Monday, February 25, 2008

"Depressed" about Emergency Contraception [Serge]

Wow. I just finished listening to a web seminar about the efficacy of emergency contraception by Dr. James Trussell, who is one of the most well reknown researchers in the field of contraception. I haven't been putting a while lot of time in studying EC lately, but essentially what Dr. Trussell had to say supports all of my previous postings on the subject, which can be found here. Here are some of the high (low) lights according to the Powerpoint slides that he presented.

1. Trussell previously hoped (published in 1992) that EC would reduce unintended pregnancies and abortion by half.

2. 15 years later 11 studies have consistently showed no decrease of pregnancy rates from use of ECs.

3. Trussell also stated that a future decrease in pregnancy rates from EC use is highly unlikely - an astounding admission.

4. He then quoted TH Huxley when he stated "The great tragedy of science - the slaying of a beautiful hypothesis by an ugly fact."

5. Due to difficulties in estimating the expected pregnancy rates, the published efficacy in the package insert of EC is almost certainly too high.

6. The only thing he could say about the actual efficacy of Plan B was that it was "more effective than nothing".

7. According to the latest research, the efficacy of Plan B can be fully explained via a pre-fertilization mechanism. Research continues to lead away from a post-fertilization mechanism.

This is amazing stuff. Since there was extensive news coverage of the effort to get Plan B to OTC status, why the silence in the wake of information that Plan B will not effect pregnancy or abortion rates? Imagine the outcry if a heart medication was thought to reduce heart attacks by 95% - and was made over-the-counter in order to increase its availability to reduce heart disease. A year later evidence comes out that no study had ever found that it had any effect on heart attack rates, and that the only thing that could be said about it is that it is "probably better than nothing". There would be a great outcry, congressional hearings, and accusations that the evil pharmaceutical companies were gouging unsuspecting patients. However, so far there has not been a peep among those concerned about "women's health" that they could be promoting an expensive medication that may not be effective.

Lastly, at the end of the seminar there was a pause before participants asked questions. Dr. Trussell commented that everyone must be too depressed.


  1. Did Dr. Trussell state whether EC was ineffective on an individual level or a population level? I suspect that it probably does prevent some pregnancies, but those are offset by pregnancies that occur because people get careless with their birth control if they think they can just use EC.

    Is there a link to an archive of this seminar? I'd love to see it.

  2. Hi Jen,

    Trussell stated that the individual effectiveness of EC is almost certainly far less than the stated 89%. He estimates it to be around 50%. Data that he has published state that we can be sure that it is at 29% effective at a 95% confidence level.

    The data does not support your conclusion. There appeared to be no increase in risky sexual activity for those who took EC. In fact, some of the studies suggested that women who take EC are more careful about their regular contraceptive than those who don't.

    I believe the ARHP ( will make at least the PP slides from the talk available at their website. You can try to get acces to the seminar by clicking on the web CME link.


  3. Thanks for the further information. I will definitely check out the slides if I can.

    There appeared to be no increase in risky sexual activity for those who took EC.

    That's good to hear. It's really too bad that EC doesn't seem to be of much help. Still, even if it's not effective enough to warrant a big push for use by the general population, it seems that it would still be worth having as an option for women who have been raped. 50% or even 29% is better than nothing.


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