AmericanPapist Comments
The issue won't be really addressed by American Bishops until this is attempted in Colorado or Missouri. Then the fireworks might start.
LCB is right, tho, Abp. Dolan is a very thoughtful thiker on such items, if I may put it that way. In fact, WI as a province is quite strong. Very much bears watching. And prayers.
"If there’s doubt of fact, you don’t act,” said Father Christopher Kubat, M.D
I don't see a problem with someone basing their moral choices upon this principle, and I think you will find a lot of support for it, as is evident from the debate after the Conn. Bishops spoke. I do not believe that is the actual standard though.
As for the Wisconsin Province, they are relatively young. Archbishop Dolan is very much a deliberate man, and he picks his fights very carefully. If I were to speculate, this is a case of not making the perfect the enemy of the good.
Fr. Kubat was an excellent doctor here in Milwaukeeand I am sure an even better priest. To bad we do not have him back here in Wisconsin.
WI as a province is quite strong.......??? In Milwaukee, Weakland's people still run the game. It is hard to have any faith or trust in people who have made a career of defending and paying off for the pervious archbishop's "other interests," reconfiguring the Faith, squandering the faithful's donations, selling of property and not to mention the payoffs for all Weakland's friends who got into trouble and on and on...
Margaret, do you know what a province is? And have you ever missed an opportunity to gripe about Abp. Dolan?
Though I'm deeply disturbed by WI and CT, I can't help but wonder... do the bishops discern a greater conflict coming, which they wish to save their ammunition for?
Ed, the possibility exists that Abp Dolan is not speaking out on this because the bill will not get through the Assembly.
But there's the "Rockford Protocol," too...which is a problem created by the Bishops (not Abp. Dolan)
A previously unmentioned study concluding that Plan B does act to prevent implantation of a conceptus, and some basic info on Plan B
to clarify our discussion:
Experts confirm abortifacient potential of morning-after pill
http://www.catholicnewsagency.co.../new.php?
n=9463
CNA STAFF, May 25, 2007 / 11:33 am (CNA).- The most recent scientific study on Levonorgestrel, the essential component of the “morning-after pill” or “emergency contraceptive,” confirms that the drug does indeed have a third effect on users, which consists in preventing the implantation of a fertilized ovum in the womb of the mother.
The promoters of the drug in Latin America, where most countries have laws against abortion, have argued that the there is no scientific basis for the “third effect,” and that therefore the drug should be legalized. Dr. Horacio Croxatto, professor at the Chilean Institute of Reproductive Medicine, said in 2006 that the morning-after pill “is not abortifacient because it only prevents pregnancy by stopping ovulation.”
Nevertheless, the most recent study (2007) by Doctors Mikolajczyk and Stanford of the Department of Medicine in Public Health of the University of Bielefeld (Germany) clearly indicates that the pill’s “real effect” includes mechanisms that prevent implantation.
Published by the magazine Fertility and Sterility, the study used data from multiple clinical studies with advanced mathematical models and concluded that if emergency contraception only inhibited ovulation its true effectiveness would only be in a range of 8-49 percent. If it acted before ovulation and if it inhibited ovulation completely, its true effectiveness would be between 16-90 percent. The rest of the pill’s effectiveness consists in its anti-implantation mechanisms, which cause an abortion.
The full text and abstract of this study can be found at Fertility and Sterility site,
http://www.asrm.org/Professional...ity/
fspage.html
accessible to members only or at
http://www.sciencedirect.com , full text for purchase. The ScienceDirect abstract follows:
Levonorgestrel emergency contraception: a joint analysis of effectiveness and mechanism of action
Rafael T. Mikolajczyk M.D.a, , and Joseph B. Stanford M.D., M.S.P.H.b
aDepartment of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
bDepartment of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
Received 12 April 2006; revised 30 November 2006; accepted 30 November 2006. Available online 22 February 2007.
Objective
To model the effectiveness that can be obtained if levonorgestrel -only emergency contraception (EC) acts only through disrupting ovulation, in relation to other effects that may occur before or after fertilization and accounting for delays in administration.
Design
We modeled follicular growth as a function of follicular size, using known day-specific probabilities of conception and
(cont. from previous post) known disruption of ovulation by levonorgestrel -only EC, to estimate the expected effectiveness of EC.
Setting
Combined data from multiple clinical studies.
Patient(s)
Simulation models.
Basic info on Plan B:
What is Plan B?
