Reliable Science on the Contraceptive Pill

Reliable science on the pill

There are many conflicting researches being bandied around on the contraceptive pill, the center of the RH debate. In the midst of this, it should be clear that in any given question (is the pill unsafe or safe, abortifacient or not), only one side is true and the other false, since it is impossible for exact contradictories to be both true. 

Due to the great emotions this topic engenders and the presence of ideologies, both secular and religious, it is all the more necessary to adopt a calm and objective attitude. For this, we have to clarify the relevant criteria to arrive at scientific truth and certainty, and if this is not possible, to arrive at the most reliable science on the contraceptive pill. 

We believe that given the enormity of the questions, research should offer (1) the latest findings, because a 1999 study can very well be overturned by a 2000 study, (2) the most comprehensive study, with special emphasis on “meta-analysis” or a systematic and extensive review of current literature, and (3) the most authoritative and prestigious peer-reviewed journals and scientific experts, and (4) the most unbiased studies that are above the partisan ideological influence of pro-RH and anti-RH lobbyists.  

Thus for a serious national debate on scientific issues, we should not use sources such as blogs, pro-life magazines, pro-abortion websites, and we should use with discernment research that is directly produced by political, commercial, religious advocates. The only exception is when the conclusion of these groups run counter to their advocacies. 

We humbly offer what we believe are the latest, most comprehensive, most authoritative and prestigious, and most unbiased studies that we know. In this on-going debate, we would gladly be told of new, additional data that outdo the reliability of these studies. 

Cancer, stroke and heart attacks

A monograph released just last year (2011) by a working group under the WHO’s International Agency for Research on Cancer (IARC) made an overall evaluation that “oral combined estrogen–progestogen contraceptives are carcinogenic to humans.” The 2011 report classified the pill as a  Group 1 carcinogen, which means the highest level of evidence of cancer risk. It specified the types of cancer the pill causes: “Oral combined estrogen–progestogen contraceptives cause cancer of the breast, in-situ and invasive cancer of the uterine cervix, and cancer of the liver.”

This is the third time the Lyon, France-based IARC evaluated the carcinogenicity of pills. The earlier monographs were published in 1989 and 2007.  Summarizing its review, the 2011 IARC monograph said: “There are increased risks for cancer of the breast in young women among current and recent users only. This effect was noted particularly among women under 35 years of age at diagnosis who had begun using contraceptives when young  (< 20 years), whereas the increased risk declined sharply with older age at diagnosis..” (WHO-IARC findings on Combined Estrogen-Progesterone Pills, retrieved from: monographs.iarc.fr/ENG/Monographs/vol100A/mono100A-19.pdf)

On breast cancer, the Mayo Clinic, consistently considered as one of the best hospitals in the world, published in 2006, an article  entitled “Oral Contraceptive Use as a Risk Factor for Pre-menopausal Breast Cancer:  A Meta-analysis.”  The meta-analysis, a study of world scientific literature on this issue, concluded that use of the pill is linked with statistically significant association with pre-menopausal breast cancer.  The association was 44% over baseline in women who have been pregnant and took the pill before their first pregnancy. (See sidebar for more data)

In 2010, the Cancer Epidemiology, Biomarkers & Prevention published a study which concluded that the current use of the pill carries “an excess risk of breast cancer". It also stated that "Previous studies convincingly showed an increase in risk of breast cancer associated with current or recent use of oral contraceptives from the 1960s to 1980s."

On cervical cancer, a systematic review of literature of 2003 published at the Lancet, one of the leading medical journals in the world, stated: “long duration use of hormonal contraceptives is associated with an increased risk of cervical cancer”.

On heart attacks, a 2005 meta-analysis at The Journal of Clinical Endocrinology & Metabolism stated that “a rigorous meta-analysis of the literature suggests that current use of low-dose OCs significantly increases the risk of both cardiac and vascular arterial events”. 

On stroke, one of the lead scientific journals of the American Heart Association, precisely titled Stroke, published a study in 2002 that concluded that indeed the pill confers “the risk of first ischemic stroke”.

Replies and counter-replies

To these findings a number of possible replies can be given.

First, all medications have side-effects, even paracetamol.  Our reply would be: Paracetamol is not usually taken everyday,  but  pill is. Also, the risk of the side effect should be proportionate to the reason for taking a medicine. In the case of contraceptives, there is no disease, since a child is not a disease. Moreover, the three side-effects which have strong empirical proof are not superficial side-effects but some of the most common causes of death among Filipinos. 

