Miffed about Mifepristone with Dr. Kristyn Brandi | Crooked Media
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April 18, 2023
America Dissected
Miffed about Mifepristone with Dr. Kristyn Brandi

In This Episode

Access to the abortion medication mifepristone is in question after a dubious ruling from an ideological judge in Texas. Abdul lays out the dangerous implications of the ruling. Then he talks to Ob/Gyn and family planning specialist Dr. Kristyn Brandi about the mifepristone, the case, and the implications for providers like her and their patients.




Dr. Abdul El-Sayed, narrating: [music break] The Supreme Court stays the controversial lower court ruling banning the abortion medication Mifepristone through Wednesday. EPA issues new EV rules designed to make two thirds of American vehicles electric by 2032. President Biden officially rescinds the COVID-19 national emergency. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] You hear a lot about freedom from certain political circles. Now, if you’re a regular listener of this podcast, you probably know my politics by now. Freedom, to me is more about being free of crippling medical debt if you get sick than the freedom to carry a gun into a school. It’s more about being free to live, learn, love as you choose than it is about starting wars over oil abroad. And it’s certainly about being able to decide what medication you want to take to control what’s happening in your own body, assuming that someone certified that that medication won’t hurt you in ways you don’t know about. Today, we’re going to talk about the ongoing turmoil let loose by ideological cultural warrior turned District court judge Matt Kacsmaryk and his ruling to ban mifepristone, the first of two medications used in the safest and most effective medication abortion regimen. But first, let me wax philosophical for a second about hypocrisy, because this isn’t the first time a right wing ideologue has had issues with the FDA. The agency at the heart of this. Kacsmaryk’s ruling argues that the FDA failed to take into account the full suite of available safety data when it ruled that mifepristone was safe back in the year 2000. Apparently, the safety data they were supposed to consider weren’t data collected from clinical trials or safety data from other countries where Mife had already been available for decades. Instead, it was anecdotes from a set of right wing blogs that were only published decades after the drug was approved. But I digress. Let’s leave their argument at the FDA didn’t fully account for safety data. But before the right wing obsession with forcing people to stay pregnant got in the way. Conservatives were obsessed with doing exactly the opposite of what this ruling did. 


[clip of Donald Trump] With the Right To Try law I’m signing today, patients with life threatening illnesses will finally have access to experimental treatments that could improve or even cure their conditions. 


Dr. Abdul El-Sayed, narrating: On May 30th, 2018, Donald Trump signed the first federal right to try legislation into law. Right to try laws allow doctors and patients to fully bypass FDA approval for drugs to treat terminal illness, and for medications that could theoretically be helpful but haven’t been vetted as safe or effective in clinical trials. In fact, Senator Ron Johnson threatened to hold up FDA reauthorization in the Senate in 2017 if the legislation wasn’t pursued. But look, this isn’t an episode about right to try and perhaps we’ll do one on that later. But you see the hypocrisy here, right? Conservatives want folks to be able to use medications that haven’t even gone through the FDA’s process when it comes to safety or efficacy in the case of right to try. But when it comes to mifepristone, a medication that’s got sterling safety data, both from clinical trials and from 23 years of use in the public, they want to question the FDA’s process, which just proves what we already know. This ruling had nothing to do with safety. It had everything to do with ideological opposition to what this drug does. And that opens up a whole world of precedents. Are the same judges about to go after prep for HIV prevention or the HPV vaccine on the argument that they somehow promote sex among LGBTQ people or unmarried people? Look, it’s not often that you’re going to find me on the same side of an argument as pharma CEOs, but literally hundreds of them signed an open letter against this judge’s ruling. I would have signed it, too. Let’s catch up on where things stand now. The case had been appealed to a three judge appeals court. They ruled that Kacsmayrk’s ruling went too far, that he couldn’t conceivably challenge the approval since it happened so long ago. But that he could appeal 2016 rule changes designed to make the drug more accessible, which is, of course, equally preposterous. Think about it. If the drug is safe and effective, it’s safe and effective, and hence it should be available to anyone who needs it. Which means that limitations on access should be lifted. There’s no half way on this. That appeals court ruling would have blocked Mife from being sent by mail. A drastic reduction in access for a medication responsible for more than half of all abortions in this country. And if you’re a woman in one of the 24 states that have banned abortion since the fall of Roe last June, you would have lost one of the last best hopes you had for getting the health care you ought to be entitled to. Even if the justification is absolutely preposterous. But then Justice Alito, the same dude who wrote the opinion killing Roe last June, jumped in. On Friday, he issued a stay of the Kacsmaryk ruling through Wednesday, which means that until then, the ruling has no effect. But the question, of course, is what happens on Wednesday? We’ll stay tuned. I wanted to give this whole saga more context, so I reached out to Dr. Kristyn Brandi, an OBGYN and family planning specialist who serves as a fellow at the American College of Obstetrics and Gynecology. We talked about mifepristone, medication abortion and the consequences of this ruling. Keep in mind, we taped this on Friday just before Justice Alito stepped in. And this is, of course, a swiftly moving story. Here’s my conversation with Dr. Kristyn Brandi. 


