The 2013 AAPLOG educational meeting in February 23rd featured a number of outstanding speakers. Named after Matthew Bulfin, AAPLOG’s founder, the 12th educational symposium delved deeply into behavioral aspect of reproductive health, reproductive biology, medical ethics, clinical aspects of women’s health care, and psychological effects of abortion. Our conference was enriched by the presence of 22 medical students, some of whom drove many hours to be with us. Jokin DeIrala, Professor of Epidemiology at the University of Navarre, introduced us to the best thinking on epidemiology in reproductive health in an absorbing presentation. Mainstream assumptions in reproductive health are ideological and not evidence based. He emphasized that risk avoidance is an accepted strategy regarding smoking and seat belts, but not HIV AIDS. The behavioral strategies of abstinence and life-long monogamy are proven HIV prevention methods and have great potential for a large part of the population. A condom strategy for HIV merely provides risk reduction for HIV, and may even increase the incidence of infection due to increased sexual activity (risk compensation) because of false perception of protection. Dr. De Irala also pointed out the true meaning of studies of sexual debut (first age of intercourse) which was an eye-opener to most in the audience. He and his team examined sexual debut in El Salvador, Peru and Span. In El Salvador and Peru fewer than 50% of adolescents were sexually active by age 18-19. Yet the mean age of sexual debut is in the range of 14-15, but this is only among those who are sexually active; this calculation does not include the majority of teens who remain virgins. So this statistic can give a completely false impression to some 15 year olds, who may feel abnormal that they are not sexually initiated, even though the majority of their peers are virgins! Another very important concept we learned was “segmentation” in public health education. A serious mistake of the AIDS establishment has been to give the same message to 13 year old girls as to sex workers – “use a condom!” Condom distribution as a universal strategy is a proven failure, especially in Africa, causing millions of unnecessary deaths. Freda Bush, in a talk echoing her new book Girls Uncovered discussed how educational administrators, social leaders, and many parents have withdrawn from the role of protecting young women, who are vulnerable. In the past, parents and older adults guided young adults toward making wise decisions regarding sexuality and marriage, but this is no longer the case. The media assaults youth with contrary messages. Dr. Bush reviewed newer brain research that confirms that the prefrontal cortex, the portion of the brain guiding sound judgment, is not fully developed until the mid-twenties. In addition to sexually transmitted infections and unintended pregnancy, girls are especially vulnerable to depression and later marital breakup as a consequence of premature sexual activity. Byron Calhoun apprised us of the prevalence of substance abuse among pregnant women – much more common than many people would assume. He recommends universal screening as the standard of care. This is done in his community collaboratively by both clinics and private physicians. He busted a number of myths about addiction to opiates during pregnancy. He demonstrated that it is much better for the mother to be slowly weaned off the addictive substance than to assume “maintenance” is less risky. Neonatal withdrawal is difficult and painful, and can be avoided if substances are gradually withdrawn from the mother before delivery. This takes knowledgeable supervising physicians, and counselors as a support system for the patients. Dr. Calhoun was particularly critical of methadone and buprenorphine programs that merely hand out the drugs, and have minimal or no counseling or treatment. These programs substitute much more addictive substances then the typical prescription drugs the patients are using initially. The babies end up sicker in these programs, and with their mothers’ substance problem worsened. Nathan Hoeldtke introduced us to genetic screening as it will be practiced in future decades. The most significant of new developments is the detection and analysis of cell-free DNA in maternal blood. As early as 10 weeks, 99% of Down syndrome fetuses can be detected with this technology. The technology is sufficiently advanced such that the entire genome of a fetus has been sequenced from cell-free DNA from maternal blood without paternal DNA. Although not yet standard of care or covered by insurance, this testing is offered now at some university centers. It is sobering that this test is so quick and easy in early pregnancy, and could easily be added to standard prenatal panels without adequate informed consent. This test has the potential to essentially eliminate other more invasive forms of prenatal testing for Down syndrome. Sister Mary Diana Dreger, an internal medicine physician and bioethics expert, gave an unusually lucid explanation of why physicians are not just technicians. Physicians are capable of appreciating moral truth and discerning the difference