24h-payday

Shake it up: Why we need research and activism to change maternity care

Last week, I attended the Normal Labour & Birth International Research Conference in Vancouver, British Columbia. With over 250 attendees from 23 countries, the conference set out to disseminate research about the nature of and optimal care for physiologic labor and birth, and to garner multidisciplinary perspectives on the implications for clinical practice, perinatal outcomes, education, management, collaboration, and policy.

I went as an agent of data dissemination. My job: to use social media (blogs, Twitter) to help make sure the conference proceedings didn’t just rattle around the four walls of the conference hotel, but got out to those in the field working to improve maternity care wherever we each are.

And I have some research I want to write about – really interesting, important research from every discipline you could imagine. But I left the three-day meeting thinking more about the (broken) link between evidence and practice than about any of the new, emerging evidence. I’ll get to the new research over the coming weeks, but first, a look at two stories that dominated the conference.

#1: Home birth on the defensive?

The plenary session by Dutch physician and epidemiologist, Simone Buitendijk, might have highlighted the unique model of midwife-led primary care geared toward planned home birth for low-risk women – a model that many birth advocates and researchers look to as a beacon of hope and reason. Buitendijk herself was co-author of the definitive study of planned home birth safety, a population-based study of over half a million births that found planned midwife-attended home birth as safe as planned midwife-attended hospital birth. And a Cochrane systematic review that came out around the same time as the Dutch home birth study provided definitive evidence that midwife-led care is superior to physician-led or shared models of care. So the Dutch have gotten it right, right? Time to celebrate and emulate? No, instead of a plenary about Dutch primary maternity care as a model to emulate, Buitendijk’s talk was a sobering call to action.

Trouble in paradise

According to Buitendijk, in spite of this evidence (or perhaps in direct response to this evidence?) a well-coordinated media campaign in the Netherlands over the past year has emphasized the dangers of home birth, pointing to an entirely different body of evidence: comparative data showing that Dutch perinatal mortality rates are higher than those in other European countries. Although only about 30 of the 1700 Dutch perinatal deaths occurred at home, and perinatal mortality at the population level is affected far more by incidence and management of preterm birth and congenital anomalies than by the labor and birth care of low-risk women with term pregnancies, the Dutch mass media have made this a story about midwifery care and home birth. The result: the rate of home birth has dipped below 25% for the first time in Dutch history.

Instilling fear in women

#2 VBAC is Back?

Eugene Declercq, who gives – hands down – the world’s most engaging and fun lectures about perinatal statistics, had the pleasure of making an 11th hour revision to his plenary talk on vaginal birth after cesarean (VBAC) thanks to ACOG, who released their new VBAC practice guidelines at 5pm the day prior. (Hat tip to yours truly for tipping him off about the new guidelines. I even got written into his plenary remarks, as the young woman with whom he had a “stimulating conversation” that led him to “stay up all night.” Har har, Gene!)

Anyway, we see in Declercq’s talk the familiar story of how VBAC rates increased briefly then plummeted in the early 2000′s as a result of new research on uterine rupture and, more precisely, an editorial by the ob-gyn editor for the New England Journal of Medicine saying that planned repeat cesarean is “unequivocally” safer than planned VBAC.

NEJM editorial

Research driving practice! That is, if the research (or overzealous interpretations of it) supports restricting practice.

Where’s the up-tick in VBAC rates when the Cochrane systematic review was published in 2004 concluding that “Planned elective repeat caesarean section and planned vaginal birth after caesarean section for women with a prior caesarean birth are both associated with benefits and harms?” The up-tick isn’t there because by then research wasn’t driving practice – ACOG guidelines calling for “immediately available” emergency obstetric care in VBAC labors were driving practice. And it wasn’t the NIH Consensus Development Conference on VBAC or the massive AHRQ systematic review underpinning the conference (i.e., evidence) that have been heralded as the beginning of the end of hospital “VBAC bans,” it’s ACOG’s (somewhat noncommittal) move away from the “immediately available” standard.

Evidence is not driving practice. Between evidence and practice there lives some kind of cocktail of power, money, activism, media, influence and serendipity (and preservatives). The relative strength of the ingredients dictates how practices evolve. Keeping with the cocktail metaphor, the VBAC plenary ended with an invitation to consumers and our advocates to shake things up – activism being the best hope for ACOG’s new guidelines to be used to drive meaningful change for the many, many childbearing women in the United States with scarred uteruses.

