Bob Casey and the Morning After Pill

I've been saying for some time that the race for United States Senate in Pennsylvania this year is what I wish for the entire country: two strong candidates with very different views, both of whom are pro-life. The incumbent, U.S. Sen. Rick Santorum (R), a Roman Catholic, has fought valiantly for pro-life legislation, including the ban on partial birth abortion, doing so with a clear and holistic ethic of life. Santorum and his wife homeschool their six children, and both have written and spoken extensively on this issue.

His challenger, state treasurer Bob Casey Jr. (D), also a Roman Catholic, likewise has maintained his commitment to protect the unborn, following in the convictional pro-life heritage of his heroic father, the late Governor Robert Casey, a New Deal Democrat who wasn't allowed to speak to the 1992 Democratic National Convention because he defied party orthodoxy on abortion rights. Casey the elder never wavered on this, despite humiliation at the DNC and beyond, refusing even to endorse his party's nominee Bill Clinton. Casey Sr. was an honored guest at my denomination's Christian Life Commission in 1997, meeting on the campus of The Southern Baptist Theological Seminary, where he urged Christians to maintain a consistent witness for the sanctity of life, a fight he waged all the way until his death. Remember that the landmark Planned Parenthood vs. Casey Supreme Court decision is named because of the governor's commitment to restrict abortion and protect women and children. Despite the criticisms of the abortion rights lobby (including a threatened third-party run by NARAL's Kate Michelman), the younger Casey stood firm that he would continue his Party's commitment to protecting the most vulnerable in society, including in that list unborn babies.

After watching today's debate between the two on NBC television's "Meet the Press" broadcast, I am saddened and cynical. When asked about the Food and Drug Administration decision to allow the "Plan B" or "morning after" or "emergency contraception" pill without a prescription, Bob Casey argued that this decision was just and that he would vote to uphold it. This technology is designed to work in such a way that, if a baby has been conceived, would prevent the child from implanting in the womb. Despite the fact that he maintained that he believes life begins at conception, Casey praised the "Plan B" pill as "contraception," and contraception that should be available even without a prescription.

I don't have a dog in the Senate fight in Pennsylvania. I am certainly no Republican partisan, having served as a pro-life, pro-family Democrat and longing for more of them so that we can have a genuine two-party system in this country. My response to the debate is not "score one for Santorum." I hope Bob Casey is simply confused, and will right the course on this tomorrow. But, for now, it is just sad.

It is not unusual to see a politican skirt around the sanctity of human life for a few votes and the esteem of the chattering classes. Republicans do this just as Democrats do (see the embryonic stem cell research bill of a while back). It's just depressing to see it from someone named "Bob Casey."

Comments

[Dcn. Michael D. Harmon]

I think it was William F. Buckley Jr. (or at least someone associated with National Review) who said, ''Organizations which are not explicitly conservative will become more liberal over time.'' That is, they will progressively conform to the Zeitgeist because they have no foundational innate protections against it.

Perhaps it is true of politicians, too?

[Judy Warner]

Al Gore used to be pro-life too. I think I'm safe in saying that his pro-life position was a bit more cynical than Casey's.

[Stuart Koehl]

>>>I think it was William F. Buckley Jr. (or at least someone associated with National Review) who said, ''Organizations which are not explicitly conservative will become more liberal over time.'' That is, they will progressively conform to the Zeitgeist because they have no foundational innate protections against it.<<<

Define conservative, then.

[Doug]

While I have not yet a firm opinion on this matter, I think a solid argument can be advanced for Casey's position that is authentically pro-life. Below I have cut and pasted a blog entry of the First Things journal dated 29 August 2006 and written by Robert T. Miller, an assistant professor at the Villanova University School of Law. It outlines the arguement. While it may or may not be persuassive to readers of this blog, I think it is a legitimate argument from a person and journal that are pro-life. Neither they, nor Casey, should be so casually dismissed and branded unfaithful to the pro-life cause. Here is the blog entry:

Charlotte Allen chastises the Bush administration, and even President Bush personally, for the recent decision by the Food and Drug Administration to approve for sale “Plan B,” a drug that prevents or terminates pregnancy if taken soon after intercourse.

Since I believe that it is always and everywhere wrong to intentionally kill an innocent human being, and since I further believe that the being that results from a conception between human gametes is a human being, I thus believe that abortion, including by the use of abortifacient drugs, is morally wrong. But that said, Allen’s response to this decision by the FDA is an overreaction.

The decision as to whether Plan B ought to be approved for sale is a decision to be made in accordance with the law. The relevant statute is §505(d) of the Food, Drug and Cosmetic Act, which provides in pertinent part that the Secretary of Health and Human Services “shall” (that is, has a legal obligation to) approve a drug unless he finds that one or more specifically enumerated conditions obtains. These conditions concern such things as adequacy of the information filed by the applicant seeking approval of the drug, the sufficiency of the tests undertaken to prove the drug safe, the safety of the methods and facilities used in manufacturing the drug, and the efficacy of the drug in its intended use.

Assuming that none of these conditions were met, there was no legal basis for the secretary to deny approval of Plan B. That Plan B, when used as intended, causes the death of innocent human beings in utero, while of paramount concern morally, is not legally relevant. If the FDA continued to withhold approval of Plan B, the drug’s manufacturer could have sued the FDA in federal court and, in all human probability, obtained a ruling ordering the FDA to approve the drug for sale.

Now, perhaps someone in the position of the Commissioner of the FDA or the Secretary of Health and Human Services, faced with these circumstances, ought to resign rather than approve Plan B. Perhaps, but I think not. People in the pro-life movement need to keep their heads and realize that there are legal and political realities that limit an officeholder’s freedom. “In a commonwealth and in the councils of princes,” St. Thomas More writes in Utopia, “if ill opinions cannot be quite rooted out, and you cannot cure some received vice according to your wishes, you must not therefore abandon the commonwealth, for the same reasons you should not forsake the ship in a storm because you cannot command the winds. … You ought rather to cast about and to manage things with all the dexterity in your power, so that if you are not able to make them go well they may be as little ill as possible.”

[Bob]

So First Things is arguing that the president was obligated to do evil? In that case I am glad I didn't renew my subscription. Did either Bush, or Casey say that the Plan B drug is immoral, but they could do nothing to prevent it?
As a Pennsylvanian I was wondering for whom I should vote, I think this piece has helped to make up my mind.

[Stuart Koehl]

>>>So First Things is arguing that the president was obligated to do evil?<<<

No, Bob. First Things is arguing that the President is obliged to obey and enforce the law.

