A forthcoming study in the journal Contraception (prepublication copy here) by noted abortion advocates takes a look at abortion pills which may be ordered online without a prescription in America. The authors say that while the certain of the pills may have been “substandard” and the ordering process “suboptimal,” this method is nonetheless “feasible” for women who want to chemically abort but for some reason either can’t or don’t want to go to the clinic.
That these deadly pills are being bought and sold online in the U.S. is a big deal, but not necessarily a surprise. The sale of drugs from online pharmacies, legitimate and otherwise, is simply a consequence of living in the internet age, however big an enforcement headache it might present for the U.S. Food and Drug Administration (FDA), the government agency charged with monitoring drug safety and efficacy.
That entrepreneurs with access to knock off drugs from foreign pharmaceutical makers might try to make a quick buck off desperate women looking for a cheaper, more convenient way of obtaining these nearly “magical” abortion pills they’ve heard about is, sadly, not unexpected.
What may surprise people, though, is the way the abortion establishment not only defends but promotes these online sales, and how this fits in with their long term plans for the abortion pill expansion in the United States.
What the study found
Researchers in four states (TX, WA, CA, and NY) acted as “mystery shoppers” (their own words) looking for abortion pills on the internet that sellers said they would ship to the U.S. Over a four month period from December 2016 to March 2017, they identified and ordered 22 products from 18 different websites.
The authors say that they received 20 out of 22 orders within three weeks of ordering, twenty which were combination mifepristone-misoprostol packets, the other two which were orders of misoprostol alone.
The standard chemical abortion now involves taking a single pill of mifepristone (RU-486) to shut down the supply of essential nutrients to the baby, then a second set of pills, prostaglandins named misoprostol, taken a day or so later, stimulate powerful uterine contractions to expel the tiny corpse. Some women, following the advice of groups like those involved in this study, have tried using the cheaper, easier to find, misoproprostol alone to abort, though this is less effective than the mifepristone-misoprostol combination.
Suppliers sold mifepristone-misosprostol packets for prices ranging from $110 to $360. Some were able to deliver in a week or less with a shipping cost averaging $25, while others charged as much as $171 for shipping or took 15 days or more to deliver Two of the four misoprostol alone packets were paid for but never arrived.
Researchers were able to use electronic checks, Visa, Mastercard, PayPal, Western Union or Bitcoin to make their purchases. Products from different websites sometimes showed up on credit card statements as being purchased from a single vendor. No matter the website nor the price, all of the combination mifepristone-misoprostol packets came from two Indian manufacturers, Zydus Healthcare (10) and Akums Drug & Pharmaceuticals (8).
Multiple problems were found with the shipments. None of the suppliers required a prescription or any relevant medical information, despite the fact that certain physical conditions render use of the drugs ineffective or dangerous. Pills were shipped without any instructions on use, though the pills are supposed to be taken in certain amounts and a certain order.
Some of drug packets came with small pinprick punctures that may have partially “degraded” or spoiled the contraction-inducing prostaglandin misoprostol used in tandem with mifepristone. Nothing on the packaging indicated they contained pharmaceutical products, much less chemical abortifacients, that required any special handling.
Though researchers posted links on the Plan C website to these sellers with grades for price, shipping time, and drug quality, they achieved their broader objective of demonstrating the presence of an online market for abortions pills.
How deep is the penetration of the American market?
As mentioned before, that a few unscrupulous entrepreneurs would try to turn a few quick bucks by selling knockoff abortion pills from a couple of rogue Indian labs is troubling, but not surprising. And that the internet is being used to sell drugs, legitimate or otherwise, is hardly new news.
Foreign companies began to develop generic copies of the new French abortion pill once they figured out the formula and saw there was market. By 2014, mifepristone was being sold under more than sixty different names from manufacturers in at least a dozen countries (NRL News Today, 9/22/14).
Actually, it is somewhat remarkable that there haven’t been more opportunists trying to cash in. Though it is clear that online sellers exist, most of the drug companies have publicly shied away from the American market.
It may be that the U.S. has had its own version (made in China) available for sale since 2000. Or it could be that an import restriction and an official warning from the FDA has frightened a few off (even a few of the suppliers in this study expressed concern to their “customers” that they concerned that they were being “investigated.”).
The Contraception study mentions three groups by name who have actively promoted on-line sales of abortion pills who say they will not ship to the U.S. – Women on Waves, Women Help Women, and safe2choose (we have written about two of these before – NRL News, January 2010 and NRL News Today, 4/18/17). Though they take orders for abortion pills on their websites, they say that they only make “information” available to women in the U.S.
