Gun Violence

Most Gun Laws Aren't Backed Up By Evidence. Here's Why.

By Maggie Koerth

Feb. 6, 2023, at 6:00 AM

In the first month of 2023, 25 people lost their lives in four mass shootings in California over just eight days. It’s a grim statistic, made all the more distressing when you consider the fact that California has one of the lowest gun death rates in the entire country. This is what a safe state looks like. 

California also has some of the strictest gun control laws in the country. And in the aftermath of those four mass shootings, new House Speaker Kevin McCarthy — who represents a district in southern California — took the opportunity to poke at the state’s firearms restrictions, saying in a press conference that federal gun control legislation would not be an automatic response to these tragedies because such laws “apparently … did not work in this situation.” 

Watch: https://abcnews.go.com/fivethirtyeight/video/tyre-nicholss-murder-finally-make-congress-police-reform-96801092

So, did California’s gun laws succeed at making it one of the safest states … or did they fail to stop a string of mass shootings? Questions about the efficacy of gun laws have gotten easier to answer in recent years as changes to federal policy have helped to bring money and people back to the field of gun violence research. But decades of neglect mean there are still lots of blank spaces — policies that don’t yet have good quality data backing them up. A recent report from the Rand Corporation that reviewed the evidence behind a variety of gun policies found just three that were supported by evidence that met the report’s quality standards.¹ 

That fact, however, doesn’t mean other gun laws don’t work — just that the research proving it doesn’t yet exist. Scientists I spoke to saw it as an “absence of evidence” problem, stemming from long-standing, intentional roadblocks in the path of gun violence research. Even the authors of the Rand report say lawmakers should still be putting policies aimed at preventing gun violence into practice now — regardless of what the science does or doesn’t say.

“I think that the goal of the lawmaker is to pick laws that they have a reasonable hope will be better than the status quo,” said Andrew Morral, a senior behavioral scientist at the Rand Corporation. “And there’s lots of ways of persuading oneself that that may be true, that don’t have to do with appealing to strict scientific evidence.”

California doesn’t just have some of the nation’s strictest gun laws and lowest gun death rates, it’s also maybe the best state to study gun laws in, said Dr. Garen Wintemute, director of the Violence Prevention Research Program at University of California, Davis Medical Center. That’s because of both the way the state makes data available to researchers and its willingness to work with researchers to further the science. Wintemute is currently part of a team that is working on a randomized controlled trial of one particular California gun law — an initiative that tracks legal gun owners over time and dispatches authorities to remove their weapons if those people later break a law or develop a condition that would make them ineligible to own guns in the state. 

It’s hard to oversell what a big deal this is. Frequently referred to as the “gold standard” of evidence-based medicine, randomized controlled trials split participants randomly (natch) into groups of people who get the treatment and groups that don’t. Because of that, it’s easier for researchers to figure out if a medication is actually working — or if it just appears to be working because of some other factor the people in the study happen to share. These kinds of studies are crucial, but almost impossible to do with public policy because, after all, how often can you randomly apply a law? 

But California has been willing to try. It took cooperation from many different levels of state leadership, Wintemute said. The government was always going to slowly expand this particular program statewide, but in this case legislators were willing to work with scientists and randomize that expansion across more than 1,000 communities, so that some randomly became part of the program earlier and some later. When the study finally concludes, researchers will be able to compare these two groups and see how joining the program affected gun violence in those places with a high level of confidence. 

Most of the time, however, the scientists who study gun laws aren’t working with the kind of research methodology like this that produces strong results. Morral, along with his Rand colleague, economist Rosanna Smart, have reviewed the vast majority of the research on gun control policies done between 1995 and 2020. Their research synthesis found that a lot of what is out there are cross-sectional studies — observational research that basically just compares gun violence statistics at one point in time in a state that has a specific law to those in a state that doesn’t. That type of study is prone to mixing up correlation and causation, Smart said. There could be lots of reasons why California has lower rates of gun violence than Alabama, but studies like this don’t try to tease apart what’s going on. They end up being interpreted by the public as proof a law works when all they’ve really done is identified differences between states. 

The Rand analysis threw out these kinds of studies and only looks at research that is, at least, quasi-experimental — studies that tracked changes in outcomes over time between comparison groups. Even then, the analysis ranked some studies as lower quality than others, based on factors such as how broadly the results could be applied. For instance, a study that only looked at the effects of minimum age requirements for gun ownership in one state would be ranked lower than a study that looked at those effects in every state where a law like that existed.

Watch: https://abcnews.go.com/fivethirtyeight/video/americans-view-crime-gun-violence-issues-fivethirtyeight-88152853

Following these rules, the Rand team found just three policies that have strong evidence supporting outcomes — and two of these are about the negative outcomes of policies that increase gun access. Stand-your-ground laws, which allow gun owners to use deadly force without trying to leave or deescalate a situation, appear to increase firearm homicides. Meanwhile, conceal-carry laws, which allow gun owners to carry a gun in public places, appear to increase the number of all homicides and increase the number of firearm homicides, specifically. The only laws restricting gun ownership that have this level of evidence behind them are child-access prevention laws, which have been shown to reduce firearm suicide, unintentional self-injuries and death, and homicides among young people. 

That makes gun control laws seem flimsy, but it shouldn’t, Morral said. Instead, the lack of evidence ought to be understood as a product of political decisions that have taken the already challenging job of social science and made it even harder. The Dickey Amendment, first attached to the 1996 omnibus spending bill, for example, famously prevented the Centers for Disease Control and Prevention from funding gun violence studies for decades. A new interpretation of that amendment in 2018 changed that, but Dickey wasn’t the only thing making it hard to study gun violence. 

Instead, the researchers told me, the biggest impediment to demonstrating whether gun control policies work is the way politicians have intentionally blocked access to the data that would be necessary to do that research. 

“So for instance, the federal government has this massive, great survey of behavioral risk indicators that they do every year in every state,” Morral said. “And you can get fantastic information on Americans’ fruit juice consumption as a risk factor for diabetes. But you can’t get whether or not they own guns.” Not knowing gun ownership rates at the state level makes it hard to evaluate causality of some gun control policies, he explained. “And it’s not because anyone thinks [gun ownership] is not a risk factor for various outcomes. It’s because it’s guns.”

The missing data problem also includes the 2003 Tiahrt Amendment that prevents the sharing of data tracing the origins of guns used in crimes with researchers, said Cassandra Crifasi, co-director of the Center for Gun Violence Solutions at Johns Hopkins University. “So now all we can see are these sort of aggregate-level state statistics,” she said. “We can no longer look at things like, when a gun is recovered in a crime, was the purchaser the same person who was in possession of the gun at the time of the crime?” 

Recently, researchers have even been missing basic crime data that used to be reported by the FBI’s Uniform Crime Reporting program. Law enforcement agencies and states were supposed to be shifting to the relatively new, much more detailed National Incident-Based Reporting System, but the transition has been a catastrophe, with some of the biggest law enforcement agencies in the country not yet making the switch because of financial and logistical complications, Smart said. “The FBI has not been able to report for the last eight quarters whether homicide rates are up or down,” Morral added. 

But much of the data that’s not available at a national level is available in California, Wintemute said. “Unlike researchers in any other state, we have access to individual firearm purchaser records,” he told me — the very data the Tiahrt Amendment blocks at the national level. “We do studies involving 100,000 gun purchasers, individually known to us, and we follow them forward in time to look for evidence of criminal activity or death or whatever the outcome might be that we’re studying,” Wintemute said. 

Unfortunately, because the data is only available in California, the results of those studies would only be applicable to California — making it data that wouldn’t be considered high-quality in the Rand report. Wintemute can demonstrate if a policy is working in his home state, but not whether it works in a big, broad, existential sense. It wouldn’t count towards expanding the number of policies Rand has found evidence to support. This is something researchers like Crifasi see as a flaw in the Rand analysis, but it’s also a reason why Morral and Smart don’t think evidence-based policy is a good standard to apply to gun control to begin with. 

It’s useful to know what there is evidence to support, Morral said. “But we don’t at all believe that legislation should rest on strong scientific evidence,” he said. Instead, the researchers from Rand described scientific evidence as a luxury that legislators don’t yet have. 

“There’s always gonna be somebody who’s the first person to implement the law,” said Smart. “And they’re going to have to derive their decision based on theory and other considerations that are not empirical scientific evidence.”

Watch: https://abcnews.go.com/fivethirtyeight/video/supreme-courts-gun-ruling-remakes-gun-control-americans-85660014

2022 In Review

The Numbers That Defined 2022

By Anna Rothschild

Dec. 30, 2022, at 6:00 AM

What a year 2022 has been. There was so … much … news. We saw record-high inflation, war in Ukraine, a landmark Supreme Court session, continuing effects of the pandemic, the Winter Olympics, the death of Queen Elizabeth II, the World Cup and, of course, the midterms. In typical FiveThirtyEight fashion, we’ve been reflecting on 2022 the way we do best: through numbers. Here, seven of our reporters share some of the most important stats of the year, highlighting big political decisions, feelings of the electorate and hints at what’s to come in 2023.

Poverty

In September, the U.S. Census Bureau released its annual supplemental poverty rate for the previous year. That’s the poverty rate after accounting for the impact of key government programs targeted at low-income families, among other things. For reporter and editor Santul Nerkar, the defining number of the year was 7.8 percent, the supplemental poverty rate for 2021 and lowest rate on record. It was the first concrete measure of how COVID-19 stimulus money affected poverty in America.

Watch: https://abcnews.go.com/fivethirtyeight/video/us-poverty-rate-hit-record-low-expect-stay-95391465

Abortion

In June, the Supreme Court released its decision in Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade as the law of the land. In short order, many states enacted abortion bans, including total bans without exceptions for rape or incest. For senior writer Amelia Thomson-DeVeaux, the defining number of the year was 10,000 — that’s how many fewer legal abortions there were in just the first two months after Roe v. Wade was overturned.

Watch: https://abcnews.go.com/fivethirtyeight/video/number-captures-impact-dobbs-decision-fivethirtyeight-95627922

Forever chemicals

Per- and polyfluorinated chemicals, or PFAS, are used in all sorts of household products, from nonstick pans to dental floss. These pervasive chemicals are dangerous to human health, and the government and industry are finally starting to crack down on them. That brings us to senior science reporter Maggie Koerth’s numbers of the year: four, the number of PFAS the Environmental Protection Agency released new guidelines for, and 4,700, the rough number of different PFAS chemicals out there.

Watch: https://abcnews.go.com/fivethirtyeight/video/epa-finally-addressing-4-dangerous-forever-chemicals-4000-95750270

Election deniers

Denying the results of the 2020 presidential election was the cornerstone of many Republican campaigns this election cycle. Election denial is hardly a new thing, but it reached unprecedented levels in the 2022 midterms. That’s why 47 is the defining number of the year for politics and tech reporter Kaleigh Rogers. It’s the percentage of Republican candidates who ran for House, Senate, governor, secretary of state and attorney general this year and didn’t accept the legitimacy of the 2020 election.

Watch: https://abcnews.go.com/fivethirtyeight/video/number-election-denying-republicans-defined-2022-midterms-fivethirtyeight-95710927

Inflation

Heading into the midterm elections, Americans told pollsters that one issue was their top priority: the economy and inflation. For senior writer Monica Potts, the 9.1 percent inflation rate in June topped her list of most important stats of the year. Here she explores the ways — big and small — that historic levels of inflation affected American lives in 2022.

Watch: https://abcnews.go.com/fivethirtyeight/video/inflations-41-year-high-impacted-american-life-fivethirtyeight-95850805

The Republican margin in the House

The results of the 2022 election were worse for Republicans than one might expect, given that the president’s party usually loses ground in the midterms. In the U.S. House, Republicans gained a majority but only a slim one. They won by only nine seats, which for editor Maya Sweedler is one of the most important numbers of the year. What Republicans will — and won’t — be able to do with that majority will define American politics for at least the next two years.

Watch: https://abcnews.go.com/fivethirtyeight/video/number-shape-republicans-politics-2023-fivethirtyeight-95905408

Democratic trifectas

With Congress divided between Democrats and Republicans after the 2022 midterms, some of the most important political shifts of the next few years could be coming at the state level. Those new policies might lean liberal because, for the first time in 12 years, more Americans will live in states totally controlled by Democrats than by Republicans. That’s why senior elections analyst Nathaniel Rakich picked 140 million as his defining stat of the year. It’s the number of Americans who will soon be living in a state where Democrats will have total control over state government.

Watch: https://abcnews.go.com/fivethirtyeight/video/140-million-americans-live-states-controlled-democrats-fivethirtyeight-95547189

Thanks for watching, reading and listening to FiveThirtyEight this year. We’ll see you in 2023!

Transcript

Maggie Koerth: I have two important numbers for you this year. Some good news. And some bad news.

First, there’s four … That’s the number of harmful per- and polyfluorinated chemicals, or PFAS, that the Environmental Protection Agency released new concentration guidelines for this year. This is the good news.

Then, there’s four thousand seven hundred … That’s roughly the number of different PFAS chemicals out there, globally. They’re present in thousands of products you buy and use. They’re even in your drinking water. And this entire category of chemicals, including the ones developed to be “safer” replacements, have increasingly been shown to be dangerous to human health.

PFAS are a problem that date back to your grandma’s day. They were invented during the Great Depression and have been used in non-stick coatings on products like pots and pans since the 1940s. Since then, they’ve become part of how we make waterproof and stain-resistant fabrics and carpets, fire-fighting foam, cleaning products, paint, food packaging and more.

But these “forever chemicals” don’t break down. They just build up in the environment. And in the early 2000s, scientists started finding these chemicals in soil and water … and, eventually, in human blood.

To put it mildly … this is not good. Just a few parts per trillion in drinking water have been linked to a wide variety of health issues, from thyroid and immune response problems, to high cholesterol, to testicular cancer. This summer, the National Academies of Sciences reported that almost 100 percent of Americans have been exposed.

Despite all of this … or maybe, behind all of this … is the fact that PFAS aren’t well regulated. The EPA didn’t even have guidelines for what an acceptable concentration of PFAS in drinking water might be until 2016. At that time, they said that 70 parts per trillion was an acceptable amount of PFAS to find in water supplies. Now they’ve dropped that by more than a thousandfold. Scientists aren’t sure they even have the tools to measure PFAS at that level.

