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Do No Harm: Far-Right Medical Groups and Religion Don’t Mix

In mid-2002, President Bush stunned the medical and women’s health communities with his nomination of Dr. David Hager to chair the Food and Drug Administration’s (FDA) Advisory Committee for Reproductive Health Drugs. This panel advises the FDA on the safety and effectiveness of drugs used in the practice of obstetrics and gynecology, including new contraceptives. Hager, an obstetrician-gynecologist, is an outspoken critic of abortion and mifepristone (also known as RU-486), the FDA-approved drug used for medical abortions. He has criticized oral contraceptives as promoting sexual activity outside of marriage and reportedly will not prescribe oral contraceptives to unmarried women. In a book he co-authored with his wife, As Jesus Cared for Women: Restoring Women Then and Now, Hager recommends scripture readings as a prescription for headaches and pre-menstrual syndrome (PMS).

The Religious Coalition for Reproductive Choice, American Medical Women’s Association, Association of Reproductive Health Professionals, National Association of Nurse Practitioners in Women’s Health, Physicians for Reproductive Choice and Health and many other organizations opposed this appointment because he used “ideological beliefs to guide medical decision-making.” , As a result, the Bush Administration backed down from appointing Hager to chair the FDA committee but did appoint him to be a member.

How could a doctor who holds views so outside the mainstream of medical practice be nominated for an influential position with a federal agency responsible for the scientific evaluation of new drugs? Hager’s nomination is one of the most prominent manifestations to date of the increasing influence of far-right medical organizations that are infiltrating mainstream medicine and promoting ideologically based anti-choice views. Groups like the Christian Medical and Dental Association (CMDA), the Catholic Medical Association, Pharmacists for Life, and the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) trade on the professional credibility of doctors and other health professionals to oppose abortion and reproductive rights.

These previously little-known groups are becoming increasingly active in policy issues that affect women’s right to the most medically appropriate and scientifically advanced reproductive health care. In August of 2002, Hager assisted the CMDA in petitioning the FDA to reverse its approval of mifepristone, now marketed under the name Mifeprex. The CMDA, AAPLOG and Concerned Women for America, a Washington, DC-based anti-choice group, filed a “citizen’s petition” claiming that the drug is unsafe and was improperly approved. The action bears all the hallmarks of the far-right medical groups. The petition uses inflammatory language and manipulates medical information about side effects and risk to suggest that Mifeprex is unsafe. The petition stresses the medical connections of the petitioners to assert their legitimacy and cloaks their anti-choice views in language that suggests their concern is for women’s health.

Who are these anti-choice groups attempting to infiltrate the medical community and advance religious doctrines to limit reproductive choice, contraception and scientific research?

The Christian Medical Association
Practicing “Medical Evangelism”
The Christian Medical Association, which recently merged with the Christian Dental Association to form the Christian Medical and Dental Association (CMDA), claims a membership of 17,000 health professionals. The association was founded in 1931 by a group of medical students who met for Bible readings, but has only recently turned its attention to national policy issues. CMDA is headquartered in Bristol, Tennessee, where it has 75 employees housed in an elaborate headquarters/meetings center built last year with a $10 million capital campaign. CMDA also has a one-person Virginia-based policy office. Dr. Davis Stevens is the executive director of the organization.

In many ways, CMDA looks like any of the many medical specialty societies in the United States. It offers continuing medical education for professionals, which is accredited by the Accreditation Council for Continuing Medical Education; has student chapters, and holds programs to address professional development issues. But the goal of the CMDA’s programs is to advance conservative religious doctrine in health care. CMDA opposes cloning, stem cell research, abortion, emergency contraception, and assisted suicide. The association supports so-called “conscience clauses” that allow health providers to refuse to provide reproductive health services and promotes the scientifically unsupported view that oral contraceptives cause abortion. Unlike most medical specialty societies, the CMDA is not represented in the American Medical Association’s House of Delegates because the AMA requires member organizations to not discriminate in membership on the basis of sexual orientation, and CMDA is anti-homosexual.

CMDA explicitly promotes evangelism by doctors to their patients and sponsors a program called “The Saline Solution,” a weekend seminar that promises to help doctors “transform your practice into a ministry” and “effectively share Christ with your patients.” CMDA Executive Director Stevens told American Medical News, “We teach our members how to raise ‘faith flags’—signals that patients are welcome to talk about their faith—within the first 15 seconds of a patient encounter.” CMDA claims that 6,000 practitioners have graduated from the seminar. CMDA’s website provides advice for doctors whose evangelism is rejected by patients or colleagues and offers a service to match like-minded doctors in building “groups of Christian doctors.” The association also recruits new members in medical schools and claims to have student groups at 95% of the medical and dental schools across the country.

