A pharmacy professor who stubbornly avoids heated political conversations is an unlikely candidate to engage in a battle over abortion, especially one as high-stakes as a case now before the highest court: the U.S. Food and drug administration (FDA) against the Alliance for Hippocratic Medicine (AHM).
But when Georgia Southern University professor Chris Adkins emailed his concerns about an academic article to the editors of Health Services Research and Managerial Epidemiology, that’s exactly what happened.
The article was published by an anti-abortion research institute and, perhaps unsurprisingly, concluded that medication abortion is far less safe than the accepted scientific consensus – one that is supported by more than 100 peer-reviewed studies across several continents and two decades of real-world use.
“The way this study used this situation to exaggerate, and I would say obfuscate, the truth behind mifepristone’s safety profile is where I thought, ‘I’ll reach out to the journal and say I have these problems,'” 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 High Court case, which will be heard this week.
“I honestly didn’t think I’d be the first to do it,” Adkins said.
Within days of Adkins’ complaint, global academic publisher Sage, which publishes the journal, launched an investigation. Within weeks, Sage not one but withdrew 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 legal system’s repeated acceptance of poor quality evidence to justify litigation and legislation to restrict abortion. Often that evidence is provided 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 compel the FDA to reverse decisions relaxing restrictions on the prescribing of mifepristone. The Biden administration and the manufacturer of the medication argue that doctors have no right to sue in the first place.
The study Adkins complained about is central to the doctors’ case, and was heavily cited by a federal district court in Amarillo, Texas, which 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 in the US, including in Democratic-led states that may have considered themselves immune from restrictions. It also has 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 scary and frankly it’s scary,” said obstetrician and gynecologist Daniel Grossman of the University of California at San Francisco (UCSF).
Grossman is also a professor and the director of Promoting new standards in reproductive health, one of the nation’s leading reproductive health research groups. His own work was taken out of context by lawyers who argued to limit abortion in court orders, he said, and he published pieces to critique the poor quality of evidence presented by anti-abortion doctors and researchers.
“Judges don’t have the expertise to review the science, just as I don’t have the expertise to understand all the legal maneuvers that are going on in this case,” Grossman said.
The anti-abortion movement pours money into research groups like the Charlotte Lozier Institute, whose raison d’êtreto be is to produce articles that its activists can cited 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 law professor 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 National Medically Dependent and Disability Law Center. That organization was founded by James Boppa lawyer who has campaigned against abortion for decades and now heads the National Right to Life.
The magazine’s current editor, Barry Bostrom, is a lawyer who has fought abortion for decades. Bostrom served as director and general counsel of Indiana Right to Lifeand at least once represented National Right to Life before the Federal Election Commission in 2009, together with Bopp.
But “this is no longer the business model”, said Ziegler. The movement no longer confines anti-abortion research to its own journals.
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Now anti-abortion researchers are also attempting to publish 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 is responsible for a significant increase in risk of adverse mental health outcomes. However, the researcher’s analysis partially depended on a “discovered” paper, overestimating risk and not following published guidelines for the type 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) calls for a retraction. So far they have been dismissed by British psychiatrists.
Despite their efforts, the researcher’s work was repeatedly cited as evidence of the harms of abortion before state and federal courts. In 2022, the researchers’ work was cited in a brief to the High Court in Dobbs v Jackson Women’s Health Organization, the case that almost ended 50 years of constitutional protection for abortion. The anti-abortion movement also has the researcher as a expert witness in court.
But fighting poor quality evidence can feel like a losing battle. Commenting in a respected journal can be a long 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- author of an article in the journal Contraceptive with Adkins on the flaws in the now-retracted Sage articles.
“We worked on it over the Thanksgiving break. My mom was visiting, and I was like, ‘I’m really sorry, we have to get this out,'” Upadhyay said. “The stakes were so high.”
Evaluating scientific evidence is difficult under the best of circumstances. To the untrained eye, academic journals are a bunch of unknown quality, and “Peer review” is a lofty term, but is only as strong as the people doing the review.
Even when researchers make a compelling case, journals can be dismissive to set the scientific record straight. This allows a disputed article to be cited further and exacerbates the damage of weak evidence.
“For every one paper that gets 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 over 47,000 retracted studies.
Should the court choose to undermine the FDA, it would result from s tragic irony – that one of the world’s most respected arbiters of science could be undone by research that would never live up to his standards.
