Wednesday, January 22, 2014

Be Careful Out There (When Discussing Emergency Contraception) [Serge]

It is very important when discussing important and controversial issues to do everything in our power to find the truth and not overstate the evidence that we have supporting our conclusions.  This can be challenging when dealing with an issue such as emergency contraception, where the data and evidence is frequently either missing, confusing, or difficult to understand.  To this point, I believe that the evidence shows that Ella and IUDs have some sort of mechanism of action post-fertilization.  I believe that the evidence does not support a post-fertilization mechanism for Plan B, but its efficacy has been greatly overstated.  Overstating our case is a frequent problem in the pro-life community, and one that we should be careful to avoid.  So lets look at the headline of this post at LifeNews:

I need a second here...

When you can't get through the headline without overstated conclusions it is not a good start.  First, the "New studies" that the post speaks of are actually not studies at all, but reviews.  The authors of these reviews looked at research done by others in the past and come to different conclusions.  There is nothing wrong with that, of course, but to state that "new studies" have concluded something certainly implies that there is new data and evidence that has settled this question.  As it turns out, the "new studies" are simply an alternate conclusion to what the original authors wrote.

The main review that is mentioned is this one from Peck and Velez from the National Catholic Bioethics Center.  It is not an easy read, but they posit that Plan B may have an effect when given prior to ovulation on the future developing embryo.  This conclusion is based on these two papers that have the exact opposite conclusion.  They are from Noe et al and the abstracts can be found here and here.  The abstract of that last paper states:

The efficacy of LNG-EC has been overestimated in studies using presumptive menstrual cycle data. Our results confirm previous similar studies and demonstrate that LNG-EC does not prevent embryo implantation and therefore cannot be labeled as abortifacient.

So how does Peck and Velez come to a completely different conclusion by looking at the same evidence?   They posit an interesting theory.  They believe that although Plan B is not effective if given after ovulation, its lingering effects on the pituitary axis and the corpus luteum hormones may still have an effect on the developing embryo.  This may be from an effect on the endometrium or another deleterious effect on the embryo (like being unable to transport an embryo to the uterus in time for implantation.)

Although this is an interesting theory, I do not believe there is adequate evidence to support it at this time.  I do believe however that we may be able to investigate this further, although it may be a moot point now that Ella and the copper IUDs are being pushed as the most effective emergency contraceptives.

So do new studies show that all forms of EC can cause early abortions?  In a word, NO.  There has been an interesting look at data published 3-4 years ago that contradicts the original author's conclusions.  If the future evidence supports this theory, then it may be possible that Plan B effects a developing embryo even though it is not effective when given after ovulation.  I plan on being very careful to look at this data before overstating possible conclusions.  I hope others will do the same.


  1. FANTASTIC post, Rich. Thanks for continuing to encourage our pro-life community to take medical research seriously and not overstate our case.

    1. I believe that both sets of researchers were taking the medical research seriously, they just had different starting assumptions, that's how they ended with different conclusions. Like how creationists and evolutionists can look at the same data and come to different conclusions.

  2. As a current PA student, I'm wondering if you have any advice regarding evaluation of various methods of contraception and the best way to avoid violating my own conscience when faced with the need to provide contraception for my future patients. We just finished discussing contraceptives in our pharmacology course. Many of the mechanisms of action of even the OCPs include prevention of implantation, but it seems that there's not enough evidence to state that conclusively. I would appreciate your perspective as I feel that many of my professors gloss over ethical issues because they are uncomfortable dealing with them.

  3. I thought we're always supposed to err on the side of life. Even if there is no conclusive evidence supporting the possibility of Plan B preventing implantation, is there conclusive evidence that Plan B does not prevent implantation? Until "future evidence" clears this question up completely, it seems to me that we should be consistent with what we believe.

  4. carjcallan,

    That is a complex topic. What ethical obligations do we have as prescribers? What about a pharmacist dispensing meds? I would say in the minimum we should inform our patients of the possible ethical implications of any meds that we prescribe, just as we would inform them of possible risks.

  5. Rosana,

    I agree that if one chooses to not use a particular contraceptive method because we have not "proven" that it does not interfere with implantation, then you should follow your conscience and not use that form of contraception.

    However, you seem to imply that the use of something that we haven't proven NOT to have a particular effect would be unethical. In that case I disagree. For example, I have a Coke Zero in front of me right now. There is no conclusive evidence that drinking Coke Zero has no effect on implantation. Should we advise women not to drink it until we prove that it is safe for the embryo?

    Lastly, outside of the rare instances of rape, I really cannot think of a instance in which a Christian couple would "need" emergency contraception that would not involve other ethical problems.

  6. Suppose I'm a foreman in charge of a construction crew and we're about to demolish an old building via explosives. Right before I'm about to do it, a subordinate tells me he thinks he might have just seen a child playing inside the building, but he can't really be sure.

    Do you say, "Oh well, there's no proof, let's just go ahead and implode the building"?

    1. Paul,

      I'm not sure how that analogy works here. How about this one. You are about to eat a sandwich for lunch and someone runs up to you and shouts for you to stop. He states that if you take another bite, the building across the street may fall, possible killing many. What are you to do?

      Well, I might suggest that you ask for evidence to support the person's claim. If there is inadequate evidence to show that eating your sandwich will cause the building to fall, you would probably eat it despite the fact that you have no proof that the next bite won't cause the building to come down.

      This is just what I am attempting to do here.

    2. When researchers initially raised the alarm claiming endometrial thinning evidence, they were not studying the women on BCPs when an _actual_ breakthrough ovulation was occurring, so they raised the alarm without cause, read this if you still think the pill kills:
      And then read this:

  7. To the person who wrote the comment that did not put forth an argument but simply insulted Serge; I advise you to rewrite your comment respectfully engaging Serge's arguments and offering support for your assertions. You are also free to ask a question for clarification. Comments that are mainly insults and a URL to another site don't make it out of the moderation zone.

  8. This article has great advice for those who _already know_ why the pill doesn't kill, if you still believe that the pill kills, go here and read this:

  9. Dear Dr. Poupard, I am responsible for the content of our pregnancy center's website and we have one page on Plan B and Ella. I would appreciate your quick review of our page:
    I can be reached at thank you.


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