The EPA is in the process of creating the first federally enforceable regulations around two PFAS chemicals. That’s likely to happen in 2023. And individual states are taking action too. By 2030, new products containing any PFAS at all will be illegal in the state of Maine.

And things are changing at the industry level too. 3M, the company that first developed and still is the exclusive manufacturer of some of these chemicals, has said they will stop making PFAS by 2025.

So the publication of unenforceable guidelines covering 4 out of 4000 plus chemicals is just the beginning. We’re at the start of a serious shift in how the public – and the government – think about PFAS.

That — plus the fact that the majority of Americans dislike changing clocks to begin with — has led to efforts to eliminate standard time … and counterefforts to eliminate daylight saving time. Can either option squeeze more day out of the light we do have? Try your hand at optimizing daylight all year long:

Unfortunately, no solution will make every American happy. Even if you’ve found a combination that satisfies your personal preferences, you may have noticed that those preferences could negatively impact other parts of the country. And advocates for changing the system we currently have — whether pro-DST or anti — feel strongly that their personal preference is the best.

Those who want to permanently stay on standard time (the time we’re on from November to March) say it’s preferential to permanent daylight saving time because standard time more closely aligns the clocks with our natural circadian rhythm, which is dictated by light exposure. Such a change would be better for our health. For instance, daylight saving time has been associated with a host of negative health effects including worse sleep and cardiovascular disease, and permanent daylight saving time could lead to higher rates of depression — prompting groups like the American Academy of Sleep Medicine to endorse permanent standard time instead. “The problem is that we don’t adapt. Our bodies align to the sun,” said Dr. Karin Johnson, a sleep medicine specialist and a professor of neurology at the University of Massachusetts Chan Medical School.

Advocates for permanent daylight saving time, however, argue that Americans live by the clock, not the sun, and that brighter evenings fit with how we live in the real world. Perhaps that’s why in the past five years 19 states have passed a bill or resolution that would implement year-round daylight saving time. A bill that passed the Senate in March would also have made it permanent, but the measure has virtually no chance of being taken up by the House before the next Congress is seated.

There’s some evidence that people are more likely to shop or be active after work if it’s still light out. But the arguments aren’t just economic, said Steve Calandrillo, a professor at the University of Washington School of Law. With more people out and about in the evening hours, the chances for traffic accidents go up when the sun sets earlier. He pointed to a study from 2004, which found that switching to permanent daylight savings time could reduce pedestrian fatalities by 13 percent and motor-vehicle fatalities by 3 percent during morning and evening hours.² Other studies suggest more evening daylight could help prevent street crime.

The problem is that both standard time and daylight saving time are fictions. Daylight saving time, which was introduced as a temporary measure for maximizing usable daylight during World War I, tends to get a bad rap for its artificiality, but standard time isn’t exactly natural either. According to Michael O’Malley, a professor of history at George Mason University and the author of “Keeping Watch: A History of American Time,” standard time was introduced in the late 19th century by railroad companies who wanted to standardize their timetables. Not everyone was happy about it. The city of Cincinnati, for example, initially continued to set its clocks to “Cincinnati time,” which was twenty-two minutes different from standard time. “Their argument was, ‘Noon is when the sun is overhead, not when the Pennsylvania Railroad says it’s noon,’” O’Malley said. Our current system of springing forward and falling back is a kludge designed to make everyone happy — which, of course, it fails at.

That’s the fundamental problem with trying to restructure time to fit our schedules. Whether it’s permanent standard time or daylight saving time, any attempt to standardize the clocks will be dislocating for someone. O’Malley’s dream is that the country could somehow return to solutions from before the 20th century, when local communities still responded to changes in daylight by shifting their own schedules to fit the season. That could mean schools might open or close earlier or later depending on when the sun rose and set in a specific place, he said. Adapting to seasonal darkness — and even finding joy in the coziness of the depths of winter — could mean living our lives differently depending on the local hours of light in the day. Slowing down, maximizing activity in sunlight hours and seeking warmth and comfort are ways that people have been coping with the long, dark, cold nights for centuries.

But the promise of daylight saving time — that we can somehow wring more productive hours of brightness out of the day — has always been a false one. No matter how we manipulate the clocks, this will always be a dark time of year. By trying to escape that reality, we may just end up making ourselves more unhappy.

Conservation

The Butterfly Effect

How do scientists keep going when extinction feels inevitable?

It used to be, if you wanted to see a Poweshiek skipperling butterfly, the thing to do was go out on the prairie and stare into the middle distance, like you were trying to see a sailboat buried in a Magic Eye painting. Just watch, and wait, and they’d appear. 

Back then, more than 20 years ago, there were Poweshieks seemingly everywhere you looked in the Upper Midwest and Canada. Little, erratic, flapping things, Poweshieks are all rust and brown fuzz, no bigger than a quarter. They thrived on the endless golden zen gardens of protected tallgrass, but you could also spot the metallic sheen of their wings dancing among the black-eyed Susans in an overgrown railroad siding, or bounding through grassy ditches pinned between the state highway and a soybean field. “All of a sudden, you’d just see this little sparkle shoot across,” said Cale Nordmeyer, a butterfly conservation specialist at the Minnesota Zoo. “Nothing else on the prairie does that.”

Now, mostly, nothing at all does that. The Poweshieks are all but gone, confined to a patchy mange of small, isolated habitats in Michigan and Manitoba. Even there, survival is precarious, and humans have become a part of the species’ life cycle. Researchers collect the white butterfly eggs — each tiny and round like the period on the end of a sentence — and hatch them in captivity, where the caterpillars are supplied with their favorite foods and conditions replicating a perfect Northern winter. In spring, the scientists carry cocoons back to the prairie and release the adult butterflies — guests now on grasslands that once belonged to them.

Our hands are all over these butterflies, yet still they slip through our grasp. This July, in 16 days of searching through the marshy prairie fens of central Michigan, a team of researchers were able to collect four wild females, perhaps some of the last wild members of the species in the whole United States. By the time you’re reading this, these Poweshieks will have died — the average adult only lives for a couple weeks. Some of their offspring are growing on a zoo backlot, slivers of green clinging to stalks of grass in plastic pots. But it’s anyone’s guess whether other caterpillars are out there under the Michigan sky. 

The Poweshiek skipperling is just one threatened species in a world where a thousand tiny things are dying every day, an era of mass extinctions that’s been creeping up on us for decades. If humans stop trying to keep the Poweshieks alive, even for a year, the species could disappear. If humans don’t stop, it might well go extinct anyway. Even successfully staving off the species’ demise would likely mean these butterflies limp into the future changed in fundamental ways — living in different places, under different conditions than they did before Western civilization staked a claim to the prairie. 

We are skirting tragedy in a time of certain uncertainty. Nobody knows whether the Poweshiek skipperlings have reached their end, or whether they’re starting on a new beginning. Probably it’s both, at once. But either way, these butterflies represent a moment of reckoning and wrestling, as environmental scientists struggle to find hope in a world where losing battles are the ones most likely to be fought. 

GHOST TOWN

The last known U.S. habitat of wild Poweshieks is a series of small prairies, the biggest maybe the size of a city block, clustered around a lake in Michigan. The specific location is kept a secret in order to protect the butterflies from both collectors and well-meaning lookiloos who might otherwise come out to photograph the Poweshieks and, inadvertently, grind the caterpillars into the damp soil. It’s a wet place, full of matted paths that twine through clots of muddy grasses and waving wildflowers. The only noises are grasshoppers, massasauga rattlesnakes and the wind. 

The conditions there weren’t perfect for Poweshieks on the warm afternoon in July 2022, when Nordmeyer took me along on his hunt. Clouds were passing overhead, blotting out the sunshine butterflies love, and the breeze was up, maybe enough to make a small, winged creature cling to a flower as if it were a port in a storm. But there were other butterflies about. Movement in the grass stirred mulberry wing skippers and dorcas coppers. They flew into the air, where a hopeful journalist repeatedly mistook them for Poweshieks. 

In mud-caked boots, we walked through areas Nordemeyer and his team called Poweshiek Country and Poweshiek City — named less than a decade ago to reflect their relative skipperling populations. But now both felt like ghost towns. Nordmeyer, who has been deeply involved in efforts to boost wild Poweshiek populations in Michigan, wasn’t worried at first. He’d come to this place regularly since 2012 and he figured that maybe it was just a little early in the season. It had been a cold spring. Maybe the wild butterflies were delayed in emerging from their cocoons. Or maybe the day was just bad. It seemed hard to believe they were gone entirely.

But that’s the same hope researchers have been clinging to since the species started vanishing, more than 20 years ago. Back then, Robert Dana couldn’t believe it, either, when he first started hearing that Poweshieks were going missing on the Minnesota prairies. It was the scientific equivalent of rumors. A small survey here. A set of anecdotal reports from hobbyist bug lovers there. Dana, then an entomologist with the Minnesota Department of Natural Resources, didn’t buy it. It was like somebody saying the grass was gone. From the first time he’d ever seen a prairie as a graduate student, Poweshieks had been there. It wasn’t the biggest butterfly, or the showiest. It was humble but distinct. Beautiful in its own quiet way. A real Upper Midwesterner of an insect. 

Dana believed the Poweshieks must be OK in the early 2000s for the same reasons Nordmeyer hoped they’re going to be now: It’s hard to imagine a world without them. The Poweshieks once defined the Northern prairies, with a range that stretched down from Manitoba, across both Dakotas, Minnesota, Wisconsin, Michigan, and even south into Iowa, Illinois and Indiana. The butterfly’s name even comes from a county in Iowa and, by extension, from an early 19th century chief of the Meskwaki people. 

And while the years between Dana’s search and Nordmeyer’s have seen a massive retreat of Poweshiek territory, it remains difficult to know if any single bad year for the species is truly a step on the road to extinction. Poweshieks are small butterflies, compact and fast — they don’t really fly so much as manically hop across the landscape from flower to flower, a dark blur just above the top of the grass. They do not travel long distances in the single year that makes up an individual’s lifetime. The tiny caterpillars, nearly invisible on a bending stem, stay within a few centimeters of where they hatch, waiting out the winter beneath the snow. A typical flight for an adult is only a few meters at a time, and it may not leave an area bigger than a square mile before it dies. 

Their short lives and small individual home ranges mean that local populations have always fluctuated a lot from year to year, and it’s easy to lose a population in one small, specific location while a different population flourishes nearby. This is what Dana assumed was actually going on in Minnesota back in the early 2000s. People who were only looking in one place, one year, were just mistaking these local fluctuations for actual disappearances, he told himself. 

Yet Dana found a hollow stillness everywhere he went, like a room grown suddenly too silent. Across more than 50 locations, his 2006 search turned up exactly one butterfly. As the horror of what he was witnessing began to truly set in, he clung to that butterfly as a beacon. “I guess I felt some kind of relief that maybe it was still hanging on, maybe it was going to recover,” Dana said. It was the last Poweshiek he’d ever see in the wild. 

Nearly 20 years later in Michigan, Nordmeyer would come up with similarly grim statistics. There were no Poweshieks in Poweshiek City. There were almost no Poweshieks anywhere. After I left the prairie patches, Nordmeyer stayed on, and it became clear the absence wasn’t just a product of bad timing. But, like Dana before him, Nordmeyer wasn’t ready to give up. Instead, he contacted the federal officials in charge of endangered species management and came to an agreement — whatever few wild Poweshieks he found would be taken into captivity and mated with the butterflies he had raised by hand.

“Fish and Wildlife [Service] pretty much decided, ‘No, we think these things are safer with you guys than they are in the wild,’” Nordmeyer said.

PLAYING GOD

Today, Poweshiek skipperlings are ferried to adulthood in the backseat of a Subaru Outback. The ride from the Minnesota Zoo to Michigan is the culmination of their new, human-directed life cycle. They make the journey still wrapped in their cocoons, no longer caterpillars but not quite yet butterflies, each one attached to a small tuft of prairie dropseed growing from a plastic pot and wrapped in a protective tower of pantyhose-covered metal framing. Nordmeyer drives the Poweshieks to Michigan, where he sets up the pots like a miniature city of beige condominiums inside a collapsible picnic shelter on site. He calls it the “Poweshiek Party Tent.” 

As each cocoon opens, the butterfly that emerges is released into the wild. Two or three at a time, Nordmeyer marks their wings with an identifying dot from a colored Sharpie, loads them into test tubes and carries them out onto the prairie in a messenger bag. He lowers them carefully by the bristly end of a paintbrush onto the waiting petals of a black-eyed Susan, their favorite flower. Over the course of a couple of weeks in 2022, Nordmeyer and his colleagues released 102 butterflies and searched the grasses for pregnant females and already laid eggs to carry back to the zoo. The caterpillars that later hatched from those eggs went on to eat their way through their own potted prairie dropseeds. In the summer, they were loaded into special cooling boxes that can mimic the overnight temperature drops that no longer happen reliably in this part of the country. As the seasons turned, humans plucked the fat babies from the plants and packed them into plastic cups filled with clay. The cups are covered with paper towels and stored in a freezer, the analogue of a caterpillar buried beneath a thick snowpack. In the spring, they’ll go back on a dropseed, spin a cocoon and wait for their cross-country road trip in that Subaru — the new year’s butterfly crop.

Nordmeyer isn’t the only one working to save the Poweshiek. At the John Ball Zoo in Michigan, scientists have figured out how to breed Poweshieks right there in captivity, no need to drop them off in a field so they can find dates. In Manitoba, researchers are monitoring Poweshiek numbers and working to both figure out what kinds of habitats the butterflies prefer, and how to keep those habitats healthy and safe. 

Twenty years ago, when Dana first called Richard Westwood, a professor of biology at the University of Winnipeg, and asked him if he’d noticed anything odd about the Poweshieks in his area, Westwood’s response was “I don’t know. They’re always around right? We don’t really pay attention.” Today, they are a species Westwood and dozens of other scientists have spent years paying intense attention to. 

The Poweshieks’ transition from a species humans neglected to one whose life is now literally in our hands is a reflection of how we’ve approached insects, as a whole. For every charismatic megafauna gracing the cover of a magazine, there are literal armfuls of smaller creatures fading quietly into the night. Insects are threatened at a rate far exceeding that of mammals, birds and reptiles, with as much as 40 percent of all insect species potentially facing extinction in the next few decades. Butterflies are one of the most affected groups, but they weren’t a major focus of conservation science until recently. The International Union for the Conservation of Nature, the agency that evaluates the conservation status of species and helps determine which are threatened, has assessed the risks posed to 67 percent of vertebrate species but only 2 percent of invertebrates, as of 2019. 