Dr. Abdul El-Sayed: All right. Can you introduce yourself for the tape? 


Dr. Kristyn Brandi: Sure. Um. So I’m Dr. Kristyn Brandi. I’m an obgyn, an abortion provider in New Jersey. Um. And I am also the board chair for Physicians for Reproductive Health. 


Dr. Abdul El-Sayed: Well, we appreciate your service and your work and uh making the time in what has become an incredibly uh busy moment as we all rush to understand what uh the the the state of the law uh is with respect to reproductive rights. Um. And that all got thrown um into a bit of chaos well back, back in June. But uh– 


Dr. Kristyn Brandi: Sure. 


Dr. Abdul El-Sayed: But then again most recently. So I just want to start from the top. 


Dr. Kristyn Brandi: Okay. 


Dr. Abdul El-Sayed: And give folks a sense of what we’re talking about here. What is mifepristone and what’s it used for? 


Dr. Kristyn Brandi: Sure. So mifepristone is a medication that blocks a particular type of hormone called progesterone. Um. When you’re pregnant, you need progesterone to help continue a pregnancy. And so by blocking that hormone, you essentially end a pregnancy. It actually initially was developed to help with an endocrine disorder, but it happened to be learned during the process of discovering it that it also had the side effect of ending a pregnancy. It existed since the 1980s. It’s been approved in other countries. Um. But we had gotten it approved through the FDA in the year 2000. 


Dr. Abdul El-Sayed: Hmm. Which already tells you something about the lag uh–


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: That we experience here in this country with respect to the way that ideology and politics can throw sand in the gears when it comes to science based approval. And, you know, that’s the context I hope folks understand, is that, you know, our FDA’s approval process is driven by science, but politics has a way of seeping in. It’s kind of like water. It’s going to it’s going to find its way into into just about anything if uncontained. Um. But the other point that that you made here is that mifepristone isn’t just a uh an abortion pill. Like that’s what it’s used for enough obviously, that’s the reason it’s being blocked. But this is a medication that’s used in other forms of health care as well, no? 


Dr. Kristyn Brandi: Right. And so initially it was developed for an endocrine disorder. So nothing to do with pregnancy at all. But we had found that it was helpful in management of pregnancy. So we use it currently for abortion care, for miscarriage management as well. We also know that it has some effects on the cervix. And so there’s a lot of emerging data about whether it can be used as something to help induce labor in someone that is continuing a pregnancy and delivering a baby. And there’s newer emerging data about things that can help with other types of gynecologic disorders, things like fibroid management, endometriosis, which currently we don’t have a lot of medical management for. And so this medication inherently should not be stigmatized. It shouldn’t be something that’s controversial. It has a lot of different uses. But because many people associate it as the abortion pill, it carries that stigma with it. 


Dr. Abdul El-Sayed: You know, the reason I ask is because both you and I trained as doctors. And one of the things you always ask about is uh the unintended consequences of a treatment, right? What are the side effects or and um that the interesting thing here is that [laugh] aside from uh putting him himself and his ideology ahead of uh all of science, um it’s very clear that this judge just didn’t think at all about the unintended consequences of his action. Like, I’ll take it at face value. I deeply disagree with his ideological positioning on abortion, but you might think that you wanted to be a little bit more surgical about the way that you go off and ban drugs that have been used safely and effectively for a very long time and ask, uh I wonder who else I’m affecting, right? Because– 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: –to your point, um ectopic pregnancies, uh stillbirths, um people who want to manage fibroids, all of them are affected by this. And it just shows a blatant disregard for the well-being of people in this country. And the failure to think even through what the blast radius of this choice is going to be independent of the fact that putting yourself ahead of people’s bodily autonomy and in effect, forcing pregnancy is itself a real problem. But even if you were to say, no, I am going to arrogate myself to that level and put myself in that way, it’s like all these other people you didn’t think through. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: Which just highlights the fact that this person has no concept of science or medicine, but also highlights the supreme arrogance of this action. So we talked about mifepristone. That is the drug that is targeted by this ruling. I want to look at this from a different perspective, though, just because I do think it’s illuminating. What is a medication abortion and um how do we think about that? 


