SCIENCE / MEDICINE : Abortion Pill: Some Hard Questions for Foes of Medical Leap Forward
A new drug with a Star Wars name, RU 486, or mifeprestone, may help change the world. But the world of the future will look back to thank the French because, sadly, U.S. physicians and scientists in this case were unable to be more than spectators.
The reason we are sidelined is that RU 486 can be used to terminate pregnancy. It may also be useful in combatting breast cancer, endometriosis, and Cushing’s syndrome and in inducing normal labor at the end of pregnancy. But its widest use to date has been in ending unwanted pregnancy in about 40,000 French women. And a recent study in the New England Journal of Medicine of 2,000 women in 73 centers in France showed clearly that RU 486 is a safe and effective way to end pregnancy within seven weeks of the last menstrual period.
RU 486 is at least as effective and safe as surgical methods in those seven weeks, and the drug, usually given in combination with prostaglandin--one of a class of hormone-like drugs--can almost certainly be given with more privacy and less humiliation. Thus it gives women and their doctors an unprecedented freedom to choose.
It is one of the great success stories in modern drug research. Most drugs we rely on--aspirin, penicillin and digitalis, to name a few--are stumbled on through clinical trial and error, and their chemical actions explained (or not) later. RU 486 was discovered through a rational scientific path.
It has been known for half a century that progesterone, a hormone that comes from the ovary in early pregnancy, is necessary to maintain gestation. So researchers sought a drug that would combine with the receptor for progesterone inside the cell, but block the hormone’s pregnancy-stabilizing actions. Etienne-Emile Baulieu, a French physician-scientist working with others at the Roussel UCLAF drug company in Paris, pioneered the use of this custom-designed drug in the early 1980s, and now Baulieu, Louise Silvestre and others have combined it with prostaglandins in this highly successful new study.
RU 486 has been extensively tested in France, and also in Scandinavia, England, China and elsewhere. Approval for commercial distribution has been obtained in France and is likely soon in several other countries.
But neither commercial distribution not even systematic research on RU 486 is allowed in the United States, nor is it likely to be soon. That includes research on its value in breast cancer, among other illnesses.
The reason is that opponents of abortion realize that if RU 486 were approved here, regulation of early abortion would become a much more difficult task. Their boycott threats have inspired such fear in American drug companies that none has had the courage to begin the long, slow program of testing the drug for Food and Drug Administration approval.
RU 486 will make it easier than ever for women to correct the mistake of an unwanted pregnancy. Only for those who see an embryo as fully human from the moment of conception, and thus view any termination of pregnancy as murder, can RU 486 fail to be seen as an advance. For those who favor reproductive choice, it is likely to be seen as a miracle drug.
The attempt to avoid unwanted children has a long record in anthropology and history. Many methods--including plants and mechanical means--have been used by cultures ancient and modern to attempt to prevent conception or cause abortion. (RU 486 is in the latter category, and has been appropriately called a contragestive rather than a contraceptive.)
Studies show that in at least half of human pre-industrial societies it has been considered acceptable--even though tragic--to kill newborns immediately upon birth if there was no way of taking care of them. We are fortunately not under such terrible pressures; not even the strongest abortion-rights advocates think that abortion should be allowed after the second trimester, and all decent people approach the decision sadly.
Yet most people in our society are capable of making gradations in an embryo’s progress toward humanity. Some would base it on the criterion of “brain birth”--the beginning of brain function. Others would draw an arbitrary line some time between conception and six months of pregnancy.
But given the facts, only a small minority would try to prevent the use of a safe drug that can terminate pregnancy in its earliest stages. To this minority we should pose some hard questions: If early abortion is murder, where is the funeral for the embryo or fetus miscarried in the first few weeks? Where is the grieving for the products of a late menstrual period, many of which, we now know, are very early spontaneous abortions? The fact is that even the vocal minority which claims that deliberate abortion is murder does not act as consistency would require, with ritualized and emotional grieving over early abortions that occur spontaneously.
Not surprisingly, some in the majority are getting angry and taking steps to make the drug available. John K. Van de Kamp, the California attorney general and gubernatorial candidate who personally opposes abortion, recently called on the state health department to bypass the Federal FDA and test RU 486 under the new rules for expediting availability of experimental AIDS drugs within the state. If the tests go well, he said, the drug should be approved. Planned Parenthood has taken the position that the drug could be given FDA approval on the basis of data already available.
Moreover, in the absence of federal approval, it is unlikely that women will take no for an answer. Since the law did not stop back-alley abortionists from springing up 20 or 30 years ago, it is extremely unlikely that legal measures could keep RU 486 out of women’s hands indefinitely.
France, a Catholic country, has courageously pioneered this important medical advance against strong internal opposition. It would be ironic indeed if a large multicultural nation such as ours, which places such strong emphasis on individual freedom, should lag much further behind than we already have.
