The educational path to become a psychiatrist is long and requires hard work and dedication. To become a Psychiatrist, a person must complete college prerequisites, then complete medical school and a residency at which time passing boards completes the path to state licensure.
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Prerequisites for Medical School
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What are the requirements for becoming a Psychiatrist?
Psychiatrists focus in mental health, however they all receive the same basic medical training. The American Psychiatric Association, says their education allows doctors to diagnose both mental and physical causes of illness. Psychotherapy, psychoanalysis, and prescribing medicine are among the treatments they employ.
As part of their preparation for medical school, aspiring psychiatrists must earn a four-year bachelor’s degree. English, mathematics, biology, chemistry, and physics are all required undergraduate courses. Even though there is no requirement for a specific major before enrolling to med school, many candidates choose to major in chemistry or biology. Because medical school is so competitive, you’ll need good grades. Participate in extracurricular activities to increase your chances of acceptance. Volunteering at a hospital or medical facility is also an option. Medical schools demand that you take a standardized test called the MCAT
4 years of medical school are necessary to obtain a medical degree.
Medical school is a four-year program that leads to a doctor’s degree. Some colleges, on the other hand, integrate a bachelor’s and a medical degrees in one program. During medical school, the first two years are spend mostly in class work in courses such as physiology, anatomy, and pharmacology, chemistry, biochemistry, neuroscience, psychiatry, and neuroscience.
The next two years of medical school are spent is clinical rotations at teaching hospitals where they assist patient care in different specialties of which psychiatry is one such rotation.
4+ years of residency and fellowship
After graduating from medical school and passing appropriate board examinations, a person must match into a residency. This is a four year process of which the first year is spent in a general hospital residency, where you will treat patients with a variety of ailments. Future psychiatrists must then spend three more years working with patients with mental health problems under the supervision of licensed Psychiatrists. After completing residency, top students may want to apply for a Fellowship where they can specialize in a subspecialty of Psychiatry such as addiction psychiatry. The final step to becoming a licensed and practicing Psychiatrist is to pass board examinations. This entire process is usually a minimum of 12 years but offers an outstanding career with great pay and the opportunity to help many people
If you’re considering a career in medicine, you might be curious in what a neurologist does and what educational training is required to become one. A neurologist is a licensed and board certified physician that has a medical degree, either an MD or DO, who treats problems with a persons nervous system and brain. Neurology can be defines as the study of the neurological system. To become a neurologist, you’ll need a lot of schooling and training.
What does a Neurologist do?
A neurologist provides direct treatment to patients, diagnosing and treating disorders with the brain and neurological system. They may propose surgical intervention. Neurologists do not perform brain surgery, but will refer patients to a Neurosurgeon for surgical evaluation. Neurologists may operate in collaboration with other doctors in additional to seeing patients.
Why would a person see a neurologist?
Patients may visit neurologists if they are experiencing symptoms of a condition, are ill, or have had trauma to the head. Some of the most common conditions that people see Neurologist for are:
Headeaches
Brain injuries
spinal cord injuries
Epilepsy
MS
Parkinson’s disease
Alzheimer’s disease
A neurologist may also be consulted by patients who have suffered strokes.
What types of testing does a neurologist do to help make a diagnosis?
A neurologist uses a variety of methods to diagnose patients. They always take the complete patient’s medical history and, in some cases, administer tests to determine how well the patient is mentally functioning. Assessing a patient’s cognitive ability, speech or memory, eyesight, balance, reflexes, coordination, or strength are examples of such tests. A neurologist is a doctor who specializes in conducting tests to aid in the diagnosis of patients.
An EEG, a CT scan, a lumbar puncture, or an MRI are some of the most typical diagnostics a neurologist might perform. They may also advise their patients to undergo sleep testing. Because it’s crucial to retain well-organized records on patients and be able to evaluate your results, a neurologist should be excellent in communication, critical thinking, and attention to detail. You’ll also have to convey your findings to patients, colleagues, and in some cases, as part of continuing neurological medical research.
Neurologists must undergo extensive training.
The neurological system and the brain are extremely complex, and diagnosing and treating patients with these issues requires a highly experienced and well-trained clinician. As a result, neurologists spend a significant amount of time in school. After earning your bachelor’s degree, you should expect on spending at least eight years in education and training to become a neurologist. This will most likely require attending med school for 4 years, followed by a one-year internship, and then 3 years of study in a neurology residency After neurology residency, there are subspecialties that one could consider going into that are highly competitive to get into and are called Fellowships.
Pharmaceutical and biotech companies who form the Open Pharma collaboration, have today announced the ever-pressing need for plain language summaries in peer-reviewed medical journal publications.
Published in the peer-reviewed journal Current Medical Research & Opinion, Open Pharma’s recommendations come as an aim to make the medical publishing model “more open” and a “more accessible and inclusive environment.”
This, the authors state, would make engagement with medical research easier for all intended audiences from patients, patient advocates and caregivers, to healthcare professionals and policymakers.
“Scientific communities are now focused on driving the next step towards openness: accessibility. The broad range of stakeholders involved in medical research now puts the pharmaceutical industry in a unique position to make the medical publishing model more open,” explain the authors.
“Few medical research articles currently include plain language summaries. The pharmaceutical industry has an opportunity to improve everyone’s understanding of medical research by regularly developing plain language summaries of their articles.
“These summaries encourage discussions around medical research and aid fully informed and shared decision-making.”
Launched in 2016, Open Pharma brings together a group of pharmaceutical and biotech companies and other research funders, alongside healthcare professionals, regulators, patients, publishers and other stakeholders in healthcare.
Their drive is to take medical research from behind paywalls to becoming fully open access (free to read for everyone online) which they state will “improve transparency, advance medical science and, ultimately improve patient care.”
Today’s call for plain language summaries begins “the next step of openness,” and crucially whilst plain language summaries are “still in their infancy,” sets out what the recommendations call a “minimum standard” for future medical publication lay plain summaries to abide to.
The minimum standard recommends for all summaries to be in the style of an abstract, understandable and readable (in text only, rather than in videos or infographics), free of technical jargon, unbiased, non-promotional, and easily accessed.
Open Pharma states other minimum standards for summaries to include should be:
explicitly linked to the source publication and relevant clinical trial identifiers, with brief reference to the existing evidence
consistent with the same overall conclusions as the scientific publication abstract
developed alongside the main content of the manuscript, in line with the International Committee of Medical Journal Editors’ authorship criteria
ideally reviewed by a non-expert during development
fully peer reviewed alongside the main content
made available to read free of charge alongside the scientific publication abstract
tagged with appropriate metadata and keywords to improve discoverability in search
engines, directories, and indexes.
“Standard minimum approaches for developing and sharing index-friendly plain language summaries are needed to help ensure that these multi-stakeholder communication channels are compliant with pharmaceutical industry standards,” the authors state.
“This would also help frame plain language summaries as valid and effective forms of sharing research.
“Creating a minimum standard does not prevent graphically or digitally enhanced summaries but acts as universal foundation to further build upon; Open Pharma strongly encourages the additional development of enhanced summaries. Such a standard would define the minimum requirements for maximizing the transparency, accountability, accessibility, discoverability and inclusivity of medical journal publications.
“And, once these (minimum standards) have been met, we encourage researchers to also consider making and sharing infographics and video summaries to help people to understand their research even more.”
Pharmaceutical and biotech companies who form the Open Pharma collaboration, have today announced the ever-pressing need for plain language summaries in peer-reviewed medical journal publications.
