#991: Contraception and the Future of Medical Research
Of all the many “hats” I have worn over the past half-century - rabbi, political historian and speech-writer, author, blogger and essayist, occasional actor, professional “Hollywood Brat,” and medical ethicist - it’s this last one which has always given me the greatest sense of purpose, pleasure, and pride. Why? Well, simply put, it’s the one pursuit that has always given me the feeling that perhaps - just perhaps - I’m making a difference. I mean, week in, week out for more years than I can remember, I have been charged with the task of vetting medical research “informed consent” forms (ICFs) whose purpose is to safeguard the rights of men, women, and children who might well become volunteer participants in serious clinical trials. It is my job - along with a host of brilliant medical specialists, surgeons, scientists, and bioengineers who work for the Institutional Review company called Advarra - to further the aims of medical research in fields ranging from oncology and infectious diseases to gynecology, gastroenterology, and dozens of other ologies in the pursuit of progress. Indeed, it is the greatest of all honors to be the enemies of those who reject science . . . who believe that Dr. Anthony Fauci is a criminal who should be put in jail for crimes against humanity. We who gladly labor in the vineyards of medical ethics are the ones, after all, who were instrumental in making sure that various COVID-19 vaccines got into the veins of people in record time . . . thus saving tens of millions of lives.
This past Wednesday (June 5, 2024), while spending the better part of the day vetting several Informed Consent Forms (ICFs) dealing with trials concerning various diseases and syndromes, I was keeping an eye on a computer “crawler” keeping me up-to-date on a particular vote in the U.S. Senate; one dealing with the future of contraception. In order to understand just what it was that the Senate was voting on this past Wednesday, one must first recall something Supreme Court Justice Clarence Thomas wrote in his concurring opinion overturning Roe v Wade (Dobbs v. Jackson Women’s Health Organization et al ): “[The Court] should reconsider” all three decisions, saying it had a duty to “correct the error” established in those precedents (Griswold v. Connecticut, a 1965 decision that declared married couples had a right to contraception; Lawrence v. Texas, a 2003 case invalidating sodomy laws and making same-sex sexual activity legal across the country; and Obergefell v. Hodges, the 2015 case establishing the right of gay couples to marry.) Then, Justice Thomas wrote, after “overruling these demonstrably erroneous decisions, the question would remain whether other constitutional provisions” protected the rights they established.
The bill the senate was voting on this past Wednesday, was the Right to Contraception Act (S1999), sponsored by Massachusetts Democrat Edward Markey and cosponsored by nearly every Democrat in that body. Its purpose in being brought to the floor for an up-or-down vote at this particular time was as clear as clear can be: to force Senate Republicans (as well as those in the House where there is a companion bill) to go on the record as to whether they are for or against permitting women to have legal access to virtually any form of birth control (sans complete sexual abstention). From a political point of view - and in an election year - it was a great idea: make Republicans accountable. According to the national poll 538, “, . . . around 90 percent of Americans said condoms and birth control pills should be legal in “all” or “most” cases, and 81 percent said the same of IUDs (intrauterine devices). And, there is very little difference in support for the legality of each of these contraceptives across party lines.’ It seemed like a slam dunk for the Democrats.’
But what did the Republicans do? Instead of voting against Senator Markey’s bill and exposing themselves as a bunch of retrograde Luddites, they voted to block action on the legislation. Senate Republicans, aware that contraception access is overwhelmingly popular even with their own voters, pretended their “no” votes were meaningless. “This is a show vote. It’s not serious. It doesn’t mean anything,” said Sen. John Cornyn, R-Texas. More than 20 GOP senators signed a statement from Sen. Rick Scott, R-Fla., declaring “There is no threat to access to contraception… and it’s disgusting that Democrats are fearmongering on this important issue to score cheap political points.” Sen. Josh Hawley, R-Mo., baselessly claimed the bill could be applied to protect access to abortion pills. He also scoffed at the notion that Griswold v. Connecticut, the 1965 case that struck down state criminal bans on the sale of birth control to married couples, is in danger. “Nobody’s gonna overturn Griswold,” he said. “No way.”
What’s that old retort from childhood? Liar, liar, pants on fire . . . “ I have to believe that those Republicans old enough to remember this verse also remember its response: I don’t care, I don’t care; I can buy another pair. The final vote was 51-39 on this procedural issue that required at least 60 senators in order to move forward. But they are unwilling to go on the record; to put their votes where their mouths are, thus facing the political consequences of their cowardice. In the main, GOP lawmakers said the measure was too broad as well as unnecessary. Alaska Sen. Lisa Murkowski and Maine Sen. Susan Collins, both Republicans, broke with their party and voted to advance the legislation. Ohio Republican U.S. Sen. JD Vance didn’t vote.
At the precise moment the crawler on the bottom of one of my computer screens flashed the news about the failed vote, I was vetting an informed consent document on the efficacy of administering an injection of a particular drug SubQ (into the fatty tissue just beneath the skin, as opposed to IV - directly into the vein) for subjects with Multiple Sclerosis - a long-lasting (chronic) disease of the central nervous system which is thought to be an autoimmune disorder . . . a condition in which the body attacks itself by mistake. The object of the study I was working on was to see if a SubQ injection is as safe and clinically efficacious as the same drug when infused or injected into a vein.
As my eyes moved over to the screen with the crawler, I was reading through the section dealing with pregnancy; both the inclusionary and exclusionary criteria, and what forms of birth control must be used by women (and men) if they are going to be participants in the study. (n.b.: there are currently more than 1 million people living with MS in the United States; women are three times more likely than men to be diagnosed with this potentially debilitating condition.)
Just about any and every Informed Consent Form (ICF) contains a rather lengthy and all-encompassing section dealing with pregnancy. In most cases, pregnancy (or the ability to get a partner pregnant) is an exclusion . . . unless the potential subject of the trial or study uses one or more forms of birth control. Then the form will continue with a long list of various acceptable methods of control.
As I was scanning this section, half my brain was thinking about the vote just concluded in the U.S. Senate. Then it dawned on me: if birth control is (G-d forbid) outlawed, it likely lead to the utter dismantling of most future medical research. How so? Well, if one cannot prevent pregnancy (except via total abstinence) one cannot participate in most - if not all - clinical trials; and without the ability to conduct ethical, well-monitored medical research, few if any new drugs or treatments will ever see the light of day. I wonder if any of these “pro-birth” (my preferred term for what has heretofore been called "pro-life”) conservatives and anti-science conspiratorialists have considered this chillingly ironic political sequela (a medical term defined as “A pathological condition resulting from a prior disease, injury, or attack.”) As much as I would like to give the anti-birth control, anti science crowd the benefit of the doubt - i.e. that they haven’t considered the very serious real-life consequences of their political actions - I cannot; the fact of the matter is that the further they progress, the more medical science - and thus all of us - retrogress.
Not a day goes by without hearing that in 2024, Democracy, freedom, and the right to choose are all on the ballot. Those making this breathless statement are telling the truth. Now we can add another truth: in 2024, the future of both science and medicine are also on the ballot. Think wisely; be proactive; the future is ours to protect, so that we may all be protected in and from the future.
Copyright©2024 Kurt Franklin Stone