Dr. Kristyn Brandi: Sure. So medication abortion is similar to a miscarriage process. That’s usually how I describe it with my patients that instead of your body recognizing that a pregnancy is abnormal and ending it, we’re giving you medication to start that process. Typically, it involves two medications, the mifepristone, what we’re talking about now. Um. That is usually used the first day. And then 24 hours later we use misoprostol, which is the second medication we use in a lot of different uh ways. But in this case, it causes bleeding and cramping to expel the pregnancy. That’s the majority of what medication abortion looks like now, which I’ll remind listeners is over half of all abortion care currently is medication abortion. Um. But there are other medications that we can use, and we may have to revert to that now that mifepristone may no longer be available to people. 


Dr. Abdul El-Sayed: And what are the alternatives right now to mifepristone? 


Dr. Kristyn Brandi: So the second medication that we typically use with mifepristone can be used alone. And so we would use that in a little bit of a higher dose, multiple doses in order to have the same effect. Um. Back in the day, we used to use other medications. One is methotrexate, which is a medication we currently use now for management of ectopic pregnancies. Um. So there are alternative options. They are really safe and effective. But we have all this data that suggests that what we’re using now is the gold standard of care. That’s what we should be using. Um. But as you mentioned earlier, that’s not really a consideration in this court case. 


Dr. Abdul El-Sayed: And the thing about it is that people think that somehow eliminating the means of a safe, effective abortion is going to stop an abortion. All that does is makes an abortion less safe. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: And, you know, thankfully, we have other safe and effective means. But on the margins, the Mife Miso approach, which is what we you know, what is the gold standard is the safest and most effective. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: Right. And and what you’re basically doing is just forcing people to a less safe version. And on the most extreme front, um you know, you take away a lot of this access and you’re talking about um reverting to a system of abortions that we saw, unfortunately, you know, decades ago, half a century ago uh before this ruling, which was extremely unsafe and, you know, often involved um going to folks who were not certified practitioners of medicine uh to do things that could ultimately be deadly. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: I want to um ask you, you know, just thinking about access. Before this ruling, what was the usual approach to accessing a medication abortion? 


Dr. Kristyn Brandi: So typical to like anything else, like you would go to a provider. Um. This could be your abortion clinic nearby. This could be an OB-GYN, family medicine doc, whoever provides typical routine reproductive health care. Um. You talk to the to the person about um, you know, if you think you’re pregnant, getting a pregnancy test, talking through your options about that pregnancy. And then if they decide on a medication abortion, um giving them medication. That being said, mifepristone has always been in this special category, something we call the REMS criteria from the FDA. That’s always been regulated different until very recently. So it’s always been something that you had to get approval from the company to be able to give it to people. You couldn’t prescribe it. You can’t like get out my prescription pad and write a prescription for it. You have to actually have it stocked in your clinic. Pharmacies didn’t have it. Um. And so often people had to come in person to get the medication. There are new rules that literally just came out this year in January that changed a lot of that, that made it so that pharmacies could prescribe this medication for the first time ever. And people were so excited that we could finally be able to treat this like any other medicine. And then all of this happened. So it really shows how this medication has always been in this separate category of, you know, medications. That has been really frustrating. And we’ve been using the science data to hopefully push that further and further to meet the science. But it feels like we’re just going back in time now. 


Dr. Abdul El-Sayed: We’ll be back with more with Dr. Kristyn Brandi after this break. [music break]. 




Dr. Abdul El-Sayed: Now we all know that uh the attack on mifepristone has nothing to do with safety. It has everything to do with ideology. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed, narrating: How safe is mifepristone? 


Dr. Kristyn Brandi: I like to use the term ridiculously safe. You know, not the most medical term, but it is 95 to 99% effective in ending a pregnancy. And it’s been quoted a lot. But I’ll say it again that mifepristone is safer than a lot of medications that you can get either prescribed or even things you can get over-the-counter like Tylenol or Ibuprofen. Safer than insulin. Safer than penicillin. People joke that it’s safer than Viagra, but it is true. It is an incredibly safe medication. Very few side effects or um or complications afterward. But again, that’s not what we’re really actually talking about here. It’s all ideology. 


Dr. Abdul El-Sayed: And I want to walk folks through the science there. So, [clears throat] you know, the interesting thing about Viagra, just because we’re let’s just talk about misogyny here and hit it right on the nose is that Viagra was initially developed as a heart disease medication. 


Dr. Kristyn Brandi: Right. 