Usually, I can't stand Thomas More, but in this case, he bears repeating:

“In a commonwealth and in the councils of princes,” if ill opinions cannot be quite rooted out, and you cannot cure some received vice according to your wishes, you must not therefore abandon the commonwealth, for the same reasons you should not forsake the ship in a storm because you cannot command the winds. … You ought rather to cast about and to manage things with all the dexterity in your power, so that if you are not able to make them go well they may be as little ill as possible.”

[YaknYeti]

Actually, I read First Things as saying that the President was obligated not to use evil means to do good. If the law says that the FDA has to approve the drug unless the testing submitted with it is insufficient and the testing was sufficient to show the drug's safety by current medical standards, not approving the drug is breaking the law (and hence evil). And simply delaying the approval for a few years rapidly approaches breaking the law.

This is a prudential judgment on my part, but I think conservatives need to be careful how much of the government we make a battlefield for our issues. We've long argued that the Supreme Court greatly overstepped its bounds in finding a "right" to abortion via privacy in the Constitution. I think it's consistent to say that the FDA was overstepping its bounds in not fulfilling its obligation to approve Plan B.

Of course, this does depend on whether adequate medical testing has been done with Plan B, and I don't know that.

[Daniel C]

No, Bob, First Things was not arguing that the President was obligated to do evil. First Things is simply stating the facts. The law is such that there was no way to prevent this from coming to market unless very specific conditions were met, which obviously did not happen, and no one could have stopped it. The decision was not the President's to make. I think First Things is making an excellent case for dismantling the Food & Drug Administration.

[Daniel C]

I would not want an FDA that authorized drugs based on the personal predilictions of whoever is in charge. Imagine what a Scientologist might approve or disapprove. Or imagine what might happen were a radical Naturopathic Physician to take the reigns.

[Russell D. Moore]

Of course a public official has the responsibility to uphold the law. That is irrelevant to this discussion. It reminds me of some Senators saying that Roe v. Wade had "settled" the abortion issue when asked if they would support a Human Life Amendment. Well, of course it is settled. The question is whether you think it should be, through constitutional means, unsettled.

The question is whether Sen. Santorum or a Sen. Casey would vote to uphold the FDA's decision to allow a abortifacient that works by innundating a woman's body with massive amounts of hormones to be available "over the counter."

Sen. Santorum and Mr. Casey are campaigning to be legislators. The citizens of Pennsylvania have the right to know how they would make such decisions. Now they do.

[Bob]

Excuse my ignorance in asking then, but could it not be argued that murder is against the law, therefore, a pill designed to cause death prior to implementation in the womb is against the law? Let us not forget that the Supreme Court does not make the law, as such Roe isn’t a law. Plus, all that Roe said was that woman have a “right to privacy,” not to an abortion (we just can’t ask). This is my understanding of where we are at in this country, but am willing to be corrected in the matter.

[Russell D. Moore]

The transcript from the "Meet the Press" debate is now available. Here is the relevant section:

MR. RUSSERT: And we are back with the contenders for the U.S. Senate seat from Pennsylvania: the Republican incumbent, Rick Santorum; his Democratic challenger, Bob Casey.

Senator Santorum, another social issue. The Federal Drug Administration has said that Plan B, the morning-after pill, can be sold over the counter to Americans 18 and older. Many in the right-to-life community have called that pill an abortifacient. Are you in favor of the FDA decision to sell the morning-after pill?

SEN. SANTORUM: No, I’m not. I, I agree that it is an abortifacient, and that, that it’s dangerous to give a dose of hormones equivalent to one third of a whole series of birth control pills to, to someone without any kind of doctor supervision. I think it could be dangerous and I think, obviously, if you’re giving it out over the counter to, to 18-year-olds it’s going to get to younger people, and I think it could be very dangerous, can lead to serious problems. And plus, I do believe that it, that it causes abortions—in some cases.

MR. RUSSERT: The morning-after pill. You in favor of it selling over the counter?

MR. CASEY: Yes, Tim. We, we disagree. I think what emergency contraception is, according to the science, is, is basically that. It is contraception, and I support it, and it’s a difference of opinion.

MR. RUSSERT: But you do believe life begins at conception?

MR. CASEY: I do.

MR. RUSSERT: And in fact, if this was fertilized, would you call it contraception or abortion?

MR. CASEY: Tim, I think the science is clear on this. I think it is contraception, and I support it. I think we’ve got to make it widely available, and I think that’s one of the ways, I think, that we reach common ground on the very tough issue of abortion: to reduce the number not just of unwanted pregnancies, but I think emergency contraception can reduce the number of abortions. That’s what we should emphasize.

SEN. SANTORUM: He says the science is clear and it is clear. In fact, it is an abortifacient in certain circumstances. If the, if the egg has been fertilized and, and the, and the pill is taken, it does cause an abortion. It’s inconsistent with his previous position. It’s a classic attempt of him, how in a general election, to try and middle and, and, and violate his principles. And I think his father would be very upset if, if he were alive today and, and heard him be supportive of something like this.

MR. CASEY: (Unintelligible).

RDM: Unintelligible indeed.

[Tony Esolen]

I've never believed in the sincerity of Junior's pro-life position. It is, unlike his father's and unlike Senator Santorum's (and, for that matter, Lynn Swann's), an anomaly. That is, it's not connected to any other position he holds regarding marriage and the family. It's not part of a coherent whole. It has no roots. That's why it withers away when the first hot wind comes scorching.

A case can be made that making an abortifacient drug available to minors violates the laws in some states that require parental notification. I wonder, too, whether the reference to Thomas More is apt. Obviously we cannot morally undermine the very idea of law, as Socrates argues in the Crito. But there are laws and there are laws. Socrates was the innocent victim of a just law applied unjustly. Thomas More was the victim of a law of very dubious justice, applied with a facade of justice; basically it was an assassination.

Could we make some distinctions?

There are just laws, that must be obeyed.

There are just laws, applied unjustly; these, argued Plato, must still be obeyed, because to disobey them would be to help to destroy law.

There are unjust laws that should be obeyed, because to disobey them would embroil the commonweal in even greater trouble.

There are unjust laws that should be disobeyed, because they strike at the heart of human nature and justice; to OBEY these laws would be to help to destroy law. That turns the FT argument upside down. So it was that the Nazi judges could find no cover in the excuse that they were merely obeying the law.

