Publisher Health

Researchers have identified how the bacterium that causes tuberculosis (TB) can evolve rapidly in response to new environments, says a study published today in eLife.
As with other species of bacteria, Mycobacterium tuberculosis (M. tuberculosis) is able to form complex structures called biofilms which allow bacterial cells to resist stressors such as antibiotics and immune cells. For this study, the research team evolved populations of M. tuberculosis in the lab and found that it could form thick biofilms due to mutations in genetic regions that cause multiple changes to happen at once. These findings could inform the development of antibiotics targeted at biofilm growth.
As the second leading cause of death due to infectious disease globally, TB is a major threat to public health and there is an urgent need for new strategies for diagnosing, treating and controlling the infection.
“TB remains a challenging infection to treat due to the bacterium’s ability to persist in the face of antibiotic and immune pressure, and to acquire novel drug resistances,” explains Madison Youngblom, Graduate Student at senior author Caitlin Pepperell’s lab, University of Wisconsin-Madison, US, and co-first author of the study alongside Tracy Smith, New York Genome Center, New York City, US. “To better treat and control TB, we need to understand the sources of the bacterium’s robustness and identify its vulnerabilities. We wanted to learn more about how it is able to form biofilms by discovering the genes and genetic regions involved in biofilm growth, as well as how the bacterium evolves in response to changes in its environment.”
To do this, the team used experimental evolution of M. tuberculosis — a powerful tool for illuminating the strengths and vulnerabilities of the bacterium that has led to important insights on the fundamental processes that guide its adaptation. They evolved six closely related M. tuberculosis strains under selective pressure to grow as a biofilm. At regular intervals, they photographed the biofilm and described its growth according to four criteria: how much liquid surface the biofilm covered, its attachment to and growth up the sides of the dish, how thick the biofilm grew and the continuity of growth (compared to discontinuous patches of growth).
Their work revealed that each strain was able to adapt rapidly to environmental pressure, with the growth of a thicker and therefore more robust biofilm. The genetic regions that mutated during the experiment, causing this biofilm growth, were mostly regulators such as regX3, phoP, embR and Rv2488c. “These regulators control the activity of multiple genes, meaning a single mutation can cause many changes to occur in one go,” Youngblom explains. “This is an efficient process that we observed when we looked at the different characteristics of the bacteria, such as their cell size and growth rate.”
Additionally, the team found evidence suggesting that the genetic background of the parent strain of M. tuberculosis had an impact on the enhanced growth of the biofilms. This means that interactions between genetic factors could play an important role in the adaptation of the M. tuberculosis to changing environments.
“Bacteria are prone to growing as biofilms in many contexts, including the infection of humans and other hosts, and during colonisation of natural and built environments,” says senior author Caitlin Pepperell, Principal Investigator at the University of Wisconsin-Madison. “In a medical context, the insights gained from our work could be used to explore potential new antibiotics that are better able to attack bacteria that grow this way. We imagine such biofilm-directed therapies for TB would likely be add-ons to conventional therapy to help shorten and simplify current treatment strategies.”
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US states with low vaccination rates bore the brunt of the COVID-19 surge caused by the Delta variant during the summer of 2021, says a study published today in eLife.
The study reaffirms the importance of high vaccination rates in preventing COVID-19 illness and deaths during variant-driven surges. The results may also help improve future modelling of COVID-19 surges.
To help public health officials plan and mitigate the potential effects of COVID-19, modelling teams from across the US joined forces to create the COVID-19 Scenario Modeling Hub in December 2020. The teams worked together to provide six to twelve-month nationwide and state-by-state projections of COVID-19 cases, hospitalisations and deaths.
“This study details the projections we made as the more transmissible Delta variant emerged in the United States in the spring of 2021,” explains co-lead author Shaun Truelove, Assistant Scientist at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US. “Using nine different models and four defined scenarios, each team assessed how virus control measures, such as mask wearing or vaccination availability and uptake might change the trajectory of COVID-19 as the Delta variant spread at state and national levels.”
