The Colorado Medical Board’s rules regarding abortion pill reversal, or APR, suddenly changed from “not unprofessional conduct per se,” to being considered outside the “generally accepted standards of medicine.” I ask board members, were you following the science, or bowing to political pressure and money?   Abortion is a lucrative business.

Although Planned Parenthood is a nonprofit in name, it is quite profitable and has a well-funded lobby to keep abortion profitable for them. Make no mistake, this is about abortion at all costs (to women and society), not about women.

Medication abortion typically involves first taking mifepristone, which reversibly binds to and therefore blocks the progesterone receptor. Progesterone is necessary to maintain the uterine lining and placenta, which provide nutrients and oxygen to the developing baby. One to two days later, she takes misoprostol, causing uterine contractions to expel the baby and placenta, and reducing the chance of the baby surviving.

Senate Bill 23-190 – passed by the legislature last spring and signed into law by Gov. Jared Polis – asked the Boards of Medicine, Pharmacy and Nursing to determine whether APR meets the generally accepted standard of medical practice. Every medical condition must have a generally accepted standard of care.

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When a woman changes her mind about her medication abortion after taking mifepristone but before misoprostol, there are only two possible approaches.  The first is “expectant management”: omitting the second drug, monitoring the patient, and hoping for the best. Historically, this will result in a 10% to 23% embryo/fetal survival. The second approach involves administering natural progesterone to dislodge mifepristone from the progesterone receptors and mitigate its abortifacient effects. Based on several pieces of evidence including a large case series, this may result in a 63% to68% survival rate. This is a dramatic improvement in the most important clinical outcome – mortality.  This alone would justify its characterization as a generally accepted standard of care – even if the evidence it rests on is not derived from randomized clinical trials – the highest level of evidence.

APR is a new treatment. All new treatments begin the same way, and APR is no exception:

• A question;
• Research and a hypothesis – predicting the outcome of a new treatment;
• Testing, and collecting data to analyze;
• Evaluating whether the hypothesis is supported or refuted by the evidence;
• Sharing this knowledge (published research);
• Continuing to evaluate to confirm or refute the hypothesis (“correction”).

Thorough evidence has been provided to the Colorado Medical Board for both safety and effectiveness of APR. To summarize:

• Manufacturer studies revealed mifepristone binding is reversible.
• Animal studies revealed progesterone can reverse mifepristone’s effects.   
• The FDA, American College of Ob/Gyn (ACOG), American Society of Reproductive Medicine, and many studies have confirmed natural progesterone is safe during pregnancy. 
• Case series revealed a more than doubling of fetal survival.
• The reality of more than 4,500 lives saved through the Abortion Pill Rescue Network.

ACOG’s and Planned Parenthood’s only remedy is “expectant management.” This recommendation is only based on “consensus and expert opinion,” the lowest level of evidence. APR has a higher level of evidence for both safety and efficacy. “Expectant management” appears to be neither safe nor effective, associated with a higher risk for hemorrhage and surgery, and more than doubling fetal death compared to progesterone.

The opponents of APR appeared to rely on ACOG opinions – not a thorough review of contemporary evidence (in comments submitted to the boards).

It is the professional and ethical responsibility of each member of the boards to evaluate the evidence, without political agenda or bias. What is at stake is a human life, and a woman desperate to save her baby. We have a safe and effective treatment. Who would heartlessly deny her this option, and only offer a more dangerous and less effective option?

The Reproductive Health Equity Act, passed by the legislature last year, enshrined a woman’s right to choose to continue her pregnancy. Does her “right to choose” under Senate Bill 23-190 now only apply to abortion? This is gaslighting and an utter lack of respect for women’s capability to make informed decisions.

Catherine Wheeler, M.D., is a board-certified OB/GYN who practiced for 24 years in Utah and now resides in Colorado.