Saving those species is an exercise in just how much control we can take over nature before we’re not only preserving it, but molding it. The people working to save the Poweshiek know they’re walking that tightrope. And they also know it’s not something that we have enough resources to do for every species that’s in danger of extinction. Choices will have to be made. 

That reality represents a big shift in the way both science and policy have thought about animal conservation, said Daniel Rohlf, a professor of wildlife law at Lewis & Clark Law School. There’s a can-do attitude that’s embedded into the law and regulations that govern how species are managed. The Endangered Species Act defines the very concept of “conservation” as doing whatever is necessary to ensure every listed species no longer needs the ESA. “The overwhelming attitude was, ‘Humans have kind of messed this up but we can fix it,’” Rohlf said. Species become endangered, but then humans come in, identify what went wrong, correct the problem, and help the species rebuild until eventually it stops needing our intervention.

There have definitely been some species for which that understanding of the world has worked. Melinda Morgan, director of the sustainability studies program at the University of New Mexico, pointed to the success we’ve had in saving the peregrine falcon. “Ban DDT and you’re great. Done,” she said, referring to the once-common, bird-killing pesticide. But the reality is that most endangered animals will not be large and iconic, with an easily identified threat that can be quickly eliminated with one weird trick, like in a clickbait ad. Most are insects, small and hard to find, easier to accidentally kill without thinking about it than to find and rescue. Most are suffering from a tangle of intertwined problems. For the Poweshiek, there are pesticides we won’t stop using, land we won’t stop developing and climate that won’t stop changing. If you resuscitate the species in a zoo, it may or may not have a wild habitat to return to. Most endangered animals are not the peregrine falcon. Most endangered animals are a mess. 

“There’s a level of overwhelm that comes with that,” Morgan said. “There’s a level of despair.” What do you do when a species you thought was fine turns out to be actually teetering on the brink of death? What do you do when you have to decide which species you’ll focus your grants and labs and manpower on, knowing there are others in just as dire straits? What do you do when you have basically become a minor deity to a species of butterfly that relies on you to guide its life across generations — and the damn thing won’t be fruitful and multiply?

This is the point where Morgan suggested I speak to a Buddhist philosopher.

UNCERTAIN HOPE

Three years ago, researchers from the Minnesota Zoo took one of the Poweshieks they’d painstakingly raised from birth, released it onto the Michigan prairie, and watched in frustration as a mint-green dragonfly, the size of a human palm, dropped out of the sky … and ate it. 

There are no guarantees in nature. Not even when everything is working the way it’s supposed to — maybe especially not then. The dragonfly, a common pondhawk, was also native to those swampy grasslands. “It sort of forced us to stop and think,” Nordmeyer said. “That's also a natural species, right? This is part of the natural order of things then, too.” 

This Far Side cartoon of a moment is where the hard science of keeping a species alive runs smack into philosophy. That’s where Joanna Macy comes in. Macy is a 93-year-old environmental activist and Buddhist scholar whose work focuses specifically on the kinds of challenges scientists face when they have to decide how far they’re willing to go to conserve a species like the Poweshiek skipperling. Her writing is dedicated to staring straight down the barrel of environmental failure and coming away with a heart that’s larger, rather than one that’s been blasted to bits. 

How do you do that? Well, consider the idea that the world is a bit like a tomato. In “Active Hope,” a 2012 book Macy wrote with psychologist Dr. Chris Johnstone, the tomato helps illustrate what human intervention in nature can often look like. If you squeeze a tomato too much, too hard — when humans alter our environment in unsustainable ways — we destroy it. You can’t unsqueeze a tomato, just like you can’t unmush the world we’ve damaged. If the chances of fixing the problem aren’t very high, then why not just stop trying to help altogether?

But the analogy doesn’t end with the world destroyed in a pasta-sauce apocalypse. Instead, Johnstone told me, every collapse carries the seeds of a future renewal. What grows will be a different tomato. You can’t get the old one back. But something can grow — if we take the seeds and plant them. 

And that’s … it. That’s the message. Somehow, that’s supposed to be uplifting? Buck up, little buttercup, and keep trying? It’s okay if that’s not enough for you. It wasn’t enough for me. But then I realized that, whether the scientists I was interviewing knew about Macy and Johnstone’s work or not, they had already come to rely on this perspective for their own sanity. They weren’t giving up because hope, for them, wasn’t dependent on the Poweshieks’ odds of survival. Instead, hope was an action to take. They wanted something good to happen, so they tried to make it so.

That’s why they could accept the risk of Poweshieks being eaten by natural predators — their efforts don’t need to be successful to be worthwhile. If the Michigan summer truly ended without any Poweshiek caterpillars clinging to the drying grasses — if the species is truly gone in the U.S. outside of captivity — it’s all still been worth it, said Anna Monfils, a professor of biology at Central Michigan University. That’s in part because the struggle is bigger than those prairie fens, and bigger than the Poweshieks. If the skipperlings died there this year, but live on in zoos and in Canada, maybe that can teach us something about what’s happening in this specific ecosystem and how it might affect the other animals that live there — the other butterflies, the dragonflies that eat them, or even the rattlesnakes hidden under the grass. “No loss is good,” she said. “But learning from that process is a better outcome than not learning.”

It matters that researchers can breed Poweshieks in captivity now, for example — not just for the Poweshieks, but for butterflies on the other side of the world who might benefit from the same techniques. And, as multiple scientists pointed out, the only way to really guarantee failure is to stop. 

Macy and Johnstone describe this as radical uncertainty, the realization that “we don’t know if this will work” goes both ways. It could mean a world where the only Poweshieks are stiff and pinned to cardboard, under glass, a memorial to themselves. But uncertainty can also mean scientists’ intervention works, putting the species in a good position to be successfully reintroduced somewhere else. It could mean a young scientist comes along who figures out how to ensure the prairies the Poweshieks once loved are safe for them again. It could mean, as Nordmeyer hoped, that we find “a new pocket of these butterflies that we didn't even know was in someone's backyard.” It isn’t naive to think things might not be as bad as they seem. And that interpretation provides a reason to do the work.

This winter, the community of scientists who have taken on that work will talk about the next steps to take with the Poweshiek now that the Michigan prairie fens are no longer a place the butterfly seems to thrive. Something will change. What that is, nobody knows yet. It’s possible they’ll stop trying to release Poweshieks in Michigan at all, and instead focus on breeding for a few years, working up the captive population so it’s large enough to try reintroduction at a different site. But it’s unlikely this is the end. There’s still too much to hope for. 

“When you get us all together in the room we can be extremely positive,” Westwood said. “It’s depressing. But I don’t see anybody here giving up. We won’t give up until it’s give-up time.” 

Because that’s the other thing that seemed truly important to these scientists: the fact that others were there, seeing the things they saw, carrying the burden with them. The ecologist Aldo Leopold once wrote that "one of the penalties of an ecological education is that one lives alone in a world of wounds." But that’s not how these researchers live. They’re part of a community that crosses borders and has spent years helping a tiny creature rebuild its own community. They may not succeed. But they won’t have been alone. And maybe that, by itself, can heal some wounds.  

2022 Election

So You Think You Can Explain The Election

By Maggie Koerth

Nov. 18, 2022, at 10:19 AM

The election is over. The results are (mostly) in. Time to decide what it all means.​ That’s a particularly popular activity in a year when Democrats pulled off something of an upset — their successes going against historical expectations and the popular narrative that suggested Republicans were set to sweep the House and Senate in the midterms.

How do we explain these results? Maybe it’s fallout from the Supreme Court overturning Roe v. Wade this summer. Maybe it’s extreme (or extremely silly) Republican candidates who snatched defeat from the jaws of victory. Maybe Democrats lost the House because they didn’t embrace Republican-led narratives about crime and punishment – or maybe they lost races because they did, and thus ceded ground. Maybe President Biden is just that beloved. 

This article is not going to tell you which singular answer is correct. That’s because there is no singular answer. I’m not a politics reporter, but the search for election explanations has led me to think about which ones I — a science reporter with an anthropology degree who spends my work days observing the political natives — trust more than others, even as I give all of them a little side-eye.

Politics, I’ve noticed, loves a just-so story. A clear, coherent reason why the zebra got his stripes. But that’s a form of storytelling that isn’t as concerned with scientific accuracy as it is with passing down culturally specific ideas about how people should behave. So what’s a person to do when they care about both? Here are the tips I keep in mind: 

• Don’t eat that hot take until dinner is done cooking 

In general, I’m going to be a lot more interested in the explanations that arise a month or two after Election Day than the ones that popped up the morning after. Trying to explain an outcome before anyone even fully knows what that outcome will be is kind of a dead giveaway that someone is post hoc ergo propter hawking a pet theory, rather than honestly searching for meaning. 

Granted, there are some factors that will make themselves clear before all the final counts are totally in. The Supreme Court’s decision, for example, likely did have an impact on this election. That’s a thing I’m willing to say just based on the fact that votes on abortion-related ballot measures in five different states all swung for the position endorsed by abortion-rights activists. That’s a fairly direct measure of how Americans are thinking and how that informs their votes — at least in those places. But that outcome wasn’t super obvious to all the pundits writing about the election before it happened. Leading up to the election, polls showed concern about abortion remaining relatively low compared to concern about the economy, and a lot of people’s narratives began to turn towards “maybe this just isn’t something Americans care about.” Getting an actual outcome certainly changed the perceived situation. And the more time goes on, the more data points will be collected that will help us understand how to answer questions about this issue and its place in American society — and what the right questions are, to begin with.

• Remember our friend, Occam’s razor 

Hey, didn’t some redistricting happen this year? And didn’t that process leave the country with six more Democratic-leaning seats than had previously existed? Occam’s razor is a principle that urges you to consider the simplest explanations for a result before you start trying to prove a more arcane, tangly hypothesis. And in that spirit, I’m gonna go out on a limb here and suggest that maybe how state governments have chosen to divide up their population — especially when that process is centered around partisan battles that each party hopes to win precisely because they hope it will bring them more power and control of election outcomes — has something to do with how the election played out. 

There are, for example, a lot of ways you could explain the Democratic Party’s losses in Florida. But anyone trying to explain that should probably start with the fact that the state has a new voting map that favors Republicans in a way it previously did not. That’s not to say that other factors aren’t involved. But I’m suspicious of any explanation of election outcomes that doesn’t start with election inputs, or at least acknowledge them. 

• The presence of data doesn’t necessarily mean the presence of truth 

Now, personally, I have no idea whether young voters are responsible for turning the mighty red wave into a pale pink splash. But I do think it’s interesting that people who believe the youth vote mattered in this election AND people who think it did not both have data to back up their assertions. Advocates can point to this being the second-highest youth midterm turnout in 30 years, with 63 percent of them voting Democratic. Detractors, on the other hand, have pointed out that the biggest predictor of whether a county’s voter turnout would decline this year was age — the younger the county, the less likely its residents were to go to the polls. 

Both those data points exist. How you interpret them probably depends on what you expected to happen and what you already believed about the American electorate. That’s a thing to watch out for. When I see dueling statistics, I know it’s time to take a pause. Just because someone can spout a statistic at you doesn’t mean they’re right. 

• Reality is usually messier than a just-so story 

Again, I’m not an expert on politics. But I can tell you that there’s not going to be one single factor that ends up explaining the results of an election. That’s especially true this election year, when states were seeing wildly different outcomes — Michigan going very blue while Florida went very red, for example. Even within states, we saw more split-ticket voting than some poll watchers had predicted. 

Kansas is a good example of how more than one factor can shape an outcome. The state voted against an anti-abotion ballot measure back in the summer and reelected its Democratic governor, Laura Kelly, in the midterms. It could be easy to look at that and assume that this was a state that “Roe’d the vote.” But while the Dobbs decision almost certainly did play a role in some election outcomes, it’s hard to say how much that affected Kelly’s win. She didn’t campaign on abortion. In fact, her anti-abortion opponent kept trying to bring up her abortion rights record — attacks that Kelly mostly responded to by changing the subject to things like education and the economy. And the same state that gave her a second term also elected Kris Kobach — the anti-abortion Republican she beat in the 2018 governor’s race — to be her attorney general. Some of this stuff is just going to be messy. Which brings me to my final point … 

• Our understanding of what Americans think is flawed, so our understanding of why they vote the way they do is complicated

The polls were pretty close to the actual election results this year, but we’re still dealing with human behavior here — something that the scientists who study human behavior are happy to admit is really, really complicated. Then you add to that all the legitimate criticisms and cautions that surround polling, not the least of which being extremely low response rates to traditional phone polls.

The big discussions around problems with polling are usually centered on how those problems affect polls of voter preference between one politician and another, or one party and another. But these ghosts haunt all opinion polls. What issues do voters care the most about? Do they favor one policy over another? How do they translate those concerns into votes? Those questions play a big role in how the media and punditry interpret the results of an election after the fact. But our answers to those questions are only as good as the polls and their biases.

In other words, any time you’re trying to explain what motivated votes after the fact, you have to assume there are details the polls got wrong and nuances they missed. As with vote choice, this reality doesn’t mean it’s time to ignore poll results entirely. But it does mean that one poll in isolation isn’t telling you as much as an aggregate. The biggest takeaway: Anyone who is certain they understand exactly why Americans make the choices they do is probably deluding themselves.

Abortion

As States Banned Abortion, Thousands More Americans Got Pills Online Anyway

By Maggie Koerth and Amelia Thomson-DeVeaux and Maggie Koerth and Amelia Thomson-DeVeaux

Nov. 1, 2022, at 11:25 AM

On Sunday, FiveThirtyEight published data showing that there were at least 10,000 fewer legal abortions in July and August than before the Supreme Court decision overturning Roe v. Wade. Those numbers — from #WeCount, a research project funded by the nonprofit Society of Family Planning, which supports abortion rights — provided a detailed, if incomplete, picture of how abortion has changed in the United States since the Dobbs decision in June. 

One key question was left unanswered, though: How many of the people unable to get a legal abortion got one another way? 

A new research paper released today begins to answer that question. It shows that Aid Access, an international abortion pill service that distributes medication abortion in places where it’s illegal, received a combined total of 6,533 more requests for pills from the United States in July and August 2022, with each month compared to an April 2022 baseline.³ Previous analysis of Aid Access data suggests that about 50 to 60 percent of requests result in completed abortions, which would mean at least an additional 3,267 abortions in July and August combined, compared to that April baseline. While this estimate is inexact, the increase demonstrates the role that self-managed abortion now plays in shaping abortion access in America.  

