You are shrill.

Good research, Bill, but they just as effectively argue (and with complete honesty) that the rate of death from this pill is approximately 50%.

Lies.

Damn Lies.

Statistics.

See also: Catholic church in Africa claiming that condoms have holes in them that lets viruses through. Yes... in a very small number of cases. But shouldn't the Catholic church be arguing that promiscuity is bad?

And shouldn't those who are anti-abortion be arguing that abortion is the termination of a living human?

If the deaths here were at all significant, it would be a good tactic, in a way, because it would reach people who don't give a crap about killing babies, but don't want full-grown women to die. But 10 deaths in 16 years makes this drug safer than aspirin and Tylenol, so this angle is beyond irrelevant.

Good research, Bill, but they just as effectively argue (and with complete honesty) that the rate of death from this pill is approximately 50%.

I don't follow at all.

Confederate Yankee,

Ah yes... the "in 50% of abortions, the female dies" argument. But see, once you reveal your cleverness, you are in fact arguing about abortion, not playing hopscotch out on the 4rd standard deviation of statistical relevance.

Bill, it is an abortion pill. If a woman takes to and the fetus dies, those affected by the pill have a 50% mortality rate, right?

Creative lying with "accurate" statistics.

And Mark J, I'm not actually arguing for either side, just trying to be a pain in the butt to Bill. :-)

Listen, I don't agree with abortion and believe that a fetus is a person, but you are a idiot Confederate Yankee. What is the point of even arguing in such a manner? You're obviously not going to impress anyone who is 1) on the other side of the issue, or 2) has any sense of comity and reflection. So what's the point in even opening your mouth?

Basically, you are engaged in the rhetorical equivalent of a circle jerk.

Anyway, I think Bill is spot on here.

That was beautiful.

Bill's got a grip on the idea of relative risk. As an internist, I'll routinely prescibe "safe" medications with far higher risks for death or injury. There's no way around it...all medications are double edged swords. If I were so risk adverse that unable to prescribe medications with the same (or worse) mobidity/mortality profile as RU-486 I would never help anyone at all. Argue against the use of RU-486 if you like, but the saftey profile is not a convincing point.

Yeah, that's fairly irresponsible. And I say that as a Malkin fan.

Most people don't know that prescription drugs taken as prescribed are actually the fourth or fifth leading cause of death by some estimates. So drugs in general aren't that safe.

I bet people would take fewer of them if they knew that.

Bill has a good point but I can't quite agree he is "spot-on".

The comparison to anti-depressants is only fair insofar as we compare these and the morning-after pill as

-- both tested on adult women (do we assume that both males and females react the same way to the anti-depressant? If females have more adverse reactions, should the drug be restricted for use in women? By the same logic, have both the anti-depressant and the morning-after pill been tested in TEEN women? Are both equally safe for patients in both groups?

-- both groups, the pregnant and the depressed (and yes, there may be some overlap there) being properly diagnosed before taking the drug? Can you just walk into a pharmacy and demand anti-depressants? Does Planned Parenthood pack up a kit for a teen girl with balloons, comic books, and a pre-pack of anti-depressant pills -- just in case she might wake up tomorrow with a severe case of regret?

If the usage of both pills is the same then the comparison is spot-on. Other wise, it's useful to think about about -- but not an excuse to stop thinking.

The comparison to anti-depressants is only fair insofar as we compare these and the morning-after pill as

If I was doing a more detailed, apples to apples analysis. As it is, I think you're nitpicking a bit.

The odds of finding a detailed apples to apples comparison regarding a drug exclusively used on women in a short-term therapy (not to mention other more specific factors, like a one-two drug cocktail utilizing hormonal and convulsant effects), is about, oh, zero.

So in the sense that my example illustrates that the relative risks of different drugs is NEVER zero - a proportion that most people are unaware of - it is indeed "spot-on" enough.

I was also tempted to issue a comparison to aspirin, statins and penicillin in order to make my overarching point that a certain number of people die every year from all drugs, but I came across the viable anti-depressant stat first, and alas, my time is limited.

a certain number of people die every year from all drugs

IIRC, about 30,000.

This might be the Hewitt post you're remembering:

The last thing we need is a witch hunt that shutters the drug development process. The "buy Canadian drugs" chorus is already targeting the American pharmaceutical industry, an industry already absorbing the extraordinary costs of the plaintiffs' bar. I am still on the right side of 50, but seniors and sufferers from any serious disease should shudder when the Lous and Aarons of the world start calling for more regulation, which means fewer drugs and fewer cures.

What is the point of even arguing in such a manner? You're obviously not going to impress anyone who is 1) on the other side of the issue, or 2) has any sense of comity and reflection. So what's the point in even opening your mouth?

It was rather dark attempt at humor, called satire, my under-educated friend. Perhaps not as well written as A Modest Proposal, but something in vein all the same. Of course, you probably thought Swift was writing a Polynesian cookbook, and that says a lot more about you than it does anyone else.

The stats for live birth maternal mortality (WHO /UNICEF) figures for the year 2000 in western countries was 1:8334 compared with 1:92000 for RU486, or it 11 times greater a risk for a women to give birth, guess the "probirthers" like killing women. But is that really a surprise?

