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A combative three-judge panel at one of the most conservative courts in the country grilled attorneys for the federal government and a drug manufacturer as anti-abortion activists continue a legal battle to overturn the government’s approval of a widely used abortion drug. On 17 May, the case against mifepristone returned to the Fifth Circuit Court of Appeals in New Orleans, where attorneys for the US Department of Justice and drug manufacturer Danco Laboratories faced skeptical Republican-appointed judges hearing oral arguments in a case that could upend abortion care for millions of Americans. Within seconds of her opening argument, Justice Department attorney Sarah Harrington was interrupted by Judge James Ho, a Donald Trump appointee, who challenged her description of the legal challenge against the drug’s approval by the US Food and Drug Administration. “I don’t think there’s ever been any court that has vacated an FDA determination that a drug is safe to be on the market,” she replied. “FDA can make that determination based on exercising its own scientific expertise, but it’s not a court’s role to come in and second-guess that expertise.” “Why not focus on the facts,” Judge Ho said, “rather than this ‘FDA can do no wrong’ theme.” The judges repeatedly interrupted Ms Harrington and appeared sympathetic to the plaintiffs: an anti-abortion group represented by influential right-wing legal group Alliance Defending Freedom, whose senior counsel Erin Morrow Halley – the wife of Republican senator Josh Hawley – baselessly asserted that medication abortion is “particularly dangerous”. Judge Jennifer Walker Elrod, who was appointed by George W Bush, also took a moment to chastise lawyers for their “unusual remarks” in filings objecting to the widely derided lower-court decision from a former right-wing activist attorney who was appointed to the federal bench by Mr Trump. Judge Elrod suggested their criticisms amounted to personal attacks and suggested that the attorney retract the statements and apologise. “Those statements reflect our view that the district court was very outside the bounds,” said Jessica Ellsworth, an attorney for Danco. “I don’t think those remarks, any of them, were intended as any personal attack.” The judges are not expected to rule immediately. But a decision from the panel judges – each with a history of support for abortion restrictions – is likely to return the case to the US Supreme Court, which has paused any action on mifepristone until the legal challenge plays out. In her arguments, Ms Hawley conflated the risk of serious complications from mifepristone – which is less than 1 per cent – with the risk that a medication abortion failed and would then require medical attention. Her arguments suggested that doctors are enduring a moral harm by providing abortion care, without evidence that doctors have been forced to do so, while also claiming that the FDA illegally approved the drug when it was approved more than 20 years ago. The judges repeatedly questioned the FDA’s approval process for mifepristone, which plaintiffs argued was done too hastily through an expedited process that is typically reserved for treating serious or life-threatening illnesses. But the FDA did not do that with mifepristone; it took years of study before the FDA’s approval. The part of that process that the agency invoked for mifepristone’s approval allowed the FDA to add safety restrictions, such as a requirement that physicians be able to diagnose ectopic pregnancies. But judges appeared to argue that because pregnancy is not an illness, mifepristone should not have been approved through that process at all, repeating plaintiffs’ false claim that the FDA called pregnancy a “life-threatening illness.” “When we celebrated Mothers’ Day, were we celebrating illness?” Judge Ho said at one point. “The arguments today demonstrated in detail that the case has no legal or scientific merit and should have been laughed out of court from the very start,” Jennifer Dalven, director of the ACLU Reproductive Freedom Project, said in a statement. “Unfortunately, the deck is stacked as the judges hearing this case are well known for their extraordinary hostility to abortion,” she added. “The whole point of the case is to prevent anyone in America, no matter where they live, from using a medication that has been safely used in this country for decades and is used in most abortions today.” Major medical groups and research from hundreds of studies over the last two decades have confirmed the overwhelming safety and efficacy of the drug, one of two drugs used in a two-drug protocol for a medication abortion, the most common form of abortion care in the US. Studies show it is as safe to use as common over-the-counter pain relievers like ibuprofen and acetaminophen, and the protocol for medication abortion is used in more than 60 other countries. The drug was first approved by the FDA in 2000 and is approved for use up to 10 weeks of pregnancy. A vast majority of abortions occur within the first nine weeks of pregnancy. From 2019 through 2020, nearly 93 per cent of all abortions were performed before the 13th week, according to the US Centers for Disease Control and Prevention. Mifepristone is also used to treat miscarriages. Roughly 10 per cent of clinically recognised pregnancies end in miscarriages, according to the American College of Obstetricians and Gynecologists. The American College of Obstetricians and Gynecologists and the American Medical Association also joined a brief in the challenge opposing arguments from anti-abortion groups. Last year, Alliance Defending Freedom filed a lawsuit in US District Court in Amarillo, Texas on behalf of a group of anti-abortion activists incorporated as the Alliance for Hippocratic Medicine, which was organised that same month with an address in Amarillo. The Alliance Defending Freedom also led the challenge at the Supreme Court that ultimately struck down Roe v Wade. In April, US District Judge Matthew Kacsmaryk – a former right-wing activist lawyer who was appointed to the federal judiciary by then-President Trump – issued a ruling to suspend the FDA’s approval of mifepristone, which was immediately challenged by abortion rights advocates, providers, major medical groups, drug manufacturers and the Biden administration. An appeal landed at the Fifth Circuit court, which has jurisdiction over the Amarillo court. A three-judge panel blocked a part of the judge’s ruling, and a subsequent ruling at the Supreme Court paused the lower-court ruling as the legal challenge continues. Read More North Carolina Republicans approve 12-week abortion ban as sweeping restrictions spread across US South Nebraska Republicans approve combined gender-affirming care ban and anti-abortion bill after epic filibuster Anti-abortion laws harm patients facing dangerous and life-threatening complications, report finds A Texas man sued his ex-wife’s friends for allegedly helping her with an abortion. Now they’re suing him Louisiana Republicans refuse rape and incest exceptions to state’s sweeping anti-abortion law What is mifepristone? The widely used pill in the abortion rights battle at the Supreme Court

