MEDICINE

Morning-after help

A controversial abortion pill has a new use

PATRICIA CHISHOLM October 19 1992
MEDICINE

Morning-after help

A controversial abortion pill has a new use

PATRICIA CHISHOLM October 19 1992

Morning-after help

MEDICINE

A controversial abortion pill has a new use

Ever since it was developed by French scientists in 1980, the drug RU 486— which can safely induce abortions in women up to the ninth week of pregnancy—has generated controversy. Even though RU 486 has not been approved for general use in the United States or Canada, debate over the drug flared again in North America last week after Scottish researchers reported that the drug can be used as a highly effective morning-after contraceptive. Writing in the authoritative New England Journal of Medicine, a team of researchers from the University of Edinburgh reported findings which showed that, if taken within 72 hours of unprotected sexual intercourse, the drug will prevent implantation of a fertilized egg in a woman’s womb. The survey reported on 800 British women who asked for assistance after unprotected intercourse. Doctors gave almost half the women high doses of birth control pills—a standard method of preventing pregnancy in such circumstances.

In the remaining cases, doctors gave the women RU 486, a steroid drug that induces menstruation. The researchers found that RU 486 was highly effective in preventing pregnancy, with fewer side effects than ordinary birth control pills.

Birth control experts said that the Scottish report was important both because of the findings about RU 486 and because it drew attention to the availability of conventional birth control pills for blocking pregnancy immediately after intercourse. The experts said that many women, and some doctors, were unaware that a dose of four birth control pills within 72 hours usually prevented implantation of the fertilized egg. At the same time, the report prompted debate between the two sides in the abortion issue. Said James Hughes, the Toronto-based president of the national antiabortion group Campaign Life Coalition: “We don’t like it. It doesn’t matter whether you kill the unborn child 8V2months after gestation or a day after it’s conceived.” For his part, Dr. Henry Morgentaler, who operates abortion clinics in six Canadian cities, said in Toronto that the French pill should be made more widely available. “It’s a tremendous advantage to women’s health so it should be permitted,” declared Morgentaler.

The French pill is part of a new generation of birth control drugs known as antiprogestins. Chemically, RU 486 is a steroid hormone that is similar to the natural hormone progesterone. When a pregnant woman takes RU 486, it blocks the action of progesterone, which is essential in helping a fertilized egg to become

implanted in the uterine wall. Although antiabortionists object to RU 486, many doctors contend that pregnancy does not begin until implantation is established. They say that places early use of RU 486 in the category of a contraceptive, not abortion. According to the University of Edinburgh report, the side effects of RU 486, including nausea and vomiting, were relatively mild compared to the same problems with conventional birth control pills.

The French pill has spawned a storm of opposition since it was first marketed in France in 1988. With the drug under attack from

French anti-abortionists, the Paris-based pharmaceutical company Roussel-Uclaf at one point decided to take the drug off the market. Within two days, the French government bowed to pressure from medical experts and women’s groups and ordered the company to resume selling the pill. It is now widely used in France, Britain, Sweden and China as a non-surgical method of abortion within the first nine weeks of pregnancy.

But Roussel-Uclaf has never applied for approval to market RU 486 in the United States or Canada. Indeed, the firm, which is partly owned by the French government, has shown itself to be sensitive to the political climate surrounding abortion in countries where its use has been considered. In 1990, the company halted clinical trials in the United States, citing widespread opposition by the anti-abortion movement. As well, company officials have said in the past that they are reluctant to apply for regulatory approval in Canada for the same reason. Said Donald Buxton, president of Montreal-based Roussel Canada: “With the controversy prevailing here and with the strength of argument on both sides of the debate, it is not clear that the social endorsement is there.”

Still, in recent months there have been signs of increasing pressure from some politicians and members of the medical establishment to have the controversial drug considered for approval in Canada. In July, Frances Lankin, health minister in Ontario’s New Democratic Party government, asked Ottawa to extend an invitation to Roussel-Uclaf to apply for regulatory approval. As well, the Ottawabased Society of Obstetricians and Gynecologists of Canada has declared that further delays in making it available to Canadian women would be unethical. But a spokesman for federal Health Minister Benoît Bouchard said that all drug companies must go through the same approval process— and so far Roussel-Uclaf has not applied for approval.

Meanwhile, researchers in the United States and Canada are studyo ing the drug’s potential for treating g other diseases, including breast cancer, brain tumors and endometriosis, a painful condition in which uterine tissue begins to grow outside the womb. Researchers at the National Cancer Institute of Canada have launched a study in Toronto involving 15 postmenopausal women with recurrent breast cancer to determine whether RU 486 could be used to treat that disease. They think that the drug might be effective, because some breast cancers depend on progesterone for growth. While the debate over RU 486 continues unabated, some important benefits of the drug may still await discovery.

PATRICIA CHISHOLM with NORA UNDERWOOD in Toronto