COVID-19 Through An Ecological Lens.

Posted on | February 2, 2022 | Comments Off on COVID-19 Through An Ecological Lens.

Mike Magee

It is fair to say that the vast majority of Americans know more about viruses today than they did 24 months ago. The death and destruction in the wake of COVID-19 and its progeny has been a powerful motivator. Fear and worry tend to focus one’s attention.

Our collective learning’s are evolving. We have already seen historic comparisons to other epidemics . Just search “The 10 worst epidemics” for confirmation. But one critical area which has been skimmed over, and only delicately probed (if at all) is the ecology or “the ecological point of view.”

For those interested, let me recommend “Natural History of Infectious Disease” published in 1972 by Nobel laureate and Australian biologist Sir Macfarlane Burnet and his colleague David O. White.

Chapter 1 begins: “In the final third of the twentieth century, we of the affluent West are confronted with no lack of environmental, social, and political problems, but one of the immemorial hazards of human existence is gone. Young people today have had almost no experience of serious infectious disease…For the first time in history deaths in infancy and childhood are not predominantly from infection.” But a few sentences on, they add this addendum, “Infectious diseases may be almost invisible, but it is still potentially as important as ever it was.”

Americans are all too familiar with the living biologic organism named COVID-19. By now, they know what it looks like, the role of its outer spikes, its nuclear makeup, and genetic alterations that allow creation of derivative variants and vaccines. But in addition to its biological science, it also has an ecological life as well.

As the authors say, ecology “deals with the interaction of organisms with their environment and especially with other organisms, whether of their own or different species in the environment.” When ecology is applied to the natural history of infectious diseases, we encounter the discipline of epidemiology – the study of the incidence, distribution, and possible control of disease.

In the eyes of an ecologist, all living entities are survivalists, and there is little difference (except in size) between a parasitic microorganism and a large predatory carnivore. They all need nourishment. As our experts write, whether the bite comes from inside or out, “It is just another method of obtaining food from the tissues of living animals.” COVID-19 is an organism that is “smaller and less highly differentiated than its host…and gains its nourishment at the expense of the host’s living substances.”

Checks and balances rule in the world of ecology absent human intervention. The authors illustrate this with an example. In the late 19th century, orange growers in California reached industrial scale. In 1888, little white cushions began to appear on their trees. Within them were tiny, sap-sucking insects, and the damaged trees production of fruit plummeted. The responsible “scale insect”, it was found, was a foreign invader from Australia.

In Australia, its primary nutrition came from the native acacia tree. Orange trees were infested as well, but rarely damaged. This was because the insects numbers were naturally controlled by a local ladybird beetle. As the ecologists explained, “If the scale insect is particularly plentiful, the ladybird larvae find an abundant food supply, and the beetles in turn become more plentiful. An excessive number of ladybirds will so diminish the population of scale insects that there will be insufficient food for the next generation, and therefore fewer ladybirds.”

But in California, there were no ladybird beetles. And so the agricultural leaders in 1889 imported the beetles, and once they reached adequate numbers in the orchards, the scale beetle “was reduced in importance to a relatively trivial pest.”

Simple,right? Well not exactly. As our experts write, “The mutual adjustment is an immensely complicated process, for all the food chains concerned are naturally interwoven, and for every species there will be fluctuations in numbers from time to time, but on the whole, in a constant environment a reasonable approach to a stable balance will be maintained.”

For predators of any shape or size (and that includes a virus) , “there is less opportunity for enemies…of restricted prey to thrive at their expense.” Vaccination, masking, and distancing, in effect, restrict us as potential prey to COVID-19.

Another point. Our ecologists remind us that “Most parasites are restricted to one host species (for their nutrition)…and the main problem that a parasitic species has to solve, if it is to survive, is to manage the transfer of its offspring from one individual host to another.” That often requires intermediate hosts “whose movement or activities will help the transfer to fresh, final hosts…an increased density of the susceptible population will facilitate its spread.”

