Using flimsy evidence, a doctor who has become this country’s leading proponent of abortion reversal — the theory that a woman who has taken the first dose of the abortion pill and regrets her decision can undo the process — is trying to provide new scientific fodder to support legislation that forces doctors to tout an unproven medical treatment.
This week Dr. George Delgado, a family medicine physician who founded the organization Abortion Pill Reversal, published a new case series that supposedly shows that the procedure is safe and effective. Anti-abortion sites have hailed it as proof that abortion reversal works, glossing over the fact that it ran in a journal with ties to an anti-abortion group. Ambiguous news headlines now suggest abortion reversal “seems possible,” but closer analysis reveals holes in the data.
The new paper builds upon a much smaller 2012 case series, criticized by the American College of Obstetricians and Gynecologists, that purported to show abortion reversal for 4 in 6 women who received a dose of the hormone progesterone after taking mifepristone — the first of two drugs used in a medication abortion. (The second drug used in an abortion medication, misoprostol, is taken within the next several days and effectively empties the uterus.)
Case series are the weakest form of scientific evidence because they lack control groups. Still, that initial paper was sufficient proof for some lawmakers that it is possible to stop the process of terminating a pregnancy via the abortion pill.
And several states — most recently, Idaho — have used that first case series as the basis for laws requiring women be told their abortions can be reversed, ignoring outcries from OB-GYNs who worry states are promoting an experimental treatment.
Delgado — who supports laws requiring doctors to tell women that abortion pill reversal is possible — says his newest observational case series only strengthens his argument.
“I am planning, like it says in the article, to do a randomized controlled trial and I do think we need to do that,” he told HuffPost. “But I don’t think we have to wait for that.”
Delgado's newest case series is much larger than his previous work. More than 550 women underwent what the paper calls “progesterone therapy.” Overall, the abortion reversal rate for those women was 48 percent, the study says. Women who received a particularly high dose of progesterone, either via injection or orally, had abortion reversal rates of 64 and 68 percent, respectively, the case series claims.
“I think reasonable, open-minded people are going to see this and say, ’Yes, this makes a lot of sense. There is no other treatment. And we should go ahead and move forward with this, and tell women about this,” Delgado told HuffPost.
But the case study results are diminished by several limitations: Two pills are required for a medication abortion. Stopping at the first one comes with a 25 percent chance the fetus will survive — even without taking a dose of progesterone.
Perhaps most crucially, the researchers did not have information about which women had an ultrasound before they were given progesterone. Some women whose ultrasounds revealed that their fetus had died may have been excluded from the study, a limitation Delgado himself acknowledges in the paper. It is not entirely clear how that may have affected the findings, though excluding those women could have boosted the seeming efficacy of the progesterone treatment. Either way, it is a significant hole in the data.
“The study is just not designed in a way that would be useful to determine if this is effective or not,” Dr. Daniel Grossman, an OB-GYN and director of Advancing New Standards in Reproductive Health, who has studied abortion medication, told HuffPost. “These patients came from more than 300 different providers. They’re all using a different regimen, and there aren’t details about those regimens.”
The Washington Post, which was the first media outlet to cover Delgado’s findings, also points out that the journal that ran Delgado’s latest paper has ties to the Watson Bowes Research Institute, an anti-abortion group. Rewire, a nonprofit news site covering reproductive health and justice, has slammed Issues in Law & Medicine as “a tool created, edited, published, and disseminated by the anti-choice movement.”
That’s partly why skeptics of abortion reversal are unmoved by the study. Dr. Hal Lawrence, executive vice president of ACOG, told Vice the case series was “poorly designed and falls far short of providing sufficient evidence to recommend this course of treatment.”
“The bottom line is we don’t change the way medicine is practiced because somebody has a new idea,” echoed Grossman. “You have to actually test that idea doing rigorous research and determining whether the treatment was safe and effective. And that’s the piece that was skipped here.”