The HPV vaccine has lowered the number of women with HPV, a sexually transmitted disease that can lead to cancer, according to a study in the journal Pediatrics. NPR’s Audie Cornish talks to Dr. Joseph Bocchini from Louisiana State University to get his read on the results.

Transcript

AUDIE CORNISH, HOST:

A vaccine has dramatically cut the number of young women with HPV, a sexually transmitted disease that can lead to cancer. Since the vaccine was introduced a decade ago, rates among teens have dropped 64 percent. That’s according to a study in this week’s Pediatrics. But many of those eligible to get the vaccine are either not getting the full series of shots or not getting any at all. Joining us to talk about this dilemma is Dr. Joseph Bocchini. He’s an infectious disease specialist in Shreveport, La., who has advised the CDC on the disease. Welcome to the program.

JOSEPH BOCCHINI: Thank you very much.

CORNISH: Now, are these results as dramatic as they sound – a drop in 64 percent among teens?

BOCCHINI: These are very dramatic results, especially with what you mentioned at the outset. With so few individuals receiving this vaccine as recommended, to see this much of a drop is – in 14- to 19-year-old girls – is really dramatic and really indicates how effective this vaccine is in preventing infection with the four types of HPV that are included in the vaccine.

CORNISH: You know, we’ve reported in the past about reluctance from parents, maybe, who don’t want to encourage their daughters to get this vaccine, maybe don’t want to talk about it because it involves a sexually transmitted disease and doctors, maybe general practitioners, who haven’t been aggressive about putting it out there. Is there a chance that this new research can help change that conversation?

BOCCHINI: I hope so because I think that you’re absolutely right. The data that’s available indicates that some providers – some physicians and other vaccinators – are not making a strong recommendation for HPV vaccine or considering it sort of as an option at 11 to 12 rather than making a strong recommendation. That’s not the correct approach because we know that for any vaccine-preventable disease, the best time to get the vaccine is before a person is exposed. And we have a great opportunity at age 11 to 12 to vaccinate all boys and girls against a group of viruses that are important causes of cancer.

CORNISH: It sounds like that you’re almost recommending a way to talk about it as well. Like, if people don’t want to talk about the sex part of sexually transmitted disease, you want to focus on the potential – the cancer risk.

BOCCHINI: Correct. Sexually transmitted disease does not need to be part of the conversation. The conversation should be that we have a vaccine that could prevent cancer. You have an opportunity to prevent approximately 90 percent of cancers that are associated with the human papillomavirus. In general, we don’t talk about how patients acquire the diseases that we want to prevent with vaccines. There’s no reason to do that routinely for HPV.

CORNISH: Vaccine is also recommended for boys who can get and transmit the disease. And they weren’t part of this study. What’s known about the rate of vaccination among them?

BOCCHINI: Well, unfortunately, the rate of vaccination for boys is even lower than it is for girl. Only about 35 percent have received a single dose, and about a third of those complete the series. So we have a long way to go to try and improve immunization rates for both boys and girls. There are over 9,000 cases of HPV-associated cancer in males each year in the United States. Many of those cases are cancers of the mouth and throat. So it is very likely that we could see a significant drop in cases of cancer of the mouth and throat in both men and women with the use of HPV vaccines.

CORNISH: Right now, the vaccine is mandatory in Virginia, Rhode Island and the District of Columbia. Do you think that it should be mandatory in all states?

BOCCHINI: Well, I think that is one way that we can significantly improve immunization rates, but I think at the present time, we need to focus on making parents more aware of the role of HPV in the development of a variety of different cancers. I think we can then start talking about whether mandates are needed to try and improve the uptake of the vaccine.

CORNISH: That’s Dr. Joseph Bocchini. He’s a pediatric infectious disease specialist at Louisiana State University in Shreveport. Dr. Bocchini, thank you so much for speaking with us.

BOCCHINI: Thank you very much. I enjoyed the opportunity.

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.

“I am what I like to call ‘new stroke’,” says Troy Hodge, a 43-year-old resident of Carroll County, Md. With a carefully trimmed beard and rectangular hipster glasses, Hodge looks spry. But two years ago, his brain stopped communicating for a time with the left half of his body.

