Some solons have morphed into pseudo-physicians. Today solons — in 14 states, part-timers — must rule not only on agriculture, zoning, welfare, environment, public safety, schools … but also medicine. It’s especially tricky when the sessions last less than two months (Florida, Louisiana, Utah, Wyoming), or meet only every other year (Montana, Nebraska, North Dakota, Texas). Of the 7,583 state legislators, only 11% declare “legislator” as their full-time occupation. Most are attorneys, business owners, retirees, or school teachers. Only a sliver are physicians.
Nevertheless, some of these “citizen legislatures” issue medical decrees.
The medical advice du jour: reversal of medication abortions. A medication abortion consists of two drugs: first, mifepristone, which blocks progesterone, which sustains a pregnancy. Next, the woman ingests misoprostol to cause cramping, expelling the fetus. Taken together, the two drugs constitute a “medication abortion.” The American College of Obstetricians and Gynecologists has estimated a 30 to 50 percent chance that a woman will carry her pregnancy to term if she doesn’t take the second dose, but she may suffer a risk to her own health.
More than half of abortions are induced by medication, a regimen approved by the FDA.
States that ban abortion have taken aim at these pills, banning their sale, their distribution, their use.
A high dose of progesterone emerges as a wondrous fix: if a woman changes her mind in the 48 hours from pill one to pill two, and takes a high dose of progesterone — presto! She will abort the abortion. An anti-abortion group, the Abortion Pill Rescue Network, says that the fix has shown a 64 to 68 percent success rate.
Enthusiasm aside, to date there have been no controlled trials, no evidence-based studies, no analysis of possible side effects. One random controlled study, from the University of California-Davis, tried to enroll 40 women, but stopped when only 12 enrolled, and three of those 12 suffered vaginal bleeding, reinforcing the caution that stopping the procedure can harm the woman. One case study (2012) touted by enthusiasts enrolled six women who took progesterone: four continued their pregnancies. But a case study of six women hardly ranks as science. The American College of Obstetricians and Gynecologists has declared that no evidence supports the efficacy or the safety of this procedure.
Nevertheless, legislators have stormed ahead, issuing medical dictums to physicians. Legislators who passed laws to make abortion harder to procure, if not impossible, have proven willing to take this next step into medical wizardry. Why not show your “pro-life” verve by authorizing an untested procedure that would let women undo their mistake? Why not promote the procedure by requiring physicians to discuss it?
Politicians eager to please “pro-life” voters have taken up the challenge. Fourteen states have required physicians to tell patients about the possibility of a progesterone fix, to stop the abortion midstream: Arizona, Arkansas, South Dakota, Idaho, Utah, Kentucky, Nebraska, North Dakota, Oklahoma ,Tennessee, Indiana, Louisiana, Montana, and West Virginia.
The courts, too, have pressed into the medical arena. In Indiana, North Dakota, Oklahoma, and Tennessee groups have pressed to stop the litigation. The rallying cry to defend the laws: religious freedom. In April, Colorado legislators subjected physicians who perform abortion medication to discipline. In October, the court ruled that Colorado was violating religious freedom.
Most patients do not know much about anatomy, pharmacology, physiology - the stuff that students learn during years of medical school, years of training. Most patients don’t know the specifics of clinical trials, statistical significance, or ethical oversight. The web and AI aside, most patients rely on their physicians for guidance, trusting them to to speak honestly, based on the science of today, not on ideological leanings.
How strange — and dangerous — to inject high school coaches, probate attorneys, retired teachers - the gamut of state legislators — into the doctor-patient discussion, letting pseudo-doctors practice medicine.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.
From The Progressive Populist, December 1, 2023
Blog | Current Issue | Back Issues | Essays | Links
About the Progressive Populist | How to Subscribe | How to Contact Us