Very impressive deconstruction. Shows that Malkin is either not very bright, or not very honest. In addition to being insane.

I totally disagree with those conclusions.

delen -

note - the United State's risk of maternal mortality is different than the aggregate for "Western countries."

guess the "probirthers" like killing women. But is that really a surprise?

Is that a joke?

Another relevant figure: the death rate from Vi*gra is about 6 in 100,000, so it's roughly 5 or 6 times more lethal than Mifeprex.

So giving birth is riskier than using RU-486. RU-486 saves lives, then. That should be the new motto of its supporters. And "Pregnancy Kills."

No act is without risk. some well-meaning parents won't vaccinate their kids because of the risks, but they do not adequately consider the real risks of NOT vaccinating.

...when it comes to shoehorning science and medicine in order to fit an ideological agenda, misrepresenting risk and utilizing hyperbole, you're doing the public debate a serious disservice, doing your readers a disservice and emulating the worst flaws of the mainstream media: combining a distorted ideological narrative with superficial analysis of complex issues.

As a staunchly pro-life conservative, and one who abhors the very idea of RU-486 as an abortifacient...I couldn't agree more. Sloppy statistics is sloppy statistics, whether it comes from Left or Right.

The uses and abuses of arguments, procedures, nostrums, and medications are undergoing changes as we begin to accept the calculated risks in abortion at any stage.

What is of concern to me is the extent to which we are kept in ignorance of the statistics on first time abortions for those under 18 who have not carried a pregnancy to term; the same for those over 30. And women with a family history of breast cancer. The ABC link is being established slowly but surely but it is being fought every step of the way by the abortion and breast cancer business.

As a survivor of breast cancer more than likely induced by the use of hormone replacement treatment, I have become an aggressive consumer of medicine. One has to be...the risks for using birth control pills whilst smoking are quite high, but doctors continue to prescribe the pill while admonishing smokers to "quit." Right. That's lazy medicine.

The whole abortion issue is so agenda-driven that it's impossible to get real information. Some of the studies of women who abort and go on to develop generalized anxiety are striking. But bring them up and you're a rabid pro-lifer...

In fifty years we'll look back at all this the way we view lobotomies now. What a panacea *they* were...the laws of unintended consequences are nowhere more apparent than in the current practice of medicine. Too much technology, not enough philosophy of science. Those guys are too narrowly educated.

Mother Nature is a tough woman. Cross her at your own risk.

By the way, should my cancer metastasize, I;m going to Europe for treatment. The "gold standard" for teatment of metastasized breast cancer in this country doesn't have good outcomes.

Thank you, Bill. You are officially my hero for the day.

And I am banging my head into a wall with you.

I don't care for bad science from anybody.

What is wrong with Malkin's post?

1. She has never taken Statistics 101
2. She is too stupid to have passed Statistics 101 with a satisfactory grade
3. She does not understand the concept of probability distribution, let alone its applications
4. All of the above

(DELETED AND BANNED FOR NASTY LEFTIST STUPIDITY -- THE MANAGEMENT)

What's her face got to do with it? Jack.

What's wrong with it was fixed by her link to my post about the issue.

2 of the women who died apparently followed the administration directions given by Planned Parenthood: inserting the pill vaginally, rather than taking it orally as directed by the FDA.

Bill, it is an abortion pill. If a woman takes to and the fetus dies, those affected by the pill have a 50% mortality rate, right?

No. To begin with, since it prevents implantation it is a contraception pill rather than an abortion pill. Moreover, what it prevents the implantation of is a zygote, not a fetus

Birth has a 100% mortality rate. Should we outlaw it? It's a smart-ass point to raise, but think about it. Birth must result in death. At some point we need to abandon the monadic rhetoric and deal with the teleological. Bill's treatment of this topic is rightous and beautifully presented. Imposing anthropomorphic moralisms on biological systems is a delicate game and typically a receipe for policy disaster. The "war on drugs" is one of many examples of this. Some of you need to consider how 'the event' represents an artifact of mortality, and not the other way around.

Thanks for doing this Bill. Reminds me why I'm a RINO/liberal hawk/etc and not a conservative. Those fols ARE scary sometimes.

Yeah, and in regard to the "more silliness" .... the morning-after pill and RU-486 are two completely different drugs.

Thanks for the enlightening stats, Bill.

If every car that auto companies sold had a defect that caused 1 in 92,000 deaths for infrequent usage, they would be sued out of existance.

The abortion/breast cancer link is bogus. It is junk science for ideologues.

What we do know is that carrying a pregnancy to term changes the population of glandular cells in the mammary gland, reducing the likelihood of cancer somewhat. It has nothing to do with a history of abortion, unless the person has never had a full term pregnancy because it was aborted.

And please don't try to claim that that is sufficient to indict abortion. No one, I hope, is going to argue that women should get pregnant to reduce breast cancer risk a little bit -- especially since, as has been mentioned, pregnancy has its own non-negligible risks.

Sorry, John, but cars DO have a defect that causes greater than 1 death in 92,000 uses - THE DRIVERS.

The morning after pill is used to prevent the fertilized egg from implanting onto the uterine wall by delivering a 3x dose of progesterone and making the female reproductive system believe that it is at the onset of menstruation.