between good and evil. Just because a technology exists does not mean that it should be utilized. Physicians can perform actions expressive of societal values but these are not specifically medical ethics. Joseph Stanford gave an excellent presentation on the menstrual cycle and what is known about fertility. He explained the bases for the various types of natural family planning programs, as well as presenting fertility therapies based on current knowledge. He gave us examples of variability in pre and post-ovulatory portions of the cycle, as well as evidence of the poor knowledge most women have regarding their fertility. His research has shown that many women are interested in natural family planning, regardless of religion, educational level or income. He also gave examples of excellent outcomes of current fertility therapies (NaproTechnology) based on natural family planning, compared to assisted reproductive technologies (IVF). David Prentice updated us on new research in stem cells including both embryonic and adult stem cells. To date there are no useful therapies from embryonic stem cells (ESCs), despite enormous infusions of money. Even proponents of ESC research now admit that earlier promises of cure were overstated and the real results are “decades away.” Problems with the oncogenic and uncontrollable nature of ESC’s have not been overcome. A number of institutions such as Geron Corporation have discontinued ESC research after initially promoting it for cancer therapies. Others, including early proponents of cloning, have renewed emphasis on adult stem cell research, using reprogrammed adult stem cells. Dr. Prentice gave examples of a growing number of successful therapies utilizing adult stem cells, including reversal of diabetes, improvement of quadriplegia, and therapeutic growth of heart and bone tissue. One of the most intriguing treatments was spray-on stem cells for use in burns. Thea Ramirez gave us an update on adoption. She emphasized that adoption can be a very healthy and life affirming solution for young women with an unplanned pregnancy. Currently 10 abortions occur for every adoption, largely due to misperceptions and myths about the harmful psychological effects of adoption on the birth mother and adoptee. Both adoption and abortion involve losses, but the loss for a woman in abortion is greater and permanent. Studies have shown that young women, whose babies are adopted, compared to those who become single parents, are more likely to complete their education, be employed, and get married; they are less likely to have a repeat out-of-wedlock pregnancy and become divorced in later marriages. Priscilla Coleman addressed psychological morbidity of birth compared to abortion for the woman faced with an unplanned pregnancy. The most well established risk factors for psychological problems with abortion include coercion, religious views valuing life, ambivalence about abortion, bonding to the fetus, young age, and conflicted relationships with others, as well as pre-existing mental health issues. Coleman’s own current research is underway studying long term effects on women who have undergone abortion. 3% strongly agreed and 8% agreed with the statement that they made realistic attempts to take their own life. 14% strongly agreed and 28% agreed with the statement that because of the abortion they stopped taking care of themselves; 73% of those affected said that this effect lasted three years or more. A study emerged from France (Roussett, 2011) indicating that women undergoing medical abortion experienced significantly more serious adverse effects such as PTSD (38%) compared with those undergoing surgical abortions, consistent with earlier studies. In contrast, motherhood offers physiological and psychological benefits including improved neural circuitry and brain development, as well as protection against suicide. Some benefits, including being overjoyed with their pregnancies just prior to delivery, occurred with both planned and unplanned pregnancies (87% and 79% in Deave, 2005). Vincent Rue provided us with an overview of studies of the effect of abortion on men. There is limited funding for this politically incorrect field of inquiry since abortion is supposed to be a “woman’s issue.” Nonetheless, men can be profoundly affected by abortion. The most common feeling is overwhelming helplessness, as well as grief. Men tend to suppress their emotions to support their partners. He also discussed how abortion is a major stressor on relationships; higher levels of verbal and physical violence are found following abortion. Both men and women exhibited an increased tendency to engage in impersonal sex following abortion (Coleman et al. 2008). Dr. Rue proposed that a significant constellation of symptoms in couples could be termed PARS, or post-abortion relationship syndrome. Criteria would include a psychologically traumatic abortion experience inducing horror, fear or helplessness; re-experiencing the abortion through dreams or intrusive thoughts, flashbacks; symptoms of avoidance and detachment; symptoms of arousal such as insomnia, irritability, hypervigilance; and impairment in intimate relationships.
