Mifepristone access is back. But for how long?

0:00Dr. Veronica Gillispie-Bell:Support for Here and Now Anytime comes from MathWorks, creator of MATLAB and Simulink software, to design and develop engineered systems, accelerating the pace of discovery in engineering and science. Learn more at mathworks.com. WBUR Podcasts, Boston. Those individuals that don't have transportation or don't have the financial means to travel to another state, really they will have no options.

0:32Leslie Josephs:The Supreme Court protects mail orders of the country's most widely used pill for abortions. But access still depends a lot on where you live.

0:51Leslie Josephs:It's Monday, May 4th, and this is Here and Now anytime from NPR and WBUR Boston. I'm Chris Bentley.

1:01Leslie Josephs:A little later on today's show, we'll hear how the shutdown of Spirit Airlines unfolded over the weekend and what's next for their customers and employees.

1:11Dr. Veronica Gillispie-Bell:For months even leading up to this, you know, Spirit had furloughed a lot of pilots and they were calling them back. And the same thing with flight attendants, just so they could staff their flights in months leading up to the bankruptcy.

1:22Leslie Josephs:But first, a single sentence order from the Supreme Court today restored access to the country's most widely used abortion pill. It was in response to a ruling Friday from an appeals court that blocked mail orders of mifepristone. And today's move by the Supreme Court pauses that ban for at least a week. Mifepristone, also known as RU486, is the most widely used oral medication approved for abortion through 10 weeks of pregnancy. Doctors often prescribe it online or over the phone. Dr. Veronica Gillespie-Bell is an OBGYN in New Orleans and a fellow with the American College of Obstetricians and Gynecologists.

2:05Leslie Josephs:She told Indira Lakshmanan the legal back and forth over mifepristone is causing some confusion for people who might need it.

2:13Dr. Veronica Gillispie-Bell:I think it causes a lot of confusion, not just for patients, but for physicians as well. I think for patients, the fact that there is any ban then starts to create some distrust as to whether the medication is safe or not. And again, just confusion as to how to even be able to access it. Well, how are you talking to your patients and for that matter to your colleagues about the options? Because we don't know what's going to happen to access to mifepristone after May 11th. And this all goes back to an appeals court ban that specifically started from access in your state of Louisiana. Yes, you know, I really take the position of the American College of Obstetricians and Gynecologists that we do believe that having access to all reproductive options is reproductive justice and reproductive rights.

3:10Dr. Veronica Gillispie-Bell:And so I think it's really important in thinking about that, that we are educating the public that Mifepristone is safe, it is effective. And yes, there are going to be challenges in being able to access it. And so I think it's important for us to pay attention to the changes to be able to help our patients navigate the system. Well, my understanding is that mifepristone is typically prescribed with another drug called misoprostol for most medication abortions in the U.S., but misoprostol can also be used on its own, and in some countries, doctors prescribe it alone. Explain to us, is it safe to prescribe this other drug on its own?

3:52Dr. Veronica Gillispie-Bell:What are the side effects? So it is safe to prescribe mesoprocital by itself. It is effective, but it is not as effective as when it is used with mifepristone. So in thinking about that and thinking about it not being as effective, then that could mean higher cases of bleeding, higher need for having to then have a surgical management because the mesoprocital alone was not effective. Well, you're talking about bleeding. So talk about the medical concerns around complications from the use of these drugs, and should these drugs require a physical exam and supervision for their use? So both of these medications are very, very safe.

4:36Dr. Veronica Gillispie-Bell:We know from data going back really to 2021 that specifically mifepristone is safe, and it is safe when it is prescribed through telehealth. So ACOG petitioned the FDA in 2021 to remove the requirement for in-person dispensing. That was finally lifted in 2023. And so there is data following cases through all that time that have shown that prescribing mifepristone through telehealth, which would mean there's not an in-person visit, is safe without complications. ACOG, of course, refers to the American College of Obstetricians and Gynecologists, of which you're a member. Explain to us, if the mifepristone ban does go through after this temporary pause, how can patients in states like yours with abortion restrictions get a medical abortion?