RU486 is an abortifacient that terminates a pregnancy that has already begun. The zygote is firmly affixed to the uterine wall (in a normal pregnancy).

Make sure you use the right terms in your arguments, please, or it makes your argument useless.

BinkyBoy -

Certainly you aren't referring to me (the author of this post), are you? Because being aware of the right terms, I did not misuse them.

To borrow your phrase: I'd advise you to specifically address the target of your arguments, please (on this comment thread?), or it makes your argument useless (or at least leads to confusion).

No, I wasn't targetting you, Bill. I noticed a few comments above that were well written, but used the incorrect terms and some assumptions that made their whole argument useless. Just trying to help, its too early to try humor, so I tried to just be blunt.

Thanks for clarification.

If every car that auto companies sold had a defect that caused 1 in 92,000 deaths for infrequent usage, they would be sued out of existance.

but there is no "defect" in these drugs. made perfectly right, it is guaranteed that some people will die from most prescription drugs. sometimes the patients do sue. they lose against the drug manufacturers, who disclose the risks up front. maybe they get something from the prescribing physician, but if he chose the wrong drug, not because the drug has risks.

" ... in the sense that ... the relative risks of ... is NEVER zero - a proportion that most people are unaware of - it is indeed "spot-on" enough. "

Spot-on, enough.

Geez. By that standard maybe "fake but accurate" wasn't so awful, either.

I agree with your 2nd important point that no drug is completely safe and your prior important point that Malkin and co. are revealing either bias or ignorance by not acknowledging that. I will go so far to explicate a point you don't make -- this is (statisically and otherwise) far better than a rusty coat hanger in a back alley. Okay?

I do NOT accept the presumption that young women acquiring this particular drugs from sources other than their own physicians and using them without support from husbands, parents or other responsible parties -- not classmates, dorm monitors, or little sisters -- are likely to experience meaningfully comparable rates of expected outcomes as other patients who take other medications -- for conditions where the "privacy" and "stigma" issues are off the table. There seems to be a back-alley sort of pharmacy shaping up where anybody can walk in, get pills, and walk out, never to be seen again. I suggest we don't really want to go that direction.

Spot-on, enough.

Geez. By that standard maybe "fake but accurate" wasn't so awful, either.

And by the standard of that comment/comparison, you are an intellectually unserious man.

The point was not to construct an apples to apples scientific experiment, rather to establish a sense of proportion regarding relative risk for common medical activities. BUT - discussing the odds of winning the Powerball might also have been "spot-on enough," in that it lends a sense of proportion that most people can easily grasp.

Thus, it was "spot-on," but as this is a subjective paradigm and not an empirical standard, I added "enough" as a qualifier.

Yet you compare my specific language to some sort of intellectual dishonesty, a la Dan Rather.

Deconstructionists like you make me wonder why I bother getting out of bed in the morning. Your mere existence saps my faith in the logical capacity of humanity, bit-by-bit, day-by-day. The Baby Jesus cries every time you post.

You are an intellectual albatross, a lodestone around common sense's bowed neck, a sateen thong-wearing fanboy to the memory of Jacques Derrida.

I'd go so far as to say that your dim ballbusting probably qualifies you for immediate sterilization - For the good of man!*

* Or at least the benefit of any poor children that you might have, who would no doubt be forced to weather your critique of their math homework based on the neatness of their handwriting.

I'll note a significant difference between RU-486 and other perscription drugs that carry risks. For all other drugs, parents have a right to know about the drugs and evaluate the risks before their children take them.

For RU-486, the adult most likey to be advising a child to take it (excluding health workers) is a statutory rapist who has a strong personal motivation to have the child take the drug.

Bill, great post. Confederate Yankee made a reasonable point in an amusing way, even if it was irrelevant to Bill's point that the danger of RU-486 to women taking the drug was being misrepresented. Commenters give him(?) a break!

Bill,

A couple of things about the analysis. If I have something wrong, please let me know -- I have limited time also and could be wrong, but I'm trying to back up the observations with links.

First of all, statistics aside, I think your basic insight is a valuable one -- and one often overlooked by people on all sides when they use anecdotal evidence to make a point.

However:

I am troubled by using research relating to taking antidepressants as a basis for comparison. It doesn't seem like a particularly relevant control group. And the study I believe you cite (link here) says:

Estimated death rates associated with specific antidepressants should be compared with caution: higher death rates may be explained by trends in use of certain drugs with more severely depressed and co-morbid patient groups as well as underlying pharmacological toxicity.

It seems that this qualifier would apply with even greater force when comparing severely depressed groups with expectant mothers. Comparing such groups seems like it would introduce so many variables as to make the value of any comparison prohibitively hard to judge.

Next:

You cite a .pdf that you claim gives the mortality rate of expectant mothers in the United States when they actually give birth. But when I went to your link, it gave that statistic for North America, not just the United States. So you're comparing deaths from the pill in the U.S., to deaths from childbirth in the U.S., Mexico, and Canada. Again, unless I am overlooking something important, this seems an unhelpful comparison.

So what is the rate of death from childbirth in the U.S. alone? I don't know. This link says:

In the United States, the maternal death rate is 17 maternal deaths per 100,000 live births in the year 2000.