Published in the peer-reviewed journal Current Medical Research & Opinion, Open Pharma’s recommendations come as an aim to make the medical publishing model “more open” and a “more accessible and inclusive environment.”
This, the authors state, would make engagement with medical research easier for all intended audiences from patients, patient advocates and caregivers, to healthcare professionals and policymakers.
“Scientific communities are now focused on driving the next step towards openness: accessibility. The broad range of stakeholders involved in medical research now puts the pharmaceutical industry in a unique position to make the medical publishing model more open,” explain the authors.
“Few medical research articles currently include plain language summaries. The pharmaceutical industry has an opportunity to improve everyone’s understanding of medical research by regularly developing plain language summaries of their articles.
“These summaries encourage discussions around medical research and aid fully informed and shared decision-making.”
Launched in 2016, Open Pharma brings together a group of pharmaceutical and biotech companies and other research funders, alongside healthcare professionals, regulators, patients, publishers and other stakeholders in healthcare.
Their drive is to take medical research from behind paywalls to becoming fully open access (free to read for everyone online) which they state will “improve transparency, advance medical science and, ultimately improve patient care.”
Today’s call for plain language summaries begins “the next step of openness,” and crucially whilst plain language summaries are “still in their infancy,” sets out what the recommendations call a “minimum standard” for future medical publication lay plain summaries to abide to.
The minimum standard recommends for all summaries to be in the style of an abstract, understandable and readable (in text only, rather than in videos or infographics), free of technical jargon, unbiased, non-promotional, and easily accessed.
Open Pharma states other minimum standards for summaries to include should be:
explicitly linked to the source publication and relevant clinical trial identifiers, with brief reference to the existing evidence
consistent with the same overall conclusions as the scientific publication abstract
developed alongside the main content of the manuscript, in line with the International Committee of Medical Journal Editors’ authorship criteria
ideally reviewed by a non-expert during development
fully peer reviewed alongside the main content
made available to read free of charge alongside the scientific publication abstract
tagged with appropriate metadata and keywords to improve discoverability in search
engines, directories, and indexes.
“Standard minimum approaches for developing and sharing index-friendly plain language summaries are needed to help ensure that these multi-stakeholder communication channels are compliant with pharmaceutical industry standards,” the authors state.
“This would also help frame plain language summaries as valid and effective forms of sharing research.
“Creating a minimum standard does not prevent graphically or digitally enhanced summaries but acts as universal foundation to further build upon; Open Pharma strongly encourages the additional development of enhanced summaries. Such a standard would define the minimum requirements for maximizing the transparency, accountability, accessibility, discoverability and inclusivity of medical journal publications.
“And, once these (minimum standards) have been met, we encourage researchers to also consider making and sharing infographics and video summaries to help people to understand their research even more.”
Medical studies without adequate pre-publication review could damage public trust in science
More information:
Adeline Rosenberg et al, Open Pharma recommendations for plain language summaries of peer-reviewed medical journal publications, Current Medical Research and Opinion (2021). DOI: 10.1080/03007995.2021.1971185
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Taylor & Francis
Citation:
World-leading pharma collaborates call for plain language summaries of peer-reviewed medical journal articles (2021, September 13)
retrieved 13 September 2021
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In Colorado, most of those who are eligible to get vaccinated against Covid-19 have received at least one dose so far, Gov. Jared Polis said Friday, highlighting the milestone.
With 75% of Colorado’s eligible residents having initiated vaccination, the governor pointed out it’s “an important accomplishment, but it also means that there’s 25%, one in four Coloradans, who are eligible, who still need to go out and get protected so that we can end this pandemic.”
Polis pleaded with the unvaccinated to get their shots, reasoning that they hold the key to the availability of critical health care.
“We actually have the lowest ICU available rate that we’ve had since the start of this crisis, in part due to the unvaccinated with Covid and just other types of trauma that goes up seasonally this time of year,” Polis explained. “Some hospitals are reaching very close to their capacity limits. And that wouldn’t be happening if people were vaccinated.”
Colorado has one of the nation’s lowest Covid-19 case rates, with 163.6 new cases per 100,000 people over the past week, according to data published Saturday by the US Centers for Disease Control and Prevention (CDC).
Meanwhile on the East Coast, Vermont, Connecticut and Massachusetts have fully vaccinated at least two-thirds of their population. The trio are also among the states seeing the lowest rate of new cases per capita over the past week, CDC data shows.
Overall, the US has fully vaccinated 53.7% of its total population while 73.7% of people 12 and older have received at least one dose as of Saturday, according to CDC data. Full vaccination offers optimal protection from the virus’ most extreme consequences, including severe illness and death.
And even though the unvaccinated now comprise a slight minority of the total population, Covid-19 patients are straining health care resources in ways that health experts have been insisting are preventable via inoculation.
At St. Anthony’s Hospital in St. Petersburg, Covid-19 patients are taking hold of ICU capacity. Hospital president Scott Smith told CNN’s Randi Kaye that 27 of the facility’s 28 ICU beds are for Covid-19 patients, and around 85% of the hospital’s Covid-19 patients are unvaccinated.
Florida has fully vaccinated 54.8% of its residents as of Saturday, CDC data shows. As of Saturday, the state was using more than 43% of its ICU beds to treat Covid-19 patients, according to data from the US Department of Health and Human Services. Nationwide, nearly 31% of ICU beds were being used for Covid-19 patients.
Vaccines provide critical protection against variants
Despite the prevalence of the more contagious Delta variant in the US, vaccines have shown to remain highly effective against hospitalization, a CDC study found.
Among all ages, the Moderna vaccine was 95% effective against hospitalization, while the Pfizer/BioNTech vaccine had an 80% effectiveness and the Johnson & Johnson vaccine had a 60% effectiveness, the study found.
But among those 75 and older, the study found vaccine effectiveness against hospitalization was lower. Effectiveness against hospitalization for adults under 75 was 89%, but it was 76% among those age 75 and older, the study found.
Meanwhile, the Mu variant of Covid-19 has emerged on health experts’ radar, but Dr. Anthony Fauci assured people Friday that it doesn’t exhibit signs of being more resistant to the vaccines more than the Delta variant.
“The reason it was brought to attention, it had a number of mutations that were of interest. But when you look at the effect of antibodies against these mutations, it is not a matter of alarm, in that although it diminishes somewhat the protection, it falls well within the range of Delta and Beta (another coronavirus variant),” Fauci said at a White House Covid-19 Response Team briefing.
And as federal health officials consider a booster vaccine dose for most Americans, full vaccination still means either two doses of an mRNA Covid-19 vaccine or one dose of Johnson & Johnson’s Covid-19 vaccine, CDC Director Dr. Rochelle Walensky said Friday. But she acknowledged that may change.
“I anticipate over time that may be updated, but we will leave that to our advisers to, to give us some recommendations,” she said during a White House Covid-19 Response Team briefing.
Testing helps avoid school quarantines, expert says
Meanwhile, as schools nationwide struggle with returning safely to classrooms, one former federal health official urged that Covid-19 testing is an effective approach to preventing outbreaks.
Placing students in “pods” in schools and routine asymptomatic testing are the most effective ways to try and reduce spread in schools, former US Food and Drug Administration Commissioner Dr. Scott Gottlieb said.
He explained that regular testing can prevent a large number of students from quarantining, and therefore, not miss classes.
“Rather than quarantine that whole classroom you just test them in a serial fashion to make sure that you didn’t have an exposure that led to a downstream case and so you can actually use testing to prevent quarantines.” he said Friday during an Axios event.
