Planet Waves | RU-486 by Meg Green


Human fetus at six weeks, photo courtesy
of the anti-abortion movement.

a/k/a RU-486
Mifepristone: A Brief Look
at the Abortion Drug Territory

M.E. Green
Planet Waves Digital Media

.......While flipping through the channels last week, somewhere between CNN and C-SPAN I heard a political analyst explain why the abortion issue was not figuring significantly in the presidential campaign of the right or the left. She said it was because, "people remain astoundingly ambiguous" regarding abortion. I did hang around long enough to hear her clarify such a sweeping statement, and then wondered if that ambiguity was why, in the six weeks since the Food and Drug Administration's approval of the controversial drug combination RU-486, the ripple created in media and medical circles has failed to crest a wave of any description.

.......Developed in 1980 at Roussel-Uclaf research laboratory in Romainville, France, RU-486 has been heralded by the scientific community as a triumph of modern medicine. Mifepristone, an anti-progestin, and misoprostal, a prostaglandin, are administered over a three-day period to abort and expel an implanted embryo, rendering a woman, in the words of the drug's developer Etienne-Emile Baulieu in his book The Abortion Pill, unpregnant. The FDA outlined precious few mandates on the use of RU-486, brand name Mifeprex, but did advise administering clinics and practices to insist on the confidence of a physician to date and chart conception accurately, to only use the drug during the intended time frame of conception to seven weeks gestation, and to ensure patients receiving the treatment would consent to a surgical procedure should the drugs fail. According to research data, RU-486 is between 92-95% effective, which is less than some forms of contraception and more than some forms of abortion.

.......Let's start with the pros. Mifepristone has not only been proclaimed safe and effective in terminating unwanted pregnancy, it takes a step away from what many consider the trauma of surgical abortion and, with it, the use of anesthesia. Abortion in pill-form may also bring us closer to reclaiming the personal respect reproductive decisions demand from any number of special interest groups.

.......The convenience factor is not to be dismissed, prompting JAMA (The Journal of the American Medical Association), in its October 18, 2000 issue, to publish a randomized study by Dr. Eric Schaff and colleagues regarding "Vaginal Misoprostol Administered 1, 2 or 3 Days After Mifepristone for Early Medical Abortion." Dr. Schaff and his colleagues concluded that the oral or vaginal dose of misoprostol may be administered a day earlier or a day later than the recommended 48 hours with the same efficacy. The study was conducted in an effort to support clinics and practices that close on the weekends and so can only administer RU-486 Monday through Wednesday, or for women who would choose to administer the final dose at home rather than in the doctor's office.

.......However, follow-up visits and ultrasound examinations are required as part of the procedure, to ensure that the drug has in fact worked. When the drug fails, a surgical abortion is required.

.......Currently the fee for the procedure is about $500, and it is, at press time, performed only in clinics that use it experimentally. After it is officially released to the market in mid-November, it will be covered by insurance policies that also cover other forms of abortion.

.......On the research front, mifepristone is being touted as a wonder drug above and beyond its use as an abortifacient. Researchers have found it effective in treating endometriosis and fibroid tumors, with the potential of treating some forms of breast cancer, brain cancer and Cushing's syndrome, a disease of the adrenal cortex.

.......Now what I would not so much call "bad news," but rather some things to consider. Aside from the inevitable sticky fingers of states' laws and the hardly surprising but nonetheless disturbing choice of Hua Lian Pharmaceutical Company -- China's proudest asset in population control at home and abroad -- as manufacturer of mifepristone, what are some of the cons of RU-486?

.......The first serious consideration, as with any drug, is what side effects may occur. Almost unanimously, media resources and academic journals outline symptoms akin to a heavy period, severe cramping, nausea and vomiting. There have been reports of prolonged bleeding -- between four and forty days after treatment -- in which cases some women have received blood transfusions. In instances of drug failure, which can result in problems ranging from intrauterine infection to continuing pregnancy -- and no one knows what the effects on a developing fetus exposed to RU-486 might be -- surgical abortions have been performed. Though the failure rate is seemingly small, in France physicians continue to insist upon administering the full course of treatment, counseling and observation on the premises, and have advised other countries to do the same.