In addition to pushing religious doctrine into health care through medical evangelism, CMDA is active on the national policy front. CMDA has vocally backed national bans on reproductive and scientific cloning and embryonic stem cell research, capitalizing on the supposed expertise of its physician membership to promote minority scientific views, such as the superiority of adult stem cells over embryonic stem cells for research purposes. In March of 2001, CMDA filed a lawsuit to halt the National Institutes of Health from funding research utilizing embryonic stem cells. In August 2001, in an attempt to influence President Bush’s upcoming decision on the federal funding of embryonic stem cell research, CMDA sent a petition signed by 600 “medical leaders” to the president, asking him to retain the complete ban on federal funding of embryonic stem cell research. When the House voted to ban the all forms of cloning in January 2003, CMDA Executive Director Stevens stressed the added legitimacy that physicians bring to these issues when he praised the physician sponsors of the measure for “bringing their valuable medical perspectives to bear on this issue.”

CMDA has been active on other choice and bioethical issues. Late in 2002, CMDA filed a friend of the court brief in support of Attorney General John Ashcroft’s attempt to overturn Oregon’s physician-assisted suicide law. In February of 2003, CMDA joined with the Catholic Medical Association to file a brief defending Florida’s abortion informed consent law, which a court struck down as a violation of the state’s constitutional right to privacy. CMDA also supported a law that allows hospitals to refuse to provide abortions based on an institutional “conscience,” dramatically expanding a right that had previously been extended only to individuals.

While the CMDA positions itself as within the medical mainstream, its positions are not mainstream and are often based on pseudoscientific claims propagated by the anti-choice community. CMDA works closely with the far-right Christian organization Focus on the Family, which promotes medically inaccurate views such as that abortion causes breast cancer. CMDA opposes emergency contraception (EC) as an “abortifacient,” despite the American College of Obstetricians and Gynecologists’ position that it does not interfere with a pregnancy. When the American Medical Association recommended in 2000 that EC be made available over-the-counter to reduce unwanted pregnancies and abortion, Dr. Richard Scheidt, a CMDA spokesperson, commented that emergency contraception “trivializes” pregnancy. “It’s something that if you don’t want you take a pill and you’re rid of it,” he said.

CMDA is also part of a disinformation campaign to denigrate oral contraceptives and condoms. Medicine and science define pregnancy as beginning with the implantation of a fertilized egg. CMDA uses its own definition—that pregnancy begins at the moment an egg is fertilized—and recommends that doctors consider counseling patients that oral contraceptives may cause abortion. This disinformation campaign may have a direct effect on access to contraceptives. In 1998, then-Rep. Tom Coburn (R-OK), an obstetrician, attempted to amend a bill requiring coverage of prescription contraceptives to exclude methods that “interfere with fertilization or terminate a pregnancy,” which would effectively exclude widely used forms of contraception—oral contraceptives, the Depo-Provera contraceptive shot, and intra-uterine devices (IUDs). Coburn also exploited a highly publicized study that said there was a lack of data on the effectiveness of condoms in preventing sexually transmitted diseases other than HIV to claim that condoms do not prevent AIDS. Coburn is currently the co-chair of the Presidential Advisory Council on HIV/AIDS.

Catholic Medical Association
Claims ‘Contraception Leads to Abortion’
The Catholic Medical Association (CMA) is far smaller and less influential than CMDA, but shows signs of increased activity and influence and has teamed up with CMDA on several high-profile initiatives. In February of 2003, CMA joined with CMDA to file a brief defending Florida’s abortion informed consent law, which had been found unconstitutional. In July of 2001, CMA joined then-Rep. Coburn and CMDA in accusing the CDC of misrepresenting the effectiveness of condoms in preventing sexually transmitted diseases (STDs).

CMA has a membership of approximately 1,200, down from a peak of 6,000 in the early 1960s. Membership is increasing, however, having stood at just 800 in 1997. New regional chapters are also being added; CMA is currently organized into 11 regional chapters. The organization provides a Washington, DC, address as its headquarters on its website, but the toll-free phone number rings to a voice mailbox in Virginia, and Michael Herzog, the executive director of CMA, is based in Wisconsin.

