April 7, 2024

The abortion pill controversy mixes science, law and politics in a toxic brew

Medication abortions accounted for 63% of all abortions in the United States in 2023, according to a report from the Guttmacher Institute. In 2020, only 53% of abortions were medication abortions. The total number was 642,700. 

The steady rise in the use of medication abortions is at risk, Guttmacher warns. On March 26 the US Supreme Court will hear arguments for Alliance for Hippocratic Medicine v. FDA. The respondents argue that the FDA’s approval of medication abortions using mifepristone in 2016 and 2021 was “arbitrary and capricious”.

Supporters of the FDA’s decision contend that the respondents’ case rests on flimsy evidence – “low-quality science” in the words of the Guttmacher Institute. 

At first blush, this seems reasonable, as two of the journal articles which underpin the respondents’ case have been retracted by the journal – an obscure publication called Health Services Research and Managerial Epidemiology – partly because of a failure to disclose links to a pro-life think tank, the Charlotte Lozier Institute. However, the retractions came only after a district court cited the studies in its decision against the FDA. Were pro-abortion activists behind the retraction? 

For non-scientists, the dispute is very involved. Perhaps the best commentary so far appeared in Reason magazine in an analysis by Ronald Bailey – who is by no means a “pro-lifer”. He explains: 

So how could the Lozier Institute researchers come to conclusions contrary to the results found by so many other researchers with respect to the safety of medication abortions? The broken science of epidemiology is perhaps to blame. Epidemiologists anxious to make a significant finding can unconsciously or consciously torture nearly any set of observational data into confessing to whatever correlations that just happen to confirm the researchers’ hypotheses.

Stanford statistician John Ioannidis surveys the dire state of epidemiology in his seminal 2005 PLoS Medicine article, “Why Most Published Research Findings Are False.” “Any claim coming from an observational study is most likely to be wrong,” asserted National Institute of Statistical Sciences researchers Stanley Young and Alan Karr in their 2011 article in the journal Significance. Young has estimated that only 5 to 10 percent of observational studies can be replicated. Of course, all of the researchers seeking to analyze the side effects of mifepristone are parsing observational data with respect to their prevalence and severity. The upshot is that the epidemiological literature is so cluttered with flawed studies that anyone can find some that confirm what they already believe and so assert that they are just “following the science.”

The disclosure justifications cited by Sage for retracting the articles are largely spurious since the researchers behind the three retracted studies clearly did not hide their pro-life institutional affiliations. More problematically, the conflicted peer reviewer should have declined to evaluate the studies. And whatever their methodological failings, the three outlier articles from an obscure journal would most likely never have attracted extra scrutiny except for being cited as “follow the science” evidence to challenge the FDA’s approval of a widely used abortifacient.

At the center of the case before the Supreme Court later this month is the proposition that any odd federal judge who claims to be “following the science” can overrule the decisions of the FDA that also claims to be “following the science.” Will the Supreme Court now “follow the science” and ignore the retracted articles when it rules on that issue later this year?