Category: Rehab News

SACRAMENTO — California voters are considering whether to roll back some of the criminal justice reforms enacted a decade ago as concerns about mass incarceration give way to public anger over property crime and a fentanyl crisis that has plagued the state since the covid-19 pandemic hit.

Proposition 36, on the November ballot, would unwind portions of a 2014 initiative, known as Proposition 47, that reduced most shoplifting and drug possession offenses to misdemeanors that rarely carried jail time.

Critics say that has allowed criminality to flourish and given those suffering from addiction little incentive to break the cycle. The law also has become a political weapon for former President Donald Trump and other Republican politicians who have tried to tie it to Vice President Kamala Harris to paint her as soft on crime. As California attorney general she took no position on the issue.

Much of the Proposition 36 debate has focused on the increased penalties for shoplifting, but the drug policy changes are even more dramatic. In addition to boosting penalties for some drug crimes, the measure would create a new “treatment-mandated felony” that could be imposed on people who illegally possess what are called “hard” drugs, including fentanyl, heroin, cocaine, and methamphetamine, and have two or more prior convictions for certain crimes.

Those who admit to the new felony would be required to complete drug or mental health treatment, job training, or other programs intended to “break the cycle of addiction and homelessness.” Those who complete the treatment program would have their charges dismissed, while failure could bring three years in prison.

The measure has opponents, including Gov. Gavin Newsom, warning about renewing a “war on drugs” that once helped swell California’s prison population.

Supporters counter that stricter penalties are necessary as overdose deaths from fentanyl crowd morgues. They also point to studies showing that more than 75% of people experiencing chronic homelessness struggle with substance abuse or a severe mental illness.

“We crafted this not to move people into any kind of custody setting, but to incentivize them into treatment,” said Greg Totten, chief executive officer at the California District Attorneys Association and a spokesperson for the initiative’s supporters.

Totten and others cast the measure as a way to revive drug courts, which they say waned in effectiveness after Proposition 47 removed the stick from what had been a carrot-and-stick approach.

Drug courts are led by a judge with a specialized caseload, use a collaborative approach to promote rehabilitation, and have been found to be effective in California and nationwide. Participants in California had “significantly lower rates of recidivism,” according to a study in 2006 commissioned by the Judicial Council of California: 29% were rearrested compared with 41% of a group who didn’t receive treatment.

The Center for Justice Innovation, a nationwide research and reform group that grew out of the New York state court system, found that drug court caseloads dropped across California after Proposition 47.

Still, advocates who favor decriminalization challenge the idea that the approach is effective and say coerced treatment violates people’s rights. Meanwhile, Lenore Anderson, a co-author of Proposition 47, said “we cannot pretend that this sort of feel-good idea that we’re going to arrest and incarcerate out of it is going to work. It never has.”

Proposition 47 led to an increase in property crime, but there is no evidence that changes in drug arrests sparked any increases in crime, found a recent study by the nonprofit, nonpartisan Public Policy Institute of California.

The latest reform effort leaves many questions, said Darren Urada of the University of California-Los Angeles Integrated Substance Abuse Programs. He was the principal investigator on UCLA’s evaluation of an earlier attempt to promote treatment.

“When policies are properly implemented, treatment obtained through courts can help people. However, there are a lot of details here that are not clear, and therefore a lot of opportunities for this to go poorly,” Urada said.

For instance, the ballot measure doesn’t say what would happen to someone who enters treatment but relapses, as is common; how long they would have to complete the program; or what would constitute completion for someone in long-term treatment for mental illness or substance abuse.

Those details were deliberately left vague so that local experts like community corrections partnerships, which are already established under existing law, could decide what works best in their jurisdictions, Totten said.

Totten expects a range of approaches including diversion programs and inpatient and outpatient treatment, and that judges would be guided by the recommendations of treatment professionals.

“I’m hopeful that that will help people who are really struggling with addiction, living on the streets, who engage in petty theft and other crimes in order to support their habit — that it will be a doorway into treatment for them,” said Anna Lembke, a Stanford University addiction expert.

The November ballot measure also would allow judges to send drug dealers to state prisons instead of county jails and boost penalties for possessing fentanyl. It would make it easier to charge someone with murder if they provide illegal drugs that kill someone.

The changes could increase California’s prison population, currently about 90,000, and its county jail and community supervision population, currently around 250,000, each by “a few thousand people,” projects the state’s nonpartisan Legislative Analyst’s Office. Opponents of the measure project that the increase would be far higher: 65,000 people, most for drug offenses and most of them people of color.

Newsom, one of the initiative’s most outspoken critics, argues that the November ballot measure lacks any funding; would reduce the $800 million in Proposition 47 savings, much of which has gone to treatment and diversion programs; and would only aggravate an existing lack of treatment alternatives.