[Deacon John M. Bresnahan]

There are two other just as important issues in this race. Even if Casey were to be all pro-life Dems hope he would be--he would vote to turn over the Senate to the Democrats. Now, the Republicans have not been as pure pro-life or as aggressively pro-life as many of us would have wished, BUT a vote for Casey who will then turn the Senate over to a party that will put virtually rabid pro-abortion senators in charge of important committees makes Casey nothing but a stealth pro-abortion politician.
The second issue is that he has become the darling of pro-homosexualist activists according to what I have read. More money has reportedly been sent to him than to any other pro-gay candidate. And do the people of Penn. want to be represented in the Senate by a passionately pro-gay marriage senator????

[Stuart Koehl]

>>>There are two other just as important issues in this race. Even if Casey were to be all pro-life Dems hope he would be--he would vote to turn over the Senate to the Democrats. <<<

Precisely. It is time that the pro-life movement learn to think strategically rather than tactically, to play the long game, and know when it is better to settle for half a loaf now with the potential for getting the rest of the loaf later, than to insist on the whole loaf now and end up with no loaf at all. As I often tell business clients, "Would you rather have 50% of something or 100% of nothing?"

[James A. Altena]

Stuart,

As I said elsewhere, it is true that sometimes conservatives have shot themselves in the foot by refusing to settle for half a loaf instead of none. But this is not one of those instances, for it is an issue of life and death, of murder, not pragmatic political horse-trading. E.g., should an unwilling German civil servant in Nazi Germany have helped to implement an order for the arrest or execution of some Jews, on the grounds that if he refused and resigned, he would be replaced by a zealous Nazi lackey who would implement the order with greater zeal and efficiency? I think not. Russell Moore and Tony Esolen are right.

To the editors -- I am curious -- does the blog on the First Things web site truly constitute First Things endorsing this position? Or is it only a forum for a particular editor or contributor to post his views on a particular subject?

[Kamilla]

Hi Bob,

Yes, muder is against the law but not all killing is legally defined as murder. It is the law which creates and changes the definition of murder and defines which acts of killing are murder. As such, abortion is not legally defined as murder even though we know it is the violent taking of an innocent human life.

It's been a long time since I've read portions of Roe v. Wade, and I've never read the entire decision. We need to remember it's co-conspirator (as it were) is Doe v. Bolton. The decision which laid the groundwork for both those cases is Griswold v. Connecticut. One must read those three cases at a minimum to understand the SCOTUS's holdings regarding abortion. I believe you can search for cases on the court's website although it may be easier to find older cases using one of the "unofficial" sources listed on this page:

http://www.supremecourtus.gov/opinions/obtainopinions.pdf

Kamilla

[GL]

What is really sad about Plan B is that the more widely used it becomes the lower the abortion rate will appear. Many pro-lifers, especially the more ill-informed ones, will think we have made major strides against abortion. The pro-choice crowd meanwhile will also point to the reduction in "abortions" as proof that their strategy was correct all along. Who knows, with time, the strategy may be so successful that the issue will go away as a significant factor in politics. Meanwhile, millions of little pre-implanted boys and girls will be killed without anyone even noticing or caring that they ever lived save their Creator.

If you have any doubt that this is where it may well go, indeed is likely to go, consider that normally pro-life politicians like President Bush and Bob Casey are in favor of Plan B being made available OTC. If they can be led to accept it can you doubt that millions of others can to.

Lord have mercy upon us.

[Deacon John M. Bresnahan]

Stuart makes an excellent point--one I believe endorsed by Pope John Paul II in his encyclical on life. It is better to get 50% (save at least half the babies) than go for a 100% that is unattainable for all the foreseeable future (and see 100% of babies at risk die for all the foreseeable future).

[Stuart Koehl]

>>>What is really sad about Plan B is that the more widely used it becomes the lower the abortion rate will appear. <<<

I suspect this is a tempest in a teapot, since not all that many women will actually use it, and after the first major round of product liability suits, it will probably come off the market. There ain't that much money in this thing, and drug companies have to watch their bottom line.

[GL]

I suspect this is a tempest in a teapot, since not all that many women will actually use it, and after the first major round of product liability suits, it will probably come off the market. There ain't that much money in this thing, and drug companies have to watch their bottom line.

I hope you are right, but how many babies will die before it is pulled off the market, if in fact that happens. I do know that Barr is struggling with how and where to advertise the product, but it is in fact planning to do so and, in fact, has already done some advertising. Barr at least thinks that it has a profitable product or it wouldn't be producing it, marketing, and fighting for FDA approval to sell it OTC. It may be wrong, but that is just speculation at this point.

[Dcn. Michael D. Harmon]

I got back to this thread late, but I will make a stab at Stuart's challenge to ''define conservative.'' It is what Barry Goldwater's conscience told him to do in 1964....

Or, one could say, it is the opposite of whatever anyone who calls himself a ''progressive'' happens to be recommending.

Or, one could spend years reading Burke, Locke, Miil, Chesterton, Oakshott, Kirk and dozens more, and then distill them in the lens of the 21st century's exigencies and say -- a conservative is a friend of the Permanent Things.

Unfortuately, I don't have room to list THEM right now, but they're out there. That's the nice thing about them being Permanent, you know.

[Tony Esolen]

Kamilla,

I don't think we can accept the nominalist position you set forth. The basis for the Nuremberg trials was precisely that "murder" is not simply defined by the state. Now if an official is suddenly ordered to commit murders which the state will no longer consider to be murders, he cannot obey. The more difficult question is whether and in what way he may, or must, disobey.

Another thing about Thomas More: he was a pragmatist in a certain limited but important sense. He was a player. So if the language of Parliament's edict could be construed in any way that would allow him, in good conscience, to sign the oath, then he would sign the oath. I think it's a good principal of politics that a just man ought to take as much leeway as the law will reasonably allow; in other words, since the law is by necessity general, its application to particular situations falls under the jurisdiction of the virtue of prudence. So if there are any reasonable grounds upon which to deny adolescents the over-the-counter use of RU-486, you take them; and, given the tumultuousness of the adolescent psyche, I don't think those grounds would be hard to find and to propound.

My college some years ago suffered an attack of scrupulosity and ditched the baseball team without any Title IX complaints having been raised, and without any accusations that the team's existence was unjust. Quite the reverse: the vice president had said that Title IX was a "dastardly law." But we rushed to fall under strict compliance with it. There are plenty of ways in which you can blunt the effect of an unjust law, or render unjust principles ineffective, without actually engaging in open disobedience. I'm not sure the Bush administration availed itself of them.

[Tony Esolen]

With regard to voting for poorly pro-life Republicans, or Democrats devoted to the destruction of the traditional family, I agree with everybody here. Half an oaf is better than none.