17 per 100,000 is 1 in 14,286 (not 3,700). But that's not the answer, yet. The link I give defines maternal death not only as death in childbirth, but as the "death of a woman that occurs directly related to the reproductive process" -- specifically including abortion: "The major causes of maternal death are obstetrical hemorrhage, ectoptic gestation, puerperal sepsis, and abortion." So if I'm reading this right, the actual number has to be some fraction of 1 in 14,286.

The penicillin allergy statistic seems more on point. Again, I agree with your basic point; I just have a problem with some of the specifics.

Let me know what you think.

Patterico -

this point is relatively meaningless, and frustrates me greatly:

It doesn't seem like a particularly relevant control group.

It frustrates me because I'm keenly aware of the necessity of controlling test design - in certain scenarios.

BUT - The point of the post is not to design a relevant control for comparison in a scientific comparison of drugs controlling for population, etc (i.e., find me a drug that only women take, only expectant mothers, administered acutely, etc. etc.).

Not only would this be hard to do (I can't immediately think of one not related to this topic, which would retain the political taint), but it's next to irrelevant because

1. the mortality rates are SO DIFFERENT anyway - it's illustrative.

2. The point is to just look at a drug that we consider "safe." Anti-depressants are very widely prescribed (much more than RU-486), so ...

2. The drugs are both common. Thus, the example is simply designed to give a perspective on relative risk. The absolutist statement in the post indicated that "no deaths" were acceptable; by that logic, I can cite aspirin as an unacceptable drug. Viagra (also less risk than RU-486). You name it. Just about all drugs can accidentally kill someone.

You bring it up respectfully, but it's the most frustrating strawman; I could also have used the chances of getting in a car accident, or some other wildly unrelated stat to establish a similar perspective (in a weaker argument). So bringing up strict test design is just a distraction, and it's also a nearly unmeetable standard. The fact remains that 5 deaths in 460,000 uses (based on the stats from the LA Times) means very little. I'd bet aspirin has an equivalent mortality rate.

As far as the childbirth mortality stat, I found two stats that said "North America," after finding one that specifically listed the mortality rate in the "United States" as 1 in 3,500. So your source may indeed be correct (looks superior); it's just what I came up with on random googling.

See here:

• 1 in 3,500 •
The risk of a women dying during childbirth in the United States.

http://www.youthnoise.com/page.php?page_id=773

I trusted the stat on that questionable source and then verified it with the link in my post that cited North America, but your source looks better. So I was probably in error.

That would put abortion at 13 times safer than childbirth, rather than 25 x.

As for "abortion" as a portion of that statistic in your cite - it is relevant to look at what they mean by that. Are they tracking deaths from elective abortion? Or abortion in the course of a difficult or dangerous pregnancy. I don't know. In any case, getting into fractions of 1 in 8000 risk - or 1 in 12,000 - it still pales next to 1 in 92,000. A representative of the professional association of abortion providers did cite the relative risk of childbirth as 13x that of abortion. Not sure if they are being accurate; he could also be misusing that statistic.

Maternal death: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental cause. Maternal deaths should be divided into two groups: (i) direct obstetric deaths are those resulting from obstetric complications of the pregnant state (pregnancy, labour, and puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from the above; and (ii) indirect obstetric deaths are those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but was aggravated by physiologic effects of pregnancy.

http://esl.jrc.it/envind/un_meths/UN_ME037.htm

Assuming this includes elective abortion (and I'm not certain), what fraction of the mortality rate can be attributed to that? I don't know. Do you? And does it make childbirth favorably compare to a rate of 1 in 92,000? I don't have the answers. But I do feel confident in saying that taking RU-486 is relatively safer than having a child.

I wasn't insisting on strict test design -- that's why I didn't quibble about the penicillin example. And I probably wouldn't with an aspirin example either.

But, for the reasons stated in the study on the anti-depressant example, I think that anti-depressants are a bad example even for strictly illustative purposes. You're talking about a group of people who start out with big problems to begin with.

What if I used rate of death in hospitals compared to childbirth? Just for illustrative purposes, of course. Hospitals are considered safe, just like anti-depressants.

But an awful lot of people die there. I bet the mortality rate of patients at hospitals is astronomical. Because the people who end up there are people who are starting out with awfully big problems to begin with.

tgibbs, (from way back)

No. To begin with, since it prevents implantation it is a contraception pill rather than an abortion pill. Moreover, what it prevents the implantation of is a zygote, not a fetus

This is false, on two counts. RU-486 terminates existing pregnancies. You're confusing it with something else (the "morning-after pill") and in addition, claiming that the morning-after can prevent implantation, when this has never been scientifically proved.

Patterico:

But, for the reasons stated in the study on the anti-depressant example, I think that anti-depressants are a bad example even for strictly illustative purposes. You're talking about a group of people who start out with big problems to begin with.

I disagree. Anti-depressants were prescribed to 25 million people in 1994, maybe up to double that nowadays (don't feel like digging up a stat). That's a huge population distribution, that includes people with severe problems and people that don't. And, the fact remains that people in the referenced study specifically unintentionlly died from "single-ingestion" of a commonly prescribed pharmaceutical. Plus, I would be willing to make a wager that there are certain riskier lifestyle choices and psychological problems more positively associated with the population of people who use RU-486 that would specifically predispose them to vaginal infections (higher incidence of STD's, etc. "a group of people who start out with (specifically relevant) big problems to begin with.")