He added that even as Covid-19 case rates decline, children are still suffering from a surge.
“Even as cases decline in every age category, the one age category where it’s continuing to increase is in school aged children,” he said.
In Fulton County, Georgia, at least seven schools will move to remote learning starting Monday, the district said in a Facebook post.
Students at Westlake High School, Sandtown Middle School and Renaissance Middle Schools are moving to remote learning due to a “high volume of positive cases and direct contacts” and have reached Level 2, which includes having 3 or more students or staff members test positive at the same site. The school system said it anticipates in-person learning to resume at these three schools on September 21.
CNN’s Virginia Langmaid, Deanna Hackney, Deidre McPhillips and Kay Jones contributed to this report.
HIV is a master of evading the immune system, using a variety of methods to prevent the body from being able to find and kill it. The vast majority of people living with HIV require daily medication to suppress the virus and therefore prevent the development of AIDS.
But for a small subset of people, this battle between the immune system and the virus looks quite different. Known as controllers, they have immune systems that can suppress the virus without any need for medication.
Get more HMS news here
Whereas most controllers can suppress the virus indefinitely, some eventually lose control over the virus and require medication to achieve viral suppression.
In a paper published Sept. 7 in Immunity, Harvard Medical School researchers at the Ragon Institute of MGH, MIT, and Harvard reported that, in these cases, control is lost after a type of immune cell, called a cytotoxic T cell, loses the ability to proliferate and kill HIV-infected cells.
In order to find these differences, the researchers, led by David Collins, HMS research fellow in medicine at Massachusetts General Hospital, compared samples collected over several years from cohorts of HIV controllers at the Ragon Institute and the University of California at San Francisco.
The study included 17 subjects with aborted control and 17 with durable control, whose immune systems continued to suppress HIV over years of observation.
In a successful immune response, cytotoxic T cells recognize small pieces of HIV, called antigens, which are found on the surface of infected cells. The T cells then kill the infected cells, destroying the virus inside.
If mutations in HIV were changing the antigens, the T cells may no longer be able to recognize them. Therefore, the most likely difference, the team thought, might be in the antigens themselves.
Comparing antigens
First, the team compared what type of antigens were presented by infected cells. Co-author Gaurav Gaiha, HMS assistant professor of medicine at Mass General,had previously shown that in controllers cytotoxic T cells often recognize HIV antigens that are unlikely to mutate.
When the team compared the two groups, they found that both sets of T cells responded to the same types of unlikely-to-mutate antigens, meaning they were starting from similar immune responses.
Working with co-author Todd Allen, HMS professor of medicine at Mass General, andhis team, the researchers next sequenced HIV from before and after loss of control, looking for mutations that could cause changes in the antigens the T cells recognized.
Even though HIV constantly mutates, within their cohort of 17 patients, they found only one mutation that allowed the antigen to escape T cell recognition.
Mutational escape wasn’t the answer, either. There was also no evidence of superinfection, the term for contracting a second, separate HIV infection, another theory that had been suggested in case studies.
The difference, therefore, was likely in the immune response itself, instead of being driven by the virus.
The team looked more closely at the HIV-specific T cells in both groups, focusing on how well the T cells could perform their various functions.
Cytotoxic T cells have two important functions when they encounter a cell presenting an HIV antigen. The first is their ability to kill infected cells by systematically rupturing them, called cytolysis.
The second function is their proliferative function: creating more HIV-specific T cells that can then hunt down and kill other infected cells.
In progressors—people with HIV who cannot control the virus naturally and who require medication to suppress it—T cells quickly become desensitized to the HIV antigens and stop responding to them, a state known as T cell exhaustion.
T cell dysfunction
Researchers thought perhaps a similar process was happening to T cells when control was lost, but they found no such evidence. With the loss of control came a clear dysfunction of the T cells—the inability to kill cells infected by HIV—but it was a different type of dysfunction than was observed in most infections.
In the group of people who lost control of HIV, there was a measurable decrease in the proliferative and cytolytic ability of the T cells seen in samples taken before the loss of control, sometimes even years before.
In addition, this dysfunction was only seen in response to HIV; the T cells were able to respond properly to other viral antigens. The researchers had thought that T cell dysfunction would come after or during loss of control, but here, the evidence shows that T cell dysfunction actually precedes it.
“Loss of proliferation was the most consistent predictor of aborted control in our study,” said Collins. “In these cases, HIV-specific T cells gradually lost their ability to proliferate and become cytolytic, sometimes years before control was lost.”
In analyses led by computational biologist and second author Jonathan Urbach of the Ragon Institute, the team next compared the genes expressed by the T cells in the two groups and found another important difference, one linked to their earlier observations.
The T cells in the loss of control group had increased expression of KLF2, a gene that, when expressed at high levels, impairs the ability of T cells to proliferate.
“This study shows that loss of control is notably different from the inability to control the virus found in the canonical immune response to HIV,” said Ragon Institute director Bruce Walker, the paper’s senior author.
“It further underlines the importance of a functional, effective T cell response to HIV in natural immune control of the virus. And with each secret HIV reveals comes an opportunity for us to use that knowledge to our advantage,” said Walker, who is also the Phillip T. and Susan M. Ragon Professor of Medicine at HMS and Mass General.
That knowledge might ultimately help researchers work towards treatments and vaccines that could train progressors’ immune systems. Further work remains to understanding why T cells become dysfunctional in some people and not in others.
The study was supported by the Howard Hughes Medical Institute, Bill and Melinda Gates Foundation, Mark and Lisa Schwartz Foundation, Phillip and Susan Ragon Foundation, National Institutes of Health, Fondo de Investigación Sanitaria, Spanish AIDS Research Network, CFAR Network of Integrated Clinical Systems, Delaney AIDS Research Enterprise, amfAR Institute for HIV Cure Research, UCSF/Gladstone Institute of Virology and Immunology Center for AIDS Research, and Harvard University Center for AIDS Research.
St. Louis is a hub for innovation and research. Here are local universities and laboratories’ latest discoveries and breakthroughs.
Memory Loss
1. Washington University researchers found a link between Alzheimer’s disease and circadian rhythm that may explain sleep disturbances in patients.
2. Wash. U. researchers also uncovered a connection between Alzheimer’s disease and receiving too little deep sleep. Seniors who receive less slow-wave sleep may have increased levels of the toxic brain protein tau, which can be a sign of Alzheimer’s.
3. Spinal fluid containing an Alzheimer’s protein can potentially be used to determine what stage of the disease patients are in and lead to improved treatment, per research at Washington University.
4. In a study, Saint Louis University researcher Jeffrey Scherrer found a 42 percent decreased risk of adult patients developing dementia when they previously received a Tdap booster vaccination.
Aging
1. In a Wash. U. study with mice, increasing the FOX01 gene decreased cartilage damage, and decreasing the gene increased symptoms of osteoarthritis.
2. Washington University’s Farshid Guilak created living joint replacements while researching arthritic joint treatment.
3. New technology from Wash. U. researchers uses cartilage cells engineered to release an anti-inflammatory drug as a response to various stressors.
Brain Cancer
1. A recent Washington University study found that glioblastoma patients may respond best to receiving chemotherapy in the morning.
2. Detailed molecular and genetic schematics of glioblastoma tumors were mapped out by Washington University in partnership with Pacific Northwest National Library, Case Western University, and the National Institutes of Health.
3. In a study involving mice, Washington University researchers found that the Zika virus can activate immune cells to remove a deadly form of brain cancer and give a boost to an immunotherapy drug.