Dr. Abdul El-Sayed: And the argument was that it had efficacy. And this is actually what it does, is that it influences um the heart valves. Now, um folks with certain heart diseases are recommended against taking Viagra because it actually does have these effects. But what they found when they were testing it was it had this other unintended consequence, which all of a sudden, men who had lost regular use of their um organs found that all of a sudden they got it back. And that’s because, you know, what an erection is, is effectively an opening up of arteries um such that you have a massive flow of blood into uh the penis, that that causes an erection. And– 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: –um so it was extremely effective at doing this thing. But you got to imagine, we’re telling folks who um are usually older and therefore are more likely to have more sensitive cardiovascular organs. You know, just as a function of being old, even if they don’t have um diagnosed cardiac disease, that they can go on ahead and um take this medication to get an erection, to do a thing that’s quite vigorous, which is to have sex. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: And, you know, by its nature, while empirically uh Viagra is pretty safe and pretty effective, you got to imagine, mechanistically that you’re opening up a bit of a Pandora’s Box, which is why, you know, there are known cases of of cardiovascular events on the medication and why they recommend against it for people with known cardiac disease. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: When you’re talking about mifepristone, it targets a hormone whose main actions are generally in reproduction. That’s what progesterone does. 


Dr. Kristyn Brandi: Right. 


Dr. Abdul El-Sayed: Right. And– 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: So it’s it’s it’s quite a surgical medication like it specifically does the thing that it’s supposed to do. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: Um. If it involves progesterone and all of the points that you made around endocrine disorders, around fibroids, like these all map to the the physiology uh involved in that system. 


Dr. Kristyn Brandi: Right. 


Dr. Abdul El-Sayed: And so we’re talking about um trying to apply a safety criterion based in, I don’t know, like the nether regions of the Internet and the mind of this particular judge and other folks trying to find an ideological argument to make. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: Um. To to take away that use of the drug. And if you were to apply the same arguments to something like Viagra, you might as well go ahead and uh and decertify Viagra, too. But this is this is specific targeting of a specific drug, specifically because one judge doesn’t like what it does. 


Dr. Kristyn Brandi: Mm hmm. Mm hmm. And I think that I’ve heard talks in back rooms about, like all right, let’s target Viagra now, let’s prove a point by, like, let’s let’s go after it and show that this is ridiculous. But I think that we need to focus on the bigger harm here that as you kind of alluded to, but let’s just say it, that this makes any medication, the process of its approval, vulnerable now. 


Dr. Abdul El-Sayed: Right. 


Dr. Kristyn Brandi: This puts up any single medication and I worry particularly stigmatized care. 


Dr. Abdul El-Sayed: Right. 


Dr. Kristyn Brandi: At risk of what is next, what’s the next thing that a judge is going to decide is not with did not go through the proper approval process and let’s just get rid of it, which is not how health care should be. That’s not how medicine or science should work. 


Dr. Abdul El-Sayed: Yeah. 


Dr. Kristyn Brandi: But it’s it’s crazy to think that, like any medication could just like just, poof, be gone because of this process now. 


Dr. Abdul El-Sayed: It it changes the criteria from is it safe and effective to is it safe and effective and is it perfectly in line with any district court judge’s ideological preconceptions about whether or not the medication should be used? 


Dr. Kristyn Brandi: Exactly. 


Dr. Abdul El-Sayed: And if that’s the way that we’re going to make clinical decisions in this country, I shudder about where we’re going next. This is a profound incursion of ideology over science and um in the most brutal way. Right. In a way that um that is entirely about one group ideologically claiming authority over anybody that can uh that can hold a pregnancy. And that is um astounding. I want to move to the to the to the ruling. Can you tell us a little bit about um the group that brought the case and uh why they brought it? 


Dr. Kristyn Brandi: Sure. And so this group was a group that was actually founded in this area of Texas. So is like incorporated in this area of Texas. Um. It consists of a different conglomeration of different groups of doctors that are anti-choice, openly anti-choice. Um. And it was made to specifically create this lawsuit and challenge it in this way, because they knew that if they were incorporated in this particular place in Texas, this is the judge that this case would go in front of. And the path would be this judge, Fifth Circuit, and Supreme Court. It was a straight shot. And so it’s really frustrating one to know that there’s colleagues of mine like OBGYNs, other health care providers that would go through such meticulous lengths to overturn this very safe medication. Um. But knowing that they did it with this intention, that it’s a new group that was invented post DOBBS for this purpose. Um. It’s just so frustrating. 


Dr. Abdul El-Sayed: And they did it specifically to judge shop. I mean, this is the thing, right? 


Dr. Kristyn Brandi: Yeah. Exactly.


Dr. Abdul El-Sayed: They specifically incorporated in Amarillo, Texas, to shop for this particular judge. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: And I love that they call themselves the what is it, the Association for Hippocratic Medicine. 


