Where I Catch The NIH With Its Pantaloons Down
Is the NIH posting incorrect information about the emergency contraception pill (ECP) on purpose? You be the judge.
From the entry on ectopic pregnancy at MedlinePlus, a service of the U.S. National Library of Medicine and the National Institutes of Health (NIH):
The "morning after pill" is associated with a 10-fold increase in risk of this condition [ectopic pregnancy] when its use fails to prevent pregnancy.
Well, knock me over with a feather and call me Fifi; a 10-fold increase you say?
The way I see it, there are 3 possible explanations for this statement:
1) It's a typo.
2) The information is accurate.
3) The government is deliberately making stuff up.
I haven't yet contacted the site operator, so the typo explanation remains a possibility.
It's also possible that, while I slept last night, the medical consensus has changed and ECP use is, indeed, associated with a 10-fold increase in risk of ectopic pregnancy. This one is easily verifiable; all we need to do is to look at the relevant literature.
Trussell does the work for us, and reviews the available studies (click on the PDF link):
[W]e identified five clinical trials of levonorgestrel-only ECPs.3-7 As shown in Table 1, these trials reported a total of 97 intrauterine pregnancies and one EP [ectopic pregnancy]. The proportion of pregnancies that were ectopic was thus 1.02% (95% exact CI 0.02%-5.55%). This proportion is consistent with the reported national rate of 12.4 and 19.7 per 1000 pregnancies in England and Wales and in the USA, respectively.8,9 Therefore, these trials provide no evidence to suggest that progestin-only ECPs increase the chance that a pregnancy will be ectopic. Moreover, because ECPs are so effective at preventing pregnancy in general, they certainly reduce a woman's absolute risk of EP.
Got that? There's no evidence to suggest that progestin-only ECPs increase the chance that a pregnancy will be ectopic. And do you [I'm looking at you, NIH] also get that when studies show no evidence of risk, telling your readers that there's a 10-fold increase in risk is irresponsible?
Which brings me to the third explanation. Given that the information about the risks of using the ECP is well known and widely available, coupled with the government's repeated refusals to base ECP-related decisions on science, I am inclined to think that the NIH is deliberately misinforming the public about the ECP.
And speaking of the NIH deliberately posting inaccurate information, referring to the ECP as the "morning after pill" is incorrect. Yes, the term is in common use and, as such, should be mentioned, in context, next to the actual drug name. But using it as the sole term is not acceptable because it can cause patients to use the ECP incorrectly. [Recall that the effectiveness of ECPs depends on timing of use.]
If you're interested in [accurate] information on emergency contraception (EC), here's a very informative review article on EC as a coast-effective approach to preventing unintended pregnancies (.pdf).
As per a commenter's suggestion I did try to email Dr. Dominic Marchiano, but it didn't go through. I found a contact page for his office; I'll try to call tomorrow to see if I can get a valid email.
I emailed Dr. Marchiano. He's out of the office till Monday. I'll update if he responds.