Submitted by Elaine Magliaro, Weekend Contributor
Back in March of this year—during oral arguments in the Hobby Lobby case—Sahil Kapur (Talking Points Memo) said he thought that the conservative Supreme Court Justices “appeared broadly ready to rule against the birth control mandate under Obamacare.” He added that “their line of questioning indicated they may have a majority to do it.” Kapur reported that Chief Justice Roberts and Justices Scalia and Alito “expressed no sympathy for the regulation while appearing concerned for the Christian business owners of Hobby Lobby and Conestoga Wood who said the contraceptive mandate violates their religious liberty and fails strict scrutiny standards under the 1993 Religious Freedom Restoration Act (RFRA).”
During oral arguments, Justice Scalia said, “You’re talking about, what, three or four birth controls, not all of them, just those that are abortifacient. That’s not terribly expensive stuff, is it?”
There are a couple of things I think Justice Scalia should know. First, the four contraceptive methods that Hobby Lobby objected to paying for—Plan B, Ella, and two intrauterine devices—are not abortifacients. They do not prevent the implantation of a fertilized egg into the uterus—which the owners of Hobby Lobby consider to be abortion. Instead—according to the Food and Drug Administration—the four contraceptive methods in question prevent fertilization of an egg. Second, the cost of intrauterine devices can be quite considerable—especially to a woman working for minimum wage or for a company like Hobby Lobby.
Plan B is also known as the morning-after pill. Ella, the week-after pill, actually works for just five days after unprotected sex. Both of these drugs are classified by the Food and Drug Administration as contraceptives. Neither is the same as the abortion drug RU486, or Mifeprex—which isn’t considered a contraceptive and isn’t covered by the new insurance requirements.
Plan B, Ella and the Cost of IUD’s
Susan Woods, a professor of health policy at George Washington University and a former assistant commissioner for women’s health at the FDA, has been frustrated by the constant references to Plan B and Ella as abortion-causing pills. She said, “It is not only factually incorrect, it is downright misleading. These products are not abortifacients. And their only connection to abortion is that they can prevent the need for one.”
Jamie Manson (National Catholic Reporter) said that the “reality is that there is overwhelming scientific evidence that the IUD and Plan B work only as contraceptives. Since Ella is new to the market, it has not been studied as extensively. But as of now, there is no scientific proof that Ella acts as an abortifacient, either.” He added that there is only one drug approved to induce abortion—RU-486, which is not on the FDA’s list of approved contraception. He continued, “It is available only by prescription and no employer is forced to pay for it as part of an employee health plan.”
Manson said that it’s important to understand the biology of conception in order to “understand why scientists believe that the IUD, Plan B and Ella are not abortifacients.”
Manson:
…In order for a woman to become pregnant after sexual intercourse, her ovaries must release an egg (ovulation). Sperm can remain viable inside her reproductive tract for five days. Therefore, if intercourse takes place up to five days before ovulation or within two days after, both sperm and egg are viable and the egg cell can be fertilized.
Now, just because an egg is fertilized doesn’t necessarily mean that it will develop into an embryo. For that to happen, the fertilized egg must be implanted into the endometrium that lines the uterus. Implantation happens seven days after fertilization, if it happens at all. Scientists estimate that, at a minimum, two-thirds of fertilized eggs fail to implant. Some scientists estimate that the number may even be as high as 80 percent, according to Discover Magazine.
For this reason, according to the medical definition, a woman is not considered pregnant until the developing embryo successfully implants the lining of the uterus.
Regarding the cost of an IUD (New York Times):
The cost of an IUD, one of the most effective forms of birth control, is considerable. It requires a visit to the doctor, and a procedure to have the device put in place. Medical exams, insertion, and follow-up visits can run upward of $1,000. Without insurance coverage, it’s likely that many women will be unable to use them.
Writing for SCOTUSblog, Dawn Johnsen, a professor of law at Indiana University School of Law-Bloomington, said the following:
Hormonal IUDs can be forty-five times more effective than oral contraceptives and ninety times more effective than male condoms in preventing pregnancy, based on typical use. Finally, cost concerns often drive women away from a preferred method to less effective methods. Almost one-third of women report that they would change their choice of contraceptive method if cost were not a factor. That’s tens of millions of women.
