The risks of a “vending-machine attitude” toward gynecological care

By Tom Quiner

Maggie Dewitte is Executive Director for Iowans for L.I.F.E. She stood up before the Iowa Board of Medicine last Friday and read a statement prepared by Dr. Donna J. Harrison on the dangers of telabortions. Dr. Harrison is President of the American Association of Pro-Life Obstetricians and Gynecologists (www.aaplog.org).

Here are the takeaway points from Dr. Harrison’s statement:

• Telabortions are a threat to women’s health.

• Telemed dispensing can’t properly evalute uterine and other physical abnormalities that may create a life-threatening complication to the patient.

• The “abortion pill” (RU-486) is not FDA approved for use in pregnancies beyond 49 day’s gestation due to dramatically increased risk of complications. Without an ultrasound, gestational age estimates were more than two weeks off in half of the women according to studies Dr. Harrison quotes. Telabortions do not provide women with ultrasounds or any kind of exam before dispensing the pills.

Here are Dr. Harrison’s complete remarks:

“Telemed dispensing of abortion drugs are not only a gross disservice to women seeking abortion,  but are also a real threat to women’s health, as it is not possible to either accurately assess  the stage of the pregnancy,  nor accurately screen for pregnancy abnormalities such as ectopic pregnancy, which is an absolute contraindication to the use of mifepristone.  Nor can telemed dispensing allow for evaluation of uterine, or other physical abnormalities that may present a life or health threatening complication for the woman.

The purpose of a physician or practitioner visit is to screen for contraindications to abortion.  Many of these contraindications will not be apparent from history, which is why a physical examination is critically important to adequate pre-abortion counseling.  Since mifepristone is not FDA approved for pregnancies over 49 day’s gestation, it is imperative that the gestational age of the pregnancy be accurately assessed prior to dispensing mifepristone.   Administration of mifepristone beyond the 49 day cut off exposes the woman to dramatically increased risks of hemorrhage, infection and failed procedures necessitating a subsequent surgical abortion.   Spitz, et al, one of the principle investigators in the U.S. clinical trial leading to FDA approval, investigated the ability of patient history to predict gestational age, and found that over half of the women had dates more than two weeks in error when compared to the simultaneous ultrasound required prior to mifepristone administration in the clinical trial.   Thus, depending on history alone, which is what happens with telemed abortion dispensing, will result in the use of mifepristone in women who are beyond the FDA approval limitation, and into the gestational age where failures and complications exponentially increase.

Ectopic pregnancy, which is present in approximately 3 out of every 100 pregnancies, is an absolute contraindication to mifepristone use.  It is not possible to do adequate screening for ectopic pregnancies via a telemed dispensing system. Further the side effects of prolonged bleeding and pain, which accompany the normal mifepristone abortion, are identical to the bleeding and pain experienced with ectopic pregnancies.  Masking ectopic pregnancy symptoms led to the death of one of the 8 women who died in the first two years after mifepristone approval.

The FDA, in its approval of RU-486/mifepristone for abortion, recognized that for the safety of patients, significant controls on dispensing must be in place, and required two in person visits as a condition for approval of this drug.  RU-486/mifepristone causes increased hemorrhages, infections and failed abortions as compared to surgical abortions, as has recently been documented in several recent publications in the medical literature.  And the incidence of hemorrhage, infection and failed abortion increases dramatically as gestational age increases. The CDC estimates that the risk of death from a mifepristone abortion due to clostridium sordellii infection alone is 10times the risk of death from a surgical abortion at a comparable gestational age.

The impetus for telemed abortions does not come from improving patient care, but rather from increasing profits.   The burden of proof of improved patient care via this system is on the proponents, who have not shown decreased complications or improved outcome.   And there is no logical reason to expect improved outcome from a vending-machine attitude toward gynecological care.  This is an abuse of women.   On behalf of the women of Iowa, we ask the Iowa Board of Medicine to deny endorsement of this abusive practice.”