tech mandates and reproductive care

I never cease to be astonished by how smarmy politicans can be: today, leaders in the Smarm Community, the anti-choice people (‘pro-lifers’). The latest RU-486 story in the NYT, sensationalistically titled “2 More Women Die After Abortion Pills”, covers two recent RU-486 deaths (two, for a total of five; four of which were probably infection-related). Naturally the pro-lifers jumped on it, using the opportunity to pontificate piously and misleadingly. Here’s “Concerned Women of America” policy director Wendy Wright:

“Sadly, people who support RU-486 apparently believe the risk of death is preferable to having a child.”

Wright’s politicized sorrow obscures the facts, some of which are included in the NYT article. It turns out that these two deaths are from infection after RU-486 abortion, and, statistically, the deathrate from infections after childbirth and abortion remains consistent across procedures and methods. [The NYT article fails to mention anything in response to this misleading quote; I would have thought that the risk of death from 'having a child' would have been appropriate here. The risk of long-term health problems, considerably greater for childbirth than for any method of abortion, might also have improved the article. But ranting about the NYT is a task for another day. For many other days.]

Politicized Research

The statistics are unsurprising, but in the politicized world of abortion statistics you would have difficulty verifying the data, or trying to flesh out Ms. Wright’s statement. For instance, if you googled something like ‘childbirth abortion mortality rates’, you could see that Google has been successfully bombed by a flood of political sites on the topic (largely anti-abortion). You have to get to the second page of results before you actually start seeing any material from the medical community.

A search of PubMed proved much more helpful. The scientific literature largely treats abortion, pregnancy, and birth control as part of a continuum of family planning and reproductive outcomes — what I’ll call the reproductive medicine approach. This makes sense. Research that seems tailor-made to proving somebody’s point about abortion (from whatever perspective) is just inherently less trustworthy.

The reproductive medicine approach makes clear that when the government gets involved in restricting women’s reproductive choices there are clear medical consequences: Whatever the risks of specific procedures, techniques, and reproductive outcomes, what’s really risky is lack of access to family planning and contraception. Unplanned pregnancies are, ultimately, the cause of most pregnancy & childbirth-related mortality, by leading to high-risk pregnancy, or in many countries, illegal or quasi-legal abortion. In the US, for instance, restrictions on abortion delay many women’s access to the very safe first trimester abortion, perversely leading to more late-term abortions. But the message from those who would politicize and involve the government in individual medical decisionmaking, is never about healthcare or policy, probably because the healthcare policies they would propose would be unacceptable to most people. Instead, they focus on particular technologies, techniques, and procedures — effectively establishing technological mandates and prohibitions.

Technological Mandates Are Bad Government

It’s almost never a good idea for the government to establish technological mandates. Technological developments are notoriously difficult to second-guess or steer; tech mandates all too often exemplify the law of unintended consequences [Library of Economics, WikiPedia]. Whenever Congress or state legislators try to take aim at specific technologies, they end up effecting a lot of other changes, scattershot. And any technologically specific law is bound to be out of date very quickly.

We usually think of tech mandates & prohibitions in geeky areas, like copyright: the DMCA (thou shalt not tamper with copy protection measures, etc.); DAT (digital audio tape recorder manufacturers shall include copy protection schemes); broadcast flags (thou shalt include broadcast flag recognition technology in video recorders). But the same impulses are clearly at play in the politics around abortion and birth control. And as in copyright, politicians’ attempts to mark out this or that technology, technique or method as sinful and wrong is bad policy. The politicization of this or that reproductive medicine technique (most recently emergency contraception and intact dilation and extraction, or so-called ‘partial-birth abortion’) only hampers attempts to improve reproductive medicine and outcomes for women, infants, and their families.

Abortion is only the most obvious example. Legislators do nobody any favors when they start toying with technological mandates in any field.* Look at the recent Congressional hearings on stem-cell research. Saletan in Slate tried to put a good spin on it: These guys are working really hard & exploring the issues; isn’t that nice? Yeah, that’s nice from a personal growth standpoint, but the problem is these guys are making laws about very specific techniques, and they have no clue what they’re talking about, much less doing. They don’t understand biology, they don’t understand genetics, they don’t understand development.

But Congress members do understand policy-making, and one might argue that they understand ethics. Well, err, anyway, they understand policy-making. So if Congress members feel they must Take Action, then I have a suggestion for them: Do what you know — make policy. Set out broad principles of respect for life (which includes the lives and health of women as well as the lives of their potential children) and autonomy. Fund research into family planning methods that enhance autonomy and health. Make principled statements that are general about no wanton cruelty (or whatever) in harvesting stem cells. Skip the specific tech mandates.

Then Congress could let the NSF & NIH apply those guidelines when funding specific grants. That’s what regulators & grantors are good at: reviewing specific proposals to see if they fall within general guidelines. And Congress could let the courts interpret those terms in the course of litigation. That’s what courts are good at: reviewing the facts of particular cases, heartwrenching, difficult cases, and figuring out how to apply broad principles. And Congress could stop grandstanding and micromanaging cases (like Schiavo) and technologies (anything to do with biology, family planning, and copyright protection is by definition a Bad Idea for Congress to muck with — others no doubt will occur).

follow-up: 2005/7/25: The AP version of the story also pointed out that the women who got the infection and took the drugs may not have followed FDA-approved instructions.

The agency also said the four deaths occurred among women who were treated at clinics that didn’t follow FDA-approved instructions for the two- pill regimen. Although the FDA stressed that it could not prove that the “off- label” use was to blame, its new public health advisory warns doctors of the possible link to such use.

The fifth death followed a ruptured tubal pregnancy, a dangerous condition and type of pregnancy that the drug does not terminate.

Geez. Could the NYT article have been any less informative?


* For that matter, technological mandates & prohibitions really might be considered a subspecies of micromanaging generally. The Terri Schiavo fiasco demonstrates why legislators should stay out of individual cases, and far, far out of medical decisionmaking.