Religious Beliefs Trump Scientific Research in Hobby Lobby Ruling
In July, Kapur wrote about the Hobby Lobby case again following the Court’s ruling. He said that when Supreme Court Justices had suggested back in March “that certain forms of birth control were abortion-inducing, nobody stood up to point out that the claim by Hobby Lobby lacked support within the medical community.” He added that “it came as little surprise that the 5-4 ruling against the Obamacare contraception mandate ignored the scientific research about whether those contraceptives actually cause abortion. The religious owners of Hobby Lobby and Conestoga Wood believed it, and that was enough.” Justice Alito wrote for the Court, “If the owners comply with the HHS mandate, they believe they will be facilitating abortions”—“decreeing it a ‘substantial burden’ on free exercise of religion and thus in violation of the Religious Freedom Restoration Act.” He also wrote, “The owners of the businesses have religious objections to abortion, and according to their religious beliefs the four contraceptive methods at issue are abortifacients.”
After the Hobby Lobby ruling, Erika Eichelberger and Molly Redden of Mother Jones pointed out that the five justices who ruled in favor of Hobby Lobby weren’t just overruling an Obamacare regulation, they were also overruling science.
But—as Kapur noted in his TPM article in July—“the justices weren’t legally required to consider the science. Quite the opposite: RFRA, a statute passed by a Democratic Congress and signed by President Bill Clinton in 1993, grants special treatment under the law to religious people regardless of whether their beliefs are substantiated by evidence.”
On a segment of The Daily Show back in March, John Stewart said, “So let me get this straight.Corporations aren’t just people, they’re ill-informed people. Whose factually incorrect beliefs must be upheld because they sincerely believe them anyway.”
It isn’t just the Hobby Lobby folks and some Supreme Court Justices who appear ill-informed about certain contraceptives. After the Hobby Lobby ruling, Katie McDonough (Salon) wrote that some of the right’s talking points on Hobby Lobby were wrong and showed a misunderstanding of health insurance and sex.
McDonough:
On Fox News, Bill O’Reilly and Megyn Kelly tried to see who could out-ignorant the other by shouting misinformation about how birth control works and the supposedly narrow scope of the ruling. Also on Fox News… Brit Hume concluded — with zero supporting medical evidence — that the four forms of contraception no longer covered by Hobby Lobby “amounted to abortion.”
While over at the National Review Online, editor Jonah Goldberg wrote that Hobby Lobby “objected to paying for what it considers to be abortifacients, which don’t prevent a pregnancy but terminate one. The pro-abortion-rights lobby can argue that ‘abortion’ and ‘birth control’ are synonymous terms, but that doesn’t make it true.” I’d respond to Goldberg by saying that the owners of Hobby Lobby may believe that the four contraceptives that it objected to are abortifacients—but that doesn’t make it true.
After returning from a two-week hiatus from The Daily Show on July 14th, Jon Stewart did a segment on the Hobby Lobby ruling. He found it interesting that the owners of Hobby Lobby consider Plan B to be an abortifacient—even though the American College of Obstetricians and Gynecologists say it isn’t. “But what would they know about vaginas?” said Stewart. “Compared to a corporation that sells foam cones and glitter.”
SOURCES
Morning-After Pills Don’t Cause Abortion, Studies Say (NPR)
What an abortifacient is — and what it isn’t (National Catholic Reporter)
Science Was Irrelevant In Hobby Lobby And That’s Congress’s Fault (Talking Points Memo)
Conservative Justices Appear Ready To Strike Birth Control Mandate (Talking Points Memo)
5 myths about the Hobby Lobby case, debunked (MSNBC)
How Hobby Lobby Ruling Could Limit Access to Birth Control (New York Times)
It appears some people object to a post that provides information about the four contraceptives at the center of the Hobby Lobby case. They prefer talking points to facts.
I wonder. Maybe employers shouldn’t cover the medical expenses for smokers with lung problems or lung cancer. After all, why should employers accommodate their lifestyle? And what about the “klutzy” behavior of skiers who get injured in skiing accidents? Should Hobby Lobby continue to cover the cost of penis pumps and Viagra for men with erectile dysfunction? Why should an employer have to pay for such aids for men who want to have sex? Can’t those fellas live according to their means?
