Traditionally, attacks on women’s reproductive rights were largely frontal in nature. Opponents argued that abortion was wrong on religious or moral grounds, and thus should be made illegal. While they continue to make those arguments, in recent years they’ve added some new arrows to their quiver. More and more, anti-choicers are seeking to restrict abortion rights or otherwise undermine support for them by relying on a particular type of “science”: science that isn’t really science at all.
When medical researchers put together a study, a lot of time and effort goes into it. Generally speaking, a study launches with strict parameters: a certain number of volunteer participants, a certain period of time. Thus, when a study is terminated early, it’s a big deal. Sometimes, for example, the benefits of the particular medication or treatment being tested are, happily, so obvious and significant that it would be unethical to deny it to people in the control group, let alone to the larger public (as in these cancer treatment trials). Other studies, however, are ended early for the opposite reason: The harm caused is so obvious, it would be unethical to continue.
This is relevant because a recent study of the efficacy of a bogus “abortion pill reversal” ended early—and not because the researchers were happy with the treatment’s effects.
First, some background about this quackery. When it comes to peddling “abortion reversal,” the big name is one Dr. George Delgado. Delgado is a San Diego physician who claimed to have found a way to reverse medical abortions if patients changed their minds after taking the first round of medication, but before taking the second.
What’s a medical abortion, you might ask? NPR sums it up nicely.
“In the first 10 weeks of a pregnancy, women who are seeking abortions generally have two options: a surgical procedure or a medication-based abortion (after that, only surgical abortions are performed). The medication-based regimen uses a combination of two medicines — mifepristone and misoprostol — which women usually take 24 hours apart.
Mifepristone pills work by blocking progesterone, a hormone that helps maintain a pregnancy. The second medicine, misoprostol, makes the uterus contract, to complete the abortion. Studies suggest that 95 percent to 98 percent of women who take both drugs in the prescribed regimen will end the pregnancy without harm to the woman.”
Dr. Delgado claimed that, if given after the first medication (mifepristone), the hormone progesterone would essentially “reverse” the abortion. It did, in the first patient he tried it on—but that was also an experimental treatment outside of a study protocol, without the approval of an institutional review board. Any physician will tell you that Delgado committed a serious ethical breach, which was potentially dangerous.
Delgado also failed to consider that pregnancy does not end for “as many as half of women” who take mifepristone but don’t take misoprostol, according to the American Congress of Obstetricians and Gynecologists (ACOG). Both steps are required. In other words, Delgado could have not bothered to give his patient the progesterone and still had a pretty good chance of achieving the same result. He didn’t actually discover anything.
Other women went to Delgado for treatment, and in 2012 he published a report on a handful of patients, but it was not based on legitimate research. An ACOG analysis of his report explained that “so-called abortion “reversal” procedures are unproven and unethical.”
A 2012 case series reported on six women who took mifepristone and were then administered varying progesterone doses. Four continued their pregnancies. This is not scientific evidence that progesterone resulted in the continuation of those pregnancies.
This study was not supervised by an institutional review board (IRB) or an ethical review committee, required to protect human research subjects, raising serious questions regarding the ethics and scientific validity of the results.
Case series with no control groups are among the weakest forms of medical evidence.
In 2018 Delgado published another report, which appeared in a journal that’s funded by anti-choice activists and was once described as “a one-stop journal for anti-vaccine, anti-abortion pseudoscience.” Again, he had not conducted an actual scientific study, such as a randomized, controlled trial. The report was another case series, just with more subjects than the previous one, and still no control group.
Dr. Jen Gunter, an OB/GYN who has published widely on reproductive health, addressed the problems with the report, and concluded that it “adds nothing to what we know and offers no proof that progesterone does anything.” Gunter has also detailed the severe shortcomings of the journal that printed it.
A 2019 investigation by The Guardian uncovered even more of Delgado’s bad deeds.
Delgado’s most recent work has included speaking engagements providing pseudo-scientific cover for anti-abortion campaigners attacking medication abortions as they grow increasingly common. Delgado has also pushed the false claim that abortion is linked to breast cancer.
The UCSD School of Medicine said Delgado, “was instructed” by his former department to stop using the school’s name after he cited it as his affiliation in a widely criticized, and briefly retracted, April 2018 paper.
It’s one thing for Delgado to promulgate false information to a patient, or even his professional peers. What’s far more alarming is that this hokum about reversing abortions is being incorporated into the anti-choice agenda. Eight states—Arkansas, Idaho, Kentucky, North Dakota, South Dakota, Oklahoma, Nebraska, and Utah—have even written it into law. Each state has passed legislation requiring that any physician administering a medical abortion must tell the patient about the (totally not real) option to “reverse” the procedure. Georgia, Kansas, North Carolina, Ohio, and Wisconsin are all considering similar legislation, and in April 2019, Texas Rep. Mike Conaway introduced a “reversal” bill in the House of Representatives.
Last June, the American Medical Association filed a lawsuit in North Dakota, noting that the law “would force physicians to tell patients that a medication abortion may be “reversed”—a patently false and unproven claim unsupported by scientific evidence. Under this law, doctors must also give patients government-scripted information on where to find a medical professional who will provide an experimental and unethical treatment to “reverse” an abortion.
This brings us back to that recent study that was abruptly stopped. This study finally subjected Dr. Delgado’s claims to the accepted standards of scientific inquiry. The study was published in the January volume of Obstetrics & Gynecology, the leading academic journal in the field.
Researchers at the University of California, Davis sought to test Delgado’s hypothesis. The subjects were women who planned to have surgical abortions, but volunteered to delay them two weeks in order to participate in the study. Participants took the first, but not the second, of the two medications that comprise a medical abortion. Half the women were given a placebo, while the other half received progesterone, just like Delgado had given his patients.
