A failed attempt to defend removal of safety provisions for women undergoing chemical abortions — Part Two of Two

By Randall K. O’Bannon, NRL Director of Education & Research

Editor’s note. In Part One, Dr. O’Bannon began his critique of a series of tweets written by Daniel Grossman, a noted abortion researcher and activist from one of the abortion training academy University of California – San Francisco’s research institutes. Dr. Grossman lit into an op-ed written by Sen. Ted Cruz and Lila Rose, founder of Live Action. Dr. O’Bannon patiently explained the many ways Grossman was in error in criticizing the op-ed which called for the federal government to reinstitute safety precautions for the distribution of mifepristone, the “abortion pill.” As was mentioned in Part One, Grossman literally crosses through, with red ink, language he finds objectionable.

Dubious claims of “safety”

Daniel Grossman’s multiple protestations about the safety of mifepristone involve not only an effort to a minimize the thousands of injuries that are known to have been incurred to women who’ve ingested the pill, but also a reliance on studies with highly questionable means for uncovering and documenting those injuries.

In a series of tweets, Grossman says “We actually have a lot of evidence about the rate of adverse events with medication [chemical] abortion. The risks are lower than continuing the pregnancy to term (since, uh, that’s the alternative).”  

In the following tweet, he lays out his “evidence.”  He tweets, “The most rigorous study of medication abortion safety included data from 11,319 MediCal patients in California. In this study, only 35 (that’s 0.31%) had a major complication, defined as hospitalization, blood transfusion, or surgery.”

Very interesting that he would cite that particular study. The only medical doctor associated with that study? You guessed it – Daniel Grossman – promoter and defender of chemical abortions.  

We have seen and critiqued this study and ones similar to it before.

The key phrase in Grossman’s tweet is “major complication” (emphasis added).  Dismiss or ignore a large number of complications as “minor” and you automatically get a much better safety profile. 

However, if you look at the actual data tables from the study, you’ll see that the complication rate for chemical abortions was not 0.31% but 5.2%! Why the huge discrepancy? Grossman and his team just decided not to count “failed” or “incomplete abortions or “minor” hemorrhages, infections or the like. The higher rates were attributed to women having aspirations (the same process used in early surgical abortions) “to alleviate bleeding or cramping symptoms,” though many of these, by Grossman’s criteria,  may not have qualified as “major.”

Any study which measures ER visits in order to ascertain the relative safety of mifepristone runs into the problem not only that women presenting at the emergency room with hemorrhaging, cramping, etc. may not tell attending physicians they have taken the abortion pill, but that they may have been counseled not to reveal this information to the doctor. 

If that fact is successfully concealed, this would have the effect of making any injuries or deaths appear to be connected to miscarriage or pregnancy rather than the abortion pill.

Bow before the guardians of “health care”

Grossman also scratches through statements from Sen. Cruz and Lila Rose about how the abortion pill has unleashed horrors on the American mothers and their innocent children. Then he disputes their common sense declaration that “abortion is not health care.” (Grossman says “It is, actually.”) When Sen. Cruz and Lila Rose write that the abortion “pill is not medicine,” Grossman again declares, “It is, actually.” 

Grossman asserts that “Medical groups, including the AMA and ACOG, disagree.” Though not directly clear to which of the earlier statement he refers, presumably he means to defend the notion that abortion – which is almost always performed to interrupt a natural and healthy bodily process –  and the abortion pill – which kills a baby but cures no disease and treats no problematic medical condition – are somehow “health care” and “medicine.” 

Grossman’s appeals to medical associations like the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) is clearly intended to bolster his assertion. In fact, it draws attention to how much the leadership of these organizations and their public positions have been corrupted by the likes of Grossman. 

The AMA, once known for trying to maintain some veneer of neutrality has in recent years, under new leadership, increasingly come out publicly against recent pro-life legislation (NPR, 7/2/19).   

Despite its moral and medical obligations to both patients – mother and child – ACOG has repeatedly allied with the abortionists, welcoming them in their ranks and increasingly defending their practice. How far that infiltration has gone is evident in ACOG’s official 2014 Practice Bulletin “Medical Management of First-Trimester Abortion.”  It offered members guidance on the performance of chemical abortions. 

If you go to the website offering the practice bulletin, you will see that it was written “with the assistance of [notorious abortionist] Mitchell D. Creinin and [wait for it…] Daniel A Grossman.”

Under such conditions as these, endorsement of compromised associations such as the AMA and ACOG doesn’t amount to a whole lot.

I respect the FDA’s scientific expertise… except when I don’t.

Grossman’s appeals to authority are selective and self-serving. The FDA, under the Obama administration, modified the label for mifepristone in 2016. It rolled back reporting requirements, extended use to 10 weeks, and allowed a broader range of prescribers. Grossman teased that this was medically justified: “Fun fact: This Obama-era change was based on a recommendation from the scientific staff at the FDA.” 

He also asserted that all these changes were scientifically sound. “The GAO [Government Accountability Office] found that the FDA followed its standard review process when it approved the revised labeling based on reviews of peer-reviewed published studies.”