This all reminds me of a third plenary talk at the Normal Birth Conference – Patti Janssen’s lecture, Transforming Research into Policy: Ingredients of Influence, in which she quotes social scientist, Martin Rein.

Science does contribute

It also reminds me of Kay Dickerson of the Cochrane Collaboration who said, “We are only to get evidence-based healthcare in this country through consumer activism.”

More on Janssen’s plenary, and updates on the research, coming soon.

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  1. July 27th, 2010 at 07:19 | #1

    Amy,
    I enjoyed catching your tweets during the conference. Thanks for being eyes and ears.

    Can I plug a link? The AABC sent out a press release this morning (I got it via the Big Push mailing list, I think?) about the MOMS for the 21st Century Act (H.R. 5807) and at the bottom of this page: http://www.birthcenters.org/news/breaking-news/?id=95 there are several action items that we can all take either as baby steps towards birth activism or just adding them to your regularly scheduled activism to-do list.

    –Kate

  2. July 27th, 2010 at 07:34 | #2

    “With over 250 attendees from 23 countries, the conference set out to disseminate research about the nature of and optimal care for physiologic labor and birth”.

    Attending a conference on normal birth and expecting to learn the scientific evidence is like attending a conference on creationism and expecting to learn the evidence. You only learn about a tiny slice of research (that may or may not be valid) that promotes a pre-approved point of view.

    The conference organizers were quite explicit in their solicitation for abstracts that the aim of the conference was to PROMOTE normal birth, and nothing else. Alternative points of view were not welcome and the vast swath of the scientific research that contradicts what was presented were not welcome, either.

    Amy, you simply cannot learn the scientific evidence if you go to conferences that are designed as echo chambers. It’s like watching Fox News and expecting to learn the truth. You need to go to conferences without an ideological agenda if you have any desire to learn what the evidence (ALL the evidence) shows.

  3. July 27th, 2010 at 08:59 | #3

    List and link all of the conferences specific to childbirth that do not have an ideological agenda.

    [It's a trick. Everything has an ideological agenda in this world, Amy.]

  4. July 27th, 2010 at 09:04 | #4

    Amy Romano,

    This paragraph…

    “Evidence is not driving practice. Between evidence and practice there lives some kind of cocktail of power, money, activism, media, influence and serendipity (and preservatives). The relative strength of the ingredients dictates how practices evolve. Keeping with the cocktail metaphor, the VBAC plenary ended with an invitation to consumers and our advocates to shake things up – activism being the best hope for ACOG’s new guidelines to be used to drive meaningful change for the many, many childbearing women in the United States with scarred uteruses.”

    … was a hit when I shared it.

  5. July 27th, 2010 at 10:02 | #5

    “List and link all of the conferences specific to childbirth that do not have an ideological agenda.
    [It's a trick. Everything has an ideological agenda in this world, Amy.]”

    Sorry, Jill, but that’s a copout and a very poor one at that. NCB advocates are always puzzling about why obstetricians don’t follow the “evidence.” That’s because NCB advocates don’t know what the evidence, all the evidence, actually shows; they only know the few papers that have been vetted for ideological purity. It’s just like the creationists who are baffled because only they seem to understand the “evidence” for creationism.

    If you’re right, Jill, NCB advocates have absolutely nothing to fear from attending conferences that are not vetted for ideological purity. If you are right, NCB advocates would come away reassured in their understanding of the “evidence.” Moreover, they could present their own evidence and engage in dialogue. But if you are wrong, NCB advocates wouldn’t dare attend a conference that might teach them something they didn’t want to know.

    Obstetricians are following the evidence, and it is bizarre for NCB advocates, who don’t have a clue as to the entire depth and breadth of the scientific evidence, to suggest otherwise.

    If you watch Fox News, you’ll only learn what the right wing conservatives want you to know. If you attend a “normal” birth conference, and don’t ever attend mainstream conferences, you’ll only learn what NCB advocates want you to know. In both cases, you’ll end up woefully uniformed.

  6. July 27th, 2010 at 11:00 | #6

    Aw, sweet. Apparently what I should have said up there was, “FIRST!”

  7. avatar
    Ashley
    July 27th, 2010 at 11:59 | #7

    I agree with Jill. It seems to me that a “mainstream” conference would likely present only one side of the issue as well. It is, after all, a medical conference, and though I’ve never attended one, I would imagine there would be as much talk on all sides of the issue as there would discussion at a cardiologists’ conference of the billions of beating human hearts around the world effectively and efficiently pumping blood throughout the body minute after minute, day after day.

