Four reasons to distrust UCSF’s study alleging safety of ‘no-test’ abortion pill protocol

A new study from the University of California, San Francisco (UCSF) claims to verify that “no-test,” self-managed chemical abortions are safe and effective — but a closer look suggests a different reality.

Setting aside the obvious limitation of the study’s relatively small sample size (complete data for just 2,397 women, despite an estimated 465,000 chemical abortions per year in the U.S.), this study has multiple real and potential problems that render its conclusions dubious at best.

Biased Authorship

Who’s behind this study? One of the researchers, Elizabeth G. Raymond, also co-authored a paper entitled “Increasing Access to Abortion With Telemedicine,” which emphasizes the importance of making it easier for women to get abortions. In addition, she co-authored a “sample protocol” for no-test abortion in order to promote “access.” She has been awarded by the pro-abortion Guttmacher Institute and is affiliated with Gynuity, which receives major funding from organizations devoted to population control and eugenics. 

Two of the top three researchers are affiliated with UCSF. One, Ushma D. Upadhyay, has been associated with the fatally flawed, pro-abortion Turnaway Study. UCSF is one of the nation’s most extensive abortion training facilities; they fund and operate over 100 training programs nationwide. They are also heavily involved in fetal tissue harvesting and experimentation. 

The other four authors are abortionists; one is affiliated with Planned Parenthood. 

Every single author on this study has a vested interest in promoting abortion, either by virtue of their direct participation therein, or consequent to their financial ties to pro-abortion organizations. Every single author on this study is biased in favor of abortion. 

Methodological Weaknesses

It should therefore come as no surprise that the researchers produced results which are pro-abortion. But how did they go about doing so?

As mentioned before, the researchers only had complete data for 2,397 women; however, their reported sample size is 3,779. How do the authors account for the 36.6% of participants for whom data was missing? Did the researchers just fill in the gaps with their own data? 

Essentially, yes. Authors state:

[W]e then conducted an analysis using multiple imputation by chained equations to account for missing outcomes due to loss to follow-up. We assumed data to be missing at random and imputed missing data …

Multiple imputation is a statistical approach that calculates and incorporates data assumed to be missing at random. It is used regularly in research, however, statisticians acknowledge its risks, saying it “needs to be applied carefully to avoid misleading conclusions.”

The authors acknowledge that, if their assumptions are inaccurate, their numbers are flawed; incidentally, their conclusion, by extension, would also be flawed. “If patients who were lost to follow-up were more likely to require additional intervention, our analysis may overestimate effectiveness.”

The authors further acknowledge they “may have failed to identify some additional interventions and adverse events”  because “[participating facilities] did not have uniform, validated criteria for confirming complete abortion using symptoms alone without ultrasonography, serum β-hCG, or urine pregnancy tests.” They continue:

Although we collected data on test results that supported the diagnosis of complete medication abortion, we did not systematically collect information on the criteria clinicians used to diagnose abortions as complete by history.

In other words, there were no defined, uniform criteria used to determine that a “complete abortion” had taken place. 

Furthermore: 

The first 3 authors (U.D.U., E.G.R., and L.R.K.) reviewed selected cases to clean data and flagged any inconsistencies within a specific medical record. These records were then rereviewed by clinic staff, who made any needed corrections. Additionally, 4 clinician coauthors with experience in abortion provision (B.K., L.C., C.M.B., and M.G.) reviewed selected cases to resolve analysis outcomes.

So the demonstrably pro-abortion team was also “cleaning” and “correcting” data, as well as “resolving analysis outcomes.” 

READ: Abortion pill complications requiring hospital visits in UK mirror US data… and it’s not good

Adverse Events

Further complicating the reported results is the fact that the authors didn’t include ER visits in their definition of what constituted an “adverse event.”

If they had, their adverse event statistic would have been closer to 2.5%, rather than the .54% they reported (72 reported ER visits among the sample/2825 patients with follow-up data = ~2.5%). If you apply this statistic to the total estimated number of chemical abortions annually, we can presume an estimated 11,625 women per year would be heading to the ER for abortion-related complications under the no-test protocol.

So what did constitute a “major adverse event?” The authors included “hospital admission, blood transfusion, [or] major surgery” in their definition. How did they determine whether or not one of those events was consequent to abortion? “The clinician authors determined the relation of adverse events to the abortion by consensus.” (emphasis added)

Remember, every one of those authors has a vested interest in abortion. Some of them also work alongside UCSF professor Daniel Grossman, who told a reporter at The Atlantic that if women who are self-managing their abortions experience complications, “they are generally advised to go to a hospital and say they had a miscarriage.” He also claimed ER doctors should falsify medical records to hide adverse events. Other pro-abortion organizations, like Plan C, also coach women to lie and claim they are experiencing a natural miscarriage, should they require medical attention.

Of note, previous studies in both the UK and the United States have shown that approximately 5-6% of women who took the abortion pill were treated at hospitals for complications, and needed treatment due to incomplete abortions.

But given that women are routinely coached not to tell follow-up doctors dealing with complications that they have taken the abortion pill, how accurate can any of the adverse event numbers really be?

“Access” Before Safety

Even if we assume the numbers obtained by this study are sound, a large number of women would be adversely affected by the implementation of an across-the-board no-test protocol. The study authors report a ~5% rate for incomplete abortions; if we apply that to the total estimated number of chemical abortions per year (465,000), we arrive at an estimated 23,250 women presenting with failed chemical abortions every year in this country alone. 

Similarly, the authors report a .54% rate for “major adverse events.” Applying that number to the total estimated number of annual chemical abortions produces an estimated 2,511 women experiencing a major adverse event annually.

Their ectopic pregnancy numbers are equally troubling (emphasis added):  

In this study, the ectopic pregnancy rate of 2 per 1000 suggests that the screening procedures used by the participating clinics will not triage all patients with ectopic risks to ultrasonography before the abortion. However, the potential benefits of expanded access, increased convenience, and earlier treatment conferred by removing testing requirements may outweigh potential risks of delayed identification of ectopic pregnancies. 

They are literally suggesting that the nearly 1,000 annual ectopic pregnancies that would go undiagnosed if the no-test protocol became standard – every one of which would be potentially fatal – might be an acceptable sacrifice if it means they can expand abortion. 

The abortion industry consistently places “access” above women’s safety.

We mandate independent trials for drug efficacy and food safety, yet we presume that abortion profiteers will produce more reliable science about the very product they sell than truly independent researchers. In no other industry would we accept the fox-guarding-the-henhouse status quo we afford the abortion industry. This study is yet one more example of the sloppy, biased “science” we should expect such a situation to produce.

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