The models projected that cases would begin to rise in July 2021 and peak in mid to late September 2021, with the number of hospitalisations and deaths also rising. They also predicted that states with the lowest vaccination rates would see the most cases, hospitalisations and deaths.
“While the timing of these projected surges was accurate, the real numbers during the Delta surge far surpassed what we projected,” says co-lead author Claire Smith, Doctoral Student at Johns Hopkins Bloomberg School of Public Health. “For example, in the worst-case scenario, the models projected about 516,000 cases during the first four weeks of the projection period (July 4 to July 31, 2021), but about 1.2 million occurred during this period.”
While their predictions about which states would see the worst surges were accurate, even these states saw more cases than anticipated. “We have learned a lot about this virus since the Delta variant, especially about waning of immunity and immune escape variants. The lack of these in the models had a major impact on our expectations of how large the resurgence could be,” says Truelove. In their projections, most models did not include waning of natural or vaccine-derived immunity; this and other incorrect assumptions about the virus or human behaviour during the surge likely contributed to these underestimations. These results highlight the challenges of modelling an ongoing epidemic and may help improve future modelling efforts.
States that met higher goals for vaccination early in the Delta surge averted more than 1.5 million cases and 21,000 deaths, the teams suggest. “These estimates should be treated with caution however, because they do not include the impact of waning which reduces vaccine effectiveness, particularly against symptomatic disease. Our estimates of vaccine protection against severe disease (hospitalisations and deaths) are more robust. Overall, because of the underestimation of deaths associated with the Delta wave, the actual numbers of lives saved are likely much higher,” says Cécile Viboud, a senior research scientist at the Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, US.
“Efforts to increase vaccination rates are critical and will save lives before and during future resurgences,” she concludes.
Viboud is a co-senior author of the study alongside Michael Runge, a research ecologist at the Eastern Ecological Science Center, United States Geological Survey, Laurel, Maryland.
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Drawn to the allure of multivitamins and dietary supplements filling nutritional gaps in their diet, people in the U.S. in 2021 spent close to $50 billion on vitamins and dietary supplements.
But Northwestern Medicine scientists say for non-pregnant, otherwise healthy Americans, vitamins are a waste of money because there isn’t enough evidence they help prevent cardiovascular disease or cancer.
“Patients ask all the time, ‘What supplements should I be taking?’ They’re wasting money and focus thinking there has to be a magic set of pills that will keep them healthy when we should all be following the evidence-based practices of eating healthy and exercising,” said Dr. Jeffrey Linder, chief of general internal medicine in the department of medicine at Northwestern University Feinberg School of Medicine.
Linder and fellow Northwestern Medicine scientists wrote an editorial that will be published June 21 in JAMA that supports new recommendations from the United States Preventive Services Task Force (USPSTF), an independent panel of national experts that frequently makes evidence-based recommendations about clinical preventive services.
Based on a systematic review of 84 studies, the USPSTF’s new guidelines state there was “insufficient evidence” that taking multivitamins, paired supplements or single supplements can help prevent cardiovascular disease and cancer in otherwise healthy, non-pregnant adults.
“The task force is not saying ‘don’t take multivitamins,’ but there’s this idea that if these were really good for you, we’d know by now,” Linder said.

Results from one of the largest global studies of atrial fibrillation (AFib) procedures show that the simple approach is usually best when it comes to ablation, a procedure where physicians destroy or ablate cardiac tissue to correct irregular heart rhythms. The findings could change the way patients are treated for AFib.
Researchers from Tulane University and partner institutions found that using advanced image-guided technology to more aggressively target diseased areas of the heart that cause arrythmias didn’t lead to better outcomes for patients — and put some at higher risk of strokes, according to results of the DECAAF II trial published in JAMA.
“Simplicity is key. Don’t ablate too much, especially at advanced stages,” said lead study author Dr. Nassir Marrouche, director of the Tulane Heart and Vascular Institute and The Research Innovation for Arrhythmia Discoveries (TRIAD) at Tulane University School of Medicine. “Too much ablation is not helping our patients today. It is putting them at higher risk. This is a practice-changing finding from our study.”