Breast Cancer
1. In partnership with Whiterabbit.ai, Washington University researchers developed software to look at breast density to identify women who might need additional screening beyond typical mammograms.
2. Wash. U. researchers also conducted a small clinical trial that found breast cancer patients with working estrogen receptors are more likely to benefit from hormone therapy.
Other Cancers
1. Whole-genome sequencing has been found to be as accurate as the typical genetic tests used to test various blood cancers and determine the type of treatment needed, according to a Washington University study.
2. A two-drug treatment for the bone cancer osteosarcoma could be an effective, less toxic alternative to the chemotherapy drug methotrexate, according to a Wash. U. study.
3. In a mouse study, Washington University researchers found a link between fatty liver disease and liver cancer in an RNA binding protein that regulates the lipid levels in the liver and blood.
4. As noted on p. 112, Wash. U. researchers also pinned down crucial features of protein fragments that may allow better vaccines and immunotherapies to combat cancer.
5. in a Washington University study involving mice, an antibody targeting the TREM2 protein spurred tumor-destroying immune cells.
Other Research
1. In a mouse study, Wash. U. researchers found that a new PET imaging agent called Galuminox that could be used to detect inflammation and study diseases such as cardiovascular disease, cancer, and COVID-19.
2. Wash. U. researchers found a link between a rare single gene mutation and at least some cases of cerebral palsy.
3. According to a Wash. U. study, certain drugs, such as efavirenz, may be able to set off a natural alarm in HIV cells by activating a dormant protein to self-destruct the infected cells.
4. Washington University researchers found that the SVEP1 gene is linked to clogged arteries and an increased likelihood of heart disease, diabetes, and high blood pressure.
5. Two antibodies, called 1G05 and 2E01, protect mice from lethal influenza B virus infections, according to research done by Washington University and the Icahn School of Medicine at Mount Sinai.
6. The packaging of cytokines provides insight into inflammation in asthma, COPD, and COVID-19, according to Wash. U. research. 7. Wash. U. researchers found that mutations in the gene NEMP1 may explain infertility and early menopause in humans.
8. Washington University researchers discovered that losing weight after undergoing gastric bypass surgery can lead to the remission of diabetes through increased metabolism.
9. According to Wash. U. researchers, taking the drug buprenorphine can decrease the risk of overdose for opioid users, even if they are also taking benzodiazepines for anxiety or other conditions.
10. High-fat ketogenic diets might be beneficial in preventing or reversing heart failure linked to a metabolic process, according to SLU researchers.
11. A new imaging agent that can assist in discerning kidney health, called RadioCF, was developed by Washington University.
12. Wash. U. researchers also found that basophil blood cells can be triggered by environmental allergens to alert itch signals to nerve cells, which might be why antihistamines don’t always work for severe itch in eczema patients.
Pediatrics
1. Washington University collaborated with The New England Journal of Medicine and the International Centre for Diarrhoeal Disease Research to conduct a clinical trial in Dhaka, Bangladesh, which found that a designed therapeutic food for malnourished children worked to repair microbiomes in the gut.
2. A Wash. U. study discovered a toxin from E. coli alters intestinal cells
for its own benefit, a fact that may explain issues with malnutrition and stunted growth.
3. According to Washington University researchers, a Chiari 1 brain malformation may stem from variants in two chromodomain genes related to brain development, CHD3 and CHD8, and is more likely in children with large heads.
Institutes & Collaborations
1. Saint Louis University has formed an Institute for Drug and Biotherapeutic Innovation and the Advanced HEAlth Data (AHEAD) Research Institute.
2. Wash. U. scientists, Agilent Technologies, and Merck are expanding research in metabolomics, which can help better understand, for instance, byproducts when the body breaks down a particular drug.
MAKING STRIDES
NEW TREATMENTS AT AREA MEDICAL CENTERS
Heart Health: To help improve accuracy in treating arrhythmias and other minimally invasive cardiovascular-related surgeries, Washington University inventors and entrepreneurs Drs. Jennifer and Jon Silva developed a 3-D hologram to show a patient’s heart during operations. At Mercy Hospital, Dr. Anthony Tae-Young Sonn (see p. 81) oversees the Transcatheter Aortic Valve Replacement program, which involves replacing a heart valve without having to undergo open-heart surgery. And in November, St. Luke’s Hospital became the region’s first medical facility to implant the Watchman FLX Device, used to close the left atrial appendage for some atrial fibrillation patients without using blood thinners and to help decrease the risk of a stroke.
Joint Approach: SSM Health St. Clare Hospital in Fenton now offers Zimmer Biomet’s ROSA® Knee System, a surgical knee replacement system involving robotic assistance that allows for more precision and flexibility during surgery.
Cold Capping: At Mercy’s Clayton-Clarkson infusion center, the Paxman scalp-cooling system aims to help prevent hair loss in chemotherapy patients by decreasing blood flow and chemo delivery to the scalp’s hair follicles.
Stroke Rehabilitation: Research at Washington University led to the creation of the IpsiHand Upper Extremity Rehabilitation System, which helps stroke patients redevelop control of their arms and hands.
“We need to start talking about the choice to remain unvaccinated as the choice to go out and drive intoxicated,” CNN Medical Analyst Dr. Leana Wen told CNN’s Wolf Blitzer.
Wen’s remarks come after the Biden administration announced Thursday a Covid-19 vaccine mandate plan that directs the US Labor Department to require all businesses with 100 employees or more to ensure their workers are either vaccinated or tested once a week. President Joe Biden also signed an executive order requiring all government employees to get their Covid-19 vaccine shots, with no option for regular testing to opt out.
And while some Republican officials have criticized his move as overreaching, health experts say the President should have implemented stricter measures to curb the recent surge of Covid-19 cases.
“From a public health perspective, it is not overreach at all. And in fact, I wish that they came out earlier and went even further,” Wen said. “We’re in the middle of the biggest public health crisis of our lifetimes. We have more than a thousand Americans who are dying every single day. We, as a society, set laws that protect people’s health and well-being all the time.”
An average of 1,110 people died in the US from Covid-19 each day over the last week, data from the US Centers for Disease Control and Prevention showed on Thursday. The rate of deaths since late August is the highest it has been since early March.
While 73.5% of those ages 12 and up have been vaccinated with at least one dose, tens of millions of eligible recipients remain unvaccinated as the highly contagious coronavirus Delta variant continues to grip pockets of the country. Around 62% of the same age group is fully vaccinated as of Friday.
“The vast minority of Americans are resistant to vaccination, but that’s where the virus has been circulating,” CNN Medical Analyst Jonathan Reiner told CNN’s Don Lemon on Friday. “We live in a country that has rules. You can’t smoke in most buildings in the United States, and you can’t drive drunk. You can’t smoke on planes. And you can’t blow virus into my face.
“That’s how it has to be in this country. And if you’re going to be a persistent threat to the public health by refusing to get vaccinated, well your actions have consequences, and the consequences may be you can’t work at your job.”
An August poll from Gallup showed that 56% of Americans favor vaccine requirements at work while 53% support them for restaurant dining and 61% approve of them for air travel.
And as for those who have not yet gotten their shots, it’s not too late to convince them, former US Surgeon General Dr. Jerome Adams said Friday.
“We need to remember that most of these people are not what I call ‘vaccine-resistant’ — some people say ‘anti-vax,’ I find that term pejorative,” Adams told CNN’s John Berman. “Most of these people are in the movable middle. They’re vaccine-hesitant.