“Prop. 36 takes us back to the 1980s,” Newsom, a Democrat, said in August as he signed a package of 10 property crime bills that he and legislative leaders tout as an alternative to the broader ballot measure.

Yet, illustrating the contentiousness of the debate, the ballot measure has been endorsed by some Democratic leaders, including San Francisco Mayor London Breed, San Diego Mayor Todd Gloria, and San Jose Mayor Matt Mahan, who often highlight its treatment requirement.

In what has become a pattern of spreading vaccine misinformation, the Florida health department is telling older Floridians and others at highest risk from covid-19 to avoid most booster shots, saying they are potentially dangerous.

Clinicians and scientists denounced the message as politically fueled scaremongering that also weakens efforts to protect against diseases like measles and whooping cough.

A prominent Florida doctor expressed dismay that medical leaders in the state, leery of angering Gov. Ron DeSantis, have been slow to counter anti-vaccine messages from Surgeon General Joseph Ladapo, including the latest covid bulletin. Ladapo is a DeSantis appointee and the top official at the state health department.

The bulletin makes a number of false or unproven claims about the efficacy and safety of mRNA-based covid vaccines by Pfizer and Moderna, including that they could threaten “the integrity of the human genome.” Florida’s guidance generally regurgitates ideas from anti-vaccine websites, said John Moore, a professor of microbiology at Weill Cornell Medicine.

Ladapo did not respond to a request for comment. DeSantis referred questions to the health department, which said the surgeon general’s guidance and citations “speak for themselves” and pointed to a post he made on the social platform X accusing the Centers for Disease Control and Prevention and FDA of “gaslighting Americans.”

DeSantis has styled himself and his administration as a bulwark against vaccine mandates, lockdowns, and other restrictive public health protections adopted during the pandemic to curb infections and save lives. Covid vaccination has become a partisan issue, with surveys by KFF, the health information nonprofit that includes KFF Health News, the publisher of California Healthline, finding that Republicans have far less confidence in the safety and efficacy of the shots than Democrats.

But vaccine historians consulted for this article could not recall any previous state health leader urging residents to shun an FDA-approved and CDC-recommended vaccination. “It’s unprecedented,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

Florida medical leaders should speak out more forcefully against Ladapo’s attacks on public health, said Jeffrey Goldhagen, a pediatrician and professor at the University of Florida College of Medicine in Jacksonville. Ladapo urged people under 65 to avoid covid shots last year and has rejected public health protocols for fighting measles outbreaks.

“What you see is a pattern of fear and neglect of professional responsibilities across the state, in part because of the fear of this governor and the vindictiveness of this governor,” said Goldhagen, a former health department director in Jacksonville.

He specifically criticized the Florida Medical Association, a trade group for physicians, noting that Ladapo is a nonvoting member of the group’s board of governors. The association did not respond to emails requesting comment.

The Florida Health Care Association, whose members run more than 600 long-term care facilities, declined to comment on Ladapo’s bulletin. One nursing home chain, LeadingAge Southeast, said it was aware of both federal and state recommendations on covid boosters and encouraged providers to “engage with their residents, families, and healthcare professionals to make informed decisions.”

A spokesperson for the U.S. Food and Drug Administration, Cherie Duvall-Jones, said the agency “strongly disagrees with the State Surgeon General of Florida’s characterization of the safety and effectiveness of the updated mRNA COVID-19 vaccines.” The vaccines met the FDA’s “rigorous, scientific standards,” she said, and she urged people to get boosters since the population’s covid immunity has waned.

Among its incorrect claims, the Florida bulletin says the new mRNA boosters wrongly target a viral variant, omicron, that is no longer circulating widely. This is false, since all major variants of covid in the past two years evolved from omicron and subsequent mutations.

“You start off with that and then you go into head-exploding-emoji territory,” Moore said. “It’s a litany of lies out of the anti-vaxxer playbook.”

Other claims in Ladapo’s bulletin include:

