The US Supreme court this month will again take up the case of the FDA approval of the abortion pill regimen, which currently is approved until 10 weeks gestation and to be dispensed by mail after a telemedicine appointment. Mifepristone, the first pill of the two-pill regimen, was originally approved by the FDA in 2000 for only up to 7 weeks of gestation, and required three in-person doctor visits. In 2016, the in-person follow-up visits were eliminated, the one visit no longer had to be a licensed physician, and its use extended to 10 weeks. Under the BIden administration, the inperson requirement was completely removed and now these pills can be dispensed after only one telemedicine visit with no followup.
In April of 2022, a Texas judge initially ruled that mifepristone should be taken off the market due an improper approval process. Higher courts have since ruled that the statute of limitations disallows that 2000 approval from being revoked, but have supported re-instating the initial restrictions of 7 weeks and requiring in-person doctor visits. The Supreme Court has ruled that the current regulations remain in place until a final ruling is made, and they take up the case later this month. Last year I wrote an article on the dangers of chemical abortion by telemedicine. Head to the NEWSLETTER ARCHIVES and check out the July 2023 issue to read that story. This month, I just want to point out that it should come as no surprise that the big news related to the upcoming court case is a study of how safe and effective telemedicine appointments are for dispensing chemical abortion drugs. There is no shortage of news stories on how thorough the study is of over 6,000 women, and its conclusion that medication abortions dispensed virtually had a success rate of 97.7% with no serious side effects. Of course I am not a researcher, but I did read the study HERE, not just the plethora of articles repeating how wonderful and conclusive it is. The first glaring problem with the study was that only 76% of the 6,034 women in the study responded to follow-up contact (4,454). So the status of 1,580 women is unknown. Apparently, that number is irrelevant. One can only wonder what the likelihood is of a person who does suffer severe complications to respond to a follow-up survey. Is it likely the non-responders have the same rate of noncomplications as those who did respond? Or is it more likely that the vast majority of people with severe complications are the ones who don’t respond? Another noteworthy point of the study is that this study involved patients who received what is called “synchronous care” (video) and “asynchronous care” (texting). Until I read this study, I didn’t even know that making telemedicine an acceptable way to receive chemical abortion drugs meant that you could do all your interaction with the clinic simply via text. Over 70% of the women in the study received text-only care. The nonresponse rate from video appointments was about 15%. The non-response rate from the texters was double, 30%. So this 97.7%
effectiveness rate is based entirely on selfreporting, with a significant lack of follow-up
contact, especially from the texting group,
which is the vast majority. How can we trust
these results? A woman receiving chemical
abortion drugs by telemedicine is likely hiding
her abortion from others in her life. If she
experiences complications, she likely suffers
them silently, and if she does have to go to the
hospital (since it isn’t with the original provider),
she is not likely to be honest with the doctors
about what brought her there. If she isn’t honest with the hospital, she can’t be honest
with the follow-up surveys if she even responds. More likely, she wants nothing to do
with the people who gave her these pills and told her they were completely safe, and will
fail to respond to follow-up texts. Is that not at least a strong possibility? One interesting
point the researchers also noted was that among the 4,454 who reported back, not even
one of them was determined to have been beyond 10 weeks of pregnancy. Is it likely that
no one underestimated their gestational age? Or is it much more likely that everyone
who underestimated their gestational age by telemedicine and expelled a sizable fetus
was afraid to admit it because they were afraid of the consequences of lying about
their gestational age? This even brings into question the veracity of the 74%. Admitting
complications opens up more questions and more intrusion, and most of these women
want to move on and never talk about it again. If we want good research on the effects
of the abortion pill, it seems to me we must have in-person followups with a doctor who
prescribed the pills, where the patient feels safe to disclose any ill-effects. This is the best
way to come closer to knowing the truth.
