Politics Posing as Medical Science

By Pat Fagan, Ph.D., Director of MARRI

NBC News and many others have lauded the results of the Peipert program evaluation of the effects of LARCs (long term reversible contraceptives), namely IUDs and implant contraceptives, which they claim have (unsurprising) effects in lowering abortions.  However, there is much to dispute about the study.   Its method is almost non-existent though a lot of words are used to describe it.  This means their results may be a massive underestimation of the effects or even a massive overestimation of the effects.  We just don’t know;  the “method” is totally unreliable.  It is analogous to going into a library to find out the level of reading in the local population, or to giving a book to those you find at a library to figure out the effect of reading on such people!  In this case they go to a group of women desirous of reversible control methods.  To make matters worse: they have no comparison control group. They do not line up treatment and control (absolutely fundamental to this type of study), but they insinuate comparisons. The project team went through all sorts of contortions to estimate the effects, but they avoided the obvious simple, fundamental step of having a control group.  This is political correctness trumping good scholarship (a dangerous trend in the social sciences that will eventually come back to haunt academia).

Though I am opposed to their way of thinking and acting (more anon), I would have expected LARCs to have had much better results than they did.  There is still way too high a rate of abortion from a method one would expect to virtually totally eliminate it. This much-lauded method does not come close.     
 

Other big concerns I have about this approach to avoiding abortions is the effect of this form of behavior on the long-term marital, family, parenting, and sexual habits of the women involved.  My prediction is that young women who use these methods (who would not feel sexually “liberated” with totally effective birth control methods) will have many more sexual partners, behavior that itself increases the likelihood of procuring an abortion.  The program will also have high STD effects, likely have very significant effects on future marital stability, and in turn have significantly weakening effects on these women’s future children’s life outcomes.  That STD rate effects would be tracked and measured is something one would expect to be second nature for OBGYNs to report upon.  Maybe there is a second study coming (but that would be useless too, given no control group.)

So: failing grades on method and on narrowness of their view of effectiveness.  And failing grades also are given to the Journal of Obstetrics and Gynecology for rushing shoddy work to press in order to influence the Presidential campaigns.  That is really sad.  It definitely is not good science, nor good politics either, though we would expect medical science to stay above the political fray.  All in all, it is a sad day for medicine and science. 

For an in-depth analysis of the study, see Dr. Michael New’s piece.