Texas is trying to limit access to abortion pills by cracking down on internet service providers and credit card processing companies. These tactics reflect the reality that, post-Roe, the internet is a critical channel for people seeking information about abortion or trying to buy pills to terminate a pregnancy—especially in states where they can no longer access these things in physical pharmacies or medical centers.
Texas has long been a laboratory for anti-abortion political tactics, and on March 15, a US District Judge heard arguments in a case that’s seeking to reverse the FDA approval of mifepristone, a drug that can be used to terminate an early pregnancy. The case would limit online-facilitated abortions and would have far-reaching consequences even in states that are not trying to restrict abortion.
Earlier this month, Republicans in the Texas state legislature introduced two bills to restrict access to abortion pills. The first bill, HB 2690, would require internet service providers (ISPs) to ban sites that provide access to the pills or information about obtaining them. Companies like AT&T and Spectrum would have to “make every reasonable and technologically feasible effort to block Internet access to information or material intended to assist or facilitate efforts to obtain an elective abortion or an abortion-inducing drug.” The bill would also forbid both publishers and ordinary people from providing information about access to abortion-inducing drugs.
The second bill, SB 1440, would make it a felony for credit card companies to process transactions for abortion pills, and would also make them liable to lawsuits from the public.
Blair Wallace, a policy and advocacy strategist at the ACLU of Texas, a nonprofit that advocates for civil liberties and reproductive choice, said the recent developments mark “a new frontier for the ways in which they’re coming for [abortion access],” adding: “It is really terrifying.”
Wallace sees it as a continuation of a strategy that seeks to criminalize whole abortion care networks with the aim of isolating people seeking abortions. More broadly, this strategy of censoring information and language has become a popular tactic in US culture wars in the last several years, and the proposed bill could incentivize platforms to aggressively remove information about abortion access out of concern for legal risk. Some sites, like Meta’s Instagram and Facebook, have reportedly removed information about abortion pills in the past.
So what might the outcome of all the Texas action be? Both the bill that targets ISPs and the misteprone case this week are unprecedented, which means neither is likely to be successful. That said, the tactics are likely to stay. “Will we see it again next session? Will we see parts of this bill stripped down and put into amendments? There’s like a million ways that this can play out,” says Wallace. Anti-abortion political strategy is coordinated nationally even though the fights are playing out at a state level, and it’s likely that other states will target online spaces going forward.
Online abortion resources can pose risks to privacy. But there are lots of ways to access them more safely. Here are some resources I recommend.
Leggett told researchers that she “became one” with her device. It helped her to control the unpredictable, violent seizures she routinely experienced, and allowed her to take charge of her own life. So she was devastated when, two years later, she was told she had to remove the implant because the company that made it had gone bust.
The removal of this implant, and others like it, might represent a breach of human rights, ethicists say in a paper published earlier this month. And the issue will only become more pressing as the brain implant market grows in the coming years and more people receive devices like Leggett’s. Read the full story.
—Jessica Hamzelou
You can read more about what happens to patients when their life-changing brain implants are removed against their wishes in the latest issue of The Checkup, Jessica’s weekly newsletter giving you the inside track on all things biotech. Sign up to receive it in your inbox every Thursday.
If you’d like to read more about brain implants, why not check out:
+ Brain waves can tell us how much pain someone is in. The research could open doors for personalized brain therapies to target and treat the worst kinds of chronic pain. Read the full story.
+ An ALS patient set a record for communicating via a brain implant. Brain interfaces could let paralyzed people speak at almost normal speeds. Read the full story.
+ Here’s how personalized brain stimulation could treat depression. Implants that track and optimize our brain activity are on the way. Read the full story.
Burkhart’s device was implanted in his brain around nine years ago, a few years after he was left unable to move his limbs following a diving accident. He volunteered to trial the device, which enabled him to move his hand and fingers. But it had to be removed seven and a half years later.
His particular implant was a small set of 100 electrodes, carefully inserted into a part of the brain that helps control movement. It worked by recording brain activity and sending these recordings to a computer, where they were processed using an algorithm. This was connected to a sleeve of electrodes worn on the arm. The idea was to translate thoughts of movement into electrical signals that would trigger movement.
Burkhart was the first to receive the implant, in 2014; he was 24 years old. Once he had recovered from the surgery, he began a training program to learn how to use it. Three times a week for around a year and a half, he visited a lab where the implant could be connected to a computer via a cable leading out of his head.
“It worked really well,” says Burkhart. “We started off just being able to open and close my hand, but after some time we were able to do individual finger movements.” He was eventually able to combine movements and control his grip strength. He was even able to play Guitar Hero.
“There was a lot that I was able to do, which was exciting,” he says. “But it was also still limited.” Not only was he only able to use the device in the lab, but he could only perform lab-based tasks. “Any of the activities we would do would be simplified,” he says.
For example, he could pour a bottle out, but it was only a bottle of beads, because the researchers didn’t want liquids around the electrical equipment. “It was kind of a bummer it wasn’t changing everything in my life, because I had seen how beneficial it could be,” he says.
At any rate, the device worked so well that the team extended the trial. Burkhart was initially meant to have the implant in place for 12 to 18 months, he says. “But everything was really successful … so we were able to continue on for quite a while after that.” The trial was extended on an annual basis, and Burkhart continued to visit the lab twice a week.
“A patient should not have to undergo forcible explantation of a device,” says Nita Farahany, a legal scholar and ethicist at Duke University in North Carolina, who has written a book about neuro rights.
“If there is evidence that a brain-computer interface could become part of the self of the human being, then it seems that under no condition besides medical necessity should it be allowed for that BCI to be explanted without the consent of the human user,” says Ienca. “If that is constitutive of the person, then you’re basically removing something constitutive of the person against their will.” Ienca likens it to the forced removal of organs, which is forbidden in international law.
Mark Cook, a neurologist who worked on the trial Leggett volunteered for, has sympathy with the company, which he says was “ahead of its time.” “I get a lot of correspondence about this; a lot of people inquiring about how wicked it was,” he says. But Cook feels that outcomes like this are always a possibility in medical trials of drugs and devices. He stresses that it’s important for participants to be fully aware of these possibilities before they take part in such trials.
Ienca and Gilbert, however, think something needs to change. Companies should have insurance that covers the maintenance of devices should volunteers need to keep them beyond the end of a clinical trial, for example. Or perhaps states could intervene and provide the necessary funding.
Burkhart has his own suggestions. “These companies need to have the responsibility of supporting these devices in one way or another,” he says. At minimum, companies should set aside funds that cover ongoing maintenance of the devices and their removal only when the user is ready, he says.
Burkhart also thinks the industry could do with a set of standards that allow components to be used in multiple devices. Take batteries, for example. It would be easier to replace a battery in one device if the same batteries were used by every company in the field, he points out. Farahany agrees. “A potential solution … is making devices interoperable so that it can be serviced by others over time,” she says.
“These kinds of challenges that we’re now observing for the first time will become more and more common in future,” says Ienca. Several big companies, including Blackrock Neurotech and Precision Neuroscience, are making significant investments in brain implant technologies. And a search for “brain-computer interface” on an online clinical trials registry gives more than 150 results. Burkhart believes around 30 to 35 people have received brain-computer interfaces similar to his.
Leggett has expressed an interest in future trials of brain implants, but her recent stroke will probably render her ineligible for other studies, says Gilbert. Since the trial ended, she has been trying various combinations of medicines to help manage her seizures. She still misses her implant.
“To finally switch off my device was the beginning of a mourning period for me,” she told Gilbert. “A loss—a feeling like I’d lost something precious and dear to me that could never be replaced. It was a part of me.”