    I also find Dr. Tuteur’s comparison of evidence supporting creationism to evidence supporting natural childbirth poorly conceived and insulting to those of us who are passionate about this issue. Creationism is a theory; natural childbirth is a fact of life and has been for thousands of years–or at least since Adam and Eve begot Cain and Abel.

  8. July 27th, 2010 at 12:08 | #8

    FoxyKate, LOL!

  9. July 27th, 2010 at 12:11 | #9

    Amy, that was officially the weirdest reply ever. I kind of enjoyed it’s uniqueness, though.

    You: This conference has an ideological bias. Amy needs to go to conferences that do not have an ideological bias.

    Me: Link to a conference about childbirth without an ideological bias.

    You: ??? and no link to a conference without an ideological bias.

    Me: *yawn*

  10. July 27th, 2010 at 12:47 | #10

    “It seems to me that a “mainstream” conference would likely present only one side of the issue as well.”

    I’ve been to quite a few conferences and I can assure you that is not the case. There are controversies in obstetrics just like there are controversies in any area of science. To understand what the evidence shows, you need to learn about ALL the evidence, not just the evidence you like. You can’t learn about the evidence for evolution by attending a creationism conference and you can’t learn about the evidence for modern obstetrics by attending a “normal” birth conference. You must also attend conferences that present points of view other than your own.

  11. July 27th, 2010 at 14:34 | #11

    Or it would be like going to med school and becoming an obstetrician and thinking you know everything you need to know about birth! See — I can do it too! :-)

  12. July 27th, 2010 at 15:17 | #12

    Hi Amy (Romano, as opposed to A.T.),
    [New thread here, since I don't want to play tag with Tuteur]:
    Thanks so much for getting this info to Gene so he could talk about it and let me express much gratitude to Gene also. You are absolutely right — the internet and social media is the way people connect to each other and gain much of their information today — including women of childbearing age and the young women who will be the next generation of mothers. That’s why Amy T. lurks on the internet — so she can pop out every now and then to yell something that sounds scary to consumers.
    So, as I understand it, if consumer demand is what it will take to change things, then our job is to educate consumers. And the way to educate consumers is through social media.
    Look for an email from me in the next hour or so on some interesting ideas that I don’t necessarily want to share with Dr. T.

  13. July 27th, 2010 at 16:27 | #13

    Thanks Amy Romano for spreading the news. We need to be aware of the global struggles in protecting normal birth, especially within societies that we glorify or exoticize for their dedication to physiologic, woman-centered birth.

    “Evidence is not driving practice.”

    Right. And I don’t even think ACOG’s latest flip-flop will have much of a trickle down effect, at least not any time soon. History has demonstrated that OBs do not generally budge from their comfort level. If ACOG wants to construct its authority over childbirth based on the “evidence” it generates, it needs to walk the talk.
    What percentage of procedures, medications, and interventions in typical hospital births are truly evidence-based?

    You are so right about that black hole between evidence and practice, and money and power seem to rise to the top. Only when we remove those elements from the equation will we see demonstrable birth change within the hospital system.

  14. July 28th, 2010 at 16:17 | #14

    Amy Tuteur, MD :<PObstetricians are following the evidence, and it is bizarre for NCB advocates, who don’t have a clue as to the entire depth and breadth of the scientific evidence, to suggest otherwise.

    Obstetricians are following the evidence? Really? Let’s just list a few routinely and commonly used obstetric management practices about which there is NO controversy in the obstetric research that they are ineffective, harmful, and generally both when used routinely or frequently and in some cases, with any use at all:

    * induction for suspected big baby
    * artificial rupture of membranes
    * no oral intake other than ice chips
    * I.V.
    * continuous electronic fetal monitoring
    * confinement to bed
    * active management of labor (treating labor progress slower than average with high-dose oxytocin)
    * directed pushing
    * pushing on one’s back or in a semi-reclined position
    * episiotomy (Episiotomy is on the decline, but it was still used in 1/4 of women having vaginal birth in 2005.)
    * immediate umbilical cord clamping
    * separating newborns from their mothers shortly after birth
    * cesarean surgery (The research literature supports a rate of no more than 15%. At rates higher than this, maternal and perinatal morbidity and mortality rates begin to climb.)

