Category: Health & Fitness

In late 2012, the best-selling author and journalist Michael Pollan (“The Omnivore’s Dilemma”) was at a dinner party in Berkeley, Calif. Among his fellow diners was a prominent developmental psychiatrist, in her 60s, who spoke at some length about a recent LSD trip. This pricked up Pollan’s ears.

His first thought, as he shared during a recent video interview: “People like that are taking LSD?” The psychiatrist went on to explain that the drug gave her a better understanding of the way children think.

“Her hypothesis,” Pollan said, “was that the effects of psychedelics, LSD in that case, give us a taste of what child consciousness would be like — this kind of 360-degree taking-in of information, not particularly focused, fascinated by everything.”

Pollan had already heard about clinical trials in which doctors were giving cancer patients psilocybin to help them deal with their fear of death. Now, he was really curious about psychedelic therapy. That curiosity became an article in The New Yorker (“The Trip Treatment,” 2015). The article became a book, “How to Change Your Mind” (2019).

And now the book has become a four-part Netflix series of the same name, which debuted Tuesday. Pollan is an executive producer (along with the Oscar-winning filmmaker Alex Gibney) and the primary on-camera presence.

A thoughtful and wide-ranging look at psychedelic therapy, the series is grounded in accounts of their centuries-long sacramental use and of their uneasy history in modern society, especially in the United States. In particular, it focuses on four substances — LSD, mescaline, MDMA (known as Ecstasy or Molly) and psilocybin (the active ingredient in magic mushrooms) — and the ways in which they are being used to treat patients with maladies including post-traumatic stress disorder, addiction, depression, anxiety and obsessive-compulsive disorder.

One of those patients is Lori Tipton, a New Orleans woman who endured a Job-like run of ill fortune. Her brother died of an overdose. Her mother murdered two people and then killed herself; Tipton found the bodies. She was raped by an acquaintance. Not surprisingly, she developed severe PTSD.

“I really felt like I couldn’t access joy in my life, even when it was right in front of me,” Tipton said in a video interview. She thought about suicide constantly. When she heard about a clinical trial for MDMA, held in 2018, she figured she had nothing to lose.

I can relate to some of this. A few years back I was diagnosed with PTSD and clinical depression after my life partner, Kate, was diagnosed with a terminal brain disease and died about 18 months later, in 2020. I didn’t have much interest in living. Running out of options, my doctor prescribed me a weekly regimen of esketamine, which is a close relative of the dissociative hallucinogen ketamine.

Like many, I had experimented with hallucinogens, including mushrooms and LSD, in my youth. I was partying, not seeking. I never planned to go back there. But the treatment started helping me almost immediately.

Pollan, 67, never did the youthful experimenting. Known primarily as an expert in plants and healthy eating — his latest book, “This is Your Mind on Plants,” comes out in paperback on July 19 — he came to psychedelics late in life. He was too young to indulge in the Summer of Love, and by the 1970s, the war on drugs and anti-LSD hysteria had quashed what had been a fertile period of scientific research in the ’50s.

But once he began studying, and experimenting, he became a convert rather quickly.

“At this age sometimes you need to be shaken out of your grooves,” he says in the Netflix series. “We have to think about these substances in a very cleareyed way and throw out the inherited thinking about it and ask, ‘What is this good for?’”

Tall and bald with the build of a swimmer, Pollan is no Timothy Leary — he isn’t asking anyone to drop out — and the medical trials described and shown in “How to Change Your Mind” shouldn’t be confused with Ken Kesey’s freewheeling acid tests of the ’60s. Back then, when psychedelics left the laboratory and entered the counterculture, the power structure freaked out.

“Kids were going to communes, and American boys were refusing to go to war,” Pollan said. “President Nixon certainly believed that LSD was responsible for a lot of this, and he may well have been right. It was a very disruptive force in society, and that is why I think the media after 1965 turns against it after being incredibly enthusiastic before 1965.”

Junk science spread nonsense about LSD scrambling chromosomes. The drug was made illegal in California in 1966, and then nationally in 1970. Researchers weren’t forbidden from continuing their work with psychedelics, but the stigma made such work very rare until it re-emerged in the 2000s. Today, clinical trials are approved by the F.D.A. and D.E.A.

“From the early ’70s to the early ’90s, there was no approved psychedelic research in human subjects,” said Charles Grob, a professor of psychiatry and pediatrics at U.C.L.A., who has written widely about psychedelic therapy. “Since then, research development has re-emerged and slowly evolved, until the last few years when professional and public interest in the topic appears to have exploded.”

Given evolving attitudes, one challenge facing the filmmakers, including the directors Alison Ellwood and Lucy Walker, was how to depict the psychedelic experience in a sophisticated way, without stumbling into the territory of a ’60s exploitation movie.

“We didn’t want to fall into the trap of using psychedelic visual tropes — wild colors, rainbow streaks, morphing images,” Ellwood wrote in an email. “We wanted to keep the visual style more personal, intimate and experiential. We wanted people watching the series who have not had their own psychedelic experiences to be able to relate to the visuals.”

One imaginative scene recreates the famous bicycle ride taken by the Swiss chemist Albert Hofmann, who first synthesized LSD in 1936 but didn’t discover its psychedelic effects until 1943 (accidentally). Feeling strange after ingesting 250 micrograms, Hofmann rode his bike during the peak of his trip. In “How to Change Your Mind,” we see the buildings around him bend and waver as he rides. The road beneath him blurs. The tombstones in a graveyard sway.

Tipton’s experience in her clinical MDMA trials was more controlled but no less profound. The results after three sessions, she said, were beyond what she could have imagined.

“As the sessions progressed, I worked with the therapists to remain embodied and fully present to my emotions as I recalled some of the most difficult experiences of my life,” Tipton said. “In doing this, I was able to find a new perspective, one that had eluded me for years. And from this place I could find empathy, forgiveness and understanding for many people in my life, but most importantly for myself.”

Her descriptions sounded familiar. In 2020, I began going to my doctor’s office once a week to ingest three nasal spray inhalers and sit for two hours, pausing only to have my blood pressure taken halfway through. I didn’t hallucinate, but I found myself conversing with Kate as if she were in the room.

I saw my grief as something separate from my being, something more akin to love than death. I didn’t identify with my pain in the same way.

It was, without question, a spiritual experience. Then, two hours later, a bit groggy but otherwise back to normal, I was ready to go home. After a few such sessions, combined with talk therapy, I started to see a light at the end of the tunnel. Esketamine is technically not a psychedelic, but it had certainly changed my mind.