• Covid boosters don’t undergo clinical trials. It’s true that covid booster shots, whose mRNA sequences are changed slightly from previous shots, aren’t tested in large trials. Neither are annual influenza vaccines. By the time such tests would be completed, flu season would be over. But the original mRNA shots underwent clinical trials, and as with flu shots, “a lot of evidence has been collected in support of the ongoing use of the vaccines,” said Natalie Dean, a biostatistician at Emory University’s Rollins School of Public Health.
• The shots pose a risk of infections, autoimmune disease, and other conditions. “I don’t know where these claims come from, but they aren’t accepted by the general medical community,” said William Schaffner, a Vanderbilt University School of Medicine infectious disease specialist. Serious side effects do occur, rarely, as with any medication. U.S. authorities were among the first to detect rare occurrences of myocarditis, an inflammation of the heart tissue, in young adults who got the covid vaccine. Most patients recovered quickly. Myocarditis is more commonly caused by covid infection itself.
• The shots could cause elevated levels of spike protein and foreign genetic material in the blood. These concerns, which circulate on social media, have been disproved or have not panned out. For example, the billionths-of-a-gram quantities of bacterial DNA alleged to be contaminating covid shots are dwarfed by our other exposures, Offit said. “You encounter foreign DNA all the time, assuming you live on the planet and eat anything made from animals or vegetables,” he said. “I don’t know Dr. Ladapo, but I assume he does.”
• Americans face “unknown risk” from too many booster shots. Scientists look at the possibility of “overvaccination” every time they study boosters. So far, no safety risks have been associated with multiple immunizations, Schaffner said.
• Floridians should get exercise and eat vegetables and “healthy fats.” “These things will benefit your general health, but none of them will prevent covid,” Schaffner said.

The bulletin urges all Floridians, including older residents, to avoid mRNA vaccines and find alternatives. But it comes off as “not in good faith” because it doesn’t specifically mention the only non-mRNA vaccine available, from Novavax, Dean said.

Several critics of Ladapo’s bulletin said it read like a tryout for a job in a Trump administration advised by longtime anti-vaccine activist Robert F. Kennedy Jr., who has said Trump wants him to help vet senior health officials. Trump has said children receive too many vaccines and suggested that vaccines cause autism, a myth debunked by years of scientific research.

Ironically, although his administration oversaw the triumphantly rapid creation of the first covid vaccines, Trump declined to receive his shots in public, as presidents have done during past epidemics.

Ladapo’s vaccine statement “aligns with Project 2025,” Offit said, referring to the conservative Heritage Foundation policy blueprint. While the plan’s authors include officials from Trump’s first term, he has said it doesn’t reflect his views.

The document calls the CDC “perhaps the most incompetent and arrogant agency in the federal government.”

Organized resistance to vaccines has existed as long as vaccination itself. Within six months of the release of the mRNA vaccines in December 2020, about 70% of American adults were vaccinated. Those who refused put themselves at greater risk of hospitalization or death if they contracted covid, studies have shown.

Cheryl Holder, an internist who practices in Miami, said Ladapo’s statements had dampened interest in vaccination overall. People who are blasé about covid “also don’t want to take the tetanus vaccine, and they don’t want to take the pneumococcal vaccine, or the flu vaccine,” she said.

“We’re in the disinformation age,” Offit said. “It’s certainly a lucrative business, more lucrative than the information business. But what really bothers me is when you have people who are credentialed stand up and say these ridiculous things.”

Ladapo, he noted, has medical and doctoral degrees from Harvard.

Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for its newsletters here.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

On March 30, 2019, a swerving car upended Tom Burke’s life.

Severely injured after the crash, Burke was airlifted from the Fort Liberty U.S. Army base in North Carolina to UNC Medical Center, in Chapel Hill, where doctors performed surgeries to rebuild his leg.

Medicaid covered most of the cost, but Burke was still left with more than $10,000 in bills. He was confined to a wheelchair for two years after the accident, unable to work his car sales job. As a result, he said, he couldn’t pay the outstanding hospital bill and his account was turned over to a collection agency.

Since then, he and his wife repeatedly tried to buy a house. But because of damage to his credit score, mortgage companies repeatedly turned them down.

“We were forced into homelessness for a time,” said Burke, whose family moved from North Carolina to Missouri in 2020. “For everything we need credit for, we’re screwed.”

Burke is among millions of people burdened by medical debt, a nationwide problem that surveys and data suggest is particularly acute in North Carolina.

Using credit bureau data, the nonprofit Urban Institute calculated that more than 8% of North Carolina consumers had an unpaid medical bill on their credit report in 2023, compared with 5% nationally.

In fact, only Oklahoma, Wyoming, South Carolina, and Texas had higher levels of medical debt on credit reports than North Carolina, researchers found.

Nationally, 41% of adults — or about 100 million people — have some kind of health care debt, according to a 2022 survey by KFF, a health information nonprofit that includes KFF Health News, the publisher of California Healthline.

The KFF survey was designed to capture not just bills patients couldn’t afford and that end up on credit reports, but also other debt patients incur to pay for health care, including from credit cards, payment plans, and loans from friends and family.

The KFF survey didn’t include state-specific findings, but if North Carolina’s debt burden precisely matched the national rate — meaning 41% of adults in the state had health care debt — then approximately 3.4 million North Carolinians would be in debt.

This is probably a low estimate, however, since the credit bureau data and other sources suggest that medical debt is higher in North Carolina than nationally.

The credit bureau data also indicates that medical debt is highest in Anson and Cleveland counties, along with a band of counties in the eastern part of the state.