The stated purpose of CMA is to uphold the “principles of the Catholic faith and morality as related to the science and practice of medicine.” In addition to opposing all abortion—past CMA President Dr. George Isajiw said in 1998, “There is no such thing as an abortion to save the life of the mother”—the CMA is opposed to modern methods of contraception, contraceptives for unmarried people, and premarital sex. For married couples, CMA promotes natural family planning as the only acceptable means of contraception. CMA President Dr. Robert Saxer, Board Members Drs. Lawrence Lyons and Catherine Dowling and CMA Pediatrics President Dr. Paul Byrne were among CMA leaders to endorse a statement by the anti-family planning American Life League that says “birth control pills, Depo-Provera injections and Norplant implants achieve their anti-fertility effects…secondarily by causing an abortion by preventing the implantation of the approximately week old human…into the wall of the mother’s womb.” CMA also promotes the medically unsupported view that homosexuality is a preventable disorder—same-sex attraction (SSA)—that can be prevented and treated.

A CMA chapter program, “Human Sexuality Revisited: Integrating Faith and Science,” offered for physician CME credit, included a presentation by anti-contraception sexuality educator Janet Smith. Smith claims that “People who contracept have fewer babies later in marriage and their marriages are weaker.” In her publication, “The Connection Between Contraception and Abortion,” she states that “even within marriage, contraception is destructive,” and that “contraception facilitates the kind of relationships and even the kind of attitudes and moral characteristics that lead to abortion.”

Pharmacists for Life International
Imposing Moral Judgments on Patients
Pharmacists for Life International (PFLI) was founded in 1984 by a group of pharmacists who refused to fill women’s prescriptions for oral contraceptives because they believed they cause abortion. Today the Powell, Ohio-based organization has 1,500 pharmacist members, assets of less than $25,000 and no paid staff. While the organization is modest, it has been effective in expanding the right of health professionals to refuse to provide reproductive health services such as contraception and emergency contraception. The president of PFLI is Karen Brauer, a pharmacist who was fired by Kmart in 1996 after she lied to a patient that an oral contraceptive was out of stock to avoid filling a prescription.

PFLI offers a clear example of the erosion of patient rights that occurs when medical professionals impose their moral judgments on patients. All health care providers have been granted a “conscience” exemption from providing abortion since shortly after the 1973 Roe. v. Wade decision that legalized abortion. PFLI has been at the forefront of efforts to expand that right to allow pharmacists to refuse to dispense legally prescribed medications such as emergency contraception if they have a moral or religious objection.Extremist anti-choice medical groups claim oral contraceptives, as well as hormonal implants and injections and IUDs, may cause abortions by interfering with the implantation of a fertilized egg. This view is based on the belief of some religions that “life begins with conception,” when an egg is fertilized. This belief contradicts the accepted medical definition of pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), a pregnancy commences when a fertilized egg is implanted in the uterus. Medications that prevent implantation, and therefore pregnancy, are labeled contraceptives.

Dr. Bogomir Kuhar, former PFLI president, is a popular promoter of the "oral contraceptives as abortifacients" view. In his book, Infant Homicides Through Contraceptives, he asserts that contraceptives are responsible for 8 to 12 million abortions annually. PFLI also advances the view that oral contraceptives are physically damaging to women. The organization endorses the Catholic church’s charge that modern contraceptives promote a “contraceptive mentality” that is damaging to women and society because contraceptives allow men to view women solely as sexual objects.

PFLI has been successful in altering the practice of medicine on two levels. First, encouraged by the Brauer case and other well-publicized instances of pharmacists who refused to fill contraceptive prescriptions, as well as the FDA’s approval of two pre-packaged forms of emergency contraception, PFLI lobbied national and state pharmacy associations to alter their codes of professional conduct to accommodate pharmacists who refuse to provide certain medications. At the urging of PFLI, the American Pharmaceutical Association (APhA), the national professional organization for pharmacists, in 1998 revised its Code of Ethics to allow pharmacists to refuse to dispense medications to which they have a religious or moral objection. The APhA stipulated, however, that pharmacists must ensure that referral systems are in place to allow patients access to their medications. PFLI disputes such reasonable accommodations, and argues that pharmacists should not be required to provide a referral if they deny a medication. According to PFLI, “it is not an inconvenience to refuse to refer such a client since the pharmacist is doing the woman and her preborn child a favor in terms of physical and spiritual health,” effectively asserting the right of pharmacists to discard the medical decisions of women and their doctors.

