Wrangling Over Abortion Intensifies
As RU-486 Pill Nears the Market
By RACHEL ZIMMERMAN November 14, 2000
Staff Reporter of THE WALL STREET JOURNAL
This week, Danco Laboratories LLC is expected to begin shipping the
first commercial supplies of the early-abortion pill known as RU-486
to medical providers.
The move comes after years of controversy over the drug,
mifepristone, to be marketed as Mifeprex. And even as the pill
becomes available, it is clear that the wrangling, far from being
over, is intensifying.
Proponents of abortion rights are funding
projects to boost access to the drug regimen. Opponents, meanwhile,
are barraging doctors with mail noting potential hazards.
And after weeks of tense negotiations over the price of the pills,
Danco has decided to charge $270 for the three-pill regimen,
according to people close to the negotiations. That cost excludes
the price of another drug, misoprostol, needed to complete the
abortion, as well as a doctor's charge, counseling and other fees,
and is prompting criticism that the bill for doing a so-called
medical abortion is way too high.
"I wish the price was more affordable," says Vicki Saporta,
executive director of the National Abortion Federation.
Ms. Saporta says that her organization has been negotiating a lower
price for nonprofit abortion clinics. She adds that the federation
helped lobby Danco, which was formed to market Mifeprex, to reduce
the minimum purchase requirement of $3,000 the company initially
proposed. Danco wouldn't comment on the dispute. The company did say
that Medicare reimbursements and other insurance coverage are still
being negotiated.
Mifeprex will only be dispensed by doctors, hospitals and clinics,
not by pharmacies. As a result, the network of providers will be
limited at first to doctors and clinics that already provide
surgical abortions, which generally range in price from $300-$700.
But the number of those who can provide a medical abortion should
swell to hundreds more within the coming months. That's because
several deep-pocketed organizations are backing projects to boost
access.
For example, the Open Society Institute, the New York-based
nonprofit funded by financier George Soros, is finalizing plans to
give about $1 million to Planned Parenthood Federation of America
early next year.
The Soros money is to support a "Nationwide Mifepristone
Affiliate-Readiness Project" that, among other things, will buy 300
ultrasound machines for fetal examination and pay for a nationwide
television and magazine advertising campaign that will begin
sometime next year.
Mr. Soros, a longtime supporter of abortion rights, will also give
away hundreds of thousands of dollars to other pro-choice
organizations, according to Ellen Chesler, who oversees the
reproductive-rights program at Mr. Soros's Open Society Institute.
For instance, the New York state chapter of the National Abortion
and Reproductive Rights Action League is undertaking a program to
make medical abortion available to family doctors in rural areas.
Why? In the U.S, 87% of counties don't have an abortion provider,
and studies show the overall number of abortion doctors decreased
14% in the 1992-1996 period, due largely to fear of antiabortion
violence and intimidation. In Alaska's state capital, Juneau, for
instance, there is not a single abortion provider. Callers to the
Juneau Coalition for Pro-Choice get a recording that says, in order
to get an abortion, "you have to leave Juneau or leave the state."
Women in northern and western Michigan have to travel 11 hours to
the nearest provider, and then wait for 24 hours before getting an
abortion; and in many rural areas of Texas, the closest provider is
often 300 miles away, says Kelli Conlin, executive director of the
New York chapter of the abortion-action league.
"Mifepristone opens up a much greater pool of potential providers,"
Ms. Conlin says. "We're hoping that local physicians in these areas
will quietly start offering this to their patients."
The Soros Foundation is also expecting to fund a new program at Long
Island College Hospital in Brooklyn to train about 20 primary-care
doctors a year who have never performed abortions to incorporate
mifepristone-induced abortions into their practices. Overall, most
of the grants are seeking to promote a shift in the way abortion is
delivered -- away from stand-alone, easy-to-target clinics and
toward more integration into mainstream medical care.
Linda Prine, a family physician in Manhattan who has not previously
provided abortions to her patients, is looking forward to
incorporating RU486 into her practice.
"Up until now, if a patient of mine was pregnant and wanted to keep
the pregnancy I could take care of her," Dr. Prine says. "If she was
pregnant and didn't want to have a baby, I had to send her away and
that never felt right. Now I can continue to stay with my patients.
If we really believe in the right to choose, we have to practice it.
Now, with medical abortion, we can."
To obtain the package of pills, physicians must fill out a
double-sided order form and a prescriber's agreement, available on
Danco's Web site and through Planned Parenthood and the National
Abortion Federation. Providers send the completed form to a national
pharmaceutical distributor, who enters the information into a
database and ships the drugs.
Meantime, the abortion politics that have been so contentious for so
many years, are heating up as antiabortion forces step up their
efforts against the new pill.
Life Dynamics, a conservative Christian group in Denton, Texas,
known for filing malpractice lawsuits against doctors who perform
abortions, has sent 150,000 letters to obstetrician/gynecologists
and family-practice physicians warning of possible adverse effects
from mifepristone.
"Physicians who perform chemical abortions will be identified,
labeled, exposed, stigmatized, ostracized and in every way treated
exactly the same as conventional abortionists," says direct mail
from Life Dynamics president, Mark Crutcher.
A graphic new Web site -- the "RU-486 Registry" -- by antiabortion
activist Neal Horsley is up again after being shut down several
times. The site promises to list doctors who prescribe mifepristone
and in some cases even their children and where they attend school.
Mr. Horsley has already been banished by three different Internet
service providers following alerts from the National Abortion
Federation. "Don't think we're discouraged," Mr. Horsley says.
"We're prepared to do whatever we can to alert people to the horror
created by those who make a living slaughtering unborn babies."
And then, there's the presidential election. If George W. Bush is
declared the winner, an amendment by Republican Rep. Tom Coburn of
Oklahoma imposing strong restrictions on mifepristone will likely
resurface: Gov. Bush has said he would sign such an amendment.
The amendment would limit medical abortions by allowing the drug to
be prescribed only by doctors already trained to perform surgical
abortions and ultrasound exams and who have admitting privileges at
a hospital less than an hour away.
Additionally, Republican Rep. Tom Bliley of Virginia, outgoing
chairman of the House Commerce Committee, continues to raise
questions about the Food and Drug Administration's September
approval of mifepristone, specifically questioning the legitimacy of
the Shanghai plant where the drug will be manufactured.
So far, none of the charges have led to further investigation by the
agency. But producing mifepristone at an obscure factory in China is
certain to be a cloud of concern hanging over the drug.
Write to Rachel Zimmerman at rachel.zimmerman@wsj.com