It’s safe to say Pollan’s has changed, too. He recently became a co-founder of the University of California Berkeley Center for the Science of Psychedelics. A portion of his author website now serves as an informational clearinghouse for people looking to learn more. Word of his effort appears to be spreading. His book on the subject was name-checked on a recent episode of the HBO Max series “Hacks.” The Netflix series has already cracked the streamer’s Top 10 in the United States.

Bit by bit, the country’s laws are beginning to reflect evolving attitudes. Last year, Oregon voters approved a ballot initiative that directs the Oregon Health Authority to license and regulate “psilocybin products and the provision of psilocybin services.” Colorado appears likely to vote on a similar initiative this fall.

For Pollan, such efforts strike a personal nerve.

“The ego is a membrane between you and the world,” he said. “It’s defensive and it’s very useful. It gets a lot done, but it also stands between us and other things and gives us this subject-object duality. When the ego is gone, there is nothing between you and the world.”

“Getting perspective on your ego is something you work at in psychotherapy,” he added. “But this happened for me in the course of an afternoon, and that’s what’s remarkable about it.”

Nearly half of the participants of a recent study who were menstruating regularly at the time of the survey reported heavier bleeding during their periods after receiving the Covid-19 vaccine. Others who did not typically menstruate — including transgender men, people on long-acting contraceptives, and post-menopausal women — also experienced unusual bleeding.

The new study — the largest to date — expands on research that has highlighted the temporary effects of Covid-19 vaccines on menstrual cycles, but until now focused primarily on cisgender women who menstruate.

Although the vaccines have largely prevented deaths and severe disease with few reported side effects, many medical experts initially brushed aside concerns when women and gender-diverse people started reporting erratic menstrual cycles after receiving the shots.

To get a better sense of these post-vaccination experiences, researchers at the University of Illinois at Urbana-Champaign and Washington University School of Medicine in St. Louis distributed an online survey in April 2021 to thousands of people across the globe. After three months, the researchers collected and analyzed more than 39,000 responses from individuals between the ages of 18 and 80 about their menstrual cycles. All the survey respondents had been fully vaccinated — with the Pfizer-BioNTech, Moderna, Johnson & Johnson vaccines or another that had been approved outside the United States. And to the best of their knowledge, the participants had not contracted Covid-19 before getting vaccinated.

The research, published Friday in the journal Science Advances, shows that 42 percent of people with regular menstrual cycles experienced heavier bleeding after vaccination, while 44 percent reported no change and 14 percent reported lighter periods. Additionally, 39 percent of respondents on gender-affirming hormone treatments, 71 percent of people on long-acting contraceptives and 66 percent of postmenopausal women experienced breakthrough bleeding after one or both of their shots.

“I think it’s important that people know this can happen, so they’re not scared, they’re not shocked and they’re not caught without supplies,” said Katharine Lee, a biological anthropologist at the Washington University School of Medicine in St. Louis, and the study’s first author.

Dr. Lee cautioned, however, that the study did not compare the results with a control group of people who did not get vaccinated. And it is possible that people who observed changes in their cycles after vaccination may have been more likely to participate in the survey. Still, the findings line up with smaller studies that have reported menstrual changes after vaccination with more robust controls.

Importantly, the new study also found that some demographics may be more likely to experience menstrual changes, and the study may help them be better prepared, Dr. Lee said. A heavier menstrual flow was more likely for those who were older, for instance. Survey respondents who used hormonal contraception, had been pregnant in the past or had been diagnosed with a reproductive condition like endometriosis, fibroids or polycystic ovarian syndrome were also more likely to have heavier bleeding during their periods. People who identified as Hispanic or Latino tended to report heavier bleeding too. And people who experienced other side effects of the vaccines, like a fever or fatigue, also had a higher chance of experiencing erratic periods.

Postmenopausal women who were slightly younger, around an average age of 60, were more likely to experience breakthrough bleeding after the vaccine than those who were older. But the type of vaccine postmenopausal women received, whether they had other side effects like a fever or whether they had a past pregnancy did not seem to have an effect on their bleeding.

Why do these changes occur?

Some level of variation in menstruation — the number of days you bleed, the heaviness of your flow and your cycle length — is normal.

“Our menstrual cycles are not perfect clocks,” said Dr. Alison Edelman, a professor of obstetrics and gynecology at Oregon Health & Science University who has also studied the impact of Covid-19 vaccines on menstruation.

Hormones secreted by the hypothalamus, the pituitary gland and the ovaries regulate the monthly cycle, and they can be affected by both internal and external factors. Stress and illness, weight loss or weight gain, calorie restriction and intense exercise can all change typical patterns of menstruation.

The endometrium, which lines the uterus and is shed during menstruation, has also been linked to the immune system. Because of the role it plays in the remodeling of uterine tissue and offering protection against pathogens, it is possible that when vaccines activate the immune system, which is what they should be doing, they also somehow trigger downstream effects in the endometrium, causing a disturbance in your menstrual cycle, Dr. Edelman said. And some individuals may be more sensitive to immune or hormone changes in their body.

In her research, Dr. Edelman found that some women’s periods came a day or two later than usual after they got vaccinated against coronavirus. But the changes were temporary — menstruation tended to return to normal after one or two cycles.

What to do if you notice menstrual irregularities after the Covid vaccine

If you experience any new or unusual patterns of bleeding, take note of it. The menstrual cycle can be thought of as another vital sign, just like your body temperature or blood pressure, that provides clues about your health, said Dr. Jennifer Kawwass, a reproductive endocrinologist at Emory University, who was not involved in the study.

“A significant change in menstrual cycle interval or bleeding profile warrants further investigation to be sure there is not an underlying endocrinologic, hematologic or anatomic cause,” Dr. Kawwass said. Breakthrough bleeding in people who no longer normally menstruate, for example, may also be a warning sign of cervical, ovarian, uterine or vaginal cancer.

That being said, subtle variation in your menstrual cycle, if you have regular periods, should not be a cause for concern and does not require that you change anything you would normally do, Dr. Kawwass said.

Clinical trials and other studies have already established that the Covid-19 vaccines are safe and effective and are unlikely to impact fertility in the long term.

Should you get vaccinated at a certain time in your cycle?

Experts agree that the chaos Covid-19 can cause throughout your body, including potential lingering effects, is far worse than any side effects caused by vaccination against the disease.

People who have previously gotten a fever after a shot may plan their next dose on a day when they will not have to go in to work, Dr. Edelman said. But you should not let temporary menstrual changes prevent you from getting fully vaccinated or boosted. Since cases are on the rise again, delaying vaccination for two weeks or longer may significantly increase your risk of getting Covid-19, she said.

Still, it’s important to track your body’s response to vaccination, and public health officials should acknowledge concerns about menstrual cycle variations in addition to warning people of the risk of getting Covid-19, said Keisha Ray, a bioethics expert at McGovern Medical School at UTHealth Houston.