That is protect rights every time.
“These robed men may interpret the law of the land — but it doesn’t mean they understand how basic biology works”
And conversely, it doesn’t mean the scientists understand the law.
God forbid we ever have a court that will ignore the natural rights because a scientist says so. In the end, given the choice to leave one’s sex life or natural rights unprotected; go with rights every time.
Thank you SCOTUS!
Yes excellent find Elaine, shoots down Megyn Kelly’s rant on Fox noise. Also how many OBGYN’s do we need to say that these four drugs aren’t abortifacients before we believe the science? As for Bill O Reilley, oy .
Great updates Elaine!
“So if there was an accident or unprotected sex and there is sperm around”
So what’s the moral here; don’t sext and drive? Beware of unescorted sperm? Damn, this was certainly a lot of effort to explain the consequences of irresponsible and apparently klutzy behavior. Instead of trying to force an employer to accommodate your lifestyle why not just, I don’t know; live according to your means?
anonymous,
Some people aren’t happy unless they’re criticizing or complaining about other folks–especially weekend contributors like me.
Nick Spinelli wrote:
“Late yesterday, the US Sentencing Commission voted unanimously to reduce the sentences of approximately 40k prisoners serving War on Drug mandatory minimum sentences. Now, that would be a good, substantive post.”
There’s this thing called WordPress, Nick. All sorts of folks are creating their own blogs. Imagine that. You need to get started on that “good, substantive post.”
Scalia’s pseudo-science complex: Phony claims, delusions and bogus ideas
These robed men may interpret the law of the land — but it doesn’t mean they understand how basic biology works
KATIE MCDONOUGH
3/27/14
http://www.salon.com/2014/03/27/scalias_pseudo_science_complex_phony_claims_delusions_and_bogus_ideas/
Excerpt:
Which is why I reached out to Dr. Anne Davis, a reproductive health provider, associate professor of clinical obstetrics and gynecology at Columbia University Medical Center, and consulting medical director at Physicians for Reproductive Health, to explain the actual science behind emergency contraception. Below is a transcript of our conversation, condensed and edited for clarity.
Can you explain how contraception like Plan B One-Step works?
Plan B is levonorgestrel. It’s been around for decades as part of standard birth control pills, and Plan B is just the progestin that is in other birth control pills. That is important to understand because it works the same way birth control pills work. And the way that birth control pills stop people from getting pregnant is by preventing ovulation from occurring, and that is exactly how Plan B works.
The reason you have to take it right away — if you are in that window where it will work for you — is because if you’re too close to ovulation, it won’t work. It will only work if ovulation is getting started — it has to stop ovulation before the ovary is even close to ovulating. If you take the Plan B too close to the time when ovulation is going to occur, it won’t work. You have to take it a few days before that.
It is quite ridiculous, on the face of it, to think that this medicine can cause an abortion when it can’t even stop ovulation if it isn’t taken at the right time. The window of time when Plan B can work is really small.
If you gave that levonorgestrel to a woman who is pregnant, absolutely nothing would happen. You could take the whole package — you could give five packages to a pregnant woman — and nothing would happen.
We actually give progestin to pregnant women to keep them from having premature labor. So there are treatments that stop people from having premature labor and miscarriages that are the same medicine, basically, as what’s in Plan B — progestin. So when you give them during the menstrual cycle they stop ovulation because they interfere with that process, but once ovulation has occurred — it’s done. There’s no point in taking [Plan B] after that because it wouldn’t work, just like taking birth control pills after you’ve already ovulated doesn’t work.
Basically, Plan B is just a higher dose of birth control pills. It has absolutely no effect on anything that happens after ovulation — which would be fertilization, implantation.
So if you object to things that stop ovulation, you could object to that, but it certainly doesn’t have a darn thing to do with abortion.
And what about ella, which is another form of emergency contraception that Hobby Lobby wants to opt out of providing?
Ella is a new medication. It’s not the same as what’s in birth control pills, it’s a different kind of medicine altogether.
