RU486: Not Selling
By Randall K. O'Bannon, Ph.D., NRL Director of Education & Research
Despite enormous media hype and unending claims by the abortion industry that there is great demand for the drug, all available evidence indicates that the abortifacient RU486 has not been the breakthrough product its supporters dreamed of.
Flunking Out on College Campuses
One of the places where the pill's promoters might have been expected to successfully make their strongest pitch is on America's college campuses. Residing there is a population of single, possibly sexually active, young women, quite often with the sort of mid-level, non-surgical, medical facility supporters considered ideal for the drug.
Yet at least 30 of the nation's major colleges and universities, including Princeton University, Boston University, the University of Michigan, the University of North Carolina at Chapel Hill, the University of Oklahoma, Florida State University, and UCLA, have indicated they will not offer the drug to their students. Yale University is the only major university that has publicly indicated plans to make RU486 available on its campus.
Different universities gave different reasons for refusing to offer the pill. However, the explanation given by Barbara Blizzard, coordinator of the Women's Clinic at the University of Texas-Austin (UTA), as to why her university's health services department wasn't offering the pill was typical. Her remarks echo similar responses given by university medical personnel at Vanderbilt University, the University of Virginia, the University of Michigan, San Diego State University, and Princeton.
First, Blizzard indicated, university health services at UTA didn't have an ultrasound machine to confirm the date of the pregnancy. The two-drug chemical method's "effectiveness" drops off substantially after the 49th day of pregnancy.
Second, said Blizzard, "It requires surgical intervention if it doesn't complete the abortion process, and we don't have anyone who can do that." Even within the 49-day framework, U.S. trials showed the pill working only 92% of the time. As a result the RU486 plus prostaglandin combination won't work for nearly one woman out of every dozen.1
Interestingly, Blizzard rejected the logic of the pill's promoters that these women can simply be sent elsewhere to complete their abortions. "For good continuity of care, you don't want to be sporadic, you want someone who is going to see you through the whole process and we just aren't equipped to do that in this case" (Daily Texan, April 18, 2001).
Different reasons were given by other schools. Michigan State University cited an inability to surgically deal with the drug's side effects (The State News, February 23, 2001). The University of Pennsylvania mentioned that it lacked facilities to handle complications (Daily Pennsylvanian, February 9, 2001).
Jonathan Zarov, health communication specialist for the University of Wisconsin, offered perhaps the most succinct (and encouraging) reason behind his school's choice not to offer the drug. "It is not a high demand here," he told the Marquette Tribune (December 1, 2000).
Old Abortionists Not Enthused, Few New Doctors Ordering Pills
Danco, the U.S. distributor of RU486, reported it had received hundreds of orders, and abortion groups like Planned Parenthood claimed it had been swamped with calls from women asking about the pill shortly after approval. However, the November 14, 2000, edition of the New York Times presented a quite different picture of how the drug has played on the market.
The Times reported that most of the orders Danco received came from clinics already offering abortion. Very significant is that many of the women who called clinics seeking the pills were confused about what RU486 was or how it worked. They believed it was a pill that could be taken at any stage of pregnancy to make the baby "magically disappear."
"There's a very common misconception in the lay public, and even way too common among physicians, that this is a nice, easy way to get rid of a pregnancy," Las Vegas abortionist William Ramos told the Times. The reality of a chemical abortion is vastly different.
A woman using the technique takes two drugs (RU486 to kill the baby, and a prostaglandin [PG] to expel the corpse); makes three office visits spread over a two-week period; endures a whole lot of uncomfortable, if not dangerous, side effects; and experiences the relatively high likelihood of hemorrhage (2%) or "failure" (8%) precipitating surgery. In truth this is a much messier, more painful, less attractive picture.
Other reasons behind the reluctance of individual doctors to prescribe the pill are the time involved in counseling and the expense of ultrasound equipment and training. Dr. Stephen Tamarin, a family practice physician from New York, told the Times that while he might do an RU486 abortion for a patient who claimed she wasn't comfortable going somewhere else, "if there's 10 people around the corner who do it and I'm up to my gills in other things, then I might not go out of my way looking for more work."
One Dallas abortionist, Dr. William West, explained to the Times why RU486 hasn't caught on in the heartland where the pill's promoters were so anxious to establish a market. "Few of these doctors in every hamlet, village, and town who are supposed to make medical abortions so widely available have ultrasound equipment or the expertise to use it."
Another sign of the relative lack of interest is the dearth of calls being made to abortion clinic doctors seeking surgical backup. At the behest of the abortion industry, the FDA decided not to require doctors offering RU486 to have training in handling complications or performing surgical abortions for women for whom the method failed. It did, however, mandate that any doctor without such skills had to make arrangements with some doctor with the surgical experience and training to handle complications or "failures."
According to the Times, "Abortion clinics would be a logical choice for such backup agreement, doctors say. But clinic doctors say they have not heard from doctors who want their services."
For example, Dr. Deborah Oyer, medical director and owner of a Seattle abortion clinic, told the Times, "We have not been called by anybody about surgical backup and we are the only clinic in the Pacific Northwest that's been using mifepristone {RU486] since the first trials."
"I'm a little surprised," Oyer admitted. "But also at some level, I'm not. In studies that were done in the last several years, there were always a significant percentage of doctors who say they would do medical [chemical] abortions. But I was always a little suspicious. It's a lot easier to say you'll do it than to actually do it."
Robin Rothrock, clinic administrator for an abortion clinic in Shreveport, Louisiana, also told the Times her clinic hadn't received any calls from physicians seeking surgical backup despite being one of only two clinics doing abortions in a 200-mile radius. The other clinic won't be offering RU486 or providing backups, its owner saying his doctors didn't have time to be on call for patients 24 hours a day.