He was at home getting ready for work as a food service director at a nearby nursing home. Hodge remembers entering the downstairs bathroom to take his blood pressure medications. He sat down on the bathroom floor and couldn’t get up. He says he felt so hot, he actually splashed some toilet water on his face because he couldn’t reach the sink.

When Hodge didn’t show up for work, a colleague got worried and came over. She called 911 when she found him on the floor.

“I remember telling her not to let me die,” says Hodge, “and from then on I really don’t remember that much.” He woke up a day or so later at a trauma center one state over, in Delaware.

“Troy experienced what we call an intracerebral hemorrhage, which basically just means bleeding within the substance of the brain,” says Dr. Steven Kittner, a neurologist at the University of Maryland School of Medicine. Hodge’s high blood pressure probably damaged the tiny vessels in his brain, Kittner says.

Hodge is one of many Americans having strokes at a younger age. About 10 percent of all strokes occur in people between 18 and 50 years old, and the risk factors include some that Hodge had: high blood pressure, overweight, off-kilter cholesterol, smoking and diabetes.

As part of his occupational therapy session, Troy Hodge gets little jolts of electricity through patches on his left arm. The stimulation is thought to help rekindle communication between the brain and nerves and muscles that were affected by his stroke. Matailong Du/NPR hide caption

toggle caption Matailong Du/NPR

In particular, ischemic strokes — caused by a blockage in the blood vessel, rather than a bleed — are sharply increasing among people under age 50, statistics show.

This is not to say that stroke is becoming a disease of young people.

“The majority of strokes are still happening in older individuals, says Dr. Amytis Towfighi, a vascular neurologist with the University of Southern California. “What’s concerning is that the incidence and prevalence of stroke amongst younger individuals has increased, and it’s increasing significantly.”

The most likely underlying reason, she says, is obesity; the constellation of health issues that come with it can wear down or block a person’s blood vessels.

A national survey found that between 1995 and 2008, the increased number of young people (ages 15 to 44) who were hospitalized for stroke closely followed an increase in several chronic conditions, including high blood pressure, diabetes, obesity and lipid disorders.

“People who are obese are at greater risk for high blood pressure, and high blood pressure is the leading risk factor for stroke,” says Dr. Mary George, senior medical officer with the CDC’s Division for Heart Disease and Stroke Prevention and an author on the national study. In 1995, about 3 percent of patients between 15 and 34 years old who had ischemic strokes were obese. By 2007, 9 percent were obese.

“One in three men in that age group had hypertension,” says George. “That’s very high.”

Hodge is a big guy, and he says he’d had high blood pressure for a long time. Perhaps, on the day of his stroke, the extra pressure on his circulatory system just caught up with him. Like water in a bent hose, the volume of blood moving through his body overloaded a delicate passageway deep inside his brain, and the vessel burst.

It was key to his survival that Hodge’s colleague found him quickly, so that he was able to get to surgeons who could drain some of the blood before the stroke caused irreversible damage. Still, in one day, Hodge became a patient at a facility just like the ones he used to work in.

“You know how they say, ‘When you have a baby it changes your life?’ Well, this changes your life,” he says.

Occupational therapist Lydia Bongiorni works with Troy Hodge on grasping and lifting objects at a rehabilitation center in Gwynn Oak, Md. “You basically have to start over again,” Hodge says. “You retrain your brain to use your limbs.” Matailong Du/NPR hide caption

toggle caption Matailong Du/NPR

He couldn’t walk or do anything that involved both hands. He started making lists, he says, because his short-term memory took a hit. And even in the bitter cold, he’ll now head out the door with just a hoodie on.

“I’m not much of a coat wearer anymore because it’s just too hard putting it on,” Hodge explains.

With only half his body under control, he says, something as simple as getting dressed, cutting an onion or stepping off a curb suddenly became a huge task. Putting on socks, he says, is “an ordeal. It’s like an Oprah show.”

