menopause, mortality, and the mind-boggling state of the world
#5SmartReads - April 9, 2025
#5SmartReads is a Webby-honored weekly news digest that amplifies underreported news and underrepresented perspectives. My goal is to help you stay informed without being overwhelmed, and to embrace nuance and reflection over picking a side.
The most important number in the world (Vox)
Finding hope about the future can feel impossible right now.
I’ll spare you the state of things right now (the vibes are awful, find joy and rest wherever you can), and direct your attention to some rare good news.
Childhood mortaility has dropped to the lowest recorded level, per a UN report this week. And despite Elon Musk’s disturbing talking point of birth rates, childhood mortality is a far more important statistic to focus on.
This statistic is a predictor for civic development, international cooperation (the UN may have missed its target to reduce child mortality by 2/3 in 2015, but we’re close to hitting that number now), and economic performance (the lower the rate, the better the economic performance).
And to refute Musk’s position, reducing child mortality is immensely beneficial to population maintenance, and improves quality of life overall for the population that’s already here.
What’s troubling is that the programs and work that made this possible - vaccine access in developing countries, improved healthcare from prenatal to postnatal stages, and better nutrition and sanitation - has been cut or at the risk of being cut, with the state of USAid and the rapid erosion of public health programs and trust in the States today.
So what can you do about it?
Staying on top of your immunizations and your family’s is a solid start (if you were born between 1980 and 1986, get your MMR titers checked and get a booster if necessary - chances are, you only received one shot of the vaccine).
Follow the basics of good health - eat a well balanced diet, sleep well, move your body, and do whatever you can to manage your stress (I have a plan to help you do just that).
If you have funds to spare, support Population Sciences International, an incredible nonprofit whose work is centered on delivering this necessary care to countries around the world. A $5.15 donation helps reach a person with essential healthcare services (vaccines, contraception access, cancer screenings). If you’d like to support an organization here in the States, New Morning delivers free or low cost contraception access to South Carolinians in need. A reduction in unintended pregnancies and unplanned births are an important factor in lowering the child mortality rate, and their work has reached over 500,000 women in South Carolina to date.
Tamsen Fadal Is the Menopause Advocate We All Need (New Beauty)
In the summer of 2020, I was feeling off.
I’d forget what I was saying, mid-sentence. I couldn’t shake the extra inches around my belly, despite the many miles I walked/ran chasing Rho and pushing Rhaki in the stroller. I’d wake up in the middle of the night, drenched in sweat.
“Cool, cool, so my body now lives in hell, and I guess this is just what happens,” I thought. And then I picked up Kennedy Ryan’s Queen Move (my second favorite book of hers, Reel is my first), and realized that Kimba and I suffered the same hell. Perimenopause.
While my gynecologist confirmed the symptoms, her focus was on my abnormal Pap smears (which led to multiple colposcopies, two LEEPs, and an eventual hysterectomy). We were so focused on treating my reproductive organ system that our focus from perimenopause was tabled.
Until this week, where I sat on the paper covered examination table, with a list of questions and a gentle script created by
to discuss my symptoms (which grew in number and fluctuated day by day), and to push for hormone replacement therapy to address said symptoms.We have a lot to do when it comes to women’s health, especially in menopause. We’re drawn to supplements first because we feel seen by their marketing, reassuring us that we’re not alone. We are lured to celebrity backed brands in the space, feeling some level of validation that if Halle Berry or Naomi Watts deals with us and still look fantastic, then we can thrive as well.
I’m all for more investment and research in women’s health, and I’m also wary of any non-regulated company that makes bold promises with no data. And that’s what makes Tamsen’s work different. Her work (her book, podcast, documentary) is evidence based as she tapped over 20 physicians and medical providers to help guide us through a universal experience.
The only promise that Tamsen makes in her work is to help you get help - explaining the symptoms (the ones you know about, and the ones you don’t) and the science behind them. Most importantly, she helps you advocate for yourself with your provider to go beyond the standard of care (prescribing hormones based on bloodwork, and to address specific symptoms).
You’re not alone. And Tamsen is the menopause best friend we all need.
(On an unrelated note, Tamsem’s Instagram strategy for her book and brand is brilliant. I’ve been studying it as I revamp my own).
#5SmartReads is all about helping you feel smarter this week.
If you want to feel better but feel overwhelmed on what to do, check out this month’s plan (mindfulness practices, workouts, meals, and more):
I love a juicy, political book. Most of my favorites are novels (Nicolle Wallace’s Eighteen Acres series, Richard North Patterson’s Protect and Defend). Mad House has quite a bit in common with these books - it’s salacious, the writing is sharp, and I couldn’t put this book down (finished it in 2 days).