Ms. Rothrock expressed her own doubts, saying she wasn't sure she'd want to do backup for private doctors offering the drug. "It comes down to taking over someone's complications," Rothrock told the Times. "Does that mean I'm putting my doctor on call in the middle of the night? We might say, 'Go to the emergency room.'"
Even among experienced abortionists, enthusiasm has not been universal. Despite years of advocacy and a recent "massive educational program," only two-thirds of the National Abortion Federation's 360 "member facilities" were indicating to NAF in September 2000 that they would be offering the drug (NAF statement, 9/18/00). Some of those planning to offer RU486 still believe surgical abortions are better because they are quicker, less painful, and involve fewer office visits and are telling their patients so.
"We're telling them straight up front that if any of us needed an abortion, we'd go for the surgical procedure," abortionist Ramos told the Times. Another abortionist, Charles Livengood from Duke University, said that while he thinks it's good to have RU486 available, "I do think that an abortion with mifepristone tends to be a prolonged and messy affair as opposed to the quick procedure I do in the clinic."2
In that vein, a comment by Dr. Livengood is instructive. "I've presented it to 10, maybe 12 women," he told the Times. "I haven't had any takers at this point."
Priced Out of the Market?
The price of an RU486/PG abortion, with Danco charging $270 for a single dose of the RU486 pills, is also an issue with abortion clinics, two national newspapers report.
Originally, the claim was that an RU486/PG abortion would cost about the same as a standard first-trimester surgical abortion, which is somewhere in the neighborhood of $300. But with the pills alone costing nearly that much themselves, there is almost no way an abortionist can charge a comparable fee and cover the additional costs associated with the mandatory three office visits, the lab work, and the extra time of counseling factored in. If the abortionist adds ultrasounds to date the pregnancy and confirm the abortion, his costs can skyrocket.
Competition among clinics is fierce, making it difficult for clinics to raise prices and turn profits. This alone is why many abortion clinics have closed.
Many that have stayed open have reportedly cut corners by training low-paid staff to handle almost everything except the surgery itself, including drawing blood, handling paperwork, and doing cleaning. "As altruistic as women and feminists want to be," Renee Chelian, owner of three Detroit abortion clinics, told a reporter in the December 30 edition of the New York Times, "the reality is that we can only stay in business if we earn enough to keep our doors open."
To cut the cost of RU486/PG abortions, Ms. Chelian told the Times she was considering offering women one of the RU486 pills instead of the three that is the standard approved dosage in these abortions. Chelian says then she could charge just $80 more for the chemical abortions.
Other clinics are planning to offer RU486 as a "loss leader," a product offered below cost in order to get customers in the door. Carmen Franco, another owner of several Detroit abortion clinics, told the Times she expects to charge $450 for RU486 abortions, less than her cost, as a way to, as the Times puts it, "draw patients to the clinic where they can see the full range of options she provides."
In other words, entice them with the lure of "easy, safe, simple" abortions by pill, and then, like the abortionists mentioned above, convince them that the cheaper (and more profitable) surgical abortion is a better option.
Representatives of the abortion industry have complained about the cost of the pills. Vicki Saporta, executive director of NAF, told the Wall Street Journal, "I wish the price was more affordable" (11/14/00). Saporta said that NAF was trying to negotiate a lower price for some clinics and was seeking to get Danco to reduce the proposed minimum $3,000 order. Danco didn't comment.
Some of the costs associated with these abortions will be picked up by wealthy groups which have funded previous abortion activism in the U.S. The Wall Street Journal reported that well-heeled financier George Soros's Open Society Institute is funding the "Nationwide Mifepristone Affiliate-Readiness Project," which will, among other things, buy 300 ultrasound machines for clinics wanting to offer RU486 and to pay for a nationwide radio and TV campaign promoting the abortion pill. The Soros Foundation is also funding a special training program for about 20 primary care doctors, trying to get them to integrate chemical abortions into their practices.
Training, the cost of pills, and the cost of equipment aren't the only money issues, though. "Remember, a physician is still a business person," abortion researcher Mitchell Creinin told American Medical News (October 23/30, 2000). "So they could be in a small community where, from a business standpoint, it's going to do them more harm than good to provide the service."
Even if a doctor were tempted by the lure of what he thought might be easy profits, he would have to weigh that against what his other patients might think of him becoming an abortionist and what that could do to his other business.
Not Meeting Expectations
Just prior to the government's approval of the drug, Danco was estimating that it would generate $3.7 million in sales by the end of 2000 and RU486 would be used in 29% of all abortions within four years (Wall Street Journal, September 5, 2000).
In a February 6, 2001, press conference, however, NAF's Vicki Saporta spoke of "hundreds" of women had used RU486 without any major complications since it became available in November.3
While no number of abortions - - surgical, chemical, or otherwise - - is acceptable, the "hundreds" figure, even for just over two months, represents a much lower number than one might have expected given all the doctors surveys have said were interested in offering the pills and all the pent-up demand NAF and Planned Parenthood have implied was reflected in the phone calls "flooding" their offices.
While there is still great concern that the presence of RU486 could tempt mothers wary of surgery to chemically abort and therefore increase the number of abortions performed, current evidence indicates that the drug may not turn out to be as big a seller as its promoters had hoped.
NOTES:
1. Taken alone, RU486 induces abortion only 64% to 85% of the time, so a prostaglandin, usually misoprostol, is given to stimulate uterine contractions to expel the corpse of the tiny child.
2. What apparently neither Ramos nor Livengood told the Times is that surgical abortion comes with its own safety risks, including perforation, scarring, and infertility.
3. Planned Parenthood said something similar about the trials of the abortion pill in Iowa before an ER doctor let the press know that a woman he had treated almost bled to death after taking the pills.