“Every time we’ve seen policy restricting abortion, we’ve seen increases in demand to Aid Access,” said Dr. Abigail Aiken, a professor of public affairs at the University of Texas at Austin and one of the co-authors on the study. “The evidence that we’ve seen shows us that when you ban or severely restrict abortion, you don’t do anything to change the need for abortion. But what you seem to do is change how and where people access care.”

Watch: https://abcnews.go.com/fivethirtyeight/video/voters-decide-future-abortion-rights-michigan-fivethirtyeight-92494272

Aid Access, the abortion provider at the heart of the study, was founded in 2018 by Dutch activist Dr. Rebecca Gomperts, who is also a co-author on the paper. Aid Access occupies a kind of legal gray area — in 2019, the Food and Drug Administration tried to stop the organization from shipping pills into the U.S., saying that Aid Access was violating federal law by distributing misbranded and unapproved drugs, but it was unsuccessful, and Gomperts has repeatedly said her organization follows the law. It’s a crime to self-manage an abortion in three states — Oklahoma, South Carolina and Nevada — and it’s against the law to prescribe abortion pills remotely in 19 states. It’s also illegal in many cases for Americans to import drugs from overseas for personal use. But these laws are difficult to enforce and individuals are rarely prosecuted, essentially creating a legal loophole for groups like Aid Access and the people who use their services. 

Because it has been offering its services to clients in the United States for several years, Aid Access has data that covers multiple phases in American abortion policy. The organization requires clients to fill out a form detailing their medical history and reason for requesting abortion pills, which is reviewed by a medical provider. If there are no medical red flags in that self-reported data, the organization sends the requester pills. 

After the constitutional right to abortion was overturned in June, Aid Access’s online request form blew up. According to the new paper, the number of weekly requests for abortion pills from Aid Access rose in a number of states, with the highest increases coming from people in states with full bans on abortion. For example, requests rose the most in Louisiana, Mississippi, Arkansas, Alabama and Oklahoma — all of which had implemented near-total bans on abortion by early July.⁴

In these states, some people may see an organization like Aid Access as their only option. Another paper published today by Ushma Upadhyay, a professor and public health social scientist at the University of California, San Francisco, found that in the aftermath of the Supreme Court ruling, an estimated one-third of reproductive-age women in the U.S. live in a census tract more than an hour from an abortion facility.⁵ For people living in Texas, estimated travel time to an abortion clinic rose by almost eight hours.

The availability of abortion pills — which, if taken during early pregnancy, result in a process very similar to an early miscarriage — has transformed the way abortion happens in the U.S.. Medication abortion was already growing in popularity, even before abortion rights appeared to be seriously threatened. A study published by the Guttmacher Institute earlier this year estimated that medication abortion accounted for more than half (54 percent) of abortions in 2020, up from 39 percent in 2017. The vast majority of U.S. abortions happen in the first trimester, which means abortion pills — which the FDA has approved for use through the 10th week of pregnancy — are an option for many patients. During the COVID-19 pandemic, a change in the way abortion pills are regulated allowed them to be prescribed legally through telehealth in some states. Since then, several online-only abortion services have popped up. These companies operate legally in the U.S. and can only mail pills to states where abortion is legal. They also offer virtual medical supervision in case of complications.

Medication abortion isn’t just used for legal abortions, though — it’s also a safe, hard-to-detect way to terminate a pregnancy outside the medical and legal system. In the era before Roe v. Wade, various methods of self-induced abortion often resulted in infection or other serious health problems. Now, though, it’s relatively easy for people to order abortion pills over the internet from services like Aid Access. 

Medication abortion is effective and low-risk — even when it’s used outside the clinical setting. A study published earlier this year of nearly 4,000 women who received abortion pills without an in-person visit found that 95 percent of the abortions were completed without the need for further medical intervention, and less than 1 percent resulted in serious complications. But it can also be intensely painful for some, and there’s no real way to know in advance what kind of experience any one person will have. Aiken said that hotline services for self-managed miscarriage and abortion can help people deal with that variability at home, but also said it was significant that the use of medication abortion and extralegal providers like Aid Access is increasing even in states where abortion remains legal. “There were a substantial portion of folks saying, ‘I’m making this request because I prefer the comfort and privacy of my own home,’” she said. “They have a choice, they could go to a clinic, they could do something else, but they’re actually choosing to self manage.”

Ultimately, pill providers like Aid Access represent a safe way of self-managing abortion — something that did not exist in the pre-Roe era. “So as long as the bans remain in place, I think we’re going to see those numbers remain stable, if not increase,” Aiken said.

Watch: https://abcnews.go.com/fivethirtyeight/video/voters-decide-future-abortion-rights-michigan-fivethirtyeight-92494272

Abortion

Overturning Roe Has Meant At Least 10,000 Fewer Legal Abortions

The same day the Supreme Court overturned Roe v. Wade in June, Alabama’s law banning abortion took effect. The next morning, phones began ringing in Georgia.

“We got nearly 100 calls the day after the Dobbs decision from patients in Alabama,” said Kwajelyn Jackson, executive director of the Feminist Women’s Health Center in Atlanta. In states where abortion remains at least partially legal the phones haven’t stopped ringing.

Since June, thousands of Americans have crossed state lines seeking abortion, like a pressure wave spreading out from a blast zone. A data set shared exclusively with FiveThirtyEight shows that in the two months after the Supreme Court decision, there were 10,670 fewer abortions as compared to pre-Dobbs estimates. That figure is a net, counting both declines in some states and increases in others, and it shows how a few states are absorbing some — but not all — of the demand for abortions in states where it’s now banned.

The results suggest that in July and August, there were more than 10,000 people who “felt they had no options,” said Ushma Upadhyay, a professor and public health social scientist at the University of California, San Francisco. Along with Dr. Alison Norris, a professor of epidemiology at the Ohio State University, she co-chairs #WeCount, a national research project led by the Society of Family Planning, a nonprofit that supports research on abortion and contraception. “They couldn't travel, and they had to figure out what else to do,” Upadhyay said.

Data compiled by #WeCount is designed to capture state-level information on abortion access in the wake of the Dobbs decision. This first data release compares the number of legal abortions — including surgical and medication abortions — in each month from April to August 2022, showing how the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June has reshaped the abortion landscape.

That topline number conceals an enormous amount of fluctuation between states. In all states that saw declines in their abortion numbers — which include the 15 states in which abortion was banned or severely limited over the summer — the number of abortions fell by about 22,000.⁶ Some of those women appear to have traveled out of state, because in other states, the number of abortions rose by an aggregate of about 12,000. 

But nationwide, the movement of abortions from states with bans and restrictions to those with fewer restrictions on access wasn’t enough to make up the shortfall. Between April and August, the number of abortions declined by 6 percent, and it’s likely that the decline in abortions represents thousands of women who sought abortions illegally or didn’t get one at all. If these trends persist, there could be at least 60,000 fewer abortions in the next year as a result of the Dobbs decision.

Even before the Dobbs ruling, getting an abortion was often an arduous, time-consuming and expensive process — particularly in Southern and Midwestern states that passed hundreds of restrictions on abortion in the past decade. In 2018, researchers at UCSF identified 27 “abortion deserts” — cities with populations of more than 50,000 where the nearest abortion clinic was more than 100 miles away. Those preexisting reductions in access mean, Norris said, that their data shows a “decline from a very diminished place already.”

The Supreme Court’s decision, though, turned entire regions of the country into abortion deserts. By the end of August, 11 states had banned abortion completely and four more had restricted it early in the first trimester.⁷ According to the Guttmacher Institute, at least 66 clinics closed between the Dobbs decision and the end of October.

The #WeCount data suggests that thousands of Americans traveled long distances to obtain abortions in July and August. In just those 15 states where abortion was either banned or became illegal after six weeks in the wake of Dobbs, there was a reduction of approximately 21,000 abortions relative to April and May. In some states with total bans, like Alabama and Mississippi, the number of abortions fell to zero in July; in others, the numbers were drastically reduced but clinics were able to serve reduced numbers of patients due to court orders or slightly less stringent restrictions. Clustered together across the South and Upper Midwest, these states formed blocs where obtaining an abortion required leaving the region, rather than crossing a single border.⁸

Watch: https://abcnews.go.com/fivethirtyeight/video/voters-decide-future-abortion-rights-michigan-fivethirtyeight-92494272

That trend began nearly a year earlier, after the Supreme Court allowed Texas to enforce a ban on abortion after about six weeks of pregnancy in September 2021. Patients from Texas are now regularly seen in clinics as far away as Minnesota, and clinics in the lower Plains states began to see a domino effect in appointment scheduling. “Texas was going to Oklahoma and then Oklahoma started coming to us,” said Ashley Brink, director of the Trust Women clinic in Wichita, Kansas. After Oklahoma banned abortion in May, a full month before the Dobbs ruling, Brink said that her clinic ended up with more than 50 percent of the patients coming from out of state. 

This kind of pattern has drastically increased wait times nationwide, especially in states — like Kansas — that have picked up the spillover from neighboring states that banned abortion. Caitlin Myers, an economics professor at Middlebury College who studies abortion, has since March been monitoring wait times at clinics in states where abortion remained legal. She found that by early August, only two of Kansas’s five abortion clinics were scheduling appointments, and the first available times were eight and 13 weekdays away.⁹ That month, the median wait time in Colorado and New Mexico was over two weeks. Waits for appointments at abortion clinics in southern Illinois were also higher than they were earlier in the summer. In August, 74 percent of patients at Planned Parenthood’s clinic in Asheville, North Carolina, came from outside the state, and the average wait time for a medication abortion was three weeks, according to a recent legal filing.

“Someone who lives three minutes, three miles from our clinic, is struggling to get an appointment and is now getting displaced to Colorado or Illinois,” Brink said. Travel comes with a different set of difficulties: A Texas study conducted in the aftermath of the state’s six-week ban found that some women who left the state delayed rent or bills to cover the cost, or were even fired because of their extended time away from work. And some states, like Kansas and Pennsylvania, still require prospective abortion patients to comply with waiting periods and other logistical hurdles. 

A likely consequence of longer wait times and travel distances is more abortions later in pregnancy. The Centers for Disease Control and Prevention estimate that only 7.7 percent of all abortions happen between the 14th and 20th week of pregnancy. But between 20 and 30 percent of current patients are in the second trimester at Whole Woman's Health of Minnesota, a clinic located in a state where abortion is legal until the point of fetal viability around 25 weeks, according to Sean Mehl, Whole Woman's assistant director of clinical services.

Despite the traffic jams backing up service in clinics, the #WeCount data shows that the number of abortions nationwide did briefly increase in the weeks before the Dobbs ruling, as clinics across the country crammed patients into their schedules, accomodating as many as possible while abortion remained legal nationwide. Although abortion rates usually dip a bit during the summer, the number of abortions this year rose 4 percent from May to June. 

In Georgia, where there was no trigger law but where restrictions were almost certainly imminent, clinics kept up that pace after Dobbs for as long as they could. According to the #WeCount data, abortions in Georgia declined only 6 percent from June to July, despite the fact that a federal court allowed the state’s six-week abortion ban to go into effect on July 20. The number of abortions dropped by more than 50 percent from July to August. 

Where abortion remains legal, some abortion providers have been able to increase capacity. Staffing wasn’t an issue for Whole Woman’s Health in Minnesota or Trust Women in Kansas — by the summer, they were flying in doctors from across the country to fill in their schedules, with more people reaching out to see if they could volunteer. “Since Dobbs, our Minnesota clinic has seen about a 50 percent increase in overall patients,” Mehl said. Virtual abortion providers, which can prescribe abortion pills online in the states where it’s legal to do so, also ramped up their medication abortion services. The #WeCount researchers found that the number of abortions offered through online-only clinics — not counting telehealth abortions offered through brick-and-mortar facilities — increased by 33 percent between April and August.

Some women may also be getting abortions without any clinic or doctor being involved — although those numbers are hard to track. The #WeCount data counts only legal abortions, which means it’s almost certainly underestimating the total number. Even before Dobbs, activist groups and online pharmacies were providing abortion pills directly to consumers through the mail. By July, Mexican activists were already reporting that they were inundated with requests for abortion pills from women all over the U.S.

But it’s also likely that some people who might have gotten an abortion in the pre-Dobbs era are simply carrying their pregnancies to term. And while that is a victory for anti-abortion advocates, the #WeCount researchers noted that there is substantial evidence that being denied a wanted abortion puts people at an increased risk of poverty, physical abuse and certain health problems. They’re also keeping an eye on whether maternal and infant mortality will increase in states with abortion bans — particularly since those states tend to have higher-than-average rates of deaths from pregnancy complications.

And Norris said it’s possible that out-of-state travel might get more difficult as time goes by. Abortion funds raised millions of dollars in the aftermath of Dobbs, which may have made it more possible for women to travel than it was in the past. But over time, volunteers’ enthusiasm or financial support to organizations like abortion funds might start to ebb. “We don’t know if it’s sustainable,” Norris said. And with more states poised to implement abortion bans in the next few months, the numbers from this report are just an early signal of a future where abortions could be even more scarce.

UPDATE (Nov. 1, 12:23 p.m.): After publication, #WeCount updated its topline estimate for the change in how many people were able to obtain abortion care in the two months following the overturning of Roe v. Wade. The number is now 10,670, not 10,570, after the organization accounted for rounding in state-level estimates.

Watch: https://abcnews.go.com/fivethirtyeight/video/arizonas-abortion-laws-back-1800s-fivethirtyeight-92215336

2022 Election

Can Focusing On Climate Change Help Win Elections?

By Maggie Koerth

Oct. 17, 2022, at 6:00 AM

“Our generation grew up watching as the climate crisis got worse and worse and politicians did nothing.” That might sound like a quote from teen climate activist Greta Thunberg, but it’s actually the opening line for a new series of political ads appearing in multiple states in the lead-up to the 2022 midterms — ads that the advocacy groups Climate Power Action and the League of Conservation Voters are hoping will tip the scales towards climate-focused Democrats.

Historically, however, climate change has not been much of a political kingmaker. Even when candidates trusted that their constituents did care deeply about the environment, it hasn’t been something that reliably changed votes. In the 2020 presidential election, for example, two-thirds of voters told exit pollster Edison Research that climate change was a “serious problem” — but 29 percent of that same group voted for then-President Donald Trump, a candidate whose position on climate change was … inconsistent … at best. 

