Arizona obstetricians and gynecologists are hoping that history does not repeat itself.
In 2012, the Arizona legislature passed a law that forced physicians to prescribe medication with an outdated FDA protocol.
That law forced doctors to practice against the standard of care.
It was disingenuously sold as protecting women’s health. Except it didn’t.
That law was extensively litigated in both state and federal court, at the taxpayer’s expense. It was found in violation of the Arizona constitution and overturned.
Now, Arizona lawmakers are at it again with SB1324.
This “new” legislation is almost exactly the same, with some wording changes to reverse the outcome of the lawsuit. It dictates how a physician can prescribe medication to a woman seeking a medically-induced abortion. It forces doctors to prescribe in accordance with the original medication labeling, which was printed fifteen years ago. The FDA approved this label in 2000, but the protocol was soon updated based on evidence-based studies. The newer protocol uses lower medication doses, is more effective, safer, and more convenient for the patient. This protocol is endorsed by the American Congress of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, and the World Health Organization. It has been widely used for years and is the current standard of care.
Medication labels and FDA protocols are often frozen in time while science moves forward. Changing medicine labels and FDA protocols are time-consuming and costly. Off-label use is common and safe; in fact, the FDA itself endorses off-label prescribing if it is evidence-based. This law, if enacted, would forever force the outdated regimen on patients even if the FDA updates its recommendations.
So what’s the point? The goal of this legislation is easy to decipher: It is meant to limit women’s access to safe, legal, and evidence-based abortion services. It does so by making pregnancy termination more costly and more inconvenient (requiring up to three doctor visits instead of one). Patients would have more side effects. Studies show they also have more complications.
Despite all of the “facts” put forward by some of our legislators, this bill does not protect or promote women’s health. Abortion (either medication-induced or surgical) is extremely safe with a low complication rate. It appears the Arizona women are really not in need of the Legislature’s protections.
We fully understand and respect that people have differing views about abortion. This holds true even among physicians in our specialty. However, we uniformly oppose government intrusion into the practice of medicine, especially when that intrusion runs counter to the standard of care and evidence-based practice.
This law intrudes upon the doctor-patient relationship as well, interfering with a physician’s ability to use his or her own professional judgment for each patient’s unique circumstances. We cannot think of another specialty where the Legislature is so invasive. Can anyone imagine Arizona politicians telling a cardiologist which protocol they should use for congestive heart failure?
We encourage our legislators in the House to oppose this bill. It will be heard sometime next week.
If this law passes, it will again be mired down in litigation, at the taxpayer’s expense.
And it will be 2012 all over again.
Ilana Addis, MD, is chairwoman of the Arizona section, American Congress of Obstetricians and Gynecologists. Julie Kwatra, MD, is legislative chair, Arizona section, American Congress of Obstetricians and Gynecologists.