By Chelsea Cirruzzo and Ben Leonard

Some Republicans suggest that U.S. gender-affirming care should be modeled after such care in Europe. | Lionel Bonaventure/AFP via Getty Images

GOP LOOKS TO EUROPE — Republicans in Congress are pointing to an unlikely source to lend credence to their push to restrict gender-affirming care for minors: European governments.

POLITICO’s Kaja Klapsa reports that GOP lawmakers argue that progressive Europe leads the way in limiting access to such care. Many U.S. medical groups support gender-affirming care, which can include hormone treatments, surgery and puberty blockers.

“Sweden, France, Norway, and the U.K. are reversing course and asking questions,” Rep. Wesley Hunt (R-Texas) said at a House Judiciary hearing this summer. “What do their doctors know that our doctors don’t?”

Many Republicans, including Missouri Attorney General Andrew Bailey, have cited Europe’s approach to transgender care to make the case for backing new U.S. laws barring or restricting such care in 21 Republican-led states.

However, a POLITICO review of transgender care in Europe found more nuance. While Europeans debate who should get care and when, only Russia has banned the practice. The reassessment of standards in some European countries has aimed to tighten eligibility for gender-affirming care but has also sought to boost research studies that include minors.

And what Europe does will likely impact the debate in the U.S. 

The U.K. has seen some of the most heated debates. Last year, the National Health Service said it would close the only provider of gender-affirming care for minors in England and Wales. It cited a review raising concerns that patients were being referred too quickly. Instead, the British plan to open new clinics with stringent eligibility criteria.

France’s guidelines warn that overdiagnosis is real, but French doctors who offer such care say the guidelines don’t impede access to care. Kids are eligible for hormone treatments at any age and breast removal from age 14, but they typically don’t get such care until 16 or older.

Sweden was the first country to allow people to legally change their gender in 1972 but recently restricted eligibility criteria. A Stockholm hospital under fire over allegedly rushing kids into treatment in 2021 opted to stop prescribing hormones to minors, saying they should only be offered in trials. A government agency recently said puberty blockers, mastectomies and hormones should be used in only “exceptional cases.”

Norway’s independent health care investigation board recommended defining gender-affirming care for minors as “experimental” but hasn’t implemented the recommendations after a year and a half. The group with the authority to set formal guidelines has instead maintained current rules allowing puberty blockers once puberty has started.

WELCOME TO TUESDAY PULSE. We hope you’re reading this newsletter with a warm mug of coffee as you enjoy a splendid fall day. Send your tips, scoops and feedback to [email protected] and [email protected] and follow along @_BenLeonard_ and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with POLITICO reporter Megan R. Wilson, who explains why proposed legislation to make health care more affordable could cost hospitals billions despite their clout on Capitol Hill.

A message from Coalition to Protect America’s Health Care:

Access to care is on the line. Congress is considering legislation that would cut billions of dollars in funding for hospitals. No other provider is open 24/7 to all who need care, with the ability to treat sicker and more complicated patients, while still responding to emergencies, natural disasters, and more. It’s time to reject cuts to care and stand up for America’s hospitals.

Rep. Michael McCaul wants fellow Republicans to support bipartisan legislation to help stem the flow of fentanyl into the U.S. | Jacquelyn Martin/AP Photo

A FENTANYL DEAL WITH DEMS — House Republican Michael McCaul’s children have lost five friends to fentanyl. That tragedy has led him to embark on a difficult task in partisan Washington: selling his fellow Republicans on a deal with the Democrats, Carmen reports.

The Texan is using his chair on the House Foreign Affairs Committee to support President Joe Biden’s diplomacy with Mexico, the source of the illicit fentanyl that’s causing tens of thousands of fatal overdoses, and to promote bills that would give Biden more tools to fight the cartels.

In so doing, McCaul’s crossing GOP colleagues who want to highlight Biden’s flagging battle against the deadly synthetic opioid, and he’s pushing for floor votes at a time when the House is focused on electing a speaker and funding the government. The threat is urgent, he says, and new sanctions against the fentanyl supply chain could save lives.

Why it matters: Nearly 110,000 Americans died of drug overdoses last year. That figure spiked from around 70,000 before the Covid-19 pandemic, according to the Centers for Disease Control and Prevention, and has shown no signs of abating.

An uphill battle: In Congress, many in the GOP have seized on the bad news to call out Biden, tying it to what they see as the president’s lax border-security policies. In July, then-Speaker Kevin McCarthy assembled a task force on combating the cartels to draw attention to the GOP’s willingness to take the fight to them.

What to watch: A White House official granted anonymity to discuss cooperation with a GOP member of Congress said the administration wants to continue working with McCaul “on legislative actions that will further our shared objective.”

