Health Canada deflects complaints about ads for `abortion-pill reversal'
TREATMENT CONDEMNED
Health Canada has essentially rejected two complaints about an anti-abortion group promoting a controversial process to “reverse” medical abortions, as the niche issue earns growing attention from both sides in the heated abortion debate.
The matter is one for provincial regulators to tackle, said federal officials this week after deciding to take no action on the advertising grievances.
The treatment involves prescribing women the drug progesterone after they've had the first of two medications used to bring about non-surgical abortions. The Society of Obstetricians and Gynaecologists of Canada (SOGC) and other medical groups have condemned it as unproven and potentially unsafe.
But almost 60 Canadians have taken the hormone for that purpose in the last three years, according to a U.s.based group that connects women with doctors willing to prescribe progesterone for “abortion-pill reversal.”
The complaints concerned online promotion of the process by Alliance for Life Ontario.
Last week, the anti-abortion group took its campaign a step further, launching a petition asking Health Minister Patty Hajdu to mandate that women obtaining a medical abortion be told about the reversal process.
Federal rules prohibit the advertising of prescription drugs directly to consumers or with unauthorized claims, though doctors can legally prescribe medicines “offlabel” — for non-approved purposes.
In emailed answers to questions, Health Canada said Alliance for Life was advertising a treatment protocol — not use of a drug per se — which means it concerns the practice of medicine. That places it into the jurisdiction of provincial colleges of physicians and surgeons, the department said.
“Health Canada's reply is very disappointing,” said Joyce Arthur, executive director of the Abortion Rights Coalition of Canada.
The coalition and two other groups were not part of the two advertising complaints, but in December wrote Health Minister Patty Hajdu, requesting that her ministry post a warning online to counter “misinformation” about the reversal process.
“They didn't even respond to our request,” Arthur complained Tuesday. “Nothing about the provincial jurisdiction of health care should prevent them from doing this simple thing, especially when this issue is happening across provinces and peoples' health is at risk.”
Jakki Jeffs, executive director of Alliance for Life, argued there is good evidence that reversal works and is safe, but said the group seems “to be under attack from all quarters” over it.
“We have always worked with integrity and from an ethical basis,” she said. “This attitude that this is dangerous, quack science is an absolute lie .... This is not cavalier medicine.”
Medical abortion involves two medications. The first is mifepristone, which blocks the progesterone that normally helps prepare the lining of the uterus for a pregnancy. The second drug, Misoprostol, taken 24 to 48 hours later, causes the uterus to contract, expelling the pregnancy.
The reversal process involves forgoing the second drug and instead taking progesterone, the idea being that it will essentially counter the effects of mifepristone.
Whether it works is one of the points of contention.
Supporters point to an observational, “case-series” study that concluded 48 per cent of 547 women who took progesterone and finished the research ended up having successful pregnancies. Rates were higher in certain sub-groups based on how the hormone was administered, according to a 2018 paper published in a journal with ties to the anti-abortion movement.
But critics say the study had questionable methodology, citing the 27 per cent of women excluded from the final results, possibly making those numbers more positive. An analysis published in the New England Journal of Medicine concluded there is no evidence that offering progesterone is more effective than “doing nothing” after the first medical-abortion drug.
A trial that tried to test the idea with a more rigorous randomized controlled trial raised another issue: safety.
Women were given the first medical-abortion drug, then either a placebo or progesterone, but the study was stopped for safety reasons after just 12 people had been enrolled. Three of them — two on placebo, one on progesterone — had such severe bleeding they had to go to hospital.
The researchers concluded that skipping the second medical-abortion drug might increase the risk of serious hemorrhaging. The American Medical Association has said abortion-pill reversal contradicts “reality and science.”
Even so, Louisiana became the latest of several U.S. states this month to pass laws requiring doctors to inform patients about reversal when they discuss medical abortion, similar to the policy requested by the Alliance for Life petition here.
Meanwhile, the Abortion Pill Rescue Network maintains that more than 2,000 babies have been born in North America after medical-abortion reversal.
In Canada, 112 women have contacted the network hotline — run by Heartbeat International — about reversal, while 57 actually received a progesterone prescription from a doctor here and took the drug, said a Heartbeat spokeswoman via Alliance for Life. Among those, there were nine “successful reversals,” though it's likely some women didn't report their outcomes and that there were “many more” live births, the group says.