“You don’t think of things that you do until you can’t do them,” he says. “You basically have to start over again. I mean, you retrain your brain to use your limbs. You retrain your brain to remember. You retrain everything. It’s pretty devastating.”

Hodge ended up living in a rehab facility for a year, relearning in his 40s how to do things that he’d done almost every day of his life.

Towfighi says a lot of her younger patients have similar experiences. She oversees neurological care for the Los Angeles County Department of Health Services, where the average age of stroke patients is 56. Even though young people tend to recover their abilities better, they can also have a tough time with recovery.

“It often affects the entire family when a young individual has a stroke,” Towfighi says, because the family loses a breadwinner. “I also do research on depression after stroke and found that a younger age is a risk factor for depression after stroke.”

Hodge didn’t get depressed, but he did have to make some tough adjustments. He told his 18-year-old daughter he wouldn’t be able to pay for her college or her car, and that she’d have to be on her own for a bit because he couldn’t help out the way he used to.

“It was a long year, and there were times when I would just cry and not stop crying. But it passed,” says Hodge.

Now, he has a one-story apartment and works part time at an exercise facility for the disabled. He’s working on his blood pressure and trying to cut out cigarettes. Once a week, he goes to occupational therapy to work on everyday skills. To help get through it, he named his problem limbs. His left leg is Eddie. His left arm is Douglas. Hodge’s cane is named Genevieve, after his mom.

“Eddie has done very well,” Hodge says. “I think he will continue to do well. Douglas? I talk to Douglas because I’m not so sure about him. He just kind of does his own thing.”

Giving one’s troubled limbs a nickname or pep talk isn’t unusual, says Lydia Bongiorni, an occupational therapist who worked with Hodge when he first entered rehab. “I’ve had quite a few patients do that,” she says. “It shows a sense of humor. That’s good.”

At an outpatient neurorehabilitation clinic at the University of Maryland, Bongiorni and Hodge spend a lot of time working with Douglas — Hodge’s notoriously uncooperative left arm and hand. It’s stuck in a stiff curl.

“Troy had a stroke a couple years ago, and people used to think you would never get movement back,” says Bongiorni. But Hodge’s muscles are fine, she explains — it’s just the messaging system from his brain to his muscles that needs repair. “I tell people that the brain wants to reconnect with that arm again, and we have to tap into different pathways of doing that.”

With a device the size of a sandwich, Bongiorni delivers a jolt of electricity through patches stuck on Hodge’s arm. It takes a lot of tiny muscles working together to move a hand, and the electrical stimulation is thought to send signals that wake up the brain to the communication it needs to do with nerves and muscles.

Hodge’s face strains as he grasps a deodorant stick and brings it haltingly up to his armpit. Bongiorni is trying to get him to use his left hand as a tool, rather than like a stump. They practice washing dishes, walking with a weight in that hand, and bringing a cup up to his mouth. Next on the list of Hodge’s goals: taking out the trash.

“I’m not up to walking it to the dumpster just yet,” he says. “I’m going to get there. I’d say by the summertime I’ll probably be taking it to the dumpster.”

Regaining his motion is not going to be easy. He’s going to have to keep practicing these things every day on his own, like a musician mastering an instrument. But, he says, “I’m only 43, so I have time to do that.”

The spread of Zika is taxing Colombia’s already over-burdened health care system.

Transcript

LINDA WERTHEIMER, HOST:

Zika is on the rise in Colombia. According to new figures just released, more than 37,000 people have been sickened by the virus since an outbreak began there last fall. For most people, Zika symptoms are mild, but the uptick is worrying because the virus could be linked to complications like birth defects and a rare neurological condition that can cause temporary paralysis. It’s called Guillain-Barre syndrome. NPR’s Nurith Aizenman is in Colombia in a place that’s seen a dramatic number of Zika infections. Good morning, Nurith.

NURITH AIZENMAN, BYLINE: Good morning.

WERTHEIMER: Let’s talk first about Guillain-Barre.