This is the background against which this latest marketing study has been done. We do find out, perhaps, something about how easy (or not) it is to obtain abortifacients online in the U.S., but we certainly learn more about the intentions of abortion activists in this country.
Research with an agenda
To understand the point and purpose of the study one only needs to go as far as author list. Despite claims that the “Authors report no conflicts of interest,” two come from Plan C, a group whose online home page opens with the question “Did you know there is a safe, private option for an at-home abortion?” The other three are associated with Gynuity, a “research and technical assistance” organization specifically devoted to bringing products like chemical abortion to the world.
One of the authors, Beverly Winikoff, is not only Gynuity’s president, but prior to that, was part of the Population Council where she was instrumental in bringing RU-486, the abortion pill, to the U.S.
The abortion pill was developed because in the 1980s because surgical abortion had become increasingly unpopular among women. Clinics were closing, the ranks of abortionists were thinning, and abortions were dropping.
Chemical abortion offered the industry the chance at a new non-surgical alternative that did not require trained surgeons or expensive fully equipped surgical centers.
The abortion pill was approved in the United States in September of 2000, though at a specific dose (three pills of mifepristone, two pills of misoprostol), limited to pregnant women just 49 days past their last menstrual period, under the supervision of a physician and requiring three separate office visits.
From the very beginning, promoters of the abortion pill chafed at any conditions or limits on distributing or prescribing the pills. Though the distributor agreed to whatever limits they had to in order to obtain FDA approval, once it had that approval in hand, the industry (through the National Abortion Federation) put forward its own protocol relaxing the requirements. with an extended timeline reduced office visits and altered doses.
They altered doses, reducing mifepristone from three pills to one, boosting the misoprostol from two pills to four, and eliminated the return visit for administration of the prostaglandin. This gave women the opportunity to take the pills at home, and extended the cutoff to 10 weeks LMP – all measures the Obama FDA eventually accepted in 2016.
Even that was too much for some, who chafed at having to make an abortionist meet the patient and deliver the pills in person. This led to the web-cam abortion, where a woman’s screening and counseling takes place over a computer monitor and an abortionist in another city remotely triggers a drawer releasing the drugs there at some storefront location.
Groups like Gynuity and Plan C find even this too burdensome. They have sought instead to have the pills sold over the counter at the local pharmacies or to have these drugs sold over the internet and delivered by mail.
This is the context for this latest “study.”
Gynuity’s broader objectives
It is no coincidence that Gynuity has, over the last year or so, been involved in a separate study of its own (perhaps more correctly identified as a campaign) studying the “feasibility” of abortion by mail in Washington, Oregon, Hawaii, and New York. (NRL News Today, 11/15/16). Women in that study find Gynuity on the internet, do an online consult, make arrangements with a local doctor for certain needed tests, and then have Gynuity ship them the drugs via overnight mail.
This is, of course, quite similar to the process Gynuity and Plan C are examining here in the Contraception study, though with a few additional minimal safeguards. That makes this touted “scientific study” very nearly just basic marketing research or even competitor surveillance.
This helps to explain why the authors walk a fine line, raising issues with the product and practices of some of the random online abortion pill retailers, but not wanting to condemn the concept. They admit there were problems with some of the batches that they received and how these orders were handled but they want people to know that the idea is “feasible” and that there was “no evidence” that the pills sold online were “dangerous or ineffective.”
They don’t want to do anything to impede the market they’re hoping will be there if their study convinces the FDA to explicitly authorize this online mailorder method.
In other words, they admit that it’s all a bit messy with a couple of opportunistic marketers of Indian generics, but want to emphasize noone has gotten hurt (yet, as far as we know), and all these minor problems can be solved once the government authorizes on line sales and allows “responsible” groups like Gynuity, Plan C, Women on Web, Women Help Women and safe2choosej with ties to reputable manufacturers, to operate.
They also want to try and make the case that the market and demand for such a product already exist, that women have already shown that they are going to do this anyway and that the government might as officially authorize responsible groups like theirs.
Something else we learn: promoters of these pills aren’t worried about chemical abortion side effects and failures that have put hundreds of women in the hospital and are responsible more than a dozen deaths in the U.S. – even when the drugs were being dispensed under more rigorous conditions.
Their assurances, their minimizing of concerns about degraded drugs, drugs that took more than two weeks to be delivered, drugs that were ordered and failed to arrive should be less than reassuring.
They simply want these drugs out there, preferably through programs like theirs, so that it is easier for more women to have abortions, without the industry having to find and train more abortionists or build more expensive clinics.