Mecklenburg County’s rate is slightly higher than the state rate. And as is the case nearly everywhere, there are large racial disparities in medical debt, with debt burdens in the county more than twice as high in nonwhite communities as in white ones, the Urban Institute data shows.

Burke, who earns less than $1,000 a month from Social Security Disability Insurance, said his family is now forced to rent, which has dramatically increased their living expenses.

His family of five shares tight quarters — a 980-square-foot rental home with just two full-sized bedrooms. They moved to Missouri because the cost of living is lower there.

Hospitals, he said, need to change their priorities.

“They’re not for patient care,” he said. “They’re for patient profit.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

ORANGEBURG, S.C. — Amari Marsh had just finished her junior year at South Carolina State University in May 2023 when she received a text message from a law enforcement officer.

“Sorry it has taken this long for paperwork to come back,” the officer wrote. “But I finally have the final report, and wanted to see if you and your boyfriend could meet me Wednesday afternoon for a follow up?”

Marsh understood that the report was related to a pregnancy loss she’d experienced that March, she said. During her second trimester, Marsh said, she unexpectedly gave birth in the middle of the night while on a toilet in her off-campus apartment. She remembered screaming and panicking and said the bathroom was covered in blood.

“I couldn’t breathe,” said Marsh, now 23.

The next day, when Marsh woke up in the hospital, she said, a law enforcement officer asked her questions. Then, a few weeks later, she said, she received a call saying she could collect her daughter’s ashes.

At that point, she said, she didn’t know she was being criminally investigated. Yet three months after her loss, Marsh was charged with murder/homicide by child abuse, law enforcement records show. She spent 22 days at the Orangeburg-Calhoun Regional Detention Center, where she was initially held without bond, facing 20 years to life in prison.

This August, 13 months after she was released from jail to house arrest with an ankle monitor, Marsh was cleared by a grand jury. Her case will not proceed to trial.

Her story raises questions about the state of reproductive rights in this country, disparities in health care, and pregnancy criminalization, especially for Black women like Marsh. More than two years after the U.S. Supreme Court issued its Dobbs v. Jackson Women’s Health Organization decision, which allowed states to outlaw abortion, the climate around these topics remains highly charged.

Marsh’s case also highlights what’s at stake in November. Sixty-one percent of voters want Congress to pass a federal law restoring a nationwide right to abortion, according to a recent poll by KFF, the health policy research, polling, and news organization that includes KFF Health News, the publisher of California Healthline. These issues could shape who wins the White House and controls Congress, and will come to a head for voters in the 10 states where ballot initiatives about abortion will be decided.

This case shows how pregnancy loss is being criminalized around the country, said U.S. Rep. James Clyburn, a Democrat and graduate of South Carolina State University whose congressional district includes Orangeburg.

“This is not a slogan when we talk about this being an ‘election about the restoration of our freedoms,’” Clyburn said.

‘I Was Scared’

When Marsh took an at-home pregnancy test in November 2022, the positive result scared her. “I didn’t know what to do. I didn’t want to let my parents down,” she said. “I was in a state of shock.”

She didn’t seek prenatal care, she said, because she kept having her period. She thought the pregnancy test might have been wrong.

An incident report filed by the Orangeburg County Sheriff’s Office on the day she lost the pregnancy stated that in January 2023 Marsh made an appointment at a Planned Parenthood clinic in Columbia to “take the Plan-C pill which would possibly cause an abortion to occur.” The report doesn’t specify whether she took — or even obtained — the drug.

During an interview at her parents’ house, Marsh denied going to Planned Parenthood or taking medicine to induce abortion.

“I’ve never been in trouble. I’ve never been pulled over. I’ve never been arrested,” Marsh said. “I never even got written up in school.”

She played clarinet as section leader in the marching band and once performed at Carnegie Hall. In college, she was majoring in biology and planned to become a doctor.

South Carolina state Rep. Seth Rose, a Democrat in Columbia and one of Marsh’s attorneys, called it a “really tragic” case. “It’s our position that she lost a child through natural causes,” he said.

On Feb. 28, 2023, Marsh said, she experienced abdominal pain that was “way worse” than regular menstrual cramps. She went to the emergency room, investigation records show, but left after several hours without being treated. Back at home, she said, the pain grew worse. She returned to the hospital, this time by ambulance.

Hospital staffers crowded around her, she said, and none of them explained what was happening to her. Bright lights shone in her face. “I was scared,” she said.

According to the sheriff’s department report, hospital staffers told Marsh that she was pregnant and that a fetal heartbeat could be detected. Freaked out and confused, she chose to leave the hospital a second time, she said, and her pain had subsided.

In the middle of the night, she said, the pain started again. She woke up, she recalled, feeling an intense urge to use the bathroom. “And when I did, the child came,” she said. “I screamed because I was scared, because I didn’t know what was going on.”