It's not apples to apples, but I think it's fine. Perhaps penicillin or Viagra would have made a better example, but I still think you're nitpicking because you're inclined to look for holes.

I updated my post with your source, btw, and one problem with your math: 17 deaths per 100,000 isn't a "1 in 14,286 (not 3,700);" it's 1 in 5,882.

Even assuming that half of those are due to abortion in the equation of maternal death, let's say (which is being unrealistically generous), that's 1 in 11,764, and still doesn't even touch the assumed 1 in 92,000 for RU-486.

MarkJ, tgibbs -

Morning After vs. RU-486

http://womensissues.about.com/od/abortionissues/f/faqru486map.htm

Mark is right - RU-486 is specifically called the "abortion pill," not the "morning after pill."

That's a huge population distribution, that includes people with severe problems and people that don't.

I can't easily find a statistic on how many people are hospitalized every year, but it would probably be accurate to say it's a lot. I bet it's a "huge population distribution, that includes people with severe problems and people that don't." But the death rate for hospitalization it would be a wildly misleading statistic to use, even for comparison purposes.

Sorry about the math error. In order to figure out what I had done, I just now divided 100,000 by 14,286 -- to see what number I had plugged into the calculator instead of 17. It was 7. Evidently the computer calculator didn't register the number "1" when I clicked on "1" and "7" to type in "17." Sorry about that! It wasn't intentional.

Even assuming that half of those are due to abortion in the equation of maternal death, let's say (which is being unrealistically generous)

Remember, the definition of maternal deaths includes all kinds of causes -- not just abortion and childbirth, but complications during pregnancy. I don't think you have any way of knowing what percentage results from actual childbirth. But I think your essential point is not far off: looking at RU-486 vs. the decision to have a child (as opposed to the actual event of childbirth).

I still think you're nitpicking because you're inclined to look for holes.

No, and I don't even think it's nitpicking. It's just discussing statistics. Statistics is much more than numbers, it's a way of looking at problems. I just have the sense that the anti-depressant example has the potential to be too heavily weighted towards a high number because of the groups involved. I just would have stuck with a difference example. Again, it was this language in the study that tipped me off:

Estimated death rates associated with specific antidepressants should be compared with caution: higher death rates may be explained by trends in use of certain drugs with more severely depressed and co-morbid patient groups as well as underlying pharmacological toxicity.

That's the scientists who did the study you cited talking, and I think it's a point that shouldn't be ignored. Again, it would be just as if you had used an analogy to death rates from hospitalization -- that would give you a hugely high rate, which would be misleading even for purposes of illustration. It's not a strawman, in my opinion. But since I'm repeating myself, it's probably best to simply note the disagreement and agree to disagree.

Patterico -

Again:

I bet it's a "huge population distribution, that includes people with severe problems and people that don't." But the death rate for hospitalization it would be a wildly misleading statistic to use, even for comparison purposes.

You are setting up a bizarre and unreasonable standard of test vs. control design, what is considered an "unreasonable" comparison (especially since the anti-depressant study was among general users with standard distribution, which includes some naturally high risk individuals).

That's not what this post is doing (and I set up clean test designs for a living, btw). The death rate of hospitalization would indeed be a relevant comparison - as would a completely non-medical comparison like the odds of getting in a car accident - in order to establish a tangible perception of risk for activities that people consider "safe."

You cannot possibly account for all of the concommittant factors that could lead a drug or medical event to be fatal, thus buttressing MY original point that 5 deaths in 480,000 is a perfectly normal risk profile for a drug, even when compared with pregnancy.

A trained epidemiologist could absolutely rip my post apart, but I'm not making concrete epidemiological assertions, just establishing PERSPECTIVE. You're evaluating on a highly specific scale for what was a very general comparison.

I just have the sense that the anti-depressant example has the potential to be too heavily weighted towards a high number because of the groups involved.

You can indeed have that sense, but you have no empirical basis for that assertion, except the cite you provided that mentions that different people with concommittant problems in the study had different risks with different drugs, BECAUSE you have no data for comparison. "A portion of people that use anti-depressants have problems that might predispose them to mortality" is not a trump card.

1. You don't have comparable evaluation of concommittant negative factors with RU-486 use

2. You have no basis to believe that the 480,000 people taking RU-486 are also not a population predisposed to medical problems. As I mentioned, a reasonable assumption would be a positive correlation to STD's, meaning a positive correlation to infection, which would magnify the death rate from the EXACT CAUSE OF DEATH that we are discussing, bacterial infection from vaginal administration of misoprostol.

So again, your standard and analysis is flawed in the same way that mine is, because you have insufficient data, and I could pick it apart ENDLESSLY. Thus, yeah, considering I could have used odds associated with various other drugs or even non-medical risks to establish a perspective that people could grasp, you are "nitpicking," and your analysis is vulnerable to the very flaws of design that you are using against my very general analysis. I like to call it "selective negative argumentation."

It remains that Viagra, penicillin and a whole host of other drugs that I could cite have apparently riskier profiles than RU-486, and my argument is not for purity of test design. This isn't a test.

