Tuesday, June 10, 2008

The Dangers of Overstating our Case [Serge]

Jill Stanek, a prominent pro-lifer and nurse, makes this statement in her WND column:

Did you know the birth control pill can cause chemical abortions?

No, probably not, unless you're a radical pro-lifer like me, or a radical pro-abort. We all know.

Sorry, Jill, you are simply wrong here.

I've been interested in this topic for a number of years, and have reviewed much of the medical literature on the topic. I often joke that I am probably the only oral and maxillofacial surgeon who subscribes to the journal Contraception, which I do in order to have electronic access to all of their back issues. In short, I have done my homework here, and can say without a doubt that Jill has seriously overstated the evidence we have for a post-fertilization effect from OCs. I would summarize the evidence we have about the mechanism of OCs in this way:

1. We do not have full knowledge of the actual mechanism of OCs, and there is little prospect that we will gain this knowledge in the near future. There are questions that we simply do not know, and will almost certainly not know anytime soon.

2. There is no direct evidence that OCs cause "chemical abortions". In other words, there is no direct evidence that OCs effect the uterine lining to cause an embryo that would otherwise implant not to.

3. There is indirect evidence that causes some to believe that OCs can cause changes to the uterine lining that would decrease the chance of embryo implantation in the cases in which breakthough ovulation occurs. This indirect evidence includes differing ectopic pregnancy rates with those on OCs and the thinning of the utering lining for women on OCs. I am well aware that some pro-lifers are persuaded by this indirect evidence that OCs cause a hostile endometrium in a minority of cases (like Randy Alcorn and Dr. Walter Larimore). However, there are also a number of pro-lifers that are unconvinced by this indirect evidence - including myself. If prompted by comments, I will go deeply into the literature on this topic to explain my reasoning. In the meanwhile, I would recommend the book "The Pill" by the Center for Bioethics and Human Dignity for good summaries of both sides of this argument.

4. Direct evidence does not exist that would prove that OCs can never act via a post-fertilization mechanism.

5. Both the package insert and the PDR lists the hostile endometrium theory as a possible mechanism of action of the pill. This is not surprising, considering #4 above. For more information on the accuracy of package information and the FDA, see this post here.

There is a real controversy regarding this issue, and science does not have all of the answers. Let me state this plainly: anyone who believes they know absolutely that OCs cause endometrial changes that result in "chemical abortions" is simply wrong. They don't. I don't know for sure either. Cool web sites and T-shirts do nothing to change this fact. Pro-lifers who overstate this case are acting very irresponsibly.

10 comments:

  1. Serge,

    If there is indirect evidence that the Pill can cause chemical abortions, and we simply have no (ethical) way of determining if it actually does, do you think it is reasonable for pro-lifers to eschew the Pill? Is it advisable, in your opinion?

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  2. Excellent question Jason,

    I actually think it may be advisable to eschew the pill regardless of whether or not it causes a hostile endometrium. However, since I believe that the likelihood of the pill causing an embryo to fail to implant is extremely small and may be zero, I would not use the potential impact on the endometrium as a sole basis to avoid the pill.

    However, I do believe we should do what we can to inform others of the truth of the situation. Women should be informed of our lack of knowledge in this area, and that there are some who believe that the potential for an embryo not to implant is real. If one needs "proof" that the pill can never cause an embryo not to implant - they should not use that method. This, however, is substantially different that stating that the pill "kills babies".

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  3. Well said, Rich.

    I think it is important for us as pro-lifers to be more committed to intellectual honesty than to emotional rhetoric. We simply can NOT prove at this time that the Pill causes micro-abortions.

    Do I think it probably happens sometimes? Sure, and thus choose not to use it in my marriage. That reasoning is similar to the structural engineer who doesn't destroy a building until he is absolutely sure that no one is at risk. But that's different from what many pro-lifers say based on faulty research and/or reasoning.

    Ed Rivet at Michigan Right to Life has also done some good research on this subject coming to the same conclusions as you, Rich, although he wrote his article knowing that he may be ostracized from the pro-life community who is already very committed to asserting the Pill as an abortifacient.

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  4. People like Jill make us lose credibility when they attack the Pill -- which in all likelihood would cause only a very rare inadvertent abortion -- while ignoring the IVF clinics that routinely flush deliberately-created embryos. Prochoicer have tried to call me on it, and I've pointed out that I'm not in the mainstream on either the Pill-bashing or on ignoring the "spare embryo" flushing as if it's not happening.

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  5. Serge -- Thanks for contributing to the important discussion of how the pill actually works to disrupt pregnancy.

    I for one would love to hear more about this, and encourage you to follow up with more analysis.

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  6. Thanks Eric. I know that your organization disagrees with me here, so I'm very pleased that you are interested in checking out my evidence and reasoning. I'll be posting on it pretty soon.

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  7. You work very hard to justify sin.

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  8. Should we not err on the side of life?

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  9. Shouldn't we be accurate in our accusations? Don't those of us claiming to represent the kingdom of God have a responsibility to be honest our presentations? No one has concluded from Rich's post that we need to endorse oral contraceptives. What he has offered is evidence and an argument that saying that it is a proven fact that "the pill kills" is a flat out inaccurate and deceptive statement.

    I am personally very concerned at some people who seem to feel that the possibility that human lives HAVE NOT been lost to the widespread use of OC's is bad news.

    We must be cautious, but we must be honestly cautious.

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  10. Dr Poupard,

    The Weekly Standard quotes you:

    http://www.weeklystandard.com/blogs/does-drug-ella-cause-abortions_626563.html#read-more

    ReplyDelete

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