Her boyfriend at the time called 911. The emergency dispatcher “kept telling me to take the baby out” of the toilet, she recalled. “I couldn’t because I couldn’t even keep myself together.”

First medical responders detected signs of life and tried to perform lifesaving measures as they headed to Regional Medical Center in Orangeburg, the incident report said. But at the hospital, Marsh learned that her infant, a girl, had not survived.

“I kept asking to see the baby,” she said. “They wouldn’t let me.”

The following day, a sheriff’s deputy told Marsh in her hospital room that the incident was under investigation but said that Marsh “was currently not in any trouble,” according to the report. Marsh responded that “she did not feel as though she did anything wrong.”

More than 10 weeks later, nothing about the text messages she received from an officer in mid-May implied that the follow-up meeting about the final report was urgent.

“Oh it doesn’t have to be Wednesday, it can be next week or another week,” the officer wrote in an exchange that Marsh shared with California Healthline. “I just have to meet with y’all in person before I can close the case out. I am so sorry”

“No problem I understand,” Marsh wrote back.

She didn’t tell her parents or consider hiring a lawyer. “I didn’t think I needed one,” she said.

Marsh arranged to meet the officer on June 2, 2023. During that meeting, she was arrested. Her boyfriend was not charged.

Her father, Herman Marsh, the band director at a local public school in Orangeburg, thought it was a bad joke until reality set in. “I told my wife, I said, ‘We need to get an attorney now.’”

Pregnancy Criminalization

When Marsh lost her pregnancy on March 1, 2023, women in South Carolina could still obtain an abortion until 20 weeks beyond fertilization, or the gestational age of 22 weeks.

Later that spring, South Carolina’s Republican-controlled legislature passed a ban that prohibits providers from performing abortions after fetal cardiac activity can be detected, with some exceptions made for cases of rape, incest, or when the mother’s life is in jeopardy. That law does not allow criminal penalties for women who seek or obtain abortions.

Solicitor David Pascoe, a Democrat elected to South Carolina’s 1st Judicial Circuit whose office handled Marsh’s prosecution, said the issues of abortion and reproductive rights weren’t relevant to this case.

“It had nothing to do with that,” he told California Healthline.

The arrest warrant alleges that not moving the infant from the toilet at the urging of the dispatcher was ultimately “a proximate cause of her daughter’s death.” The warrant also cites as the cause of death “respiratory complications” due to a premature delivery stemming from a maternal chlamydia infection. Marsh said she was unaware of the infection until after the pregnancy loss.

Pascoe said the question raised by investigators was whether Marsh failed to render aid to the infant before emergency responders arrived at the apartment, he said. Ultimately, the grand jury decided there wasn’t probable cause to proceed with a criminal trial, he said. “I respect the grand jury’s opinion.”

Marsh’s case is a “prime example of how pregnancy loss can become a criminal investigation very quickly,” said Dana Sussman, senior vice president of Pregnancy Justice, a nonprofit that tracks such cases. While similar cases predate the Supreme Court’s Dobbs decision, she said, they seem to be increasing.

“The Dobbs decision unleashed and empowered prosecutors to look at pregnant people as a suspect class and at pregnancy loss as a suspicious event,” she said.

Local and national anti-abortion groups seized on Marsh’s story when her name and mug shot were published online by The Times and Democrat of Orangeburg. Holly Gatling, executive director of South Carolina Citizens for Life, wrote a blog post about Marsh titled, in part, “Orangeburg Newborn Dies in Toilet” that was published by National Right to Life. Gatling and National Right to Life did not respond to interview requests.

Marsh said she made the mistake of googling herself when she was released from jail.

“It was heartbreaking to see all those things,” she said. “I cried so many times.”

Some physicians are also afraid of being painted as criminals. The nonprofit Physicians for Human Rights published a report on Sept. 17 about Florida’s six-week abortion ban that included input from two dozen doctors, many of whom expressed fear about the criminal penalties imposed by the law.

“The health care systems are afraid,” said Michele Heisler, medical director for the nonprofit. “There’s all these gray areas. So everyone is just trying to be extra careful. Unfortunately, as a result, patients are suffering.”

Chelsea Daniels, a family medicine doctor who works for Planned Parenthood in Miami and performs abortions, said that in early September she saw a patient who had a miscarriage during the first trimester of her pregnancy. The patient had been to four hospitals and brought in the ultrasound scans performed at each facility.

“No one would touch her,” Daniels said. “Each ultrasound scan she brought in represents, on the other side, a really terrified doctor who is doing their best to interpret the really murky legal language around abortion care and miscarriage management, which are the same things, essentially.”

Florida is one of the 10 states with a ballot measure related to abortion in November, although it is the only Southern state with one. Others are Montana, Missouri, and Maryland.