Dr. Kristyn Brandi: Yeah, the alliance of–


Dr. Abdul El-Sayed: Alliance. 


Dr. Kristyn Brandi: –for Hippocratic Oath or something like that. Like it’s it’s so ironic and hurtful, really. 


Dr. Abdul El-Sayed: It’s like you intend specifically to do harm and then you model yourself off the dude who said [laughter] first, do no harm. 


Dr. Kristyn Brandi: Right. 


Dr. Abdul El-Sayed: And you judge shop specifically to find judges who you know are going to rule in your favor because all y’all are part of this, you know, odd ideological um obsession uh with with this particular form of health care. And the fascinating thing is the argument that they made is that we as physicians don’t want to be in a situation to have to care for people who are hurt in theory, by this extremely safe and effective drug. 


Dr. Kristyn Brandi: Mm hmm. Which is bonkers on so many levels. One, that and again, I’m not a lawyer, but my understanding is that you have to have some type of standing. You have to have some stake in the game in order to put a lawsuit forward. And that is so flimsy. As far as like, do you actually have a claim to make in this space? But also going back to the efficacy of this drug, I don’t know where they came up with data around that this is unsafe, that people are showing up in emergency rooms in droves for complications. That’s just not the reality of this medicine. But that’s their claim and this judge agreed with them. So that’s where we’re at right now. 


Dr. Abdul El-Sayed: You know what I’d love to see? I’d love to see a group of doctors who come together and make the exact same claim about guns. 


Dr. Kristyn Brandi: Hmm. Mm hmm. Mm hmm.


Dr. Abdul El-Sayed: I mean, I don’t know any doctor who’s super excited to treat gunshot wounds. 


Dr. Kristyn Brandi: Nope. 


Dr. Abdul El-Sayed: And that shit will traumatize you. 


Dr. Kristyn Brandi: Absolutely. 


Dr. Abdul El-Sayed: And you see it in emergency rooms all the time. In fact, a new study just came out that more than half of all uh people surveyed, representative sample were affected by gun violence in this country. If you look at life expectancy numbers in this country, uh they are being dragged down by gun violence in both homicide and suicide among young people. And so, I mean, I really wish the Alliance for Hippocratic Medicine would have decided, you know what, I’m sick and tired of having to treat people for gunshot wounds. We really should sue the manufacturers. No. Instead, they decided to target this particular medication that has been– 


Dr. Kristyn Brandi: Yup. 


Dr. Abdul El-Sayed: –in use safely and effectively for 23 years. I mean, this is the other thing about it is that the proof is in the pudding at some point. You if you were at the point of an FDA approval, you might be able to look at the the information and say, listen, we don’t actually have enough data. And there’s good theoretical reason to believe that this is unsafe. It’s been 23 years. 


Dr. Kristyn Brandi: Right. 


Dr. Abdul El-Sayed: There aren’t people showing up in droves, right with with with with grievous injuries because of mifepristone? 


Dr. Kristyn Brandi: No. There there’s been 5 million people that have used this medicine since it started. 5 million people. You think if there were complications, we would have heard about it, that we would have seen it. There would have been studies. There would have been news articles and reporting on it, but it’s just not the reality of this medicine. But yeah, we are just going to disregard 5 million people’s lived experience with this medication because of this ruling. 


Dr. Abdul El-Sayed: Can you tell us why they were so interested in bringing this case with this particular judge? 


Dr. Kristyn Brandi: So it was pretty clear that this judge from the start was picked to further their goals. Um this was a Trump appointee. It was someone that when they were going through the process of approval, kind of said the general language you’re supposed to say in order to become a judge. They’ve written on this extensively. They’ve they have open opinions of very anti-choice views. And so it was very clear if they got anything on their desk that would be remotely related to abortion that they would have taken the opportunity. It’s just it’s really hard to think about like this was all done by design. 


Dr. Abdul El-Sayed: [sigh] So we have a situation now where on the same day that this judge ruled, he issued a stay that lasted for seven days. There was another ruling. 


Dr. Kristyn Brandi: Right. 


Dr. Abdul El-Sayed: Uh. That uh was brought by 18 attorneys general. To in effect, do exactly the opposite of what this ruling would do. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: And since there has been some movement with the appeals court, can you talk to us about um what what’s transpired and you know where we are um in the conversation about access to mifepristone right now? 