[Kamilla]

>>I suspect this is a tempest in a teapot, since not all that many women will actually use it, and after the first major round of product liability suits, it will probably come off the market. There ain't that much money in this thing, and drug companies have to watch their bottom line.<<

Yeah, that same thing was said about abortion thirty years ago. And that holocaust is still costing us roughly a million lives a year. Similar claims were made when the FDA approved RU-486 and how many women have died now with it still on the market?

Tempest in a teapot? Hardly.

Kamilla

[Kamilla]

>>I don't think we can accept the nominalist position you set forth. The basis for the Nuremberg trials was precisely that "murder" is not simply defined by the state. Now if an official is suddenly ordered to commit murders which the state will no longer consider to be murders, he cannot obey. The more difficult question is whether and in what way he may, or must, disobey.<<

I don't know that my position is so much nominalist as descriptive of the present state of affairs with regard to abortion. But maybe I'm confused on that point (it's been known to happen).

Yes, agreed as to the basis of the Nuremberg trials and how this shows that murder is not simply defined by the state. However, I am not aware of any state or organization composed of independent mamber states, at least speaking of the Western/Industrialized world which shares our basis for positive law, which defines abortion as murder. Regulates it, yes, but defines it as murder, no.

Kamilla

[Kamilla]

sorry to pile on but I believe I should say one more thing.

Tony,

Your point about nominalism is well taken. I am also probably guilty of equivocation - perhaps in trying to salvage a position I didn't state clearly to start with. At any rate, I think I need to go away and think about it before I post any further on the subject.

Kamilla

P.S. The "morning after" or "plan b" pill is not the same drug as ru-486. Rather, it is a high dose of what is more routinely used as a daily birth control pill.

[Stuart Koehl]

>>>P.S. The "morning after" or "plan b" pill is not the same drug as ru-486. Rather, it is a high dose of what is more routinely used as a daily birth control pill.<<<

I, for one, was aware of that. However, birth control pills at normal dosage are known to have side effects, which is why they are issued only with a prescription. Now, we have far more powerful dosages of the same artificial hormones being issued over the counter. The potential for abuse is immense, and I anticipate that the personal liability lawyers are lining up already to file the first class action suit as soon as some poor woman dies as a result of misusing these pills.

[Ross S. Heckmann]

Russell,

Glad to see that you are a fellow pro-life Democrat. I belong to Democrats for Life and am an officer in the California chapter. Anybody reading this comment should feel free to check us out at http://www.democratsforlife.org and feel free to join our pro-life efforts in the Democratic Party.

Below please find a copy of a letter sent July 12, 2006, by a faithful, fellow pro-life Democrat Dr. David Six. Dr. Six got his Ph.D. in biochemistry from U.C. San Diego and is currently working as a scientist at Duke University Medical Center. Dr. Six's letter below is to Steven Ertelt, founder and editor of LifeNews.com. Dr. Six disputes the notion that "Plan B" (also known as the "morning-after pill") is an abortifacient. Unless and until somebody can refute Dr. Six's arguments and research, I do not think we pro-lifers can treat Plan B as an abortifacient. Therefore, whether Bob Casey was right or wrong to endorse what the FDA did in connection with Plan B, it cannot be said that Casey betrayed the pro-life cause.

Very truly yours,

Ross S. Heckmann
rosss.heckmann@gmail.com
Arcadia, California

Steven,

I appreciate your dedication to the pro-life cause. I also appreciate that pro-lifers want to give the benefit of the doubt to human embryos. That is why I oppose long-term hormonal birth control (as well as the IUD). Research clearly indicates that these methods of contraception can indeed function as anti-implantation drugs or devices (i.e. abortifacients). The mechanism of the hormones is to cause the gradual thinning of the uterine lining that leads to a decreased chance of implantation of the already conceived embryo. In contrast single-higher dose hormonal contraception would not have this same effect. As far as what the manufacturer says, I think that they are likely to mention all the
side-effects and possible functions of the hormones from the research into long-term use. Most importantly there is indeed research on rats and monkeys and some on humans that the use of Plan B as directed does not have any effect on implantation or post-implantation. I assure you if there were any contrary research I would change my mind. I do not support over-the-counter availability of any hormonal drug or device. Here is what one physician said in a letter to editor of Scientific American: Dr.
Beverly Nuckols founder of lifeethics.org says: "The latest medical data indicate that morning-after pills block ovulation when they work. There is no evidence that they stop the implantation of an embryo." Her email is:
Beverly B. Nuckols, MD, at bnuckols@LifeEthics.org.

Here are the scientific abstracts of all the research I could find.

Steroids. 2003 Nov;68(10-13):1095-8. Mechanisms of action of emergency contraception.
Croxatto HB, Ortiz ME, Muller AL.
The use of levonorgestrel (LNG) alone or combined with ethinylestradiol (Yuzpe regimen), for hormonal emergency contraception (HEC) has been approved in several countries whereas in
others it is still under debate or has been
rejected under the claim that these formulations abort the developmental potential of the embryo. The issue is whether they act by preventing fertilization or by impeding the successful
development of the zygote through and beyond implantation. Until now, published work has left this issue largely unresolved, and this paucity of knowledge sustains heated controversies in many settings. A single study indicates that LNG impairs sperm migration in the genital tract of women in ways that could interfere with fertilization. Several studies in women examined the effects of HEC on the outcome of the leading follicle, but lack of precision in the timing of treatment relative to follicular growth, maturation, or rupture confers great variability and inconsistency of results within and
between studies. Nonetheless, results indicate that ovulatory dysfunction may account for the prevention of pregnancy in a large proportion of cases. Studies searching for possible alterations of the endometrium at the time implantation would normally take place, found minimal changes of doubtful significance. Recent studies in animals cast serious doubts that LNG prevents pregnancy by interfering with post-fertilization events. Failure to prevent expected pregnancies is close to 25% in women, and this is likely to be accounted for entirely by treatment given too late to prevent fertilization. The exact mode of action of HEC
remains undetermined.

Contraception. 2003 May;67(5):415-9 Postcoital treatment with levonorgestrel does not disrupt postfertilization events in the rat.
Muller AL, Llados CM, Croxatto HB.
Levonorgestrel (LNG), a progestin widely used for regular hormonal contraception, is also used for emergency contraception (EC) to prevent pregnancy after unprotected intercourse.
However, its mode of action in EC is only
partially understood. One unresolved question is whether or not EC prevents pregnancy by interfering with postfertilization events. Here, we report the effects of acute treatment with LNG upon ovulation, fertilization and implantation in the rat. LNG inhibited ovulation totally or partially, depending on the timing of treatment and/or total dose administered, whereas it had no effect on fertilization or
implantation when it was administered shortly before or after mating, or before implantation. It is concluded that acute postcoital administration of LNG at doses several-fold higher than those used for EC in women, which are able to inhibit ovulation, had no
postfertilization effect that impairs fertility in the rat.

