No, IVF Embryos Aren’t Kids.

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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 Hambly, 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.

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, Siddine, just turned one. As I watch her delight in crawling around our house, picking up toys, laughing with her sister, or cuddling with Saru 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 one one-thousandth 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 jurists' 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. They're 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 negative 321 degrees is a human, so that you can 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. Elizabeth 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 Elizabeth Smith.

Elizabeth, thank you so much for taking the.

But as somebody who spends your days thinking about reproduction and reproductive rights, how long have you seen this on the horizon? And what were the first inklings? So, I think, the seeds of this decision.

I'm 43.

. I grew up in San Antonio, Texas. I worked for the Planned Parenthood affiliate in San Antonio as a teenager. And I went with other teens to do safe sex talks to, for other teens in San Antonio. 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 nineties, 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 receded in various places, throughout kind of our, you know, national public, you know, conversation 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, 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,

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,

just, that to me, I just can't understand it. Now, has there been, like, 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?

And so,

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, you know, with their community, if, when, and how to form a family.

But if antis 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 a fetus is a person, and we're focused on their right, it's a way to obfuscate, to change the conversation, to not focus on the living, breathing person who's pregnant and what they want and need.

Absolutely. And I guess, you know, the thing that I can't understand, and you know, 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 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 is something hallowed about this lump of cells because of a level of, you know, claimed 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 rub to me. A lot of how the Judeo-Christian 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 lump of cells created in vitro in a test tube by scientists has the same life as that human that is born at the end of a pregnancy, 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 to me, it just like, it blows the mind because you're like, y'all, lost the plot here. 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. in your assumed veneration of, you know, your faith and your attempt to irrigate your faith over the rights of people who don't believe or may believe, but interpret differently.

Has that, you know, I mean, I know we're gonna talk a little bit more.

And that is actually the way that, you know, our partner works from a faith tradition.

I want to ask you a little bit more just about 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 court ruling has forced the hands of healthcare providers regarding their ability?

And so it was known. justices in the court knew what this, what this opinion would do. And we saw immediately some of the biggest 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 canceled, 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 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 say that they were going to fix the situation. And so they very quickly moved a bill, Alabama House Bill 237, which purports to provide immunity, both civil and criminal, to providers of IVF, except for acts or omissions that are intentional and not related to IVF. And the bill also purports to be retroactive on its face. So it was passed, the bill was passed by both chambers, and it is meant to be a quote unquote, fix.

But in analyzing the legislation,

it definitely falls short of what Alabamans need and want in order to access fertility care in their state, you know, without, without fear. And so it remains to be seen whether this legislation, when it goes into effect, will, one, be effective, and, two, whether it may be challenged, 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 beat the bar that they have set.

That's C-A-S-E-Y-G-R-A-N-T-S.

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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 heard by the Supreme Court, who would then have to reverse their precedent that is based in this case, which you would assume, given the overt nature of the way this ruling is written, wouldn't happen until you had new justices.

you know, amending statutes is easy. Amending a constitution is much more difficult. So this is 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.

So, as long as that language is in the Alabama Constitution, it is the Alabama Supreme Court that 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.

One is, like I said, the legislature passes a bill 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.

the implications of this opinion?

Whether they will have the needed votes to actually pass federal protection is a big question.

We have been having a public conversation on reproductive health rights and justice, on abortion, on pregnancy, like never before in the almost two years since DOBS 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 even more forward, because it has really, I think, let people know that the danger of overturning Roe and the danger of the radical anti-abortion position is this, that IVF could be in danger. So the good news is that there was a bill that had been introduced in Missouri, a state that passes lots of anti-abortion bans and restrictions and restrictions on reproductive health. The bill could have, if it had been enacted, could have presented serious limitations on IVF access, but the legislator who introduced it withdrew it. 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 cabined.

Advocates in Florida have been advocating, strongly, talking to legislators about how that Florida bill would also limit or end access to IVF. Prior to the Alabama opinion, the conversation in the Florida legislature was, no, no, this bill has nothing to do with abortion. Don't turn this rock over. Don't worry about it. It won't harm IVF access.

Nothing to see here. But in the last week, that bill has also been put on pause and we are hearing that the bill is dead and the Florida legislature is going to adjourn signing next week. So efforts that 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.

on this one. They followed a lot of the arguments that are made to oppose abortion rights to their logical conclusion, 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 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 against the anti-abortion position or for the protection of abortion rights who otherwise might not have been?

open to listening to the alternative view?

And, you know, polling and 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 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 cause 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 restrictive constitutional amendment that was on the ballot in early August, 2022 was, 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, we didn't know what percentage, by what percentage we might win. And then we saw Kansans go to the polls and resoundingly 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 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 in support of abortion rights and supportive access to reproductive healthcare.

And to conclude this soliloquy, 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.

Yeah, I appreciate.

And I want to ask you, you know, for those folks in Alabama who are, you know, we're midway through a long, protracted IVF course, what recourse do they have? What are the circumstances that they're facing now?

When it gets enacted, will, you know, their IVF providers resume providing care, you know, where they feel like this is enough and they can reschedule appointments? Or will those providers, you know, not resume care? And if that happens, then, as you alluded to, there are the really awful and incredibly expensive questions about, you know, moving embryos to another state and trying to get care in that other state.

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 we likely don't have time, but there are really 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, we'll maybe be looking to other states if they can manage, you know,

Elizabeth, we really appreciate you joining us, sharing your work and your perspective with us and being out there fighting the good fight. So thank you so much for taking the time to join us today. Thank you for having me.

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 costs of knowing you have COVID, as opposed to any other respiratory virus that could be causing your symptoms. That cost is that you'd need to spend five days isolating.

So, as too 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, UnitedHealth confirmed that its subsidiary, Change Healthcare, 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 healthcare transactions, managing the back end for nearly 70,000 pharmacies nationwide. The Russia-based cyber gang, Black Hat, 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 healthcare companies.

I raise this story because it highlights the growing risks inherent in our increasingly tech-enabled healthcare system and what that could mean for our data privacy, but, even worse, our healthcare 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 healthcare 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. 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 3,000 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 Hambly and Marsha Mansouray, leaders of Ottawa County's Health Department. This week, we learned that a court-ordered panel of arbitrators had facilitated an agreement in which Hambly would be guaranteed her job through 2025.

The county commission, who had started all this, bowed to their will and voted 11 to 0 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 Crooked Media and me at Abdul El-Sayed, no dash, on Instagram, TikTok, and Twitter.

America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma LeCrank. Charlotte Landis mixes and masters the show. Production support from Ari Schwartz.

Our theme song is by Taka Asazawa and Alex Uviera. Our executive producers are Leo Duran, Sarah Geismar, and me, Dr. Abdul El-Sayed, your host. Thanks for listening.

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