.......Beyond immediate side effects, we next need to consider long-term effects. With such a brief history, research on any long-term effects of the drug combo is limited, however, we can look to the vast amount of research available regarding reproductive science for clues. For example, estrogen, as manufactured by the body, found in some plants that humans consume on a regular basis, and prevalent in most oral contraceptives, is a proven carcinogen and contributes to heart disease, blood clots and stroke. This is hardly a secret -- it's all printed on your Ortho-Novum package insert. And oral contraceptives represent only a small fraction of how reproductive science has been party to multi-generational cancers and endocrine disruption, also known as hormone imbalance. Much of this has been created by the mass pollution of the food supply, air and water by indistrual chemicals including pesticides, phthalates, dioxins and PCBs, all of which are hormonally active at what are called "background levels" already found in the human body.

.......Mifepristone works by flooding the uterus with an anti-progestin, referred to as a "blocker," preventing progesterone from finding its receptors and supporting pregnancy. Introducing this synthetic blocker to the womb, of course, does what RU-486 is marketed for, but introducing it to an interdependent endocrine system can and will create several disruptions in the body.

.......In July of 1994, The American Journal of Physiology published a study by Dr. Klaus Wiedemann and colleagues that concluded mifepristone was effective in stimulating effective growth hormone release, but suppressed the normal functioning of sleep-endocrine production, affecting REM sleep and deep wave sleep in healthy males. In December of 1990, The American Journal of Obstetrics and Gynecology published the findings of Dr. Donna Shoupe and colleagues that mifepristone affects the pituitary gland's secretion of luteinizing hormone, which is partially responsible for the regulation of a woman's menstrual cycle. Again, neither study could predict long-term consequences for use of mifepristone, but we have no shortage of examples for what happens when we don't ask.

.......During my channel surfing, the political analyst of note went on to describe why we as a country are considered ambiguous. She mentioned that many women and men want to protect Roe v. Wade, but would not mind seeing restrictions placed on late-term abortion, or even restrictions to the point of the infamous "rape, incest, or danger to the life of the mother." We are ambiguous because a right-wing, Christian Coalition card-carrying, Baptist minister might escort his sixteen-year-old daughter or wife suffering from multiple sclerosis to an abortion clinic. We are ambiguous because a left-wing, ACLU card-carrying, women's health professional might try to argue her sixteen-year-old daughter or genetically faultless best friend away from an abortion clinic. We are ambiguous because we take pills now and ask questions later, and are relieved or outraged when the answers come down.

.......Is that ambiguity, or is that life?

.......We would do very well to examine our choices. Choice is, after all, what this whole issue has brought us to. Here we sit on the verge of a new government, where apparently both sides view our collective refusal to throw a blanket over a non-blanket issue as somewhat confused and therefore do not warrant enough attention or assurance that our freedoms will not be threatened.

.......An unconsidered choice exists. Dismissing RU-486 after its tumultuous and successful past is probably a bit harsh. Embracing it with full-body contact might be a bit foolish. Allowing abortion industry and legislation to continue as they are is, after any real scrutiny, irresponsible. Altering industry and legislation puts us all in a precarious situation. What about considering the choice available before religious doctrine and righteous politicians took up residence in a woman's private womb?

.......Through much of recorded history, and for the past thirty years, many grassroots movements have urged women and men to reclaim their reproductive destiny. Herbal contraception and abortion and menstrual extraction are only a few of the procedures and remedies available to us through some serious study and the support of a strong tribe.

.......Rebecca Chalker and Carol Downer, in A Woman's Book of Choices, discuss the method of menstrual extraction, which can be performed by women for women and without medical or governmental interference. It is also an excellent sourcebook on legalized abortion, folk remedies and our friend RU-486. All Women Are Healers by Diane Stein points herbal devotees in the right direction, along with giving some sound advice on women's health and a welcome indictment of the FDA's policies regarding "nutritional supplements." Rosemary Gladstar's Herbal Healing for Women suggests specific herbal remedies as well. Finally, Cunt: A Declaration of Independence by Inga Muscio (see Genexhibitionist review) discusses the author's methods and innovations surrounding reproductive health and, most importantly, the necessity of a supportive sisterhood. None of these books are "how to" manuals, but all give precise information as to where to look and who to ask.

.......So. Perhaps some of us are happy with where reproductive rights stand, and further, are thrilled that Mifeprex is now at a druggist near you. Perhaps some of us know that whoever ascends the throne on Pennsylvania Avenue, or any of four Supreme benches, the time to take right action is long passed. Perhaps some of us are infertile, or still exist in the delusional bubble of opportunity where it is impossible to have or help create an unplanned pregnancy. Perhaps some of us are not totally clear on how we would handle a personal crisis until it becomes personal, and if that makes us ambiguous, perhaps that, too, is our choice.++

Meg Green is a freelance writer and Waldorf school techer.

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