“I found that when I talk to them with compassion and with empathy, I can convince a lot of them over time to get their vaccination.”
Health care systems strained
Six US states saw at least a 10% increase in new Covid-19 cases in the past week compared to the week before, data from Johns Hopkins University showed Friday, while the other states didn’t see a change or experienced a decline in cases altogether.
Alabama, one of the states that saw the recent drop in new cases, is now facing a shortage of 60 intensive care unit beds — an uptick of 20 from last Friday, the state’s Health Officer Dr. Scott Harris said.
That’s 60 patients “who are receiving critical care because they’re chronically ill, and yet they don’t have an ICU bed,” Harris said Friday.
“They’re being cared for in an emergency department or a ward bed that’s been converted to an ICU room or on a gurney in the hallway,” Harris said.
Alabama on Thursday reported 2,667 Covid-19 hospitalizations and 53 deaths, he added.
In West Virginia, 252 Covid-19 patients are in ICUs and another 141 are on ventilators, marking the most people hospitalized with the disease since the pandemic began, Gov. Jim Justice said Friday.
“A high percentage of the folks in the hospitals are unvaccinated,” Justice said. “We lost another 38 people since Wednesday. We’re going to continue to lose people in this surge without any questions,” he said.
Minnesota health officials linked at least 69 Covid-19 cases to the State Fair, according to a statement obtained from the state’s health department by CNN affiliate WCCO. The Minnesota State Fair’s website says the event ran from August 25 through September 5 in Falcon Heights.
Heated debate over mask mandates
Meanwhile, the debate over mask mandates remains heated in many states, especially when it comes to schools.
In Kentucky, schools will have the choice of whether they will mandate masks, after the General Assembly overrode the governor’s partial veto on that portion of a bill pertaining to Covid-19 provisions in schools, officials say.
Kentucky Gov. Andy Beshear vetoed the part of the SB1 bill that would eliminate the mask mandate for K-12 schools and leave it up to school districts to decide if masking is necessary, he said at a media gaggle on Friday.
Beshear said that the Senate’s recent rejection of a statewide school mask mandate is the wrong choice — and one that will reap harmful results.
“Mask requirement for schools is not only the right thing to do for our young people, especially those who are too young to even get vaccinated,” Beshear said. “It’s our best way to keep our children learning in the classroom.”
Meanwhile in Mississippi, Gov. Tate Reeves said Thursday that Biden’s vaccine mandate plan is unconstitutional.
“A member of the executive branch of government does not have the authority to mandate something such as this,” Reeves said.
CNN’s Lauren Mascarenhas, Melissa Alonso, Jaide Garcia, Claudia Dominguez and Jennifer Feldman, Mirna Alsharif, Rebekah Riess and Liam Reilly contributed to this report.
At a 2019 antiabortion conference in Ontario, Canada, Byron Calhoun was introduced as a “messenger of God.”
The doctor assumed the podium in a pinstripe suit and bow tie, his high forehead glinting underneath the hotel ballroom’s bright fluorescents. Dozens of conference-goers clapped, then grew quiet, eyes fixed on Calhoun and the statistic that brought them all there, blown up on a banner behind him: “1 out of every 5 babies is killed by abortion.”
“I can either throw my hands up, and be like a lot of my colleagues,” Calhoun said. Or “I can be like Queen Esther,” a biblical figure known for saving her people from genocide.
It can be “unpleasant business” to fight for the lives of the unborn, he said. “But that’s what I’m called to do.”
Calhoun is the only high-risk obstetrician and gynecologist in Charleston, W.Va., with a strong hold over much of the central part of the state. He is also an internationally known antiabortion activist. In treating women with fetal abnormalities or preexisting conditions that could complicate their pregnancies, Calhoun rarely discusses abortion, according to interviews with three former patients and six doctors. His practice highlights a fraught ethical area: When doctors personally oppose abortion, their beliefs can affect the care they provide, leading a patient down a path that could put their health at risk.
Six OB/GYNs who work in the Charleston area, or who have worked there in the past, say they see Calhoun’s open antiabortion advocacy and his medical practice as a conflict with the potential to harm patients, especially in a state short on doctors with his expertise. Four of those doctors — three of whom spoke on the condition of anonymity because they work closely with Calhoun — say they avoid sending certain cases to his office because patients have told them he does not discuss abortion as an option. If they believe a patient with a high-risk pregnancy or fetal anomaly should consider termination, they said, they will try to send her somewhere else.
Three said they also avoid sending Calhoun any patients who need more advanced testing to determine the severity of their anomalies, because they have also heard from patients that he often refuses to perform these tests. In a 2016 lawsuit filed against the Charleston Area Medical Center and West Virginia University, a doctor who trained under Calhoun claimed that Calhoun denied an amniocentesis — the most definitive form of fetal genetic testing — to a patient who requested the procedure. According to the lawsuit, the other tests he performed were not conclusive and “came back past the date for this patient to have an elective abortion,” though Calhoun had allegedly assured the patient those results would come quickly.
Charleston is the closest option for many West Virginians seeking high-risk pregnancy care, and even then, it can be a long trip. Pictured is Rainelle, a drive of 1 hour and 45 minutes. (Bonnie Jo Mount/The Washington Post)Downtown Charleston. (Bonnie Jo Mount/The Washington Post)
LEFT: Charleston is the closest option for many West Virginians seeking high-risk pregnancy care, and even then, it can be a long trip. Pictured is Rainelle, a drive of 1 hour and 45 minutes. (Bonnie Jo Mount/The Washington Post)RIGHT: Downtown Charleston. (Bonnie Jo Mount/The Washington Post)
“I would not send patients to him because I was finding that they were not getting appropriately counseled,” said Lori Tucker, an OB/GYN based in Martinsburg, W.Va., who has advocated for abortion access. “I don’t think he wants to be put in a position where he would have to take on the responsibility of having a conversation about termination.”
The Lily provided Calhoun with a detailed list of questions, facts and assertions that would be included in this story. He did not respond to many attempts to contact him, through multiple channels, over a period of 18 months.
As Texas bans abortion after six weeks gestation — and other states indicate that they will soon follow suit — abortion rights advocates have been laser-focused on the threat posed by state legislation. But there are other, less visible, barriers that patients seeking abortions face. Approximately 4,500 doctors are members of the American Association of Pro-Life Obstetricians and Gynecologists, an organization Calhoun led as president from 2000 to 2006. When doctors consult on fetal abnormalities and high-risk pregnancies, their conversations can alter the course of their patients’ lives. And while doctors who choose not to discuss abortion aren’t breaking any laws, they are violating guidance widely accepted by the OB/GYN community.
According to the American College of Obstetricians and Gynecologists (ACOG), the 60,000-member professional organization for OB/GYNs to which Calhoun belongs, the “standard of care” is for doctors to raise abortion as an option if they have reason to think their patient might be unsure about a pregnancy. This includes any case with a severe fetal abnormality or any high-risk case, when pregnancy complications “may be so severe that abortion is the only measure to preserve a woman’s health or save her life.” The doctor should inform her of all the options “in a balanced manner,” avoiding any “personal bias,” ACOG says. If a patient decides to terminate, ACOG says, the doctor should either perform the abortion or make a referral.
From 2006 to 2014, Calhoun worked alongside another maternal-fetal medicine specialist at the Charleston Area Medical Center, Luis Bracero, who would perform abortions at the hospital. Because the doctors worked on some of the same cases, Bracero heard from patients that he and Calhoun approached their consultations differently, Bracero said. Bracero would lay out all the patient’s options, he said, and Calhoun “would just tell them to continue with the pregnancy.”