To site a modern example, a certain percentage of fully boosted and immunized are able to be infected by the Omicron variant and remain asymptomatic carriers and spreaders, especially if they enter dense gatherings where they and unvaccinated and unmasked persons are present in crowds.

One last caution as we continue to investigate the origins of this pandemic (whether a zoonotic host or laboratory creation): The authors warn that “disastrous disturbances of natural ecosystems” are often the result of “irresistible pressure of technological advance…short term human benefit will sooner or later bring long-term ecological or social problems which demand unacceptable effort and expense for their solution.”

As we corner our biologic adversary, it might be useful to examine this unfortunate disaster closely and thoughtfully, through an ecological lens.

Covid – “A Mirror for Social Thought and Plausible Action.”

Posted on | January 27, 2022 | Comments Off on Covid – “A Mirror for Social Thought and Plausible Action.”

Mike Magee

As we enter the third year of the Covid pandemic, with perhaps a partial end in sight, the weight of the debate shows signs of shifting away from genetically engineered therapies, and toward a social science search for historic context.

Renowned historian, Charles E. Rosenberg, envisioned a similar transition for the AIDS epidemic in 1989. He described its likely future course then as a “social phenomenon” with these words, “Epidemics start at a moment in time, proceed on a stage limited in space and duration, follow a plot line of increasing and revelatory tension, move to a crisis of individual and collective character, then drift toward closure.”

The devastating human toll of HIV/AIDS, in full view of a spectacularly disinterested President Ronald Reagan, couldn’t help but force commentators of the day to search for historic context. One suggested that the epidemic in their midst was “as well suited to the concerns of moralists as to the research of scholars seeking an understanding of the relationship among ideology, social structure, and the construction of particular selves.”

Current historians have begun to parse out explanations for former President Donald Trump’s denials, deflections, and deliberate obfuscation in the early months of the Covid pandemic. Was it a “failure of imagination”, the threat to economic or political interests, emotional immaturity, complacency, or some combination? Why did the sick have to suffer and bodies have to accumulate?

For the AIDS epidemic, Rosenberg believed that “accepting the existence of the epidemic” would have forced or triggered the need to create a response. In contrast to America’s early beginnings, when the weight of responsibility could be laid at the feet of an invisible Theocratic hand, modern citizenry (aside from the Jerry Falwell’s and Pat Buchanan’s of that day) sought a “rational understanding” and a pathway toward control.

Recognition did carry with it an expectation of collective action, and a search for context. In 2008, two decades after his piece on HIV/AIDS, and stimulated by a new crisis with H1N1 Bird Flu, Rosenberg published a paper in the Journal of Infectious Diseases titled “Siting Epidemic Disease: 3 Centuries of American History.”

In this concept piece, he laid out the variables or parameters for evaluating the long list of American epidemics including geography, ecology, demography, medical knowledge, cultural values and collective experience.

Scientific progress, as we’ve seen with mRNA constructed Covid vaccines, makes a difference. As Rosenberg admitted, “AIDS was configured very differently—both socially and biologically—in 1983, in 1993, and in 2003.” But he also suggested that the declaration of an end to the “era of great epidemics” in the 1950’s was premature. In fact, we find ourselves still under the control of intersecting and instigating megatrends that were first ignited by discoveries a century and a half ago including new modes of transportation, economic growth, and migration driven urbanization.

As Rosenberg suggested, progress often carries with it hidden human risks. This presents modern leaders with stark choices. In his words, “It is an occasion to balance faith in the laboratory’s power with anxieties about anticipated failures in public policy and ambivalence about the perhaps ironic fruits of global economic relationships, as well as the diversity and inequality associated with such economic growth.”

Where the laboratory scientist might see Covid as a challenge for medical innovators, social scientists see it as an opportunity for humankind to focus on what really matters. For them, epidemics are “sampling devices that enable us to see, at one moment in time, the configuration of values and attitudes…a natural experiment, a kind of strength-of-materials test for the precise relationships among society’s social values, technical understanding, and capacity for public and private response.”

While the microbes continue to evolve at a frightening speed, humans are slower to learn and adapt to these biologic threats. What social scientists like Rosenberg suggest, is that epidemics have always been, and remain, “a mirror for social thought and plausible action.”

