美国国家公共电台 NPR--Why an ulcer drug could be the last option for many abortion patients

Why an ulcer¹ drug could be the last option for many abortion² patients

Transcript³

A federal judge in Texas could rule as soon as today on whether to cut off access to a key medication abortion protocol⁴, giving lawyers until day's end to submit additional arguments. Fearing another major blow to abortion access, some providers are already considering alternatives.

At the Trust Women clinic in Wichita, Kansas, it's already been crisis mode for months. And now clinic Director Ashley Brink⁵ says the staff is bracing⁶ for another — maybe even bigger — wave of uncertainty⁷.

"We're at an unprecedented⁸ time," Brink says. "We've never faced this kind of crisis, and so there is a lot of unknowns."

First, they got patients from Texas after that state's abortion ban took effect in 2021. Then, patients came from all over the region after last summer's landmark⁹ U.S. Supreme¹⁰ Court decision. And now, they're facing the possibility of a nationwide ruling that would block access to a common abortion pill.

An(other) unprecedented moment

In states where abortion is still legal, providers know they could soon lose the ability to prescribe the abortion drug mifepristone. A coalition¹¹ of anti-abortion-rights groups, arguing that the drug was improperly¹² approved, is asking the federal judge appointed by President Trump¹³ to overturn that approval.

Under the current two-drug protocol, the patient first takes mifepristone, which works by blocking progesterone, a hormone¹⁴ that helps a pregnancy¹⁵ progress. The second drug, misoprostol, then causes contractions¹⁶ to bring on what's essentially¹⁷ a medically induced miscarriage¹⁸.

If the judge overturns the approval of that protocol, Brink says the Wichita clinic will only be able to offer patients either a surgical¹⁹ abortion or misoprostol alone. For now, that means preparing the staff with extra training on how to communicate to patients about the impact of the new protocol if they're forced to make the change.

"Because it is a different procedure than using the two-medication regimen with mifepristone," Brink says, "we're having to make sure everyone has the right language and the right information to ensure that they're communicating that effectively."

Downsides and unknowns

A recent study by the Guttmacher Institute found that 98% of medication abortions²⁰ in the U.S. used the two-drug protocol in 2020.

But internationally, the second drug, misoprostol, has been used alone for decades, says Dr. Jamila Perritt, president and CEO of Physicians for Reproductive Health. Perritt says the case could leave both healthcare providers and patients facing complex medical and legal decisions about how to move forward without mifepristone.

"At this point, there are still a lot of unknowns in terms of how this is going to play out," Perritt says. "What we do know is that misoprostol has been used on its own for decades around the world and is effective at ending an early pregnancy."

The World Health Organization says misoprostol can be used effectively alone, often with additional doses.

There are downsides, though, including a higher risk of side effects like nausea²¹ and cramping²², says Dr. Ushma Upadhyay, a public health professor at the University of California, San Francisco, who is researching the misoprostol-only protocol.

"It's so important that patients understand how long they'll be bleeding after they take the miso alone," she says. "And it is longer."

A learning curve

Most available research also suggests using only misoprostol is somewhat less effective than when it is combined with mifepristone.

Upadhyay says removing mifepristone from the equation will mean difficult decisions for doctors and patients, particularly those traveling from states where abortion is illegal: "I think it's going to be a huge learning curve for clinicians to figure out — what's the best, right protocol for this patient? How should I counsel this specific patient based on their legal risks and based on how far they traveled to get here?"

But for patients who don't want to undergo a surgical procedure, misoprostol alone may become the option of choice.

Leah Coplon, director of clinical operations for Abortion on Demand, a telehealth medication abortion clinic serving 23 states, says her organization is preparing to make the shift to misoprostol-alone if necessary.

"Obviously we hope that we can continue to use mifepristone and misoprostol, but we're ready if necessary," she says.

For now, Coplon says the clinic is working to update the information that would be provided to patients taking the drug. She's also preparing to order more doses of misoprostol, as well as "comfort medications" to help patients manage any additional pain they might experience with the single-drug protocol.

An alternative protocol

While most medication abortion patients in the United States choose the two-drug regimen, a small number already are using misoprostol alone.

Carafem, an organization that provides medication abortion through telehealth as well as at clinics in Chicago, Atlanta and outside Washington, D.C., began offering the single-drug protocol in 2020 amidst growing threats to abortion access in general and mifepristone in particular.

"It made sense to us to better understand how to use it and make it available," says Chief Operating Officer Melissa Grant.

Depending on the location, Grant says the two-drug protocol typically costs patients at Carafem around $199, compared with about $175 for misoprostol-only. Grant says about 10% to 15% of her clients choose misoprostol alone, in part because it's slightly less expensive than the two-drug protocol — a number she expects to grow if the mifepristone regimen becomes unavailable.

