President's Message: Medical Abortion: Protecting Patients and Physicians Everywhere

Michael Schrader, MD, PhD

MEDICAL ABORTION: PROTECTING PATIENTS AND PHYSICIANS EVERYWHERE

Beginning with the leaked Alito Dobbs opinion in May, the Supreme Court decision to overturn Roe v Wade has eliminated patient rights, eroded physician authority, and thrown medicine into a turmoil. This partisan, judicial activism overturned a 50 year precedent and has caused disruption to patient wellbeing and the practice of medicine. We are seeing narrow-viewed legislators attempting to control the practice of medicine in their own states and nationwide. Medical and surgical abortion have become a standard of care over the past half century. The freedom of women patients to control their reproductive health is a cornerstone of economic, social, and political equality. In 2020, 240,000 abortions were performed in states that are now restricting or in the process of restricting abortion.

There are multiple repercussions of banning abortion. Many women denied legal abortion will seek out illegal procedures, putting themselves at great risk of harm and even death. Unwanted pregnancy has poorer health outcomes for both mother and child compared to intended pregnancy. OB/Gyn residents in many states will not meet national training standards. Decreased access to abortion will increase maternal and child poverty which strongly correlates to poorer health. Potential legal jeopardy has created an undue burden on physicians with yet unforeseen consequences for the practice of medicine.

Thirty years ago the San Francisco Medical Society made a bold move in support of medical abortion, which in France had already been called “The moral property of women.” The SFMS had policy supporting the medical abortion medication then known as RU-486, already in wide use in Europe, and had succeeded in getting that adopted by the CMA and AMA. The FDA had still declined to authorize RU-486 for use in the United States. Steve Heilig of the SFMS, who had already written about RU-486 for JAMA, UCSF, and other publications, and had published a survey of California OB/Gyn physicians showing they supported use of RU-486 here, was approached by a New York group called Abortion Rights Mobilization to recruit a pregnant woman seeking an abortion.

A number of SFMS OB/GYNs were selected to refer appropriate patients for screening, until one agreed to attempt a dramatic effort to publicize the need for this medication here. The woman flew to England, was handed RU-486 by a physician there, and then flew to JFK Airport. Customs officials and the media had been alerted that she would be smuggling this drug and it was seized at customs. Her case was on the front page of the New York Times and all television news networks. Federal seizure of the pills was immediately challenged. The Supreme Court had to rule quickly and denied her use of the illegal drug. The woman, whose anonymity was preserved as much as possible, subsequently underwent a legal surgical abortion.

This publicity effort eventually paved the way for legalization of medical abortion by the FDA. Presidential candidate Bill Clinton cited this event, pledging to bring the medication here. But even so, due to political factors it took eight more years for the FDA to approve it in 2000, and even then with undue restrictions not supported by evidence, some of which remain even today. Still, over half of all abortions done in the United States are now done via medication.

This year, the SFMMS Delegation to the CMA House of Delegates proposed policy to shield physicians who use telemedicine to prescribe medical abortion across state lines, supported by UCSF experts. This would be similar to recently passed legislation in Massachusetts to protect physicians and patients. While this was not initially successful, we have followed up with a resolution that has been submitted to the Year Round Resolution process. We have also urged FDA review of the possibility of making these medications Over-The-Counter to increase access.

Medical abortion is a safe and effective treatment that should be available to all women.

Dr. Schrader practices internal medicine at Dignity Health, is President of the SFMMS, and co-chairs the SFMMS delegation to the CMA.