“If no one speaks up, no one will know.”
Jen Villavicencio, ACOG spokesperson
In conservative states, this kind of guidance is not uncommon, said Jen Villavicencio, an ACOG spokesperson and expert in complex family planning who performs abortions as part of her medical practice. Many doctors “don’t think twice” about leaving abortion out of the conversation, she said — and few ever face censure from their state medical boards. Patients in antiabortion areas are especially unlikely to recognize and report the omission, Villavicencio said. West Virginia is among the most antiabortion states in the country, where 58 percent of people believe abortion should be illegal in all or most cases, according to a 2020 Pew Research Center survey. Though medical professionals overwhelmingly say it’s unethical and medically risky to omit abortion from medical consultations, two of Calhoun’s patients interviewed for this story say they are glad abortion was never discussed.
“The burden is placed on the person who has been wronged — the patient,” said Villavicencio. “If no one speaks up, no one will know.”
While confidentiality laws protect the identities of Calhoun’s patients, The Lily was able, through infant obituaries and online reviews of medical care, to speak with eight women who say they received care from Calhoun. Three of those patients — two of whom spoke on the record — said Calhoun told them their babies would likely die but did not mention abortion as an option. One patient said Calhoun counseled her to have an abortion when she saw him 11 years ago. The other four said they saw Calhoun for care that did not include conversations about the future of their pregnancies.
Several leading maternal-fetal medicine specialists, when told the histories of some of Calhoun’s patients, said the doctor had offered false hope. In one case, this led to months of emotional distress and significant health risks during delivery.
In the United States, “you have to tell people they have the legal opportunity” to have an abortion, Calhoun said at the Ontario conference — and he said he makes sure he’s “clear on that.” But he is open about the fact that he doesn’t perform abortions or refer patients to them, a violation of ACOG guidance. Asked about this in a 2014 deposition that he gave as an expert witness in a lawsuit against an abortion clinic, Calhoun said that if a patient doesn’t know where to go, “the yellow pages are available.”
Calhoun has been the vice-chair of obstetrics and gynecology at West Virginia University since 2006, despite many calling for his removal after that same 2014 lawsuit. On Calhoun’s recommendation, a former patient sued the clinic for allegedly leaving a 13-week fetal skull in her uterus. A circuit court judge dismissed the case, ruling in favor of the clinic and raising questions about Calhoun’s role. The medical director for the National Institute of Family and Life Advocates, Calhoun remains closely connected to one of the country’s most prominent antiabortion legal groups.
Despite the opposition, Calhoun is “well respected” in the West Virginia medical community, said David Patton, an OB/GYN in Charleston. In the 15 years he has referred patients to Calhoun, Patton said he has “never had a problem.” None of his patients have ever complained about a lack of counseling on abortion. “I think he’s really honest,” Patton said. “He doesn’t sugarcoat a lot of things.”
Christina Menkin, a nurse-midwife in Charleston, said she has worked with dozens of patients who also saw Calhoun. No one ever shared a negative experience, she said. She knows Calhoun as a “competent, respectful, conscientious physician.”
At the Ontario conference, hosted by the antiabortion nonprofit Alliance for Life, Calhoun shared some of his personal history that has helped shape his convictions. He and his wife struggled with infertility before they had their biological daughter. They adopted four kids, including two with special needs. One of their adopted children, Faith, was born with a metabolic disorder and required round-the-clock care before she died in August 2017 at age 27.
During his presentation, Calhoun clicked through to a photo of Faith, strapped into her wheelchair with a big smile. “She was going to die in three weeks, she was going to die in a week, she was going to die in a year, she was going to die, blah blah blah blah blah blah blah. You know, the usual, omniscient doctor telling you what’s going to happen.”
Doctors “think they’re Godlike, but they’re not,” he said.
They insist they know too much from ultrasounds, he added, which are really just “shades of black and white and gray.”
Spring daffodils outside the Charleston Area Medical Center Women and Children’s Hospital. (Bonnie Jo Mount/The Washington Post)
When they walk out of Calhoun’s consultation room, some patients question the care they receive. Two or three times a year, patients who have been to Calhoun’s practice travel an additional two and a half hours to Morgantown, W.Va., said Leo Brancazio, who practices there as a maternal-fetal medicine specialist. They come to Brancazio for a second opinion, he said, recognizing that abortion should have been discussed.
This doesn’t happen a lot, because most patients in West Virginia are personally opposed to abortion, Brancazio said. Patients who seek a second opinion, he added, must be confident enough to question their doctor and “health-savvy” enough to find the next-closest high-risk specialist without a referral. They also need the time and money necessary to travel.
“They are, for the most part, accepting what their doctor tells them.”
When Hayley and Donnie Smelcer arrived for their appointment at the Charleston Area Medical Center in June 2018, Calhoun, they said, already had their file open on the table. There was a large black splotch on the ultrasound where their baby’s brain should have been.
Calhoun confirmed what Hayley’s OB/GYN had told them to expect: Their unborn daughter had holoprosencephaly, a disorder in which the right and left sides of a baby’s brain are fused together. They recall Calhoun saying that the baby statistically would probably not survive to term — and even if she did, she would require permanent life support and 24-hour care. But then Calhoun said something they hadn’t heard from the other doctor: They had reason to hope.
Hayley and Donnie Smelcer at home in April with their infant twins, Lucy and Oliver, in April. Their first child lived for only 20 hours. (Bonnie Jo Mount/The Washington Post)
“I don’t play God. I’m going to fight for this baby,” they remember him saying. He would line up a team of specialists at a major research hospital in Cincinnati, a five-hour drive from where they live in Rainelle, W.Va. If Hayley, who was relying on Medicaid for insurance, went into early labor, Calhoun said he would charter a helicopter to get her there.
The Smelcers, who are staunchly opposed to abortion, said Calhoun never mentioned it. Even after learning the severity of the condition, they say they never asked about it. They were happy to find a doctor who believed in their baby.
“From the beginning, through every appointment, he never at all said anything about termination or anything like that,” said Hayley, who was 19 and working on her GED when she got pregnant. “He never even asked if that was an option we wanted to do.”
Hayley focused on a future where her daughter would be born healthy. Every week, an app on her phone compared her baby to a different kind of produce. Isabella was the size of a pomegranate, a sweet potato, a cantaloupe. Hayley browsed newborn Halloween costumes and picked out hair bows. Sometimes she allowed herself to imagine the nursery. It would be elephant-themed, with gray walls and pink glitter.
Sixteen weeks before her due date, Hayley went into labor. At the closest hospital, in Fairlea, W.Va., 45 minutes from their house, Donnie begged the doctors to call the helicopter he said Calhoun had promised. There was no point, they said: It was storming and the baby was too sick. Izzy lived for 20 hours, Hayley and Donnie said, passing away in Hayley’s arms from cardiac arrest.
Calhoun was an “amazing” doctor, Hayley said, who cared enough to send a bouquet of flowers to Izzy’s funeral. A few days after she got home from the hospital, Hayley said he called to check in, letting her know that he had lost a child, too.
These kinds of connections are important, said Steve Calvin, a high-risk pregnancy doctor and adjunct professor at the University of Minnesota, who is a member of the American Association of Pro-Life OB/GYNs. When antiabortion doctors allow their beliefs to shape their counseling, he said, they are uniquely equipped to connect with patients who share their convictions.