AIZENMAN: Yeah. So as you just said, Linda, Guillain-Barre, it’s a condition that affects your neurological system. Basically, your immune system attacks your nerves, and in a lot of cases, it can be really severe. People can be fully paralyzed for weeks. They have to be on breathing machines. It can take you months to recover, and some people never walk again. Normally, it’s extremely rare, but people here are really worried because there’s been this dramatic surge in cases since the Zika outbreak began. And this is happening in a lot of the countries where the Zika outbreak is happening. It’s in Brazil, in El Salvador, Venezuela. I’m in the city called Cucuta, and I visited a couple of ICUs here, including one at the main hospital. I talked to a neurologist named Jairo Lizarazo. Here he is.

JAIRO LIZARAZO: (Foreign language spoken).

AIZENMAN: He’s saying that around the end of January they suddenly started to get a lot of cases, and now they’re seeing about a case every day – a new case every day. Across Colombia, they’ve seen almost a hundred cases since last fall, which is just way more than usual.

WERTHEIMER: Do we know for sure that Guillain-Barre is linked to Zika virus?

AIZENMAN: It’s an open question. It’s hard to tell if someone has had Zika unless you test them right away while they still an active infection, but the Guillain-Barre symptoms tend to develop a while afterwards. And even if someone has had Zika, you’ve got to prove it wasn’t just a coincidence that they then developed Guillain-Barre. So people here, including Dr. Lizarazo who we just heard from, are launching studies to look into this, but there are no firm answers yet.

WERTHEIMER: OK. What about microcephaly, babies born with abnormally small heads? What is happening with that in Colombia?

AIZENMAN: It’s definitely a concern. The latest numbers are that about 6,300 pregnant women in Colombia are suspected to have fallen sick with Zika. So far, there haven’t been any of those babies born with microcephaly like we saw – we’ve seen in Brazil. But that said, if you think about the time wave of the Zika epidemic, it hit Brazil first. The numbers in Colombia didn’t really start swelling until late last year.

And researchers suspect that Zika may cause these birth defects if the woman is infected in her first trimester. So based on that timing, officials we’ve spoken with say they would expect that if Zika is causing microcephaly it would be several more months before we’d see these cases in Colombia. So, for now, they’re monitoring pregnant women who’ve had Zika. They’re going to run a very large study in cooperation with the U.S. Centers for Disease Control, and Colombia is seen as a key to trying to prove a link between birth defects and Zika.

WERTHEIMER: We don’t have too much time left, but let me ask you how the health care system in Colombia is holding up.

AIZENMAN: There are a lot of dedicated and excellent doctors here, but from what I’ve seen, the system is already feeling the strain. I’ve gone to several clinics where they’re asking pregnant women to come in for more tests. And these Guillain-Barre cases are really expensive. One of the main treatments for the disease requires you to clean out the blood – antibodies from the blood. It’s really costly and here is Dr. Lizarazo again, the neurologist from the hospital in Cucuta.

LIZARAZO: (Foreign language spoken).

AIZENMAN: He’s saying there’s already a deficit of ICU beds, and with more Guillain-Barre, it’s going to be really tough.

WERTHEIMER: NPR’s global health correspondent Nurith Aizenman, thank you very much.

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.

The world wasn’t prepared for Zika to fly across continents in the span of a few months. In 2015, when the virus began rapidly spreading across the Americas, health workers were surprised, and researchers were caught flat-footed when it came time to provide information to protecting the public’s health.

Scientists misjudged Zika virus as a minor and trivial ailment when it was discovered in 1947, says Dr. Ken Stuart, the founder and director of the Center for Infectious Disease Research in Seattle. That oversight is one reason for the dearth of medical knowledge around the virus.

But it didn’t have to be that way, he says. Stuart spoke with NPR’s Ari Shapiro on why the Zika outbreak has unfolded the way it did and how things could have gone better. This interview has been edited for length and clarity.

Interview Highlights

On why scientists didn’t pay much attention to Zika for decades after it was identified

It was discovered in Uganda and was thought to be isolated and to occur infrequently. So there was essentially no research done. I think only one person in the U.S. was working on Zika virus.

We were unaware of the severity of the disease … [and] were unaware this virus had the capability for getting distributed so rapidly.

