Elizabeth Ferries-Rowe MD, FACOG
Indiana HB 1128 was passed by a vote of 54-41 in the Indiana House on Feb. 27, 2017, and has been sent to the Senate where it is currently in the Judiciary committee. In part, this bill addresses medical abortion – a procedure available in the first seven weeks of pregnancy in which a patient receives two medications 48 hours apart to induce abortion. Should a patient who has taken the first medication then choose to carry the pregnancy, their caregiver would withhold the second medication. One small case series (seven patients) speculated that administering progesterone, in addition to withholding the second medication, may “reverse” the abortion (i.e. increase the chance of pregnancy continuing). A subsequent review, however, concluded that “evidence is insufficient to determine whether treatment with progesterone after mifepristone results in a higher proportion of continuing pregnancies compared to expectant management.”
Published science does not support that this treatment works. Despite this, HB 1128 requires abortion providers to give patients information regarding progesterone therapy to “reverse” abortion. Untrained elected officials are prescribing medical counseling which doctors must provide, and requiring this counseling to include referrals for medically unproven therapies.
HB1128’s merits were colored by the testimony of two Indiana physicians who report having used progesterone to “reverse” abortions in 300 patients, but these physicians’ claims remain unpublished and cannot be reviewed for scientific merit. We can’t review the criteria for receiving this treatment, or protocols for administration. We don’t know what other factors in the patients’ health impacted the results. We don’t know the total number of women who received the therapy- only those whose pregnancies were sustained, so we can’t calculate a success rate. Without information on adverse results, we can’t assess its safety. Without an objective review of their intervention, and because published data is weak, it is premature to require all providers to counsel patients about this unproven intervention.
Which brings me to a fundamental contradiction in the bill:
The full House sent the original version of the bill back to committee the week before to address various concerns, including the lack of scientific merit. The revised bill “fixed” this concern by including the following language: “No scientifically validated medical study confirms that an abortion may be reversed after taking abortion inducing drugs.” (sec 4.2.K.iii) Contrast this to the following language in the same bill, which specifies that pre-treatment counseling must include “objective scientific information of the risks and alternatives to the procedure or the use of an abortion inducing drug” (sec 4.1.D).
The majority of House members were convinced scientifically objective information was important – except for “abortion reversals”, in which case non-scientific counseling is mandatory. The contradiction is puzzling; the disregard for science is disheartening; and the legal requirement that providers include medically unproven therapies when counseling patients is dangerous.
The willingness of the House to support a bill based on this type of pseudoscience is a direct result of a culture that views expertise as elitism, rather than as a valuable tool to advance the health and well-being of humankind. The progress of this bill through the legislative process is a microcosm of an environment that is skeptical of education and investigation, preferring to rely on emotional appeal and unproven data that confirms pre-existing opinions. In the case of legislation of medical care, the implications are frightening. Can you continue to trust your doctors to provide medically sound advice – or will you worry they are parroting unproven theories at the mandate of the government? Unless we successfully advocate for systematic investigation, peer review, and a minimum of scientific literacy for everyone, this is just the beginning. Today, that advocacy starts with the next step for the bill – your Indiana State Senators.
Elizabeth Ferries-Rowe is a Fellow of the American College of Obstetricians and Gynecologists, and a leading health care professional in Indianapolis with a degree in medical ethics.