It’s a selective, progesterone receptor modulator — and this is a more complicated thing. The way it works to prevent pregnancy is it delays ovulation. When you give it to someone who is heading up to ovulation, it slows that whole process down at the level of the ovary so that ovulation doesn’t occur until days later. So if there was an accident or unprotected sex and there is sperm around, you take ella; it pushes ovulation a few days into the future so by that time there’s hopefully no sperm there so you don’t get pregnant.
It’s a different mechanism than Plan B, but it still works at the level of ovulation. But the important distinction between ella and Plan B is that ella is a lot more effective than Plan B. There are a couple of large studies that have been done where people were assigned one or the other, and the pregnancy rates were lower with ella than with Plan B. And that was part of a clinical trial, which is the gold standard.
We know that ella is more effective that Plan B, which kind of makes sense because once you get real close to ovulation, Plan B is not going to do it, but ella will push that process forward so you can avoid ovulation and avoid pregnancy.
We are trying to use it whenever we can because it’s more effective. Unfortunately, it has to be prescribed, while Plan B is now available over the counter. So if [unprotected sex or an accident] happens on Saturday night and you can’t get to the doctor for a prescription for ella, you are probably going to take Plan B.
An OB/GYN’s opinion on the Supreme Court, Hobby Lobby, and contraception
POSTED BY DR. JEN GUNTER ⋅
JULY 1, 2014
http://drjengunter.wordpress.com/2014/07/01/an-obgyns-opinion-on-the-supreme-court-hobby-lobby-and-contraception/
Excerpt:
The Supreme Court, in a 5-4 decision, sided with Hobby Lobby (and much of the religious right in the United States) and ruled that a closely held private corporation does not have to provide insurance coverage for certain birth control methods. Justice Alito, speaking for the majority wrote:
“The owners of the businesses have religious objections to abortion, and according to their religious beliefs the four contraceptive methods at issue are abortifacients. If the owners comply with the HHS mandate, they believe they will be facilitating abortions…It is not for us to say that their religious beliefs are mistaken or insubstantial.”
As an OB/GYN I see six disastrous consequences of this decision:
1) The idea that religious beliefs of some are more important that the religious beliefs of others. Any woman wanting to use one of the 4 methods of contraception listed obviously doesn’t share the same beliefs as the closely held corporation who employs her. Why are her beliefs less important? Why can her place of employment push their religious beliefs (because a place of employment now has the rights of an individual) into the exam room? The First Amendment rights of women seeking health care are less important that the First Amendment rights of a corporation. Thank you Justice Alito for putting us in our place.
2) Legislating a belief over science. The 4 methods of contraception that Hobby Lobby takes issue with are Plan B, Ella, and the two IUDs, ParaGard and Mirena. We call these methods contraceptives not abortifacients because in science, unlike the Supreme Court, we like facts and facts tell us that these methods do not cause abortion (which is by definition the disruption of a pregnancy that is already implanted, no matter how early). But even if we take the evangelical definition of pregnancy (the wandering fertilized egg) we know for sure Plan B has no effect because it is biochemically impossible for a progestin in that dose (or probably any dose) to prevent pregnancy by any definition, scientific or otherwise. The bulk of the medical evidence suggests that the two IUDs in the United States do not prevent a fertilized egg from implanting and the same goes for Ella. We can’t say with 100% accuracy because there is no easily accessible test to tell us that a fertilized egg is wandering aimlessly around the upper reproductive tract and so the information comes from indirect methods like studying the mechanisms of action in lab and animal models and studies that have looked at the time of the cycle that the method is used. Science is fact and apparently facts don’t matter to the Supreme Court. Good to know.
3) A slippery slope for other contraceptives. If you believe the untruth that Plan B (a progestin) causes abortion (by any definition, evangelical or scientific) then all hormonal contraceptives should be excluded for sexually active women as they all contain progestins. Quick start pill taking (starting the birth control pill the day you get them versus waiting for your period) is very common and improves compliance, however, if you share the magical belief that progestins could prevent a fertilized egg from implanting then all oral contraceptives have to go, otherwise every time a woman starts her pills mid cycle a baby might die (never mind the possibility of escape ovulation). Hey, if you want to pervert science you can go down any rabbit hole.