Forty women were supposed to participate in the study. However, it was stopped after only 12 had taken part, because 25% of those volunteers suffered “severe hemorrhage” which necessitated emergency transport to a hospital via ambulance. Of the three women who hemorrhaged, one had taken the progesterone and two had taken the placebo. From the data collected, the study’s authors concluded that Delgado’s hypothesis remains unproven. Additionally—and here’s the really important part—they noted that “(p)atients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.”
Going further, lead researcher Dr. Mitchell Creinin stated, “Encouraging women to not complete the [two-step medical abortion] regimen should be considered experimental. Does progesterone work? We don’t know. We have no evidence that it works.” In an important clarification, he added that “It’s not that medical abortion is dangerous. It’s not completing the regimen, and encouraging women, leading them to believe that not finishing the regimen is safe. That’s really dangerous.”
In a perfect world, doctors don’t administer treatment to patients unless they know it is likely to work and is safe. When medical researchers don’t have evidence that a treatment works, they test it until they do. Ethics dictate that when trying to get the evidence produces harm, they must stop trying. That’s science. Doing things the Delgado way is malpractice.
When legislators who supported laws requiring doctors to inform their patients about this dangerous, unproven treatment were asked if the results of Dr. Creinin’s study changed their minds, just five responded. Only one expressed openness to revisiting the matter. The rest had no change in opinion.
By publicizing the possibility of “reversing” abortions, the anti-choice movement can reinforce and spread the false notion that large numbers of pregnant people are changing their minds mid-abortion. Dr. Delgado himself insists that patients “do change their minds all the time.” Anti-choicers also use this fallacy to buttress their contention that large numbers of women regret having an abortion after the fact. The facts, once again, suggest something quite different.
A study published this month in Social Science & Medicine found that 99% of people who have an abortion do not express regret when looking back five years later. The authors wrote that their “findings challenge the rationale for policies regulating access to abortion that are premised on emotional harm claims.”
Yet the so-called rationale of regret appeared in the Supreme Court majority opinion written by Justice Anthony Kennedy in 2000’s Gonzales v. Carhart, the case that confirmed the constitutionality of a federal law that banned a specific abortion procedure typically performed in the later part of the second trimester (I won’t use their term for it: You can look it up if you don’t know which one I’m talking about).
Beyond that case, the notion that women might change their minds or later regret their abortion undergirds paternalistic restrictions, like waiting periods or the forced viewing of an ultrasound. As the Guttmacher Institute stated: “Waiting periods serve no medical purpose; these hurdles are intended to make abortion less accessible … Imposing them on women seeking abortion is an unnecessary burden and singles out these patients as unable to make informed decisions without the imposition of a state-mandated waiting period.”
Of course, there are numerous other abortion-related laws that have no basis in science. One category of these is known as Targeted Restriction of Abortion Provider (TRAP) laws. TRAP laws create hurdles to providing abortions that have no demonstrated scientific benefit to patients, though anti-choice supporters justify the restrictions by claiming that they have medical benefits.
Five states mandate that physicians tell their patients surgical abortions cause breast cancer, a claim that numerous studies have proven false. The evidence is so clear that the National Cancer Institute made an unambiguous statement: “Induced abortion is not associated with an increase in breast cancer risk.”
Possibly the most egregious recent example of the pure scientific ignorance from the forced-birth side comes out of Ohio. With some guidance from a representative of an organization called Right to Life Action Coalition of Ohio, State Rep. John Becker proposed legislation in December that would make it illegal for insurance providers to cover abortions. But that’s not the part that puts Becker into the Anti-Science Hall of Fame.
This mess of a law would make one exception to the insurance coverage ban on abortions, to allow coverage for an operation “intended to reimplant” an ectopic pregnancy. In other words: to put it back into the uterus, ostensibly so it can grow into a happy Republican baby. Besides the anti-choice implications, there’s a huge problem with Becker’s legislation: No such procedure exists. When challenged, Becker admitted he had done no research into whether reimplanting an ectopic pregnancy was medically possible, much less safe. So where did he get the idea?
“I heard about it over the years,” Becker said. “I never questioned it or gave it a lot of thought.” That proud ignorance is Republicanism in a nutshell, folks.
Yet another piece of proposed legislation in the Ohio statehouse would make it possible to charge physicians with something called “abortion murder” if they don’t take certain steps to preserve the life of the woman and her fetus, “including attempting to reimplant an ectopic pregnancy into the woman’s uterus.” (Just this week an even more draconian “abortion murder” law was proposed in neighboring Indiana) I’ll let a physician take this one, so that I can remove my palm from my forehead.
The new Ohio HB413, p.184: To avoid criminal charges, including murder, for abortion, a physician must Ã¢Â€ÂœÃ¢Â€Â¦[attempt to] reimplant an ectopic pregnancy into the womenÃ¢Â€Â™s uterusÃ¢Â€ÂI donÃ¢Â€Â™t believe IÃ¢Â€Â™m typing this again but, thatÃ¢Â€Â™s impossible. WeÃ¢Â€Â™ll all be going to jail@ACOGAction pic.twitter.com/KtnNRShZLW
— David N Hackney MD, FACOG (@DavidNHackney) November 19, 2019
Attacks on reproductive rights come in many forms. On Friday, The Man Who Lost The Popular Vote became the first president to attend our country’s preeminent anti-choice gathering, adding yet another layer of urgency to the fight for reproductive rights and autonomy. Fighting forced birtherism in the arena of politics is vitally important … just as it is in the arena of science.
Ian Reifowitz is the author of The Tribalization of Politics: How Rush Limbaugh’s Race-Baiting Rhetoric on the Obama Presidency Paved the Way for Trump (Foreword by Markos Moulitsas)