If there is a poster child for the Bush administration's policies on matters of sex and women's reproductive issues, it is Dr. W. David Hager, a Kentucky-based obstetrician and gynecologist who mixes a heavy dose of religious preaching into his medical practice. Hager's nomination to the FDA's Reproductive Health Advisory Committee sent a shockwave through political and scientific circles alike.
Dr. Hager is the author of several books, including As Jesus Cared for Women: Restoring Women Then and Now (1998), which recommends scripture readings as a treatment for premenstrual syndrome, postpar-tum depression, and eating disorders. A staunch anti-abortion activist far out of the mainstream of the medical profession, Hager has publicly likened the contraceptive pill to abortion and, in his private practice, has reportedly refused to prescribe contraceptives to unmarried women.13 As press accounts have noted in detail, Hager is an aggressive advocate for the Christian Right's political agenda. As a member of the Christian Medical and Dental Society, for instance, he helped submit a peti tion to the FDA in August 2002 to halt distribution and marketing of the abortion pill RU-486.
Appointing such a religious extremist to a scientific advisory board on women's reproductive issues was a highly controversial move, even for the Bush administration. To help limit opposition, the administration actually announced Hager's appointment to the panel on Christmas Eve in 2002, ensuring that it would receive little immediate notice in the press.
Hager says he personally refuses to prescribe Plan B to his patients on moral grounds. "Your faith is an integral part of your life and everything that you do," he told a reporter, contending that "83 percent of patients in this country say that they prefer that their physicians pray with them."14 It also bears noting, given Hager's moralizing about issues of women's sexuality, that he has drawn controversy for his own alleged sexual proclivities. In a recent account, his now-divorced wife, also a devout Christian, asserts that Hager not only cheated on her during their marriage but forcibly sodomized her against her will on a regular basis for at least seven years until she divorced him—in the same year he was appointed to the FDA panel.15
Since becoming a government adviser, Hager has taken ample advantage of his position. As a member of FDA's advisory panel, it was Hager who first raised the spurious issue of whether the sample size of young girls in Barr Pharmaceuticals' clinical trials was too small. He brought up the issue at the FDA advisory panel meeting. Then, he says, when a request came "from outside the agency" for a minority report, he followed up with a letter about the issue to Galson.16 In 2005, speaking to a religious congregation, Hager explained his role in the FDA's decision: apparently he was doing the Lord's bidding as well as George W. Bush's. "God has used me to stand in the breach," Hager told the congregation. He said that when he urged Galson to overturn the panel's recommendations, "I argued from a scientific perspective, and God took that information, and he used it through this minority report to influence the decision."17
Hager may have bragged that he argued from a "scientific perspective," but there is little doubt about what really motivates him and the Bush administration to try to block Plan B from being sold over the counter. The objections have little to do with science and everything to do with the politics of right-wing Christian fundamentalists.
First of all, Hager and the Bush administration consider Plan B through the lens of anti-abortion politics. Scientifically speaking, the drug normally works as a contraceptive—that is, it prevents ovulation in the woman who takes it so that conception and pregnancy cannot occur. However, there is a chance that ovulation may have occurred at the time the drug is taken. In that case, within the first seventy-two hours after intercourse, Plan B would prevent the egg's implantation in a woman's uterus. In other words, in some cases the drug could take effect after conception has occurred.
The expressed view of David Hager—and the de facto view of the U.S. government under the Bush administration—is that life begins at the moment of conception and thus Plan B can be equated with abortion. Therefore, Hager believes, it is his moral duty to "save the lives" of these hours-old embryos even though, medically and scientifically, the accepted standard for when a pregnancy begins—according to the Code of Federal Regulations, the American College of Obstetricians and Gynecologists, and the National Institutes of Health, among others—is after implantation in a woman's uterus.
The logic of Hager's—and the Bush administration's—fundamental-ist ideology makes it a moral imperative to impose their sectarian view on all women in the United States, even if it realistically means that the number of abortions will surely rise as a consequence.