5:32Dr. Veronica Gillispie-Bell:Would they still be able to use the other drug on its own without seeing a doctor in person getting a prescription from out of state? They will not. They will have to travel to states where there is access. And so, of course, that then causes disparities. So those individuals that don't have transportation or don't have the financial means to travel to another state, really, they will have no options. Dr. Veronica Gillespie-Bell is a practicing OBGYN based in New Orleans. She's also a fellow with the American College of Obstetricians and Gynecologists. thank you so much for joining us. Thank you, my pleasure.

6:16Leslie Josephs:We've got more perspective on that mythopristone ruling from the University of California Davis School of Law professor Mary Ziegler. She's also been following other restrictions on birth control. You can find that conversation and a whole lot more at hereandnow.org. But coming up next, I hope you were not among the thousands of people stranded over the weekend by the sudden closure of Spirit Airlines. If you were, I definitely don't need to tell you that Spirit shut down Saturday morning after talks over a government bailout fell apart. But like a rescheduled flight with two layovers, this story is far from over.

6:57Leslie Josephs:Indira has more after the break.

7:25Dr. Veronica Gillispie-Bell:Thank you. just greenwashing? And of course, Is Business Broken? Follow Is Business Broken wherever you get your podcasts.

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8:37Dr. Veronica Gillispie-Bell:The airline that many people love to hate until they needed that cheap flight to Fort Lauderdale has run out of runway. Spirit Airlines shut down on Saturday after a$500 million federal bailout failed to materialize. Here to explain what's next is Leslie Josephs, who covers the airline industry for CNBC. Leslie, welcome back. Thanks so much for having me. So let's start with the immediate fallout. Is Spirit or other airlines helping customers who are currently traveling or have tickets for flights that now don't exist anymore? So pretty much every airline in the country is trying to fly Spirit customers.

9:13Dr. Veronica Gillispie-Bell:We heard from United, American, Delta, Frontier, JetBlue, which was the number two airline at Fort Lauderdale Spirits Hub, all rushing in to get as many customers as possible. And what they're doing is capping fares. This is something that we see when there's a major hurricane or storm, so customers can get out of harm's way as quickly as possible without facing those very high fares. Well, in this case, get out of their vacation without having to pay a heck of a lot more than they initially paid on a budget airline. You know, on a very serious note, 17 ,000 people have lost their jobs. That includes pilots, flight attendants, technicians, people with decades of experience.

9:55Dr. Veronica Gillispie-Bell:What happens to them now? So they will be looking for jobs. Unfortunately, this does leave a lot of people out of work. You know, you work in this industry and you're used to pretty much every shock that you can think of. It's what it happens to you. It always seems to be the thing that you didn't think of. And we've seen this, you know, time again, whether it's a terror attack or COVID-19 pandemic, which was the industry's biggest ever shock. And a lot of people were at risk of losing their jobs. um with airlines are hiring uh the speed with which they are hiring is not as high as it was maybe after the pandemic they had lost a lot of employees that took voluntary buyouts and other packages like that the uh pilot pipeline has been moving along and they're not as desperate to hire but what we've heard we've talked to ceos for example from united who told me last year i look at these classes of incoming pilots, and there's so many people from Spirit.

10:55Dr. Veronica Gillispie-Bell:He said one class had pretty much the entire class was from Spirit. So they are still in demand, but things are not as maybe easy to find a job as a few years ago. But if they do want to stay in the industry, those applications have been going through for months, even leading up to this. Spirit had furloughed a lot of pilots, and they were calling them back. And the same thing with flight attendants just so they could staff their flights in months leading up to the bankruptcy. Okay, Leslie, Spirit had about 4 % of U.S. market share, according to aviation data firm Serium. People love to hate on all those add-on prices for boarding passes, seats, bags.

11:34Dr. Veronica Gillispie-Bell:They hate it on the no-fill service and the flimsy seats. But the reality is Spirit is credited with democratizing air travel for people who couldn't otherwise afford tickets. So what happens when there isn't a budget airline like this in the market? That's a great question. Without Spirit, even though it was a small part of the country's air system and didn't carry that many passengers compared with, say, a Delta or American, them not being there means that airlines will have more pricing power. Of course, they're all vying for Spirit's gates, their slots, and their travelers overall. So we saw JetBlue announcing a slew of new routes from Fort Lauderdale, you know, going as far as Cali, Columbia, and Nashville, and pretty much all over the place.