Hum Reprod. 2004 Jun;19(6):1352-6
Post-coital administration of levonorgestrel does not interfere with post-fertilization events in the new-world monkey Cebus apella. Ortiz ME, Ortiz RE, Fuentes MA, Parraguez VH, Croxatto HB.
BACKGROUND: Experimental evidence to disprove the belief that emergency contraception with levonorgestrel (LNG) prevents pregnancy by interfering with post-fertilization events is
lacking. Here we determined the effect of
post-coital and pre-ovulatory administration of LNG on fertility and ovulation, respectively, in the Cebus monkey. METHODS: To determine the effect on fertility, LNG 0.75 mg or vehicle were administered orally or s.c. once or twice within the first 24 h after mating occurring very close to the time of ovulation. Females that became
pregnant were aborted with mifepristone and re-entered the study after a resting cycle until each of 12 females had contributed, in a randomized order, two LNG and two vehicle-treated cycles. To determine the effect on
ovulation, LNG 0.75 mg or vehicle were injected twice coinciding with follicles smaller or larger than 5 mm in diameter. Six females contributed five treated cycles each.
RESULTS: The pregnancy rate was identical in vehicle- and LNG-treated cycles. LNG inhibited or delayed ovulation only when treatment coincided with a follicle <5 mm diameter.
CONCLUSION: In Cebus monkeys, LNG can inhibit or delay ovulation but, once fertilization has taken place, it cannot prevent the establishment of pregnancy. These findings do not support the hypothesis that emergency contraception with LNG prevents pregnancy by interfering with
post-fertilization events.

Hum Reprod Update. 2004 Jul-Aug;10(4):341-8. Mechanisms of action of mifepristone and levonorgestrel when used for emergency contraception. Gemzell-Danielsson K, Marions L.

An emergency contraceptive method is used after coitus but before pregnancy occurs. The use of emergency contraception is largely under-utilized worldwide. One of the main barriers
to widespread use is concern about the
mechanism of action. Recently, treatment with either 10 mg mifepristone or 1.5 mg of levonorgestrel has emerged as the most effective hormonal method for emergency contraception with very low side-effects. However, the knowledge of the mechanism of action of mifepristone and levonorgestrel in humans, when used for contraceptive purposes and especially for emergency contraception, remains incomplete. The objective of this review is to summarize available data on the effects of mifepristone and levonorgestrel on female reproductive functions relevant to the emergency use of the compounds. When summarized, available data from studies in humans indicate that the contraceptive effects of both levonorgestrel and mifepristone, when used in single low doses for emergency contraception, involve either blockade or delay of ovulation, due to either prevention or delay of the LH surge, rather than to inhibition of implantation.

Contraception. 2004 Dec;70(6):442-50. Pituitary-ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75-mg dose given on the days preceding ovulation. Croxatto HB, Brache V, Pavez M, Cochon L, Forcelledo ML, Alvarez F, Massai R, Faundes A, Salvatierra AM.
We assessed to what extent the standard dose of levonorgestrel (LNG), used for emergency contraception, or a single dose (half dose), given in the follicular phase, affects the
ovulatory process during the ensuing 5-day period. Fifty-eight women were divided into three groups according to timing of treatment. Each woman contributed with three treatment cycles separated by resting cycles. All received
placebo in one cycle, and standard or single
dose in two other cycles, in a randomized order. The diameter of the dominant follicle determined the time of treatment. Each woman had the same diameter assigned for all her treatments. Diameters were grouped into 33 categories: 12-14, 15-17 or 18-20 mm. Follicular rupture failed to occur during the 5-day period in 44%, 50% and 36% of cycles with the standard, half dose and placebo, respectively. Ovulatory dysfunction,
characterized by follicular rupture associated with absent, blunted or mistimed gonadotropin surge, occurred in 35%, 36% and 5% of standard, single dose or placebo cycles, respectively. In conclusion, LNG can disrupt the ovulatory process in 93% of cycles treated when the diameter of the dominant follicle is between 12 and 17 mm. It is highly probable that this mode of action fully accounts for the contraceptive efficacy as well as the failure rate of this method. The present data suggest that half the dose may be as effective as the standard dose.

[GL]

Ross,

I am aware of these studies. I am also aware that the manufacturer says the following on its web site:

Plan B® may also work by preventing it from attaching to the uterus (womb).

Apparently, the manufacturer is not as confident as Dr. Six that its product may not prevent the implantation of an embryo.

I understand that Dr. Six is not saying this, but I would warn that some who say Plan B is not an abortifacient are playing with words. They define a pregnancy as occuring only after implantation. By that definition, any drug that failed to prevent conception but succeeded at preventing implantation would not be an abortifacient. The issue is not when pregnancy begins, which is a matter of definition in the medical science, but when life begins. Without question, life begins at conception.

Again, I understand the Dr. Six is not playing loose with words. He is basing his opinion on studies that tend to show that Plan B prevents conception. If that is the case, then Plan B would not be an abortifacient. Again, however, the manufacturer apparently is unwillingly to rely completely on those studies. I am unwilling to accept the studies you cite as the final word given the reluctance of the manufacturer to do so, especially when it is obvious that accepting the studies' conclusions would be to its advantage in marketing its product.

[GL]

Stuart,

As to whether Plan B will reduce the reported abortion rate, consider the following from the manufacturer's web site:

Approximately 2.7 million unplanned pregnancies occur each year in the United States, of which 54% result in abortion. And more than half of all abortions are a result of contraceptive failure. Unplanned pregnancies that result in abortions may be significantly reduced with more awareness of, and the availability of, EC.

Again, the manufacturer may be wrong or may be misleading, but it is marketing its product as a means of reducing the number of abortions (as it defines that term).

[GL]

By the way, I plan to hold my nose and vote GOP like I always do. As the years go by, however, it becomes harder to keep the stench out of my nostrils as I enter the voting booth.

[Stuart Koehl]

>>>Again, the manufacturer may be wrong or may be misleading<<<

I think the period can go right there. Manufacturers market their product in the way they believe will maximize sales. Any relationship between product claims and ground truth is purely coincidental. Notice that none of these claims are backed by peer-reviewed research. Most of the literature surrounding abortion is like that.