Dr. Kristyn Brandi: Sure. And the other thing that all of this has happened in like six days, it’s been like a week where all this has transpired. So you’re right, There was a another opinion in the state of Washington that was actually doing great work. We were really excited about this one that was actually using the data and the evidence to suggest that mifepristone no longer needs to be regulated by these restrictive rules that the FDA has put under it. So it was a great ruling, something that would have improved access to care. The issue is that it is in direct conflict with what happened in Texas. And so now we’re at this place where there’s these two rulings that the FDA is supposed to follow, and they don’t necessarily know which one to answer to um and which is why it’s kind of going up the process and very likely will be heard by the Supreme Court. What the Fifth Circuit did was conclude that you couldn’t necessarily go all the way back and say that this medication didn’t go through the proper process because it just was too long ago. But what they did was there were some changes in 2016, again, to make the FDA follow the evidence and get more in line with what evidence was saying as far as the best regiment, the best timing, the number of in-person visits. They threw those out the window and said that the 2016 changes don’t matter anymore. So now we’re back to the initial approval of what mifepristone was in 2000. What that means is that if that is all like um allowed to pass, we would go back to having used potentially a higher dose of mifepristone. So three times the dose that we know is safe and effective currently, people would be required to come in person three times to in order to go through the process. They would have to get the mifepristone in person, they’d then have to get the second medication, misoprostol in person, and then have a follow up visit in person, which is no longer required. Most people are getting this via telehealth and entirely doing this remotely. And so we’re adding on these additional requirements, including potentially back in the day, it was only approved up to seven weeks. Now it’s currently approved up to ten weeks gestation. So we’re also rolling back who’s a candidate for this medicine. Um. And it’s rolled back that other clinicians, advanced practice clinicians like nurse practitioners, midwives, people that are providing this care and providing it just as safe as physicians. Um. They are no longer allowed to provide this medication. The big asterisk to all of that is that this seems to be the rules, if you are not one of the states listed in the Washington case, that perhaps the Washington case will protect the places that were in that lawsuit from these rules. Um. So those are mostly liberal places, although I’m in New Jersey and New Jersey and New York were not part of that lawsuit. So even though we have great laws to protect abortion care, we may still have to revert back to these old mifepristone rules, which is really frustrating. Um. So, yeah, so there’s so many things in conflict right now that people are really at a standstill and trying to figure out what are they going to do? Because many of us have patients on Saturday. And so how are we going to apply these new laws and figure out what is safe and effective, but also what’s legal in our area? 


Dr. Abdul El-Sayed: I was going to ask, how soon would that be that would that would affect your patients this week? 


Dr. Kristyn Brandi: Tomorrow. Yeah. So the ruling, if there’s no challenge and nothing happens from the Supreme Court, they go into effect essentially midnight tonight on Friday so. 


Dr. Abdul El-Sayed: Yeah so we’re taping this on Friday afternoon. So they’d go into effect midnight um–


Dr. Kristyn Brandi: Tonight. Yeah.


Dr. Abdul El-Sayed: Between Friday and Saturday. 


Dr. Kristyn Brandi: Yeah. 


Dr. Abdul El-Sayed: Okay. That is uh that is that is nuts. And– 


Dr. Kristyn Brandi: Yeah. 


Dr. Abdul El-Sayed: And then all of this is is going to go to the Supreme Court. 


Dr. Kristyn Brandi: It’s inevitable, I think, because we just have too much information that’s in conflict right now between these two big decisions. One saying that mifepristone is totally fine and you should be able to use it without restrictions. And this other one very much restricting its use. So it makes sense it’s going to go to the Supreme Court. The problem is, what is the Supreme Court going to say? Um. They have not been so friendly around abortion issues recently. And so it’s concerning about what that end result will look like now. 


Dr. Abdul El-Sayed: We’ll be back with more with Dr. Kristyn Brandi after this break. [music break]. 




Dr. Abdul El-Sayed: I mean, they kicked this whole thing off in June. Um. And the thing that kills me is that the ostensible argument that they were making is that this ought to be a states rights issue. 


Dr. Kristyn Brandi: Mm hmm. Right.


Dr. Abdul El-Sayed: And what what this judge did is he saw their wink and nod and went ahead and tried to make medication abortion inaccessible throughout the entire country. 


Dr. Kristyn Brandi: Mm hmm. 


Dr. Abdul El-Sayed: Now, if they followed their own ruling, you would imagine, right? Or at least their own legal reasoning underneath the ruling, you would imagine that they would strike that ban down because, of course, this is supposed to be a decision made by states. And I think this is going to be a really important tell for them. 


Dr. Kristyn Brandi: Yeah. 


Dr. Abdul El-Sayed: On the one hand, you can imagine them going on ahead and doing what it is that they all seem to want to do. And on the other, you can imagine them trying to preserve whatever fig leaf they tried to put there in the first ruling. All of this, though, in the end, I think redounds to the great detriment of the political movement against abortion, because I think when you you know, you look at polling on this, people see this as as way too far. I mean, I think they saw the fall of Roe as way too far. And I think this just–


Dr. Kristyn Brandi: Right. 