This Is Not My First Pandemic.

Posted on | January 19, 2022 | 3 Comments

Mike Magee

This is not my first pandemic. When I was a little boy –70 years ago – I was lying on an examination table on a Sunday morning, in my underwear, in my father’s office that was attached to the house.

The door to the room was closed and my brothers and sisters were huddled outside.  I was inside with my father and a neurologist who had extended to him the professional courtesy of coming to our home on a Sunday morning. It was cold in that room, but his hands were warm as he raised my leg in the air and said, “Now, with all your might, I want you to hold you leg up” – and he let go.

I was four years old and I remember that leg falling to the table, as if it were detached, not even mine.  And I can’t remember what he said. But I do know that the way he said it allowed him to not only tell my father and me that I had polio, but also to bring us closer together – as father and son – to manage both our fears which were coming from very different places that day, and to point us both to a more hopeful future.

Some 20 years later, I became a doctor. But in truth, my medical education began that day in his office.  I recovered quickly, was soon back to exploring, wondering, questioning.  And one day, I said to my mother, “Mom, do you think if dad had wanted to, he could have been a bus driver?”

It seemed to me at the time that being a bus driver was the most complex, responsible and interesting of all jobs, certainly beyond the reach of most normal human beings.  That you could master the skills necessary to drive this huge machine; that you could deal with the complexity of communicating with all types of human beings; that you could safely transport them to their destination, and remain calm, collected, and happy most of the time; and that you could do it day in and day out, year in and year out. Well, you can understand why I was so impressed.

This morning, on the eve of my 74^th birthday, as our nation struggles with its own pandemic, and societal disruption made worse by a partially compromised health care system unable to manage a massive accumulation of fear and worry, I found myself reflecting again on these two stories.

From the first story – the boy with polio and the two doctors together one Sunday morning – I recall with gratitude the neurologist’s “professional courtesy.” How should we caregivers – doctors, nurses, family members – treat each other? How well do we care for each other and each other’s families these days?  With all we have been through, how do we find our way back to that space, that feeling I felt that Sunday morning, as I watched two caregivers care for each other as they cared for me?

And the 2nd story, the bus driver and my mother’s reaction.  Did she silently voice, “Do you know what your father does, how complicated it is, and the toll on all of us?” Perhaps somehow my own questioning of the connection between caring health professionals and the maintenance of a healthy, civil society was seeded that day, transferred from my mother’s inner sanctum, to my childhood unconscious recesses for later exploration.

Fifty years later, with a team of sociologists in Philadelphia, our studies established that physicians, nurses, and caregivers contribute 3 important functions to stable civic societies that go far beyond the standard nuts & bolts of healthcare.

The first is this – that together as a collective, hundreds of thousands of times each day, health care professionals  process the populace’s fear and worry, which in our absence would accumulate and undermine our society.

Second, as with my father and his small son, in individualizing care, they subtly reinforce essential bonds between the individual, the family, the community and society.

And third, caregivers point the people toward a hopeful future, instilling in them the confidence necessary to invest their money, their time, and their dreams in what could be, rather than what might have been.

My mother knew the truth – the full role and contribution of health care workers and their imperfect systems. She observed it. She supported it. She nurtured it.

We, as Americans struggling to stay afloat in an ever changing and destabilized environment, are still learning the full meaning of what doctors and nurses and their many teammates do.  We are so busy doing that we fail to appreciate what has been done, and what, together we will accomplish in the future.  But my mother knew!

As for driving a bus, the idea still intrigues me. And truth be told, the skills, responsibility, and sense of common stewardship that members of the health care team work to master are quite transferable to many other critical roles in society. Caring for each other, after all, is (or at least should be) our common human goal and purpose.

Doris Kearns Goodwin and Jon Meacham Reflections on Jan. 6th.