AAPLOG, February 2013: Research and Strategy Meeting Summary
The Matthew Bulfin Educational Symposium was preceded by the annual research and strategy meeting on February 22nd. New literature on preterm birth by Byron Calhoun, who reminded us that there are now 137 papers documenting a statistically significant risk for preterm birth after abortion. In a new paper by Klemetti in 2012 with impeccable data from Finland, we find that the most significant increase in risk is in very preterm birth (< 28 weeks) with 69% increased risk after >/=2 and 178% increased risk after >/=3 abortions. Joel Brind reviewed new research on the abortion breast cancer link from China, which is on the brink of a burgeoning breast cancer epidemic. Because abortion is so prevalent in China, interpretation of epidemiologic data is difficult. Women who have NOT had an abortion are atypical and higher risk in other ways, which makes comparison with more typical women with an abortion history more problematic. In a presentation on psychological effects of abortion, new research, especially the effects of coercion, was discussed by Priscilla Coleman. Michael New, in a social science research update, reinforced that the wording of surveys can greatly affect the outcome of calculating “pro-choice” and “pro-life” percentages. A Rasmussen poll in November, 2012 appeared to contradict the historic shift of the majority of the American public from pro-choice to pro-life in a May, 2012 Gallup poll. New stated that this was just a matter of semantics, and a true shift toward the pro-life position is occurring, especially in those under 30. Donna Harrison discussed the types of abortion studies, and the difficulty of securing accurate statistics. Of note is that some studies on abortion in countries where abortion is illegal are promoted and funded by pro-abortion groups in the U.S. such as Guttmacher and IPAS, and produce distorted, biased and unreliable conclusions. The research symposium was privileged to have two speakers from the MELISA Institute (Molecular Epidemiology for Life Sciences Accountability, www.melisainstitute.com) in Chile, Elard Koch and Paula Aracena. After Dr. Donna Harrison discussed MELISA’s new article in the International Journal of Women’s Health (http://www.dovepress.com/articles.php?article_id=11688) re-evaluating abortion related mortality in Mexico, Dr. Koch discussed the biological plausibility of detecting eight biological markers for pregnancy immediately after fertilization as did Dr. Aracena, who reviewed state-of-the-art proteomic approaches to identify novel biomarkers. Dr. Koch also gave an update of new research on potential embryonic and fetal interventions to reach “phenotype reprogramming” in Down syndrome babies. The strategy portion of the meeting included Denise Burke, William Saunders, and Charmaine Yoest of AUL, and Steve Aden of ADF, reviewing judicial decisions. Anna Franzonello of AUL discussed life-related legislation; Matt Bowman of ADF reviewed conscience rights in light of the Affordable Care Act (Obamacare). Wendy Wright, Rebecca Oas and Marie Smith updated us on the monumental efforts taking place by numerous organizations to impose abortion on developing countries, diverting resources from genuine medical needs. Mark Rienzi gave a helpful presentation for physicians preparing for depositions. The case of a pregnant woman in Ireland who died of E. Coli sepsis was reviewed in detail by Eoghan de Faiote, who stated that reports that the woman or her husband had requested an abortion were inaccurate. Additionally, there is no evidence to date that pregnancy termination would have saved her. A virulent strain of E Coli in Ireland was the cause of this and other deaths, and there is as yet no conclusion as to the source of the bacteria. Dennis Sullivan and Gifford Grobien gave illuminating ethical analyses of this case and of difficult maternal/fetal situations. Following the strategy meeting, in a special seminar Germain Grisez engaged us in a compelling discussion of moral ways of acting in life-threatening medical conflicts, with regard to traditional Thomistic and natural law analysis.