‘I Found My Strength’

Zipporah Sumpter, one of Marsh’s lawyers, said the law enforcement system treated her client as a criminal instead of a grieving mother. “This is not a criminal matter,” Sumpter said.

It was not just the fraught climate around pregnancy that caused Marsh to suffer; “race definitely played a factor,” said Sumpter, who does not believe Marsh received compassionate care when she went to the hospital the first or second time.

The management of Regional Medical Center, where Marsh was treated, changed shortly after her hospitalization. The hospital is now managed by the Medical University of South Carolina, and its spokesperson declined to comment on Marsh’s case.

Historically, birth outcomes for Black women in Orangeburg County, where Marsh lost her pregnancy, have ranked among the worst in South Carolina. From 2020 through 2022, the average mortality rate for Black infants born in Orangeburg County was more than three times as high as the average rate for white infants statewide.

Today, Marsh is still trying to process all that happened. She moved back in with her parents and is seeing a therapist. She is taking classes at a local community college and hopes to reenroll at South Carolina State University to earn a four-year degree. She still wants to become a doctor. She keeps her daughter’s ashes on a bookshelf in her bedroom.

“Through all of this, I found my strength. I found my voice. I want to help other young women that are in my position now and will be in the future,” she said. “I always had faith that God was going to be on my side, but I didn’t know how it was going to go with the justice system we have today.”

KFF Health News Florida correspondent Daniel Chang contributed to this article.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

En lo que se ha convertido en un patrón de diseminación de desinformación sobre las vacunas, el Departamento de Salud de Florida está aconsejando a sus residentes mayores y a otros en mayor riesgo de covid-19 que eviten la mayoría de los refuerzos, asegurando que son potencialmente peligrosos.

Clínicos y científicos denuncian este mensaje como una táctica de miedo con motivación política que también debilita los esfuerzos para proteger contra enfermedades como el sarampión y la tos ferina.

Un destacado médico de Florida expresó su consternación por el hecho de que los líderes médicos del estado, temerosos de enfurecer al gobernador Ron DeSantis, hayan sido lentos para contrarrestar los mensajes antivacunas del cirujano general Joseph Ladapo, incluido el último boletín sobre covid.

Ladapo fue nombrado por DeSantis y es el principal funcionario del departamento de salud estatal.

El boletín contiene una serie de afirmaciones falsas, o no comprobadas, sobre la eficacia y seguridad de las vacunas contra covid basadas en ARNm de Pfizer y Moderna, diciendo cosas tales como que podrían amenazar “la integridad del genoma humano”.

En general, la guía de Florida repite ideas de sitios de internet antivacunas, dijo John Moore, profesor de microbiología en Weill Cornell Medicine.

Ladapo no respondió a una solicitud de comentarios. DeSantis remitió las preguntas al departamento, que dijo que las directrices y citas del cirujano general “hablan por sí mismas” y señaló un post suyo en la plataforma X acusando a los Centros para el Control y Prevención de Enfermedades (CDC) y la Administración de Drogas y Alimentos (FDA) de “engañar a los estadounidenses”.

DeSantis se ha presentado a sí mismo y a su administración como un baluarte contra los mandatos de vacunas, los confinamientos y otras protecciones de salud pública restrictivas adoptadas durante la pandemia para frenar las infecciones y salvar vidas.

La inmunización contra covid se ha convertido en un tema partidista, con encuestas de KFF, la organización de información sobre salud que incluye KFF Health News, que muestran que los republicanos tienen mucha menos confianza en la seguridad y eficacia de las vacunas que los demócratas.

Pero historiadores de las vacunas consultados para este artículo no recordaron ningún líder de salud estatal anterior que instara a los residentes a rechazar una vacuna aprobada por la FDA y recomendada por los CDC. “Es algo sin precedentes”, dijo Paul Offit, director del Centro de Educación sobre Vacunas del Hospital Infantil de Philadelphia.

Líderes médicos de Florida deberían pronunciarse más enérgicamente contra los ataques de Ladapo a la salud pública, dijo Jeffrey Goldhagen, pediatra y profesor en la Facultad de Medicina de la Universidad de Florida en Jacksonville.

El año pasado, Ladapo instó a las personas menores de 65 años a no vacunarse contra covid, y ha rechazado los protocolos de salud pública para combatir brotes de sarampión.

“Lo que ves es un patrón de miedo y negligencia de las responsabilidades profesionales en todo el estado, en parte debido al temor a este gobernador y a su espíritu de venganza”, dijo Goldhagen, ex director del Departamento de Salud en Jacksonville.

Criticó específicamente a la Asociación Médica de Florida, un grupo comercial para médicos, señalando que Ladapo es miembro sin derecho a voto de la junta de gobernadores del grupo. La asociación no respondió a correos electrónicos solicitando comentarios.