Posted on | January 10, 2022 | 5 Comments

Mike Magee

On the one year anniversary of the June 6th Insurrection, historians were well represented by two of their own – Jon Meacham and Doris Kearns Goodwin – who were invited to address members of Congress in a session moderated by Carla D. Hayden, Librarian of Congress. Here is a review for your reflection and consideration.

Ms. Hayden welcomed members to “a solemn occasion, a patriotic occasion, and a prayerful one for our country.” She also quoted words from the show Hamilton, “If we lay a strong enough foundation, we will pass it on to you.” She then turned to the two historians, and asked them, speaking of the Founders, “Were they sure (they had a strong enough foundation back then)? Did they know?”

Over the next hour, Meacham and Goodwin, traded and shared historical narratives, chosen to illustrate both America’s vulnerability and resilience.

Meacham led initially with these remarks, “I think they (the Founders) would be surprised that we have come this far. They were aware of the fallibility of humankind. They were incredibly aware of the fragility of humankind. They had a keen awareness of imperfection and appetite and ambition. They knew that the struggle in everyone’s soul, which would find full expression in a popular government, was (a struggle) between generosity and greed, and between kindness and cruelty….It was about curbing our worst instincts, to give our better angels a chance to take flight.”

In a moment of self-reflection, he said, “If I get things right 51% of the time, that is a good day. Why would a popular government be anything different? A Democracy is the manifestation of all of us. So our habits of heart and mind matter enormously. What you saw a year ago today was the worst instincts of both human nature and American politics – the will to power over the idea of equality and the rule of law taking precedence. And without recognition that the experiment is worth defending…Without the defense…then we slip into a state of chaos.”

Goodwin then affirmed that knowledge and truth are prerequisites for preservation of the American experiment. She said, “I keep thinking as a historian that the interesting thing is we know what the people living at the time did not know. We know the Revolution was won. We know George Washington became the President, not a military (dictator). We know the Civil War ended with the Union restored. We know the Allies won WW II. But the people living (at the beginning of our nation) did not know that. They were living with the same anxiety we are living with today. How will this resolve itself? The hope (is that)…we have come through these times before…We are going to write the chapter of our story just like our ancestors wrote the chapters of their stories and they did pretty well. They failed at times. But as you say, even though there are bad angels, we got extraordinary good angels, even on January 6th.”

Both historians were drawn to comparisons with the 1850’s. Meacham went first. “Mark Twain once said, ‘history may not repeat itself but it does rhyme.’ The issue I think about the 1850’s…is that we did not have a common story. There was not a sense we were all devoted to what became the most important sentence ever originally rendered in English, which is ‘All men are created equal, with inalienable rights, among them, life, liberty, and the pursuit of happiness.’ An amazing sentence that has changed more lives around the world than any other single sentence. It was written, not in a vacuum, but as part of this remarkable experiment that we were part of and are part of. It is a reorientation of reality, when you think about it, from popes and princes and prelates and kings who are given authority over all of us…who were organized (vertically), to reorganize (horizontally)…and the American (vision), for all its faults, was the fullest political manifestation of that shift in reality…There was an idea worth defending. If enough of us do not assent to that idea, then madness comes.”

Goodwin picked up, telling the story of Preston Brooks, a violently racist congressman from South Carolina, who in the 1850’s nearly beat to death with his cane the leading abolitionist in the Senate, Massachusetts Senator Charles Sumner, on the Senate floor. Rather than unify the elected politicians of the day, it further galvanized their disagreement over slavery, creating what were called then “alternate realities.” In Goodwin’s words, “That is when you knew something was happening in the country. There was a sense that there was a partisan crack in the 1850’s…Obviously it ended badly with the Civil War. But out of that, what came, had to be done, which was to undue the original sin of slavery, and those people fought for that. We had a leader in Abraham Lincoln who carried us through that.”

Forty years later, Goodwin recounted, “Teddy Roosevelt warned that the real problem for Democracy, the threat would be if people began regarding each other as the other rather than as common American citizens…He saw what we are feeling today. What did he do about it? He argued there should be a fundamental fairness, ‘a square deal’ for the rich and the poor.” A bit further on, Goodwin picks up the thread, repeating parts of LBJ’s classic March 15, 1965 “We Shall Overcome” address to a joint session of Congress that Goodwin’s future husband, Richard, wrote.

