Friday, July 04, 2008
Meet Susan Martinuk, a right-wing Canadian syndicated columnist. Native people? They're "cashing in on victimhood." Supervised safe-injection sites? "State-sponsored addiction." Unions? Forget it. Same-sex marriage? Well, what do you think her position might be? Do you really need to follow this link?
So it's hardly a surprise that she's weighed in on the Morgentaler Order of Canada award.
All too typical of far-right ideologues, she begins with character assassination. "Dr. (I use this term loosely) Morgentaler" -- that sort of thing. And this:
His great healthcare legacy is a chain of private abortion clinics where doctors can make great wads of cash outside of the medical/ethical oversight of hospital committees and other doctors.
This is what my mother used to call lying by implication. The impression is given of big profits made outside the official health care system. In fact most of Morgentaler's clinics are non-profit, because they receive funding from the provinces and are licensed by provincial health departments. Doctors and other health professionals who work in these clinics are subject to the same rules of practice as they would be working anywhere else, rules that are enforced by provincial licensing bodies.
What Martinuk is referring to here is the discredited Therapeutic Abortion Committee system, overturned by the Supreme Court of Canada two decades ago. This was a system under which women had to plead their cases before a three-doctor panel, some of which never approved a single request. And TACs were only set up in about one-fifth of Canada's hospitals at the time.
She claims--this time lying directly--that Morgentaler was found guilty of medical negligence in 1998 by the Supreme Court of Nova Scotia. He wasn't even a respondent in the case. And she makes reference to an earlier (1976) charge by the "Quebec College of Physicians" (sic) that he had failed to take a patient's history, and run some routine tests. In fact, the Disciplinary Committee of the Professional Corporation of Physicians of Quebec suspended Morgentaler's licence for one year because he had just been convicted of performing illegal abortions.
(That conviction, as everyone knows, was overturned. A jury had found him innocent of wrong-doing and a higher court had reversed the verdict and found him guilty. Morgentaler was acquitted by juries once in Ontario and three times in Quebec. Parliament passed the so-called "Morgentaler amendment" to the Criminal Code in 1975 to prevent the substitution of guilty verdicts by higher courts. But the persecution continued. Only the victory of Rene Levesque's Parti Quebecois in 1976 stopped the abuse of judicial process in the latter province. And his trial in Ontario resulted in the overturning of the restrictive abortion law in effect at the time, Section 251 of the Criminal Code, by a 5-2 decision in 1988.)
But it's when Martinuk delves into the alleged dire medical sequelae of abortion that she truly outdoes herself. She is described, disingenuously, as "a former medical researcher who conducted PhD studies in the field of infertility and reproductive technologies." The implication is that she is an Authority, with the expertise to comment. Except that she isn't any such thing.
Back in the early '90s, as a PhD student, she co-authored a few publications on human and animal ovulation. But she abandoned her PhD. Since then, she writes newspaper columns for a living. She is no more an expert on the abortion issue than I am, so I offer this point-by-point rebuttal of what must appear to the uninitiated to be an impressive array of sources and authorities that claim that abortion is dangerous for both mother and any babies she might have subsequently.
- Abortion causes subsequent prematurity and low birth weight.
Studies of this alleged connection have, until recently, been inconclusive and contradictory. But Martinuk fails to cite the most recent study, by Tilahun Adera et al, Journal of Epidemiology and Community Health (December 2007), which surprises me a little, because it concludes, on the basis of a massive data-set, that having a miscarriage or induced abortion is indeed linked to prematurity and low birth weight. However, that data-set, as the authors themselves admit, is problematic for several reasons.
The data was collected from the period 1959-1967, when abortion was still illegal (and hence likely to be underreported, skewing the statistics). Abortion techniques more than forty years ago were not nearly so refined as they are today--coathangers versus vacuum aspiration in antiseptic conditions. Spontaneous abortions (miscarriages, which occur in about 25% of all pregnancies) and induced abortions are not distinguished in the data. Indeed, Adera himself concedes that the public health implications of his study might be more applicable to "developing countries."
Martinuk is not only not up-to-date, but the source she seems to prefer is the Journal of American Physicians and Surgeons (formerly the Medical Sentinel) which, despite its academic-sounding title, has a politically far-right axe to grind. JPANDS has, in the past, published commentaries and articles that have claimed, inter alia, that evolution and global warming are bunk (the latter article co-authored by our old friend Arthur B. Robinson), that the Food and Drug Administration is unconstitutional, and that the HIV virus doesn't cause AIDS. JPANDS has duly found its way onto Quackwatch's list of "fundamentally flawed" journals.
- Abortion causes breast cancer.
I'm amazed that this old canard still has legs, but once again our reliable JPANDS is cited--twice! The US National Cancer Institute isn't buying it; neither is the American Cancer Society. As the ACS puts it, " the public is not well-served by false alarms and at the present time, the scientific evidence does not support a causal association between induced abortion and breast cancer."
- Abortion causes psychological and physical harm.
Martinuk had me going for a while on this one. It wouldn't surprise me that many women are uneasy, ambivalent and stressed about the abortion decision, living in North America, where "pro-life" propaganda is prevalent and Church, mosque and synagogue call abortion murder. That could well cause emotional problems of one kind or another. So I had a look at the most recent study that she cites but doesn't source: Coleman, P.K., et al., “State-Funded Abortions Versus Deliveries: A Comparison of Outpatient Mental Health Claims Over 4 Years” American Journal of Orthopsychiatry 2002, Vol. 72, No. 1, 141–152. It's an oddly-written study, with a suspicious amount of moralizing in it, but the evidence, based on a survey of women in California, looked pretty conclusive to me: women are more likely to seek medical attention for mental disorders following an abortion than following a live birth.