Dr. Abdul El-Sayed: It’s so brazenly an incursion on people’s rights that I, I hope that this will spur politicians to action and people to the polls to elect the politicians who are willing to take action. I want to ask you, though. Right. So stepping back as a provider, but also as an advocate. How are you feeling right now? I mean, how are you trying to make sense of this? And even even worse. How are you? What? How are you talking to your patients about this? 


Dr. Kristyn Brandi: I mean, I’d be lying if I said that I was okay. To be frank, that’s, it’s been a hard week on top of a hard year. Um. And I name the fact that, you know, I’m privileged to work in a place that has a lot of protections around care, um but it’s just been overwhelming the emotional toll of, you know, the care that you provide. I’ve spent quite a bit of time in school. I’m a sub specialist in complex family planning, so I did extra fellowship training just to provide um complex abortion care um. To think that people that are not medically trained, that do not have this expertise are just making decisions about the way that I and my colleagues can provide care. It’s just frustrating to no end but to see how it’s impacted communities and patients has been truly heartbreaking. That I remember the day that Dobbs went down and had friends that were providing care in clinic and then all of a sudden just had to like, turn the next person away. And it’s just been a lot of that moral injury of just I have the skills, I have the tools, there’s someone in front of me that needs my help and I can’t help them. Um. It’s just unimaginable and it just keeps happening. And I think now it’s really hitting home because now this is going to impact everybody. That my patients that have been okay, that have had access to care, this will impact them now. And I see that not only for the fact that they won’t be able to get this medicine that works really well to help manage their care, but also particularly when we dissect some of these rules that may come up for this new mifepristone um regulation, like the three in-person visits, that’s going to mean that people are going to come three separate times to get care, which is like 2 to 3 more visits than they need. And that’s going to mean that two or three less people are going to have that spot to get the care that they need because we have to accommodate that first person. Um. So the health care system has already been suffering since COVID. The abortion health care system has been in crisis since Dobbs and this is only making things worse. And so it’s been a lot of self-care, a lot of, you know, supporting each other. I think the abortion care community is a really tight knit group. Um. And we have always been, you know, a tight knit group because we’ve been trying to survive all these attacks for so many years now. But um we are tired. It is exhausting to keep doing this. And I know many people are leaving their communities or leaving this care altogether because it’s just too much for a lot of people. 


Dr. Abdul El-Sayed: Hmm. And you talked a little bit about that, the privilege to work uh in a state where there are still protection for abortion rights and the people that you get to take care of are folks who live in those states, for people who live in 24 states in this country, nearly half of the states in this country, this was the lifeline that is now being taken away from them. And you know, I shudder to think about all of the lives that are going to be lost because people are now pursuing or are forced to pursue unsafe abortions uh or all of the lives that are just changed irreparably um in circumstances where they do not have bodily control. And all of that because of an ideology that says that some people get to make those decisions for them. You know, right now there’s we’re in a moment and you talked about this where it just keeps happening and things keep getting worse. But we have to believe in a in a moment where things can be better. And when you talk to folks who want to be a part of making it better, what do you tell them to do? What are the things that our listeners uh can do to help push and drive for uh an America where reproductive justice um is a true guarantee and it is not taken away by people like this judge? 


Dr. Kristyn Brandi: Yeah, and thank you for asking that, because I think that there’s a lot of hype around how bad this is. And I felt that in your last question, like, I just feel the weight of it all the time now. Um. But we have to keep going. I mean, I have to keep seeing patients because my patients need me. And that’s the same as everyone across the country. Like, we’re going to keep going to work and taking care of people. I think one thing that people can do, especially if you’re not an abortion provider, you’re not in this space at all, is just talk about it with your friends, with your colleagues, with your family, like anybody that’s willing to listen. Um. Abortion care has been so stigmatized for so long. And I think since the Dobbs decision, we’re really starting to break open what is the impact if people don’t have abortion care accessible? We’ve seen that since S.B.8. And now with Dobbs that it impacts people broadly, people that have desired pregnancies uh that have a complication and now they can’t access care. Um. And so just hearing these stories and telling stories, I think is a really powerful tool that we can share to help people understand that things are going to get worse if we don’t do something about it. Um. And through that, hopefully that will move people to to vote, to talk to their legislators, to share their own abortion stories, which they may not have told anyone before, but are really powerful to be able to move people to action. And just even though we’re all tired just to keep going as best we can do things like donate to abortion funds, donate to organizations that are helping speak out on these issues and that are talking to legislators directly. There’s a lot that can still be done, and we knew that Roe was always the floor. It was never the ceiling. We always needed something bigger than Roe. Um. And now that it’s very clear that the courts are not going to save us, they’re not going to be the place that um that is going to protect this care. Like it’s really going to have to come from people leading legislators to making laws that are going to actually protect this care. So we have to keep moving and doing something and thinking about how the intersections particularly are really important. One thing just to mention is that um we are talking about this abortion health care crisis, but we forget that it is a part of a bigger maternal health care crisis, a reproductive health care crisis in this country. That since COVID, we’ve lost a lot of labor and deliveries. Um. People are closing their labor and delivery wards. And so for having more and more people deliver and they have nowhere to go. Like this is a systemic problem about how are we helping people that become pregnant get care they need regardless of their choice, regardless of what their needs are. Um. This is such a huge problem within health care right now, and we need legislators to do something to fix it so that people can have, you know, healthy pregnancies if they want them, to end pregnancies if they don’t, um and making sure that all those options are available safely to people at this moment. 