She begins by setting the narrative in Selma, Alabama. “This is how change takes place. When an outside movement to create the social conscience and change public sentiment (takes flight), then the inside channels of power have to mobilize….(LBJ) understood that when John Lewis and his fellow soldiers on that bridge (endured) a brutal attack, that the consciousness of the country had been changed, and it was time to move to that.” Suggesting that this was a ‘lean in’ moment occurring just a week after Bloody Sunday, she repeated the words her late husband had crafted and LBJ had uttered that evening, “This is not a Negro movement, not a White movement, not a Northern movement, not a Southern movement…It is simply wrong to deny your fellow Americans the right to vote…There is a long way to go, but if we work together, we shall overcome.”  Summarizing, Goodwin simple states, “The outside movement met the inside power.”

Before the session ended, Meacham recommended to Congressional leaders in the solemnly silent chamber to “tap the brakes on nostalgia.” Explaining his meaning, he said, “There is a human tendency to want the past to have been simpler…But there was never a once upon a time and there is not going to be a happily ever after. This is an unfolding job….You are here to do this, to govern in an imperfect world. And you know that. This country as we know it right now is about 56 years old…The first actually integrated election occurred in 1968. 52 years ago.”

Asked to sum up, Jon Meacham said, “January 6th is not a wake-up call. That is not the right way to put it. It is, as the President says, an inflection point – either a step on the way to the abyss, or it is a call to arms, figuratively, for citizens to engage and say…the work we are about is more important than the will and whim of a single man or single party or single interest.”

In turn, Doris Kearns Goodwin closed by emphasizing that the work of the June 6th Select Committee of the House was critical. She said, “We have to retell the story of January 6th with all the gaps filled in. I have a fundamental belief that if that story is told in its fullest…we can retell it in a way that really happened and I do believe a line will be drawn. Maybe it is 50/50 now and (with an additional 5% convinced) becomes 55/45.” The goal she says is for transformation of our leaders so that “the ambition for self, (now) becomes something larger”, allowing our representatives to stand up for what is right.

In closing, the words of Winston Churchill were invoked: “The future is unknowable, but the past gives us hope. It is the present we have to get through.”

You may view the full session in its entirety HERE.

One Year After January 6th: A Role For Restorative Justice and Universal Health Care In America.

Posted on | January 6, 2022 | 2 Comments

Mike Magee

“We’re better than this” is the common refrain heard from many political leaders following the deadly assault on our democracy on January 6th. We hear empty appeals for blind appeasement from the likes of Kevin McCarthy in the interest of “bringing our country together.” But for those of us who study medical history, pursuing this course takes our nation in exactly the wrong direction.

Rather, the model we must follow is the model of Germany in 1945, or South Africa in 1995. In both cases, strict legal and public accountability (retributive justice) were married with fundamental expansion of universal social services to rebuild confidence and trust in their government’s ability to assure safety and security, and an equal playing field for all of their citizens (restorative justice).

In sorting through the legacy of Hitler’s regime in Germany, the Allied forces established the International Military Tribunal.  One of the series of trials, opened on November 19, 1945 in the Palace of Justice in Nuremberg, delved into egregious examples of medical criminality, including Nazi experimentation on human subjects. These trials are often cited as an example of “retributive justice.” Of 23 defendants, 7 were hanged, 7 acquitted, and the rest given sentences of from 10 years to life in prison.

These judgments were conducted under the direction of U.S. judges and prosecutors and fully compliant with U.S. standards of criminal procedure. Yet another 25 years would pass before any of the 10 agreed-upon medical ethics research standards were integrated into US trial law.

Legal scholars such as Michelle Miller at Cornell Law School attribute this lapse to the self-regarding biases of leaders within the Medical Industrial Complex. As Jay Katz, a physician and professor of law at Yale wrote in 1992 of the Nuremberg directives, “It was a good code for barbarians, but an unnecessary code for ordinary physician-scientists.” In other words, it was assumed that American medicine’s noble professionalism was adequate to ensure appropriate ethical standards.