La Asociación de Atención Médica de Florida, cuyos miembros administran más de 600 centros de atención de largo plazo, se negó a comentar sobre el boletín de Ladapo. Una cadena de hogares de adultos mayores, LeadingAge Southeast, dijo que estaba al tanto de las recomendaciones federales y estatales sobre los refuerzos de covid y alentó a los proveedores a “involucrarse con sus residentes, familias y profesionales de salud para tomar decisiones informadas”.

Cherie Duvall-Jones, vocera de la FDA, dijo que la agencia “está en fuerte desacuerdo con la caracterización del cirujano general de Florida sobre la seguridad y eficacia de las vacunas actualizadas de ARNm contra COVID-19”.

Las vacunas cumplieron con los “rigurosos estándares científicos” de la FDA, dijo, y exhortó a las personas a recibir refuerzos ya que la inmunidad de la población contra covid ha disminuido.

Entre sus afirmaciones incorrectas, el boletín dice que los nuevos refuerzos de ARNm atacan una variante viral, ómicron, que ya no circula ampliamente. Esto es falso, ya que todas las variantes principales de covid en los últimos dos años evolucionaron a partir de ómicron y mutaciones posteriores.

“Empiezas con eso y luego te adentras en territorio de ‘emojis con la cabeza explotando’”, dijo Moore. “Es una letanía de mentiras sacadas de un manual antivacunas”.

Otras afirmaciones en el boletín de Ladapo incluyen:

• Los refuerzos de la vacuna contra covid no se prueban en ensayos clínicos. Es cierto que las dosis de refuerzo de la vacuna contra covid, cuyas secuencias de ARNm se modifican ligeramente en comparación con las dosis anteriores, no se prueban en ensayos clínicos a gran escala. Tampoco se prueban las vacunas anuales contra la gripe. Para cuando estas pruebas estuvieran completas, la temporada de gripe ya habría terminado. Sin embargo, las vacunas originales de ARNm sí pasaron por ensayos clínicos y, al igual que con las vacunas contra la gripe, “se ha recopilado mucha evidencia que respalda el uso continuo de las vacunas”, dijo Natalie Dean, bioestadística en la Escuela de Salud Pública Rollins de la Universidad Emory.
• Las vacunas presentan un riesgo de infecciones, enfermedades autoinmunes y otras afecciones. “No sé de dónde vienen estas afirmaciones, pero no son aceptadas por la comunidad médica en general”, dijo William Schaffner, especialista en enfermedades infecciosas de la Facultad de Medicina de la Universidad Vanderbilt. Los efectos secundarios graves ocurren, raramente, como con cualquier medicamento. Las autoridades estadounidenses fueron de las primeras en detectar casos raros de miocarditis, una inflamación del tejido cardíaco, en adultos jóvenes que recibieron la vacuna contra covid. La mayoría de los pacientes se recuperaron rápidamente. La miocarditis es causada con mayor frecuencia por la infección de covid en sí.
• Las vacunas podrían causar niveles elevados de proteína espiga y material genético extraño en la sangre. Estas preocupaciones, que circulan en las redes sociales, han sido refutadas o no han tenido fundamento. Por ejemplo, las cantidades de billonésimas de gramo de ADN bacteriano que supuestamente contaminan las vacunas contra covid son insignificantes en comparación con otras exposiciones, dijo Offit. “Encuentras ADN extraño todo el tiempo, asumiendo que vives en el planeta y comes cualquier cosa hecha de animales o vegetales”, dijo. “No conozco al Dr. Ladapo, pero asumo que él también lo hace”.
• Los estadounidenses enfrentan un “riesgo desconocido” por recibir demasiadas dosis de refuerzo. Los científicos examinan la posibilidad de una “sobre vacunación” cada vez que estudian los refuerzos. Hasta ahora, no se han asociado riesgos de seguridad con múltiples inmunizaciones, dijo Schaffner.
• Los floridanos deben hacer ejercicio y comer vegetales y “grasas saludables”. “Estas cosas beneficiarán tu salud general, pero ninguna de ellas previene covid”, dijo Schaffner.

El boletín insta a todos, incluidos los residentes mayores, a evitar las vacunas de ARNm y encontrar alternativas. Pero parece que “no es de buena fe” porque no menciona específicamente la única vacuna no basada en ARNm disponible, de Novavax, dijo Dean.

Varios críticos del boletín de Ladapo dijeron que parecía un ensayo para un puesto en una administración Trump, editado por el activista antivacunas de larga data Robert F. Kennedy Jr., quien ha declarado que Trump quiere que lo ayude a evaluar a los altos funcionarios de salud.