“agenda driven pundits”- megyn kelly
===========
yep
How does Plan B really work? Don’t ask the Supreme Court, ask an OB/GYN
POSTED BY DR. JEN GUNTER ⋅
JULY 4, 2014
http://drjengunter.wordpress.com/2014/07/04/how-does-plan-b-really-work-dont-ask-the-supreme-court-ask-an-obgyn/
Excerpt:
Never has a medication been more misunderstood than poor Plan B (levonorgestrel or LNG), a post coital contraceptive (a.k.a. morning-after pill).
It’s not just Justices Alito, Thomas, Roberts, Scalia, Kennedy and Dr. Hobby Lobby who fail to grasp the mechanism of action, but many other people are confused including journalists (the NY Times has an error in the mechanisms of action in a recent article) and even some doctors. The misinformation about LNG post coital contraception has essentially become urban medical myth, sometimes perpetuated with good intentions (reporters trying to strive for due diligence or health care professionals trying to teach students or explain to patients) and sometimes with bad intentions (Justice Alito et al and the American Association of Pro-Life OB/GYNs I’m looking at you).
Fortunately there are excellent studies that tell us exactly how Plan B works so let’s get to it:
Plan B is levonorgestrel, a progestin (a synthetic version of the hormone progesterone). The hormone progesterone is released by the sac that stays behind after ovulation (called the corpus luteum). The job of progesterone is to get the uterus primed to accept a fertilized egg and if implantation happens it maintains the pregnancy until the placenta can produce its own progesterone. This hormone is pro-gestational, hence the choice of the name pro-gesterone. This is a bit of a spoiler alert because a synthetic version of a pro-gestational hormone is unlikely to do the exact opposite.
How does plan B work? It has one and only one mechanism of action, it inhibits ovulation.
A variety of hormonal changes happen as the ovary readies an egg (a.k.a follicle) for ovulation. Ovulation, the actual release of the egg, is triggered by a massive surge of a hormone called luteinizing hormone (LH). After ovulation the egg has a 24 hour window to be fertilized (it has a pretty short shelf life). Plan B when given 2 to 3 days BEFORE the LH surge can inhibit,delay, or blunt the LH surge and prevent ovulation. Outside of that 48 hours window Plan B is very ineffective.
Bill O’Reilly Thinks IUDs Sold At Target?!
POSTED BY PRISCILLA 62PC ON JULY 07, 2014
http://www.newshounds.us/20140707_bill_o_reilly_thinks_iuds_sold_at_target
In addition to fearing and loathing lady parts, right wing men don’t seem to know how they work. When he was slut shaming Sandra Fluke, Rush Limbaugh claimed that she needed a lot of birth control because she was having so much sex. Rush obviously doesn’t know that the birth control pill is not connected to the amount of sex, but rather, a daily regimen. Not surprisingly, Bill O’Reilly doesn’t seem to have a grasp of the topic either as he thinks that you can get any and all contraceptives you need at – wait for it – Target. Once again, Bill O’Reilly is wrong.
During a recent discussion with Megyn Kelly (who mocked Sandra Fluke), about the Hobby Lobby decision, he questioned why women are upset because, after all, you can get birth control at Target.
Fact Check – While you can purchase the pill at Target, you can’t get an IUD there because it requires insertion by a doctor and costs anywhere from $500 to $900. So no, Bill, you can’t get an IUD at Target.
Megyn Kelly Misrepresented My Article About Contraception
I’m an OB-GYN. She’s Not.
By Jen Gunter
7/18/14
http://www.newrepublic.com/article/118761/what-megan-kelly-doesnt-understand-about-contraception-obgy
Excerpt:
I was quoted on a Fox show. While this is somewhat surprising, the fact that I was put in the same category as Jon Stewart (apparently we are both liberal ideologues) actually left me feeling honored. The issue, of course, is the four methods of birth control that Hobby Lobby is no longer required to cover under their employee health plan due to the recent Supreme Court ruling. Megyn Kelly of Fox apparently took issue with Jon Stewart calling out claims that Plan B is an abortifacient—a drug causing abortion—as “not true” (he is correct) and my statement that “three of the four contraceptives do not lead to abortion, even using the conservative definition of when life begins,” which appeared in The New Republic. Ms. Kelly claims that Plan B and ella (levonorgestrel and ulipristal acetate postcoital contraception, respectively), and Mirena IUS and ParaGard (both intrauterine devices or IUDs), “Can and do end fertilized eggs.” She is wrong.