The increased transparency around menstrual changes or other side effects of vaccination could also have another benefit: reducing people’s vaccine hesitancy.

“We’re trying to be truthful. We’re trying to validate people’s lived experiences,” said Dr. Lee. In turn, she hopes that the new research will help improve conversations around people’s health and lead to more inclusive clinical trials in the future.

Even before the constitutional right to an abortion was struck down last month, health insurance coverage for it was spotty. Abortion benefits largely depended on where a woman lived or whom she worked for.

Those factors have become even more crucial now that the Supreme Court has left it to the states to regulate abortion. The existing patchwork of coverage is likely to become more restrictive, and the gulf will widen between states that had already banned abortion-related benefits and those that mandate coverage.

Dozens of large employers are attempting to fill the gaps by paying expenses for workers who need to cross state lines for a legal abortion, though there are still questions about how much risk companies are taking on and how far an anti-abortion state — or an aggressive prosecutor — could go to stop them.

For women without that extra support or coverage, the new logistical challenges and the added costs may be impossible to overcome.

“People with financial resources will find ways to get the treatment they want or need,” said Susan M. Nash, a benefits lawyer and partner at Winston & Strawn with expertise in health care. “But the people who can’t travel or have limited means to access treatment outside of the health plan will be adversely impacted here.”

Here’s a look at how the decision, Dobbs v. Jackson, may affect insurance coverage across the country:

How much does an abortion cost?

The median cost to a patient for a medication abortion — which involves two drugs, generally taken up to 10 to 12 weeks of pregnancy — was $560 in 2020, according to a recent study at the University of California San Francisco’s Advancing New Standards in Reproductive Health program. A procedural abortion was $575 during the first trimester and $895 during the second trimester. That doesn’t include travel costs and other expenses, such as child care and time off from work, which will be increasingly necessary for women in a growing number of states. And costs varied substantially by region.

Most patients pay out of pocket, research has found, in large part because their insurance doesn’t cover the procedure. Even before the Dobbs decision, 11 states restricted the type of abortion coverage private health insurance plans could cover, and 26 states barred all plans in their state’s health insurance exchange from covering abortion, researchers found.

Will Medicaid cover abortion?

Just like before the ruling, that largely depends on where you live.

Medicaid, a public health program largely for low-income households that is administered by the states, is financed by federal and state money. Even before the Dobbs decision, federal law — known as the Hyde Amendment — didn’t allow federal funds to pay for abortions, except in limited circumstances: if the pregnancy was the result of rape or incest or caused a life-endangering condition for the woman. States could choose to use their own money to pay for abortions beyond those situations, and 16 states had such policies last year, according to the Kaiser Family Foundation (though nine were ordered by courts to have them).

The vast majority of states don’t pay for anything beyond those limited circumstances — and South Dakota, in violation of federal law, covers abortions only in the case of life endangerment, according to a 2019 study by the Government Accountability Office.

Like South Dakota, a growing list of states that ban abortions — including Alabama, Arkansas, Louisiana and Missouri — make exceptions only when the woman’s life is endangered. That puts them in conflict with federal law that also requires abortion coverage in cases of rape or incest.

The Centers for Medicare & Medicaid Services said it would notify states when they were out of compliance with federal requirements, and added that the Department of Health and Human Services was taking steps to expand access to medication abortion in those limited circumstances. Details on how that will happen are still vague.

What about marketplace plans?

The health insurance marketplace created under the Affordable Care Act has similar restrictions. Plans offered within the marketplace are not required to cover abortion, and federal money — including premium subsidies in the form of tax credits — cannot be used to pay for them. Here, too, there are exceptions for rape, incest and life endangerment, but they are not universal.

There are 26 states that ban marketplace plan coverage of abortions, said Alina Salganicoff, director of women’s health policy at Kaiser. But a few states don’t make exceptions for rape or incest, and some states make no exceptions at all, she added.

In contrast, insurers in seven states are required to include abortion coverage in all plans sold on the marketplace, according to Kaiser, but no federal dollars are used.

For example, in states like New York, where abortion is legal under state law, policy holders with subsidized marketplace plans have $1 of their monthly premium held separately to be used for abortion and other services.

But if an individual with a marketplace plan lives in a state where abortion is banned, it’s likely their policy won’t provide coverage in their own state or across state lines.

I’m covered by my employer’s plan. Will my benefits change?

That will depend on where you live, the type of insurance plan your employer uses and their stance on coverage.

Basically, if a company pays for its employees’ health care from its own coffers, workers, even those in states where abortion is illegal, may have broader access to benefits. But employers that buy insurance policies for workers could be further restricted.

Large employers are often self-insured, which means they collect a share of their workers’ premiums and pay for their health care (though an insurer or administrator usually processes claims). These plans generally follow federal rules under the Employee Retirement Income Security Act of 1974, known as ERISA, which provide broad flexibility in designing a health care plan.

Other employers buy insurance on behalf of their workers, and the insurer is responsible for costs. Health insurers are regulated by the states and must follow their rules — if abortion is banned there, you’re unlikely to receive any coverage, even if you travel out of state.

Many larger employers are providing travel benefits for workers who would need to cross state lines for abortion. This is often an extension of existing policies. Typically these plans have offered travel benefits for people seeking cancer treatments, transplants or other specialized therapies if they don’t have access to a provider in their state or have to travel a certain number of miles to reach one, benefits lawyers said.

But there are still concerns about employers’ criminal and civil liability, particularly in states with laws that would call for criminal prosecution of anyone in the state who “aids and abets” an abortion, even if it occurs in another state where abortion is legal.

Health plans governed by federal ERISA regulations may have additional protections against legal actions brought under state law, benefits experts said, as long as the services are legal in the state where they are provided. Benefits lawyers also point to Justice Brett Kavanaugh’s concurrence in Dobbs, in which he said states with abortion bans could not stop women from seeking the procedure elsewhere. But while ERISA regulations often supersede state laws that may apply to plans, that doesn’t extend to state criminal laws.

“This issue will likely be the subject of continuing litigation and debate,” according to the reproductive rights task force at Morgan Lewis, a law firm in Washington.

Will my employer coverage work differently if I travel out of state?

That depends on your plan.

But when an insured person travels out of state for an abortion or related medication, it’s more likely the providers will fall outside the plan’s network, which generally costs the insured person more or means expenses will be reimbursed at a lower rate, said Sarah Raaii, a senior associate at McDermott, Will & Emery. Some employers could decide to ease that burden by making up the difference and covering certain out-of-network procedures and services at the in-network rate, she added.

What does the ruling mean for telehealth coverage?

Women in states with abortion bans may consider getting prescriptions for abortion-related drugs through a telehealth visit from a provider located in a state where abortion is permitted.

