NPR ran a story today on the Institute of Medicines report to be released tomorrow which will include a list of recommended services to be covered with no cost-sharing under the Obamacare law.

But there are a few key points that NPR did not include. The real issue is not about "birth control" as such but rather about specific contraceptives that can function as abortifacients, in particular, emergency contraceptives. This isnt a matter of opinion or political ideology. The FDA approved label for Plan B suggests it can prevent implantation of an embryo. Moreover, the most recently approved EC, "ella", is chemically similar to RU-486 and it may destroy an embryo after it is already implanted.

Additionally, this is a question of whether the government should mandate every health plan to cover these drugs free of cost. Whatever one's position is on the issues of contraceptives, abortifacients, and such, it does not matter whether proponents of such drugs do not care about the effect on human embryos. The point is that many Americans do care, and many religious health plans would care, and that they should not be forced to violate their conscience. Non-discrimination laws are in effect for this very reason. The IOM recommendations will potentially require people who are not in favor of these drugs to cover and participate in something they find objectionable. You don't have to agree with such objections, but at the same time people should not be forced to violate their consciences.

Here is our letter to HHS with more information.

And here is more information on ella, taken from my public comments at the second IOM meeting on January 12, 2011:

While the FDA approved the drug application of Ella as an emergency contraceptive, this drug is known to be chemically and functionally similar to the abortifacient drug, RU-486. In a study published this month in the Annals of Pharmacotherapy, the mechanism of action of ulipristal in human ovarian and endometrial tissue is identical to that of its parent compound, mifepristone.[1]

In one study of ulipristal on monkeys, 4 out of 5 fetuses were aborted.[2] On one with rats, all were aborted.[3] [E]xisting studies in animals are instructive in terms of the potential abortive effects of the drug in humans.[4]

A recent study concluded that it can be reasonably expected that the prescribed dose of 30 mg of ulipristal will have an abortive effect on early pregnancy in humans.[5] This is the dose of ulipristal now available as an EC in the United States.



[1] Harrison, D, Mitroka, J Defining Reality: The Potential Role of Pharmacists in Assessing the Impact of Progesterone Receptor Modulators and Misoprostol in Reproductive Health. Annals of Pharmacotherapy January 2011, Volume 45

[2] European Medicines Agency.CHMP assessment report for EllaOne. (Doc.Ref.: EMEA/261787/2009). London,UK. www.ema.europa.eu/docs/en_GB/document_library/EPAR_Public_assessment_report/human/001027/WC500023673.pdf (accessed 2010 Dec 9).

[3] Food and Drug Administration. Mifeprex label. www.accessdata.fda/gov/drugsatfda_docs/label/2000/20687lbl.htm (accessed 2010 Sept 26).

[4] Harrison, D and Mitroka, J Defining Reality: The Potential Role of Pharmacists in Assessing the Impact of Progesterone Receptor Modulators and Misoprostol in Reproductive Health. Annal of Pharmacotherapy January 2011, Volume 45

[5] Ibid