PFLI has lobbied state legislatures to pass “conscience clause” protections for pharmacists into law. The first such law, passed in South Dakota, allows pharmacists to refuse to dispense a prescription if the medication would “destroy an unborn child,” which the state defines, against the accepted medical definition, as a pre-implanted fertilized egg. This allows pharmacists to refuse to provide emergency contraception, all hormonal contraceptives, and IUDs. Numerous states have considered similar laws in recent years. PFLI’s influence extends into other areas of medicine as well. In 1998, PFLI was invited to testify at the FDA’s Reproductive Health Drugs Advisory Committee hearing on approval of mifepristone.

Pro-Life Ob/Gyns
Confusing Research
The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) was founded in 1973 shortly after the Roe. v. Wade decision as a special interest group within the American College of Obstetricians and Gynecologists (ACOG). The year before, ACOG had affirmed the right of abortion. AAPLOG currently has 2,500 members and is still recognized as a special interest group within ACOG; its president is Dr. Byron Calhoun.

AAPLOG opposes abortion and advances medically unproven links between abortion and breast cancer and the existence of “post-abortion syndrome” and other psychological disorders in women who have had abortions. However, on the supposed abortifacient nature of oral contraceptives, AAPLOG presents two views on its website. One asserts that contraceptives can cause abortion and that any form of contraception is “anti-life.” The other asserts that contraceptives are not abortifacients because there is no firm evidence that they make the lining of the uterus less hospitable to a fertilized egg. AAPLOG President Byron Calhoun, Dr. David Hager, and Dr. Susan Crockett, one of Hager’s colleagues on the FDA Advisory Committee for Reproductive Health Drugs, are among the signers of a 1998 report, “Hormonal Contraceptives: Are They Abortifacients?” that concluded that “we know of no existing scientific studies that validate the ‘hormonal contraception is partly abortifacient’ theory.”

Dr. Crockett, who is the director of maternity services at Christus Santa Rosa Hospital in San Antonio, is a board member of AAPLOG and a member of CMDA. She contributed a chapter, “Using Hormone Contraceptives is a Decision Involving Science, Scripture and Conscience,” to the book The Reproduction Revolution co-edited by Hager. Dr. Bernard Nathanson, producer of the infamous anti-abortion video “Silent Scream,” is a director emeritus of AAPLOG. Nathanson opposes abortion as well as contraception “on moral and ethical grounds.”

AAPLOG broke with their physician colleagues in ACOG by supporting a ban on so-called “partial-birth” abortions and by opposing a 1995 recommendation by the Accreditation Council for Graduate Medical Education that obstetric-gynecology programs be required to provide abortion training. AAPLOG and other anti-choice groups successfully lobbied the Council to include in its revised recommendation for abortion training a clause stating: "No program or resident with a religious or moral objection will be required to provide training in, or to perform, induced abortions.”

What the Future Holds
The influence of far-right medical groups is growing. The Religious Right has found that the professional credibility of doctors offers a powerful way to promote its anti-choice agenda. The election of George W. Bush gave these organizations an opportunity to penetrate the medical regulatory and policymaking structures.

In a clear recognition of the influence that medical professionals can have in public policy debates, Focus on the Family launched the Physician’s Resource Council to mobilize far-right physicians. Dr. Hager is the obstetrics/gynecology member of the council. Some 20 state physician advisory councils operate as satellite organizations and coordinate their efforts through the Consortium of State Physicians Resource Councils, which has lobbied Congress in favor of abstinence-only sex education. The state-level councils are becoming increasingly active, especially promoting abstinence-only education and the supposed dangers of premarital sexual activity.

The opposition of far-right medical groups to abortion is familiar. But the concerted effort to label many contraceptives as “abortifacients” is a newer and growing part of the “abortion wars.” Many of these groups are attempting to make their religious opposition to contraception the law of the land. They are opposing attempts to mandate insurance coverage of contraceptives, supporting federal funding for unproven “abstinence-only” sexuality education that attempts to discredit contraception, attempting to have emergency contraception recognized as an abortifacient, and dramatically expanding the right of health professionals to refuse to provide, and refer for, contraceptive health services.

Good medicine is guided by accepted public health and medical standards that seek to provide the best care while balancing the rights of patients and providers. Against established professional standards, far-right medical groups are attempting to insert their own religious ideology into health care, in disregard of the needs and wishes of patients. If they succeed, medicine, science, providers, and patients all will lose.

This report was researched and written by Patricia Miller for the Religious Coalition for Reproductive Choice. For additional information, please contact info@rcrc.org or 202-628-7700 ext. 12.

For a foot-noted version of this article as a PDF file, please email info@rcrc.org