12:23Dr. Veronica Gillispie-Bell:So that added capacity could help keep fare somewhat low, but Spirit's not there. You know, these are airlines that might not charge as low as Spirit did, at least for a bare-bones ticket. And I've talked to people that say, you know, for that short flight, I don't care. I didn't have to have the add-ons. I packed light. Maybe they were commuting and worked in a city and lived in another. And they just wanted the cheapest thing possible. They brought the essentials, and two hours they were where they needed to go, and they don't have that option right now. Frontier Airlines, which is kind of the most equivalent in business model and kind of neck and neck with Spirit over the years, they still exist.

13:01Dr. Veronica Gillispie-Bell:But low-cost airlines have been particularly challenged by the high fuel prices and even before the run-up. All right. Well, Leslie, the airline industry as a whole is staring down this crisis from rising jet fuel prices with the Iran war. Major carriers are slashing their profit projections. Is there a chance we're going to see more reshuffling, more bankruptcies within the airline industry this year? It is possible. Exactly when that happens is not clear. The airline industry had been banking on Spirit to essentially disappear for months. You know, they filed for their second bankruptcy last August in less than a year.

13:39Dr. Veronica Gillispie-Bell:That was a signal airlines were already kind of jumping in. But they had Spirit made it, and this is why I think there was a lot of consternation about an 11th hour government bailout because they thought one Spirit would eventually collapse anyway. But they had been essentially betting on Spirit not being there. So that takes capacity out of the market, gives them a chance at one more pricing power, higher revenue, and getting more customers on board their planes. All right. Leslie Josephs, airline reporter at CNBC, thank you so much for joining us. My pleasure.

14:22Leslie Josephs:We've got to take one more short break, and we'll be right back.

14:28Leslie Josephs:Lots more we're following today over at hereandnow.org, like how seeking out new experiences and social connections can help people stay healthy later in life. Ken Stern wrote about just that in his book Healthy to 100. He's the founder of the Longevity Project and a former CEO of NPR, I might add. He told Indira that staying healthy is, in part, a state of mind. We're conditioned in the U.S. to think of health being associated to health care or fitness and nutrition. All those things are important, but so is mental attitudes, purpose, and what I write about in my book, Healthy to 100, social connection.

15:09Leslie Josephs:As a former Surgeon General, Vivek Murthy has declared, we have a loneliness crisis in the U.S. That's a health care crisis. Being socially connected, the other side of the coin, actually critically important and tons of research. If you want to take care of your health, quit smoking and get socially connected. That should be high priorities for everyone.

15:28Dr. Veronica Gillispie-Bell:You also observe that we live in one of the most ageist societies on Earth, one that constantly reinforces negative stereotypes about age. And those negative attitudes, as you say, can undermine our own mental and physical wellness. I was struck in your book that you travel to Japan, South Korea, Singapore, Italy, Spain for your research. What do those societies get right about aging that we get wrong? Quite a bit.

15:53Leslie Josephs:And let's understand first the gaps between ourselves and those countries. Japan, which is the longest-lived country on Earth, life expectancy there is seven or eight years longer than U.S. Healthy life expectancy, which is the years we can expect to live in good health, almost a decade longer. Women in Japan, the median life expectancy in Japan is 90. Wow.

16:43Leslie Josephs:society. They don't think of that as we kind of do as sort of a decline narrative. It's a time in all those places where people are considered an integral part of society, and that has lots of different consequences, A, for the effectiveness of society, but also for our own health and healthy aging. There's a lot more to that conversation between Ken Stern and Indira Lakshmanan about staying healthy in older age. And you can listen to it all right now at hereandnow.org. But that'll do it for today's podcast. Here and Now Anytime comes from NPR and WBUR Boston. Today's stories were produced by Sam Rapelson, Jill Ryan, and Will Walkie.

17:25Leslie Josephs:Today's editors were Todd Bunt, Mikaela Rodriguez, Michael Scotto, and Kat Welch. Technical direction from Caleb Green and James Trout. Our theme music is by Mike Moschetto, Max Liebman, and me, Chris Bentley. Our digital producers are Allison Hagen and Grace Griffin, and Here and Now's executive producer is Alan Price. Thanks for listening. We'll be back with you tomorrow.