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Dr. Mitchell Creinin never expected to investigate the treatment he did not intend.
However, Creinin spent the next year or using a research proposal from the Family Planning Society to put the test a treatment he sees as suspicious – the one who recently acquired a traction , mostly through the Internet, in groups that conflict with abortion. They call it "abortion pill reversal."
The procedure – a series of oral or injected doses of hormone progesterone administered within a few days – has appeared outside the standard course of scientific analysis, says Creinin, a medical researcher and professor at the University of California , Davis.
Creinin, an OB-GYN, spent most of his family planning research career. She studied topics from various treatments for failure as women chose the way to control birth.
The practice of abortions, he says, is always part of his training and philosophy. "I need to provide these services to help women," says Creinin.
Advocates of "abortion pill reversal" say that it can stop an abortion-based drug for the first three months, if the progesterone is administered on time.
But Creinin said that progesterone treatments are ineffective in removing abortion that has begun. And, Creinin said, the promotion of treatment can be potentially harmful by giving pregnant women misleading information that an abortion can be withdrawn.
Even critics of abortion abortion say that the term is a proven mistake, written in the laws of many states.
Consumers in Arkansas, Idaho, South Dakota and Utah have made it a legal requirement over the years that doctors who provide Medical abortions should tell their patients that "reversal" is an option, although they do not stop telling patients if they feel that treatment is not working.
Medical researchers such as Creinin and the American College of Obstetrics and Gynecology are concerned with that trend.
"You are creating a law based on no science – completely zero science," says Creinin.
The advocates say that they have the evidence. But this is anecdotal, says Creinin, or comes from studies without strict controls.
In the first 10 weeks of a Pregnancy, women seeking abortion have two options: an operation or a drug-based abortion (then only make surgical abortion).
Treatment-based medicine uses a combination of two drugs – mifepristone and misoprostol – which women usually last 24 hours.
Mifepristone works by blocking progesterone, a hormone that helps in maintaining pregnancy. The second drug, misoprostol, produces a contract for the uterus, to complete abortion. Studies suggest that 95 percent to 98 percent of women who take the same prescribed lifestyle drugs will end in pregnancy without harm to the woman. Surgical postponement may complete abortion, if necessary.
So what happens if a woman takes mifepristone, then her mind changes and wants to continue with pregnancy?
If heart change arrives for the first time after he swallowed the initial drug, his doctor can help his vomiting. If he has not absorbed the first drug, the process can be stopped before it starts.
The bigger question, and the one where data is murkier, is: What happens if a woman takes the first drug but never goes
According to the American College of Obstetrics and Gynecology, "as The number of women who have taken mifepristone continues their pregnancies. " (If pregnancy continues, mifepristone is not known to cause birth defects, ACOG notes.)
During 2012, San Diego's physician George Delgado has had a chemical way of stopping the abortion process with greater certainty – a way to give more control over a woman who has changed her mind. He called his protocol "abortion pill reversal."
A family medicine doctor, Delgado called himself "pro-life," not anti-abortion. He said about a decade ago he was interested in a 24-hour window after a woman takes mifepristone but before taking a misoprostol.
He received a call from a local activist who said Delgado needed help from a woman. He swallowed the first tablet in the abortion regimen but was re-altered and did not want to end his pregnancy.
"People are changing their minds all the time," Delgado said.
Hoping to help her, Delgado gave her progesterone – a multi-drug drug, including treatment for irregular vaginal bleeding and as part of hormone replacement therapy during menopause. If progesterone is useful in other ways, Delgado considers it to be possible to stop progesterone-blocker mifepristone, and stop abortion.
Delgado said that the pregnancy of the first patient continues unconditionally, which he values in progesterone.
He then began giving progesterone treatment to more patients who came to him. He continued to build a network of clinics across the country who wanted to provide progesterone to patients who did not want to go through their abortions, although he did not say how many clinicians were part of his research.
days, Delgado says, most of the women who visit her for progesterone treatment are self referrals. While searching online, the website has been found for the Abortion Pill Rescue Network, a group of clinics nationwide that provide treatment. The network is backed by Heartbeat International, an anti-abortion rights group, and, according to spokeswoman Andrea Trudden, with more than 500 clinicians wishing to prescribe progesterone in patients who started the abortion process of medicine.
In supporting their claims regarding abortion recovery, Delgado and colleagues published their research on medical journals.
In 2012, Delgado wrote a Annals of Pharmacotherapy report on the experiences of six pregnant women who received mifepristone and then injected progesterone. Four of the women, said the paper, have brought their pregnancies into the term.
In a statement released in August 2017, ACOG said the results of the study, a type known as a series of cases that did not include the comparison team, "is not scientific evidence progesterone has resulted in continual pregnancies. " The ACOG statement also states: "The series of cases with no control group is among the poorest forms of medical evidence."