[Gina]

However, birth control pills at normal dosage are known to have side effects, which is why they are issued only with a prescription. Now, we have far more powerful dosages of the same artificial hormones being issued over the counter.

I know what I would be thinking, if I didn't see this as abortion. "Why should I go to a doctor for a scrip and then bother about remembering a little pill every day, when all I would need to do if I found myself pregnant would be to run to the drugstore for a quick fix-it?" After all, what's worse- side effects that go on continuously or side effects for a one-time pill?

It would be the expedient and economical thing to do, and poor women would be the ones most likely to think that way.

[Claire]

"Why should I go to a doctor for a scrip and then bother about remembering a little pill every day, when all I would need to do if I found myself pregnant would be to run to the drugstore for a quick fix-it?"

... Except that by the time one finds oneself pregnant, it's already too late for Plan B.

[Ranee Mueller]

As abhorrent as "Plan B" is to me, the things that bother me about the FDA and our President's response are that it will be available without a prescription, the risks of the high dosage of the drug Stuart spoke of already, and that the President in no way indicated that he was only doing this to follow the law. He endorsed it.

[Bobby Winters]

Stuart et al,

Is it possible that the drug manufacturer's claims for plan B are more than just gilding the Lilly? Could they be softening up the ground to make anti-implantation drugs more acceptable by separating them from abortifacients? Or am I just being paranoid again?

[Stuart Koehl]

>>>tuart et al,

Is it possible that the drug manufacturer's claims for plan B are more than just gilding the Lilly? Could they be softening up the ground to make anti-implantation drugs more acceptable by separating them from abortifacients? Or am I just being paranoid again?<<<

Not at all. Planned Parenthood entered into a price deal with the manufacturer whereby it purchases Plan B for about $14 per dose, and resells it at $20-30 per dose. The manufacturer has every incentive, therefore to make the pills look as attractive as possible, since it has traded off the high margins needed at the beginning of a drug's life to recoup the costs of R&D. Because its margins on the prescription side were so small (relatively speaking), by going OTC the company can now make up its costs on volume sales.

[Stuart Koehl]

Robert Miller responds to his critics over at First Things:

Robert T. Miller writes:

I argued here last week that, as morally objectionable as Plan B (the “morning after” drug that prevents conception or acts as an abortifacient) may be, the Bush administration had little choice under the law but to approve it for sale. Much as I expected, some of my pro-life friends responded angrily, some lecturing me on the natural law and some accusing me of being a son of perdition.

Contemplating the emotion underlying this response, I suspect that some in the pro-life camp may be confusing two quite different moral norms related to the taking of human life. On the one hand, there is the norm against intentionally killing an innocent human being. This norm is absolute in the sense that it applies always and everywhere, there being no circumstances whatsoever in which we may intentionally kill the innocent. That being so, we ought rather die as martyrs than engage in such killing. On the other hand, there is a norm requiring us to act to save the innocent from being killed by others. This norm is not absolute because our obligation so to act depends on the totality of the circumstances—on such things as the means available to us, our relation to the one in danger, our other moral commitments, the prospects for successful action, and so on.

When we see on television the victims of genocide in Darfur, for example, although we know that they are doomed to a violent death, we do no wrong if we conclude, reasonably and in good faith, that helping them is not reasonably possible because we lack the means to do so, because the attempt would do more harm than good, or because there are other persons, closer to home, to whom we owe a superior duty. As St. Thomas says, we ought to will the good of all, but our obligation to act for the good of any depends on the circumstances.

Some modern philosophers, especially consequentialists, are confused by this, thinking that someone who fails to rescue another from death acts as wrongly as does someone who intentionally kills another. There are exceptional cases where that may be true, as when an adult stands passively by and watches a small child drown in a bathtub, but, generally speaking, failing to rescue the innocent from death may or may not be wrong, and when it is wrong, it may be more or less wrong—all depending on the circumstances of the case.

In any event, even when the moral guilt of the intentional murderer and the man who fails to save an innocent are equal, the kind of moral wrongdoing differs. One man chooses an action that is incapable of being ordered to the final end of human nature; the other fails to choose an action that, in the circumstances, is uniquely well ordered to that end. Because judgments about whether particular actions are well ordered to the final end are often difficult and uncertain, we should judge others especially leniently in evaluating their conduct in such cases.

My pro-life friends who think that people ought go to any lengths whatsoever to prevent abortions are, I think, confusing the two kinds of moral norms in play. They are acting as if the obligation to save the innocent were as absolute as the obligation not to kill the innocent, and it simply is not. There are, tragically, many circumstances in which we are unable to save innocents from a violent death, and in those cases we have no moral obligation to act. Those are cases about which we pray, trusting in a God who judges justly.

[James A. Altena]

I vigorously dissent from Robert Miller. We are not confused in the manner he supposes. The question is not whether "people ought go to any lengths whatsoever to prevent abortions" (which would lead to acts such as bombing abortions clinics and murdering abortionists). The question is whether more reasonably could have been done in this case to prevent abortions. Many of us believe so. Miller is simply engaging in casuistry here -- and also condoning a Pontius-Pilate style washing of the hands type of self-exculpation for those involved.

Yes, there are times when, faced with a policy which which one strongly disagrees, one should swallow hard, remain within the system, and fight the good fight for the long-term strategic goal instead of focusing upon the short-term tactical loss. But this can also all too easily slip into the self-deceiving and self-serving provision of the time-server who seeks comfort for himself, instead of suffering loss for the Gospel and taking up our Cross to follow Christ. E.g., I have in mind those in apostate denominations (I have one in particular in mind) who, no matter what happens, make the same futile noises about "reclaiming the church" (it is apostate, not just heretical -- there is nothing left to reclaim); "they can't take away our church from us" (though they already have), "we're not threatening to leave; we're threatening to stay," (staying in an apostate former "church" is a threat? to whom?), etc., etc.

[Stuart Koehl]

>>>I vigorously dissent from Robert Miller.<<<

I, too, dissent--but not categorically.

I believe that overall, Miller's principle is correct. One cannot in fact save everyone, and one cannot, by human effort, rid the world of evil. One must therefore pick one's fights, weighing carefully the consequences of action vs. inaction, the likelihood of success, and the consequences of failure.

That said, I have to disagree with Miller's statement: "In any event, even when the moral guilt of the intentional murderer and the man who fails to save an innocent are equal, the kind of moral wrongdoing differs." Certainly, I cannot square it with Eastern Christian moral theology, which holds that anything that obscures the "image and likeness within" constitutes some form of hamartia. Too many people use Miller's reasoning to excuse inaction, which in effect raises inaction either to moral neutrality or to a positive good. In return, that provides an incentive towards inaction, which in turn continually lowers the bar regarding rationales for inaction.