    I’m sure I’ll think of others after I submit this, and, of course, this list does not include anything from the much longer list of practices and policies about which there is controversy but a good case can be made against them for routine or frequent use.

  15. avatar
    Suzanne Wertman
    July 29th, 2010 at 07:45 | #15

    Thanks, Amy! That’s excellent news from the conference–It’s sobering (I couldn’t help it, with all the cocktail talk!) to hear about the challenges in the Netherlands, but I am hopeful that all of the energy building from consumers who are tired of being afraid and from researchers who are getting mainstream attention will continue gaining momentum and finally get ALL women the safe and satisfying pregnancies and births they deserve.

  16. July 29th, 2010 at 09:25 | #16

    “Science does contribute to policy and practice but the link is neither consensual, graceful, or self evident.

    Love that tweet.

  17. avatar
    Kathi Wilson
    July 29th, 2010 at 14:14 | #17

    @Henci Goer

    Thanks, Henci, for this list. Anyone who believes that “obstetricians follow the evidence” should do an environmental scan of practices across the country (even Canada) to see the wide variation in routine practices that exists. If they are all following the evidence, why is this so?

    An analogue between physiologic birth and creationism is odd, indeed, as it implies that the former doesn’t really exist. As for the purpose of the conference, there is little money to be made from physiologic birth, and it’s hard to get funding for research from which there is little financial gain. I go to obstetrical conferences, too, and although there is some useful learning and research presented there which I appreciate, there are also “research” presentations from industry which has the sole purpose of promoting the product. Follow the money….

  18. August 4th, 2010 at 08:29 | #18

    “Obstetricians are following the evidence? Really? Let’s just list a few routinely and commonly used obstetric management practices about which there is NO controversy in the obstetric research that they are ineffective, harmful, and generally both when used routinely or frequently and in some cases, with any use at all:”

    Yes, really they are.

    Henci, when was the last time anyone asked you to testify about the obstetric evidence in a court room? Never, right? And why is that? Because no one considers you an expert on the obstetric evidence except you.

    Where did you get your medical degree? Oh, you don’t have one.
    How about your midwifery degree? Don’t have one of those, either.
    How about your PhD in a scientific descipline. No, no advanced degree in science.
    How about your PhD in statistics? No, no advanced degree in statistics.

    You are a woman who teaches childbirth classes who decded to make money by writing a book that grossly distorts the existing scientific research, and often making claims that are flat out false.

    Only lay people think you understand the scientific research and that’s because they don’t know any better. No one who knows anything about obstetrics pays any attention to you.

  19. avatar
    B
    August 4th, 2010 at 10:18 | #19

    Amy Tuteur MD, you have a medical degree, but it doesn’t make you an expert on research and statistics either. When is the last time you attended or presented at a conference, or did any collaboration with peers to improve the state of modern obstetrics and gynecology? Where are your academic journal articles and books that criticize weaknesses and misinformation in research and childbirth publications? When you can muster up more than a collection of scathing and unprofessional blog entries, come back and let us know.

  20. August 4th, 2010 at 10:42 | #20

    “Amy Tuteur MD, you have a medical degree, but it doesn’t make you an expert on research and statistics either.”

    Unlike Henci Goer, I don’t claim to be an expert on research and statistics. I simply claim to be an obstetrician, and it is part of my job to read the obstetric literature.

  21. avatar
    b
    August 4th, 2010 at 13:16 | #21

    B said August 4th, 2010 at 10:18 | #19 Reply | Quote Amy Tuteur MD, “you have a medical degree,….”

    hey B, Big B that is. You know, as opposed to me, little b. (I think Big B is my evil twin http://childbirthtruthsquad.wordpress.com/2010/08/04/the-evil-twin-or-is-it-twin-small-t/

    When was the last time you attended or presented at a genuine medical conference? Where are yours or Romano’s or anyone on the midwifery side’s great claims to a research background? Since she deletes all the criticism that shows she doesn’t know what she is talking about, it might be hard to tell. http://childbirthtruthsquad.wordpress.com/2010/07/21/things-amy-romano-of-science-fiction-and-sensibility-doesn%e2%80%99t-want-you-to-read/

    Pulling out a Research For Dummies book from the Borders isn’t a ringing endorsement.

    PS trying googling Amy Romano and Delete. In fact, if one googles her name or the name of this blog it is trending high.

