RU-486: THE ABORTION BATTLE’S NEW FRONTIER : Dr. Grimes’ Bitter Pill : Medicine: Is the abortion pill a vital drug worth testing, as Dr. David Alan Grimes, its best-known U.S. researcher, insists? Or is it, as opponents say, a ‘human pesticide?’

Psychic Makes Baby Vanish Before Birth --Front-page headline in the Sun, a tabloid

PRO

RU-486 is the most exciting new drug we’ve had in fertility control since the development of the birth control pill three decades ago. It opens entire new vistas, with benefits far beyond reproductive medicine, ranging from treatment of endometriosis to breast cancer.”

Dr. David A. Grimes

USC School of Medicine

CON

“There will be serious resistance to RU-486. The drug companies are well aware of the political, medical and legal risks. With the first misadventure they will be sued out of their shoes. This drug has not been sufficiently tested and will not be for another 20 years.”

Dr. Bernard Nathanson, Cornell University Medical College

Depending on your reproductive politics, Dr. David Alan Grimes is either a mass murderer or a brilliant, ethic-driven scientist. He’s either a courageous humanist who risks his livelihood and conceivably his life for others--or a twisted, soulless technician comparable to Nazi death camp physician Joseph Mengele. That there is very little opinion in between is a reflection of the hot seat he occupies.

Grimes is North America’s best-known researcher on RU-486, the French-made abortion drug that opponents call “the death pill,” “the chemical coat hanger,” “the human pesticide” and “the Dalkon Shield of the ‘90s.”

He works at the only place in the country that has tested the drug as an abortion-inducing medication: Los Angeles County-USC Medical Center’s Women’s Hospital.

But the clinical trials have recently been suspended there after nearly six years of research. Involving almost 400 Southern California women, the studies ended in mid-February after Roussel-Uclaf, the Paris-based manufacturer of the drug, decided to stop supplying it.

“The reason,” says Ariel Mouttet, Roussel-Uclaf’s international product manager for RU-486, “is because we think public and political opinion in the States is not ready to accept either abortion or 486. Testing means nothing if we don’t plan to market 486 in the States. We will resume testing it in the States when the debate and the climate on abortion has been resolved.”

But a lack of pills hasn’t slowed Grimes. Considered by some to be the country’s leading gynecologist/epidemiologist, he is also an expert on sexually transmitted diseases and an authority on high-tech contraceptives, some so sophisticated that he says husbands may not even know their wives are using them. (Norplant, a hormone-releasing device embedded under the skin of the upper arm, is expected to win FDA approval by the end of the year.)

An international lecturer and professor in both USC’s departments of Preventive Medicine and Obstetrics and Gynecology, Grimes is a busy guy. If anything, given the growing national clamor for information on RU-486, demands on his time have increased since the pill studies stopped. One might expect him to be tense.

So what is the Harvard-educated research scholar doing with a tawdry tabloid in his slide show tonight?

Business as usual, it turns out. Grimes owns a whole collection of supermarket scandal-sheet pages, visual Napalm he occasionally drops into serious speeches when he wants to make a big point.

He and other medical school professors have long employed joke slides to keep overworked students from falling asleep in lectures. But Grimes truly relishes the incongruity of an academic quoting the tabloids. He takes his heavy artillery with him on the road.

This April evening, on his own time, Grimes is engaged in what he terms “consciousness-raising” for about 60 members of the Show Coalition, a political networking group for the entertainment industry which frequently invites governors, congressmen, cabinet members and other big-time policy makers to speak at its gatherings.

Speaking from the living room of an elegant West L.A. condo owned by Lila Garrett, head of comedy development for Aaron Spelling Productions, Grimes is earnestly sharing his expectations for RU-486. He predicts it will prove such a boon to world health that it will one day win the Nobel Prize for its inventor--his hero--Dr. Etienne-Emile Baulieu of France. (Baulieu has already won America’s most prestigious medical accolade, the Albert Lasker Medical Research Award, for his work on steroid hormones--which led to his discovery of RU-486 in 1980; 46 Lasker winners have gone on to receive Nobels.)

Grimes points out that RU-486 has been judged safe for human testing by the FDA. As for effectiveness, he says that when accompanied by a dose of prostaglandin, which causes uterine contractions, RU-486 has, in recent studies throughout the world, proved successful for about 95% of women. Those for whom the method failed were offered traditional surgical abortions.

“I’m optimistic that RU-486 will eventually be marketed in America. It’s safe, effective and popular,” Grimes tells the attentive group, which appears to strongly favor abortion rights.

Then he flings the coup de grace : a slide of a tabloid headline about a psychic’s alleged ability to make a baby disappear before birth.