AFib occurs when the upper and lower chambers of the heart are out of sync, causing the heart to beat irregularly. It affects more than 2.7 million Americans and is a leading risk factor for strokes. When AFib cannot be controlled by medication, doctors perform a procedure to ablate fibrotic or diseased areas of the heart with heat or cold to create a scar that disrupts the electrical signal that causes the arrhythmia.
For the study, researchers followed 843 AFib patients undergoing ablation treatment at 44 hospitals in 10 countries, including the United States, Germany, France and Australia. All the patients received magnetic resonance imaging (MRI) scans to quantify the amount of diseased tissue within their hearts. (Those with a higher percentage of diseased tissue are at higher risk for arrythmia relapse, according to findings from the original DECAAF trial.)
Half of the patients received standard care — pulmonary vein isolation (PVI) treatment where doctors ablate areas in the left upper chamber of the heart where the four lung veins meet.
For the other group, doctors used the MRI scans to create a detailed 3D map of all diseased areas along the left atrium of the heart. They performed conventional PVI treatment and then used the digital map to ablate diseased tissue more aggressively and precisely outside of conventional treatment areas.
All of the study patients received smartphone EKG devices to monitor their heart rhythms daily after treatment, and researchers followed up with them at 3-, 6- and 12-month intervals.
Researchers found no significant difference in arrhythmia recurrence between the two groups. However, the group that received the more aggressive treatment experienced a higher rate of poor safety outcomes with six patients (1.5%) suffering a stroke.
Marrouche said that the study shows that AFib patients with extensive fibrosis have too much scarring for aggressive ablative therapy to be effective using conventional tools. Researchers also suspect that it is not only the extent of fibrosis that played a role in the study outcomes. In evaluating hundreds of procedures by the world’s leading electrophysiologists, they discovered that there is little uniformity in how doctors perform ablation interventions, which may also contribute to disparate outcomes, Marrouche said.
“Atrial fibrillation procedures have become too complex over the years. We are ablating hundreds of thousands of people a year now, and we have been striving to do more and more ablation for the population with persistent or continuous AFib,” Marrouche said. “But our study shows that isn’t necessary, especially for those with more myopathy. Simple ablations can effectively treat these patients instead of going for extensive ablation to treat fibrotic areas that we struggle to control.”
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A new study published today in the peer-reviewed journal Current Medical Research and Opinion, reveals that females are “significantly” more likely to suffer from Long COVID than males and will experience substantially different symptoms.
Long COVID is a syndrome in which complications persist more than four weeks after the initial infection of COVID-19, sometimes for many months.
Researchers from the Johnson & Johnson Office of the Chief Medical Officer Health of Women Team, who carried out the analysis of data from around 1.3 million patients, observed females with Long COVID are presenting with a variety of symptoms including ear, nose, and throat issues; mood, neurological, skin, gastrointestinal and rheumatological disorders; as well as fatigue.
Male patients, however, were more likely to experience endocrine disorders such as diabetes and kidney disorders.
“Knowledge about fundamental sex differences underpinning the clinical manifestations, disease progression, and health outcomes of COVID-19 is crucial for the identification and rational design of effective therapies and public health interventions that are inclusive of and sensitive to the potential differential treatment needs of both sexes,” the authors explain.
“Differences in immune system function between females and males could be an important driver of sex differences in Long COVID syndrome. Females mount more rapid and robust innate and adaptive immune responses, which can protect them from initial infection and severity. However, this same difference can render females more vulnerable to prolonged autoimmune-related diseases.”
As part of the review, researchers restricted their search of academic papers to those published between December 2019-August 2020 for COVID-19 and to January 2020-June 2021 for Long COVID syndrome. The total sample size spanning articles reviewed amounted to 1,393,355 unique individuals.

Agricultural pollution comes from the prairie, but its economic impact on humans is a problem for cities.
A study led by environmental scientists at Rice University’s George R. Brown School of Engineering puts numbers to the toll of reactive nitrogen species produced in America’s croplands.