Adding to the irony, at the very same moment that the leaders of the Medical Industrial Complex were rejecting President’s Truman’s 1946 call for a national health plan as “socialized medicine,” our military under the Marshall Plan was fast at work creating highly successful national health plans for our two main vanquished archenemies, Germany and Japan. We were willing to allocate precious taxpayer resources to assure this expression of “restorative justice.”

An analysis of the German and Japanese programs made some years later by the Rand Corporation summed up the Marshall Plan’s rationale: “Nation-building efforts cannot be successful unless adequate attention is paid to the health of the population. The health status of those living in the country has a direct impact on the nation’s construction and development, and history teaches us it can be a tool in capturing goodwill of the nation’s residents.”

A similar restorative approach was utilized in South Africa in 1995. Nelson Mandela’s Truth and Reconciliation Commission conducted over 1000 public hearings on their road to a free democracy, offering amnesty to those who publicly admitted past crimes of sectarian violence and asked for forgiveness. Less recognized, Mandela simultaneously instituted fundamental social service reform, including free primary level public health care for all in 1996 serviced in over 350 newly constructed health clinics by 1997.

Now a quarter of a century later, Mandela’s words, delivered that day, continue to resonate on our own shores.

He said: “With our freedom won, we faced the challenge of using our limited resources to provide the majority of our people with adequate housing, education and health services. These things are regarded as basic human needs anywhere in the world and yet most of our people had been denied them…

“Because there were very few hospitals and clinics, only those with money and who were healthy enough could travel the long distances to get proper medical help. This was the situation of millions of South Africans across the country.

“One of the most important steps the government has taken to deal with this crisis in our nation’s health was to introduce free universal primary health care. Since April last year, for the first time in our history, basic health-care has become available to everybody without cost. And to make that health-care easily accessible, to especially the poor, we launched the clinic-building programme so that there would be a clinic within walking distance – five kilometres – of every household.

“Primary Health Care uses measures for both prevention and cure, like immunisation, family planning and health education. But in order for these programmes to work we also need to make sure that communities have adequate shelter, employment, sanitation and clean water supply. Poverty and lack of essential services are the greatest threat to our nation’s health.”

The failures of this nation’s health care system have been well documented, and now include the mismanagement of the Covid-19 pandemic, certain to claim more than a million American lives. As with Germany in 1945, and South Africa in 1995, creation of reliable health access for all would assist our troubled nation in her efforts to address racism, disinformation, and the current erosion of public trust – problems that are egregious and deep-seated.

Criminal investigations of the January 6^th insurrectionists are well underway and appropriate expressions of retributive justice. No one is above the law. At the same time, movement toward universal health care in America, as an expression of restorative justice, and a means to begin to address societal financial, educational and health inequities, would be a logical next step if we truly wish to “bring our nation together.”

A 2022 New Year Message – With Help From The Lamont’s.

Posted on | December 31, 2021 | 2 Comments

On December 31, 2021, our family received a Holiday Card from Ned and Annie Lamont and their family. Its message so capsulized our own feelings that I wanted to share the message with you. Here is their wish – and ours as well.

For Sarah Weddington (1945-2021), RIP = Rest In Power.

Posted on | December 30, 2021 | 2 Comments

Mike Magee

“I am sure when my obituary is written, the lead paragraph will be about Roe v. Wade. I thought, over a period of time, that the right of a woman to make a decision about what she would do in a particular pregnancy would be accepted, that by this time, the 30th anniversary of Roe v. Wade, the controversy over abortion would have gradually faded away like the closing scenes of a movie and we could go on to other issues. I was wrong.”  Sarah Weddington, 2003.

_______________________________________________________

Sarah Catherine Ragle Weddington died in her home in Austin, Texas on December 27, 2021. She was 76. She was born in Abilene, Texas on February 5, 1945, the daughter of a Methodist minister father and a college business professor mother.