On trying to get a handle on emerging infectious diseases

[We can] try to deploy resources consciously to develop fundamental understanding of groups of infectious agents and diseases they cause. Zika virus is a fairly small virus that has a single strand of RNA as its genome, fairly simple. And there are other related viruses [like Spondweni virus], so working on related viruses and how that virus affects the cells and individuals it infects when it causes disease will help with the next outbreak of a related organism.

On why that doesn’t always happen

This really goes back to funding priorities. Much of the funding devoted to infectious disease today is in reaction to outbreaks. Therefore, we’re not generally prepared to respond quickly.

In other cases there are diseases that are very rare but they have an advocacy group that generates research activities. In the case of diseases like Zika, which were isolated in remote areas of the world where that population had no resources or advocacy group, there was no push to do research.

On how we’ll respond to outbreaks in the future

We’re not stuck with what we’ve got. There are conversations between federal funding agencies and private organizations to try to prioritize the utilization of their resources, and I would say the NIH has been a leader in supporting the fundamental research that actually, probably positions us best to be prepared to respond to these disease outbreaks.

Midway through Matt Keil’s second deployment in Iraq, he came home and married his fiancee, Tracy, in 2007.

He had two weeks R&R; no time for a honeymoon.

Before he went back to war the couple had the sort of conversation unique to newlyweds in the military. “I told her if you get a phone call that I’m injured, I’m probably fine,” Matt says. “But if they come to the apartment or to your work in person, then I’m dead.”

Six weeks later the news came — a phone call, thankfully. Matt had been shot in the shoulder. It wasn’t until Tracy got to Walter Reed Army Medical Center that she got the full story. The sniper’s bullet had nicked Matt’s spine.

“The doctor came in and told me he was paralyzed from the neck down, and he said it was a ‘Christopher Reeve’-type injury,” says Tracy.

Questions overwhelmed them about the future, including whether they’d ever be able to have children. It seemed like something they could figure out later.
“They were kinda telling us we’re putting the cart before the horse,” Matt recalls. “You guys got to get through a whole hell of a lot of rehab.”

Time was running out, though, and the Keils didn’t realize it.

To have children they’d need help: in vitro fertilization. But IVF is expensive, costing, on average, at least $12,000 per cycle of treatment, according to the American Society for Reproductive Medicine.

The Pentagon’s health care system for active-duty troops covers IVF for wounded soldiers like Matt Keil. The Department of Veterans Affairs for veterans doesn’t. By the time the Keils learned about the difference, it was too late.

“We were just swallowing the fact that he was never going to go back to work,” Tracy says. “But finding out that IVF wouldn’t be covered because we agreed to retire out so quickly, that was hard, because nobody told me that.”

A law passed in 1992 made it illegal for the VA to pay for IVF, which some people oppose because embryos are often destroyed in the process.

The only option for the Keils would have been to get the procedure done immediately after Matt’s injury. They had missed the window.

Matt was just starting to accept that with the limits of current science he might never walk again. But the limit on his ability to pay for IVF was put in his way by Congress.

“This is a direct result of a combat injury,” says Tracy. “Don’t tell me that his service wasn’t good enough for us to have a chance at a family. Because we’ve already lost so much. I just want to have a family with the man that I love and please don’t make this any worse than it already has to be.”

In the decades since Congress banned IVF for the VA, the procedure has become much more common. And about 1,400 troops came back from Iraq and Afghanistan with severe injuries to their reproductive organs. Thousands more have head injuries, paralysis or other conditions that make IVF their best option.

Bills to change the law come up periodically, only to be blocked at the last minute, says Sen. Patty Murray, a Democrat from Washington. “They don’t come out and say that directly, but there continues to be a backroom concern about the practice of IVF,” Murray says. Murray’s bipartisan IVF bill nearly passed last summer.

Republican Sen. Thom Tillis of North Carolina, who is staunchly against abortion rights, effectively blocked it. Tillis declined requests for comment, but said at the time that he opposed the bill because other problems at the VA need to be fixed first.