“RU-486 is the closest thing we have to this!” concludes the scientist as the crowd, caught off guard, explodes in laughter.

Grimes is living up to his belief that if you want to educate, you’ve first got to engage and entertain. It’s a philosophy that last year helped him win the highest teaching honors given at USC’s School of Medicine: an award voted by fourth-year medical students, and a similar one bestowed by the residents in the department of obstetrics and gynecology.

Glib and poised whether addressing lay or scientific audiences, Grimes is a natural for this high-powered entertainment crowd. He’s a former federal bureaucrat with the Centers for Disease Control and a current consultant to the U.S. House of Representatives.

He refers to USC as the country’s “epicenter of contraceptive research and design.” And he calls its head, Dr. Daniel R. Mishell, who won the medical school the right to research RU-486, “the guru of fertility research, Mr. Contraception U.S.A.”

Few would disagree. Says TV’s Dr. Art Ulene, who was a member of the medical school faculty under Mishell from 1970 to 1976: “The team at USC is world-renowned and world-respected. They’re literally at the forefront of contraceptive research.”

Says Dr. Jack Lippes, inventor of the Lippes Loop, for years the most widely used IUD: “Since Mishell has been there, the department’s been the top of the top. Every new thing that is important, whether it’s vaginal rings or Norplant, is tried out there.”

In his Westside presentation, Grimes does not mention the widespread argument that abortion in any form is legalized killing, except to say that banning the drug because of religious beliefs would be like allowing Jehovah’s Witnesses to outlaw blood banks.

Nor does he bring up the less well-known argument that RU-486 has been tested insufficiently. Some doctors claim that RU-486 could eventually be proved harmful, perhaps even lethal, as occurred with supposedly safe products such as the Dalkon Shield IUD, early birth control pills and DES (a hormone used to prevent miscarriages).

For the finale, Grimes invites all the women on one side of the room to stand. Then he requests that everyone look around and appreciate the uniqueness of these individuals--and to remember that there will never be any more quite like them again.

“From the time we started this evening, this many women throughout the world--about 22 an hour, day in, day out--died from the complications of illegal abortions,” the soft-spoken physician says, citing World Health Organization estimates.

“I have two daughters. My fervent hope is that they will never have to experience this sort of degradation, disease and death as punishment for the crime of having loved another human being.”

By the time Grimes’ talk ends with this melodramatic flourish he appears to have totally captured the audience, which includes director John Landis of “Animal House” fame and Landis’ wife, costume designer Deborah Nadoolman. A board member of Planned Parenthood’s L.A. chapter, Nadoolman arranged for Grimes’ appearance.

By necessity, a lot has been left out. Grimes doesn’t reveal, for instance, that he has been personally threatened with kidnaping by anti-abortion activists. Nor does he present his truly alarming ammunition: slides from his visits to Third World countries where abortion is illegal or unavailable.

He doesn’t show the picture of the woman dying with a stick in her uterus. Or the close-up of gangrene of the uterus. These slides are usually reserved for medical students.

But even without such photographic horrors, Grimes’ audience is thoroughly riled up. Some in the group are so upset that Roussel-Uclaf has withdrawn RU-486 from further testing in the United States that they suggest forming their own pharmaceutical firm. They want to re-create RU-486 exactly, or make a slightly altered version so that research in the United States can continue.

A similar solution has, in fact, been proposed by California attorney general John Van de Kamp, who has called on the state health department to oversee testing of RU-486 by researchers or drug companies interested in distributing the drug within the state. (Under a two-year-old “mini-FDA” program, drugs can be approved for sale in California if they are manufactured and distributed solely within the state.)

San Francisco Supervisor Terence Hallinan also has submitted a resolution to the governor and the state Legislature, urging that the state fund testing of RU-486 in San Francisco, where three hospitals have offered to conduct studies.

Grimes was involved behind the scenes in both developments, having been asked for assistance by associates of Van de Kamp and Hallinan.

“RU-486 is a relatively simple molecule to synthesize,” Grimes says in a question-and-answer session after his talk, noting that, already, half a dozen small California companies “that want to run with this thing” have requested his help.

“The big boys won’t touch it,” Grimes reports. In the wake of threatened boycotts from anti-contraceptive and anti-abortion activists, the number of U.S. firms aggressively involved in the contraception business has shrunk from eight to one (Ortho Pharmaceutical Corp.) since the early 1970s.

“The problem is that (to duplicate or import RU-486) you need the consent of Roussel-Uclaf. They own the international patent on it. You can’t do anything without their permission,” Grimes says.