>>>There are, tragically, many circumstances in which we are unable to save innocents from a violent death, and in those cases we have no moral obligation to act. <<<

In particular, I disagree with him here. I would prefer to say that we do indeed have a moral obligation to act, but sometimes circumstances preclude us from acting. That should not be seen as an excuse or a vindication, but rather as an occasion for grief and metanoia.

[GL]

I would agree with James' and Stuart's response to Robert Miller. I would add on the compromise argument that compromise is good when it advances you toward the good, but it is evil when it advances you toward the evil. The question is, overall, have you made progress toward the ultimate goal (or, at least, prevented regress from that goal). When, however, you compromise in a way to enable regress rather than to limit it, that is a bad (dare I say evil) compromise. I believe the agreement to make Plan B OTC falls into the latter category. This was a political decision to try to appeal to the center before the November elections. Bush and his political advisors probably believe that they will preserve more centrist votes by this decision than they will lose pro-life votes (figuring that we have little choice but to vote from them and probably planning on reminding us of the Roberts and Alito nominations should we waver). Frankly, they are correct, but it was a crass decision.

It may well be, as Robert Miller intimates, that Bush's advisors in the FDA argued that such a move was required by law. I must say, however, that few legal questions are so cut and dried. I seriously doubt that there was not any reasonable argument that could have been made in front of a court to defend a decision not to make it available OTC. I for one would have preferred a law suit being filed by Planned Parenthood or Barr to force the issue and to have the administration, if necessary, take it all the way to the Supreme Court (assuming that the Court would grant cert). Bush (and many, if not most, of his predecessors) has been willing to defend in court weaker cases than this would have been. To say that Bush was forced to do this based on the law is a cop out. In any event, as Ranee notes, Bush never claimed that was his reason for approving OTC status and, in fact, said that he believed Plan B should be OTC for women 18 and older.

[GL]

Things could be worse. See CHILE’S NEW CONTRACEPTIVE POLICY SHARPLY CRITICIZED: The Catholic Church And Local Politicians Condemn Plan to Provide Morning After Pill Free Of Charge To Women Over 14 Years Old.

[GL]

Just out of curiosity, I decided to see what Chile's fertility rate is. I found the following:

Year     Fertility Rate
2000          2.20
2001          2.16
2002          2.13
2003          2.09
2004          2.06
2005          2.02

As demonstrated by the above, since 2000, Chile has gone from having just above replacement rate fertility to just below. Now it will make Plan B available for free to any female (I hesitate to call a 14-year-old a woman) 14 years or older. Apparently Chile is unconcerned about slipping into European or East Asian levels of fertility, which appears to be the direction it was heading even before this latest decision.

[Firinnteine]

Does anyone have a direct response to Ross Heckmann's citations? I don't have the scientific training (or the time) to analyze the studies he references, but if all the scientific evidence indicates that this is not in fact an abortifacient (which appears to be his claim), then we're having the wrong argument -- we could declaim against contraception (again), but not against abortion. If there is scientific evidence that this is an abortifacient, someone ought to supply references, so that Mr. Heckmann and others can consider all the relevant facts and decide whether they might need to change their positions.

Quoting the company isn't necessarily definitive if the company doesn't have any science to back up its claims, either... which has not yet been demonstrated one way or the other.

People often (I believe rightly) call Mr. Hart to defend his claims about homosexuality on this forum. It's only fair that we hold ourselves to the same standard.

[Kamilla]

http://www.go2planb.com/section/about/index.html

Although this website claims Plan B is Not an abortifacient, they clearly state that a secondary action is to prevent implantation if fertilization does occur. The abortifacient effect is, as with all hormonal contraceptives, a secondary effect and not the primary action of the drugs. The primary action being to prevent ovulation so there is nothing to fertilize.

In addition, confusion may be arising from the claim that it is not an abortifacient because it does not interrupt an established pregnancy where by "established" they mean one in which implantation has occured before the incident of unprotected sex and the subsequent taking of the pills.

But the drug clearly is an abortifacient as a secondary action - as are all hormone-based contraceptives.

Kamilla

[GL]

Quoting the company isn't necessarily definitive if the company doesn't have any science to back up its claims, either... which has not yet been demonstrated one way or the other.

I am aware of no studies that show that Plan B in fact prevents implantation. Some have argued that Barr has made the statement that its drug may prevent successful implantation because it is not exactly sure what mechanisms make its drug work. I don't doubt that. It would not be unusual for a drug company not to fully understand the exact mechanism by which its products work.

What is relevant about Barr's statement is that it is unwilling to assert, despite the studies cited above, that its product does not in fact have that effect. It would clearly be to its benefit to say that it did not have that effect. For some reason, it is unwilling to do so and you can rest assured that it has access to and has reviewed all the relevant studies done of its drug.

The issue that interests me more (and on which I am currently working) is whether pharmacist should be able to refuse to fill a prescription for (or now provide OTC to an adult) Plan B on the basis of conscience. As some of the regulations requiring them to do so make exceptions for pharmacists who dispense no contraceptives, it is important in those states to also show that there is some reason for pharmacists to be concerned that Plan B may, in some instances, act as an abortifacient. The issue, it seems to me, is not whether in fact it has been shown to do so, but rather whether it has been shown irrefutably not to do so. Barr's unwillingness to dismiss that possibility when it has every interest in doing so and when, at a minimum, it has engaged in significant research in developing its product and undoubtedly has in hand all the available research findings, makes evident the fact that it does not believe the evidence against Plan B preventing implantation is irrefutable. A pharmacist who wants to do nothing which may result in the death of an embryo should not be required to act as if that possibility does not exist with Plan B when its own manufacturer states explicitly that its drug may indeed have that effect.

Should a pharmacist who opposes abortion (including by abortifacients) be required to dispense (either by prescription or OTC) a drug when the manufacturer of that drug is unwilling to emphatically state that the drug does not prevent implanation but, to the contrary, explicitly states that it may? Must a pharmacist who wishes to avoid doing so discontinue his sales of all contraceptives when he has no moral reservation against non-abortifacient contraceptives? (That is, must such a pharmacist follow the Catholic teaching when he may be following the teachings of his own church which permits the use of non-abortifacient contraceptives but prohibits the use of abortifacients and abortion?) This is a serious matter of the free exercise of religion.

As to how President Bush and the FDA should act, it can be argued that they accepted the studies that Plan B is not an abortifacient. I am unaware of either the President or the FDA taking such a position. If they have, I would welcome a citation to a source on that.