Plan B is emergency contraception, a backup method to birth control. It is in the form of two levonorgestrel pills (0.75 mg in each pill) that are taken by mouth after unprotected sex. Levonorgestrel is a synthetic hormone used in birth control pills for over 35 years. Plan B can reduce a woman’s risk of pregnancy when taken as directed if she has had unprotected sex. Plan B contains only progestin, levonorgestrel, a synthetic hormone used in birth control pills for over 35 years. It is currently available only by prescription
How does Plan B work?
Plan B works like other birth control pills to prevent pregnancy. Plan B acts primarily by stopping the release of an egg from the ovary (ovulation). It may prevent the union of sperm and egg (fertilization). If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B, Plan B will not work.
http://www.fda.gov/cder/drug/inf.../
planBQandA.htm
"Ed, the possibility exists that Abp Dolan is not speaking out on this because the bill will not get through the Assembly."
I take a more pessimistic view. I think the Wisconsin bishops have dropped their opposition because it's likely a futile effort and the legislature is going to pass it the bill regardless of the lobbying. I didn't blame the Connecticut bishops, and I don't fault the bishops of Wisconsin for no longer fighting what might be inevitable.
As a sidenote, when I was talking to Archbishop Chaput the other week and Dolan's name was brought up, I perceived in his voice a healthy amount of affection/respect for Chaput's peer, so I think Ed is right that Archbishop Dolan likely explored every option that might prove successful in this fight.
Like Thomas said, an authoritative message on this matter is sorely needed, and right soon.
It is impressive to see how seriously we Catholics believe in the highest value of all human life, even the smallest and even those who came into being through violent aggression.
There are serious flaws however in the scientific data that is used to conclude that Plan B (one or two high doses of levonorgestrel given orally within 72 hours of an assault) acts as an abortifacient in some instances.
The Mikolajczyk/Stanford paper is a model based on projections based on a WHO study with very imperfect data. Their study does not involve observations in actual women. The WHO study did observe actual women and estimated odds of conception based on the women's menstrual histories. These were often women who wanted free medicine to prevent an unwanted pregnancy. To give an idea of how inaccurate that data was, 4 of the women were subsequently found to be pregnant the day they took the medicine. Obviously, that recollection of first day of last normal menstrual period was a little off. Yet, is is the basis for calculating the effectiveness of Plan B.
The increase in ectopic pregancies with levonorgestrel is noted with daily dosing in routine oral contraceptives. Looking for this effect with Plan B, has not revealed such an increase.
Routine oral contraceptives in current doses are abortifacient some of the time. But they have a whole month to alter the endometrial (uterine lining) tissue. Plan B does not have that sustained time. Examinations of the tissue after Plan B does not show significant change. Examination of endometrial tissue of women on oral contraceptives does show change consistant with "hostility" to an embryo trying to implant.
The FDA does not say the pills are abortifacient, only that they "may" be. The FDA is the same agency that ok'd menopause hormones and vioxx without regard to heart disease. My point is that they are not the Magisterium and they don't claim to be.
Two recent papers that I recommend to all are:
Novikova, et al, Contraception, 75 (2007) 112-8 "Effectiveness of levonorgestrel emergency contraception given before or after ovulation-a pilot study."
And Lalitkumar et al, Human Reproduction, pp1-7, 2007. Be forewarned that the Human Reproduction article is based on highly immoral research. Although this can't be justified, it is worth reading in order to understand the issue before us regarding Plan B.
Mary, the Mikolajczyk/Stanford paper is a model based on multiple clinical studies. I am wondering if these multiple studies were all part of the WHO study. Where is this WHO study documented? Also if four of the women misrepresented their status, does this necessarily negate the statistical margin of error in mathematical models? Finally I wonder what the misrepresentation rate is in clinical studies that have not detected a abortifacient effect. Thanks.
John,
Good questions. The papers against abortifacient effect of Plan B don't rely on interviews but direct examination the drug effects on the subjects' bodies, including blood testing, ultrasound or biopsy and examination of endometrial tissue. So, patient recall is not a factor. No paper, of course has data to observe conceptions. But they do look at inhibition of ovulation. Which does occur if the drugs are given early enough. Since the presumed abortifacient effect would be damage to the endometrium that would make it difficult for an embryo to implant, several studies look at endometrium. No one has found changes to make implantation difficult.
The Lancet Vol 352, August 8, 1998 has results from the Task Force on Postovulatory Methods of Fertility Regulation. It's a study of 1,998 women in 21 studies. Their estimate of conception is based on work with healthy Americans. The WHO relies on patient recall for last menstrual period and length of cycles. There is minimal screening to assure any of the women are, in fact fertile, and no screening of male partners.