And Patetrico -

Estimated death rates associated with specific antidepressants should be compared with caution: higher death rates may be explained by trends in use of certain drugs with more severely depressed and co-morbid patient groups as well as underlying pharmacological toxicity.

This is an advisement against comparisons BETWEEN drugs, btw. As you spread out the analysis to anti-depressants as a WHOLE, the distribution widens and becomes more and more representative of the ENTIRE POPULATIOn, giving you a normal curve of people with severe problems and people with mild problems.

Remember, the definition of maternal deaths includes all kinds of causes -- not just abortion and childbirth, but complications during pregnancy.

That's fine.

Excluding the possibility of the inclusion of elective abortions, my language could be tightened by saying "the risk of carrying a child to term," rather than the event of "childbirth." That was my intent anyway.

Nitpicking.

I'm going to give the link to this post to my father-in-law. He's a hospital administrator and former statistics professor. He'll have good insights -- and he'll tell me whether I'm all wet about this.

your analysis is vulnerable to the very flaws of design that you are using against my very general analysis

Your comments convey the impression that I'm arguing against your general analysis. I'm not. Remember?

Patterico -

What did I say?

A trained epidemiologist could absolutely rip my post apart, but I'm not making concrete epidemiological assertions, just establishing PERSPECTIVE. You're evaluating on a highly specific scale for what was a very general comparison.

Do it for your own edification, by all means.

The comparison between anti-depressants and RU-486 is indeed very inexact and vulnerable to a multitude of problems; this can be argued from multiple perspectives. But you are still focusing too heavily on this, IMO. Your instincts are also correct regarding controlling test design.

Your comments convey the impression that I'm arguing against your general analysis. I'm not. Remember?

Then what's the point? I feel 100% confident in saying, prescribed anti-depressants carry a higher mortality risk than use of RU-486. Whether it's 1 in 3,000 or 1 in 50,000 based on factors we can't accurately account for, this is still true. "Nitpicking."

Malkin has posted a followup, Revisiting RU-486, conceding Bill's main point that many other drugs are prescribed with much higher mortality rates.

However, she notes that a number of agencies are investigating the drug under the fear/suspicion that the very few reported deaths are "just the tip of the iceberg." At issue here are the factors that can lead to death -- unusual infections whose symptoms match exactly what the patient who takes RU-486 is told to expect. How easy is it for a woman to discern whether her bleeding and cramping are "normal" or life-threatening?

I believe there is also value in challenging the conventional wisdom that RU-486 is a "completely safe" and "harmless" alternative to surgical abortion.

Joan -

I posted a follow-up to her follow-up:

http://www.indcjournal.com/archives/001983.php

Also, I'm not sure that the conventional wisdom for RU-486 being "harmless" is in any way exceptional, in the sense that most commonly prescribed drugs have that conventional wisdom. No prescription drugs should be considered totally "harmless."

Sorry for the double post, but I want to task Bill on another issue: his assumption that the 5 reported deaths represent an accurate accounting. Yes, at the outset he says, "Assuming accurate data (admittedly a big assumption)," but then he continues from there. He didn't have to make that assumption. One of the quotes in Michelle's first post includes this line: The FDA estimates that, in general, only about 10% of problems with drugs are reported.

If only 10% of drug-related problems are reported generally, we could reasonably assume that at least 50 (maternal) deaths have occurred after RU-486. But that's assuming that the 10% reporting rate would hold for RU-486 usage, which I doubt. Pro-abortionists do everything they can to minimize the risks of abortion, including failing to tell women the very real risks and long-term side effects of surgical abortions. Do you honestly think that Planned Parenthood is going to report negative side effects of RU-486 administration when they are not legally bound to do so? I wouldn't expect them to make reports even if they were legally required.

If the reported deaths represent only 10% of actual deaths (probably a low number), then the risk of death from RU-486 jumps to 1 in 9,200, not Bill's 1 in 92,000. (Did I do that math correctly?) And I think we can all recognize that even the 1-in-9,200 uses figure is low, because if the 10% problem reporting is an average across all drugs, we can agree that problems with RU-486 are excellent candidates for falling into the memory hole.

I suspect that the agencies now investigating RU-486 share my skepticism regarding accurate reporting. And I think it's rather disingenuous of Bill to put together this lengthy analysis/hit piece while dismissing the single most important issue, the accuracy of the reported deaths figure, in a parenthetical.

At any rate, I'm glad the investigations are under way.

Bill has a tought time taking compliments from folks--that's his cantankerous personality. I know if I ever have a blog and Patterico ever stops by to say "Great post, here's how you can make it better" I'm going to be pretty flattered.

Sounds like we need that Sparkle person to stop by and knock cranky old fart Bill down a few notches.

Joan -

Sorry for the double post, but I want to task Bill on another issue: his assumption that the 5 reported deaths represent an accurate accounting.

sorry, but I have to lightly task you a bit on your tasking. My post clearly caveats this initially(as you mention). And this:

The FDA estimates that, in general, only about 10% of problems with drugs are reported.

It's naturally built into any comparison of drugs, as I note a second time:

despite the necessary caveat of side effects and related deaths that go unreported (a challenge with epidemiological analysis of any drug),

Thus, any drug comparison will include a variable fudge factor. And yes, your math was correct.

