by R Alta Charo, J.D.
New England Journal of Medicine 14 June 2017. doi: 10.1056/NEJMp1707107 Open access
Human reproduction has become the victim of alternative science, rife with alternative definitions of well-understood medical conditions and characterized by rejection of the scientific method as the standard for generating and evaluating evidence. Alternative science begins with alternative facts of the sort propounded by the Trump administration and its appointees, including Health and Human Services (HHS) Secretary Tom Price, who has claimed that “there’s not one” woman who can’t afford birth control on her own (despite the high up-front cost of the most reliable contraceptives)….
As the new deputy assistant secretary of HHS for population affairs, Teresa Manning, formerly a lobbyist for the National Right to Life Committee, will help to shape federal programs for family planning, despite her stated opposition to such a governmental role. She insists that contraception is ineffective, despite evidence that hormonal methods are 91% effective and long-acting reversible contraceptives such as intrauterine devices (IUDs) are 99% effective at preventing pregnancy.
Charmaine Yoest, former head of the anti-abortion advocacy group Americans United for Life, helped to develop the strategy for a Texas statute that was so filled with obstacles to abortion services, presented in the guise of protections for women’s health, that the US Supreme Court abandoned its usual degree of deference to state legislatures and struck down the law because its underlying factual claims were patently false. Now Yoest will serve as assistant secretary for public affairs at HHS. She asserts that condoms (whose use reduces the risk of HIV transmission by at least 70%) do not protect against HIV or other sexually transmitted infections. Yoest also claims contraception does not reduce the number of abortions and says that to accept this argument “would be, frankly, carrying water for the other side to allow them to redefine the issue in that way.”…
Even worse, Yoest continues to cite long-discredited studies that used retrospective reporting to support her assertion that abortion causes breast cancer, despite the overwhelming evidence to the contrary from properly constructed prospective studies. Such statements by the person now in charge of public affairs at HHS will only encourage the alarming pattern of state legislation requiring physicians to provide this misinformation in the name of “informed consent.” …
Despite… medical facts, legislatures and even the Supreme Court have tolerated individuals’ making up their own definitions for abortifacient and pregnancy and then using them to justify refusals to fill prescriptions or offer insurance coverage for contraceptives. People who accord moral status to the fertilized egg prior to implantation should argue their case openly and on its own merits. Framing these refusals as opposition to abortion is a tactic to garner more public sympathy than one could by properly framing them as opposition to contraception…
For too long, we have seen alternative science used to convince the public that there is no need to face difficult policy choices… Reasonable people may disagree about how to interpret data, but they do not ignore scientific method by giving credence to flawed, fraudulent, or misrepresented studies. They may disagree about the moral significance of fertilization, but they do not delete implantation from the stages of pregnancy and do not confuse the public debate by conflating opposition to abortion with opposition to contraception. They may disagree about the morality of using cadaveric fetal tissue for research, but they do not claim that it is useless. Ignoring, denying, or reimagining reality has real consequences for public policy and human health. Whether in the debates regarding climate change, evolutionary theory, or human reproduction, alternative facts are just fiction, and alternative science is just bad policy.