The study led by Daniel Cohan, an associate professor of civil and environmental engineering, and graduate student Lina Luo quantifies emissions of nitrogen oxides, ammonia and nitrous oxide from fertilized soils over three years (2011, 2012 and 2017) and compares their impacts by region on air quality, health and climate.
While seasonal and regional impacts differ across types of emission, the study found total annual damages from ammonia were much larger overall — at $72 billion — than those from nitrogen oxides ($12 billion) and nitrous oxide ($13 billion).
Air pollution damages are measured by increased mortality and morbidity and the value of statistical life, while monetized damages from climate change include the threats to crops, property, ecosystem services and human health.
On that basis, the researchers found the health impact of air pollution from ammonia and nitrogen oxides, which react to form particulate matter and ozone, substantially outweighed climate impact from nitrous oxide in all regions and years.

A Rutgers scientist is part of an international team that has determined the process for incorporating selenium — an essential trace mineral found in soil, water and some foods that increases antioxidant effects in the body — to 25 specialized proteins, a discovery that could help develop new therapies to treat a multitude of diseases from cancer to diabetes.
The research, detailed in Science magazine, includes the most in-depth description yet of the process by which selenium gets to where it needs to be in cells, which is crucial for many aspects of cell and organismal biology. First, selenium is encapsulated within selenocysteine (Sec), an essential amino acid. Then, Sec is incorporated into 25 so-called selenoproteins, all of them key to a host of cellular and metabolic processes.
Understanding the workings of these vital mechanisms in such a detailed manner is critical to the development of new medical therapies, according to researchers including Paul Copeland, a professor in the Department of Biochemistry and Molecular Biology at Rutgers Robert Wood Johnson Medical School.
“This work revealed structures that had never before been seen, some of which are unique in all of biology,” said Copeland, an author of the study.
Copeland and the team were able to visualize the cell mechanisms by using a specialized cryo-electron microscope, which uses beams of electrons rather than light to form three-dimensional images of complex biological formations at nearly atomic resolution. The process uses frozen samples of molecular complexes and then applies sophisticated image processing — employing today’s vast computing power to string together thousands of images to produce three-dimensional cross-sections and even stop-motion animation conveying a sense of motion within the biomolecules. As a result, scientists can view representations of the intricate structure of proteins and other biomolecules and even how these structures move and change as they function as cellular “machines.”
The incorporation of selenium takes place deep within an individual cell’s intricate machinery. Scientists already knew which proteins and molecules of RNA — a nucleic acid present in all cells involved in the production of proteins — enabled the process. However, they were not able to discern the critical step of how these factors worked in tandem to complete the cycle, dictating the function of the cell’s ribosome — a large macromolecular machine that binds RNA to make more proteins. What they found was that the processes that occur are not like any understood to take place anywhere else in the human body.
“This amino acid gets attached to a unique RNA molecule and that has to be carried to the ribosome via a unique protein factor,” said Copeland, whose lab has spent the past 20 years working to understand how these biomolecules function on a biochemical level. “And all of this evolved in humans specifically to allow selenium to be incorporated into this handful of proteins.”
Once Sec is ensconced in the selenoproteins, the proteins perform a wide range of vital functions necessary for growth and development. They produce nucleotides, the building blocks of DNA. They break down or store fat for energy. They create cell membranes. They produce the thyroid hormone, which controls the human body’s metabolism. And they respond to what is known as oxidative stress by detoxifying chemically reactive byproducts in cells.
Diseases and disorders such as cancer, heart disease, male infertility, diabetes and hypothyroidism can arise when the production of selenoproteins is disrupted.
“Understanding the mechanism by which Sec is incorporated is a foundational part of developing new therapies for a multitude of disease states,” Copeland said.
The study was led by scientists at the Institute for Medical Physics and Biophysics in Berlin, Germany, the Max Planck Institute for Molecular Genetics in Berlin, Germany, and the University of Illinois at Chicago in Chicago, Ill.
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Materials provided by Rutgers University. Original written by Kitta MacPherson. Note: Content may be edited for style and length.

Some people who experience heart failure have less biodiversity in their gut or have elevated gut metabolites, both of which are associated with more hospital visits and greater risk of death, according to a systematic review of research findings led by Georgetown University School of Nursing & Health Study researchers and colleagues.