Isabella is buried at Wallace Memorial Cemetery in Clintonville, W.Va. (Bonnie Jo Mount/The Washington Post)The Smelcers say Calhoun never mentioned abortion was an option when Hayley was pregnant with their first child. The couple is staunchly opposed to abortion. (Bonnie Jo Mount/The Washington Post)
LEFT: Isabella is buried at Wallace Memorial Cemetery in Clintonville, W.Va. (Bonnie Jo Mount/The Washington Post)RIGHT: The Smelcers say Calhoun never mentioned abortion was an option when Hayley was pregnant with their first child. The couple is staunchly opposed to abortion. (Bonnie Jo Mount/The Washington Post)
Still, it’s important to make sure patients know that abortion is an option, said Alan Peaceman, a maternal-fetal medicine specialist at Northwestern’s Feinberg School of Medicine. He says he always talks about termination, even if a patient has explicitly said that she opposes the procedure. Some patients might not know that abortion is something they should consider, or may feel differently about the issue when confronted with it in their own lives, Peaceman said. He always makes sure the option is “overtly known.”
The Lily asked Mary Norton, the division chief of maternal-fetal medicine at the University of California San Francisco School of Medicine, the top OB/GYN department in the country, to comment on the care the Smelcers say they received from Calhoun. It’s “ridiculous,” she said, to suggest sending a helicopter when there are no treatments that could improve the baby’s condition.
“It sounds like he was trying to paint a different picture than what was really happening,” she said.
“It sets up unrealistic expectations for the family, and that’s not fair to them,” Peaceman said. “There is an emotional cost to prolonging something that is inevitable.”
Brooklynn Stalnaker was a high school senior, and 20 weeks pregnant, when she learned her daughter had polycystic kidney disease, a condition where babies are born without working kidneys and underdeveloped lungs. Because she lived in Clarksburg, closer to Morgantown than Charleston, Brancazio was the first high-risk doctor she saw.
Brancazio suggested termination when she saw him in 2016, warning her that she may be risking her health if she continued the pregnancy, said Stalnaker and her grandmother, Betty Lopez, who was also in the consultation room. Brancazio said the baby “would die as soon as she was born,” Stalnaker and Lopez recalled. Although she opposes abortion, Stalnaker said, she briefly considered it, worried about her health. (Brancazio says he doesn’t recall Stalnaker’s case.)
Together with her family, who Lopez says are all deeply opposed to abortion, Stalnaker decided to consult with another doctor. They drove to Charleston, where she said they heard something very different. While Calhoun told her that her baby — whom Stalnaker planned to name “Braelynn” — would likely die soon after she was born, he also told Stalnaker that “he’s seen babies do crazy things and survive crazy things,” she said. “He never mentioned abortion.” He told her there would be no risk to her health if she carried the baby to term, she said.
Brooklynn Stalnaker honored her late daughter, Braelynn, with a tattoo. Braelynn lived for two hours. (Bonnie Jo Mount/The Washington Post)
He also said she had to deliver the baby through a Caesarean section, according to Stalnaker. Because she had no amniotic fluid, she said she was told, vaginal birth was not an option. When informed of this assessment in an interview, without medical records, all four maternal-fetal medicine specialists interviewed by The Lily, including Norton and Peaceman, disputed it. While a C-section may increase the chance that a mother could deliver a live baby with polycystic kidney disease, it would have no impact on the baby’s health outcomes, and increases the risk to the mother, Norton said.
There are health risks associated with the decision to carry any fetus to term, which can be hard to justify with a fatal diagnosis, said Norton. The longer you carry a baby, the more susceptible you become to various health complications, all four specialists agreed, including blood clots, hemorrhaging and hypertension. Among high-income countries, the U.S. has one of the highest maternal mortality rates.
Mothers who give birth with a C-section are three to four times as likely to die during childbirth as mothers who give birth vaginally. The scar on the uterus left behind from the procedure can make it more difficult to have additional children. A C-section is typically performed to help the baby, said Norton, except in cases when the mother’s health is at risk.
“We would basically never do a C-section if the baby was not going to survive,” she said.
After her initial appointment, Stalnaker and her family started driving to Charleston regularly. Calhoun would bring up plans for Braelynn’s future, Stalnaker said, describing how the NICU doctors would push air inside her baby’s body until her lungs developed.
The whole time, Stalnaker said, she knew her daughter wasn’t going to make it. Maybe it was just a “mother’s instinct,” she said, but it was frustrating to talk about the pregnancy with her family members, buoyed by Calhoun. Her 8-year-old sister told her friends that she couldn’t wait to be an aunt. Her grandmother set up a bassinet in Stalnaker’s room and stocked the house with diapers and lotions. Every time Stalnaker found something baby-related lying around the house, she said, she wanted to stuff it in a closet.
“I mean, personally, I felt like I was counting down the days for my baby to die. So pretty much every day it felt worse.”
To appease her grandmother, Stalnaker spent hours at a maternity photo shoot, posing with baby dresses and baby shoes. On the day of the C-section, Stalnaker’s grandfather drove to the hospital with a car seat, Lopez said.
Braelynn died of kidney disease two hours after Stalnaker gave birth.
“I felt like I was counting down the days for my baby to die.”
Brooklynn Stalnaker
Stalnaker did not have any complications during her pregnancy, and says she is happy with the care she received from Calhoun, who sent a bouquet of flowers after she left the hospital. No doctor had ever given her that kind of personal attention, she said.
But even though the C-section went as planned and Stalnaker went on to have two healthy children, Norton said a patient in this situation deserved to fully understand the risk she was taking. If Stalnaker had been Norton’s patient, she added, she would have cautioned her against a C-section.
Calhoun has said publicly that an abortion is never necessary to save the life of the mother. He will deliver babies early, and they will die from prematurity, he said, but he will never engage in what he calls “direct killing.” He has repeated versions of this statement at conferences, in an online video series, and while testifying on abortion legislation before the U.S. House Judiciary Committee.
Norton says she regularly sees patients with medical conditions that require abortion. While doctors should generally remain neutral in consultations about the future of a pregnancy, Norton said, they must make an exception for patients with certain health conditions, like severe cases of pulmonary hypertension or heart disease. If patients do not opt for an abortion in these situations, studies show, they can die. In one case, Norton said, she recommended termination to a patient who decided to continue with her pregnancy, despite risks to her health. The patient died just after the delivery.
Calhoun sees patients with heart conditions regularly, he said at a Christian conference for doctors and nurses in London in October 2018. These patients, he said, often tell him that they need an abortion.
“I say, so? … Why don’t we just take care of you?” he told members of the Christian Medical Fellowship. “You’re more likely to die in the surgery for the abortion than you are with pregnancy, trust me. I’ve been doing this a long time.” (Studies show that abortions in the United States are safe and have few complications.)
Calhoun’s position on this issue is rare even among antiabortion OB/GYNs, said Calvin, who opposes abortion himself. It’s an “irrational” belief that “does not reflect reality,” he said, adding that sometimes abortion is the only thing that will save a mother’s life.
Calhoun has traveled all over the world to lecture on the dangers of abortion, sought out by antiabortion organizations for his expertise. He has published over 80 peer-reviewed articles in medical journals and has presented his work at more than 90 conferences and lectures, according to his resume.
His routine at these conferences is often the same: He pulls up a PowerPoint presentation, running through the potential risks. Abortion has been linked to breast cancer, sleep disorders, alcoholism, drug abuse, “death by violent causes,” he says, and a variety of mental health disorders. (These claims are “lies,” said American College of Obstetricians and Gynecologists representative Kate Connors, adding that these kinds of statements spread “fear and stigma” around abortion.)