It may not be easy. Even before the Dobbs decision, some states banned telehealth visits from prescribing abortion-inducing medications or had other rules that limited the feasibility of remote visits anyway. And six states had laws that banned the mailing of abortion drugs, according to Kaiser.

With broader abortion bans, the rules around telehealth visits and insurance coverage may become trickier. But one aspect is relatively clear: The location of the patient during the telehealth visit will determine whether it’s legal to prescribe abortion medication at that time, said Marshall E. Jackson Jr., a partner with McDermott Will & Emery who focuses on digital health care.

For example, a patient living in Missouri, where abortion is banned, could not have abortion medication prescribed during a telehealth consultation while she was in her home state. But if the telehealth visit occurred while she was working from her employer’s office in Illinois — and the medication was mailed there — that would be generally permitted, he said.

How much do I have to worry about privacy if I use insurance?

That will also depend on your location.

“If there is a criminal statute in the state you live in, you need to be concerned,” said Amy M. Gordon, a partner and benefits lawyer at Winston & Strawn. “It depends on how aggressive prosecutors will be prosecuting those outside of their state. Therefore, the risks are still open questions.”

Let’s say you live in a state where abortion is banned but you travel to another state to receive a prescription for abortion-inducing drugs or to have the procedure. When plan benefits are used to pay, that information is generally protected under the Health Insurance Portability and Accountability Act, known as HIPAA, the federal rule that governs the privacy of a patient’s health records.

But medical and billing records that are typically kept private can be released without the patient’s written permission in response to a warrant or subpoena.

“An employer that sponsors a group health plan can argue this is protected health information, and therefore it should not be turned over,” Ms. Gordon said. “However, this is not bulletproof. There are provisions in HIPAA that permit disclosure to law enforcement seeking to enforce the law.”

Are there resources for people without insurance?

Yes. The federal government is encouraging people to visit reproductiverights.gov, which includes links to other resources that can help users find abortion providers and so-called abortion funds, which can provide financial assistance.

According to the Guttmacher Institute, a reproductive health research group that supports abortion rights, there are more than 80 abortion funds that help patients seeking the procedure or medication. Other groups, including the Brigid Alliance, help provide travel, lodging and logistical support to patients.

Is coverage for infertility treatments or contraceptives affected?

Contraceptive coverage is not affected by the ruling. Most private health plans, including plans in the health insurance marketplace, must cover contraceptive methods and counseling, including emergency contraceptives, as prescribed by a health care provider, according to Ellen Montz, director of the Center for Consumer Information and Insurance Oversight at the Center for Medicare & Medicaid Services.

These plans must cover these services without charging a co-payment or coinsurance when provided by an in-network provider — even if someone hasn’t met the deductible, she added.

But there are fears that some types of infertility treatments, which are increasingly covered by employer-provided insurance, could be restricted, depending on the legal language included in abortion bans.

Legal experts say new rules don’t pose an immediate threat to infertility patients, their health care providers and embryos created in labs, but that could quickly change, depending on how the new abortion bans are enforced.

“That could be the next frontier,” said Ms. Raaii of McDermott, Will & Emery, “through which states try to enforce these laws against patients, providers, employers, payers or others.”

Dr. Joyce C. Lashof, who fought for health equity and broke barriers as the first woman to head a state public health department and the first to serve as dean of the School of Public Health at the University of California, Berkeley, died on June 4 at an assisted living community in Berkeley. She was 96.

Her daughter, Carol Lashof, said the cause was heart failure.

Over a long and varied career, friends and family members said, Dr. Lashof always prioritized the fight for social justice. In the 1960s, she founded a community health center to provide medical care in a low-income section of Chicago. After her appointment as director of the Illinois Department of Public Health in 1973, the year of the Supreme Court’s Roe v. Wade decision codifying the constitutional right to abortion, Dr. Lashof established protocols to provide women access to safe abortion in the state, Carol Lashof said.

In the 1980s, Dr. Lashof leveraged her powers as a top university administrator to organize initiatives to fight discrimination against people with AIDS and to protest Apartheid in South Africa.

She championed social justice outside of her professional life as well, taking her family on so many marches for peace and civil rights in the 1960s that they came to view mass protests as “a family outing,” her son, Dan, recalled. Joan Baez once performed in their living room in Chicago, the family said, for a fund-raiser for the anti-segregation Student Non-Violent Coordinating Committee.

“From the start, her work in medicine and public health was deeply animated by a profound commitment to issues of social justice in our society,” said Nancy Krieger, a professor of social epidemiology at Harvard who worked on AIDS policy with Dr. Lashof as a Berkeley graduate student in the 1980s. “That included issues around racism, that included issues around social class, that included issues around gender.”

After a brief tenure as a deputy assistant secretary at the federal Department of Health, Education and Welfare and a longer tenure as assistant director of the Office of Technology Assessment, she was appointed to run Berkeley’s School of Public Health in 1981. In that post, Dr. Krieger said, she was not content to limit her scope to administrative tasks.

At the height of the AIDS epidemic in 1986, for example, she set her sights on defeating Proposition 64, a California ballot initiative spearheaded by the far-right political agitator Lyndon LaRouche that would have mandated mass testing for AIDS and, critics feared, mass quarantines.

Dr. Lashof secured the cooperation of all four public health schools in the California university system to prepare a policy analysis on the initiative, which Dr. Krieger said was their first such joint project. The analysis, presented to the California State Assembly, demonstrated the potentially harmful effects of the measure and, Dr. Krieger said, contributed to its defeat.

Dr. Lashof’s friends said she approached activism with the mind of a scientist. “It was about always wanting to bring the evidence to bear on what the problems were that were causing health inequities,” Dr. Krieger said.

Those efforts often started at the neighborhood level. In 1967, Dr. Lashof, then on the faculty of the University of Illinois College of Medicine, opened the Mile Square Health Center in Chicago, a community health clinic financed by the federal Office of Equal Opportunity that provided medical care to an impoverished area of the city.

“She was one of the key people in helping get community health centers federally funded and viable in this country,” Dr. Krieger said.

The Mile Square center, the second such community health center in the country, never achieved the same level of renown as the first, in Mound Bayou, Miss., which made Dr. H. Jack Geiger, one if its founders, nationally known.

“Joyce often was overshadowed, in particular by men who were more charismatic at a time when sexism was more common,” said Meredith Minkler, a professor emerita of health and social behavior at Berkeley who worked with Dr. Lashof on social justice issues over the years. “But she wasn’t concerned about being in the limelight. She was concerned about creating change.”