Thanks, Mary. So you are saying that the "multiple clinical studies" which the Mikolajczyk/Stanford mathematical model analyzed were exclusively WHO studies? Could you reference the documentation for this? Thanks. Studies have focused on endometrium changes as being a factor in preventing implantation -- I was wondering if these studies are based on results obtained from work with healthy Americans and how variances in subject history and health would impact levonorgestrel's effects. Also I wonder if studies have been done to determine if such high doses of levonorgestrel have long-term adverse effects on the conceptus, ie birth defects, or on the woman herself. But I guess long-term studies of levonorgestrel given in such large and rapid dosages are not yet feasible.
It sure would be great if we could have conclusive studies that have stood the test of time. Otherwise without such certainty Plan B still seems too great a risk for little (relative) gain. I just can't do it.
John,
Have asked my med. library to send another copy of the M&S study. WHO is the biggest study consistantly reference. I can double check if the paper sites anything bigger or more extensive. But in researching recently, haven't seen or heard of anything. Since, I think the "effectiveness" of Plan B has been over-called, I doubt that the political climate will make it easy to get a better study out any time soon.
If you check the papers I've referenced previously, you can see studies were done on Cental American women and tissue collected from Swedish women.
Regarding levonorgestrel having a lack of anti-ovulatory effect in different ethnic groups, not sure where you're coming from. Have you seen something like this with other synthetic hormone use? As far as assessing subjects health status, that's where the serum measurements come in, as well as history and exam.
Long term effects are of course not measured, although we have over a decade's worth of work to look at. And so far, so good.
As far as possible gain, in the Catholic world, we're talking about using levonorgestrel to interupt an ongoing sexual assault. Not repetitive use, hopefully. But to the assault victim, and therefore to us, as her brothers and sisters in Christ, a big potential gain.
I'd like absolute certainty also, but I don't get that very often in medical practice. Even treating hypertension is a use of best data we have. Not an absoute promise to any particular patient that treatment costs will be less than the benefits to them. And rarely, the risks include death from unanticipated drug effects.
Unlike you, I find the data gives me the moral certainty that giving Plan B to sexual assault victims is the best thing I can in the situation.
Thank you for the information, Mary. I will look into what you referenced. Yes, it would be great to have factual certainty when a wrong approach could result in needless human death.
The question of gain is the issue we have been discussing of course, including whether or not conception constitutes "an ongoing sexual assault." The discussion is conducted with a view, as her brothers and sisters, to the woman's best longterm interests. Do her interests automatically necessitate contraceptive measures? I have been surprised by the many comments and public statements that would say not to contracept, and this has given me pause.
John,
Received the full text of the M/S article and their first reference is the WHO study. I think this very much weakens their calculations efficacy based on expected pregnancies.
If you or anyone else finds an article on accuracy of urine LH testing shortly after coitus, please direct me to it. Since much of the Plan B for assualt victims discussion assumes ovulation testing in this setting is as accurate as it is for couples using NFP. Thanks,
Mary
Update:
Bps. Morlino and Listecki have REPUDIATED the Wisconsin Catholic Conference's 'green light' on the Bill in question based on being double-crossed.
They expected the Bill to contain a "conscience clause" and it was stripped out at the last minute.
Curious: Bp. Morlino went public with a letter and Abp. Dolan was NOT mentioned therein as 'supporting' his letter--nor was Abp Weakland, nor Bps. Morneau, Sklba, Fliss, (etc.)--a total of 9 who are absent...
I don't see how it is compassionate to give a woman who has been raped, a dangerous chemical such as Plan B! Pregnancy is not a disease, please!!!
Whereas Plan B is another dangerous assault on a woman's body! A woman is raped and then another assault is offered to her! What care and compassion! What about having enough police to protect women? What about going after the thugs who rape women? Why isn't all porn in the media banned since it feeds and fosters rape?
Here is manifested yet again the false attitude that the woman's body has to be 'fixed' or doctored with instead of protecting her from the thugs in the first place.
Doctors' discarded the Hippocratic Oath in the 70's here and that is why everything they say must be carefully scrutinized since as a group they have lost their credibility.
And yes, we should do no harm to the human baby. Drying up the lining of the uterus is certainly harmful to it. And this has been known for years. Back in the 80's MAP was banned because radical feminists exerted pressure in the US. But it was always OK for third world women since their fertility was seen as harmful to the US. Now the whole thing has been rehabilitated and repackaged as 'liberation' for American women. Apparently women's health takes a back-seat to preventing pregnancy.
The Bishops of Connecticut should be ashamed of themselves! They of all people should have true compassion for women! I don't expect it from the government or the medical establishment.
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