Sunday, March 18, 2012

Dear NH Senate: Please Stay Out of My Exam Room

I try to keep my practice of medicine and my politics separate.  I wish that others, specifically the NH State Legislature, would do the same.  Especially when the person introducing a certain bill A) doesn't have a license to practice medicine, B) clearly believes everything she reads on the internet, and C) has no idea what the hell she is talking about.

So, here we go (deep breath, stepping onto my soapbox).

I'm talking about HB 1659-FN. This bill was sponsored by Rep. Jeanine Notter (R- Merrimack) and was passed by the NH House on March 15.  It's called, apparently without a bit of irony, the Women's Right to Know Act.

Oh, where to even start with this...


I. “Abortion” means the act of using or prescribing any instrument, medicine, drug, or any other substance, device, or means with the intent to terminate the clinically diagnosable pregnancy of a woman with knowledge that the termination by those means will with reasonable likelihood cause the death of the unborn child. Such use, prescription, or means is not an abortion if done with the intent to:
(a) Save the life or preserve the health of an unborn child;
(b) Remove a dead unborn child caused by spontaneous abortion; or
(c) Remove an ectopic pregnancy.
OK, (a) (b) and (c) are also abortions.  They are.  I don't care what your intent is, the outcome is the same.  You don't get to change the definition to suit your political needs.

132-B:4 Informed Consent Requirement. No abortion shall be performed or induced without the voluntary and informed consent of the woman upon whom the abortion is to be performed or induced. Except in the case of a medical emergency, consent to an abortion is voluntary and informed if and only if:I. At least 24 hours before the abortion, the physician who is to perform the abortion or the referring physician has informed the woman, orally and in person, of the following:(a) The name of the physician who will perform the abortion;(b) Medically-accurate information that a reasonable patient would consider material to the decision of whether or not to undergo the abortion, including (1) a description of the proposed abortion method; (2) the immediate and long-term medical risks associated with the proposed abortion method including, but not limited to, the risks of infection, hemorrhage, cervical or uterine perforation, danger to subsequent pregnancies, and increased risk of breast cancer; and (3) alternatives to the abortion;(c) The probable gestational age of the unborn child at the time the abortion is to be performed;(d) The probable anatomical and physiological characteristics of the unborn child at the time the abortion is to be performed;(e) The medical risks associated with carrying her child to term; and(f) Any need for anti-Rh immune globulin therapy if she is Rh negative, the likely consequences of refusing such therapy, and the cost of the therapy.II. At least 24 hours before the abortion, the physician who is to perform the abortion, the referring physician, or a qualified person has informed the woman, orally and in person, that:(a) Medical assistance benefits may be available for prenatal care, childbirth, and neonatal care, and that more detailed information on the availability of such assistance is contained in the printed materials given to her and the streaming video as described in RSA 132-B:5.(b) The printed materials and streaming video in RSA 132-B:5 describe the unborn child and list agencies that offer alternatives to abortion.
 Informed consent is good.  I'm all for it. However, the key word is informed- meaning that people are provided with unbiased scientifically accurate information.  I'll get back to this whole breast cancer thing in a minute.  My problem with the above bolded material is that doctors are required to describe the "probable anatomical and physiological characteristics of the unborn child" and that the patient is required to watch a video that describes the "unborn child."  First of all, there is no medical need here.  The characteristics of the fetus are not really relevant to the procedure that the patient will undergo.  I have a problem with the term "unborn child."  It's a fetus.  That's the medical terminology.  "Unborn child" is unnecessarily inflammatory and political.  I have not seen the streaming video referred to in the bill, and I have searched everywhere online for it.  I can only assume, and I think it's a good assumption, that it has an anti-abortion bias, given the inflammatory term "unborn child," in its description.


OK, on to this whole "abortion causes breast cancer" nonsense.  This is what the bill says:
(e) Materials that inform the pregnant woman that there is evidence of a direct link between abortion and breast cancer. It is scientifically undisputed that full-term pregnancy reduces a woman’s lifetime risk of breast cancer. It is also undisputed that the earlier a woman has a first full-term pregnancy, the lower her risk of breast cancer becomes, because following a full-term pregnancy the breast tissue exposed to estrogen through the menstrual cycle is more mature and cancer resistant. In fact, for each year that a woman’s first full-term pregnancy is delayed, her risk of breast cancer rises 3.5 percent. The theory that there is a direct link between abortion and breast cancer builds upon this undisputed foundation. During the first and second trimesters of pregnancy the breasts develop merely by duplicating immature tissues. Once a woman passes the thirty-second week of pregnancy (third trimester), the immature cells develop into mature cancer resistant cells. When an abortion ends a normal pregnancy, the woman is left with more immature breast tissue than she had before she was pregnant. In short, the amount of immature breast tissue is increased and this tissue is exposed to significantly greater amounts of estrogen—a known cause of breast cancer. Women facing an abortion decision have a right to know that such medical data exists. At the very least, women must be informed that it is undisputed that pregnancy provides a protective effect against the later development of breast cancer.

I don't dispute that earlier pregnancy is associated with a lower lifetime risk of breast cancer. That's where my agreement with the above text ends.  The most influential article promoting this theory was written by one Joel Brind, PhD.  Full text here. This study was a meta-analysis, which is generally one of the weakest types of studies.  A meta-analysis pools data from a bunch of different studies, using that data to support or refute a new hypothesis.  A good summary of the advantages and weaknesses of meta-analyses can be found here.  This is an excellent critique of Brind's paper which outlines its many flaws.  Not surprisingly, anyone with an anti-abortion agenda was quick to latch onto these results.   Just as quickly, more research began to be produced, which almost uniformly refuted Brind's finding.  This is one of the best- it looks at the records of 1.5 million Danish women and shows no link between abortion and breast cancer. This is another excellent one.  It is a case-control study- meaning it matches cases (women who have had abortions) with matched controls (women who have not had abortions but otherwise have similar ages and medical histories).  It showed no link between abortion and breast cancer.  In 2003, the National Cancer Institute held a symposium on pregnancy, abortion, and breast cancer.  Dr. Brind was the only researcher who supported an abortion-breast cancer link.

Want more?  Here you go! http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17111259&ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12800205&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12646509&ordinalpos=35&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

There's still more.  Lots more.  If you would like links to them, please email me.


In summary, the scientific evidence is overwhelming- abortions do not cause breast cancer.

Representative Notter appears to have little understanding of medical science.  For example, she believes that birth control pills somehow cause prostate cancer in men.


She has a clear agenda.  I don't want her agenda in my exam room.  Neither should you.  No matter what your feelings are surrounding abortion, let's keep bad science and bad politics out of the doctor-patient relationship.

1 comment:

  1. If this passes, would they require a woman who is having an involuntary abortion, such as might be required for an ectopic pregnancy, to wait 24 hours and/or watch this video? What absurdity.

    ReplyDelete