Heatwaves can be uncomfortable at the best of times, but what if you’re already having hot flushes? Dr Naomi Potter, founder of Menopause Care and co-author of bestselling book, Menopausing, with Davina McCall, points out that eight in 10 people who go through menopause experience symptoms like hot flushes – a sudden surge of heat, often accompanied by redness and sweating. Night sweats and trouble sleeping are also common during perimenopause and menopause – not the sort of things you want to be dealing with when a heatwave hits. “The increasing temperatures can make hot flushes and night sweats worse, and make it harder to cool down when you do experience them,” says Potter, explaining that the lack of oestrogen associated with menopause affects the part of the brain that helps regulate body temperature. “If you’re already hot and sweaty, then having a night sweat or hot flush can just make everything worse and uncomfortable.” Here’s her advice for getting through the summer heatwaves… Travelling “Public transport can be awful at the best of times in the heat, especially when travelling on tubes, trains and buses where you’re cramped in, so if you experience a hot flush while travelling, it can be extremely unpleasant,” Potter says. “Try carrying water and a small fan, to give some comfort in these moments, if just for a short relief.” If you can, invest in a water bottle designed to keep liquids cold, so you’ll always have something cool to sip when you need to. Be drink savvy Speaking of drinks, Potter also suggests trying to limit alcohol, coffee and sugary beverages, especially if menopause symptoms are proving troublesome. Iced tea and water are ideal options. “During the summer, you’re more likely to be dehydrated, and alcohol, coffee and fizzy drinks worsen dehydration,” she explains. “So it’s worth bearing that in mind and staying hydrated with water.” Sleep Menopause might already be impacting your mood and energy levels, so sleepless nights can be a double whammy. “In the case of night sweats, you’ll often experience broken and interrupted sleep, which has a knock-on effect and impact on lifestyle and work the next day,” says Potter. “Create a cool sleeping environment by wearing light breathable bed clothes and have a spare by the bed in case you wake up sweaty, so you can change without having to properly wake up to find new clothes,” she suggests. Plus, a well-positioned bedroom fan will be your summer best friend. Dress light It goes without saying that clothing also affects temperature – so if hot flushes are bothering you, tweaking your wardrobe could certainly help. Potter suggests dressing in “lightweight, breathable fabrics” such as cotton or linen. Plus, a light pair of cycling shorts/long knickers under skirts and dresses can help massively with sweating and discomfort at this time of year. Get the right support Heatwave or no heatwave, menopause doesn’t have to mean suffering in silence and just soldiering on if symptoms are impacting you. “If somebody is having symptoms, then it is definitely worth seeing their GP because there’s lots that can be done,” says Potter. “And if you have a menopause-friendly workplace, it is definitely worth talking to [managers] because with recently headlines, many workplaces are much more supportive of the menopause. “I think it’s vital that conversations like this continue,” Potter adds. “Without speaking about experiences, then there is no way for people to realise that this is a normal life event, and there is help if it is required.” Storing HRT in the heat Finally, if you are taking hormone-replacement therapy (HRT), make sure it’s being stored correctly when temperatures soar. “Most HRT should be stored at room temperature. If this is the case with yours (it will say on the side of the packaging), do not refrigerate or freeze it. Instead, storing it in a cool dark place, away from direct light, should be fine,” says Potter. You will want to keep it away from excessive temperatures though – basically anywhere that can get particularly hot when it’s sunny, such as inside cars, on window ledges. “And aircraft holds,” Potter adds, “where temperatures are unknown and can rise rapidly.”

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By Brendan Pierson A U.S. appeals court ruled on Wednesday to restrict access to the abortion pill mifepristone,

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