So a $12 million ad campaign aimed specifically at promoting Democratic candidates’ climate change bona fides seems, at first glance, like a fool’s errand. But even though the content of these ads makes it clear they’re meant for a narrow audience — young voters, who see themselves as part of a generation bearing the consequences of inaction on climate change — the ads aren’t even for all of them. Instead, the groups funding these ads are trying to reach a specific sliver of a slice of a subset of young voters. And yet there’s reason to think that, on those slender margins, climate change could be becoming an issue that really sways elections.

One thing definitely working in favor of climate change as a voting issue this year is the existence of actual legislative change on climate, said Anthony Leiserowitz, director of the Yale Program on Climate Change Communication. Attempts to reach out to voters on climate issues are happening in context with the passage of the Inflation Reduction Act, President Biden’s spending bill that includes a number of tax breaks, new regulations, financing and incentives focused on reducing the country’s carbon emissions over the long term.

Watch: https://abcnews.go.com/fivethirtyeight/video/oregon-elect-republican-governor-fivethirtyeight-91521213

The passage of that bill is genuinely a big deal, Leiserowitz said. Outside of that, “there has been little to no major national action on climate change. And I’ve been doing this for 30 years,” he told me. 

The passage of the IRA is in keeping with what voters say they want. A large majority of Democratic voters think the Biden administration and Congress need to be doing more to deal with climate change — 82 percent according to a Pew Research Center survey from May. And that same report found that 58 percent of all Americans felt that the federal government wasn’t doing enough to combat climate change. Given results like that, it would be easy to assume that the passage of a federal bill finally addressing climate would be something that could really motivate voters — at least the liberal-leaning ones.

But the relationship between voters and climate policy has long fallen under the label of “it’s complicated.” There is an established gap between what voters say they want — action on climate change — and what they’re willing to do to achieve that. In 2019, for example, polling by Reuters and Ipsos found that while 69 percent of Americans wanted the government to take “aggressive” action on climate change, only 42 percent were likely to install solar panels on their own home; 38 percent were likely to begin carpooling to reduce emissions; and just 34 percent were likely to pay an extra $100 a year in taxes to support climate policies. And in 13 years of YouGov polls tracking which issues registered voters see as the most important, climate change has consistently taken a back seat to economic issues like jobs and inflation. As of Oct. 10, 12 percent of voters listed climate change and the environment as their No. 1 concern, while 22 percent cited inflation and high prices. It’s not that emphasizing climate change is a turn-off for voters — President Biden got a solid B+ on Greenpeace’s 2020 election Climate Scorecard. But neither is climate an issue that seems to attract voters on its own. Having the highest score on the Greenpeace scorecard during his candidacy was not enough to catapult Washington’s Democratic governor, Jay Inslee, to the White House.

That history is probably why ads touting climate change policy have been relatively rare this campaign cycle. Of the nearly 350 ad campaigns the University of Virginia’s Center for Politics is tracking in this midterm election, abortion and crime have been the primary issues at play, to the point that the center’s most recent analysis doesn’t even mention climate. Even in the month of September, after the passage of the IRA, ads focused on energy and the environment were still playing third fiddle to other issues like crime and inflation, according to data from the Wesleyan Media Project, which documents details of political advertising. The project found that 15 percent of nationwide political ads in September were focused on energy and environmental issues (which could include climate change), compared to 26 percent of ads focused on public safety and 19 percent on inflation. Even among the ads created by the LCV, some aren’t about climate change or the IRA, specifically — instead talking more broadly about how a specific candidate fits with the Democratic platform. 

But the main goal of the LCV’s ad campaign appears to be persuading people to vote for a candidate because that person has gotten climate policy done — something that’s presented in the ads as a bit of a surprise, a “can you believe they actually did it?” moment. Years of research have shown that the persuasion effects created by advertising — whether political or otherwise — do not last very long, and they are very small, capable of maybe creating a percentage-point difference in swing, said Lynn Vavreck, a professor of politics and public policy at the University of California, Los Angeles. “But don’t confuse small in size with not being pivotal,” she said. 

That’s because while the voting public as a whole has this messy situationship with climate change, there’s a segment of Democratic-leaning voters for whom it is increasingly the real deal. Young and left-leaning voters were most likely to rank climate change as their No. 1 issue in the most recent YouGov poll from Oct. 10. Eighteen percent of voters under 30 and 19 percent of Democrats said it’s the most important issue facing the U.S., compared to 11 percent of voters 65 and older, and just 2 percent of Republicans. And in the ongoing FiveThirtyEight/Ipsos panel survey conducted between April and September using Ipsos’s KnowledgePanel, as much as 36 percent of Democrats named climate change as one of the country’s top issues.¹⁰

Watch: https://abcnews.go.com/fivethirtyeight/video/races-bringing-democrats-odds-holding-senate-fivethirtyeight-91476350

Young people have the strongest beliefs about the reality of climate change and the need to take action on it, said Charlotte Hill, a professor of political science at the University of California, Berkeley. That trend is so strong that it even crosses party lines: Forty-seven percent of voting-age Republicans under 30 told Pew in May that the government was doing too little to combat climate change, compared to just 18 percent of Republicans 65 and older. But young (and particularly young, left-leaning) voters are such good targets for these ads because they are also the age group least likely to turn out for a midterm election. And “it’s also pretty consistent that the top reason that young people cite for not voting is not liking the candidates or the issues,” Hill said.

Targeting the people who care the most about climate change, and are the least likely to just go out and vote on their own, with ads that tell them politicians are actually acting on their desires can produce the kind of small differences that tip the scales in some elections, Hill and Vavreck said. 

But the LCV campaign took this one step further, by targeting ads at 2 million specific voters who live in the districts where that tiny margin of change will matter the most, including seven states where the statewide Senate race is a tight one — Arizona, Colorado, Georgia, New Hampshire, Nevada, Pennsylvania and Wisconsin. The model is based off of similar microtargeting work from the 2020 presidential election, when the goal was to persuade undecided voters who cared a lot about climate issues to cast their ballot in favor of Biden, said Pete Maysmith, senior vice president of campaigns at LCV. Those voters approved of Trump more than Biden, but the targeted ads seem to have convinced at least a portion of them to vote Democrat. Based on post-election surveys and a controlled experiment, LCV believes they increased Biden’s vote margin by 5.6 percentage points, relative to the control population. 

Nobody knows yet how big a difference the group will be able to make with this latest round of micro-targeted ads. But evidence suggests that small can be big, and that fact changes the stakes on climate change advertising. 

At the time of this recording, 62 deaths have been recorded as a result of Hurricane Ian, and that number is expected to rise. Natural disasters — particularly hurricanes — have long shaped public perception of both politicians and climate policy. In this installment of the FiveThirtyEight Politics podcast, the crew breaks down how the handling of Hurricane Ian could reflect on Florida Gov. Ron DeSantis and how climate change policy has become more popular among Americans impacted by destructive weather events.

The team is also joined by Tia Mitchell, The Atlanta Journal-Constitution’s Washington correspondent, to discuss a listener question that goes beyond the midterm forecast model: Could President Biden really enact more of his policy agenda if just two more Democratic senators were elected?

Lastly, they analyze why Minority Leader Mitch McConnell is backing the new Electoral Count Reform Act and when the new bill will be voted on in the Senate.

You can listen to the episode by clicking the “play” button in the audio player above or by downloading it in iTunes, the ESPN App or your favorite podcast platform. If you are new to podcasts, learn how to listen.

The FiveThirtyEight Politics podcast is recorded Mondays and Thursdays. Help new listeners discover the show by leaving us a rating and review on iTunes. Have a comment, question or suggestion for “good polling vs. bad polling”? Get in touch by email, on Twitter or in the comments.

Hurricanes

How Natural Disasters Can Change A Politician

By Maggie Koerth

Sep. 30, 2022, at 2:36 PM

In September 2017, Hurricane Irma swept across the southern tip of Florida, swamping what was then the state’s 26th Congressional District. The following July, that district’s Republican representative, Carlos Curbelo, introduced a bill that would tax greenhouse-gas emissions to help reduce the impact of climate change on his hurricane-prone constituency. Curbelo’s party affiliation raised eyebrows at the time, but for him, the threat of recurrent disasters sent political partisanship out the window. “This is not an academic discussion for those of us who live in South Florida. This is a local issue,” he told Audubon magazine in 2018.

And he’s not alone. Today, although some one-quarter of elected officials walking the halls of Congress don’t believe human-caused climate change is even real, research suggests that politicians can be persuaded to take action on climate change and other environmental issues. Unfortunately, it might take a headline-grabbing hurricane to do it. In the past decade, several studies have suggested that lawmakers are more likely to take action on climate change when they — and their constituents — have had to deal with the disastrous consequences of previously doing nothing. 

From the 1969 Cuyahoga River fire that led to the creation of the Environmental Protection Agency to the 1990 Oil Pollution Act that was born out of a series of oil spills, most notably from the Exxon Valdez, a long history of environmental disasters have inspired improvements in environmental policy, said M. Daniele Paserman, an economist at Boston University. 

“Disasters make environmental problems more salient,” he said. Paserman’s research has found that, between 1989 and 2014, congresspeople from districts hit by a hurricane were more likely to sponsor or co-sponsor environmental regulatory bills in the following year. And he’s not the only one who has noticed similar correlations. According to another study, which looked at abnormal temperature and precipitation trends between 2004 and 2011, members of Congress whose home states were experiencing weird weather were more likely to vote for all kinds of environmental legislation. More broadly, international research from 34 countries found that nuclear disasters increased the number of renewable-energy policies implemented for as long as seven years after the event. 

This line of research is relatively new and the number of studies relatively thin. But all of this builds on a larger question that has been studied more in depth: how personally experiencing the effects of climate change shape belief and behavior in the general public. 

A 2021 review of existing literature discovered ample evidence that living through a natural disaster is associated with higher levels of self-reported belief that climate change is a problem and a greater concern about what this might do to you and your family. Our own polling with Ipsos earlier this month showed something similar. Even among Republicans, nearly half of those who had experienced an extreme weather event in the past five years told us they were worried about climate change, compared with only 17 percent who hadn’t experienced a natural disaster.

But there are limits to the ability of a disaster to prevent future calamities. For one thing, the same review paper that showed increased belief in climate change didn’t find a corresponding increase in behaviors that would deal with that issue. And changes in belief are still heavily moderated by what people already think. For example, in a 2019 survey of people who experienced severe flooding in the United Kingdom during the winter of 2013-14, the ones who walked away with the highest levels of concern about climate change were those who had already attributed floods to global warming. 

So, it probably shouldn’t be a shock that the much smaller number of papers looking at how politicians might change their behavior in the face of climate change comes with its own set of caveats and complications. Studies have indicated that only countries with strong democracies see an increase in climate policy following climate disasters. And Paserman’s study found that the effects were tightly linked to proximity to the disaster. Even lawmakers who served in the same state where a hurricane occurred but whose districts were unaffected weren’t as likely to step up for political change. 

And while that paper found that politicians who experienced climate disasters were more likely to push for climate policies regardless of party, a different study — the one that showed abnormal temperature and precipitation trends were correlated with representatives’ environmental votes — found that party did matter. Moderate Democrats made the biggest shift toward more environmental-policy support, said Erich Muehlegger, an economist at the University of California, Davis, and an author on that paper. “We didn’t find much of a result for Republicans, nor did we find much of a result for the more strident Democrats, though that might be due to the fact that they were always voting for environmental regulations,” he said. “You can’t become more pro-environment if you were already on top of all those issues.” 

It’s going to take a lot more research to fully understand why politicians sometimes change their policy in the face of climate disaster and sometimes don’t. Meanwhile, just because lawmakers are responding to natural disasters with environmental votes doesn’t mean they aren’t seeing other, seedier kinds of legislative opportunities from the same event. Ethan Kaplan, an economist at University of Maryland, College Park, and his colleagues found that politicians are likely to use the immediate aftermath of a natural disaster to push through votes favoring the concerns of special-interest donors when nobody is paying attention. That’s not a contradiction to the idea that disaster could prompt politicians to take action on climate change. Instead, Kaplan said, the two things can run parallel. A disaster can create a distraction for donors’ goals in the short term, even as it prompts greater environmental policies in the long run. 

Monkeypox

Why Monkeypox Wasn’t Another COVID-19

Thanks to public health and a little luck, this disease didn’t become a pandemic.

By Maggie Koerth

Sep. 14, 2022, at 6:00 AM

When you’ve lived through two-plus years of a pandemic, it can feel weird to see “disease” and “good news” in the same sentence. But here we are, watching a disease decline, with cautious optimism. Two weeks ago, the World Health Organization announced that monkeypox cases in Europe had fallen so fast, the outbreak could be eliminated there. And while the U.S. recently experienced its first monkeypox death, cases here have fallen by 40 percent between the middle and end of August. In other words, it’s too early to declare victory and dust off our hands, but the situation is generally improving.

This news shows that public health officials — and the public itself — got some important stuff right in combating this serious illness. But monkeypox is also a reminder that humans will encounter many potentially dangerous new diseases. COVID wasn’t the first, or the last. What stops most diseases from becoming pandemics is as much about luck as it is about human intervention.

This spring, many of us braced ourselves for the worst. Monkeypox seemed mysterious, and cases of it were soaring. But a positive outcome was not surprising to the scientists who study the disease. “One of the difficulties I’ve faced in public communication is trying to get people to understand that none of us who work in public health thought the sky was going to be falling from monkeypox,” said Jay Varma, a professor of population health sciences at Weill Cornell Medical College. “We were just concerned that a lot of people were going to suffer needlessly … because we had a diagnostic test, a drug to treat this and a vaccine to prevent it all stockpiled.” Monkeypox was, in other words, a serious disease that needed attention to make sure vulnerable groups were protected, but it was never likely to become the same kind of massive problem as COVID-19. 

In August, scientists surveyed more than 800 men who have sex with men, trying to find out how monkeypox — and the education campaigns surrounding it — had affected their lives. According to results published by the Centers for Disease Control and Prevention, about half of the men made some important changes to their behavior. Of the 824 surveyed, 48 percent reported reducing their overall number of sex partners, 50 percent said they had reduced their one-time sexual encounters and 50 percent said they had reduced sex with people they met on dating apps and in sex clubs. Those voluntary behavioral changes as well as the public health campaigns that inspired them have been particularly crucial to curbing monkeypox, said Varma and Rodney Rohde, a professor of clinical laboratory science at Texas State University. 