Then I checked into the authors of the study. Phyllis Coleman. Jesse Cougle. David Reardon. Vincent Rue. They co-authored another study on the same subject with Martha Shuping and Philip Ney. As it happens, I once ran into Ney on Parliament Hill: he's a veteran anti-choice crusader from Vancouver. That made me curious. I soon discovered that Shuping and Reardon are "Physicians for Life." Reardon and Ney claim that women who have abortions abuse their children. (That one's been so utterly debunked that it no longer seems to be part of the anti-choicers' armamentarium.) Rue is what might be called a professional anti-abortionist, and Cougle and Coleman, associates of Reardon, are not exactly above the fray either.
Now, lest I be accused of crude ad hominem here, let me simply note that none of the authors of these scary studies is dispassionate on the issue of abortion. Just as I'm a little wary of global warming denial funded by Exxon, or other less-than-disinterested research, I am entitled, I think, to a healthy scepticism when authors of scientific studies on the evils of abortion turn out to be raving pro-life lobbyists.
Next I turned to the unsourced 2001 study by the College of Physicians and Surgeons of Ontario. That would be "Health Services Utilization After Induced Abortions in Ontario: A Comparison Between Community Clinics and Hospitals," Ostbye, T., et al., American Journal of Medical Quality, Vol. 16, No. 3, 99-106 (2001). Now, what is the comparison that Martinuk is using when she talks about women having higher rates of this and that when they have abortions?
The comparison is between the relative safety of hospital abortions and clinic abortions. [Not solely: see UPDATE below--DD] Clinics appear to be safer than hospitals. What point did Martinuk think she was making here?*
It gets worse (for her). I quote the conclusion of this study in full:
Overall, the rates of postabortion health services utilization and hospitalizations are low, which emphasizes the relative safety of abortion services in Ontario regardless of location of service. The rates of postabortion health services utilization including hospitalizations were lower in patients undergoing abortions in community clinics than in hospital. This may be partially attributed to higher surgical volumes, which are associated with better outcomes and mandated clinical quality assessments. The findings are also partially attributable to the referral from clinics to the hospitals those patinets considered to be at high risk in a clinic setting during an induced abortion. The referral structure allows the community clinics and hospitals to work together to ensure that the safest alternative is provided to women seeking abortion services.
Administrative data can be used to derive patient outcome information that is of value to service providers. However, it is not possible to fully control for systemic differences between patient groups (eg, gestational age or procedure used) using such administrative data.
Then we go to the claim that women who have abortions are five times more likely to abuse drugs and alcohol. That's "Abortion and Subsequent Substance Abuse," David C. Reardon and Philip G. Ney, The American Journal of Drug and Alcohol Abuse, Volume 26, Issue 1 (2000), 61-75. Some old familiar faces! It's starting to feel like Anti-Choice Homecoming Week here.
And then (for the sake of completeness) there is the rather dated reference to the alleged suicide/abortion connection: "Suicides after pregnancy in Finland, 1987-94: register linkage study," Mika Gissler, et al., British Medical Journal, Volume 313: (7 December, 1996), 1431-1434. The first thing to note here is that suicide as a cause of death of women in Finland is approximately four times higher than in Canada. (I have taken 1996, the year the study was published, as the year for comparison purposes.) About 4% of all deaths of Finnish women were as a result of suicide. In Canada, 848 women committed suicide in 1996;101,107 women died that year, so that suicide accounted for less than 1% of all deaths. The suicide rate (per hundred thousand population) is 10.7 for Finnish women, and 5.7 for Canadian women.The number of confounding variables, and the generalization of the results of this study, are highly problematic. Indeed, on the latter, the authors themselves conclude:
Abortion might mean a selection of women at higher risk for suicide because of reasons like depression. Another explanation for the higher suicide rate after an abortion could be low social class, low social support, and previous life events or that abortion is chosen by women who are at higher risk for suicide because of other reasons. Increased risk for a suicide after an induced abortion can, besides indicating common risk factors for both,result from a negative effect of induced abortion on mental wellbeing. With our data, however, it was not possible to study the causality more carefully. (Emphasis mine-DD)
UPDATE: Eamon Knight pointed me to a comprehensive fisking of JPANDS' abortion/breast cancer "study" here.
*UPDATE: (July 6) Whoops. Although the authors of the study outline a number of confounding variables (e.g., previous hospitalization for psychiatric problems is significantly higher among patients who subsequently seek abortion), Martinuk is correct on her figures, although these apply to the hospitals: the clinics have a better record. The study measured the relative safety of clinics v. hospitals re abortion patients, but a control group was also used, and post-abortion patients did not fare as well as either the general clinic or hospital population.
The authors' conclusion stands, however: the rates of post-abortion complications are low in Ontario. Hence Martinuk's figures apply to a fairly small percentage of patients overall. Even so, I mischaracterized both the extent of the study and the figures that she provided.
Mea culpa, and I'm just glad that no one had to point my errors out to me. I'm indebted to reader "plum grenville" at my joint for prompting me go back and look at the study again. That will teach me to be overly snotty.
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