The abortion pill by any other name

Natalie Hudson
The Interim

On a beautiful, sunny day this past August, a young woman, eight weeks pregnant, walked into a Canadian medical clinic to inquire about an abortion. The attending doctor gave her two tablets of Cytotec, also known as misoprostol, without a prescription. This is a drug that is legal in Canada and commonly used for gastric ulcers. In this case, however, the pills were intended to initiate uterine contractions that would lead to the termination of her pregnancy.

The young woman was then given a prescription for methotrexate and instructed to come back to the walk-in clinic the following day to have it administered by injection, completing the “medical” abortion. Before getting the prescription, the woman had a change of heart and contacted her sister, an ultrasound technician, for help.

Canadian Physicians for Life president Dr. Will Johnston, who was alerted to the case through another pro-life group, said the woman did not know what she had been given. He told The Interim, “I had difficulty getting the information, because the doctor at the clinic would not say what the pills were.”

A case like this raises, at the very least, serious concerns about informed consent. “These are do-it-yourself, office-based, ‘mom and pop’ abortions that are promoted to save the woman from surgical abortion,” Johnston said, adding this kind of shabby medicine is a real “back-alley abortion,” wherein women are given noxious drug cocktails with little or no information as to their effects. “The entire abortion industry is in violation of informed consent, but these women are not even being informed of the fact that the drugs they are taking are not authorized to be used for abortions,” said Johnston.

Dr. Ellen Wiebe disagrees. In an e-mail interview with The Interim, she said, “Misoprostol is a very safe drug. As a family doctor, I have used misoprostol in many patients for the approved uses in doses of 600-800 micrograms every day for years. The abortion patients take the same dose, but only once or twice.”

Wiebe supervised the RU-486 trials in Canada, but the abortion drug did not receive approval after a woman lost her life during the clinical trials. “Every abortion patient signs a consent form,” Wiebe said, “indicating that these drugs are approved in Canada for other uses, but we have been using them for abortions for 13 years.”

Are women really being informed? Just prior to the RU-486 trials in 2001 that included more than 800 Canadian women, the manufacturer of misoprostol, G.D. Searle, issued a letter sternly warning that the off-label use of misoprostol for an abortion could cause, among a litany of horrific effects, “serious adverse events… includ(ing) maternal or fetal death.” In an interview with journalist Celeste McGovern of B.C. Report magazine, Searle spokesman Jack Domeischel said, “We’ve never had the intention of marketing it for abortions and we’re not going to recommend it for that purpose.”

Wiebe admitted that the 800 women involved in the 2001 RU-486 trials were never warned about the Searle company’s letter. A decision was made not to tell them. Wiebe said the letter “was a terrible thing, because we need (misopristol). We use it for miscarriages as well as induction of labour.”

The Pro-Life Society of B.C. filed complaints in 2001 with the College of Physicians and Surgeons of B.C. regarding Wiebe’s use of misoprostol for a purpose not recommended by Searle. “It’s unethical to use a drug for purposes which the pharmaceutical company states it’s not to be used for,” said society president Ted Gerk in an interview.

Now, methotrexate is being used in combination with misoprostol. It replaces the banned RU-486 drug mifepristone. Mifepristone is a progesterone inhibitor that shuts off nutrition to the placenta and fetus and is linked to the bacteria clostridium sordellii that can, in some cases, be fatal. There have been five deaths in Canada and the U.S. related to mifepristone, three of which were directly related to the bacterial infection.

Methotrexate, on the other hand, is an extremely toxic anti-cancer drug that works by inhibiting the replication of RNA and DNA in cancer cells. In the growing embryo, it has a similar mechanism, but the long-term effects to women are unknown. Six full pages are devoted to the hazards of methotrexate in The Physician’s Desk Reference, an encyclopedic compendium of prescription drugs marketed in the U.S., whereas the average entry for drugs runs about half a page.

The PDR warns, “Methotrexate should be used only by physicians whose knowledge includes the use of antimetabolite therapy … Because of the possibility of serious toxic reactions, the patient should be informed by the physician of the risks involved and should be under a physician’s constant supervision.”

Despite these warnings, the concoction of the legal drugs misopristol and methotrexate is available across Canada for abortions up to seven weeks. Once a drug has been approved in Canada for one specific indication, a licensed doctor is permitted to prescribe it for other uses as well.

Wiebe said, “In my area, women have a choice between medical and surgical abortions, because my clinic offers medical abortions and three other clinics offer surgical abortions.”

In Toronto, The Hassle Free Clinic states on its website that at least one abortuary, the Women’s Care Clinic, offers misopristol and methotrexate – or “M&M” – abortions.
The recent situation of the young mother who was eight weeks pregnant also raises questions about what to do when a woman regrets her abortion half way through.

Johnston has dealt with several cases of women who have regretted their decision to abort part way through second-trimester surgical abortions where a laminaria insert has been administered to force open the cervix.  “These laminaria inserts can be removed and the pregnancy will most often continue unharmed,” said Johnston.

He strongly advises regular cervical checks for the duration of the pregnancy as the laminaria inserts, designed to stretch open the cervix, can damage it, resulting in a premature birth. In all of the cases that he has dealt with, the pregnancies carried on successfully.

Because a chemical abortion requires at least two visits to the doctor and lag time in-between, women can change their minds after the first dose of drugs. Misoprostol, which will induce contractions, may not harm the developing baby, but if the woman has been given methotrexate first, nothing can be done.

Johnston finds it ironic that a “women’s right to choose” disappears once the procedure begins.  Those attending her abortion become very “censorious and hectoring towards a woman if she changes her mind, for fear of a lawsuit,” he said. “The tone becomes patronizing and imperious towards the woman who, in their minds, has now exercised her choice and must get on with it.”

Chemical abortions are cheaper and potentially less invasive, if a surgical procedure is not needed to finish the job. According to Wiebe, the real reason why they are provided is that women want an abortion that will feel like a miscarriage. “We see more ‘anti-choice women’ like yourself in our clinic,” she claimed. “Often, women who believe abortion is wrong, is murder, is a sin, come to us with an unwanted pregnancy and tell us that (chemical abortions) feel less like a ‘real abortion’ and more like a natural miscarriage.

Our counsellors try to help them remember that their God is forgiving.”

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