The first time I prescribed mifepristone for a medical abortion was several years after it was approved in 2000. It was for a colleague, a resident who was considered a rising star in clinical medicine (names withheld to protect privacy) who paged me to get my personal and professional advice.
Like countless women, that morning she took an at-home pregnancy test and found herself terrified at the result. Terrified that a positive test would compromise her career and force her into parenthood, a role she was not prepared for emotionally or financially. She was in tears trying to explain how she found herself in this situation. “I am so sorry to bother you,” she said. “I don’t know what to do.”
I remember the sense of relief she felt when I told her that she was not alone, that this was nobody’s fault and that as far as I was concerned, she needed health care plain and simple.
I remember the sense of relief she felt when I told her that she was not alone, that this was nobody’s fault and that as far as I was concerned, she needed health care plain and simple. I explained to her she that had options, including a two-step medication regimen that could offer her a dignified way to receive that health care. I was a registered prescriber (a requirement of the safety monitoring program that had been in place after mifepristone’s approval) and there were a number of reporting obligations that we had to meet, including several in-person visits and in-person dispensing of the drug (she couldn’t pick it up in a pharmacy). She was able to undergo a safe way to end her pregnancy and resume clinical obligations with minimal disruption. I will never forget a comment she made to me casually in a hallway when I saw her months later: “Science made this possible, but advocacy made it a reality.” I had no idea how fleeting the reality those words described was at the time.
Decades later, the science is even more clear — but misinformation and manipulation of the science has created a new reality that does not end with the Supreme Court hearing in Food and Drug Administration v. Alliance for Hippocratic Medicine. Despite incredibly strict safety requirements, and the options for physicians to exercise conscientious objections to performing an abortion, there is now a desire to undermine the authority of the FDA along with creating doubt in the mind of any willing prescribing clinician.
It almost doesn’t matter that the Supreme Court challenge cites debunked blog posts and fake studies that have been retracted from the literature — the fact that the arguments have been made has effectively injected doubt and fear into public perception, much like the casual references to injecting bleach to treat Covid-19, which prompted increased calls to poison control centers around the country. When cases appear before courts and judges make decisions, no matter how counterintuitive, there is always a lasting effect. In this case, we’re seeing the compromise of lives and health care.
People speak often about the importance of the doctor-patient relationship and its sanctity. But what happens when there is no real relationship due to fear, misinformation and a degradation of trust? What happens when a medication that has fewer serious adverse events than Tylenol, a common over-the-counter medication, is deemed to be harmful by a politically motivated judge in Texas? What if women stop using birth control because popular influencers have convinced them they could die if they take contraception? All of this is now a reality, and one that can’t be ignored or pushed aside.
Hippocrates, the namesake of the defendants in this Supreme Court case, once said the following about patient care: “Cure sometimes, treat often, comfort always.” I think about this advice often and wonder how I would respond to my colleague’s phone call today if I were in a particular state. If I had acted differently than providing her the health care she needed, her care and her entire future would be altered without her autonomy, choice or dignity. There is little comfort in knowing that we are just one judgment away from denying care, compromising trust and setting back the progress of scientists, advocates and decades of reproductive justice.