Unlike my piece or the myriad posts I have written on the subject on my own blog, Ms. Kelly offers no scientific articles to bolster her claims, but rather rests her case on product monographs—basic descriptions of the drugs—and the opinion of the Supreme Court majority. These are five men whose last biology class was likely 40 or more years ago (i.e., before the basic science evaluating these methods of contraception existed) and who do not practice medicine…
As a board certified OB/GYN, I’ll stick to what I know. The medicine.
The International Federation of Gynecology and Obstetrics (FIGO) issued a statement in 2008 indicating that a post-fertilization effect for Plan B was not consistent with the mechanism of action and thus should be removed from the product labeling. There is a plethora of medical evidence (this 2013 review article has many excellent references, as does this 2011 FIGO statement) showing no post-fertilization effect on either the embryo or on the endometrium (lining of the uterus). Plan B works by inhibiting a specific hormonal surge that happens before ovulation. It doesn’t work when given on or after the day of ovulation. In one study when Plan B was given after its window of efficacy, the number of pregnancies was exactly what would have been expected had no method been used (i.e., it didn’t work). Were there a lining-of-the-uterus effect, Plan B would be expected to work after ovulation has occurred, but it doesn’t.
“First, the four contraceptive methods that Hobby Lobby objected to paying for—Plan B, Ella, and two intrauterine devices—are not abortifacients. They do not prevent the implantation of a fertilized egg into the uterus—”
FALSE… here’s why:
How does the Paraguard IUD work?
“Paraguard may prevent implantation.” Source: paraguard.com
How does Mirena work?
“…makes the lining of your uterus thin…” Source: mirena-us.com
How does Plan B One-Step work?
“…may also work by… preventing attachment (implantation) to the uterus (womb).” Source: planbonestep.com
“On a segment of The Daily Show back in March, John Stewart said, “So let me get this straight.Corporations aren’t just people, they’re ill-informed people. Whose factually incorrect beliefs must be upheld because they sincerely believe them anyway.”
Amazing – these leftwing nutjobs are calling certain people ill-informed while AT THE SAME TIME deliberately spreading misinformation. (Really though – who would consider anything from Jon Stewart reliable and accurate in the first place)
“After returning from a two-week hiatus from The Daily Show on July 14th, Jon Stewart did a segment on the Hobby Lobby ruling. He found it interesting that the owners of Hobby Lobby consider Plan B to be an abortifacient—even though the American College of Obstetricians and Gynecologists say it isn’t. “But what would they know about vaginas?” said Stewart. “Compared to a corporation that sells foam cones and glitter.”
Aaaaannndd Megyn Kelly cleaned the floor with Jon Stewart in the above clip posted from YouTube. Kelly brutally illustrated how and where Jon Stewart was wrong citing the sources from the FDA and the websites of said contraceptives.
Jon Stewart, maybe you should go to Hobby Lobby and get some foam and glitter and construct a vagina.
[youtube http://www.youtube.com/watch?v=UH9yGVmN0hs&w=560&h=315%5D
Wow! I really need to re-read ‘My Body Myself’! The FDA is teaching ‘new biology.
Not that it matters as a matter of law, nevertheless, were I to dream up the best antidote I could imagine for science, surely the antidote would be stare decisis?
Annie,
I know that some who are on this board, seemingly 24-7, cannot imagine that some of us actually have a life. In the real world.
It’s tragic to see just how pathetically dependent a large percentage of our population has become on government. When exactly did we lose the ability to be accountable for ourselves?
NEWS FLASH! You don’t want to get pregnant; don’t have sex. If you want sex but not pregnancy, then budget for contraception. If you want your employer to offer an insurance option that covers certain contraceptives then find one that does. If your employer changes the plan, then follow the prior steps.
I know, that sort of thinking is so Neanderthal. We’re in the 21st century now; common sense is no match for the intellectuals among us, right. In the meantime, while the victims here continue to point blame at 5 “white” guys, I’ll continue to teach my children to lead a moral, virtuous and self-reliant lifestyle. Even if that is no longer in vogue.