Lo que nadie cuenta por acá

Me sorprendió encontrar hoy este artículo en The New York Times, diario reconocidamente liberal. Aquí va para aquellos de ustedes que puedan leer in english.

Scientists Will Gather to Discuss Safety of Abortion Pill

By GARDINER HARRIS
Published: May 11, 2006
Worried about a bacterial infection that led to the deaths of at least five women who took the abortion pill RU-486, scientists from the nation's leading public health agencies will gather in Atlanta today for the first meeting in 10 years on the drug's safety.

Scientists from the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health will consider whether the means of administering abortion drugs make pregnant women more susceptible to the bacterium Clostridium sordellii.
They will also discuss whether the deaths may signal the emergence of a new and more virulent strain of the bacterium that poses a threat to pregnant women generally, not just those who use RU-486.
The five deaths were confirmed as resulting from infection by Clostridium sordellii, which can induce toxic shock. The cause of a sixth death has not been announced, although the same bacterium is suspected.
Clostridium sordellii infections are rare, but pregnancy appears to increase the risks, said Dr. David E. Soper, vice chairman of the obstetrics and gynecology department at the Medical University of South Carolina.
Abortion experts have been at a loss to explain why four of the deaths occurred in California. Initially, the F.D.A. investigated whether the pills used in California might have been contaminated, but an agency official said tests had found no evidence of contamination.
Another theory concerned the role a dry climate might play in encouraging the growth of Clostridium sordellii, which lives in soil.
Some experts believe that pregnant women who take RU-486 with another drug, misoprostol, are more vulnerable to infection. RU-486 by itself ends early pregnancies, but the pill is routinely given along with misoprostol, which causes uterine contractions that expel the dead fetus.
After examining many studies, the F.D.A. in 2000 approved a protocol that requires women to take misoprostol orally. But abortion providers have instead instructed women to insert misoprostol vaginally.
Some scientists say the vaginal insertion may introduce bacteria along with the drug.
"The tablets are small, and women don't necessarily know where their vagina begins and ends," said Dr. Phillip G. Stubblefield, a professor of obstetrics and gynecology at Boston University.
If women are not careful, Dr. Stubblefield said, they can easily drag the tablet across the perineum, between the rectum and vagina, and contaminate the vagina with the bacteria.
Other experts dismissed the contamination idea. "I'm still using the vaginal route," said Dr. Mitchell Creinin, director of family planning at the University of Pittsburgh.
In 2004, the F.D.A. put strong warnings regarding the risks of infection on RU-486 labels.
There has been no hint that the F.D.A. is considering further restrictions on the use of the drug.
Abortion rights advocates are also concerned over the F.D.A.'s indefinite delay in deciding whether to approve over-the-counter sales of Plan B, an emergency contraceptive that has a use different from that of RU-486. Most agency observers blame politics for the delay.
After the deaths, the National Abortion Federation's insurer insisted that its clinics use the F.D.A. protocol when providing abortion drugs or face the loss of their medical malpractice insurance.
In the United States, some abortion doctors have decided against using RU-486 altogether. Among them is Dr. Peter Bours of Portland, Ore., a member of the federation.
"I'm not sure I want to be in a shared insurance group policy with people doing medical procedures because you share that risk," Dr. Bours said.
Until March, Planned Parenthood, the nation's largest abortion provider, continued to instruct its doctors to give misoprostol vaginally, said Dr. Vanessa Cullins, vice president for medical affairs. But with the sixth death, in March, the organization now uses an oral protocol.
The deaths linked to RU-486 have created an unusual split in the small world of abortion providers, a growing number of whom say that they will not dispense the drug. The risk of death with pill-based abortions now appears to be about 10 times that of surgical abortions.
Dr. James McGregor, a visiting professor of obstetrics and gynecology at the University of Southern California, said RU-486 might make women more susceptible to Clostridium sordellii in part because the drug may inhibit mechanisms that moderate immunity. In cases of toxic shock, the body's immune response becomes lethal.
"The body ends up attacking itself," and RU-486 may encourage this attack, Dr. McGregor said.
Dr. Soper, of South Carolina, said that once a Clostridium sordellii infection took hold, there was little hope.
"I'll never forget when I was a fellow in San Diego, and I had this post-partum patient literally die before my eyes," Dr. Soper said.
After the patient gave birth, she told her husband that she felt extremely tired. He took her back to the hospital, and she died quickly, Dr. Soper said.
The oral administration of misoprostol is more common in Europe, but vaginal use there has been growing.
Ann Furedi, chief executive of the British Pregnancy Advisory Service, which provides 25 percent of all abortions in Britain, said her agency relied on vaginal drug insertion.
Clinics in Sweden and Hong Kong do the same, and vaginal use is growing in France, according to Gynuity Health Projects, a New York group that supports the use of RU-486 around the world.
In the debate over RU-486 versus a surgical abortion, women have diverging opinions. A 43-year-old New York mother of two who said that she had had "every kind of abortion," told her abortion provider during a counseling session recently that she would consider only a pill-based procedure.
"I do not like doctors and hospitals," said the woman, who did not wish her name to be used for privacy reasons. "Both of my children were born at home without anything. And that's how I want to have my abortion: in home, in my privacy, at my own pace and without somebody's other agenda over me."
Reached at home after taking both abortion drugs, the woman said she felt fine. After going to the bank, the pharmacy and the deli, she planned to nap much of the day, she said.
Anne Hawkins, 36, also of New York, said she, too, had had both pill-based and surgical abortions. But taking RU-486, she said, "was the worst experience, the most physically and emotionally painful thing, that I've ever been through."
Ms. Hawkins had another abortion in March, and she chose surgery.
"It was 10 minutes, max, and then it was over," Ms. Hawkins said of the surgical procedure. "The pill for me was the experience of having a baby. Contractions for 10 hours, sweating, screaming, being by myself. It was emotionally scarring and physically horrible."