In 2018, Delgado and his colleagues in his healthcare network published a larger series of cases, this one involving 754 patients, the journal Legal and Medical Issues . The paper concluded that the return of the effects of mifepristone to progesterone "is safe and effective."
Researchers acknowledge that the study does not randomly assign women to receive a placebo or mifepristone. A study like this, called randomized placebo-controlled trial, provides substantial evidence. But Delgado and his colleagues say that doing this kind of test "to women who are sorry for abortion and want to save the pregnancy is not right."
"There is no alternative treatment," he said. "You can not always wait for [randomized, controlled trials] If it saves, there is no alternative."
State legislations take into account the abortion "abortion bills"
One of Delgado's critics, Dr. Daniel Grossman, an OB-GYN at the University of California, San Francisco, says that all published studies that support the use of this progesterone are interrupted by lack of techniques that promote the "success rate" of the treatment reversal.
October, Grossman and Kari White, a sociologist at the University of Alabama, Birmingham who are studying family planning issues, wrote an editorial in the New England Journal of Medicine revealing Delgado's research methodology, which states that he used flawed statistics and didn & # 39; Set strict criteria for the characteristics of patients to be fulfilled to include in the study.
"A systematic review that we included in 2015 did not prove that evidence of continued pregnancy is more likely after progesterone treatment compared to the expectation of women who took the mifepristone," they wrote.
"I think there's a big bias against the recovery of the abortion pill," Delgado said in reply. "ACOG indicates that bias by emission with strong statements. … It's a new science, but we have huge amounts of data, and it's proven safe."
Critics did not slow Delgado's supporters in 2019, state legislators – Kansas, Kentucky, North Dakota and Nebraska – are considering charges that require abortion providers to say their patients about abortion abortion. Returning to 2017, Delgado affirmed the same law in Colorado, although this measure never made it to law.
Grossman has said that he is a raging states that forces abortion providers to give their patients an inaccurate information related to abortion care.
Furthermore, Grossman says, "these laws take an extra step … and it is important that patients are encouraged to become a part of clinical research that is not necessarily monitored … It's really an experimental treatment. "  Progesterone is not checked by the Food and Drug Administration for the recovery of an abortion drug. Doctors are allowed to prescribe medicines for non-FDA-approved items as part of drug training. It is known as using off-label.
Until Delgado published his paper in 2018, Delgado told his patients that they were receiving a "novel treatment." He said he believes that there is now enough research to support regular off-label prescription progesterone for women who do not want to complete a drug based abortion.
"Now we have a huge amount of data There is no alternative And it's proven safe," Delgado says. "Why did not you give it?"
Although Creinin disagrees with the evidence supporting the use of progesterone, he agrees with the idea that women seeking abortion may be uncertain about the decision on their first appointment. Creinin said she supported policies that allow women to control as long as the decision about whether or not to terminate a pregnancy.
"Some people change their mind," says Creinin. "It's a normal part of human nature."
UCSF's Grossman agrees.
He encourages abortion providers, if possible, to send the home of mifepristone and misoprostol to the patient, if he asks for it. That way, he can start the protocol only and when he is ready, instead of making a decision at a clinic where he can feel. (FDA rules about mifepristone say that the pill can only be given to some types of clinics – usually abortion clinics. And some states have additional restrictions on how and where medicines may be prescribed and taken.)
test abolition return
Creinin's study, approved by the institutional review board of UC Davis in December, is registered in ClinicalTrials. gov, which tracks medical research.
Study is conducted to include 40 women between 44 and 63 days of pregnancy and are looking for a surgical abortion. As a condition of research, women should be prepared to get mifepristone, the first pill that normally replaces a medical abortion, then a placebo or progesterone.
After two weeks, researchers will find that there is a difference in continual pregnancy rates. If progesterone avoids the effects of mifepristone, says Creinin, he can see that more women in the progesterone group are still pregnant, with a growing pregnancy.
The main ethical point, the researchers say, is that all women in this study want to have abortion and get one by the end of the study. The study does not study women seeking "reversal." It tells them that if mifepristone does not motivate abortion, they will be given a surgical abortion.
Creinin says that study participants will be paid for their study time, but will not be paid for having an abortion. And patients are also responsible for the cost of surgery operations – either through their insurance or out-of-pocket.
There is doubt that Creinin with progesterone has any effect, since it is thought that mifepristone can not recover the progesterone in the body
But if it has a significant effect on the clinically, he says, "Would I know that. "
Creinin hopes that his work will help medical researchers better understand whether this type of treatment really helps women who change
If the results show that progesterone does not work, Creinin expects state lawmakers to slow down in giving doctors to tell their patients about ineffective treatment.
Creinin enrollment patients were enrolled in February. He is not sure how long the study is, but he says he's likely to have no initial results for at least a year.
Dr. Mara Gordon is the NPR Health and Media Fellow from the Department of Family Medicine at Georgetown University School of Medicine.