Ending Medical Manipulation

When Todd Akin said that women who had been raped were at little risk of getting pregnant because their bodies had "ways to try to shut that whole thing down" he didn't misspeak, though that's what he claimed. He spoke all too clearly about a conservative worldview based on a pseudo-medical fact that has gained remarkable legitimacy and has had a pernicious effect on women's health.

The formula is simple: draw from an ideologically motivated, fringe medical opinion manufactured to support conservative policy goals. Repeat these assertions often enough that they gain a patina of fact among conservatives. Often, these dubious claims are made by just one doctor, like John C. Willke, former head of the National Right to Life Committee, who posited that the trauma of rape makes a woman's fallopian tubes "spastic" so she can't be impregnated. He never sought to prove his theory and didn't need to. It was convenient justification for the conservative belief that rape shouldn't be a protected category of federal abortion funding.

Nowhere is this manipulation more clear then with contraception. In the late 1990s, when lawmakers were expanding access to contraceptives by requiring insurers to cover them, social conservatives began conflating abortion and contraception. They based their claims on a book by Randy Alcorn, a conservative Protestant minister and noted abortion clinic protestor with no medical training. Alcorn said the Pill could cause an abortion because it thinned the endometrium, which could prevent a fertilized egg from implanting in the uterus if the Pill's primary and secondary mechanisms -- preventing ovulation and increasing the viscosity of cervical mucus -- failed. It was a claim that experts found dubious but jibed with the belief of social conservatives that only "naughty" girls used contraceptives and insurers shouldn't be forced to pay for them.

When Congress subsequently moved to mandate that insurers cover contraceptives for federal employees, Rep. Tom Colburn tried to limit contraceptives covered to those that "do not interfere with fertilization or terminate pregnancy." Pharmacists for Life sought to allow pharmacists to refuse to dispense the Pill based on moral objections.

It was in this atmosphere that the Food and Drug Administration approved the first emergency contraceptive in 1999. The leaders of the Catholic Church led the attack against EC, charging it was an abortifacient because it prevented implantation. EC works like regular oral contraceptives -- by preventing ovulation. But, as Pam Belluck recently documented in the New York Times, the science at the time was unclear and the FDA included preventing implantation as one of several other possible methods of action on the drug's label. Even if it did prevent implantation -- which it has since been shown not to--the whole implantation objection was itself a canard. The American College of OB/GYNs defines pregnancy as beginning at implantation.

That year, the Vatican denounced EC as equivalent to abortion at a major UN meeting. When George Bush came to office, he worked to prevent EC from going over the counter at the request of Protestant conservatives and the Catholic bishops. He appointed Dr. Joseph Stanford, who co-authored an article in a medical journal recommending that doctors tell patients that the Pill may be an abortifacient, to the FDA advisory committee in charge of the decision. When the committee recommended that EC go over the counter, Bush overruled the decision.

The Catholic bishops lobbied to allow healthcare personnel to refuse to provide EC based on "conscience" protections developed for abortion. In 2008, the Bush administration created a federal exemption clause that defined abortion as any procedure or drug "that results in the termination of the life of a human ... whether before or after implantation." The right had succeeded in redefining contraception as abortion and many people were none the wiser. When President Obama mandated that health plans cover contraceptives, Cardinal Timothy Dolan, head of the U.S. bishops, told Catholics that it would require insurers to cover "abortion-inducing drugs" in reference to EC.

This is only one example of how the right systematically distorts science. It uses unfounded claims that abortion causes irreversible psychological damage to press for ever-more onerous waiting periods and informed consent procedures that limit access to abortion. It charges that clinics routinely abort later term fetuses to pass mandatory ultrasound laws like the one that attracted controversy in Virginia. Most recently, it asserted that fetuses can feel pain in the second trimester despite the fact that the American College of OB/GYNs says there is "no legitimate scientific information" to that effect. Nonetheless, nine states have enacted "fetal pain" laws that ban abortion after 20 weeks.

Social conservatives have every right to hold the religious belief that life begins at conception and to act accordingly in their private lives. But they don't have a right to distort science to achieve their ends. The media need to be rigorous in challenging false medical assertions. Medical societies, which have been slow to wade into controversial issues, need to condemn publicly fringe physicians on unproven medical assertions. It shouldn't take Akin's spectacular rape-as-contraception fiction to wake us up to the medical manipulations of the right.