The Congressional Budget Office estimates a change in VA policy to pay for fertility treatment could cost more than $500 million over four years.

Murray says vets should get the same options as active-duty troops. “It’s really ridiculous that Congress would deny a widely used medical procedure to our veterans just because of their own … beliefs,” she says.

Rep. Jeff Miller, the Republican chairman of the House Committee on Veterans’ Affairs, said he’s working toward a compromise that “meets the needs of this special group of severely injured veterans while being sensitive to concerns surrounding IVF procedures.”

In the meantime, many fertility clinics across the country offer discounted rates for veterans who are paying out of their own pockets for IVF.

For the Keils, who spent the year after Matt’s injury figuring out how their new life could work, offers like that came too late.

“We weren’t at a good spot in our marriage at the time, and thought that if we’re going to bring kids into this world they need to be brought into a healthy relationship,” says Matt.

“What if we didn’t even end up staying together?” Tracy adds.

They took a year to work it out, and then decided it was for sure — their marriage would survive. They also wanted a family.

“We were ready, and it didn’t matter what it was going to take,” Tracy says.

The VA told them what they already knew — no coverage for IVF. The decision still seemed crazy to them, considering how much medical care VA would pay for.

“I served my country. I was injured,” Matt says. “All my medical supplies are paid for, but the one thing they won’t facilitate [by] paying — that I lost the ability to have — was a family.”

Paying for IVF on their own seemed impossible to Matt and Tracy.

The Keils play with their twins, Matthew and Faith, at their home near Parker, Colo., in 2012. Ed Andrieski/AP hide caption

toggle caption Ed Andrieski/AP

Matt’s condition meant that IVF would be even more of a financial strain than usual. Among other things, Tracy was her husband’s full-time caregiver, and they would need to hire help while she was getting treatments.

Their savings weren’t going to cut it.

But then a veterans charity paid for the Keils’ wheelchair accessible house, so they could target their money toward IVF. The local VFW held a fundraiser to help. Kids all around Denver and then Colorado set up lemonade stands and collected donations, too.

The couple’s twins, Faith and Matthew, were born in November 2010. They ride on the back of their dad’s motorized wheelchair. When he wants to lift them high in the air they jump on his feet and he reclines the chair until he’s upside down.

This winter the kids are outside building igloos and snowmen.

Thousands of vets have injuries that make IVF their only option for having a family. Matt and Tracy Keil say they want them all to get that chance.

U.S. manufacturers of medical devices started 2016 with a windfall — a two-year suspension of a controversial tax on their revenue.

Medical devices include a wide range of products and machines used in medical care, such as tongue depressors, endoscopes and MRI scanners, for example. Manufacturers say the tax on devices hurt their business. The Congressional Research Service estimates companies paid out $2.4 billion in 2014.

“When this tax went into place it forced us to make cuts and sustain those cuts,” says George Montague, chief financial officer of Minnesota-based Smiths Medical. His firm takes in more than $1 billion a year for its specialty medical products.

Smiths Medical had paid $10 million a year in medical device taxes, Montague says, “and so now we’re getting that funding back.” He insists the money will go into building the business.

“We’re making significant investment in our product portfolio — in improving our product portfolio,” Montague says. “And what this enables us to do is accelerate some of that investment.”

The medical technology industry has branded the device tax a job-killer. Montague says Smiths Medical will now be adding new jobs, but he doesn’t know how many.

Minnesota is home to a concentration of device makers, and U.S. Rep. Erik Paulsen, R-Minn., is a leading opponent of the tax. He says the law suspending it for two years could provide a major boost to Minnesota’s economy.

“There are estimates that because of Minnesota’s high concentration in this sector — essentially the largest in the world in a concentrated environment — that Minnesota would be paying 25 percent of the tax,” Paulsen says. “That’s a big deal to our economy.”

Bob Paulson is CEO of NxThera, a small firm in Minnesota that makes devices involved in the treatment of urological conditions. His company had only been paying the device tax since November, he says, when NxThera started selling products in the United States. The tax made it harder to find financing, he says, because investors balked at putting their money into an industry that’s been singled out to pay a tax. Thanks to the tax hiatus, he says, he now plans to enlarge his staff of 43 researchers and sales people.

