A pharmacy professor who strenuously avoids heated political discussions is an unlikely candidate to get involved in a fight over abortion, particularly one as high stakes as a case now before the supreme court: the US Food and Drug Administration (FDA) v the Alliance for Hippocratic Medicine (AHM).
But when the professor Chris Adkins of South University in Georgia emailed his concerns about an academic article to the editors of Health Services Research and Managerial Epidemiology, that’s exactly what happened.
The article had been published by an anti-abortion research institute and, perhaps unsurprisingly, concluded that medication abortion was far less safe than the accepted scientific consensus – one established by more than 100 peer-reviewed studies across multiple continents and two decades of real-world use.
“The way this study used this situation to exaggerate, and I’ll say obfuscate, the truth behind mifepristone’s safety profile is where I thought: ‘I’ll reach out to the journal and say I’ve got these issues,’” said Adkins, referring to the drug targeted by researchers. Mifepristone is one half of a two-pill regimen that treats miscarriage and ends early pregnancy, and its future hangs in the balance of the supreme court case, to be heard this week.
“I honestly didn’t think I would be the first to do that,” said Adkins.
Within a couple days of Adkins’ complaint, the global academic publisher Sage, which publishes the journal, began investigating. Within weeks, Sage retracted not one but three papers by the anti-abortion researchers.
Adkins’ concerns go to the heart of a problem that has bedeviled scientists for at least a decade: the judicial system’s repeated adoption of poor-quality evidence to justify litigation and legislation to restrict abortion. Often that evidence is produced by the anti-abortion movement itself.
FDA v AHM is scheduled for oral arguments on Tuesday. The suit, brought by anti-abortion doctors, seeks to force the FDA to reverse decisions that relaxed restrictions on prescribing mifepristone. The Biden administration and the medication’s manufacturer argue the doctors have no right to sue in the first place.
The study Adkins complained about is central to the doctors’ case, and was cited heavily by a federal district court in Amarillo, Texas, that kicked off the government’s appeal when it found in favor of anti-abortion doctors.
How the supreme court decides the case could have profound implications. A finding in favor of anti-abortion doctors could reshape abortion access again in the US, including in Democratic-led states that might have considered themselves immune from restrictions. It also holds the potential to upend the FDA’s authority, which could call into question the future of all kinds of controversial drugs, from contraception to vaccines to treatments for HIV.
Researchers are skeptical that Sage’s retractions alone will make a difference in the court’s decision.
“It’s frustrating, it’s depressing, it’s maddening and quite honestly it’s frightening,” said the obstetrician and gynecologist Daniel Grossman of the University of California at San Francisco (UCSF).
Grossman is also a professor and the director of Advancing New Standards in Reproductive Health, one of the nation’s foremost reproductive health research groups. His own work has been taken out of context by attorneys arguing to restrict abortion in court briefs, he said, and he has published pieces to criticize the poor quality of evidence produced by anti-abortion doctors and researchers.
“Judges don’t have expertise to be able to review the science, just like I don’t have all the expertise to understand all the legal maneuvering that’s happening in this case,” said Grossman.
The anti-abortion movement pours money into research groups such as the Charlotte Lozier Institute, whose raison d’être is to produce articles its activists can cite in litigation, legislation and promotional materials. The institute was founded in 2011 by one of the nation’s most powerful anti-abortion advocacy groups, Susan B Anthony Pro-life America, and its researchers are responsible for the three now-retracted articles flagged by Adkins.
Mary Ziegler, a professor of law at the University of California at Davis and a leading legal historian of the abortion debate, says the movement has spent decades investing in its own research arm. Campaigners started fringe publications, such as the journal Issues in Law and Medicine, a peer-reviewed publication produced by the the National Legal Center for the Medically Dependent and Disabled. That organization was founded by James Bopp, a lawyer who has campaigned against abortion for decades, and is now the lead council of the National Right to Life.
The journal’s current editor, Barry Bostrom, is an attorney who fought abortion for decades. Bostrom has served as director and general counsel of Indiana Right to Life, and at least once represented National Right to Life before the Federal Election Commission in 2009, alongside Bopp.
But “that’s not the business model anymore”, Ziegler said. The movement is no longer limiting anti-abortion research to its own journals.
Now, anti-abortion researchers also seek to place their research in journals published by academic publishers such as Sage or, in another example, the British Journal of Psychiatry, published by the Royal College of Psychiatrists.
In the latter example, an American researcher found that abortion accounts for a substantial increase of risk in adverse mental health outcomes. However, the researcher’s analysis depended in part on a “debunked” paper, overestimated risk and did not follow published guidelines for the kind of analysis performed.
Researchers have repeatedly raised concerns to the British Journal of Psychiatry and even recently published an article in the British Medical Journal (BMJ) calling for a retraction. So far, they have been rebuffed by British psychiatrists.
In spite of their efforts, the researcher’s work has been repeatedly cited as evidence of the harms of abortion before state courts and federal courts. In 2022, the researchers’ work was cited in a brief to the supreme court in Dobbs v Jackson Women’s Health Organization, the case that ended nearly 50 years of constitutional protection for abortion. The anti-abortion movement has also used the researcher as an expert witness in court.
But fighting poor-quality evidence can feel like a losing battle. Responding in a well-respected journal can be a lengthy process that doesn’t always pay off.
Ushma Upadhyay, a public health social scientist trained in demography, and a professor in the department of obstetrics and gynecology at UCSF, contributed to both the BMJ article that failed to secure a retraction, and co-authored an article in the journal Contraception with Adkins on the flaws in the now-retracted Sage articles.
“We worked on it over Thanksgiving break. My mom was visiting, and I was like: ‘I’m really sorry, we have to get this out,’” said Upadhyay. “The stakes were so high.”
Evaluating scientific evidence is difficult under the best of circumstances. To the untrained eye, academic journals are a thicket of unknown quality, and “peer review” is a lofty term but is only as strong as the people doing the reviewing.
Even when researchers make a compelling case, journals can be loath to correct the scientific record. That allows a contested article to be further cited and compounds the damage of poor evidence..
“For every one paper that is retracted, there are probably 10 that should be,” Ivan Oransky, co-founder of Retraction Watch, recently told the New York Times. Retraction Watch maintains a database of more than 47,000 retracted studies.
Should the court choose to undermine the FDA, it will be the result of a tragic irony – that one of the world’s most respected arbiters of science could be undone by research that would never meet its standards.
