Thursday, March 9, 2017

Abortion Reversal Bill: Indiana House Rejects Science

Originally posted at

Indiana HB 1128 was passed by a vote of 54-41 in the Indiana House on Feb. 27, 2017, and has been sent to the Senate where it is currently in the Judiciary committee. In part, this bill addresses medical abortion – a procedure available in the first seven weeks of pregnancy in which a patient receives two medications 48 hours apart to induce abortion.  Should a patient who has taken the first medication then choose to carry the pregnancy, their caregiver would withhold the second medication.  One small case series (seven patients) speculated that administering progesterone, in addition to withholding the second medication, may “reverse” the abortion (i.e. increase the chance of pregnancy continuing). A subsequent review, however, concluded that “evidence is insufficient to determine whether treatment with progesterone after mifepristone results in a higher proportion of continuing pregnancies compared to expectant management.”

Published science does not support that this treatment works. Despite this, HB 1128 requires abortion providers to give patients information regarding progesterone therapy to “reverse” abortion. Untrained elected officials are prescribing medical counseling which doctors must provide, and requiring this counseling to include referrals for medically unproven therapies.

HB1128’s merits were colored by the testimony of two Indiana physicians who report having used progesterone to “reverse” abortions in 300 patients, but these physicians’ claims remain unpublished and cannot be reviewed for scientific merit. We can’t review the criteria for receiving this treatment, or protocols for administration. We don’t know what other factors in the patients’ health impacted the results. We don’t know the total number of women who received the therapy- only those whose pregnancies were sustained, so we can’t calculate a success rate. Without information on adverse results, we can’t assess its safety. Without an objective review of their intervention, and because published data is weak, it is premature to require all providers to counsel patients about this unproven intervention.

Which brings me to a fundamental contradiction in the bill:

The full House sent the original version of the bill back to committee the week before to address various concerns, including the lack of scientific merit. The revised bill “fixed” this concern by including the following language: “No scientifically validated medical study confirms that an abortion may be reversed after taking abortion inducing drugs.” (sec 4.2.K.iii) Contrast this to the following language in the same bill, which specifies that pre-treatment counseling must include “objective scientific information of the risks and alternatives to the procedure or the use of an abortion inducing drug” (sec 4.1.D).

The majority of House members were convinced scientifically objective information was important – except for “abortion reversals”, in which case non-scientific counseling is mandatory. The contradiction is puzzling; the disregard for science is disheartening; and the legal requirement that providers include medically unproven therapies when counseling patients is dangerous.

The willingness of the House to support a bill based on this type of pseudoscience is a direct result of a culture that views expertise as elitism, rather than as a valuable tool to advance the health and well-being of humankind. The progress of this bill through the legislative process is a microcosm of an environment that is skeptical of education and investigation, preferring to rely on emotional appeal and unproven data that confirms pre-existing opinions. In the case of legislation of medical care, the implications are frightening. Can you continue to trust your doctors to provide medically sound advice – or will you worry they are parroting unproven theories at the mandate of the government? Unless we successfully advocate for systematic investigation, peer review, and a minimum of scientific literacy for everyone, this is just the beginning. Today, that advocacy starts with the next step for the bill – your Indiana State Senators.

Taking Back the Feminine Mystique

With apologies to every English teacher who ever told me not to start an essay like this...

Feminism, as defined by the Merriam-Webster Unabridged Dictionary, is "the theory of the political, economic, and social equality of the sexes". A feminist, by extension, is a person who believes in these things.  Definitions matter, so it makes sense to start there.  As I watched a webcast by vlogger Philip DeFranco on International Women's Day, though, I was struck by his refusal to call himself a feminist - even though he states he believes in the equality that characterizes the term - because he doesn't want to be associated with man-hating "toxic feminism".

Maybe he said it to appease the advertisers on his feed - which only serves to reinforce the pervasive nature of the problem. I've seen similar sentiments - mostly by women - on my social media feed, though, that essentially express support for the ideals of feminism, but rejection of the term. It's as if they're saying, "I sort of believe in equality, but not in any way that could be deemed offensive or would group me with man-hating frigid feminists." They feel compelled to make this distinction because they've allowed those who oppose  - either overtly or covertly - the equality espoused by feminism to define the conversation. By selectively highlighting stereotypes and inflammatory language, conservatives hoping to maintain the status quo - or, with luck, to get back to the good ol' days, when wives had slippers, a pipe, and a Manhattan waiting at 5:30 - have created the notion that feminists are angry, unshaven beasts. And we've allowed them to do it.

This is an aggressive and effective tactic that works particularly well on social media. The playbook reads like this:
  • Identify a small group of people aligned with your enemy
  • Write up a scathing invective that reveals this small group to be unpleasant, evil, or - God forbid - un-American.
  • Generally apply all the criticisms of this minority to the larger target group, even though most of your ridicule does not apply.
  • Mitigate the risk of backlash against your smear campaign with a line that reflects vague support for the ideals of the group, while still distinguishing yourself from the target group.
  • Maintain an ongoing negative campaign to prevent new members from affiliating with the target group.
  • Allow the target group to dissolve by attrition.

This approach is not inevitably successful, though. Members of the Republican Party, for example, don't feel the same compulsion to perseverate over connotation. Many of the Republicans I know are good people who reject the more racist, jingoistic, and sexist aspects of their current leader and his ilk. But they don't reject the term "Republican" because of some rather flamboyant bad actors. If the notion of Republicanism is not anathema, despite some fairly disagreeable Republicans, then why so feminism?

And there are real consequences to relinquishing the term. When every conversation about equality includes excuses, qualifications, and apologies - when literally no term exists for the position you purport to hold - then your position is necessarily weak and unconvincing. This is not an accident. Words matter, and when we allow the opposition to define terms - to take away our words - then that position suffers. If you believe in equality of the sexes, then you are a feminist - like it or not. If you reject the term, then what are you? By the transitive property (Ooh! English AND math in the same essay - public high school teachers FTW) where "x" is "feminism" and "y" is the definition thereof: if "x=y" and you are not "x", then you are not "y". When you reject the term, you implicitly (even if unintentionally) reject the position.

If you believe in equality of the sexes, say so. If you wish to introduce nuance, feel free. But understand you are nuancing your feminism, not creating something new from whole cloth. The connotation changes when we take ownership and change it.

I am a feminist. Are you?