The gut microbiome is a delicately balanced ecosystem comprised primarily of bacteria as well as viruses, fungi and protozoa. The microbiome can affect cardiovascular disease, which is a leading cause of death in the United States; heart failure, affecting over six million Americans annually, is often the end-stage of progressive cardiovascular disease.
For their overview, the investigators looked at seven years of genetic, pharmacologic and other types of research findings from around the world to generate a wide perspective on how the microbiome can influence heart failure. The investigators zeroed in on one harmful metabolite, trimethylamine-N-oxide (TMAO), that can be produced by churning gut microbiota when full-fat dairy products, egg yolks and red meat are consumed.
The analysis appeared June 20, 2022, in Heart Failure Reviews.
“To diagnose and manage heart failure we rely on certain findings and test results, but we do not know how poor heart function influences the activities of the gut, including the absorption of food and medications,” says Kelley Anderson, PhD, FNP, CHFN, associate professor of nursing at Georgetown and corresponding author of the study. “There is now an appreciation of a back-and-forth relationship between the heart and elements in the gut, as clearly the heart and vascular system do not work in isolation — the health of one system can directly influence the other, but clear connections are still being worked out scientifically.”
The investigators parsed 511 research articles published between 2014 and 2021 that connected the microbiome with heart failure and winnowed their focus to the 30 most relevant articles. In recent years, more advanced technology, particularly tools that can closely examine the biological roles of DNA and RNA in the body, provided more detailed insights into the gut/heart relationship and those studies were of particular interest.
The researchers could not pinpoint the effects of diet on the interplay between the microbiome and the cardiovascular system due to a lack of strong data from the studies they reviewed. The investigators noted that nutrition is an important component of overall cardiovascular health, so having the opportunity to explore the impact of diet in relation to the microbiome is a promising area for future research efforts.
In terms of possible interventions to mitigate negative impacts of the microbiome on heart disease, Anderson noted that there are ongoing studies evaluating the use of antibiotics, prebiotics and probiotics, all of which can impact the microbiome, as well as intestinal binders that glom on to and help shuttle harmful elements out of the gut.
“We are currently developing a forward-looking study to evaluate the microbiome in patients with heart failure. We are particularly interested in the symptomatic experience of patients with end-stage heart failure as well as disease-related weight loss and wasting during this stage of cardiovascular disease,” says Anderson.
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SharecloseShare pageCopy linkAbout sharingHeather Lawrence was shocked at the state she found her 90-year-old mother, Violet, in when she visited her in hospital.”The bed was soaked in urine. The continence pad between her legs was also soaked in urine, the door wide open, no underwear on. It was a mixed ward as well,” Heather says.”I mean there were other people in there that could have been walking up and down seeing her, with the door wide open as well. My mum, she was a very proud woman, she wouldn’t have been wanted to be seen like that at all.”Violet, who had dementia, was taken to Tameside General Hospital, in Greater Manchester, in May 2021, after a fall. Her health deteriorated in hospital and she developed an inflamed groin with a nasty rash stretching to her stomach – due to prolonged exposure to urine. She died a few weeks later. Heather tells BBC News: “I don’t really know how to put it into words about the dignity of care. I just feel like she wasn’t allowed to be given that dignity. And that’s with a lot of dementia patients. I think they just fade away and appear to be insignificant, when they’re not.” What those living with dementia want people to knowDementia patients being ‘dumped in hospital’The street helping people with dementia to rememberTameside has not resolved Heather’s concerns but officials have