I only wish it was fiction (or an entire season of Veep). That it documented the real-life insanity that was the 118th Congress is frightening, to say the least. The book could be a prequel to Don’t Look Up or Idiocracy, reflecting what a dark time it is in the relatively short arc of American history.
We may be a younger country than the rest of our peeks, but we don’t do anything by half measures - including the breaking of our institutions.
Writing about those in power is daunting (as I know firsthand), forcing you to balance the need to inform while also writing in a way that grips the reader’s attention. Annie Karni and Luke Broadwater did a brilliant job of doing both, and I love how this piece details their interview and research process (and how it differed from their regular reporting), as well as how open some of their interview subjects were.
If you wonder just how we got to this point, this book helps answer that very question, as well as presents the increasingly difficult opportunity of how we get back on track.
It’s not polished stump speeches, or carefully planned media hits. It’s something more simple - and difficult for so many members of Congress - to do: be honest, speak plainly, and repeat your message over and over, on every platform possible.
Cory Booker is a clear example of how to do just that.
BritBox has been a delightful addition to my streaming library. There’s something really comforting about a cozy mystery or revisiting one of my favorite comfort shows (Downtown Abbey, a Philippa Gregory adaptation).
The Change is neither of those shows. If you are a mid-life woman, you will find it makes you seen, makes you laugh, and makes you slightly uncomfortable (as any good British comedy does).
The ‘why’ behind this series, which Bridget Christie created and stars in, is one that goes deeper in a topic that’s often dismissed - that perimenopause/menopausal transition where women are irrevocably changed, but in many ways are expected to stay the same.
‘“I do see women’s time, a lot of it goes to nothing. Nobody sees us, we don’t get awards, nobody thanks us. It’s tricky, because I’m a comedian, and I don’t want to make anything that’s worthy. But I did really want to say, ‘I know what you’ve been doing, and I’m thanking you.’”
Really, it’s about menopause as a retaking of destiny; imagine if, for whatever reason – call it hormones, call it wisdom – you were to stop clearing up after others, stop biting your tongue. What would that be like?‘
What started as a ‘oh, this looks interesting’ whim has turned into my deep respect and study of Christie, and this interview does her justice. She makes you feel seen, smart, and that everything you do matters.
What Trump’s Second Term Could Mean for PDUFA’s Future (BioSpace)
The biopharma industry funding the government is a fact that’s often manipulated to fit a narrative. I’d like to explain why this is, and the incredible impact it has had.
PDUFA is the Prescription Drug User Fee Act, authorized by Congress in 1992. Simply put, a drug sponsor (the company that’s filing the drug with the FDA) pays a fee in order to have timely review and transparency with the agency of their drug application. There are other user fees that help fund the agenda (GDUFA for generics, MDUFA for medical devices, OMUFA for over the counter monograph drugs). These fees make up about 45% of the FDA’s total budget, with 65% of the funding for drugs for humans coming from them.
These user fees largely goes towards employee salaries (from reviewers to inspectors), which helps fund regular and comprehensive inspections of the facilities that make the drug (both the active ingredient and finished product), transparency with the agency (dedicated meetings and open correspondence during the development), and a specified timeline for review of a drug application. These fees support FDA’s mandate on the drug side to ensure every product they approve is safe first, then effective.
Before PDUFA, most drug applications were coming from foreign companies. When PDUFA was implemented, the number of US-based sponsors dramatically increased, and the FDA rose to become a gold standard in new therapeutics and drugs being introduced here first, and other countries quickly granting approvals once a drug received FDA approval.
We still have a lot of work to do, particularly when it comes to drug pricing and improving regulatory approvals of restricted items like sunscreen and other ingredients we touch in our personal care, food, and environmental products. PDUFA offers a blueprint to do just that, if we only invest the time and resources to help make it happen.
PDUFA is up for reauthorization in 2027. With the recent gutting of this particular department, it signals that the administration’s intention is to gut the very program that’s made the United States the leader in new therapeutics, devices, and drugs to help us live longer and healthier.
I work in biopharma because it is an immense responsibility to work on medications that can help improve people’s lives when they are given a terrifying diagnosis. Anyone who works in this field comes to this work with a deep purpose to do good, and knowing our work is literally life and death is something we take extremely seriously. PDUFA has allowed us to bring this work to the market with greater efficiency, transparency, and speed. Waivers granted to small companies filing their first product has been a big factor for the startup biopharma market to grow.
Gutting the FDA and eliminating this program is the most inefficient and expensive thing we can do.
Other reads: