William M. Briggs

Statistician to the Stars!

Stream: Did Ohio’s New Abortion Law Cause An Increase In Adverse Events?

Today’s post is at The Stream: Did Ohio’s New Abortion Law Cause An Increase In Adverse Events?

…The drugs mifepristone and misoprostol are sometimes injected into pregnant women to kill the lives inside their wombs. The procedure is called a “medical” or “medication abortion” to distinguish it from other methods of killing the unborn, usually involving sharp objects or vacuums.

In 2000, the U.S. Food and Drug Administration approved a version of the mifepristone + misoprostol method of killing. This version requires medium doses of both drugs be given at an abortionist’s office on different days. To ease demands on their time, some abortionists instead prefer a second, “off-label” combination of these drugs: a high dose of mifepristone at the office and a low dose of misoprostol self-administered at would-be mothers’ homes.

The distinction is important because Ohio in February 2011 passed a law requiring abortionists to use only the FDA-approved method. The law was passed in dispute. Some abortionists complained that the work of killing was better using the off-label method.

A group of researchers led by Ushma D. Upadhyay tried to investigate the questions, studying pre-law and post-law abortion data. They published their attempt in “Comparison of Outcomes before and after Ohio’s Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study” in the journal PLOS: Medicine.

The researchers found four abortion sites willing to cooperate with their research. The immediate finding was that the fraction of medication abortions dropped dramatically at all four of the abortion sites after the law passed. The average rate was 22% of all abortions were medication before the law, which dropped to only 5% some time after. One site even discontinued medication abortions for a period of almost two years.

The researchers do not say if the medication abortions that were performed post-law were all the FDA-approved method or if any were the now illegal off-label method. This is not surprising, because admitting to use of the off-label method would be admitting violating the law. Given that the sympathies of the abortionists and the researchers was not with the law, it is possible biases creep in, both in the analyses and in way treatments themselves are administered. Confirmation bias is ever a possibility…

More people who would have benefited from reading my book Uncertainty: The Soul of Modeling, Probability & Statistics. Go to the Stream and read the rest.

22 Comments

  1. Somewhat O/T, but California senate passed a law crimilizing whistle-blowing at Planned Parenthood (all “medical” facilities, which should also cut into personal injury lawsuits at all medical facilities, one would think). I thought that appropriate—hide the ovens and pretend you’re relocating the Jews, right? Anyone who tells is toast.

    Interesting this whole debate—since the 70’s it was easy to get “morning after” contraception without any special pill. Regular contraceptives do the job. Planned Parenthood still lists the dosages. Yet no one seems to be aware of this reality. Of course, the authors of the study in question did not ask if the women had tried this method and it failed, so I guess another study better be funded, right?

  2. Well, I guess when you set out to kill, you want to do it in a safe way. Like the story about the man castrating a bull with two rocks. Wouldn’t want to get your thumbs caught between them. Safety first.

    The Ohio law seems have good intentions (for at least one of the parties involved) but wonder if it really was necessary. A case of a solution looking for a problem? The legislature was maybe bored; didn’t have enough to do?

  3. Some observations from another report (link at bottom):

    Applying the Ohio law forces women to take larger does — having greater adverse side effects — than the “off-label” approach that seemed to work as well (inducing an abortion) and safer for the ex-mother (reduced adverse side effects).

    “…laws [like the Ohio law] were often passed in tandem with other restrictions, like requiring hospital admitting privileges for the doctors performing abortions, and having facilities providing them meet certain building standards.”
    – That likely explains why the abortions via this method dropped — fewer doctors could legally practice it (and if they did, the odds of getting caught would be very high due to anti-abortion interest groups of which Ohio has in spades … so they almost certainly complied with the law).

    THEN, comes this observation:

    “There’s an increasing number of restrictions on all abortions, including medication abortion,” … “Often they’re under the guise of improving health and safety for women. And what is needed is more evidence.”

    In other words, the Ohio law, by mandating a govt-approved approach — that causes more adverse side effects and thereby decreases health and safety — is marketed as being the opposite of what it is.

    Who’s doing that marketing? By & large religious special interest group & activists/advocates in the legislative system. You can look that up.

    In other words, many highly religious people, who ostensibly value “truth,” lie about what they’re law is doing [absence of evidence] to achieve what they think is a greater good.

    The end (fewer abortions) justifies the means (violate the ninth commandment by stating the more harmful approach is really safer).

    If one ‘judges a tree by its fruits,’ then its a sure bet (if one could bet & verify outcomes to collect) that those well-intentioned people applying lies likely have some ‘splainin’ to do to the highest authority sooner or later…

    Other article/report: http://khn.org/news/did-it-hurt-or-help-researchers-analyze-ohios-2011-abortion-law/

    9th Commandment: en.wikipedia.org/wiki/Thou_shalt_not_bear_false_witness_against_thy_neighbour

  4. Ken: You can, of course, provide an accurate, fully documented report that shows beyond a shadow of a doubt that the mean religious people are causing this. (I am really looking forward to the section on “religious people hold gun to head of women to get her pregnant and then need an abortion”).
    The “Higher Authority” considers abortion murder. I think I’d worry more about that than some unsubstantiated “facts” concerning who’s lying. You think murder is fine, but lying is wrong. Check out the sixth commandment concerning “not murdering” people. Very important one.

  5. Ken means the 8th and Sheri means the 5th, obviously.

  6. acricketchirps: It depends on what background you come from what the numbering system is. Catholic is 8th and 5th.

  7. ‘(I am really looking forward to the section on “religious people hold gun to head of women to get her pregnant and then need an abortion”).’

    Here you go:

    http://www.ncbi.nlm.nih.gov/pubmed/8765248

  8. Ken, the article you link to says this:
    “The FDA updated its original medication abortion protocols in March. So, the Ohio law, which says doctors must adhere to the agency’s rules, now aligns with this revamped regimen, meaning women only have to see a doctor twice, can take smaller doses and have 10 weeks to get a medication abortion.”

    So it would seem that this comment:
    “Applying the Ohio law forces women to take larger does — having greater adverse side effects — than the “off-label” approach that seemed to work as well (inducing an abortion) and safer for the ex-mother (reduced adverse side effects).”
    would no longer apply, or am I missing something?

  9. Steve – re ‘missing something’ about the larger doses:

    Yes, in part: The analysis Briggs’ did applies to the a study conducted prior to earlier this year — a period between when the Ohio law went into effect and when the Feds changed the criteria for using that abortion pill regimen.

    So, yes, subsequent to that change, the “off-label” approach is ok and the problems I culled from that report/article ought to vanish as women do things differently. However, relative to the intervening period of the analysis Briggs’ cited, where the Ohio law change was cited as worsening the situation, the issue/quote I cited would be/may be applicable.

  10. Ken, thanks for the clarification.

    Reading further in the article that you link to it seems as/more likely that the drop in use of the medication procedure was due to the higher costs associated with more visits to the doctor than the effects of the larger doses, although it doesn’t go into detail about the range of costs across methods.

  11. Steve, yes, higher costs via more visits … and also from that more counseling of side-effects, etc., etc. … undoubtedly a host of factors at play. Chances are we’ll never really know why, the topic is too emotionally charged and those most interested invariably have a pro or con bias, next to impossible to offset entirely no matter how one tries to be objective. Human nature…

  12. Sheri – RE: ‘show beyond a shadow of a doubt that the mean religious people are causing this’

    My point wasn’t & isn’t that religious are causing anything directly related to the topic du jour — the point was and is that many religious people are hypocrites of a very high order … and are so expressly by using their religiosity to enable their hypocrisy.

    The article notes that some legislation that endangered women more [in conjunction with constraints that made abortion more difficult to obtain] was presented as making women safer.

    The vast majority of such legislation is by anti-abortion groups, and the most power & majority of them are based on religious values (AUL, cited in the article I quoted, was founded by a minister & is being run by a CEO who went to Trinity Int’l Univ., a religious institution). This is so easily verified/observed that arguing about it is a “straw man.”

    You rationalize that killing a fetus is a major sin — true.

    But does that legitimize lying about proposed legislation to get it passed into law to minimize such killings?

    Your remarks suggest you believe so … but consider that most such legislation fails (out of 50 states only Ohio passed the law whose effects were evaluated here). That indicates that, on this particular topic, some religious people are doing a lot of lying, but with no offsetting beneficial outcome (if such an outcome even qualifies as offsetting).

    In other words, is lying (sinning a particular way) justified by noble intent (offsetting someone else’s ability to commit a greater sin) but ignoble outcome?

    I really doubt it; as do most religious authorities. The lying attaches to the liar.

    And if the outcome of reduced abortions arising from diminished access did occur, how beneficial of an outcome is that, really? The forced avoidance of sin (murder of a fetus) does not necessarily absolve the pregnant woman still seeking an abortion (consider free will & intent/desire; if forced obedience were a criteria then every unrepentant monster in prison’s solitary confinement would by such standard qualify as living an angelic life). Some fetal lives may be save, but many of the mother’s will remain every bit as guilty, in pursuing the noble outcome only part of the issue is being addressed (coveting a different outcome remains).

    This is just an abbreviated case-study of the adage, “two wrongs don’t make a right.” Though, routinely, many self-reporting as “religious” will flout just such a hypocrisy as if its something to be celebrated.

    That’s just one example of a myriad such that non-religious observers note about so many religious people (and the hypocrites tend to be the more outspoken & noticed) … and which leads them to conclude that joining a given church, or even accepting a religion at all, is something they won’t do. That is also a recurring theme in this blog.

    When one is inclined to react with a histrionic “knee-jerk” response, that’s a clue that something’s hit home and indicates time to reflect, not lash out.

  13. Lee: Nice try. I said a religious person holding a gun to the head of a woman to get her pregnant. I would like to see your study/statistics that clearly show 100% of rapists are religious people who don’t allow women to have abortions. (Note that 32% of the women keep the child and 5% give them up for adoption—so abortion is not the only choice made in these cases.)

    Ken: Again, unless you can show that religious people held a gun to women’s head, forced them to have sex and then remain pregnant, your argument is not valid. Women make the choice to have sex (except in the cases of rape and these are a small percentage). If they do not want to get pregnant, it can be avoided by not having sex. What they want to have sex without consequence, which nature says “no” to and science tries to say yes by killing the undesired consequence.

    You did not provide iron-clad evidence that lies were told. If they lied, then that is wrong. Show me proof. Of course, murder is apparently less wrong in your eyes, which is scary. You’re fine with women committing murder but not with “religious people” possibly lying about statistical studies of a drug.

    Seriously, two wrongs don’t make a right??? You’re arguing fornication and murder together are justifiable and right—two wrongs make that a right.

    Your responses are often knee-jerk, so may I assume this blog and it’s comments often “hit home” and you don’t bother to take time to reflect any more than you accuse others of?

    You also assume that my objections to abortion are religious, but the reasons are many and do not require any religion be inserted into the argument. Of course, it’s so much easier just to “lash out” and declare someone’s viewpoint that of a religious zealot, whom you despise, than actually entertain the notion that religion might have nothing to do with the viewpoint. Denial is a wonderful thing, isn’t it?

  14. Well, whatever the case, I smell nosy puritans nosing around women’s vaginas and making life just a little more difficult for people. Does conservatism ever produce anything beneficial to anyone?

    JMJ

  15. More tea vicar?

  16. JMJ: Many more benefits than nosy progressives refusing to let people smoke, drink, eat sugar, drive without safety belts, ride without helmets, let their kids play alone at the park, forcing school kids to eat kale, etc. Maybe if they didn’t spend so much time worrying about women’s sexual organs….Such a jealous fit they have. It’s like they never get any. Or is it that so many progressive women hate men? That might be it. So the progressives take whatever they can from everyone else because they can’t get the one thing they want?? I see now.

  17. Jersey, it’s not so much the vagina that I’m concerned with as the uterus–and again, not so much the uterus as the human being living inside the uterus. As fo making life more difficult, I suppose you’re right; life *is* a lot simpler when you’re dead.

  18. “I said a religious person holding a gun to the head of a woman to get her pregnant.”

    Right. Some rapes are accomplished with guns, some of those rapes result in pregnancies, and nearly all the perpetrators are religious.

  19. Oh look the moral degenerate JMJ is back. His presence is proof that leftism never produces anything beneficial.

  20. Lee: Proof of your claim that nearly all the perpetrators are religious, please. Otherwise, I’ll assume you made it up in your head. Also proof that religion in some way played a part in the decision to rape. Proof that people who rape actually believe in their religion, not just say they are religious. Otherwise, you’re making things up to suit your fantasy about religion and people who do bad things and will be ignored. If you are including Islam in the religion category and invaders claiming to be refugees, in Europe especially, then I might agree with that assessment. However, Islam is a religion of peace so watch what you say.

    acricketchirps: JMJ does not seem to consider the life inside to be human (or maybe he does—sometimes I think he’s just being PC) but he may believe in the theory that at some point a lump of tissue magically becomes a human being. Interesting that many progressives deny religion but believe in magic.

  21. Ever notice how guys always are out to “protect” women, yet women very often disagree with the methods used? Is this whole “we support abortion” just a way for guys to have sex and get rid of child support? Do they care in the least about the woman? I’m thinking they do not.

  22. “Seriously, two wrongs don’t make a right??? You’re arguing fornication and murder together are justifiable and right—two wrongs make that a right.”

    @Sheri, Thank You JESUS for this statement. The root of the issue is sexual sin (notably fornication, adultery and in a few cases rape). We ALL know it but the abortion fanatics are openly perverted in their hearts and their ways. They kill the INNOCENT for their own sins which they claim are good despite them requiring murder to exercise. They have no mercy, no conscience, no common sense even. They are just FOOLS blinded by evil and hypocrites of the highest order.

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