offered to meet her.New research, shown exclusively to BBC Radio 4’s File on 4 programme, has found other dementia patients have had to endure similar indignity. Dr Katie Featherstone, from the Geller Institute of Ageing and Memory, at the University of West London, observed the continence care of dementia patients in three hospitals in England and Wales over the course a year for a study funded by the National Institute for Health and Care Research.She found patients who were not helped to go to the toilet and instead left to wet and soil themselves.”We identified what we call pad cultures – the everyday use of continence pads in the care of all people with dementia, regardless of their continence but also regardless of their independence, as a standard practice,” Dr Featherstone says.She found some good practice – but time pressures and too few staff meant many felt compelled to use pads as a “workaround”. When Bessie, 86, was taken into Rotherham General Hospital, in 2019, after falling at home, she had been continent. Despite this, her daughters Janine Ward and Susan Nurden say, staff were not responsive when Bessie asked to go to the toilet. Unknown to her daughters, the hospital had also placed her in continence pads.”There was no way that my mum would soil herself,” Janine says. “She knew what she was doing. She would make a fuss she wanted to go to the toilet – and if you don’t respond in time, she’s going to get distressed and she’s going to shout for someone to come.”Bessie should have been referred to the Rotherham NHS Foundation Trust’s continence team but never was.Janine and Susan felt their mother’s continence and frail mobility put her at risk of another fall at home. They wanted her moved to a care home near them – but the hospital and social services disagreed. They said Bessie was incontinent and put in place a care plan to discharge her home with additional carers, commodes and continence pads (although, those never materialised.)On Bessie’s first night back, Janine was with her when the carers arrived with the commode for the living room.Janine says: “They sat her on it. The lounge curtains were still open, a big full picture window. I can’t explain how I felt. “I said, ‘You have just put my mum on that commode with the curtains wide open, why didn’t you close them up?’ at which point they closed them. I would have thought that closing the curtains would have showed some respect for dignity, wouldn’t you?”Contacted by BBC News, the trust and Rotherham council offered an apology to Bessie’s family and said patient care had subsequently been improved.’Become institutionalised’Dr Featherstone says people with dementia often forget how to go to the toilet once they have been made to use pads.”We do know that a lot of people living with dementia who go into hospital continent, leave the hospital with incontinence,” she says. “So just wearing a pads and those practices surrounding it can mean that people start to lose their continence. “And that can have real implications for people later on. It might be difficult for families to care for somebody if they have to care for incontinence as well. And it might mean that people become institutionalised.”Prof June Andrews, who has worked in dementia care for over 30 years, says rigorous continence assessments are essential to prevent assumptions being made.”I certainly see paperwork where someone has asked the question perhaps of the relatives as to whether or not the patient is continent. And that’s the entire extent of the assessment that has taken place,” she says.”It’s absolutely vital for families to know that they should ask whether or not a continence assessment has taken place and who has done it. It’s the kind of thing that will get missed if nobody’s asking questions about it.”Dementia UK’s Director of Research and Publication Dr Karen Harrison Dening, who co-authored the report, said: “People, whatever their underlying conditions and whatever age, do not go into hospital expecting to become incontinent. “Staff not only require targeted education on the specific ways they can promote an individual’s independence but health care organisations should be mandated and responsible for maintaining an older person’s autonomy.”File on 4 – Dignity in Dementiais on BBC Radio 4 on Tuesday, 21 June, at 20:00, and Sunday, 26 June, at 17:00, and on demand on BBC Sounds.