Joyce Ruth Cohen was born on March 27, 1926, in Philadelphia, the daughter of Harry Cohen, a certified public accountant whose parents were Jewish immigrants from Ukraine, and Rose (Brodsky) Cohen, a homemaker who was born in Ukraine and served as a volunteer with the Hebrew Immigrant Aid Society, helping settle German Jewish refugees in the United States during and after World War II.

“Her mother clearly instilled in her an ambition to take a full role in society,” Dan Lashof said. “She had been interested in medicine from an early age, and at some point said she wanted to be a nurse. Her mother said, ‘Well, if you’re going to be a nurse and do all that work, you might as well be a doctor and be in charge.’”

But after graduating from Duke University with honors in 1946, she found her path to top graduate medical programs blocked. Many then restricted the number of Jewish applicants they accepted and, as the war ended, were giving admissions priority to men returning from the armed services, according to the National Library of Medicine. She finally earned a spot at the Women’s Medical College of Pennsylvania in Philadelphia.

She married Richard K. Lashof, a theoretical mathematician, in 1950. By the mid-1950s, both she and her husband were junior faculty members at the University of Chicago. In 1960, she once again faced gender discrimination when the department chairman denied her a promotion.

“The chair informed me that he could not recommend a woman for a tenure-track appointment, especially a married woman, because she undoubtedly would follow her husband wherever he would go,” Dr. Lashof said at a health conference in 1990. “C’est la vie.”

Undeterred, she joined the faculty at the University of Illinois College of Medicine. There she was appointed to direct a study of health needs, a project that led to her work developing community health centers.

In addition to her children, Dr. Lashof is survived by six grandchildren and two great-grandchildren. Her husband died in 2010. Their eldest daughter, Judith Lashof, died of breast cancer in 2018.

In the early 1980s, Dr. Lashof donned a cap and gown to march in a protest urging the University of California to divest from South Africa. She was, Dr. Minkler said, the only campus dean to do so.

“She would stick her neck out,” Dr. Minkler said. “It didn’t matter who she needed to cross.”

When she was 91, Dr. Lashof carried a sign that read “End the Muslim Ban Now” at a protest in Alameda, Calif., against the Trump administration’s ban on travel to the United States by citizens of five predominantly Muslim countries.

Toward the end of her life, Dr. Lashof was heartened by the many advances in social justice that had been made over the years, Carol Lashof said. But in recent months, she was aghast to hear that the Supreme Court was considering overturning Roe v. Wade.

“She was absolutely baffled,” Carol Lashof said. “She just looked at me and said, ‘How could that have happened?’”

Dr. Lashof’s many accomplishments were all the more significant because she was a woman.

“Breaking numerous glass ceilings was critical in her career,” Dr. Minkler said, “and it was one of her most important legacies.”

As fall approaches, new students will arrive on college campuses toting all kinds of things: luggage and school supplies, mini fridges and sports equipment. But in the midst of the preparation for move-in day, many have not considered what tools they will need to support themselves emotionally.

In other words, what can they do to protect their mental health?

In a 2017 survey of more than 700 parents and guardians, over 40 percent said they did not discuss the potential for either anxiety or depression when helping their teenagers prepare for college or postsecondary school. In addition, most of the caregivers said mental health services on campus were not a priority when choosing a school.

But a large number of teenagers are struggling. According to the Centers for Disease Control and Prevention, more than 1 in 3 high school students experienced persistent feelings of sadness or hopelessness in 2019, representing a 40 percent increase since 2009.

Once they arrive on campus, these problems don’t go away. A survey conducted in March by Inside Higher Ed and College Pulse found that undergraduate students were more than twice as likely to rate their overall mental health as “poor” (22 percent) versus “excellent” (9 percent).

And a new study using eight years of data from more than 350,000 students at nearly 400 campuses found that the mental health of college students across the United States has been on the decline. More than 60 percent of students surveyed during the 2020-2021 academic year met criteria for one or more mental health problems, a nearly 50 percent increase from 2013.

Experts suggest that parents and teenagers take proactive steps now to help plan for and preserve mental well-being during the big transition to college.

Connect early with the counseling center

Consider contacting the college’s counseling center before you arrive on campus. This is particularly important for those who already have an emotional disorder or other mental health concern.

At SUNY Broome Community College in Binghamton, N.Y., the counseling center begins seeing registered students as early as Aug. 1, one month before classes begin.

“A lot of times the students who come to us early, they have a lot that they need to unpack,” said Melissa Martin, a licensed social worker and the chairwoman of counseling services at the school.

The Jed Foundation, a suicide prevention organization that aims to protect the emotional health of teenagers and young adults, suggests asking the following of the school’s counseling center:

• What services are provided?

• Are there a maximum number of sessions allowed per year?

• Is there a counselor on call 24 hours a day? If not, what after-hours emergency services are available?

• What accommodations are available through disability services for students with emotional disorders?

• What is the school’s policy on taking leaves of absence?

• Are there other types of support available, like text lines or resident advisers?

Check to see if the counseling center provides off-campus referrals, and assemble a short list of potential providers to have in your back pocket ahead of arriving at school. This is a good practice for any student, as it may be necessary to seek outside support if the school’s counseling center develops a waiting list. It also helps to familiarize yourself with your insurance plan to see what type of coverage it provides. If you won’t be using your parents’ plan, compare the campus health insurance to other available options like those provided by the Affordable Care Act.

“I think it’s never too early to say, ‘Hey, I need help,’” Ms. Martin said. “You might not see anyone else reaching out for help, but they might not be talking about it.”

Studies have found that students of color are less likely than white students to use mental health services offered on campus, in part because of the stigma associated with mental health care but also because of a lack of diversity among counseling staff.

Those seeking a provider of color may have to take on the extra burden of trying to find a therapist off campus, said Ebony O. McGee, a professor of diversity and STEM education at Vanderbilt University’s Peabody College.

“That student might actually not do it, which opens the possibility of turning to unhealthy things,” she said.

Embrace other types of support

There are many resources available to students besides the counseling center. Tutoring, academic and peer advising, education coaching, student activities and career services can all help support a student’s emotional well-being.

Connecting with other students is especially important, the experts said.

“College students report that loneliness and isolation and feeling like they don’t fit in — those kinds of emotions are very common and challenging in first year of college,” said John MacPhee, chief executive of The Jed Foundation.

Spend some time looking at the school’s extracurricular activities and clubs, and thinking about how to engage with others while on campus. And consider having a roommate even if you have the option of living alone, Mr. MacPhee added — it can broaden your social network and help buffer stressors.

Don’t count out high school friends or anyone back home — a sibling, parent or religious leader, for example — who has been especially helpful.

“I often recommend making a list of your three to five biggest supporting people in your life,” Ms. Martin said. “And when you’re not feeling the best at school, you know you can reach out to one of them.”