That’s because other studies have shown that while one-night stands account for only a fraction of sex happening daily among men who have sex with men — about 3 percent of daily sexual relationships — those interactions are responsible for about half of daily monkeypox transmissions. 

Vaccination campaigns have also been important, but the behavioral changes seem to be more widespread in the high-risk community than vaccination has been, Varma said. “The original guidance from the CDC has been refreshingly frank and honest and transparent about what are the behaviors that put people at highest risk and what are the ways in which you can minimize your risk, without questioning whether sex is an essential activity to life,” he said.

But had the monkeypox outbreak happened just a few years ago, it might not have been on the radar of anyone outside the most affected communities. Dr. Sonja Rasmussen, a Johns Hopkins University professor of genetic medicine who worked at the CDC for 20 years, remembers a former director at the agency often saying that when public health did its job well, we never heard about it.

New diseases are popping up and entering the U.S. all the time, according to Rasmussen and the other experts I spoke with. But SARS-CoV-2 aside, most of them are swiftly and effectively shut down by the hard work of public health. “Remember that MERS outbreak … when there were two cases in the U.S.?” she asked, referring to the time in May 2014 when a particularly deadly cousin of COVID cropped up in unlinked cases in Indiana and Florida. “People would say, ‘I don’t even remember that.’ And … that’s because we dealt with it.” 

We’re more likely to hear about these diseases now because everyone is much more primed to pay attention after a couple of years of COVID. But the reality is that thousands of people nationwide are working to ensure those diseases don’t spread unnoticed, that the highest-risk populations are treated, and that we don’t end up constantly marinating in preventable pandemics. That’s the good news. 

The bad news: Not every pandemic is a preventable one. “We did get a little lucky [with monkeypox],” Rohde said. Yes, there’s pain involved and some risk of death, but if and when this disease is nipped in the bud, that will be in part because the virus makes itself relatively easy to prune. It’s not a respiratory virus that people can easily spread to strangers at the bus stop. The mode of transmission, primarily through sex, limits who can spread to whom. The transmission rate is also different from that of COVID, he said. And the mode of transmission means the virus affects primarily a high-risk group rather than all of society, so it’s easier to change behavior and administer pharmaceutical treatments. Monkeypox is also a DNA virus, not an RNA virus like SARS-CoV-2, so it mutates less than COVID and can be prevented with older, existing vaccines. Those are the kinds of outbreaks humans can stop from turning into pandemics. Of course, both scientists and the public have to take action when they pop up, but it’s relatively easy to manage. 

Most new or new-to-us diseases that appear will have more in common with monkeypox than with COVID. They’ll be dealt with. And you’ll forget you ever saw them on the news. But, eventually, another pathogen will come along that’s more challenging just by its nature – another fast-spreading, fast-mutating respiratory virus that hits everybody all at once. “I am concerned as we move away from COVID that we’re going to say, ‘That’s our pandemic. We don’t need to fund [public health infrastructure] anymore,’” Rasmussen said. 

Unfortunately, one of the biggest takeaways from this monkeypox outbreak and how it was handled is a paradox. You don’t need to assume that every new disease you hear about will be another uncontrollable pandemic, so you can let that tension go. But, at the same time, that doesn’t mean another pandemic won’t happen in your lifetime. Somebody needs to be on the job, paying attention. 

“It doesn’t matter if you’re tired, if you’re fatigued, if you’re done with it,” Rohde said. “Those [infectious diseases] don’t care. They never get tired.” 

Monkeypox

Who Should Get Tested For A New Disease?

Monkeypox shows how hard it is to answer that question.

By Maggie Koerth

Aug. 24, 2022, at 6:00 AM

Between May 6 and July 20, doctors in the United Kingdom confirmed 2,162 cases of monkeypox. Ninety-nine percent of those cases were men.¹¹ That could be most reflective of who is contracting the virus. But it could also be partly because 80 percent of the people tested were men.

Public health officials have emphasized that the monkeypox outbreak is largely affecting men who have sex with men. That’s not incorrect. But there’s a side effect of that kind of framing: People who don’t fit into that category may think they can’t get monkeypox, might be afraid of what others will think of them if they contract it, or may even have trouble convincing a doctor to test them — even if they have symptoms of the disease. “You’ll never find [a disease] in a population you don’t test,” said Thomas Holland, a professor of infectious diseases at Duke University, who also sees patients at the University’s hospital.

This problem hampered U.S. public health officials during the initial stages of the COVID-19 pandemic, when tests for the illness were unavailable unless you’d recently traveled abroad, and the virus spread unchecked through communities believed to be uninfected. We know how that turned out.

Deciding who to test for a new — or newly ascendant — illness is a challenging paradox. Limiting testing isn’t always a bad idea and can even be necessary because of a lack of resources. But, sometimes, it is a bad idea. And it’s not always clear which side of that line you’re on until it’s too late. 

When medical experts are faced with deciding which patients should be tested for a new, scary illness, they have to ask themselves, “Is this gonna be more like Ebola, or more like COVID-19?” 

In 2014, when Ebola made a brief landfall in North America, and in the first months of 2020, when COVID-19 was brand new in the U.S., tests for either disease were a limited resource. In both cases, the public health community kept a tight rein on who could get tested. It took more than a fever and chills, said Brittany Kmush, a professor of public health at Syracuse University, since the symptoms of both diseases overlapped with other more benign illnesses. To be tested for either, patients needed an epidemiological connection to them — in particular, having recently visited countries where they were already known to exist.

“That worked pretty well for the Ebola outbreak,” Kmush told me. The protocol kept hospitals from being overwhelmed, caught the cases that truly needed isolating, and no significant spread went undetected. But the same wasn’t true with COVID-19. “I think with COVID, we really learned a lesson that we don’t always know what is going on,” she said.

But broad, open testing isn’t always the right choice. That did turn out to be necessary with COVID-19, Holland said, but early on there were a number of factors that made the strategy unworkable. Infamously, both tests and processing equipment were in short supply at the time, and getting results could take a week. In the meantime, he said, people waiting for results were kept at the hospital in isolation units visited only by staff wearing protective coverings and masks, which were themselves a limited resource.

Lots of hospital patients had symptoms that could have been COVID-19, he said. But, at that early stage, statistically speaking, Holland knew most of them didn’t have it. There was real danger in treating all those people as potential COVID-19 cases, not just the stress of unnecessary isolation and using up limited hospital space, but also from failing to diagnose what, if not COVID-19, was actually wrong with them.

“It was how I spent my days,” he said, deciding who got a COVID-19 test and who did not. “Those were some of the hardest conversations I’ve ever had professionally.”

But Holland and other experts I spoke also with see problems with how access to monkeypox testing has been restricted. Testing capacity for this new disease was limited early in the spring and summer, but it isn’t now, said Sandra Kemmerly, an infectious disease specialist in the New Orleans-based Ochsner Health System. And while monkeypox occurs primarily in men who have sex with men right now, it’s perfectly capable of infecting people outside that demographic.

The Centers for Disease Control and Prevention’s criteria for a probable monkeypox case includes having known contact with other monkeypox cases, being in contact with a community where it’s spreading (like men who have sex with men), or having recently traveled to a country where monkeypox is spreading. However, Kemmerly said the Ochsner Health System is encouraging doctors to expand their idea of who might be a potential case — to test based on symptoms rather than on contact with a high-risk community.

“One thing that’s been taught to us through HIV and repeated in COVID is if you have very narrow criteria for testing you’ll miss cases,” Kemmerly said. On the other hand, Holland said, wider testing needs to be balanced with the potential for false positives and the risk of informing someone that they have a disease that’s been heavily stigmatized when they actually don’t. 

The good news is that doctors say they’ve learned some lessons from past pandemics. For example, the experience of COVID-19 seems to have taught the public health community the importance of producing more tests and quickly enabling more places to process them. Kemmerly was impressed with how quickly the CDC made partnerships with commercial labs and increased testing capacity on monkeypox. 

Holland also found it important that testing for monkeypox has been expanded to a wider variety of medical facilities people are likely to already frequent — like dermatologists and sexual health clinics. 

And the COVID-19 experience has also made wastewater testing for communicable diseases something more local public health systems have familiarity with and infrastructure for, Kmush said. (Some areas of California are already using it to test for monkeypox.) That would really help because even if men continue to make up the bulk of individual test-takers, wastewater can help determine whether the virus has spread further.

But maybe the most important lesson for the future, Kemmerly said, is that you can’t just pick one position — test broadly or test narrowly — and expect to stick with that for the long haul. “As new diseases emerge and different modes of transmission become more common, we have to be ready to more rapidly reevaluate our criteria for testing,” she said. When all the options are imperfect, the worst thing you can do is refuse to change. 

Climate Change

Why The Same Temperature Can Feel Different Somewhere Else

By Maggie Koerth

Aug. 5, 2022, at 9:56 AM

In much of the United States, the high 80s in Fahrenheit is hot, but it’s not hot-hot. It could even be a day of sweet relief in the South, maybe time for a family picnic. But last month, across the United Kingdom, headlines warned of temperatures that could hit 31 degrees Celsius. When Americans found out that translated to 88 degrees Fahrenheit, they quickly concluded: “Europeans are weak.” And while temperatures in Europe kept going up, eventually hitting levels even Texans would find daunting and killing thousands of people across the continent, the question of how a temperature could mean serious danger in one place while being an average summer Saturday in another remained. 

The temperature may be an objective number, but how we experience it is not. Culture influences the biology and psychology of thermal comfort, shaping what our bodies are used to dealing with and how our homes and businesses are set up to adapt. In fact, the very numbers of thermal comfort aren’t even universal. There are dozens of ways to measure what a hot summer day actually feels like; different countries do it differently, and how you measure affects how we communicate and understand risk.

What’s more, the climate is changing faster than our cultural and subjective experience of it. So if you’re ever tempted to flex on people in other parts of the world for not being able to take the heat, maybe it’s time to recognize that you and they are living in very different kitchens. 

Most of the time, when you check the daily weather report, you’re looking at the air temperature — a measurement of heat in the air around you. But that measurement doesn’t tell the whole story of human experience. What you feel like when you open the door — and how the situation you find outside affects your body — depends on more than temperature, said Margaret Sugg, a professor of geography and planning at Appalachian State University. Humidity, air speed and direction, how hot it usually is compared to right now, and even how much the air cooled during the previous night: These factors all play a role in determining whether 88 degrees Fahrenheit feels comfortable or crushing. How we talk about our thermal comfort is both cultural and scientific. 

For example, we use the heat index in the United States to measure the difference between real and perceived temperature. This is a formula that combines air temperature and humidity to give people a better indication of when they might be at risk of heat stroke. The heat index tells us that 88 degrees with 40 percent humidity feels like 88 degrees, and while there is risk there if you’re out in the sun being active for a long time, it’s not a huge deal. In contrast, 88 degrees with 90 percent humidity feels like 113 degrees — cramps and exhaustion are likely, and activity could put you on the path to heat stroke. 

But “there’s a ton of metrics out there, you could spend forever researching them,” Sugg said. Another researcher, Salman Shooshtarian, a design and social context lecturer at Australia’s Royal Melbourne Institute of Technology, told me more than 116 different indices are used in different contexts. Heat index just happens to be one for which you can gather data cheaply, Sugg said. These indices can vary by country. Canada uses one called Humidex, which also combines temperature and humidity but uses a different formula and categorizes its results based on degree of comfort rather than risk of heat sickness. Another system, called the wet bulb globe temperature, takes many more factors into account, including cloud cover, wind speed and sun angle, and frames its results around how long you can work in direct sunlight before feeling ill and how long a break you need each hour. (The Occupational Safety and Health Administration is a big fan of that one.) There are even proprietary versions with secret math formulas, like AccuWeather’s “RealFeel.”

These different indices matter because they’re all telling you something slightly different and presenting their results in ways that leave you with different understandings of what’s at risk and what you should do about it. And studies have shown that they have to be recalibrated to correctly define “normal” and “safe” in different countries. The dangers of heat, in other words, are at least partially determined by culture. And that’s not the only way temperature — a thing that seems so basic, so absolute — can be pretty subjective.

“I’m from Wisconsin, and I live in Tennessee,” said Alisa Hass, a professor of geography at Middle Tennessee State University. “Moving south is a huge shock to the body.” That’s because your body acclimatizes to the temperature range it’s used to — literally, your physiology changes. People accustomed to spending time outside in higher temperatures sweat more and have increased blood flow to the skin, two changes that can help the body offload excess heat. These are short-term effects and can go away if the person gets de-acclimatized,  a process that helps explain why lower high temperatures in spring can produce the same levels of heat sickness as higher highs later in the summer, Sugg said. 

But there’s long-term acclimatization, as well, with people used to living in hotter climates feeling more comfortable at higher temperatures — even if their health risks are actually larger. For example, in a comparison of outdoor workers in Mississippi and North Carolina, Sugg found that the Mississippi workers believed their jobs had lower heat risks but were also the ones experiencing more heat-strain events. Another study that compared the temperature and local perception of temperature across a bunch of European cities found that what people considered “neutral” in comfort corresponded pretty well with local temperature ranges and was, in fact, closer to the local maximum temperatures than the local mean. 

There’s a whole host of studies showing that where you grew up and what you’re used to affects what temperatures you perceive as comfortable and safe. The reasons seem to range from physiological acclimatization to behavioral adaptations chosen based on the normal climate — like the fact that more than 80 percent of Tennessee households have central air conditioning, compared to 60 percent of Wisconsin households and less than 5 percent of homes in the U.K. Even sex and gender can affect whether you feel comfortable at a certain temperature. There are decades of literature showing women are more comfortable at warmer temperatures indoors (where office air conditioning is often calibrated by a metric designed with male bodies and male clothing in mind) and out. The same study that found differences in local perception of temperature across Europe found that women in the study consistently reported a higher neutrally comfortable temperature than men, no matter where they lived. 

And the subjective nature of temperature only gets messier as climates change. Quite quickly, the climates people have acclimatized to over their whole lives have become much hotter and wetter. So what happens to a place with the cultural infrastructure adaptations of the U.K. when it starts to have the comfort index of Wisconsin or Tennessee? Well, that’s what we saw last month. The good news, Shooshtarian said, is that acclimatizing to heat seems to take less time than acclimating to cold. But climate change also complicates our efforts to adapt. After all, Shooshtarian pointed out, people in the U.K. could install more central air, but that energy use will make climate change worse. To survive and thrive, the future might need a new culture all its own — one that adapts to rising temperatures and to the causes of them.