A second possible reply: according to some studies, there is only a slight risk. Reply:  We have to take note of the actual words of the most reliable studies: “excess risk of breast cancer” and “significantly increases risk” of heart attacks. And if, for the sake of argument, the risk were slight, cancer –the big C-- is no light matter.

Thirdly, someone might say: government authorities prescribe them.  Our reply: not all government orders are correct. They can also make mistakes, especially now when foreign governments and wealthy and powerful commercial lobbies are actively pushing for the RH Bill.

A fourth reply would be that the pregnancy is a greater risk than cancer.  On the contrary, the datum from the science shows pregnancy has a protective effect against breast cancer.  The journal Breast Care: A Multidisciplinary Journal for Research, Diagnosis and Therapy published a study in 2009 that showed that “A meta-analysis of large Scandinavian epidemiological studies found that [women who have never given birth] have a 30% increased risk compared with women who have had at least 1 full-term pregnancy. Additionally, an increasing protective effect was found with increasing number of full-term pregnancies. For each birth, the risk was reduced by about 7%.”

Abortifacient effects

 Some people might still decide to take the pill or to prescribe it in the name of “helping the woman avoid an onerous pregnancy”. However, another aspect has to be taken into account.  A third party outside of the doctor and of the woman: the possible presence of a child.

The question of whether the pill is abortifacient or not is of inestimable significance, because the value of a human being cannot be measured.

But the first question is: When does a woman have a child, another human, in her womb? Based on the most authoritative and unbiased sources, the most reliable answer is: fertilization, when the human male sperm unites with the human female egg. This conclusion was the “overwhelming agreement in countless scientific writings”, and of most authoritative experts, including scientists from Harvard Medical School and the Mayo Clinic that were gathered together in the US Senate in 1983. It is a position upheld in 2011by the  Philippine Medical Association in their pro-RH but anti-contraceptive statement, which they said, is “founded strongly on the principle that ‘life or conception begins at fertilization’”. (bold letters in the original)

Second question: Does the pill abort the human being at his or her embryonic stage? The answer is yes.

Science has shown that the pill works to stop pregnancy by at least three ways: 1) to prevent the discharge of female egg cells, a process called ovulation (no egg, no fertilization, no human being) , 2) to change the cervical mucus which increases the difficulty of sperm entry  into the uterus (no meeting of sperm and egg, no fertilization, no human being),  and 3) cause changes in the lining of the uterus that makes it hostile for the fertilized egg (the human at the embryonic stage) to rest on the mother’s womb and obtain nutrition (no food, death to a previously alive human being).

The third action, which was not widely known until recently, has been shown in many studies. The most famous of which is the study of Dr. Walter Larimore that was published in one of the scientific journals of the American Medical Association in the year 2000. Dr. Larimore narrates: “I have prescribed ‘the Pill’ since 1978. My wife and I used the Pill for years, having no moral concerns about it. Then, in 1995 my friend … showed me a patient information brochure … that claimed the Pill had a postfertilization effect causing ". . . the unrecognized loss of preborn children." …  its claims seemed to be outlandish, excessive, and inaccurate. So, I decided to begin a literature search to disprove these claims to my partner, myself, and any patients who might ask about it.” In the end, Dr. Larimore found 94 studies that showed that the pill does indeed have a postfertilization effect. From then on, he stopped prescribing the pill.

Writing to the Inquirer in July 2011, Dr. Larimore and his co-author, Dr. Joseph Stanford, stressed that “this fact is now so well-established in medical literature that the United States Food and Drug Administration says of the pill: ‘Although the primary mechanism of action is inhibition of ovulation, other alterations include… changes in the endometrium which reduce the likelihood of implantation.’” He also referred to the pro-RH American Society for Reproductive Medicine that admitted in 2008 that the pill modifies “the endometrium, thus preventing implantation.”

How do we explain the third action? While it is true that contraceptive pills are supposed to prevent ovulation in the first place, hence the fertilization is rendered unlikely, it can never be overemphasized that no drug is 100% effective. It is a scientific fact that even if a woman is on the pill, ovulation is not always suppressed, and this is referred to as “breakthrough ovulation”. This can occur in around 20% of cycles of women on the pill, and in case this happens, the woman can still get pregnant if she is sexually active on the day of breakthrough ovulation. This datum is mentioned  in a 2003 study published in Fertility and Sterility, the official science journal of the American Society of Reproductive Medicine.

Thus, as Dr. Walter Larimore and Dr. Stanford said: “given that there are highly effective, inexpensive, totally natural, and non-abortifacient methods of birth control (the methods of modern natural family planning), it appears that most arguments for using birth -control pills can be said to be advocating convenience for mothers and fathers at the potential expense of innocent and invaluable human life.”