One way that students of color can protect their mental health is by taking an African American history or ethnic studies class and exploring some of the structural problems that contribute to stress, anxiety and depression, said Dr. McGee, who has studied the emotional struggles experienced by high-achieving Black students.

“When many Black and brown students have mental health situations, it is often because of racialized or gendered racialized experiences,” she said. “It is about that environment that breeds alienation.”

Dr. McGee recommended seeking out spaces of comfort and understanding. “Go to places and spaces where you are affirmed and celebrated, and not simply tolerated,” she said. It could be an extracurricular activity or a religious organization — anywhere you might find other marginalized students of color.

Practice basic wellness habits

In the summer before college, teenagers should take stock of how they’re eating, sleeping and socializing, the experts said, especially given that they may have formed some unhealthy habits during the pandemic. If a student’s basic needs are neglected, it becomes more difficult to cultivate a healthier mental state.

Learning how to support yourself and taking steps to become more independent can also make the college transition less jarring. Before arriving on campus, practice managing a budget; advocating for yourself with a teacher, doctor or coach; or spending time outside of your childhood home — perhaps with a relative, or at summer camp.

Senior year can be “a rollicking ride” especially during the age of Covid, said Dave Anderson, a clinical psychologist at the Child Mind Institute, a nonprofit that provides therapy and other services to children and families with mental health and learning disorders. “It’s just ups and downs, and disappointment and hopes, and trying to figure out where they’re supposed to be.”

He advised one teenage client (who had slept an average of five hours a night during his senior year) to begin getting eight hours of sleep each night this summer, and to be aware of how much time he was spending on screens. His client also began eating a healthier diet that included more vegetables, and started working out first thing in the morning because he knows his college classes will start later in the day.

Drinking is “another thing that we’ll discuss very openly with teenagers during the summer before college,” Dr. Anderson said. Many high school students are already drinking alcohol socially with friends, he added, and in college they may feel pressure to binge drink or “pre-game.” But teenagers can prepare mentally for this and other types of circumstances — including drug use and sexual situations — by setting boundaries now.

“How can we make sure that this summer you’re setting intentional goals related to your limits and what you feel like is safe for you?” he asks college-bound teens. That conversation can sometimes make parents nervous, Dr. Anderson added.

“But if we can speak honestly to kids about that, they will be more likely to set those limits when they get to college because they’ve practiced.”

EAST LONDON, South Africa — Before he passed out amid the crush of bodies, Simbongile Mtsweni gasped for air as a gas that felt like fire crept into his nose and lungs. “When I came to,” he said, “I was on the second floor and started vomiting when I realized I was lying next to dead people.”

Hundreds of young people, drawn by a notice on Facebook promising a party at the end of the school term with free alcohol and Wi-Fi, had flocked to the small, packed tavern in East London, a city on South Africa’s southern coast.

Twenty-one of them, all teenagers, would not survive the night. Witnesses, investigators — the entire nation — have been struggling to understand how a night of revelry ended with broken and bleeding young people on the floors of the tavern, called Enyobeni, in the Scenery Park township of East London.

“We came for fun, not for dead bodies,” said Lubabalo Dongeni, an 18-year-old high school student, still limping five days after the incident.

A mass funeral was held on Wednesday, where President Cyril Ramaphosa warned against underage drinking and suggested that the legal drinking age be raised from 18 to 21.

The funeral was broadcast live on national television as the president and cabinet ministers sat in view of rows of coffins. But for the families still waiting to hear why their children died, the mystery only deepened.

Dr. Litha Matiwane, an official from the provincial health department, told the mourners that the deaths could not be attributed to a stampede, while acknowledging witness accounts of panicked people trying to flee the building. He said the cause of death was still being investigated.

With no answers yet, people in the community have found plenty of targets for blame and anger.

The license given to the hastily built tavern with two floors and just one entrance is under scrutiny, the owners are under criminal investigation, and a D.J. who performed there says the community is “baying” for his blood. There has been rampant speculation about the noxious gas that filled the air, who released it, and whether it contributed to the deaths, the deadly panic or both.

Six people who had been inside the tavern, as well as others who were outside, said in interviews that the combination of the mysterious gas, the crush of people and an airless room could have caused the tragedy. The dead were as young as 14, and most younger than 18.

Township residents are furious at the local police for taking hours to respond to emergency calls. Beyond East London, the episode has raised a national debate about underage drinking and the place of alcohol in South Africa. Some people point to other systemic failures, from the location and construction of the tavern to lax enforcement of liquor license laws in townships.

The teenagers who were there that night are visibly traumatized.

Members of a high school boys’ soccer team were in the tavern, but a midfielder and the goalkeeper never made it out. The team’s striker said he now struggles with survivor’s guilt.

A 19-year-old blames herself for helping her 17-year-old friend get into the party, where she died. When a group of teenagers visited the tavern recently to lay white plastic roses at its entrance, they were overcome with emotion.

The entrance, a single metal door painted brown, was the focus of chaos that night. The party was supposed to end at midnight on Saturday, June 25, but outside, dozens of people were still trying to get inside, according to videos taken with cellphones. After 12:30 a.m., the tavern went dark, but no one flinched — electricity blackouts are a common occurrence in South Africa.

But as the flashing disco lights returned minutes later, a gas wafted through the ground floor, survivors said. Some said it smelled like pepper spray, while others likened it to tear gas.

People rushed to get out, while those outside in the cold winter night tried to get in. That’s when bouncers pulled the door shut, the witnesses said, trapping everyone inside.

While the dance music, a popular local style called amapiano, thumped on the second floor, people on the ground floor climbed over each other to get out, breaking the only two windows in a room no bigger than 350 square feet.

Brian Mapasa, a rapper who had just finished his set on the second floor, said that he could hear gasping all around him. He was making his way downstairs to the exit when the door shut and the crush began. Trapped people pressed so tightly against him, his legs went numb, he said.

Two people bit him as they tried to climb over him, he recalled, the half-circle of scabs on his forearms still red six days later. Mr. Mapasa said that the gas had tingled as it touched his wounds. He felt groggy, he added, sinking to his knees.

The music only stopped when screams pierced the pandemonium, survivors recalled. The neon lights, bouncing off the yellow walls with swirling brown murals, illuminated bodies sprawled on the dance floor, and the friends unable to revive them.

Some people jumped from the second floor. Only then did the bouncers open the lone door, to carry some of the bodies outside, several survivors said.

Nolitha Qhekaza’s bedroom window is a few feet from the tavern’s entrance. When people jumped from the balcony, they landed on her roof. Dead and wounded teenagers were laid on her front lawn, she said. A girl with a broken leg lay on her dining room floor until after 7 a.m.