Yet Grossman has been noticeably less reluctant to defer to FDA expertise when it comes to the limitations the FDA’s Risk Evaluation and Mitigation Strategies (REMS) impose on the distribution of mifepristone. These precautions were reiterated by the same FDA in 2016 along with the new label, continuing to limit distribution of the drugs to certified prescribers rather than allow them to be sold by pharmacies or delivered by mail. 

In his tweets Grossman now quibbles with Sen. Cruz and Lila Rose about how far a federal judge’s 2020 ruling suspending some of the REMS regulations went. He acts as if he only ever wanted certified clinicians to be able to mail these to patients during the pandemic. But he was a prominent signatory to a 2017 opinion piece calling for the FDA to end all REMS restrictions on the drug (“Sixteen Years of Overregulation: Time to Unburden Mifeprex,” New England Journal of Medicine, February 23, 2017).

That the FDA made modifications, but continued restrictions on the drug in 2016 (still in place today) are an indication it still believed that mifepristone was one of those “medications with serious safety concerns” that required a special “drug safety program… to help ensure the benefits of the medication outweigh its risks.” 

The FDA that Grossman praised as enlightened and scientific for modifying mifepristone’s label in 2016 is the same FDA that continues to assert the necessity of REMS, such as those it maintains on mifepristone, “designed to reinforce medication use behaviors and actions that support the safe use of that medication.” These are regulations Grossman vehemently opposes.

If Grossman believes we are bound, in the name of science, to accept the FDA’s ruling on the label changes, shouldn’t Grossman be ready to defer to the FDA’s judgment on the REMS regulations?

The classic “abortion is safer than childbirth” ploy

Grossman attempts to sweep all of mifepristone’s safety problems under the rug by trotting out the classic argument of abortion advocates that whatever problems abortion might have, it is still safer than continued pregnancy or childbirth.  In his tweets, for example, Grossman claims that record shows the risk of adverse events is lower for women having chemical abortions than those women who continue their pregnancy to term. He says that women giving birth need transfusions ten times more often than do mifepristone patients.

While the assertion about lower rates of adverse events for continuing pregnancy is not directly cited, Grossman then posts a link to his 2015 study of ER visits. In Part One, we showed that the study of ER visits was flawed. Grossman and his like-minded colleagues spun away a good portion of complications by asserting they weren’t sufficiently severe (and ignoring patients who were treated at clinics or never revealed their abortions to personnel at the ER).

Early on, Grossman offhandedly throws out the claim that abortion is 14 times safer than childbirth. The link he cites leads back to an infamous analysis by fellow abortionists David Grimes and Elizabeth Raymond published in the journal Obstetrics & Gynecology in February 2012. There is not sufficient time to analyze it here, but it suffered from a number of structural and statistical deficiencies. Those include doing a much better job of tracking maternal deaths connected to birth than those deaths connected to abortion. Abortion will always look a lot safer if, for whatever reason, deaths associated with it are not recorded as such or are attributed to other causes. 

However, another study from Finland, where records of both maternal and abortion deaths are fully recorded and accessible, shows quite the opposite result. Maternal mortality rates from induced abortion are nearly three times that for women giving birth (Mika Gissler, et al, “Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000, “ American Journal of Obstetrics and Gynecology, February 2004).

The link Grossman gives for the claim that women giving birth require transfusions ten times more often than women who have undergone chemical abortion shares something Grossman leaves out in his tweet. The authors of that study conclude that the factors associated with this risk were “modifiable” and said that the conditions were “easily identified and treatable” (Journal of Women’s Health, July 2012). In other words, if the risk of transfusion is indeed higher for women carrying to term, it may not necessarily be because pregnancy is inherently or inevitably riskier, but because those women were not getting appropriate care.

The difference, of course, is that the risk connected to childbirth, whatever it is, is one that occurs in the natural course of pregnancy. The risk from abortion is typically a new one that is introduced to a healthy pregnancy by the initiation of the abortion.  

Attentive doctors and good prenatal care can often treat whatever underlying conditions threaten a woman’s health during pregnancy, without harming the baby. Abortion, on the other hand, harms the child without really helping the mother.

Should the abortion pill be stopped?

Grossman makes plenty of other cute and clever remarks, such as editing Sen. Cruz and Lila Rose’s headline to read “The Federal Government Must Stop the Deadly increase access to the Abortion Pill.” But the basic point is the same. Grossman thinks the abortion pill is wonderful, and he wants more women to have ready access to it. 

He has minimal concern for the maternal lives that are lost, for the women who have been injured, believing their losses more than compensated for by the millions of babies that are “safely” aborted.  He doesn’t like people pointing out that he and his compatriots have dedicated a good part of their professional careers to “killing innocent children,” though he fails to show where this assessment is erroneous.

The abortion pill does kill innocent children. That’s what it was designed to do. And  it does additional damage to the lives and health of some of the women who have bought the fairy tale of the abortion pill’s innocence, simplicity, and safety promoted by the likes of doctors like Grossman.

Sen. Cruz and Lila Rose were right. Mifepristone is a deadly drug that needs to be stopped. It has killed too many already.