  22. avatar
    Wendy
    August 4th, 2010 at 18:59 | #22

    @Amy Tuteur, MD
    Amy, is that really the best you can do to rebut Henci’s arguments?
    http://www.nizkor.org/features/fallacies/ad-hominem.html

  23. avatar
    B
    August 4th, 2010 at 21:29 | #23

    Amy Tuteur, MD :
    “Amy Tuteur MD, you have a medical degree, but it doesn’t make you an expert on research and statistics either.”
    Unlike Henci Goer, I don’t claim to be an expert on research and statistics. I simply claim to be an obstetrician, and it is part of my job to read the obstetric literature.

    And Dr. Tuteur, reading the literature is not your job, it is your hobby, since you are a long-retired ob-gyn (who had what, only 6 years of experience before retiring?) who doesn’t teach or research. Perhaps you call blogging your profession now, but it conveniently relieves you from having any accountability with any medical boards or education/organization affiliations.

    And you don’t think that a birth educator is capable of reading and understanding obstetric literature? Michaela and Augusto Odone had no medical or scientific background, but they studied and developed a useful treatment for ALD with the help of medical professionals that respected them and didn’t treat them like morons.

    So, if you want to criticize Henci Goer’s assertions, then go ahead and show the data to prove her wrong, but you don’t have much of a leg to stand on if you want to squabble about credibility.

    And little b, you and Dr. Tuteur enjoy treating NCB activists like morons. Despite your attitude, I agree with you that it isn’t right for NCB advocates to delete criticisms that they don’t like. They should present the counter arguments and hold their position backed by their evidence.

  24. avatar
    B
    August 4th, 2010 at 21:40 | #24

    @b
    I wrote a comment on your blog, which funnily enough is awaiting moderation. Nice conspiracy theory, but I’ve been posting as “B” for a long time on other birth blogs. Check and you will see.

  25. August 5th, 2010 at 13:49 | #25

    “I wrote a comment on your blog, which funnily enough is awaiting moderation. Nice conspiracy theory, but I’ve been posting as “B” for a long time on other birth blogs. Check and you will see.”

    OK. Why don’t you post a few links for us, right here.

  26. avatar
    B
    August 5th, 2010 at 22:25 | #26

    Ok, since I can’t use the direct links without the post being blocked from appearing, here are the blogs, dates, and post topics where you can find my comments. Feel free to check. It is a pleasure to bust your ridiculous conspiracy theory.

    Stand and Deliver – May 30, 2009 Collaboration, transfers and attitudes

    Stand and Deliver – Sept 21, 2009 Ergo Baby Carrier review

    Navelgazing Midwife – May 13, 2010 Being unmidwifed

    The Unnecesarean – May 20, 2010 Canadian government publishes birth intervention rates

    Mom’s Tinfoil Hat – July 19, 2010 Birth plan, doulas and episiotomy nonsense

    And of course my posts on Science and Sensibility. There are many more posts out there besides these.

  27. August 6th, 2010 at 06:22 | #27

    Gee, seems like everyone else has posted links. Something must have changed.

    And do you have any links, or sites rather, that aren’t on blogs that are Midwifery Mind Control deletion-fests? You can see over on Skeptical OB that many people have complained that they have had posts not posted on the blogs you list. http://skepticalob.blogspot.com/

    How about a neutral place like news article comment section. Although as we all know, midwife fanatics will overcome the lack of control on those boards and re-double their efforts by piling on the “flag for abuse” button. http://childbirthtruthsquad.wordpress.com/2010/07/20/can%e2%80%99t-see-the-forest-through-the-trees/

    Otherwise, all you show is that there is a longer history to this. Seems like Midwifery “education” means keeping women from seeing people poke holes in their arguments. And Midwifery “choice” means which midwife do you choose.

  28. August 6th, 2010 at 06:35 | #28

    Oops. I meant to link to the below with this comment, not the link I did. Although, if people want another look at counter-arguments that this blog wouldn’t post, that is fine too.

