A French Doctor Defends RU 486, His Embattled 'Abortion Pill'
In recent years, the furious debate over abortion in America has been focused on surgical procedures in hospitals and clinics. In the '90s, if French medical researcher Dr. Etienne-Emile Baulieu has his way, the emphasis may shift to drugs and pharmaceutical labs. Baulieu, 63, a renowned hormone specialist, is the developer of RU 486, an antihormone that has been called "the abortion pill" because it offers women a safe, unintrusive way to terminate pregnancy.
Not surprisingly, the new drug is mired in controversy. Antiabortionists here and abroad have called RU 486 a "chemical weapon" and threatened to boycott the products of its French manufacturer, Roussel Uclaf, for which Baulieu is a consultant. In 1988 antiabortionists' protests prompted Roussel to take the drug off the market until the French Minister of Health, Claude Evin, declared that, morally, RU 486 had become "the property of women" and ordered the company to resume production.
Last month the results of the largest study ever made of RU 486 confirmed that it is as safe and effective as surgical abortions and has few side effects, findings which have led Roussel Uclaf officials to consider expanding the market for the drug to include Britain, the Netherlands and the Scandinavian countries. Still, because of the power of the right-to-life lobby, it may be years before RU 486 is available in the U.S. This frustrates Baulieu, a native of Strasbourg who lives near Paris with Yolande, his wife of 42 years and the mother of his three children. "RU 486 is a medicine," he says. "There is no reason to make a moral debate out of it. If something works, there's no reason to stop it." In his office at France's National Institute of Health and Medical Research, Baulieu spoke with Paris bureau chief Cathy Nolan about the discovery that some say may eventually win him the Nobel Prize.
Did you anticipate the furor RU 486 has provoked?
No, but in a way I do not care too much. I respect other people, and I think opponents will change their minds. There is no reason to be against us. We didn't invent abortion. As far back as the Middle Ages, women were given herbs and potions. People have always looked for a less brutal way of ending pregnancy.
How does it work?
RU 486 is an antiprogesterone, which means that it blocks the effects of progesterone, a hormone produced by the ovaries that permits pregnancy to be established and to continue. Without progesterone, the fertilized egg separates from the uterine wall and is subsequently expelled through vaginal bleeding.
What is the drug's success rate?
When administered within 49 days of a woman's last period, you have 96 percent efficiency, about the same as the suction method of abortion. In cases where expulsion is not complete, or where bleeding is too heavy, the woman will need to have suction or a D&C [the surgical scraping of the lining of the uterus].
What are the advantages of RU 486 over other abortion methods?
First, because it's taken orally, there isn't any surgical trauma. The cervix is not dilated mechanically, so there's no risk of infection. Second, you can intervene earlier. The suction method works best toward the eighth or ninth week, when the embryo is more developed. With the pill, the earlier you are, the better it works.
Some see RU 486 as a do-it-yourself abortion pill. Is that accurate?
It's not as easy as all that. In France, according to the law, a woman must be a legal resident and must go to one of 800 hospital centers authorized to administer RU 486. Two days after being given RU 486, she returns for a dose of prostaglandin, which causes contractions and helps foster expulsion. Because serious cramping and heavy bleeding may occur, we like to have medical care available, so women stay at the center for four hours.
Are there any long-term negative effects from taking RU 486?
Over the past seven years, clinical tests have been done in 15 to 20 countries, with no serious adverse reactions reported. Since it was legalized in France, 35,000 women have used it. But you never know. As a British biologist first said of the birth control pill, "No woman should be kept on the pill for 20 years until, in fact, a sufficient number have been kept on the pill for 20 years."
Would you like to see RU 486 eventually become an over-the-counter drug?
No. We want women to use the drug only under medical supervision. Of each 1,000 pregnancies, at least five are ectopic, which means the fertilized egg develops outside the uterus. You cannot use RU 486 in such cases; you would need surgery or you could die.
Do you agree with pro-life critics who predict that the availability of RU 486 will lead to an increased number of abortions?
No, I think that's a superficial argument. Abortions have been legal in France since 1975, yet their number has decreased. The number of pregnancy interruptions and, conversely, the number of children that people want, are not decided by law. If a woman decides not to have a child, whether she aborts with RU 486, surgery or a coat hanger, she'll do it.
Whom do you see benefiting most from your discovery?
In countries like the U.S., where abortion is very safe, the psychological and privacy aspects of the drug are the main advantages. But in developing countries, where medical practices are more primitive, I predict that it will be a lifesaving drug. More than 100,000 women, maybe 200,000, die from abortions each year worldwide. Millions of others are infected, wounded, psychologically traumatized. In less developed countries, even if RU 486 is not used perfectly, it will still be a vast improvement.
Have any American drug companies expressed interest in distributing the drug?
None of the big ones. It's sad, but the problem is that you don't make that much on birth control products. In addition, legal liability is always a danger. It is possible Roussel will sell RU 486 in conjunction with a nonprofit organization like Planned Parenthood after FDA approval.
What are your personal views on abortion?
I have always thought that women should be in control of reproduction, and I do not think that scientists and physicians can be anything but pro-choice. But I don't like abortion—I am for pregnancies and children that are wanted. Today our goal is choice—the choice to use RU 486 as an abortifacient if needed or wanted. Our goal for tomorrow is to defuse the abortion issue forever. One way is the earliest possible use of RU 486 as soon as a woman's period is late. I call it contragestion. I would like the word abortion to be suppressed from the vocabulary of the 21st century. That would be an achievement.
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