"We [would] have one less option, which is not good," Grant says. "This is the next step toward making abortion completely inaccessible²³ across the country."

Meanwhile, Elisa Wells, co-founder of the group Plan C Pills, which provides information for people seeking abortion medications online, says her organization will continue to point clients toward alternative sources of both mifepristone and misoprostol.

Wells estimates that since the Dobbs v. Jackson Women's Health Organization decision last year, at least 30,000 people have obtained abortion pills through these networks.

"These alternative sources of pills ... may be the only option for people who are seeking an abortion solution," Wells says. "We know that there is a very robust²⁴ pipeline²⁵ of product coming into the U.S. right now and being distributed within the U.S."

An uncertain legal landscape

Abortion rights opponents are quick to point out that misoprostol is currently approved for use as an ulcer drug — not as a standalone medication to induce abortion.

"Misoprostol alone would not be an FDA-approved use of that drug for chemical abortion," says Julie Blake, senior counsel with Alliance Defending Freedom, which is representing the anti-abortion groups in the lawsuit²⁶ challenging mifepristone's approval. "Using drugs that were approved for other purposes off-label certainly carries additional dangers and safety risks."

But off-label doesn't necessarily mean illegal, says Farah Diaz-Tello, senior counsel at If/When/How, a reproductive rights legal group.

"Off-label use of medications is very common; it happens every single day," Diaz-Tello says. "As long as it is within the standard of care that there isn't a problem with it."

But Blake's colleague, Alliance Defending Freedom attorney Erik Baptist, says he believes doctors who prescribe misoprostol for abortion could open themselves up to lawsuits²⁷.

"When it's prescribed off-label, that puts the doctor or the prescriber in a little more tenuous²⁸ position when it comes to medical malpractice or tort liability in theory, because it's never been FDA-approved for that particular purpose," Baptist says.

The current lawsuit doesn't directly target off-label uses. Perritt of Physicians for Reproductive Health notes that misoprostol is already widely — and safely — used off-label for miscarriage management, in procedures like IUD insertion and for abortion. But she worries about an increasingly murky²⁹ legal landscape surrounding abortion pills.

"If they're coming for mifepristone, believe me, they're coming for misoprostol. It will not end with the one medication," Perritt says. "And so all of this is at risk."

1 ulcer   

n.溃疡，腐坏物

参考例句：

• She had an ulcer in her mouth.她口腔出现溃疡。
• A bacterium is identified as the cause for his duodenal ulcer.一种细菌被断定为造成他十二指肠溃疡的根源。

2 abortion   

n.流产，堕胎

参考例句：

• She had an abortion at the women's health clinic.她在妇女保健医院做了流产手术。
• A number of considerations have led her to have a wilful abortion.多种考虑使她执意堕胎。

3 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

4 protocol   

n.议定书，草约，会谈记录，外交礼节

参考例句：

• We must observe the correct protocol.我们必须遵守应有的礼仪。
• The statesmen signed a protocol.那些政治家签了议定书。

5 brink   

n.(悬崖、河流等的)边缘，边沿

参考例句：

• The tree grew on the brink of the cliff.那棵树生长在峭壁的边缘。
• The two countries were poised on the brink of war.这两个国家处于交战的边缘。

6 bracing   

adj.令人振奋的

参考例句：

• The country is bracing itself for the threatened enemy invasion. 这个国家正准备奋起抵抗敌人的入侵威胁。
• The atmosphere in the new government was bracing. 新政府的气氛是令人振奋的。

7 uncertainty   

n.易变，靠不住，不确知，不确定的事物

参考例句：

• Her comments will add to the uncertainty of the situation.她的批评将会使局势更加不稳定。
• After six weeks of uncertainty,the strain was beginning to take its toll.6个星期的忐忑不安后，压力开始产生影响了。

8 unprecedented   

adj.无前例的，新奇的

参考例句：

• The air crash caused an unprecedented number of deaths.这次空难的死亡人数是空前的。
• A flood of this sort is really unprecedented.这样大的洪水真是十年九不遇。

9 landmark   

n.陆标，划时代的事，地界标

参考例句：

• The Russian Revolution represents a landmark in world history.俄国革命是世界历史上的一个里程碑。
• The tower was once a landmark for ships.这座塔曾是船只的陆标。

10 supreme   

adj.极度的，最重要的；至高的，最高的

参考例句：

• It was the supreme moment in his life.那是他一生中最重要的时刻。
• He handed up the indictment to the supreme court.他把起诉书送交最高法院。

