Wednesday, March 01, 2006

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.

Another Update:

I emailed Dr. Marchiano. He's out of the office till Monday. I'll update if he responds.



At 6:13 PM, Anonymous Anonymous said...

The author is listed at the bottom. He is at a Univ. of Penna.-affiliated hospital. Why not contact him to see whether that was in his original revision of the article?

At 8:00 PM, Blogger ema said...

Good catch. Thank you.

At 11:59 PM, Blogger Whispers said...

Have you contacted NLM about this? Even though Richard Sternberg works there, I can vouch for the integrity of the institution as a whole. The people who work for MedlinePlus are not making decisions as to the content of what is posted there. The suggestion above to contact the author instead seems sound to me. (I worked at NLM for four+ years, FWIW.)

At 1:55 AM, Blogger Monado said...

I am eager to hear what the author said about this. I live in Toronto, where anti-abortion groups are allowed to run billboard adds implying that medical abortion causes an increase in breast cancer—another fiction. Please let us know what the author says and if the N.I.H. modifies its posted information. I'll be linking to this post from my 'blog.

At 3:53 AM, Blogger element said...

Ugh. I just want to cry. Is there nothing in this government that hasn't beeen tainted by censorships and misinformation by the Bush administration. I can no longer believe anything from the government on its face value - not about port security, climate change, evolution, air quality, and more.

FYI - I posted four article on my site about the latest science screwups by the Bush admin.

I'm a scientist, and this whole thing is so depressing. I won't work for a government lab as long as Bush or his cronies are in the White House.

At 3:34 PM, Anonymous Anonymous said...

All in line with good epidemiology. Whoever wrote this isn't the first epidemiologist to create furor over nothing. The government may be guilty of creating unnecessary alarm, but so is every epidemiologist warning of the next great epidemic. The Anti-smoking crowd comes to mind (of course that is also based on an Epi-Fraud). Epidemiologist have a place in our society-- evaluating controlled studies, but until a real epidemic shows up, we should ignore them altogether when it comes to publicized news or suggestions.

In the last 20 years, I have seen but 2 reported studies that had an RR > 2.0. As points out quite well (and, any RR < 3.0 should leave you bored to tears.

At 5:27 PM, Anonymous Anonymous said...

The causal relationship between ectopic pregancy and morning after contraception is confused in the statement you quote. This is what it should say:

Since the pill works only on the uterus, it will not terminate an ectopic pregnancy. Thus if the treatment doesn't end the pregnancy, see a physician immediately. An ectopic pregancy is a life-threatening emergency.

At 6:31 PM, Anonymous Anonymous said...

I think you are throwing apples where oranges are required. Your statement "There's no evidence to suggest that progestin-only ECPs increase the chance that a pregnancy will be ectopic." is probably true. However this is not what the NIH is stating. Rather, there appears to be an increased incidence of ectopics out of the pregnancies that result from the FAILED use of progesteron-only emergency contraceptive pill. The original source of this warning is at

At 7:21 PM, Anonymous Anonymous said...

RDL, I can't find anything in that link related to ECP.

At 7:51 PM, Anonymous Anonymous said...

Is there any way 5-10 of the top feminist sites could join together and let their readers somehow contribute to a fund set up to distribute free birth control? Whether it be condoms or whatever, teh government and school boards simply cannot be trusted with such responsibilities anymore. If one of you would start it, I would be more than willign to contribute, I can't do much, but I could help a little. What about if a fund was started to suppor tthe local chapters of planned parenthood in south dakota and mississippi, but earmark the funding for free birth control only...idk, just an idea, but i keep reading the same concerns on almost every website, and yet there is no cohesive movement to help the women in these areas...i think most of the readers would love to DO something instead of sitting and feeling helpless...can't we unite and get some things done? Or would it be possible to target these states and try to open independent birth control centers where only contraception was handed out, and education? Idk, I am tired of feeling helpless over this issue!!!!! Dammit!

At 10:18 PM, Blogger ema said...


Incorrect; read Dr. Trussell's letter. The studies he looks at are the ones where the pregnancy was the result of failed ECP use, not a subsequent pregnancy in a former, successful, ECP user.

For example, from the first study cited:

The primary outcome was unintended pregnancy; other outcomes were side-effects and timing of next menstruation.

Also, form the link you provided (p9):

Twelve cases of ectopic pregnancy (out of a total of 201 unintended pregnancies) have been reported to the Committee on Safety of Medicines (CSM) following failure of Levonelle [~Plan B]. Since pregnancies that occur in women taking progestogen-only pills (POPs) are more likely to be ectopic than those occurring in women who use other methods of contraception this is not unexpected.

What they are sying is that, since pregnancies that occur in women who use POPs (on the regular 28 day regimen) are more likely to be ectopic, and since the ECP is also progestin-only, maybe a pregnancy occuring after ECP failure is also more likely to be ectopic.

Of course, that's not the proper way to determine anything. For one thing, POPs have a different dosage/regimen vs. ECPs.

At 1:47 PM, Anonymous Anonymous said...

First of all the data base is called MedlinePlus, not puls

I will be very angry if this was a deliberate act on the part of MedlinePlus.
I volunteer in a medical library and sometimes research info. for patients and staff.
I would hate to think I am giving them propaganda instead of reliable health info.

This is what it truly is, propaganda.

it is dispicable and goes along with the religious right's lying about abortion increasing a women's risk of breast cancer.

this needs to be clarified and medlinePlus needs to correct this info and should be made to verify all gyn info.

At 11:24 PM, Blogger ema said...

Anon, thank you; fixed.

At 7:43 PM, Blogger Monado said...

The statement is still on Medline, so I used their contact form to ask about it. The query should go to the Editorial Content Team. They promise a response within three days.


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