From Koop to RFK Jr.: The Dangerous Manipulation of Science
This commentary is a repost from “Sex on Wednesdays” by Martha Kempner on Substack. Find her other articles on The Queen Zone here.
Good Science Makes for Bad Politics
C. Everett Koop, the Surgeon General under President Ronald Reagan, was a controversial figure from the moment of his nomination. A pioneering pediatric surgeon, Koop was adamantly anti-abortion. Dr. Koop once said, “How could I ever accept the destruction of the unborn after a career devoted to the repair of imperfect newborns, knowing the joy and fulfillment they brought to their families?”
Koop became a favorite of the burgeoning “pro-life movement” in the late 1970s after a book and speaking tour in which he and theologian Francis Shaeffer argued that allowing abortion because a baby was “unwanted” would pave the moral ground for euthanasia of disabled or elderly people. (Oh, that slippery slope.) Evangelicals, who were just gaining political power, were pleased with his nomination for Surgeon General in 1981 because they did not think Reagan himself was committed enough to banning abortion.
The left, on other hand, felt that Koop was a dangerous and ideological choice. They also pointed out that even though he was a surgeon, he had no public health experience. (Oh, how our standards have fallen.) The New York Times ran an editorial headlined “Dr. Unqualified,” the American Public Health Association argued we’d be better off with no Surgeon General, and Senator Ted Kennedy said Koop held “cruel, outdated, and patronizing stereotypes of women.
When he did take his post—after eight months of confirmation hearings—everybody was surprised. He didn’t touch the issue of abortion at all during Reagan’s first term later saying that he saw it as a moral issue that was outside the purview of his office. (Oh, for the days when.) He took on big tobacco and got warnings put on packages of cigarettes. Most importantly, he took a commonsense approach to the emerging HIV epidemic. Unlike others in the White House who were flippant and cruel and suggested quarantining gay men, Koop argued for confidential testing, condom use, and widespread education (including sex education starting in third grade).
Toward the end of his second term in office, Reagan dragged Koop into the abortion debate. He asked the Surgeon General to write a report about the psychological effects of abortion on women. Reagan was looking to throw a bone to the Far Right who thought he had not done enough to restrict abortion. Koop wrote in his autobiography that he was naïve at the time and didn’t understand that Reagan expected him to use this as an opportunity to vehemently oppose abortion. That’s not what happened.
He approached the report as a scientist. He interviewed experts and activists on both sides and read what little research there was on the topic. He came to believe that anti-choice groups deliberately distorted the science. After months of research, he concluded that there “… was no unbiased, rigorous scientific research on the effects of abortion on women’s health that could serve as the basis for a Surgeon General’s report on the issue.” He never wrote the report.
Many believe that this decision, along with his vocal actions on AIDS, is what prevented the George H.W. Bush Administration from appointing him Secretary of Health, a position which he wanted. (Oh, how good this would be right now.)
Editorial credit Ringo Chiu via Shutterstock.com
As of last Thursday we have a new Secretary of Health. He is not a man of science. He is not a man of integrity. He has said that he supports access to abortion up to the point of viability, but he also said that he wanted to work for Kamala Harris. Neither side of the abortion debate trusts him to be impartial or stick to his word.
In a move that seems to echo history, Trump has asked RFK, Jr. to study the safety of mifepristone. The President claims he has not yet decided whether to restrict access to the embattled abortion drug.
If RFK, Jr. were to put out an accurate report on the safety of mifepristone he would explain that there have been five deaths per million uses since it was approved 2000. That’s a death rate of 0.0005%. He might also say that mifepristone is safer than penicillin (20 deaths per million) and Viagra (49 deaths per million). And he’d note that mifepristone comes with 0.31% risk of complications compared to 0.41% risk with a procedural/surgical abortion and 1.3% risk with pregnancy/childbirth.
Somehow, I can’t see this being the report he writes. He’s not naïve. He knows exactly what is expected of him. Moreover, with his extreme and entirely unproven vaccine positions, he’s demonstrated himself eager to warp science to fit ideology.
This is likely the first of many examples of what happens to research under a fauxtalitarian regime. (Did I just coin a new word?) They’re cutting funding, limiting topics, and dictating language. It’s going to get a lot harder for researchers to conduct studies and for the rest of us to interpret them. And there’s another problem we have to worry about: what happens when legitimate research plays into ideological talking points in a way even the authors did not intend?
This week I offer two stories where good science makes for bad politics.