SharecloseShare pageCopy linkAbout sharingImage source, Mark StoryIn September 2021, Mississippi’s chief legal officer sat down for an interview with Pro-Life Weekly, a Catholic television programme featuring anti-abortion activists. Lynn Fitch looked how she almost always does during public appearances: dyed-blonde hair blow-dried straight and neat, tasteful jewellery and a monochrome suit, this time in powder blue. The attorney general was there to celebrate. The United States Supreme Court had just announced the date it would hear her state’s challenge to Roe v Wade, the 1973 ruling that has, for the nearly 50 years since, served as a nationwide guarantee to abortion access. The case, Dobbs v Jackson Women’s Health Organization, centres on a Mississippi law that would ban abortion after 15 weeks of pregnancy, even in cases of rape or incest. Under Ms Fitch’s direction, the state asked the Supreme Court to uphold the law and slash the landmark Roe v Wade decision in the process. A ruling is expected this month. A leaked draft suggests it is likely that Mississippi’s ban will be upheld, paving the way for other states to also outlaw abortion. Ms Fitch – who declined to be interviewed – had argued that overturning Roe v Wade would be “game-changing”, “uplifting” women by eliminating what she described as a false choice between family and career. “Fifty years ago, for professional women, they wanted you to make a choice. Now you don’t have to,” she said on Pro-Life Weekly. “You have the option in life to really achieve your dreams, your goals, and you can have those beautiful children as well.”If she wins the case, and Roe v Wade falls, some 40 million women may lose access to abortion, pro-choice advocates warn. It could also make Ms Fitch, a single working parent of three, a Republican superstar and poster-child for her own argument: modern women don’t need abortion to have it all.Image source, Getty ImagesAbortion was not always an animating theme of Ms Fitch’s political career. When she first took public office, as Mississippi state treasurer in 2011, she pushed for legislation that would guarantee men and women were paid equally.Her convictions were shaped in many ways by her upbringing, and especially her experiences as a single mother, says Hayes Dent, a long-time friend and colleague, who ran her first political campaign.When Mr Dent first met Ms Fitch, she had just been named executive director of the Mississippi State Personnel Board, a state agency, by then-governor Haley Barbour. Mr Dent was immediately impressed.”Having been around every major political figure in Mississippi for 40 years, I could just tell: she’s going to run,” Mr Dent said. “And when she pulls that trigger, she’s going to be successful.” It wasn’t for another couple of years that she did, launching a campaign for state treasurer. Whens he launched her first political campaign, for state treasurer in 2011, “she was an underdog,” said Austin Barbour, a national GOP strategist (no relation to former Governor Barbour). Mr Dent, who had kept tabs on Ms Fitch, reached out to her in the middle of that 2011 cycle and asked to come on board her campaign.”I said ‘Look, I think you can win this race,'” he recalled. She accepted, and the two ran an ambitious campaign, even driving the length of the state in a day, making a handful of different stops and placing fundraiser calls in the hours between. “Her attitude was ‘what is the task at hand,'” Mr Dent said. “It’d be like ‘Look, we’ve gotta go to the tobacco spitting festival.’ And she’d do great! She wouldn’t spit tobacco, but she was great.”The only reason Ms Fitch would turn down a campaign event was her kids, cutting out early to make a school basketball game or parent-teacher conference. She was a natural campaigner, but fundraising lagged, so Mr Dent asked her father for a personal donation. Image source, Getty ImagesBill Fitch still lived in Holly Springs, the small, rural town near the state’s northern edge where Ms Fitch spent most of her childhood. Her father had inherited land on the historic Galena Plantation and used the sprawling 8,000-acre property to restore the family farm, turning it into a premier quail hunting destination. The late Supreme Court Justice Antonin Scalia, and Mississippi governors Barbour and Phil Bryant, became frequent guests. Visitors of Fitch Farms could elect to stay in the former home of Confederate general and first grand wizard of the Klu Klux Klan, Nathan Bedford Forrest, which Mr Fitch had bought and transported onto the property. Ms Fitch has told local media of “special” childhood memories at her father’s farm, riding horses and hunting quail. As a teenager, she was the “prototypical popular girl”, Mr Dent said. “Leader, cheerleader, athletic, the whole nine yards,” he said. She went to the University of Mississippi, joined a sorority and graduated with a degree in business administration and later in law. When Mr Dent drove to her father’s farm to make his pitch for a campaign donation, he said: “I told him if I left there with a big cheque, she was going to win”. She won, and then won again four years later, securing a second term as state treasurer. In this office, she targeted state debt, expanded access to financial education in the state, and advocated for equal pay laws (Mississippi remains the only state that does not ensure equal pay for equal