My analysis was contingent upon current information; to propose that Malkin's implication - again on current information - is inaccurate. For the record, I bet the LA Times stats are missing something.

And also for the record, I don't really think that only 5 deaths are related to RU-486. It might be 7, might be 10, it might be 50.

Damn you, spongeworthy.

Straight to HELL!

PS - I disagree with the premise of Patterico's constructive criticism.

I know you do. You're making a point and the right one. I guess he's saying you could change it just a little bit and actually make an accurate comparison, one that would stand up to some pretty rigid analysis. That's, as you say, pretty constructive.

Oh, and since you've chosen to relegate my eternal soul to the Fire, I'm going to run fetch that Sparkle to tan your hide for you. Brace for impact!

Bill,

Just so it's clear, I'm not going to try to get my father-in-law to rip apart your post by pointing out that the comparison is not exact -- of course it's not, as you acknowledge. What I'm curious to know from him is whether the *numbers* tell us anything helpful.

I'll make the point to him that you are citing the numbers simply to make a broad general point. I'm not looking to be unfair about this.

You emphasized the numbers in your post; it appears to me that you think that the numbers are relevant *beyond* simply reminding people that people die from all sorts of things. The latter point is indisputable *and* something people forget all the time. It's the specific relevance of citing the specific numbers that I'm dubious about, even to make a general point. That's the aspect of this that I'm hoping my father-in-law can shed some light on.

If I'm wrong to question this aspect of your argument, he'll tell me and I'll tell you.

Incidentally, if I had to guess, I'd say he's a supporter of RU-486. I know he's an ardent supporter of birth control and sex education. So I think we'll get the straight scoop from him -- if he has time to reply (he's quite busy lately).

Cool, very fair.

All you have to do is threaten him with some Sparkle-hatin' and he settles right the hell down, don't he?

By the way: re your assumption that I *want* to find flaws in your analysis -- it looks like you assume I am against RU-486, right?

Well, I'm not.

I haven't given it a great deal of research or thought, but my relatively uninformed opinion is that it's little different from a birth-control pill -- which can prevent pregnancy not only through blocking ovulation, but also through preventing the implantation of a fertilized egg in the uterine wall. This is arguably a non-surgical abortion.

If you're a strict life-begins-at-conception type, you should probably oppose birth control pills as well. But I'm not. I'm much more disturbed by mid- and late-term abortion, which strike me as barbaric in most cases.

I remember when my daughters were born. Labor was quick in both cases. I took my wife to hospital at 1:15 AM when she said her waters broke, and my first was born at 5:45 AM that morning. She weighed 8lb6oz, and had lots of hair. It was a Tuesday.

My second was born on a Tuesday at 1:10pm, also on a Tuesday. She weighed 9lb6oz, and already had her eyes open and could hold her head up. Because the staff had to deal with a small amount of retained placenta, my daughter and I spent 30 minutes or more just looking at each other.

I bathed them when they were days old, fed them late at night and changed their daipers. I read books to them when they were young. We had our favorites. I first read Dr Seuss when I read those books to my daughters.

I have ensured that they had all the normal inoculations, and I agonized over the thought that my children might have been one of those who would die as a result of the injections. However, since I never had problems with those inoculations, and because of the risks associated with not having them, I went ahead. I recently asked my oldest to be inoculated against meningococcal meningitis.

I have infected them with my tastes for music and reading material. They read Scientific American because I do. They listen to Led Zepelin because I do.

I have counselled them that ultimately it is a woman's decision about whether or not to have a baby, but that it is far better not to get pregnant in the first place if they are not ready to have a baby. I have also communicated that I would like grandchildren.

I have invested so much effort in them, both emotionally and financially, that I would hate to have them act in haste so that I could repent at leisure. The news that any of the birth control methods they might use can lead to death is of keen interest to me.

As I recall, Michelle Malkin in a parent as well.

I make no claims that anyone responding here is or is not a parent, but it seems to me that before making suggestions that Michelle Malkin is ideologically predisposed to denying women a choice, Bill, it just might be that she can imagine what it might feel like to lose a daughter, and having successfully had two children, she just might feel that having babies is no big deal.

OK, Bill -- you were not as dismissive of the issue as I took from my first reading -- please forgive me, it was a rather long piece and my eyes may have glazed over once or twice. But I'm not going to let you off the hook (albeit a very small hook) so easily. You said, about the under-reporting of problems:It's naturally built into any comparison of drugs.

But:
1) You didn't just compare the safety of RU-486 to the safety of other drugs; you compared it to the safety of child-birth. I would guess that there are much more accurate statistics on child-birth-related deaths than on any drug, but that's just a guess. But if you accept the idea that child-birth-related deaths are accurately reported and drug-related deaths are not, you can't compare them without making some adjustment to the drug-related deaths figures.

2) You're assuming the under-reporting of RU-486 deaths and problems is comparable to the under-reporting of all other drugs, or, in your specifical example, anti-depressants. I think this is a bad assumption, given the politicization of abortion and the known behaviors of Planned Parenthood.

I take your point: there are no safe drugs, only safe doses, usually. But I'll just chime in with Patterico and say that I have the same misgivings: It's the specific relevance of citing the specific numbers that I'm dubious about, even to make a general point.