From the Mixed-Up Files of Mrs. Mirena E. Mifepristweiner
Contraception is under attack from the left and the right. On the one hand we have the wellness TikTokers would like us to believe that all hormonal methods of birth control—and most methods we have available today do have some hormones in them—are terrible for body and soul. On the other we have the masters of Project 2025 who are systematically trying to take us back to the days where women were barefoot, pregnant, and quiet. Each side has gotten an inadvertent gift recently in the form of legitimate research.
Study #1 – Increased Risk: Correlation But Not Causation
The first is retrospective study of Danish women who have used hormonal birth control methods published in the British Medical Journal. It has long been known that hormonal contraceptives can raise the increase of stroke or heart attack, especially in people with pre-existing conditions, those with higher BMIs, and those who smoke. This study put real world numbers to that increased risk for a variety of hormonal methods. (Remember this is an observational study, and as such it deals in correlation but can’t go as far as to prove causation.)
It found that use of combined oral contraceptive pill (the kinds that use estrogen and progestin) was associated with double the risk of ischemic stroke and myocardial infarction (aka heart attack). This sounds terrifying until you look at the real-world incidence of these complications. The increased risk translates to one extra stroke for every 4,760 women using the combined pill for one year and one extra heart attack for every 10,000 women per year of use. That’s not nothing, but it’s also not reason for every woman in America (or Denmark) to throw out their birth control pills.
This study also broke down risk by type of hormonal contraception with some interesting results. The vaginal ring, which contains estrogen and progestin, was associated with a higher increased risk of both heart attack and stroke than pills with the same two hormones. This is likely because of its direct and continual release of hormones. But the patch, which also continually releases both estrogen and progestin, was only associated with increased risk of stroke. The progestin-only pills increased risk of both (though less than the combined pill), but the implant and injection which also contain only progestin were only associated with higher risk of strokes. In fact, for these two methods the risk of heart attack was not calculated because there were so few events.
Perhaps the most important take-away from this study is that hormonal IUDs like Mirena or Skyla were not associated with any increased risk. The authors note that these cause the smallest increase in serum progestin levels which may explain why they don’t increase risk.
This is a good study that adds to our understanding of the risk of medication and devices that millions of people around the world use. It’s important, and it’s going to be reduced to alarmist headlines that make both wellness influencers and Comstock enthusiasts giddy. I fear that neither side will spread this information in a careful, nonbiased way that helps women who are trying not to get pregnant.
Study #2 – Just Adding To The Confusion
Which brings us to our second study which is also legitimate (it doesn’t get more legitimate than the New England Journal of Medicine), and plays right into the hands of those who are “this close” to getting rid of Mifepristone and chomping at the bit to go after emergency contraception.
This new study looked at 133 women who sought medication abortions in Mexico City. Instead of being given the standard regimen of mifepristone and misoprostol, these women were given a double dose of Ella and misoprostol. All but four of the women successfully terminated their pregnancy without any further intervention. That’s about a 97% effectiveness rate.
Ella is the prescription version of emergency contraception pills. Like Plan B and its generics, Ella is taken after unprotected sex to prevent pregnancy. Ella is a little more effective than the other formulations, can be taken up to five days after sex, and works for people over 165 pounds (which the others often do not). Like other ECPs, Ella works by preventing ovulation: if there’s no egg, it doesn’t matter that there are already some sperm in the area.
Unlike other ECPs, Ella doesn’t use hormones similar to those in birth control pills. Instead, it relies on ulipristal acetate which is a progesterone blocker. (Mifepristone is also a progesterone blocker.) Researchers have said it highly unlikely that Ella (especially in the dose prescribed for emergency contraception) acts after fertilization to prevent implantation. Nonetheless, some people continue to argue (possibly while twirling their evil mustaches) that Ella must be an abortifacient. Remember in the world of real science, pregnancy doesn’t start until the blastocyst is nestled nicely in the uterine lining, so even preventing implantation wouldn’t make it an abortion drug, but the mustache twirlers don’t care about that.
And this study seemingly reinforces their arguments even though it doesn’t add much to our understanding of anything. First of all, the women were given a dose of Ella that’s double what’s used for emergency contraception. More importantly, they likely would have successfully terminated their pregnancies without Ella because they were given misoprostol. Misoprostol induces miscarriage by opening the cervix and causing uterine contractions. Misoprostol alone can be 93% effective with multiple doses.
To be clear, this study does not show that using Ella and misoprostol together is any more effective than using misoprostol alone, and it doesn’t show that taking Ella by itself will affect an established pregnancy.
What it does do is add to the confusion about which pill is which and what does what, and that is only good news for the Project 2025 types who don’t want us to have access to any of them.