Trump ha dicho que los niños reciben demasiadas vacunas y sugirió que causan autismo, un mito desmentido por años de investigación científica.

Irónicamente, aunque su administración supervisó la creación rápida y triunfal de las primeras vacunas contra covid, Trump se negó a recibir sus vacunas en público, como lo han hecho otros presidentes durante epidemias pasadas.

La declaración de Ladapo sobre las vacunas “se alinea con el Proyecto 2025”, dijo Offit, refiriéndose al plan de políticas de la conservadora Fundación Heritage. Aunque los autores del plan incluyen funcionarios del primer mandato de Trump, él ha dicho que no refleja sus puntos de vista.

El documento califica a los CDC como “tal vez la agencia más incompetente y arrogante del gobierno federal”.

La resistencia organizada a las vacunas ha existido desde que existe la vacunación. Durante los seis meses posteriores al lanzamiento de las vacunas de ARNm en diciembre de 2020, aproximadamente el 70% de los adultos estadounidenses estaban vacunados. Aquellos que se negaron se pusieron en mayor riesgo de hospitalización o muerte si contraían el coronavirus que causa covid, según han demostrado los estudios.

Cheryl Holder, internista que ejerce en Miami, dijo que las declaraciones de Ladapo habían causa una baja en el interés general en las vacunas. Las personas que son indiferentes a covid “tampoco quieren ponerse la vacuna contra el tétanos, ni la vacuna neumocócica, ni la vacuna contra la gripe”, dijo.

“Estamos en la era de la desinformación”, dijo Offit. “Ciertamente es un negocio lucrativo, más lucrativo que el negocio de la información. Pero lo que realmente me molesta es cuando personas con credenciales se paran y dicen estas cosas ridículas”.

Destacó que Ladapo tiene el título médico y doctorados de la Universidad de Harvard.

Healthbeat es una redacción sin fines de lucro que cubre temas de salud pública, que publica Civic News Company y KFF Health News. Regístrate para recibir sus boletines aquí.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

The Host

Recent comments from former President Donald Trump and Republican lawmakers preview potential health policy pursuits under a second Trump administration. Trump is yet again eyeing changes to the Affordable Care Act, while key lawmakers want to repeal Medicare drug price negotiations.

Also, this week brought news of the first publicly reported death attributed to delayed care under a state abortion ban. Vice President Kamala Harris said the death shows the consequences of Trump’s actions to block abortion access.

This week’s panelists are Emmarie Huetteman of KFF Health News, Joanne Kenen of Politico and the Johns Hopkins University’s schools of nursing and public health, Tami Luhby of CNN, and Shefali Luthra of The 19th.

Among the takeaways from this week’s episode:

• Sen. JD Vance (R-Ohio), Trump’s running mate, says Trump is interested in loosening ACA rules to make cheaper policies available. While the campaign has said little about what Trump would do or how it would work, the changes could include eliminating protections against higher premiums for those with preexisting conditions. Republicans would also likely let enhanced subsidies for ACA premiums expire.
• Key Republican lawmakers said this week that they’re interested in repealing the Inflation Reduction Act’s provisions enabling Medicare drug pricing negotiations. Should Trump win, that stance could create intraparty tensions with the former president, who has vowed to “take on Big Pharma.”
• A state review board in Georgia ruled that the death in 2022 of a 28-year-old mother, after her doctors delayed performing a dilatation and curettage procedure, was preventable. Harris tied the death to Trump’s efforts to overturn Roe v. Wade, which included appointing three Supreme Court justices who voted to eliminate the constitutional right to an abortion.
• And in health tech news, the FDA has separately green-lighted two new Apple product functions: an Apple Watch feature that assesses the wearer’s risk of sleep apnea, and an AirPods feature that turns the earbuds into hearing aids.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too: 

Emmarie Huetteman: The Washington Post’s “What Warning Labels Could Look Like on Your Favorite Foods,” by Lauren Weber and Rachel Roubein. 

Shefali Luthra: KFF Health News’ “At Catholic Hospitals, a Mission of Charity Runs Up Against High Care Costs for Patients,” by Rachana Pradhan. 

Tami Luhby: Politico Magazine’s “Doctors Are Leaving Conservative States To Learn To Perform Abortions. We Followed One,” by Alice Miranda Ollstein. 

Joanne Kenen: The New York Times’ “This Chatbot Pulls People Away From Conspiracy Theories,” by Teddy Rosenbluth, and The Atlantic’s “When Fact-Checks Backfire,” by Jerusalem Demsas. 

Also mentioned on this week’s podcast:

ProPublica’s “Abortion Bans Have Delayed Emergency Medical Care. In Georgia, Experts Say This Mother’s Death Was Preventable,” by Kavitha Surana.

To hear all our podcasts, click here.

And subscribe to KFF Health News’ “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.