First: the epidemiological facts (NYT, Dec. 8, 2011)
  • About 50% of all pregnancies are unplanned
  • More than 40% of children are born to unwed mothers
  • More than 1.2 million abortions are performed every year in the U.S. That’s 2% of all women of reproductive age.
The scientific/medical facts:
progesterone

 

 

 

 

  • Normally, progesterone concentration starts rising at day 13-14 of the menstrual cycle, reaching maximum on days 21-22, and then declining to their lowest levels on days 28- 29. Progesterone converts the endometrium (lining of the uterus) to its secretory stage to prepare the uterus for implantation. At the same time progesterone affects the vaginal epithelium and cervical mucus, making it thick and impenetrable to sperm. If pregnancy does not occur, progesterone levels will decrease, leading, in the human, to menstruation. Normal menstrual bleeding is progesterone-withdrawal bleeding.
  • Plan B (1.2 mg of synthetic progesterone) is based on the observation that an acute rise in plasma progesterone levels to higher than physiological levels inhibits progesterone’s normal activities. Hence, no ovulation and no preparation of the uterine mucosa to implant the fertilized egg.
  • Plan B underwent extensive clinical trial, showing a high degree of efficacy  and negligible side-effects if used within 72 hours of intercourse. Based on the data it received unanimous FDA expert panel and FDA scientific staff approvals Furthermore, ACOG (the American Congress of Obstetricians and Gynecologists), AAFP (the American Academy of Pediatrics), and the AMA endorsed its sale over-the-counter, reasoning that emergency contraception requires an immediate and unimpeded access. But in 1999 Plan B was approved for prescription-only use only.
  • In 2003 advocacy groups filed for over-the-counter use. Again, the expert advisory panel and the FDA stuff unanimously supported the application.

Now, here is the NYT reporting on what happened next:

But in a highly unusual move, top agency officials rejected the application because, some said later, they feared being fired if they approved it.  The agency delayed reconsideration for years despite promises by top Bush administration officials to do so. Then in 2006, the Bush adminisration allowed over-the-counter sales to women 18 and older but required a prescription for those 17 and younger. In 2009, the F.D.A. lowered the easy-access age limit by a year after a federal judge ruled that its decision had been driven by politics and not science.”

What are the metaphysical/political objections to free access to Plan B?
The catholic church and the evangelical right-to-life advocates couldn’t possibly object to the anti-ovulatory effect of progesterone; it doesn’t rise to the level of even their definition of abortion. But inhibition of progesterone’s effect on the uterine linings is apparently forbidden. Where is it written?  Last I checked my Bible there isn’t even a mention of the issue.
The early fathers of the Church, like Origen, Iraenius, St. Jerome, St. Augustine, didn’t even consider abortion in their writings. In fact, the Roaman pagan St. Augustine, before his conversion, was known to be a world-class womanizer, and some of his consorts must have needed an abortion. The whole issue of abortion accreted to religious dogma like barnacles to a boat. Medieval scholars closeted in their monasteries spun theological dogmas that strayed far and wide from “original intent”, and were totally divorced from real
Fathers of the early Church. Would you trust their judgment on sexual matters?

 

 

 

 

 

 

 

 

So why did Secretary Sebelius and president Obama choose to overrule the FDA recommendation, something that even the Bush administration, the most anti-science administration in modern history, didn’t dare to do? I can’t escape the conclusion that the decision was totally political, the President’s concern for 11 year-old girls notwithstanding. About 10% of 11 year-olds do ovulate an can become pregnant. If my granddaughters were  part of the 10%, and if their parents and schools did not provide them with good sex education, and if they were wild enough to engage in sexual activity, then I would like for Plan B to be available to them. It sure is better than an abortion or pregnancy at this young age. And if the pregnancy is carried to term, as the religious authorities dictate, who will raise the baby? An 11 year-old? Or are the bishops and the self-righteous right-to-life zealots going to do it?
The fake concern about 11 year-old girls screams hypocrisy! This administration hasn’t learned yet that trying to curry favor with the religious (and non-religious, for that matter) right wing is not going to change the abiding antipathy they harbor toward it.
I never thought I’d see the day when a President who professed to govern based of the Science will debase himself pandering to the medieval zealots among us.
Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.

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