    “Although as we all know, midwife fanatics will overcome the lack of control on those boards and re-double their efforts by piling on the “flag for abuse” button”

    http://childbirthtruthsquad.wordpress.com/2010/07/23/flag-me-down/

  29. avatar
    B
    August 6th, 2010 at 10:08 | #29

    This is ridiculous. I tried to post a list of links and it doesn’t work here or on your blog – check your own admin settings for allowing more than 2 links in a post. To get the info across, I wrote a new post with all the relevant blogs, dates, and subjects where you can clearly see I have posted as B for about 2 years. Now this proof isn’t sufficient for you, because I showed only links to blogs based around birth? Well, the subject and your conspiracy theory is based around my presence on birth blogs, is it not? I’ve posted on news articles, feminism sites, parenting sites, political sites etc. but sometimes I use B, or my name, or another nickname, or even Anonymous – the onus is not on me to track down everything all over the internet to prove something to you. I’ve already busted your conspiracy theory.

    I’m usually just part of the peanut gallery, but I’m flattered you’ve chosen me to create such a fabulous story around. Those who know me as a semi-regular commenter on their blogs over time must also be amused too.

    So that’s the end of that. You’ll have to find something else to twitch about.

  30. avatar
    B
    August 6th, 2010 at 13:02 | #31

    Great, that was a fun detour! Now, back to the blog topic?

  31. August 9th, 2010 at 08:42 | #32

    The blog comments topic was why does this fringe movement think its amateurish, biased, self-serving propaganda/marketing materials dressed up as so-called “research” justifies a take-over of US maternity care?

    The majority of women don’t want what Lamaze and other back to nature types offer. Less medical help in exchange for what? more pain and death. They act like the average woman has to be sent off to the re-education camps for believing legit research.

  32. avatar
    Jennifer
    August 11th, 2010 at 09:09 | #33

    What a joke these comments are! Amy Tuteur makes a povocative statement that obstetricians are following evidence but can’t back it up. Henci throws out a few examples and Amy rebutts it by crying about how everyone likes Henci’s book but she has no advanced degree.

    Baby b is whining about how capital B is such a name thief and does the ultimate in sleazy self promotion– posting multiple links to their own blog. Baby b’s emotional rants are getting old.

  33. avatar
    FangedFaerie
    August 11th, 2010 at 13:45 | #34

    I’m not sure what the problem is, little b. If the majority of women don’t want Lamaze, then they won’t attend Lamaze-related classes or pay for Lamaze-related material. Why block whatever percentage of women who DO want that information?

  34. avatar
    b
    August 12th, 2010 at 09:23 | #35

    @Jennifer

    Maybe if the Deletion Squad here would post the factual responses on the discussion with the links and quotes from academic journals, then we wouldn’t seem so to the crowd that never ventures far from the safety of like-minded blogs.

    But, much like they posture that they know statistics and research, and delete comments that show they don’t, they selectively delete blog comments to exclude real, hard evidence presented that shows they are completely wrong about their claims, and their (unlinked) alleged citations don’t come close to supporting their points. Embarrassing isn’t it?

    http://childbirthtruthsquad.wordpress.com/2010/08/12/keeping-baby-close-the-importance-of-high-touch-parenting-and-deleting-correct-information/

    Don’t worry. In a week or so, if you search for these people, the posts, or their blogs, it comes up pretty high.

    “What a joke these comments are!” “Baby b is whining about how capital B is such a name thief and does the ultimate in sleazy self promotion”

    Was your sense of humor surgically removed, or is this a congenital problem? Everyone else thought it was funny. Whatever. Of course, I could have insisted she was wrong because, you know, because it was a one million possibility that all those posts really followed mine.

    Sort of like the way NCBers insist that a homebirth study showing higher deaths rates that are limited to full-term births, that take place in the home (not on the way to the hospital), and have a midwife or doctor attending aren’t valid. There’s a one in a bazillion chance that a few of the homebirth deaths were really mistaken accidental homebirths that are so precipitous (like 10 minutes or so) that they can’t get out the door and they happen to have a midwife over for coffee when it happened and the baby died.

    Henci Goer doesn’t even know where the bulk of data for Cytotec is and forms her “opinon” on a few blippy case reports.

    Goer (on comments on other posts on this blog)
    “I’m not exactly sure what you are referring to, but Searle has NEVER conducted research into misoprostol’s use as an obstetric agent”

    b
    “This is completely ridiculous. Searle and its successors have about 20 re-lablings of the drug. In every single blasted one of them, as in the original research, its abortifacient/obstetrical properties must be addressed.”

    Or maybe we are all whining babies because we think a drug that has been on the market for 25 years, might have some data of its own and at the FDA.

    Whining baby @ SS = people who know medicine, reseach and pharma, as characterized by those who don’t want to hear about it.

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