Swallowing bitter pills

ru486newsprintThe FDA announced this week that another two women who had undergone abortions using pills had died. It is important for reporters to be very specific about what is and is not known about life and death issues such as these, and many reporters did a fine job. But there was one component that was sorely lacking. Let's look at this sample coverage from Andrew Bridges with Associated Press:

Two more women have died after using the abortion pill RU-486, federal health regulators said Friday, in warning doctors to watch for a rare but deadly infection implicated in earlier deaths.

At least seven U.S. women have died after taking the pill, sold since 2000. The Food and Drug Administration cannot prove the drug was to blame in any of the cases.

This information is certainly helpful, but I was thinking back to a story I read in December that had shocked me. Not because the news was so surprising so much as bizarrely underreported. Here's Salynn Boyles of WebMD in an article published by Fox:

The FDA received reports of 607 adverse events involving the abortion drug RU-486 over a four-year period, it was reported this week.

The adverse events included five reported deaths and 68 cases of severe bleeding that required transfusions.

Late last month, federal officials confirmed that five women who died of toxic shock syndrome within a week of taking the drug to induce abortions had the same rare bacterial infection.

Now, seven deaths provides some context, certainly. But 68 cases of severe bleeding that required blood transfusions? And 607 adverse events? Ay yay yay! Without debating the morality of abortion, why would reporters hide this? If you or a woman you knew were considering abortion -- whether you agreed with her thinking or not -- wouldn't you want to share information like this with her? Why, in a story about the dangers of an abortion pill, would you not mention that you may be facing a blood transfusion if you take the pill? Yes, these numbers are comparatively small relative to the half-million women who have used pills to end pregnancies, but that doesn't excuse hiding them.

Anyway, most outlets tried to push the story forward by looking at Planned Parenthood's announcement that it was changing the way it administered the drug. Four of the seven women who died did so after receiving their abortion pills from Planned Parenthood. Apparently the FDA and Planned Parenthood have been battling for a while over the way Planned Parenthood directs patients to take the drug. The New York Times' Gardiner Harris explains:

When Mifeprex was first approved by the agency in 2000, the standard regimen was to give the drug in a doctor's office followed two days later by an oral dose of a different drug, misoprostol, also in a doctor's office. Women expelled the fetus over the following days or weeks in a process that mimicked a miscarriage. The procedure must begin within 49 days of conception.

Soon after Mifeprex's approval, most Planned Parenthood doctors switched to a different regimen, instructing women to insert misoprostol vaginally at home two to three days after taking Mifeprex. Studies of the new regimen showed that it was effective, and it allowed women to take lower doses of misoprostol. It also meant fewer office visits for Planned Parenthood.

But this regimen was not approved by the drug agency. It is not unusual for doctors to use drugs differently from how they are officially approved. But as reports of deaths among women undergoing the procedure trickled into the F.D.A., government officials issued stern warnings that doctors should stick to the approved regimen.

Until Friday, Planned Parenthood had rejected those warnings.

bitter pill 01I just want to point out this one device author Gardiner Harris used when writing about Planned Parenthood. He says that Planned Parenthood is using a regimen not approved by the FDA. Then he says that it's not uncommon for doctors to deviate from approved uses. That is most certainly true. It's also remarkably generous for him to include in a story about two women's deaths. Especially since those deaths followed medical consultations with Planned Parenthood that included instructions contrary to what the FDA approved for an extremely controversial and dangerous drug. I think it's good that he mentioned it, so I'm not criticizing him. But it's good to think about whether all sources get this treatment.

To draw a comparison, let's say that seven men from around the country all died after hunting trips. The only thing they had in common was that they used the same make and model of gun, which had just been put on the market. Would we expect most reporters to put the best construction on the gun manufacturer? I don't know.

Reporters, and most of us are guilty of this whether we're reporters or not, tend to put the best construction on those with whom we agree while attacking the motivations or practices of those with whom we disagree. If you want to write an attack piece, putting the worst construction on one group's actions -- and the best construction on their opponents -- is the easiest way to do it. It's also unethical and fails to provide a news service to readers. Generously explaining everybody's side is more difficult but it ends up providing a better -- albeit much more complex -- story.

In the meantime, someone should probably dig a bit more into all these complications from abortion pills, not just the deaths.

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