In the early hours of that Sunday morning, Ms. Qhekaza, a 55-year-old grandmother, called the police 10 times, from 2:25 a.m. to 3:35 a.m., her call logs show.

Police and ambulances finally began to arrive around 4 a.m., neighbors said. As officers cordoned off the area, parents tried to push past the tape. Some of the unconscious victims were still inside the tavern, splayed on pleather couches or just lying on the dance floor — the dead and injured side by side.

Images of the scene circulated on social media. That is how some parents learned not only that their children had gone out that night, but that they had died.

“My son was trending,” said Sidwenn Rangile, father of Mbulelo Rangile, the soccer team’s goalkeeper.

Unable to find his son at local hospitals, Mr. Rangile sped to the morgue. At first, he didn’t recognize his son’s body among the rows of corpses because the boy’s skin had turned so dark. Another victim, a 17-year-old, was similarly unrecognizable just hours after her death, said her friend, Sinenjongo Phuthumani, who was also at the tavern.

Even grieving parents like Mr. Rangile have faced criticism in the heavy news coverage of the disaster.

“If the finger is to be pointed, it has to be pointed to all of us,” he said. “But it is unfair to blame us.”

The tavern owners, Siyakhangela and Vuyokazi Ndevu, have shouldered much of the public condemnation.

The tavern, which shares a wall with several private homes, has long divided this community, where residents used their savings to slowly build their homes. Neighbors had complained about urine stains along their walls and empty bottles strewn outside, parties that went on until 8 a.m., and children vomiting in their gardens.

The Ndevus refused to comment.

Several neighbors said that they met with police and an inspector of the Eastern Cape Liquor Board just three weeks before the disaster. But spokesmen for the liquor board and the police both said that they had no record of complaints about the tavern.

The tavern’s license was granted in 2012, but the liquor board was unaware that the owner had added a second floor in recent years.

Last week, the liquor board filed a criminal case against Vuyokazi Ndevu, in whose name the license was granted, for selling alcohol to minors. Police have not said if they will press charges against her. At the funeral on Wednesday, officials announced that the tavern’s liquor license had been revoked.

Nationally, the conversation has turned to alcohol abuse and unregulated taverns in South Africa, particularly in poor, mostly Black townships. More than half of South Africans do not drink alcohol, but those who do report heavy binge drinking, according to the World Health Organization.

In Scenery Park, where drug use is rising, going to a tavern to drink is popular among teens, and is seen as the lesser evil, said the soccer coach Ludumo Salman, who started the soccer club for high schoolers.

Esethu Sotheni, who runs a nonprofit for young people in East London’s townships, said, “I hope this is going to be a wake-up call, because this is a reality across South Africa.”

As the United States has grappled with the unfolding consequences of the Supreme Court’s decision overruling Roe v. Wade, one question lurks between the lines of court opinions and news stories alike: Why are the risks of pregnancy so rarely discussed anywhere, even though that information is relevant not just to individual decisions but to policies about abortion, pregnancy, and health care for women?

With the wave of abortion bans taking place in states across America, those risks are going to be more in the spotlight — figuring both in women’s decisions about whether to risk getting pregnant if they live in a state that has banned abortions, and the arguments that will happen in state legislature chambers over how much threat to a mother’s health must be present to permit an abortion under untested and rapidly changing state laws.

“We spend an awful lot of time talking about avoiding behaviors because of very small risks that could happen that are associated with the fetus. ‘Don’t eat bean sprouts,’ or ‘don’t eat deli meats,’” Emily Oster, a Brown University economist and author “Expecting Better,” a data-driven book about pregnancy, told me. “And then we sort of never talk to people about the risks of things that are almost definitely going to happen.”

For instance, in a vaginal birth, “Your vagina’s going to tear. It’s going to tear a lot,” she said. “That’s not even risk, it’s just realistic.” Those who give birth via cesarean section, a major abdominal surgery, end up with a large wound requiring a significant recovery period.

And more serious complications, while rare, are not that rare. In any given moms’ group, someone has probably survived hyperemesis gravidarum (which can occur in up to one in 30 pregnancies), an ectopic pregnancy (up to one in 50 pregnancies), or a pregnancy-induced hypertensive disorder (up to one in 10 pregnancies). All of those conditions can be lethal.

In most situations, the standard for risk is informed consent: awareness of the potential for harm, and a chance to accept or refuse it. If riding in a car or taking a plane meant a near-guaranteed abdominal or genital wound and a 10 percent chance of a life-threatening accident, people would expect a warning and an opportunity to consider whether the journey was worth it.

But pregnancy is different.

Jonathan Lord, a practicing gynecologist and the English medical director of MSI Reproductive Choices, an organization that provides family planning and abortion services in countries around the world, said that he suspects people often don’t talk about the dangers of pregnancy for women’s health because they see such conversations as a cause of unnecessary distress. “It’s sort of ingrained in society, really. It’s not so much a medical thing, but people do not talk about the risks and the unpleasant aspects, and I think that’s largely because people want to be kind,” he said.

Oster had a similar hypothesis about serious pregnancy complications. “In general, we’re not interested in confronting the risk of really bad things,” she said. “We would very much like to pretend that they’re zero.”

And yet if you look at the messaging around risks to the fetus during pregnancy, rather than the mother, the plot thickens.

Women are “bombarded” with messaging about the risks they themselves could pose to their fetuses, said Rebecca Blaylock, the research lead of the British Pregnancy Advisory Service, a charity that provides abortion and other reproductive health services. The research team at her organization, along with colleagues from Sheffield University, studied British media messaging around pregnancy. They found that media coverage overwhelmingly framed women as a vector of harm, not a population in need of protection. Fetuses were the sole focus of health outcomes.

Such assumptions even affected prenatal care. “We were seeing women suffering with hyperemesis gravidarum” — an extreme and potentially deadly form of morning sickness that involves near-constant vomiting — “who weren’t receiving appropriate treatment because their health care providers thought the medication posed a risk to their pregnancy, and who really felt they had no option but to terminate an otherwise wanted pregnancy at that point,” Blalock said.

The differing attitudes toward risk “really fit within a larger cultural climate where women are blamed for any and all ills that may or may not befall their children, and a preoccupation with reproducing the next generation of healthy citizens” Blaylock told me.

That study focused on the United Kingdom. But Kate Manne, a professor of philosophy at Cornell University and author of two books on the ways sexism shapes society, said that there is a widespread assumption in the United States and elsewhere that having children is something that women are naturally or even morally destined to do. Accordingly, guiding them toward that — even if that means denying them an opportunity to give informed consent to the risks — is seen by some as in their best interests. (She noted that transgender men and nonbinary people can also get pregnant, but said that the norms and societal assumptions about pregnancy tend to presume pregnant people are women.)