Arguing for compassion based on the facts, a number of FDA advisory committee members underscored the importance of making recommendations based on a risk-benefit analysis, particularly in regard to young people. Dr. Leslie Clapp, a pediatrician from Buffalo, New York, for instance, spoke about her own clinical practice and acknowledged that, while abstinence is the best option for teens, "If you are a sexually active ten or eleven year old, it's certainly a bad situation. ... I think their families and they would have far preferred this option than pregnancy, and it would have been safer."18 Dr. Abby Berenson, a specialist in adolescent gynecology from Galveston, Texas, echoed the sentiment. She argued that "barriers to use," such as a prescription requirement for Plan B, "will ultimately result in unintended pregnancies." These, in turn, pose disproportionate health risks to adolescent women, including premature labor, anemia, and high blood pressure.19
Such logic is irrelevant to Hager and senior Bush administration offi cials because it conflicts with their policy agenda of demonizing the "social ill" posed by sex outside marriage. With regard to the Plan B debate, Hager and top administration officials presumably believe that the availability of an emergency contraceptive without a prescription will lead women to be more promiscuous. It doesn't matter that the facts do not substantiate this concern. Prominent medical studies have shown that there is no link between sexual activity and access to Plan B or other emergency contraceptives. For instance, a recent study in the United Kingdom showed that making emergency "morning after" contraceptive pills available over the counter—as Britain did in 2001—has not changed rates of contraceptive use or unprotected sex.20 Indeed, as David Grimes of Family Health International noted, it is no more accurate to say that emergency contraception will promote risky sexual behavior than it is to say "that a fire extinguisher beneath the kitchen sink makes one a risky cook."21
Were concerns about women's promiscuity behind the bogus objections voiced by FDA's Galson? Some of his own staff seemed to think that's what motivated the Bush administration appointee. After all, Gal-son broke with agency protocol, not only by overruling two advisory panels and his own staff, but by taking the practically unprecedented step of writing the official response to the drug company himself.22 In an internal FDA memo obtained by the Associated Press, Galson tried to quell complaints from his own staff. As he noted in that memo: "Some staff have expressed the concern that this decision is based on non-medical implications of teen sexual behavior, or judgments about the propriety of this activity."23 Answering these concerns, Galson asserted that politics did not influence his decision. He also claimed, in a press conference following his decision, that he had not "met personally" with any White House officials during the decision-making process.24 But few close watchers of the incident could find these carefully scripted denials much more credible than the bogus scientific objection he had raised in the first place.
After Galson's ruling, Barr Pharmaceuticals swiftly reapplied for FDA approval with a revised proposal to sell Plan B on a nonprescription basis but behind the pharmacy counter so that it could be dispensed only to girls sixteen years or older. In August 2005, the sorry tale seemed to reach a conclusion when the FDA decided to "indefinitely postpone" its decision about Plan B, effectively prohibiting the drug from being sold without a prescription. The issue had been heatedly discussed earlier that year in the Senate confirmation of the Bush administration's since-departed FDA head, Lester M. Crawford, who had promised a final FDA decision on the matter. Crawford's wholly unprecedented move, for the agency to indefinitely withhold nonprescription status for a drug verified as safe and effective by the agency's own scientists, resulted in the resignation of one of FDA's top officials, Susan Wood, director of the agency's Office of Women's Health.25
Dr. Frank Davidoff, who was a member of the FDA's Nonprescription Drugs Advisory Committee, also quit the agency. In his resignation letter, Davidoff wrote: "I can no longer associate myself with an organization that is capable of making such an important decision so flagrantly on the basis of political influence rather than the scientific and clinical evidence."26 Even more recently, in November 2005, a review by the Government Accountability Office confirmed that the incident "did not follow FDA's traditional practices." As the GAO report explains, while the accounts provided by FDA officials differed, there was good evidence to indicate that the decision on Plan B had been made at the highest levels before the agency's scientific review had been completed.27
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