Dr. Tim Johnson: Reason on RU-486

It can be hard to find a quiet voice of reason within the din of the abortion debate. With yesterday’s announcement of the approval of RU-486, the abortion pill now called Mifeprex, the discussion has been revived again. Even the medical community is sharply divided, with emotions at times coloring the advice that the public depends on to be impartial.

But if such a thing exists, here is my best shot: as long as abortion remains legal in this country, medical science will attempt to find a way to improve it — make it safer, less invasive and more private. Without question, RU-486 succeeds on those accounts. According to the data we have so far, RU-486, or mifepristone, is probably slightly safer than a traditional surgical abortion — although there are still some very rare occasions where excessive bleeding can be a concern. And because it is done earlier in the pregnancy and in a more private setting than a surgical abortion, it may make it psychologically less troubling for some women determined to have an abortion.

However, although many doctors will not want to hear this, that does not mean that the drug should be distributed at will. The procedure is not so simple as popping a pill and magically ending a pregnancy — it involves hours, or even days, of severe cramping and bleeding, and requires a few return trips to the doctor’s office to administer the drugs under a doctor’s supervision and make sure the pregnancy has been completely terminated.

Because it is crucial that the drug not be mishandled or misapplied, I believe that the special aspects of this drug justify some caveats for its use. I believe the FDA has placed reasonable guidelines on the application of its use. Politics aside, it is the medically smart thing to do.

Drug Guidelines

For example, the drug’s effectiveness drops after the seventh week, making proper dating of the pregnancy vital. I agree that doctors who want to prescribe the drug should have experience with dating a pregnancy through the use of ultrasound. And I agree that any woman taking the drug should be within a reasonable distance from an emergency room.

However, doctors do not necessarily need to know how to do a surgical abortion to prescribe the drug. For any emergencies, such as excessive bleeding, they can always rely on a colleague as a backup. The FDA was right not to enforce this requirement, which would have severely restricted the use of the pill beyond what is medically necessary.

RU-486 is the first technological advancement on abortion we have had in this country for decades. Again, apart from your own personal belief about abortion, as long as it is legal, women and their doctors should work together to make it as safe as possible.