“We don’t tend to think of pregnancy as something that someone might very rationally decide not to do because it’s too much of a risk,” she said. “That kind of thought process is obviated by the sense that it’s natural and moral, and perhaps also holy, for women to do this.”

But such reluctance to acknowledge risks can make the dangers of pregnancy invisible to policymakers as well. One consequence is abortion bans that are written so bluntly that they fail to provide clear paths for doctors to protect women’s lives and health. In Poland, where most abortions are not allowed, vague exceptions that would allow them to go ahead have left doctors confused about potential liability, leading to the death of a pregnant woman last year. And now similar confusion is unfolding in U.S. states whose abortion bans took effect after last week’s Supreme Court decision overturning Roe v. Wade.

Doctors in several U.S. states, for instance, have raised concerns about whether women will be able to get timely care for ectopic pregnancies, a condition in which a fertilized egg implants outside the uterus or in the wrong part of it. Such pregnancies are never viable: It is not possible for a fetus to grow to term unless it implants correctly. But those that implant in scar tissue in the uterus, Dr. Lord said, can continue to develop for several months before eventually rupturing, at which point they are life threatening to the mother, he said.

“You really need to get in there early before it’s grown to that extent,” he said. “It’s an inevitability that the fetus will die, but it will probably kill the mother with it.”

“I do fear that in those states that have got strict laws, that will happen.”

Vladimir Zelenko, a self-described “simple country doctor” from upstate New York who rocketed to prominence in the early days of the Covid-19 pandemic when his controversial treatment for the coronavirus gained White House support, died on Thursday in Dallas. He was 48.

His wife, Rinat Zelenko, said he died of lung cancer at a hospital where he was receiving treatment.

Until early 2020, Dr. Zelenko, who was also known by his Hebrew name, Zev, spent his days caring for patients in and around Kiryas Joel, a village of about 35,000 Hasidic Jews roughly an hour northwest of New York City.

Like many health care providers, he scrambled when the coronavirus began to appear in his community. Within weeks he had landed on what he insisted was an effective cure: a three-drug cocktail of the antimalarial drug hydroxychloroquine, the antibiotic azithromycin and zinc sulfate.

He was not the first physician to promote hydroxychloroquine. But he began to draw national attention on March 21 — two days after President Donald J. Trump first mentioned the drug in a press briefing — when Dr. Zelenko posted a video to YouTube and Facebook in which he claimed a 100 percent success rate with the treatment. He implored Mr. Trump to adopt it.

A day later, Mark Meadows, Mr. Trump’s chief of staff, reached out to Dr. Zelenko for more information. So did talk-show bookers. Over the next week Dr. Zelenko made the rounds on conservative media, speaking on podcasts hosted by Steve Bannon and Rudolph W. Giuliani. Sean Hannity of Fox News touted his research during an interview with Vice President Mike Pence.

“At the time, it was a brand-new finding, and I viewed it like a commander in the battlefield,” Dr. Zelenko told The New York Times. “I realized I needed to speak to the five-star general.”

On March 28, the Food and Drug Administration granted emergency authorization to doctors to prescribe hydroxychloroquine and another antimalarial drug, chloroquine, to treat Covid. Mr. Trump called the treatment “very effective” and possibly “the biggest game changer in the history of medicine.”

But, as fellow medical professionals began to point out, Dr. Zelenko had only his own anecdotal evidence to support his case, and what little research had been done painted a mixed picture.

Still, he became something of a folk hero on the right, someone who offered not just hope amid the pandemic but also an alternative to the medical establishment and Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, who insisted that months of research would be needed to find an effective treatment.

Dr. Zelenko continued to text and speak with Mr. Meadows, Mr. Giuliani and several members of Congress. But he clashed with leaders in Kiryas Joel, who said that his talk of treating hundreds of Covid patients gave the impression that the community was overwhelmed by Covid, potentially stoking antisemitism.

Over the next few months, researchers cast further doubt on the efficacy of hydroxychloroquine. A study published in The New England Journal of Medicine found no benefit from the treatment, and other studies highlighted a risk of dangerous heart arrhythmias in some patients.

Those results and others led the F.D.A. to revoke its emergency authorization on June 15, 2020.

A quiet, unassuming man, Dr. Zelenko seemed unprepared for the attention he received, which included harassing phone calls and even death threats. In May 2020, a federal prosecutor opened an investigation into whether he had falsely claimed F.D.A. approval for his research.

That same month, Dr. Zelenko announced in a video that he was closing his practice and leaving the Kiryas Joel community. He accused several of its leaders of instigating a campaign against him.

After the F.D.A. rescinded its approval of hydroxychloroquine as a Covid treatment, he founded a company, Zelenko Labs, to promote other nonconventional treatments for the disease, including vitamins and quercetin, an anti-inflammatory drug.

And while he claimed to be apolitical, he embraced the image of a victim of the establishment. He founded a nonprofit, the Zelenko Freedom Foundation, to press his case. In December 2020, Twitter suspended his account, stating that it had violated standards prohibiting “platform manipulation and spam.”

Dr. Zelenko was born on Nov. 27, 1973, in Kyiv, Ukraine, and immigrated to the United States with his family when he was 3, settling in the Sheepshead Bay section of Brooklyn.

His father, Alex, drove a taxi, and his mother, Larisa (Portnoy) Zelenko, worked in a fur factory and later, after studying computer programming, for Morgan Stanley.

In a memoir, “Metamorphosis” (2018), Dr. Zelenko wrote that he grew up nonreligious and entered Hofstra University as an avowed atheist.

“I enjoyed debating with people and proving to them that G-d did not exist,” he wrote. “I studied philosophy and was drawn to nihilistic thinkers such as Sartre and Nietzsche.”

But after a trip to Israel, he began to change his mind. He gravitated toward Orthodox Judaism, and in particular the Chabad-Lubavitch movement.

He graduated from Hofstra in 1995 with a degree in chemistry, and he received his medical degree from the State University of New York at Buffalo in 2000. After returning to Brooklyn for his residency, he moved to Monroe, a town that neighbors Kiryas Joel, in 2004.

Dr. Zelenko spent three years working for Ezras Choilim, a medical center in Monroe, and advising the local Hatzolah ambulance service. He opened his own practice in 2007, with offices in Monroe and Monsey, another upstate town with a large Orthodox Jewish population.

In 2018, doctors found a rare form of cancer in his chest and, in hopes of treating it, removed his right lung.

Dr. Zelenko’s first marriage ended in divorce. Along with his second wife, he is survived by their two children, Shira and Liba; six children from his first marriage, Levi Yitzchok, Esther Tova, Eta Devorah, Nochum Dovid, Shmuel Nosson Yaakov and Menachem Mendel; his parents; and a brother, Ephraim.