Event Reporting System, or VAERS, and found there were about 17,000 reports of tinnitus following COVID vaccination in the U.S. However, it's important to note that, according to the CDC, these reports alone "cannot be used to determine if a vaccine caused or contributed to an adverse event or illness."

Robertson: What is currently known about whether there's any potential link between tinnitus and COVID vaccination?

Henderson: So there is indeed a dearth of research on this topic. However, many studies have shown that COVID itself can cause tinnitus. A CDC spokesperson told me in an email that in order to further evaluate reports of tinnitus following COVID vaccination, the agency analyzed data from a different database, its Vaccine Safety Datalink, or VSD.

They said, "Unlike VAERS, which relies primarily on voluntary reports from healthcare providers, patients, and others, the VSD uses data from electronic health records." They also said, "Consequently, the VSD data are less likely to be affected by the reporting biases and other biases that impact spontaneous reporting patterns to VAERS and data quality." The spokesperson told me that the data thus far does not suggest a link between COVID vaccination and tinnitus, but they're continuing to monitor it regardless.

Robertson: Okay, so Poland's experience says one thing, while the CDC data is saying something else. Why does Poland want more research into tinnitus and COVID vaccines?

Henderson: He thinks that continuing to understand the relationship is important. Poland told me that the potential relationship represents a "research and medical desert, for which research funding needs to be provided."

Tinnitus can't be seen or measured in the same way that other conditions can be, he says, and there is little in the way of evidence-based treatment. Poland says his own symptoms are like having a high-pitched dog whistle blown into his ears 24 hours a day, 7 days a week. He says this can be maddening. And when it's particularly bad, he'll listen to certain sounds, like crickets and orange noise, through earbuds. Ultimately, Poland says that transparency is "where trust is built in medicine."

Robertson: Thank you, Jennifer. Hope to have you on the podcast again soon.

Henderson: Thanks, Rachael.

Robertson: And that is it for today. If you like what you heard, leave us a review wherever you listen to podcasts, and hit subscribe if you haven't already. Subscribing (on , , or wherever else) helps us bring you the news you need from people you can trust. Thank you so much for listening, and we'll see you again in a couple of weeks.

This episode was hosted and produced by me, Rachael Robertson, with additional guest host Sophie Putka. Sound engineering by Greg Laub. Our guests were app reporters Rachael Robertson, Joyce Frieden, and Jennifer Henderson. Links to their stories are in the show notes. MedPod Today is a production of app. For more information about the show, check out .