Bright and inquisitive, she graduated from small Methodist McMurry College magna cum laude at the age of 19, and enrolled at the University of Texas at Austin Law School. She was one of 40 women in a school of 1,600 students. Her course work was briefly interrupted in her final year, at age 22, by an unwanted pregnancy. With her soon to be law student husband, Ron Weddington, she traveled to Mexico for what she later described in a 1992 autobiography as a “safe abortion.” She later remembered her last thoughts as they administered her anesthesia, “I hope I don’t die, and I pray that no one ever finds out about this.”

After passing the Texas bar, she hung out a shingle in Austin, Texas where she supported herself by writing wills, and resolving uncontested divorces. She had no trial experience, but was fascinated by women’s rights issues, and with several other women in the area, advised college women which doctors in the area might be willing to perform abortions, currently illegal in the state unless to save the life of the mother.

At the time, she was asked by one student whether she could be prosecuted for helping a friend receive an abortion. Not knowing the answer, she turned to a more experienced former fellow student and friend, Linda Coffee, who was clerking for a federal district judge in Dallas. At the same time, Coffee was advising a pregnant woman named Norma McCorvey, who had already had two children given up to adoption, and was pursuing an illegal abortion as a solution to a third unwanted pregnancy.

In December 1969, Coffee wrote Weddington, “Would you consider being co-counsel in the event that a suit is actually filed? I have always found that it is a great deal more fun to work with someone on a lawsuit of this nature.” Two months later, the new legal team met in a pizza shop with McCorvey, soon to be retitled Jane Roe, and a challenge to the Texas anti-abortion law, and to Dallas District Attorney, Henry Wade, was born.

In December 1971, when Sarah Weddington, age 26, stood before the Justices of the Supreme Court to argue Roe v. Wade, she had never tried a legal case. The lawyer’s lounge at the Court didn’t even have a women’s rest room. She felt the full weight of responsibility on her young shoulders. She later recalled, “I cared so much about the result. I was the only person that would be allowed to speak to the Court for the plaintiffs, asking them to overturn the restrictive Texas law. So it was fear-invoking, awe-inspiring, and something you just want so much to win you can taste it.” In October 1972, she was back again to field the all male Court’s questions.

One year later, her name would be forever recorded in legal history, and the case itself would be one of the most cited precedents ever to appear in American legal annals. The 7-2 majority decision leaned heavily of the First, Fourth, Ninth and Fourteenth Amendments, and resulted in a cascading reversal of existing state laws outlawing abortion in the years that followed.

Initially widely praised and supported by both medical and religious organizations, within five years, the reversal of Roe v. Wade became the rallying call and fundraising organizing tool of a new evangelical political movement self-titled, the Moral Majority. As it rose, so did the number and seriousness of death threats to the young lawyer.

What became of Sarah Weddington? She was Texan through and through, part of a group of notable women achievers of the time, sometimes referred to as the “Great Austin Matriarchy”which included Barbara Jordan, Sissy Farenthold, Ann Richards, Molly Ivins, and Liz Carpenter. In 1972, while awaiting the epic decision, she ran for a seat in the 150-member Texas House of Representatives and won, serving three successive terms. Her legislative aide at the time was none other than the future Texas Governor, Ann Richards. Three years later, she was labeled “the hardest working member of the house.” Over the years that followed, she served in President Jimmy Carter’s administration on women’s issues, helped advance the movement to approve the Equal Rights Amendment, and ultimately settled in as the first female director of Federal Government Relations for the state of Texas.

Of hiding her own abortion, she later said, “For a lot of years, that was exactly the way I felt. Now there’s a major push to encourage women to tell their stories so people will realize that it is not a shameful thing. One out of every five women will have an abortion.”

Four years ago, she was asked to predict the staying power of the Roe v. Wade decision. She said at the time, “If Gorsuch’s nomination is approved, will abortion be illegal the next day? No. One new judge won’t necessarily make much difference. But two or three might.”

Up to her death, she was known for advocacy. Sherrilyn Ifill, president of the NAACP Legal Defense and Educational Fund, marked her loss with three simple words: “Rest in power.”

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