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MORE MONEY FOR MRNA IN AFRICA — The Bill & Melinda Gates Foundation announced Monday it will give $40 million to fund three African and one European vaccine manufacturers using mRNA to develop shots, Carmen reports.

The Institut Pasteur de Dakar and Biovac, research institutes with vaccine manufacturing experience based in Senegal and South Africa, will each receive $5 million to acquire mRNA technology from Belgium-based Quantoom Biosciences to develop locally relevant vaccines, the Gates Foundation said. Quantoom will receive $20 million to further advance the technology and make it cheaper. Another vaccine manufacturer from a low- or middle-income country, yet to be named, will also receive $10 million, the Foundation said.

EU COUNTRIES DECLARE ‘SOCIAL EMERGENCY’ — EU countries have agreed that precarious work conditions can negatively impact mental health and have committed to take action to address the psychological impact of arrangements such as gig and temporary work, POLITICO’s Ashleigh Furlong reports.

On Monday, the EU's Employment, Social Policy, Health and Consumer Affairs Council set out its position on mental health and employment by adopting the first-ever set of conclusions on the topic.

Yolanda Díaz Pérez, Spain’s acting minister for work and social economy, described the situation as “a social emergency,” classifying it as a “public health problem … linked to labor rights.”

Under the Council’s conclusions, countries agreed to look at the legal and practical implications of new forms of work like gig and temporary agency work, promote quality employment practices to combat precariousness at work and beef up public systems that safeguard mental health at work, such as by providing the systems with additional resources.

A message from Coalition to Protect America’s Health Care:

DISPARITIES IN EHR USE — Providers at two hospitals between 2018 and 2020 were less likely to look at a patient of color’s electronic health records than a white patient’s, according to a new study in JAMA Network Open.

The study, which looked at more than 243,000 adult inpatient hospital stays between 2018 and 2020 at Vanderbilt University Medical Center and Northwestern Medicine, analyzed the race and ethnicities of patients and observed health professionals' use of their electronic health records.

It found that clinicians were significantly less likely to have high levels of engagement with the EHRs of patients of color, which included Black and Hispanic patients, than white patients. Types of engagement measured included updating medical notes, scanning patient barcodes and viewing patient information, such as a list of health issues or medication records.

Why it matters: While the researchers didn’t study the quality of care patients received, they said higher electronic health record engagement could lead to more thoroughness and meticulous care.

According to the researchers, reasons for the disparities could include less access to health care services for marginalized communities, language and communication barriers, underrepresentation of marginalized groups in clinical trials and racial discrimination in health care.

It’s important to note that the research was done at only two centers, so outcomes may differ in another setting.

A NEW POLITICO PODCAST: POLITICO Tech is an authoritative insider briefing on the politics and policy of technology. From crypto and the metaverse to cybersecurity and AI, we explore the who, what and how of policy shaping future industries. We’re kicking off with a series exploring darknet marketplaces, the virtual platforms that enable actors from all corners of the online world to traffic illicit goods. As malware and cybercrime attacks become increasingly frequent, regulators and law enforcement agencies work different angles to shut these platforms down, but new, often more unassailable marketplaces pop up. SUBSCRIBE AND START LISTENING TODAY.

COVID WAVE SHOWS SIGNS OF CURBING — The late summer rise in Covid-19 hospitalizations appears to be wavering. Since mid-September, hospitalizations have declined, and the most recent week ending on Sept. 30 saw a 6 percent decline, per CDC data.

However, in that same week, Covid deaths rose 3.8 percent. Data is limited, though, since the CDC stopped tracking individual Covid cases, relying primarily on hospitalization and death data.

And while the most recent Covid wave looks to be ebbing, the number of patients visiting their providers for flu-like symptoms has ticked up, and respiratory syncytial virus cases are rising, according to CDC data. Vaccines are now available for all three illnesses.

The Washington Post reports on the mental and physical challenges that childhood cancer survivors face later in life.

ProPublica reports on the reliability of a test used on stillborn babies that’s been used to send women to prison for murder.

POLITICO’s Alice Miranda Ollstein and Lauren Gardner report on a handful of individual pharmacies dispensing abortion pills.

A message from Coalition to Protect America’s Health Care:

When it matters most, will the care be there? Hospitals are the cornerstones of our communities, but supply chain challenges, high inflation, and workforce shortages have pushed them to the brink – especially those in rural and underserved communities. Now, some in Congress are proposing billions of dollars in cuts to hospital-based care. Nowhere else do patients have access to quality, around-the-clock care, regardless of their ability to pay. America’s hospitals and hospital systems care for sicker patients, provide more complex procedures, are ready on standby during emergencies, and, for many, are the only trauma care centers for miles. Protect care for all to ensure it is there, when it matters most.

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