The Interim In a startling front-page article in the Ottawa Citizen on Sept. 24, Dr. Ellen Wiebe admitted the hazards of methotrexate abortions. The article appeared at the same time The Interim went to press with a front-page article on the same topic, for which Wiebe had been interviewed.
More striking than her admissions were the obvious intentions for which she had made them. Wiebe, who ran the first studies on methotrexate abortions in Canada and provides them to women at her Vancouver facility, wants Health Canada to legalize RU-486. She argues that since methotrexate abortions are so dangerous and can take up to 44 days to complete, the other drug cocktail, RU-486, would be “much better.” But how much better could RU-486 possibly be, given the history of both drug combinations?
In the Citizen article, Wiebe confessed that the bleeding caused by methotrexate is so heavy that if women were not using them for an abortion, “we would tell them to go to the hospital.” She admitted, “Women have to be prepared to have awful and horrible cramps for a day. And then in five per cent of the time it doesn’t work, and then, the medications that we use can cause abnormalities of the baby. Then they have to have surgery.”
Ironically, RU-486 or mifepristone abortions have almost identical symptoms. RU-486 still relies on misoprostol to enact the same painful uterine contractions that women experience in the methotrexate abortions. Acting alone, mifepristone cannot be relied upon to extract the fetus and for this reason, researchers studying abortifacients consider it “inadequate for general clinical use.”
Just like methotrexate, RU-486 can take days, and even weeks, for the procedure to complete itself, and in some cases, there will still be an incomplete abortion, resulting in a surgical procedure.
In fact, during the RU-486 trials in 2001, a woman participating in the trials went to a Vancouver hospital on Aug. 28, complaining of severe abdominal cramping, bleeding, dizziness and weakness. As these were considered “standard” symptoms for the chemical abortion procedure, she was sent home, only to come back to the hospital days later. She died Sept. 1, 2001 of a gangrene infection that had spread from her uterus, poisoning her vital organs and eventually stopping her heart.
Ordinary RU-486 symptoms, because of their severity, can mask an underlying complication. If a woman is already experiencing nausea, cramping, bleeding and diarrhea, how are doctors to know if these symptoms are not a result of the bacterial infection that has been associated with the abortion drug?
Randall O’Bannon, director of education and research at the United States National Right to Life Committee, pointed out that one in 100 women was hospitalized in the U.S. trials and that was under carefully controlled clinical circumstances. “What,” wondered O’Bannon, “would the rates be under ordinary circumstances, where follow-ups are likely to be much less rigorous?”
In July 2005, The Annals of Pharmacotherapy, a leading peer-reviewed, international pharmacotherapy journal for physicians and pharmacists, explained the mechanism of mifepristone and its link to the fatal bacterial infection that has claimed the lives of at least five women in the U.S. and one in Canada.
The Annals quoted Brown University Professor Ralph P. Miech, MD, PhD, who wrote in his book, “Pathophysiology of mifepristone-induced septic shock due to Clostridium sordellii,” that mifepristone, a progesterone inhibitor, “cause(s) changes in the cervix that allow C. sordellii, a common vaginal bacteria, to enter the cervical canal. C. sordellii thrives in this low-oxygen environment and derives nutrition from the decaying fetal tissue.”
Other hormonal effects of mifepristone, known as antiglucocorticoid actions, may interfere with chemical regulators known as cytokines, upsetting the delicate balance between over- and under-stimulation of the immune system. “This disruption impairs the body’s ability to fight off C. sordellii and may help spread the bacteria’s toxic byproducts, a combination that can result in widespread septic shock.”
The effects of RU-486 on a woman’s future health remain unknown. The drug was developed in the 1980s and has not been around long enough, but it is known that RU-486 crosses the blood follicle barrier and gets into the follicular fluid surrounding a woman’s ripening eggs. What impact this will have on future pregnancies, or on children born later on, has not yet been adequately researched.
Even the Food and Drug Administration of the United States, which had approved the use of RU-486 in 2000 under dubious conditions and procedural violations, has placed a “black box” warning on the package of mifepristone. In a “question and answer” page on the FDA website, it admitted that “through Nov. 5, 2004, the FDA has received information from United States postmarketing reports of 676 adverse events that occurred among patients who had taken mifepristone for medical termination of pregnancy.”
In July of 2005, the FDA revised the black box warning for Mifeprex, the market name for mifepristone, and issued a new “Dear Doctor” letter because of additional postmarketing adverse events in the United States, including “overwhelming bacterial infection (septic shock)” and death.
The 2005 black box revisions now include information on the “serious nature” of vaginal bleeding, which “occurs in almost all patients.” The FDA goes on to quote U.S. and French trials, which warn that “women should expect to experience vaginal bleeding or spotting for an average of nine to 16 days, while up to eight per cent of all subjects may experience some type of bleeding for 30 days or more.”
The revisions also include information on ectopic pregnancy, warning physicians that “since some of the expected symptoms of a medical abortion may be similar to those of a ruptured ectopic pregnancy,” this anomaly may not be detected.
While Wiebe and her counterparts continue to promote RU-486 as though it were a wonder drug, feminists Janice G. Raymond, Renate Klein, and Lynette J. Dumble, in their book RU-486: Misconceptions, Myths, and Morals, point out that either RU-486 or the methotrexate abortions are an ordeal “that involves an excruciatingly long wait for the embryo to be expelled from the uterus, accompanied by pain, bleeding, vomiting and nausea and other complications that are drawn out over a substantially lengthy period of time.”
Incredibly, as the Ottawa Citizen article reported, because of the continued ban on RU-486, the Society of Obstetricians and Gynecologists of Canada is drawing up guidelines on how to use methotrexate and misopristol to terminate pregnancies. The guidelines for the use of these “off-label” drugs, which are not intended by the manufacturers to be used for abortions, are to be released this fall.