There’s a great Perspective essay in this week’s New England Journal of Medicine called, “Alternative Science and Human Reproduction“. It was written by Alta Charo, JD, a Professor of Law and Bioethics at the University of Wisconsin–Madison. In it, she discusses how recent Trump administration appointees, including some in the Department of Health and Human Services, have used “alternative science” to promote their personal views about contraception. She also discusses the pervasive use of “alternative definitions of well-understood medical conditions” to obfuscate anti-contraception agendas. Both should concern anyone interested in women’s issues and reproductive rights. Let’s take a closer look.
Trump’s anti-science appointees
- Teresa Manning, an anti-abortion adjunct professor at Antonin Scalia Law School at George Mason University, is the new deputy assistant secretary of HHS for population affairs. In that role, she will help oversee federal programs for family planning including managing the $286 million Title X federal family planning program that serves low-income or uninsured women. Formerly, she was a lobbyist for the National Right to Life committee and she has worked as a policy and legal analyst for right-to-life issues at the conservative Family Research Council lobbying group in Washington, D.C. In an interview with NPR in 2003, Manning said that “contraception doesn’t work” and that women taking the pill will eventually get pregnant. Really? While they are using them or after they stop? Doesn’t she know that many studies have documented the effectiveness of both birth control pills (91%) and long-acting reversible contraceptives (99%)? Or, doesn’t she care? How on earth has she ended up in this position?
- Charmaine Yoest is the former head of the anti-abortion advocacy group Americans United for Life. According to Charo, Yoest helped to develop,
“the strategy for a Texas statutes that was so filled with obstacles to abortion services, presented in the guise of protections for women’s health, that the U.S. Supreme Court abandoned its usual degree of deference to state legislatures and struck down the law because its underlying factual claims were patently false.”
She has been appointed to serve as the assistant secretary for public affairs at HHS. Her fake science declarations include asserting that condoms do not protect against HIV or other sexually transmitted diseases (STDs). She is either purposefully ignorant or this is a bald-faced lie. How can you work in the area of women’s health and not know that condoms are effective at reducing the transmission of HIV as well as some STDs (those that are transmitted by genital fluids as opposed to skin-to-skin contact)? Yoast also asserts that abortion causes breast cancer and mental health issues despite good evidence to the contrary. Her expertise in advocating for her personal views should serve her well in her new position, but not the public.
- Valerie Huber was recently named to an HHS position in which she will help run programs on adolescent health. Formerly, she was the head of Ascend (formerly the National Abstinence Education Association), an organization that claims there is a causal relationship between abstinence-only programs and a reduction in poverty. There is a relationship between teen pregnancy and poverty, but abstinence-only programs have not been proven to prevent those pregnancies.
- Katy Talento was named to the Domestic Policy Council. Her most egregious statements about contraceptives included claims that the most effective types of contraceptives cause infertility and miscarriages and a misrepresentation of a 2012 study in which she said the author showed that contraceptives “break your uterus.”
The appointment of these four anti-science women by the Trump Administration should come as no surprise since these are the same folks who have eliminated Climate Scientists from the EPA and, in general, have appointed people to high positions who are opposed to the mission of the agencies they were chosen to lead.
Alternative definitions and rejections of science
Charo also points out that redefining the stages of pregnancy is another tactic being used by individuals and organizations that are against contraception. She says that by redefining how pregnancies are dated, they have been able to generate statistics that “falsely enhances the viability statistics for lower gestational ages and helps to bolster arguments for 20-week limits on abortion rights.” These “alternative facts” have been used by some state legislatures to support abortion restrictions.
Another alternative definition that has been used is to claim that contraceptions are actually abortifacients. Although it has been around for a long time, Charo says it now has “enormous importance with the rise of ‘conscience clause’ refusals to prescribe or provide contraceptives by physicians, nurses, and pharmacists.”
Charo notes that most physicians, including the federal government, define pregnancy as occurring after implantation of the fertilized egg. Hormonal contraceptives work primarily by preventing ovulation although they also thicken the mucus of the cervix, making it harder for the sperm to enter the uterus, and thin the lining of the uterus, making it less likely for a fertilized egg to implant. They do not interrupt an established pregnancy. According to the essay, the most commonly used IUDs work by inhibiting fertilization by altering the uterine environment so it is hostile to sperm. They can sometimes prevent implantation but they do not interrupt an established pregnancy.
A recent statement on contraception by the American College of Obstetricians and Gynecologists sums it up by saying:
“The facts are that no credible research confirms the false statement that birth control causes miscarriages. In addition, FDA-approved contraceptive methods are not abortifacients. Every FDA approved contraceptive acts before implantation, does not interfere with a pregnancy, and is not effective after a fertilized egg has implanted successfully in the uterus.”
By redefining pregnancy and according “moral status to the fertilized egg” prior to implantation, anti-contraception advocates engender sympathy from those against abortion even though what is happening medically is not abortion at all.
Alternative science vs. Tough public policy choices
Charo reminds us that
- Facts matter
- Scientific methods matter, and
- Medical terminology matter
Of course, you may say, but remember she was writing this for readers of the New England Journal of Medicine where most readers would strongly agree with these statements.
Reasonable people, she says, “may disagree about the moral significance of fertilization, but they do not delete implantation from the stages of pregnancy and do not confuse the public debate by conflating opposition to abortion with opposition to contraception…Ignoring, denying, or reimagining reality has real consequences for public policy and human health.”
She closes by reminding us that
“alternative facts are just fiction, and alternative science is just bad policy.”
Those of us who care deeply about women’s health and reproductive rights have plenty of reason for concern now that advocates of fake science are in positions of power and alternative facts have been weaponized by state legislatures. We must be vigilant and we must resist.
More by this author: Most Americans Do Know Something About Science After All
Patricia Salber, MD, MBA
Patricia Salber, MD, MBA is the Founder. CEO, and Editor-in-Chief of The Doctor Weighs In (TDWI). Founded in 2005 as a single-author blog, it has evolved into a multi-authored, multi-media health information site with a global audience. She has worked hard to ensure that TDWI is a trusted resource for health information on a wide variety of health topics. Moreover, Dr. Salber is widely acknowledged as an important contributor to the health information space, including having been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.
Dr. Salber has a long list of peer-reviewed publications as well as publications in trade and popular press. She has published two books, the latest being “Connected Health: Improving Care, Safety, and Efficiency with Wearables and IoT solutions. She has hosted podcasts and video interviews with many well-known healthcare experts and innovators. Spreading the word about health and healthcare innovation is her passion.
She attended the University of California Berkeley for her undergraduate and graduate studies and UC San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.
She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. And, also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. GM was the largest private purchaser of healthcare in the world at that time. After leaving KP, she worked as a physician executive in a number of health plans, including serving as EVP and Chief Medical Officer at Universal American.
She consults and/or advises a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, and Doctor Base (acquired). She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle, and Reath, LLP.
Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She chairs the organization’s Development Committee and she also chairs MedShare's Western Regional Council.
Dr. Salber is married and lives with her husband and dog in beautiful Marin County in California. She has three grown children and two granddaughters with whom she loves to travel.