[Kamilla]

GL,

Since Plan B is a Progestin-only pill, similar to the "mini-pill", I don't see how anyone can dispute that it prevents implantation. Have you checked the PDR? I know that doesn't contain the studies themselves but the information it provides should be based on those studies.

Here is a page: http://www.teencarecenter.com/index.php?s=factsheets&p=sheet10

which provides references to an older version of the PDR.

Kamilla

[Stuart Koehl]

>>> Some have argued that Barr has made the statement that its drug may prevent successful implantation because it is not exactly sure what mechanisms make its drug work<<<

That's reassuring (although we're not quite sure how asprin works, either).

[GL]

Kamilla,

In fairness to the other side, it is possible that a low dose of a drug taken continously would have different effects from two higher doses taken within 12 hours of each other. I believe that more study is needed of the mechanisms of action for Plan B when used as intended.

As to accepting Barr's statement that Plan B may prevent implantation, I am reminded of a Civil War general (I don't recall who) who refused to return runaway slaves during the war on the grounds that it was the "infelicity" of the rebels' position that insofar as application of the Fugitive Slave Act, he took them at their word (that is, that they were no longer part of the U.S.) I believe that we can apply that same position to Barr and its product. If it says its product may prevent implantation, then we should take it at its word until we have irrefutable evidence to the contrary.

[I would welcome the identity and a source for the quote from the Union general in question.]

[Stuart Koehl]

>>>I am reminded of a Civil War general (I don't recall who) who refused to return runaway slaves during the war on the grounds that it was the "infelicity" of the rebels' position that insofar as application of the Fugitive Slave Act, he took them at their word (that is, that they were no longer part of the U.S.)<<<

Major General Benjamin F. Butler, aka "Beast Butler", former Senator from the Commonwealth of Massachussets and one of the Union's less stellar military minds. But he had a way with him. Butler also used those slaves (aka "contraband") to dig trenches, haul supplies, cook meals and do the myriad chores that an army of occupation needs done. In return, he fed them and paid them a pittance, He also made a tidy fortune impounding cotton (more contraband) and selling it to Northern mill owners.

[Bob]

I think that it is a truism that the Bush administration has been nominally pro-life (the funding to groups like Planned Parenthood has increased during the Bush terms), but the bigger question is where Conservatives will go if the Republican nominee is Guiliani, or some other social progressive? I personally voted for a 3rd party candidate last time after voting for W the first time. The only justification I saw for voting for Bush was the Supreme Court, and that almost caused me to pull the lever for Bush. The Republican Party is further left than it was 5, 6, or even 10 years ago.
So what is a “Conservative” in today’s political climate? Good question. The real danger I see in the neo-con approach to politics is the rhetoric that is being used. People say that Bush is a conservative, but the question maybe asked ‘what is he trying to conserve?’ Also it seems to me to be “pro-life,” today simply means you are against certain forms of infanticide (e.g. partial birth abortion).

[firinnteine]

GL -- thanks, that helped clarify. I'd still like to know on what basis Barr is withholding judgment on the possible abortifacient results of its product, though. (Is it possible that they're simply closing up loopholes for conceivable future lawsuits, just in case?)

[James A. Altena]

A historical aside (thanks to Stuart for providing the occasion) --

The infamous Gen. Butler was also known as "Spoons" Butler for his looting of fine silver from wealthy New Orleans families and churches after the city fell to Adm. Farragut and Butler was put in charge there as military governor. The moniker "Beast" was due to an order he issued that any woman who insulted a Union soldier should be arrested and treated as a prostitute, which aroused international protests and led to him being reassigned from his command there. Later on he became a US representative from and governor of Massachusetts, and ran for president in 1884 on the Greenback Party ticket. As a congressman, he was once discovered to have taken a bribe of $78,000 (close to $2 million in today's money). Asked what he would say to his constituents, he retorted, "They'll say, 'Why didn't he steal more?'" He was duly re-elected.

[GL]

Stuart,

Thanks. I had thought it was Butler, but I could not find the quote online while I was typing the earlier message and thought it must be some other general. How can such an useful quote not be available online? He was a colorful character. If I recall, he also called on his troops to treat any woman of New Orleans who insulted the troops as prostitutes ("a woman of the town plying her avocation" in the words of his order).

Firinnteine,

I am fairly confident that Barr put the acknowledgment that Plan B might prevent implantation on its web site, at least in part, because of the advice of its attorneys. Every word on its web site was probably run by its attorneys. No doubt, the attorneys believed it would be wise to make the statement in case of future litigation. Use of the word "may" gives Barr the widest possible latitude because implicit in the word "may" are the words "may not." Still, it indicates that Barr believes it needed to warn that such an effect is indeed possible.

[GL]

Lest there be any doubt about what compromise (i.e., appeasement) gets one, see Extend the availability of Plan B to all women in need: The FDA's decision is a step forward but there are still prodigious injustices regarding its availability.

[Beverly B. Nuckols, MD]

I'm the prolife family physician who is quoted above. I have the "LifeEthics.org" blog and website.

The manufacturer's information should be changed at the website and through the FDA, however they get these things approved.

There is very good evidence that there is no post-ovulatory effect of Plan B that would interfere with implantation. The study by Durand included serial blood tests, ultrasounds, and biopsies. The uterine lining was full and had normal blood vessels. The chemicals and proteins, etc., the conditions in the uterus, were unchanged except for a slightly higher "glycodelin A" protein, which would actually encourage implantation. The main effect, however, after ovulation is to make the mucus thick and to make the sperm unable to penetrate the covering of the oocyte ('the egg').

Those who are familiar with Natural Family Planning would understand the importance of the thicker mucus. Others might be familiar with treatment for recurrent miscarriage with doses of progesterone. All of these are consistent with Plan B's acting to prevent fertilization, but not to prevent implantation.

The problem is that even with personalized education and easy (or advance) access to Plan B, women who have unprotected intercourse only take the pill 20% of the time when they should, and that these women do not change their habits and continue to have unprotected sex.

We'll probably see a big increase in sexually transmitted infections, pregnancies, and abortions because too many will "skip" the condom and rely on Plan B, but then not follow through with spending the money and/or swallow the pills.

If you want to read the Durand article, it's posted in text form at http://www.freerepublic.com/focus/f-news/1689548/posts

I've covered information on Plan B quite a bit on my blog (at http://www.lifeethics.org/www.lifeethics.org/index.html I'm on a friend's computer, away from home, so don't have the links with me.)