Trust Me, Baby

Bush White House snookers Clinton on morning-after pill

Just two months ago, George Bush's administration offered Hillary Clinton a deal. If the New York junior senator quit blocking the president's nominee to head the U.S. Food and Drug Administration, she'd get something in return—a decision on over-the-counter sales of the morning-after pill. The status of the drug, a booster dose of the common birth control pill approved by an FDA advisory panel and the staff itself, has been under consideration for nearly two years.

The senator got all the necessary assurances. Health and Human Services secretary Michael Leavitt promised in a July 13 letter that the FDA, under his oversight, "will act on this application by September 1." And Senator Michael Enzi, the Republican chair of the committee handling the nomination, on which Clinton sits, pledged to hold a hearing if the promise wasn't kept. And so Clinton, along with her colleague Patty Murray of Washington, got out of the way. Five days later, the Senate confirmed the new FDA commissioner, Lester Crawford.

Then came August 26, when Crawford announced his agency was taking "action" on the morning-after pill, or Plan B. The FDA did not do what Clinton had anticipated—that is, unveil a ruling on whether to make Plan B available without a prescription. Instead, it indefinitely postponed any ruling. While Crawford admitted that Plan B is safe, he said the age restrictions on teenage girls' access to it—age restrictions the agency had requested to begin with—have raised legal issues that need examining in a process that could take months, or longer.

American women have waited nearly two years for an FDA decision on this drug.
photo: Courtesy of Duramed Pharmaceuticals, Inc.
American women have waited nearly two years for an FDA decision on this drug.

Clinton was outraged. That day, she and Senator Murray accused Crawford of choosing politics over science, and of acting in bad faith.

"Secretary Leavitt and the FDA not only broke their promise to Congress, they broke their promise to the American people," the senators said in a joint statement. "It is a breach of faith to have this administration give us their word that a decision would be made, and have that promise violated."

In retrospect, Clinton's aides say, maybe the senator was naïve to take the word of the Bush administration. But who could have imagined the administration would outright snooker two senators? Explains one staffer, "It was everyone's understanding that they weren't messing with us."

The latest development in the Plan B battle reveals more than just the administration's dishonesty, though. It shows how much the Bush White House remains in the clutches of the right's most extreme elements. Many conservatives actually support the idea of putting Plan B on drugstore shelves, says Ann Stone of the Virginia-based Republicans for Choice, who counts herself as one. "Clearly," she adds, "the FDA is pandering to very vocal, extreme right-wing groups."

With this latest delay, say supporters of Plan B, the FDA has put politics, once again, over science. And because Plan B represents a last chance to deter unwanted pregnancy, they argue, it has put politics over abortion prevention—despite President Bush's claims to respect the "culture of life."

"If the pro-lifers are really pro-life, they should be pro–Plan B," Stone says. "But they are hypocrites for setting up a situation that will result in more abortion, not less."


Plan B seems like an obvious place to find common ground on abortion, as Clinton famously urged both sides to do in a speech last January. At least, her aides say, the senator thought it was. The drug, after all, is contraception, meant to prevent unintended pregnancies. If it becomes more widely available, then the country could make a real dent in the annual rate of abortions.

Princeton University professor James Trussell, who teaches economics and public affairs, sat on the FDA advisory panel that approved over-the-counter sales of Plan B back in December 2003 (see "Hillary's Plan B," July 13–19, 2005). He has analyzed statistics and surveys on women's health, sexual activity, and contraceptive use, and has estimated that, if Plan B were widely available here, it could reduce the annual number of unintended pregnancies by half. By extension, that means the annual figure of 1.3 million abortions could drop to 650,000.

"We could expect a really powerful impact," he says.

That benefit has been lost as the Plan B battle has played out. Opponents describe the pill as tantamount to an abortion—it is not, according to medical definitions—and they complain it will encourage promiscuity among young girls. The most outspoken critic, the right-wing Concerned Women for America, has fired off a dizzying array of objections. The group insists it is worried about the long-term safety of the pill, no matter what scientists say. In the 33 countries where Plan B is available without a prescription, CWA argues, a handful of studies have shown a rise in sexually transmitted infections. It has even equated the drug to "a pedophile's best friend," imagining that a child rapist could slip the pill to a girl to "hide" his crime.

That such extreme views have gained traction with the FDA has frustrated Plan B proponents. Asked how abortion politics has colored the debate, for instance, Trussell has a hard time hiding his disdain. "There are no two sides to this issue," he says. "What those people are spouting is their political ideology, not science. It's just nonsense."

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