work between men and women). Rifts split America’s abortion ‘ground zero’ stateUS Democrats’ bid for federal abortion law failsAnd she developed her knack for connecting to voters, leaning on both her Holly Springs upbringing and an apparent ease in the public eye. In interviews and campaign videos, Ms Fitch looks preternaturally poised. She makes easy eye contact, her speech slow and relaxed, often thanking God and her family for the opportunity to serve her state.”Rural roots matter to voters in this state,” said Mr Barbour, the Republican strategist. “And she’s very likeable, she just is.” Ms Fitch also helped bolster her conservative credentials with her support for then-presidential candidate Donald Trump, leading Mississippi’s Women for Trump coalition in 2016. When Mr Trump was in Jackson for a campaign rally, she sat in the front row. Two years later, Ms Fitch announced she would make a bid for Mississippi Attorney General – an office that had never been held by a woman.But she wasn’t the underdog, and glided to victory in November 2019 with nearly 60% of the vote on a promise to uphold “conservative values and principles”.Image source, Getty ImagesAs a devoted Republican in a solidly Republican state, where Ms Fitch stood on abortion was taken as given, even if she didn’t run on it. Across the country, about 60% of Americans say abortion should be legal in all or most cases, according to data from the Pew Research Centre. But among Mississippi Republicans, nearly 70% believe abortion should illegal in all or most cases. “You don’t run in Mississippi, you don’t run in rural conservative states and not want to see Roe v Wade overturned,” said Mr Barbour, the Republican strategist. “It’s just ingrained”. The abortion ban before the Supreme Court was passed by Mississippi’s state legislature in 2018, two years before Ms Fitch took office as Attorney General. The law, which bans abortions outright after 15 weeks, was immediately challenged in court on behalf of Jackson Women’s Health Organization, Mississippi’s last abortion clinic. A federal district court struck down the ban, saying it was unconstitutional, and that was upheld by a higher court in 2019. But in June 2020, five months into the job, Attorney General Fitch petitioned the US Supreme Court to review the 15-week ban. The court, with its 6-3 conservative majority, accepted and heard the case in December of last year. Now, she’s known nationally as the lawyer expected to topple Roe v Wade. At times, Ms Fitch has said her state is merely making an argument for the rule of law: asking the Supreme Court to turn over abortion policymaking to the states. But more often, she says the case is about women’s empowerment. Roe v Wade, she has said, made women believe they had to pick: family or career, not both. “The court in Roe pitted women against our children, and woman against woman,” she wrote in a Washington Post op-ed. The choice is misleading and paternalistic, argued Ms Fitch. It’s an position seemingly drawn from her own life: a single mother who has ascended to the highest levels of state office, while remaining devoted to her children and grandchildren. “Being a single mom has sort of dominated her thought process, and her life experience,” Mr Dent said. “I think that’s one of the reasons she feels so strongly about this”. In a world without Roe v Wade, Ms Fitch said during a television interview last year, “babies will be saved” and mothers “get a chance to really redirect their lives. They have all these new and different opportunities that they didn’t have 50 years ago”. Image source, Attorney General Lynn Fitch/FacebookPro-choice activists have accused Ms Fitch of using feminist language to cover over an inherently anti-feminist policy.Her arguments lean “heavily into false claims that they are ’empowering women'”, said Dina Montemarano, research director for NARAL Pro-Choice America. This tactic, Ms Montemarano said, is often used by anti-abortion activists to assert control over women’s bodies and violate their fundamental freedoms. In an opening brief submitted to the Supreme Court, Ms Fitch wrote of “sweeping policy advancements [which] now promote women’s full pursuit of both career and family”. But in a counter-argument submitted to the Supreme Court, 154 economists warned in a brief that this optimism was “premature and false”. “Mississippi’s celebration of parental leave policies is particularly bizarre, as the United States is one of only two countries without a national paid maternity leave policy,” the economists wrote. Mississippi, specifically, has no state laws mandating paid family leave. It is the poorest state in the nation and has the highest rates of both infant mortality and child poverty.But if Roe is indeed thrown out, Ms Fitch will return to Mississippi a conservative hero. “I’m 99% sure she will run for attorney general again,” Mr Dent said. “And based on how the last three years have gone, it’s hard for me to imagine she’ll have any Republican opposition this time”. There are also early rumblings that she may one day run for governor. She has not yet commented on this speculation. If she wins, Ms Fitch would be the first female governor in Mississippi’s history. More on this storyOklahoma bans most abortions after conceptionUS Democrats’ bid for federal abortion law failsAmazon will pay staff travel expenses for abortions