11 coalition   

n.结合体，同盟，结合，联合

参考例句：

• The several parties formed a coalition.这几个政党组成了政治联盟。
• Coalition forces take great care to avoid civilian casualties.联盟军队竭尽全力避免造成平民伤亡。

12 improperly   

不正确地，不适当地

参考例句：

• Of course it was acting improperly. 这样做就是不对嘛！
• He is trying to improperly influence a witness. 他在试图误导证人。

13 trump   

n.王牌，法宝；v.打出王牌，吹喇叭

参考例句：

• He was never able to trump up the courage to have a showdown.他始终鼓不起勇气摊牌。
• The coach saved his star player for a trump card.教练保留他的明星选手，作为他的王牌。

14 hormone   

n.荷尔蒙，激素，内分泌

参考例句：

• Hormone implants are used as growth boosters.激素植入物被用作生长辅助剂。
• This hormone interacts closely with other hormones in the body.这种荷尔蒙与体內其他荷尔蒙紧密地相互作用。

15 pregnancy   

n.怀孕，怀孕期

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕早期常有恶心的现象。
• Smoking during pregnancy increases the risk of miscarriage.怀孕期吸烟会增加流产的危险。

16 contractions   

n.收缩( contraction的名词复数 )；缩减；缩略词；（分娩时）子宫收缩

参考例句：

• Contractions are much more common in speech than in writing. 缩略词在口语里比在书写中常见得多。 来自《简明英汉词典》
• Muscle contractions are powered by the chemical adenosine triphosphate(ATP ). 肌肉收缩是由化学物质三磷酸腺苷(ATP)提供动力的。 来自辞典例句

17 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

18 miscarriage   

n.失败，未达到预期的结果；流产

参考例句：

• The miscarriage of our plans was a great blow.计划的失败给我们以巨大的打击。
• Women who smoke are more to have a miscarriage.女性吸烟者更容易流产。

19 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。

20 abortions   

n.小产( abortion的名词复数 )；小产胎儿；（计划）等中止或夭折；败育

参考例句：

• The Venerable Master: By not having abortions, by not killing living beings. 上人：不堕胎、不杀生。 来自互联网
• Conclusion Chromosome abnormality is one of the causes of spontaneous abortions. 结论：染色体异常是导致反复自然流产的原因之一。 来自互联网

21 nausea   

n.作呕，恶心；极端的憎恶(或厌恶)

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕期常有恶心的现象。
• He experienced nausea after eating octopus.吃了章鱼后他感到恶心。

22 cramping   

图像压缩

参考例句：

• The bleeding may keep my left hand from cramping. 淌血会叫我的左手不抽筋。
• This loss of sodium can cause dehydration and cramping. 钠流失会造成脱水和抽筋。

23 inaccessible   

adj.达不到的，难接近的

参考例句：

• This novel seems to me among the most inaccessible.这本书对我来说是最难懂的小说之一。
• The top of Mount Everest is the most inaccessible place in the world.珠穆朗玛峰是世界上最难到达的地方。

24 robust   

adj.强壮的，强健的，粗野的，需要体力的，浓的

参考例句：

• She is too tall and robust.她个子太高，身体太壮。
• China wants to keep growth robust to reduce poverty and avoid job losses,AP commented.美联社评论道，中国希望保持经济强势增长，以减少贫困和失业状况。

25 pipeline   

n.管道，管线

参考例句：

• The pipeline supplies Jordan with 15 per cent of its crude oil.该管道供给约旦15%的原油。
• A single pipeline serves all the houses with water.一条单管路给所有的房子供水。

26 lawsuit   

n.诉讼，控诉

参考例句：

• They threatened him with a lawsuit.他们以诉讼威逼他。
• He was perpetually involving himself in this long lawsuit.他使自己无休止地卷入这场长时间的诉讼。

27 lawsuits   

n.诉讼( lawsuit的名词复数 )

参考例句：

• Lawsuits involving property rights and farming and grazing rights increased markedly. 涉及财产权，耕作与放牧权的诉讼案件显著地增加。 来自辞典例句
• I've lost and won more lawsuits than any man in England. 全英国的人算我官司打得最多，赢的也多，输的也多。 来自辞典例句

28 tenuous   

adj.细薄的，稀薄的，空洞的

参考例句：

• He has a rather tenuous grasp of reality.他对现实认识很肤浅。
• The air ten miles above the earth is very tenuous.距离地面十公里的空气十分稀薄。

29 murky   

adj.黑暗的，朦胧的；adv.阴暗地，混浊地；n.阴暗；昏暗

参考例句：

• She threw it into the river's murky depths.她把它扔进了混浊的河水深处。
• She had a decidedly murky past.她的历史背景令人捉摸不透。