“It absolutely means additional money that we can invest in both of those areas,” he says.

Still, some industry analysts question whether suspending the tax will significantly boost the number of jobs created.

The Congressional Research Service concluded the tax was having fairly minor effects on employment, changing payrolls by no more than two-tenths of 1 percent. The same report called the tax difficult to justify, and noted that such excise taxes are typically put in place to discourage a particular behavior, such as smoking.

Jason McGorman, a senior analyst with Bloomberg Intelligence, says the suspension won’t really change what big companies are doing, but will help their bottom lines. Big, publicly traded firms also might return the money to shareholders by buying up their own shares, he says.

“Smaller companies felt a bigger tax bite than the giants, so they are more likely to put the tax savings back into the business,” McGorman says.

Industry analyst Brooks West, of Piper Jaffray, says device makers would be smart to reinvest the windfall.

“Politically, they better spend this money on R and D,” West says, “or the government can look at this and say, you know, ‘Look, if you just pass this on to the shareholders, we’re going to reimpose the tax.’ “

But Rep. Paulsen says he doubts the tax will return. He’s optimistic the two-year tax suspension will become a permanent repeal.

This story is part of NPR’s reporting partnership with Minnesota Public Radio and Kaiser Health News.

The U.S. Supreme Court next month is scheduled to hear its biggest abortion case in at least a decade, and the reach of that decision will likely be impacted by the absence of Justice Antonin Scalia, who died over the weekend.

A Texas law requires that doctors have local admitting privileges, and that clinics make costly building upgrades to operate like out-patient surgical centers. Numerous other states have passed similar laws, and Scalia was widely expected to provide a fifth vote to uphold such restrictions.

Without him, it may not change much for Texas. A 4-4 split in the court would leave in place the 5th Circuit Court of Appeals ruling that upheld these provisions. Ilyse Hogue of NARAL Pro-Choice America says that would shut down a number of clinics that perform abortion. And she says that would come in addition to other Texas restrictions that have already closed about half the state’s clinics, leaving some women to travel hundreds of miles to obtain an abortion.

“We would be looking at an even greater health care crisis in Texas than we’re already facing,” Hogue says.

But a split decision in the Supreme Court would have no national precedent. That means other appeals court rulings striking down similar laws would also stand. And Hogue says there are more cases to come.

“I think this vacancy is far, far greater in terms of its implication than this one case in Texas,” she says. “There are so many laws looking to restrict not only abortion access and abortion rights, but a broader set of reproductive rights in front of the court right now.”

One of them also comes up next month, when the court hears a challenge to the Affordable Care Act’s mandate on covering birth control for female employees.

There’s also been a wave of abortion restrictions passed since Republicans took control of numerous statehouses in 2011, and many of those cases are winding their way through the appeals courts. Abortion opponents had been hoping to have them affirmed by the Supreme Court, with the help of a great ally in Justice Scalia.

“He was one of the two justices on the court who has publicly opposed Roe v. Wade in prior cases and prior votes,” says Clarke Forsythe, senior counsel with Americans United for Life. “And he was probably the most vocal and longstanding, having been there since 1986.”

Scalia had said that since the U.S. Constitution does not recognize a right to abortion, neither should the Supreme Court. The issue, he wrote, should be left to the states.

Now, if the court flips to a liberal majority, Forsythe foresees a large scale rolling back of decades of abortion restrictions. He can imagine justices overturning the ban on public funding for the procedure. That ban is known as the Hyde Amendment, something presidential candidates Hillary Clinton and Bernie Sanders have both vowed to overturn.

Forsythe also thinks a liberal Supreme Court “will probably throw out all parental notice and parental consent laws in the country, will throw out all informed consent laws in the country, and virtually any regulation, and create an absolute right to abortion for any reason at any time that we haven’t seen in 42 years.”

Abortion rights groups say all that is speculation at best. But with so much at stake, both sides of this contentious issue say they’re throwing themselves into the fierce battle over choosing Scalia’s replacement.