He opposes proceeding with copycat drugs and losing the decade of research that went into RU-486. Undeterred, hostess Garrett proposes a time-honored Hollywood tradition: illegally duplicating RU-486 and worrying about the lawsuits later.

Grimes abhors the idea. Or the notion, predicted by another audience member, that radical feminists may create an “underground railroad for RU-486” to distribute the drug illegally in the U.S.

“Let’s bring it in the front door,” he recommends. “We owe it to women.”

Though the researcher believes that RU-486 should, eventually, be “demedicalized” and sold over the counter (“We’ve got to get doctors and medical people out of the process”), he likes the stringent controls that now surround the drug.

Every single pill that has been sent to the United States for testing has been carefully accounted for, he says. And just as only French women are allowed to take RU-486 in France, where research continues, only Southern California residents were permitted to take part in the studies at County-USC. Grimes and his team wanted to be sure participants would stick around for follow-up study.

“I get calls from all over the country--Buffalo, Springfield, Houston--from people who want to get in on this,” he says.

Meanwhile, Grimes has been trying to get more RU-486 through the World Health Organization, but concludes, “I’m not optimistic about it.”

He is upbeat, however, about the power of those who favor abortion rights to affect political and corporate decision-making. “Roussel-Uclaf responds to pressure. The trouble is, it’s largely been on the other side,” he points out, reminding the group that the drug could be approved in the United States for non-abortion purposes. RU-486 has shown potential usefulness in treating endometriosis, Cushings syndrome, ulcers, breast cancer and in inducing labor in pregnant women during deliveries.

“All you have to do is get the drug in for any indication, then we could use it for any reason,” Grimes says, though he prefers RU-486 be brought in under an honest pretext.

But he’s clearly tired of being delayed by what he calls “medical McCarthyism.”

“Europe is already way ahead of us,” he declares. “The whole world is already far ahead of us. A woman in Dacca, Bangladesh, has more contraceptive choices than a woman in the United States. Think about it.”

That abortion is probably the country’s most divisive issue has not been lost on 43-year-old David Grimes.

He’s used to facing abortion foes in person.

Says Randall Terry, the founder of Operation Rescue, the anti-abortion organization known for its annual Easter week abortion clinic blockades: “His (Grimes’) name is fitting to his task. He will have to answer to God. Unless he repents, the fires of hell will welcome him for his part in this holocaust because he rejects the savior.

“This doctor,” Terry adds, “or any other doctor, who some now tout as a hero for helping develop these types of drugs, will be remembered as a villain, much like Dr. Mengele and his Nazi doctor cohorts. They are the hyenas of humanity. While on one floor (at Women’s Hospital) they’re delivering babies, on another floor they’re developing ways to exterminate them.”

Terry’s organization, in fact, kept Grimes from working at a local clinic where he was scheduled to perform abortions on the Saturday before Easter. (Grimes also has a small private practice and works one morning each week seeing cancer patients in Duarte’s City of Hope National Medical Center.) Apprised of Operation Rescue plans, Grimes did as instructed. He stayed home. Only the clinic’s owner performs abortions when there’s a protest.

Grimes responds to Terry in two ways. In a flippant moment, he cracks, “If I’m getting under Randall Terry’s skin, I must be doing something right.”

In a more somber one, he replies, “The vast majority of my time has been spent trying to prevent abortions. I probably spend 90% of my time as a teacher on the road lecturing on contraception and responsible sexual behavior.

“I don’t kill babies. I do provide abortions as part of the range of services I provide to women as an obstetrician/gynecologist. And like most of my colleagues, we believe it is an important service to provide. If that brings notoriety, so be it.”

Grimes first became a target of anti-abortion groups when, in the mid ‘70s, he and others at the Centers for Disease Control published material stating that abortion is safe. Protests intensified when Grimes served as chief of the Centers for Disease Control’s Abortion Surveillance Branch in the early ‘80s.

He unwittingly allowed his home address and phone number to be listed in the Atlanta telephone directory when he worked for the CDC and taught at Atlanta’s Emory University.

A trash can full of baby dolls painted red was left on his doorstep. His neighborhood was leafleted with pictures of chopped-up fetuses. Some of the South’s most persistent abortion protesters repeatedly turned the Grimes’ family’s front yard into a campsite.

Grimes recalls that his lawyer eventually cut a deal with the protesters’ attorney. The group agreed to notify the police before camping out at his home (so an officer could be present, arrests could be made or the demonstration would be conducted within the law).

Since he moved to Los Angeles in 1986, he says, he’s encountered no demonstrations at the hospital or at his unlisted address in a Los Angeles suburb.

Not that the presence or absence of protesters would make any difference.

“I’m not going to be bullied by that kind of stuff. I’m not embarrassed by what I do,” says the doctor who is himself a veteran of protest front lines.