COVID-19

No President Is Safe From His Own COVID-19 Policy

By Maggie Koerth

Jul. 22, 2022, at 12:56 PM

The French philosopher Joseph de Maistre once said that every country gets the government it deserves. Likewise, perhaps every American president gets the COVID-19 infection he deserves.

OK, “deserves” might be a strong word. While de Maistre, a counter-Enlightenment intellectual who believed in the divine right of kings as the most stable form of government, probably would endorse the concept of pathogen as karmic comeuppance, we here at FiveThirtyEight believe a case of COVID isn’t anyone’s punishment for anything.

But, mayyyybe that’s a little less true if you’re the guy deciding what choices are available to everyone else. The news this week that President Biden had been diagnosed with COVID started me thinking about the ways an American president can set the stage for his own infection through his decisions about pandemic policy. If anyone in this country ever got a case of COVID because of their own mistakes, it’s Biden and Donald Trump. It’s almost as if each man’s illness was a microcosm of the larger way he chose to approach the virus — and of how those choices affected everyone else in the country he led.

Trump likely got his infection via a famously cavalier approach to party planning — throwing a largely unmasked gathering at a point in the pandemic when vaccines weren’t yet available. On Sept. 26, 2020, the then-president held a Rose Garden event to celebrate the nomination of Amy Coney Barrett to the Supreme Court. Case numbers in Washington, D.C., were low at the time, but this was a party full of hugging and handshakes — and it launched a superspreader event that likely infected not just the president and first lady but also multiple members of Congress, White House staffers, members of the media and a whole litany of government and campaign workers.

Trump ended up in the hospital with a case so severe, he came close to being put on a ventilator and was given basically every drug doctors could think of to treat COVID — a mixture of dexamethasone, remdesivir and monoclonal antibodies. Throughout the ordeal, Trump’s large-scale public policy choices — mocking and dismissing masks and other ways of preventing transmission, downplaying the severity of COVID risks, promising a miracle would come along and make the virus disappear, etc. — were reflected in his own experience.

But while President Biden has approached the pandemic in a very different way than President Trump, he, too, has made a series of choices that set the stage for his own infection. If the overarching theme of Trump’s approach to COVID was to shut his eyes and hope the pandemic couldn’t see him if he couldn’t see it, the overarching theme of Biden’s approach has been to frame a collective disaster as just another matter of personal responsibility.

The administration thought it had a silver bullet, going so far as to declare that July 4, 2021, would be a celebration of freedom from COVID. They were so certain that individual vaccinations would be enough that they rolled back federal mask mandates in May 2021 under the assumption that if you did the right thing and got vaccinated, then you’d be fine. Even as delta, omicron, and multiple omicronlets proved this theory wrong, Biden’s policy has continued to focus mainly on getting more Americans vaccinated and boosted. Other policy options that could prevent spread — ventilation requirements, reliable data collection on case numbers, masking during periods of high transmission, getting vaccines to other countries where the virus still spreads unchecked — have largely been left to wither.

The result is an America where COVID keeps mutating, waves of disease keep coming and the populations of the most vulnerable remain isolated, trapped and dying. We have an America where we take COVID seriously but not literally. We have an America where even the most responsible and well-protected of Americans is almost guaranteed to get COVID eventually.

Even a president who trusts the science. 

Abortion

Even Exceptions To Abortion Bans Pit A Mother’s Life Against Doctors’ Fears

By Maggie Koerth and Amelia Thomson-DeVeaux and Maggie Koerth and Amelia Thomson-DeVeaux

Jun. 30, 2022, at 6:00 AM

Layla Houshmand was eight weeks pregnant in the spring of 2021 when she woke up to find her field of vision smeared with a hazy sheen, like Vaseline rubbed on the lens of a camera. She was already worried about her own health. She’d spent the day before nursing herself through the pain of a migraine. But now the headache was worse and her vision was blurring and Houshmand was even more scared. Then the vomiting began. Nothing would stay down. During one 90-minute appointment with an ophthalmologist, she remembered vomiting 20 times. 

Something was clearly going horribly wrong with Houshmand’s body. Her ophthalmologist suspected a stroke in her optic nerve and told her the condition can be caused by pregnancy, but Houshmand was stuck in a Catch-22: The pregnancy was now also preventing treatment. Doctors told her that she needed steroids and blood thinners and a specific type of MRI that could make sure there wasn’t something even more serious happening. But she couldn’t get any of those things because they could endanger her fetus. 

Houshmand decided she wanted an abortion. She wasn’t willing to risk losing eyesight and continuing to be in pain, vomiting over and over, with no solution … not for an eight-week pregnancy. But her doctors couldn’t help her — abortion wasn’t even an option they brought up. Houshmand had to find a private clinic that could treat her on her own. After the abortion she found out the truth: She had a life-threatening infection in her optic nerve. 

As long as she was pregnant, none of the doctors Houshmand encountered would do the things that needed to happen to diagnose her — or treat her. Without an abortion, she was just a sick pregnant woman, rather than a woman who needed an abortion to save her life. 

Watch: https://abcnews.go.com/fivethirtyeight/video/overturning-roe-means-abortion-access-us-fivethirtyeight-85676655

With the end of Roe v. Wade’s abortion protections, there are now millions of Americans who won’t be able to get an abortion if they want one. Some, like Houshmand, will be people who are seeking abortion because of the way a pregnancy is affecting their health. In theory, this shouldn’t be a problem, thanks to exceptions for the life of the mother that are common, even in the strictest abortion bans. But the medical professionals, legal experts and researchers we spoke to said those exceptions are usually vague, creating an environment where patients have to meet some unspoken and arbitrary criteria to get treatment. 

When it’s not clear what is legal, patients are often treated as though nothing is. It can be hard to prove your medical emergency is enough of an emergency to get an abortion in a doctor’s office or hospital, or to get Medicaid and other insurers to pay for it. Uncertainty breeds fear and stigma for doctors, who might delay treatment so they can evaluate just how close a person is to dying. In some situations, patients are simply shuttled from one facility to the next like a hot potato until they find a place willing to offer care.

There are a lot of unknowns about what will happen in the wake of the Dobbs decision. But doctors say they do know at least one thing: Overturning Roe v. Wade will lead to more situations where the health and safety of a pregnant person comes second to doctors’ own risks and fears. They know this because it’s already been happening for years. 

As she sat in the ophthalmologist’s office, it was obvious to Houshmand that her symptoms were freaking out the eye doctor. And what that doctor had to say was freaking out Houshmand. Her vision loss might be permanent, and she could also end up losing vision in her other eye. But, Houshmand remembers the ophthalmologist saying, “You’re pregnant so there’s nothing I can do for you.” 

No one ever said the word “abortion” out loud or even suggested it as an option — and this was in Maryland, a state that has very few restrictions on abortion. The doctors just told her what she needed and why she couldn’t have it. When Houshmand tried to call her OB-GYN’s office to ask what kind of abortion would be safe for someone who might have had an optic nerve stroke, the flustered medical assistant who answered the phone didn’t answer her questions and tried to talk her out of making any quick decisions. And the OB-GYN couldn’t even help Houshmand — she worked at a religiously affiliated hospital and Houshmand’s condition didn’t meet its standard for when abortions could be performed. 

Houshmand felt trapped between the parts of the medical system that were ideologically opposed to her choice, and the parts that were too afraid of controversy to help her. 

And it is pretty common for sick pregnant people to end up squeezed in that vise, said Dr. Lisa Harris, a professor of obstetrics and gynecology at the University of Michigan who specializes in treating pregnant patients with complex medical problems. While she can remember cases where death was certain if an abortion couldn’t be performed — a patient with heart and lung failure, for example — they only come up maybe once a year in her work. But patients like Houshmand happen all the time, she said. “Maybe it’s a 30 or 50 percent chance that someone might die. And they might not die immediately. Maybe it would be in the next week or month, or even year or beyond.” 

Abortion bans and abortion restrictions nearly all contain exceptions that allow abortion to save the life of the mother, and, in some cases, preserve her health as well. But every law and statute that contains this exception is written a little differently, and most of them are ambiguous about what constitutes “life-threatening” and how that should be determined. Maryland’s “life of the mother” exception to its ban on post-viability abortions specifically allows doctors to use their best medical judgment. But that kind of detail isn’t common, said Joanne Rosen, a senior lecturer on public health and law at Johns Hopkins University. What’s more, she said, “the states that are the most hostile to abortion are the states least likely to provide really helpful specificity.” Take Tennessee’s abortion ban, which requires doctors who perform an abortion to prove that “the abortion was necessary to prevent the death of the pregnant woman or to prevent serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman.”

Legislators in these states may worry that if the laws give doctors too much leeway, some will take advantage and use that as an excuse to perform any abortion they want, said David Cohen, a law professor at Drexel University’s Kline School of Law who has studied abortion restrictions. Rosen agreed, saying the ambiguity is part of how states make abortion — even doctor-recommended abortion — hard to get. Even if doctors’ actual liability is kind of nebulous, the fear that they could go to jail, incur legal costs or lose their medical license is acutely clear. “It will massively change the risk calculus,” Cohen said. “People will have to think, ‘Will I spend 10 to 20 years in jail for performing this abortion?’”

There’s no clear answer to that question under an ambiguous law. After Texas passed Senate Bill 8, which banned abortion after fetal cardiac activity is detected, as early as six weeks, and opened the door for expensive civil lawsuits against doctors, a group of researchers interviewed 25 clinicians in the state and found a huge amount of variation in how those people were interpreting exceptions in the law. Some were still providing abortion counseling and referrals. Others felt they weren’t allowed to even mention the treatment. Some thought the health of the mother exception in the law allowed them to perform abortions for patients whose water broke before the point of fetal viability. Others were sending those patients home to wait until infection set in and the patient could be admitted to an intensive care unit. 

Meanwhile, hospitals often err on the side of caution even in states without bans. “It’s common when I talk with friends who work at hospitals, where, even though abortion is legal in their state, their hospital or clinic has chosen not to allow them to do abortion, because they don’t want controversy,” said Jonas Swartz, a professor of obstetrics and gynecology at Duke University Medical School. Several other medical professionals we spoke with also said that secular hospitals often had policies on abortion that were more strict than state law. Jen Moore Conrow, former director of the Pregnancy Early Access Center at the University of Pennsylvania, described setting up the hospital’s new internal clinic for handling miscarriage and medically necessary abortion in 2015, and then not being allowed to publicly talk about that clinic in the media for two years. A Penn Medicine spokesperson said the system is committed to providing information to the public, including frequently addressing reproductive health issues in the press. “The chair of our department was like, ‘We don’t ever want to be an abortion clinic.’ And I’m like well, we are an abortion clinic,” Conrow said.

“When you’re pregnant, you’re a second-class citizen inside your own body,” Houshmand said. “It was just abundantly clear to me that everyone was prioritizing this eight-week embryo over me.” Houshmand wrestled with those feelings while she argued with her doctor’s office on the phone, while she called abortion clinics on her own, and while she waited overnight for the appointment she’d managed to get. She felt like she was going crazy. The pain was so intense that she’d barely slept in two days. She passed out in her shower. And, seemingly out of nowhere, Houshmand began to have thoughts of suicide. 

She would later find out that was caused by the infection in her brain. But in some ways she was lucky. Her emergency happened at the right place, at the right time. If she’d gone through this experience now, she might not have been able to get that appointment since wait times are rising as remaining clinics struggle to meet a demand for abortions that doesn’t go away just because national abortion rights have.

Delayed treatment has real impacts on the health and welfare of pregnant people. A condition that wasn’t immediately dangerous two weeks ago might be life and death today. And with every week that passes, the fetus gets bigger and abortion becomes more complicated and riskier, as well. Maternal mortality rates are higher in states that have more abortion restrictions, even after scientists account for demographic factors. Suzanne Baird, an obstetric nursing and health care consultant and a member of the board of the Association of Women’s Health, Obstetric and Neonatal Nurses, said delays could be one reason why. She pointed to a 2018 report by nine state committees that review individual cases of maternal mortality in the United States. This report found that delayed diagnosis and treatment had been a major factor in those deaths. 

In North Carolina, for example, Swartz has had to follow state restrictions, including a 72-hour waiting period and reading mandatory scripts meant to dissuade a patient from an abortion — even when the patient is sick. It’s common, he told us, to find himself debating whether a patient who isn’t in an emergency situation yet, will be by the time the waiting period is up. 

Likewise, Medicaid and many other state-funded insurance providers can’t use federal funds to pay for abortions unless the life of the mother is at risk. And doctors we spoke to say those exceptions are approved in arbitrary, haphazard ways that vary widely by state as well as the reviewer of that particular case. If the case is denied, the patient has little means to pay out of pocket. Conrow described having to delay the care of a patient with sickle cell anemia, waiting to see if Medicaid would cover the patient’s abortion, knowing that sometimes Medicaid will cover abortions for people with the disorder … and sometimes it won’t. In 2019, a report from the Government Accountability Office found that some states weren’t following federal requirements for Medicaid abortion funding — such as paying for abortion pills, or covering abortions in the cases of rape or incest. 

Even when patients aren’t going to die, they can still be left with lifelong complications that abortion could have helped them avoid, Harris said. One of her first cases at the University of Michigan involved a patient who wanted an abortion because of a fetal anomaly, but who also had placenta previa — a condition where the placenta grows across the part of the uterus that would normally open during childbirth. Instead of giving her a second-trimester abortion, dilating the cervix and removing the fetus through the birth canal, doctors had decided to induce labor with drugs. Days of contractions later, when the patient still hadn’t given birth, her doctors planned a hysterotomy. That procedure is like a C-section, surgery that cuts through the abdominal wall and uterus, but because the uterus is still so small in the second trimester, the scarring resulting from the hysterotomy would have meant the patient would never be able to give birth vaginally — and might have had trouble maintaining a future pregnancy at all. Instead, Harris performed an abortion, leaving the patient’s uterus intact. 

