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Medical abortion reversal: science and politics meet

      To the Editors:
      I read with great interest today your recent publication of the article by Bhatti et al.
      • Bhatti K.Z.
      • Nguyen A.T.
      • Stuart G.S.
      Medical abortion reversal: science and politics meet.
      The 2 senior authors are well experienced in medical and surgical abortion and are highly qualified to comment on the medical aspects of abortion. The authors use evidence-based medicine to demonstrate the safety and effectiveness of medical abortion.
      The remainder of their article is basically their personal opinion of abortion and abortion law masked as science. Their claim that “medical abortion reversal bills are not based in science” is untenable. Medical abortion reversal is completely based on science and medicine and on a valid, common-sense, and not-disproven medical theory and has no proof of deleterious effect. Its efficacy is currently in the state of systematic evaluation because medical abortion efficacy was investigated years ago.
      The authors are quite inconsistent in their use of evidence-based data. Their claim that “counseling about medical abortion reversal … poses a direct threat to women’s health” is completely unsupported by any such evidence. The inclusion of references to multimillion dollar lawsuit information is tangential to the nature of the paper (relevant to neither medicine nor politics) and is a carefully manufactured and included distraction or scare tactic designed to inflame emotion favorable to the authors’ personal beliefs.
      Medical abortion reversal is a physician-initiated and supervised practice of growing popularity that has not been proven harmful. Evidence of its efficacy continues to accumulate. It is based on the principles of human safety and dignity and the sanctity of the life of all humans, not just that of an inconvenienced mother. There are no reported cases of death or permanent disability related to medical abortion reversal. The authors’ failure to use evidence-based medicine to prove the practice unsafe is inconsistent and does not hold up to academic scrutiny.
      A more appropriate conclusion by the authors would have been a modification of their final sentence to the following: “given the current paucity of evidence for medical abortion reversal toxicity, and given its potential efficacy, it is the responsibility of physicians and obstetrician-gynecologists to advocate for our patients who are undecided about their medical abortion to offer this as a safe alternative. To do otherwise violates our moral obligation to provide informed consent.”
      Until and unless medical abortion reversal is demonstrated to be harmful, there should be no law prohibiting it. Conversely, with the current growing state of knowledge of the potential efficacy of it, a law that requires it to be discussed is reasonable. Any law that requires truly informed consent from abortion practitioners is beneficial to the public good.

      Reference

        • Bhatti K.Z.
        • Nguyen A.T.
        • Stuart G.S.
        Medical abortion reversal: science and politics meet.
        Am J Obstet Gynecol. 2018; 218: 315.e1-315.e6

      Linked Article

      • Medical abortion reversal: science and politics meet
        American Journal of Obstetrics & GynecologyVol. 218Issue 3
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          Medical abortion is a safe, effective, and acceptable option for patients seeking an early nonsurgical abortion. In 2014, medical abortion accounted for nearly one third (31%) of all abortions performed in the United States. State-level attempts to restrict reproductive and sexual health have recently included bills that require physicians to inform women that a medical abortion is reversible. In this commentary, we will review the history, current evidence-based regimen, and regulation of medical abortion.
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      • May 2019 (vol. 220, no. 5, page 504)
        American Journal of Obstetrics & GynecologyVol. 221Issue 4
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          Doherty MG. Medical abortion reversal: science and politics meet. Letter. Am J Obstet Gynecol 2019;220:504-5.
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        American Journal of Obstetrics & GynecologyVol. 220Issue 5