Dr. Abdul El-Sayed: Well, I really appreciate you fighting the good fight on this and being one of those folks on the ground um who’s doing all they can to provide services. And in coming and joining us to share your expertise and insights with us. Um. Our guest today was Dr. Kristyn Brandi. She is the Darney-Landy fellow at the American College of Obstetricians and Gynecologists. We really, really appreciate your time and your insight. 


Dr. Kristyn Brandi: Thanks for having me. [music break]


Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. Look, that was a tough interview. So let’s start with some good news. The EPA is proposing new emission rules that experts expect will vastly expand EV use around the country. While the EPA can’t actually drive car sales directly. The Clean Air Act allows them to limit the total tailpipe emissions across all cars a company sells. This will force the auto industry’s hand. The EPA is proposing two new rules. One will require that upwards of two thirds of cars sold will be all electric by 2032. The other governing heavy duty vehicles, think big rig trucks and busses will require that up to 25% be all electric by that time. Experts estimate that together the rules would eliminate the equivalent of two years worth of American CO2 emissions. Yeah, big effing deal. The rule, while sweeping, isn’t catching the automotive industry by surprise. Look, I’m a Michigander and we’re car people. We account for more combustion engines than any place on earth and I do not say that proudly. In fact, my dad moved to America to build them. But even Detroit thinks this is the right move. They’ve seen this coming for a while now, which is why nearly every major auto company has dumped billions into developing new EVs. Now, you might wonder why this is a health story. Well, think about the very name of the law that enables the FDA to act. It’s called the Clean Air Act. We forget sometimes that every single ounce of polluted air that carries greenhouse gases into the atmosphere gets sieved through our lungs before it gets there. Idling trucks, for example, are one of the worst sources of air pollution in communities like Southwest Detroit, the most polluted place in the most polluted city, in the most polluted county where I happen to serve as health director. That polluted air accounts for high rates of asthma, chronic lung disease and lung cancer. Never mind the fact that on the back end, the climate crisis is a public health crisis. Destroyed homes and infrastructure, forced migration of both humans and wildlife. That brings us in contact with them. All of those are public health issues. So yeah, I support the rule. Finally, this happened last week. 


[clip of unspecified news reporter] The president taking a significant and symbolic step into a post-pandemic world. The White House is just now saying that the president has just signed a bill that will end the national emergency declared during the COVID pandemic. 


Dr. Abdul El-Sayed: President Biden signed legislation officially ending the national emergency over COVID 19. Importantly, this is different from the public health emergency slated to end on May 11. The administration had expressed opposition to the bill, which cleared the Democratically held Senate 68 to 23, in effect, forcing the president’s hand. All of this does signal the beginning of the end of the official infrastructure stood up to tackle the greatest public health crisis of all of our lifetimes. An unprecedented mobilization of everything from testing to vaccines, treatment, as I’ve expressed so many times before on this podcast, that kind of unprecedented action should not have been necessary, but it was because our existing public health infrastructure had been so badly hobbled in the decades before the pandemic. My hope now is that we upgrade that infrastructure so we’re never caught with our pants down again, but that that’s not really happening and that should be its own emergency. That’s it for today. On your way out don’t forget to rate and review. It does go a long way. Like literally just right now. Pick up your phone. Swipe down. Go five stars. Abdul’s great. Really loved the show, scandi boho. And if you really love the show, you can drop by the Crooked store for some American Dissected merch. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illic-Frank. Vasilis Fotopoulos 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 Geismer, Michael Martinez and me. Dr. 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 view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veterans Services.