Being pregnant can make you sick, and it can exacerbate existing illnesses you never knew you had. The needs of pregnant people sometimes end up at odds with the needs of a fetus. And in that way, abortion restrictions — and vague life of the mother exceptions — are a thumb on the scale. The end of Roe v. Wade will obviously throw that balance even more out of whack, but the asymmetry was already there. The risks to pregnant people just get bigger as their choices shrink. “Hospitals want to get out of making these decisions but they won’t be able to,” said Greer Donley, a law professor at the University of Pittsburgh who has studied the law surrounding abortion and medical emergencies. “They will see pregnant people who have life-threatening complications and no other options, and they’ll have to make the call.”

A year after the abortion that saved her life — and allowed her to know her life needed saving — Houshmand has vowed to never get pregnant again. After her abortion, when she met with doctors from the Wills Eye Hospital in Philadelphia, they told her the immunosuppression that happens during pregnancy had allowed a normally harmless virus that causes cold sores to run rampant, attacking her optic nerves and, possibly, her brain. 

Houshmand has had antiviral medications injected into her eye, and she’s gone through three surgeries. She is still legally blind in her right eye, and she suffers from PTSD. “I never want to live through the experience of not being in charge of my own body ever again,” she said. The risk just isn’t worth it.

When we spoke with her, Houshmand had a fourth eye surgery scheduled. It took place less than a week after the Supreme Court overturned Roe v. Wade. 

Abortion

We Want To Hear About Your Experiences With Abortion Restrictions In U.S. Hospitals

By Maggie Koerth and Amelia Thomson-DeVeaux and Maggie Koerth and Amelia Thomson-DeVeaux

Jun. 14, 2022, at 2:59 PM

If the U.S. Supreme Court really does overturn Roe v. Wade, abortion would effectively become illegal in 13 states — and heavily restricted in many others — because of trigger laws designed to go into effect either immediately or within weeks. Each of these laws is a little different, but all of them make some kind of exception for the health or life of the mother. 

But determining when someone’s health or life is at risk is not always straightforward. 

Medical science doesn’t come with tidy boundaries between life and death, emergency and non-emergency. Sometimes it’s not clear if an emergency is life-threatening until it’s too late. Other times, a medical problem could mean losing years of one’s life or struggling with long-term health problems but not necessarily dying today or tomorrow. 

We’re looking for patients, clinicians and hospital administrators who have had to navigate these kinds of situations. We’re especially interested in talking to people who have had to ask a hospital board to approve an abortion in this kind of case, or who have been on the boards considering such cases. We want to understand how biology and medicine leave patients and the people who care for them in gray areas that can’t be easily legislated. 

If this describes you, we’d like to hear from you. Please fill out this form and we may get back to you about an upcoming story.

Mass Shootings

Mass Shootings Can Traumatize People Who Weren’t Even There

By Maggie Koerth

Jun. 9, 2022, at 10:38 AM

At the end of the day on May 24, more than 400 children walked away from Robb Elementary in Uvalde, Texas as survivors. That single day of grade school will follow them for years, a formative trauma that increases their risks of experiencing depression, missing school days and even earning less money over their lifetimes. Research shows that violence in the classroom harms kids regardless of whether it physically injures them. 

There were also more than 50 million children enrolled at other K-12 schools in the United States that day. Whether they were across town or across the country, many of those children will also have memories of May 24, 2022; sirens, blaring news reports, or the hushed, tense whispers of adults. They know something awful happened to kids just like them. Next year, they’ll do active shooter drills in their own schools and remember that this will be real someday for someone, even if it’s never real for them.

Is that, also, a kind of trauma? 

There is precious little known about how the impacts of school shootings ripple out to children in the rest of the community, state and nation. But there’s plenty of research that suggests the trauma of violence in general probably doesn’t stop at the specific location where it happened. And that, experts told me, means we need to be thinking differently about the damage violence can cause and who is at risk. 

Despite the high-profile nature of school shootings, and mass shootings more broadly, the mental health impacts of these kinds of events have not been widely studied. Five years ago, Dr. Sandro Galea, an epidemiologist at the Boston University School of Public Health, co-published a review of research on how mass shootings impact mental health. The 49 peer-reviewed papers he analyzed were mostly focused on what happened to direct survivors — people who were at the site of a mass shooting but left alive. There were only a few that addressed indirect exposure. 

These studies found evidence of trauma even for those who were not in the room or building where a mass shooting happened, though impacts were larger the closer people were to the actual incident. Other factors — such as media exposure, or the amount of time someone spent discussing the shooting with family and friends — also seemed to affect who came away with symptoms of trauma and how severe they were. But the amount of research on this subject was very small and incomplete, and it’s hard to say much with certainty. 

And according to Gaelea that is still true today. “The issue of mental health in community members who are not directly affected… most people in the mental health space think it’s a real issue but there actually has been very little research on it,” he told me. 

More broadly, there’s lots of evidence that, in certain situations, people can have their mental health impacted by traumatic events even if they weren’t personally in physical danger. “We’ve known for 20 years that watching media images of people suffering can, in and of itself, be a trigger for common mood anxiety disorders, things like depression and post-traumatic stress,” Galea said. 

Evidence suggests there are multiple kinds of indirect trauma, said Jennifer Carlson, a professor of sociology, government and public policy at the University of Arizona. Vicarious trauma, she said, is what happens when people like social workers are deeply exposed to the trauma of their clients and feel helpless to prevent those people from experiencing traumatic events. Community trauma, meanwhile, happens when whole populations are collectively traumatized by something that affects everyone on a cultural level, even if some individuals don’t experience it personally. The traumatic impact of the Holocaust on the Jewish community is a good example of this, as is the collective trauma expressed by Black Americans in the wake of the George Floyd murder. 

This knowledge has implications for how we think about the trauma of school shootings, even if we don’t know exactly how school shootings are affecting the mental health of kids nationwide. People who aren’t affected physically by a disaster are often reminded that they have a low risk of experiencing something like that themselves. There are tens of millions of kids enrolled in school every year, but only a little over a hundred a year — if that — become direct victims of a school shooting. The risk is low. 

But that’s the wrong way to think about risk when we know a traumatic event will happen. The number of school shootings every year that involve active shooters are very small — averaging 5 per year between 2021 and 2011, according to the Naval Postgraduate School’s K-12 School Shooting Database. But you have to go back to 1981 to find a year without at least one. School shootings are almost guaranteed to happen every year — we just don’t know to whom, Carlson said. 

And that means the risk of harm isn’t just about the physical likelihood of being shot, it’s also about anticipating a trauma that will happen to someone — maybe even you — and feeling powerless to stop it and at the mercy of chance. “I am a sociologist of crime,” Carlson said. “I’m very much on board with [the idea that] people overestimate their likelihood of victimization.” But this is different, she said. The likelihood of anticipatory trauma can be high even if the risk of injury and death is low. 

Given that, it’s useless to tell people not to be afraid of something like gun violence. It isn’t just about the personal risk of getting shot, Galea said. In 2016, he published an analysis that found the chances of an American knowing a gun violence victim at some point in their lifetime are nearly 100 percent. There’s a greater social burden than the statistics of direct risk can show. 

Gun Violence

Suicide Prevention Could Prevent Mass Shootings

By Maggie Koerth

Jun. 6, 2022, at 1:32 PM

The following is an updated version of this article, published in 2019.

Imagine a doctor who wanted to treat a broken leg with chemotherapy. Or treat cancer with a cast.

Just because cancer and broken legs are both things that happen to the body doesn’t mean they call for the same treatment. These are the kinds of issues policymakers face every day. Take gun violence. It feels like one big problem, but it’s actually a bunch of different problems that don’t necessarily have a single cause. But it’s also easy to get so focused on the differences between types of gun violence that we miss the unexpected connections. Just like a fragile, cracked bone could be a symptom of certain kinds of cancers, researchers are finding evidence that suicides and mass shootings can often be different expressions of the same problem.

I first reported on this connection back in 2019, as part of trying to explain why a suicide prevention tool — “red flag laws” that enable family members and law enforcement to determine that a person is a threat to themselves or others and temporarily remove guns from their home — was being proposed as a way to prevent mass shootings. 

Today, 19 states have enacted red flag laws and they’ve had mixed results in violence prevention. But the connections between suicidality and mass shootings have just gotten stronger. “Many of these mass shootings are angry suicides,”  James Densley, professor of criminal justice at Minnesota’s Metropolitan State University, told me four years ago. And now there’s even more evidence to suggest that’s true. 

It isn’t news that a lot of mass shooters suffer from suicidal ideation, said James Lankford, a professor of criminology at the University of Alabama. But it wasn’t until he published a 2021 study comparing mass shooters to other demographic groups that he truly realized just how much more mass shooters had in common with people who die by suicide than they did with other kinds of homicide offenders.

“Homicides are rarely premeditated but public mass shootings almost always are,” Lankford said. So are suicides. While mass shootings were 3.8 times more likely to be premeditated than standard homicides, they were only 1.2 times more likely to premeditated compared to suicide. Mass shooters were more likely than other homicide offenders to act alone. They were more likely to be killed by law enforcement. And while standard homicide offenders aren’t particularly likely to experience suicidal tendencies, in Lankford’s study anyway, mass shooters were a bit more likely to have a history of suicidal ideation than even people who actually died by suicide. 

Lankford is not the first person to find connections between suicide and mass shootings. In a database of more than 150 mass shootings that took place between 1966 and 2018, Densley found that about half the attackers in his sample had demonstrated signs of feeling suicidal before they hurt others. A different set of researchers who analyzed 41 school shooters for the Secret Service and Department of Education found that 78 percent had a history of thinking about or attempting suicide.

“We’ve even talked to a couple of people who tried to kill themselves but failed and then launched an attack because they were hoping police would kill them,” said Marisa Randazzo, a former chief psychologist for the Secret Service who now consults on active threat assessment with schools and other organizations, told me.

A third set of researchers, who compiled the details of 119 lone-actor terrorists, did not specifically track whether the people in their data set had thought about or attempted suicide, but the researchers told me they also found significant overlap between mass shootings and choices that suggested suicidal tendencies. “A fairly sizeable subset only planned this to be a one-off event” — that is, something they didn’t return from — said Paul Gill, a professor of security and crime science at University College London and the researcher in charge of that data set. “They were taking preparations to maximize the chances of death by cop or their own hand.”

In other words, acts of mass violence are functioning as a method of suicide. “These are individuals who are planning in advance to commit a crime for which there’s almost no chance they’ll avoid life imprisonment or death as a direct result of the crime,” Lankford said. “It’s very reasonable to say that they’re not very invested in their current lives, or their future lives.” 

That fact has implications for policy and prevention. 

A connection to suicide means armed guards are unlikely to be a deterrent to mass shooters, Densley said. In 2021, he published a paper that analyzed 133 cases of school shootings between 1980 and 2018 and found that the ones where armed guards were present had a death rate 2.8 times higher than those with no armed guards on scene. Densley thinks this could partly be because in the eyes of a shooter exhibiting suicidal ideation, good guys with guns are a feature, not a bug. They may see a higher chance of death for themselves and they may go in more heavily armed — and more innocent people could be caught in the ensuing shootouts. And even if that’s not the case, Lankford said, a shooter having armed guards to fight creates a story that increases the killer’s chances of achieving notoriety and fame.

The connection to suicide also means potential mass shooters can easily slip under the radar of law enforcement, who are trained to deal with crime, not crisis, Lankford said. It’s not uncommon for future mass shooters to come to the attention of law enforcement before their major attack, but those interactions often go nowhere because that person has no connection to violent crime or gangs, and they have no previous criminal record. “Those questions aren’t useful in assessing the threat of a mass shooter,” he told me. 

And these kinds of shooters remain difficult to profile. Even knowing the connection to suicidality doesn’t particularly help because most suicidal people aren’t a danger to others, just themselves. 

But there is some good news here. Mass shootings are very often preceded by what experts describe as cries for help — shooters tell other people about their plans, they make threats, they describe their desire to kill and be killed. In a 2021 study of 170 perpetrators of mass shootings, researchers found that 44 percent had leaked specific details of their own plans beforehand. Multiple studies have found that family and friends of a mass shooter are often aware that something is wrong long before the violence happens. That happened one-third of the time in Densley’s database, 64 percent in Gill’s, and 81 percent in the cases Randazzo logged.

And this is why many experts who study the epidemiology of mass shooters like the idea of red flag laws as a preventative. Even once you identify some details that many of the attackers have in common, such a large swath of the population shares these traits that the “profile” is fairly useless for prevention. Red flag laws circumvent that problem by focusing less on a type of person and more on a type of emotional and situational crisis — where the people involved aren’t necessarily “bad guys” but troubled individuals in need of help. Gill thinks of it as a public health approach, analogous to the way we treat physical health problems that are hard to profile.

“We know that raised cholesterol leads to heart problems. We don’t have the ability to predict who in the general population who already has raised cholesterol will go on to have a heart attack. So we put in place prevention policies to try to decrease cholesterol in the whole ‘at risk’ community,” he said.

For the researchers who study mass violence, what’s appealing about red flag laws is that these rules have the potential to shift the emphasis from a cut-and-dried checklist of dangerous traits to a more nuanced system that accounts for a person’s big-picture emotional state. 

Right now, experts said, even when friends, family and teachers know something is wrong with a potential shooter, they may not be able to actually do much about it. Sometimes people don’t know who to tell. Sometimes they choose not to tell in order to avoid sending a loved one to prison for crimes they haven’t yet committed. Sometimes the authorities can’t do anything because the nature of the threat doesn’t include illegal behavior.

All these researchers supported red flag laws because they could create a clear plan of action for friends and family concerned about a loved one’s combination of emotional crisis and violent threats. It creates a place to take concerns, a system to evaluate those concerns and a means of mitigating them. That’s particularly true, researchers said, if national red flag laws are set up so that the system isn’t punitive. Ideally, the process would focus on helping a person get through to the other side of an emotional crisis rather than putting them in jail. It’s also important, the researchers said, to make sure the laws are focused on professional evaluations of overall behavior, not checklists.

And there’s some evidence this could work. An analysis of records from California, where one of the first red flag laws was enacted in 2016, found at least 21 cases where the laws had been used specifically because people around a person were worried about their potential to commit a mass shooting. As of 2019, none of those people had followed through on that potential. It’s impossible to know, however, how those risks would have played out if the red flag hadn’t been there. 

But if those parts work together the way they should, then red flag laws really could be a useful tool for combating the segment of mass shootings that function like very public, violent suicides. “There’s an important piece when we interviewed school shooters and active threat cases,” Randazzo said. “They feel very strongly about two things: They have to carry out the violence, they have no options left, but they also don’t want to do it and hope someone will stop them.”