In the meantime, let me suggest you submit this post to the next Skeptic's Circle; it would make a great entry.

I accept the validity of your point #1 (though maternal death rates include complications for any death up to a year after birth, so there is some underreporting, fudge factor)

but can't really put much stock in #2 for the purposes of my analysis, as it's too much of an amorphous political sentiment to peg a number on. But I understand where you're coming from.

As for ...

please forgive me, it was a rather long piece and my eyes may have glazed over once or twice

I aim to please! :-)

According to the Statistical Abstract of the United States the maternal death rate for residents per 100000 live births was 9.9 (7.2 for white women, 24.7 for black women).

According to the Statistical Abstract of the United States the maternal death rate for residents per 100000 live births was 9.9 (7.2 for white women, 24.7 for black women).

UNICEF:

Maternal mortality ratio,reported (1985-2003)
8

Maternal mortality ratio,adjusted (2000)
17

http://www.unicef.org/infobycountry/usa_statistics.html

I'm late to the discussion, as usual, but I'll just toss in kudos for putting perspective on the issue. It's true that any medication has some risk, especially when not taken as indicated. It was a non-issue as far as I'm concerned, and I'm actually against the use of RU-486 on ethical grounds. That said, I hope it doesn't turn out some day to be extraordinarily dangerous, as long as women are taking it anyway.

By the way, about your note "pretty inconsistent" in reference to Hugh Hewitt: that's about the only consistent thing you'll find from him (inconsistency). I'm assuming I'm closely aligned ideologically to him, but you never can tell for sure because he contradicts himself rhetorically all the time. It irritates the crap out of me.

I suppose Hugh Hewitt is the reason that as a woman of child-bearing age in the State of Louisiana it costs me $200/mo to have health insurance. However, that plan will only cover 1 visit/yr to my OB/GYN. In the event that I should become pregnant, my health insurance company will not even cover my doctor's visit to determine whether or not I am actually pregnant. I would have to pay $400/mo for added "pregnancy insurance." Ironically, whether I am paying $200 or $400/mo, no health insurance company would cover the $40/mo expense of birth control. If I were a man, however, most health insurance companies would cover the cost of Viagra.

See "Equity in Prescription Insurance and Contraceptive Coverage" article posted on www.plannedparenthood.org
http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/birthcontrol/fact-prescription-coverage.xml

Bill:

Here's what my father-in-law said. I interpret it as agreement with you:

Scattered reactions after a quick scan of this:

I don't know the details of the stats behind all this. Have seen some scientifically-oriented news stories that quote the very low fatality rate associated with the drug. Not sure why anti-depressants are an especially bad example. Seems to me the best approach for comparing to other drugs would be to take a reasonable sampling of commonly taken drugs and compute associated death rates to see where RU-486 ranks. It's hard to know what to consider a fair comparison, since -- unlike almost every other drug -- RU-486 is not a drug you take over and over. Is one dose of another drug or one year's worth of doses the fair comparison?

The real safety issue isn't this drug vs. another, but this drug vs. not this drug. For example, I guess it's interesting to know that Vioxx is more dangerous than Prilosec, but if I have a condition that I'm taking Vioxx for, Prilosec is irrelevant. I need to know the risks of Vioxx vs. nothing vs. alternative therapies.

Every medical therapy (or for that matter, every decision not to undergo a medical therapy) carries a risk of complications or deaths. Our solution has been to try to make sure the person knows how loaded the dice they're about to roll are. Bariatric surgery (for morbid obesity) has been making some news because it carries a substantial risk of death (about 1 in 200) and a VERY high risk of serious complications. Patients know that, and we can't keep up with the demand.

Finally, the comments gloss over the difficulty of knowing what's coincidence and what's related to the drug. I can have half-million people drink a cup of distilled water, and some of them will die or have an infection or a heart attack afterward. I have to have a control group to compare my water drinkers to, and it's devilishly hard to find an exact control group for something like RU-486.

Despite the last paragraph, I interpret the whole of his response as essentially agreeing with your use of anti-depressants as a fair example. Surprises me a bit, and I haven't had a chance to talk to him about it, but there you have it.

I told you I'd communicate what he said even if he disagreed with me.

Anyway, I think your post was excellent regardless of the validity of any of my "nitpicking."

IN YOUR FACE, LOSER! I WIN!

Just kidding. Sorry if I got cranky defending my premise; you weren't the first to question that angle, and those before you weren't nearly as reasonable.

Nitpicker.

Patterico, seems to me your father-in-law is saying the most appropriate comparisons are to carrying the baby to term and surgical abortions which are the alternatives.

Reflected in the maternal mortality rate.

I think an important point that Ms Malkin was trying to make was lost in the pro-anti abortion emotion.

When it was learned that Viagra had cause 4 cases of blindness (some temporary) "the News Hour" had a special segment on it. Here we hear not a peep. (at least I didn't)

How many doses of Viagra have been taken worldwide, and what percentage have resulted in blindness? I don't know but I think Ms. Malkin's point, or at least part of it, is that whether this is seen as a big deal depends less on science and statistics than one's point of view.

As far as the pro-anti abortion wars go this is just another ho-hum side skirmish as far as I'm concerned.