Calhoun has blamed ACOG. The organization is perpetuating a “conspiracy of silence” around abortion, Calhoun said, refusing to acknowledge its harmful side effects.
It’s a view shared by many in the American Association of Pro-Life Obstetricians and Gynecologists. Created in April 1973, three months after Roe v. Wade legalized abortion, the group is a home for doctors who oppose ACOG’s stance on abortion. By joining, members make a commitment: Elective abortion “will have no role or place in our practice of the healing arts,” according to a letter the group sends to members.
In interviews, the members referred to medicine as “art” and doctors as “artists,” free to sculpt their practice in their own image. By recommending that all physicians discuss abortion and either “perform or refer,” no matter their views on the issue, ACOG is treating its doctors like “robots,” says Christina Francis, an OB/GYN in Fort Wayne, Ind. and chairman of the board of the American Association of Pro-Life Obstetricians and Gynecologists.
“Our educated opinions and even sometimes our moral opinions come into play” — as they should, Francis said. “People do not want amoral physicians.”
Connors defended ACOG’s position on abortion. The organization’s “affirmation of abortion as medical care,” she said, “is an evidence-based position that is without bias or judgment.”
In the early 1990s, Calhoun developed the concept of “perinatal hospice,” an approach to fetal care that reflected his own values. The idea sprung from a patient, he has said in several lectures. Her baby had a fatal diagnosis, but she was opposed to abortion. When the baby was born, Calhoun said, he invited the baby’s siblings to join the parents in the delivery room. For the duration of the baby’s life, they passed him back and forth, holding him until he passed away.
A life might only be 20 minutes long, he told a group of medical students at the University of Texas Medical Branch at Galveston in April 2018, at a lecture hosted by an antiabortion student group. But if “the whole time you’re alive, someone is loving you, and holding you, and supporting you, and with you,” he said, “that is a life well lived.”
The idea of “hospice” was wildly popular among people who are dying, Calhoun said. “So what if we take those concepts,” he asked himself, “and apply them before babies are born?”
“Our educated opinions and even sometimes our moral opinions come into play.”
Christina Francis, an OB/GYN and chairman of the board of the American Association of Pro-Life Obstetricians and Gynecologist
Working with a few other doctors, Calhoun decided that “perinatal hospice” would be “very high touch, not so high tech.” He would bring together a team of medical and nonmedical specialists that would care for the baby and the family, helping the mother to mourn her child while it was still inside her.
Since Calhoun first wrote about the idea of perinatal hospice in 1996, the concept has ballooned, spurred by Calhoun’s continued advocacy and research.
Perinatal hospice services are now offered by approximately 250 U.S. hospitals, medical centers and hospice facilities, and more than 70 around the world.
Abortion access in conservative states is more tenuous today than it’s been in decades. A 6-3 conservative majority on the Supreme Court has emboldened state legislatures to pass sweeping antiabortion legislation, with clinics forced to adapt to new regulations or close their doors. In Charleston, abortion rights advocates say Calhoun is on a mission to shut down the Women’s Health Center, the last clinic in the state.
A waiting room at the Women’s Health Center of Charleston, West Virginia’s lone abortion clinic. (Bonnie Jo Mount/The Washington Post)A procedure room at the clinic. (Bonnie Jo Mount/The Washington Post)
In June 2013, a former clinic patient, Itai Gravely, filed a lawsuit against the Women’s Health Center, claiming a physician had left a 13-week fetal skull in her uterus during her abortion. Calhoun was the catalyst for the complaint, according to the court decision and an interview with Gravely. He also served as the plaintiff’s expert witness.
Gravely went to the hospital the day after her abortion with residual bleeding. Calhoun, working in the emergency room, performed a dilation and curettage (D&C), records show, a common procedure used to clear out the uterus after an abortion or miscarriage.
Gravely got a call from Calhoun one year later, according to the decision. He told her he’d seen the skull on the ultrasound, though he’d never mentioned it at the hospital. Then, the decision shows, he gave Gravely the name of a lawyer, Jeremy Dys, who was the president and general counsel for the Family Policy Council of West Virginia, a conservative, faith-based advocacy group.
At the hearing, the judge called Gravely’s claims “immaterial and, frankly, sensational.” Evidence showed that there was no 13-week fetal skull. She questioned why Calhoun had waited a full year to tell Gravely about it. It was remarkable, the judge wrote, that Calhoun had referred Gravely to Dys. (When asked in his deposition what prompted him to call Gravely a year after her hospital visit, Calhoun said that recent complications at other abortion clinics had jogged his memory.)
That same month, Calhoun wrote a letter urging West Virginia Attorney General Patrick Morrisey (R) to investigate the state’s abortion clinics. West Virginia’s clinics are a “totally unregulated environment” that provide “substandard care,” he wrote. He said in the letter that he saw post-abortive patients with complications “probably at least weekly,” a statement that was disproved by data issued by Calhoun’s hospital.
The letter and lawsuit prompted an outcry from women who sought OB/GYN care in the area, with many calling on WVU to take action against Calhoun for his antiabortion activism. State Del. Nancy Guthrie (D) filed a complaint with the West Virginia Board of Medicine in December 2013, suggesting that Calhoun’s claims about abortion complications at the hospital may have been “knowingly false” and urging the board to investigate.
“How in the world could a state-run university allow this guy to practice as the vice head of obstetrics?” Guthrie said in an interview. “It just didn’t make any sense.”
Guthrie never heard anything from the Board of Medicine about Calhoun, she said. (The board expunges this type of correspondence after two years, and said they have no recollection of Guthrie’s letter.)
Since 2006, Calhoun has taught classes and overseen dozens of residents at the West Virginia University School of Medicine. For his teaching work, separate from his work at the hospital, he makes $80,000 a year, according to his contract. At antiabortion conferences, he is introduced with his university title, though he clarifies that he is not speaking on behalf of the University.
Executive director of communications April Kaull said the university is “strongly committed to the ideals of free thought and speech.” When that commitment is “tested,” she wrote in an email, “our governing principle is to resolve such differences through discussion, debate and rigorous scientific inquiry.”
“Dr. Calhoun’s affiliation with West Virginia University does not preclude him from formulating personal ideas and beliefs regarding reproductive health and does not prohibit him from sharing his personal beliefs with others. However, when he is speaking as a private citizen, he must have a clear understanding that he is not speaking as a WVU representative,” added executive director of communications and institutional relations Tara Scatterday.
Calhoun works closely with OB/GYN residents who pass through West Virginia University, according to several doctors affiliated with WVU, supervising their work before they disperse to hospitals and medical practices all over the country.
“The footprint he’s leaving is so much bigger because he’s making an impression on kids who are in medical school and residency when they’re learning about these things,” said Tucker, the OB/GYN in Martinsburg.
In Ontario, an audience member asked Calhoun if his antiabortion lecture material was part of the standard medical school curriculum.
He couldn’t speak for all medical schools, he said, but his students know this information.
“I teach them this stuff all the time,” he said.
Do you have an experience with an antiabortion OB/GYN?Email us.
Correction: An earlier version of this article misstated where Lori Tucker works.
About this story
Editing by Neema Roshania Patel and David Fallis. Design and development by Christine Ashack. Art direction by Amy Cavenaile and Rachel Orr. Photo editing by Haley Hamblin. Research by Alice Crites. Copy editing by Laura Michalski. Graphic by Dylan Moriarty. Illustrations by Lisk Feng. Photos by Bonnie Jo Mount.