At Harvard in 1969, Grimes participated in the Vietnam War protest that shut down the university. As a second-year medical student at North Carolina University, he says, he successfully led a boycott to end a “poorly taught” epidemiology class. (In effect, Grimes became the teacher, with the permission of the dean.)

As an obstetrical resident he refused to perform “brutalizing” circumcisions. And when residents were relegated to sleeping in unheated “closets,” Grimes managed to get five residents’ rooms condemned as unfit for human habitation by the city of Raleigh.

Grimes attributes the lack of harassment here to L.A.’s reputation for tolerance. It’s a place he likes immensely, having been swiftly won over during a job-interview lunch, dining outdoors on burritos at Lawry’s Restaurant in the middle of winter.

Dr. John Willke, president of the National Right to Life Committee, contends that protests haven’t followed Grimes to Los Angeles because sites such as Women’s Hospital aren’t worth picketing.

“Grimes has been doing testing. We couldn’t control it. They’re just a Planned Parenthood clone. It wouldn’t do any good,” Willke maintains. “One of the reasons is that it (Women’s Hospital) is on a campus. It’s hard to get to. It’s not quite like an abortion clinic where there’s only one door. A lot of people go there for good reasons.”

Willke knows Grimes fairly well, having previously squared off against him in such forums as television’s “Donahue” show.

“He’s one of the more notorious abortionists in the United States,” says Willke. “These people are absolute, dyed-in-the-wool baby killers.”

People seem either to love David Grimes or hate him. For every anti-abortion activist comparing him to a Nazi war criminal, there is a supporter cheering him on.

“In my opinion, he just about walks on water,” says Sarah Freeman, an assistant clinical professor at Emory University’s department of Gynecology and Obstetrics who has known Grimes for 15 years.

“Anytime you’re around David you can see his commitment to women’s health. You can see it in the way he treats his patients, in the way he respects other professionals. You can see he has the dedication to make things better for women.”

Freeman first met Grimes when she was a public health nurse in Atlanta and he used to work at family-planning clinics, providing contraceptives for poor people through the local health department.

“The fact that he was willing to do the research with the abortion pill was amazing. It shows his dedication to the profession. He doesn’t just give lip service about what he believes in. He’ll go out on a limb.”

Maria Lacarra, the energetic registered nurse who collaborates with Mishell and Grimes on RU-486 research at Women’s Hospital, agrees.

“Grimes and I are about the only two here who will do (surgical) abortions on women who have AIDS. Nobody wants to deal with it. As soon as you say AIDS, everybody flees the scene,” she says.

“Grimes is always willing to help, even when he’s obviously tired. He makes the patients feel at ease. He’s very non-judgmental and treats things like sexually transmitted diseases as if they’re a cold or a cough. If a patient is three hours late, he will still see her. I almost have to protect him sometimes. I tell him ‘You’re too nice.’ ”

Ask Grimes’ wife, Kathy, if that’s the case and she answers with a knowing nod. Citing an example of her husband’s popularity with the rank and file, she says, “His secretary . . . loves him. He’s very nice to his patients. He tells me everything. There was an older woman who tried to seduce him. He told me about it. He’s always making jokes about how he’s in his 40s now and needs to get a mistress and a Porsche.” (Grimes drives a Honda.)

A former X-ray technician who met her husband when she was a student at Northeastern University and he was an undergraduate at Harvard, Kathy Grimes has spent most of her married life as a homemaker.

When they wed, just before he entered medical school, she fully expected to wind up the wife of a pediatrician in a prosperous private practice. But Grimes’ first pediatric hospital admission was a 12-year-old boy who died of congestive heart failure.

“It was just too tough to see,” he remembers. “We had a young daughter and I identified so strongly with the parents.”

The doctor, who had been interested in population biology and fertility research, liked the preventive medicine aspects of obstetrics and gynecology. He changed his specialty and quickly wound up working in public health, spending a decade as a commissioned officer in the U.S. Public Health Service.

Now that the couple’s two daughters are almost grown (19-year-old Robin attends Duke University and 17-year-old Heather is in high school), Kathy Grimes is beginning to explore her own career options and considering entering an entirely new, as-yet-undecided vocation.

And if an unwanted pregnancy interrupted that career? Would she take RU-486 if it were available?

She says she would probably have a traditional suction abortion. Grimes wouldn’t try to change her mind.

“I wouldn’t take care of my wife myself,” he says, recalling that he learned very early on it’s better to concentrate on being a husband and father to his family and forget about being their physician. “But I would do for her what I do for all my patients. I would present the facts as I know them and let her make her own decision.”