Please visit the new home of Majikthise at

« Donna Shalala's gardeners join janitors' strike | Main | Frist threatens to block NSA hearings »

March 03, 2006

Is the NIH posting misleading EC info?

Emma, an OB-GYN blogging at The Well Timed Period, spotted a very suspicious claim in the Medline Plus entry on ectopic pregnacy:

The "morning after pill" is associated with a 10-fold increase in risk of this condition [ectopic pregnancy] when its use fails to prevent pregnancy.

MedlinePlus is a online health encycolpedia for consumers published by the National Institutes of Health.

Emma writes:

Well, knock me over with a feather and call me Fifi; a 10-fold increase you say?

The way I see it, there are 3 possible explanations for this statement:
1) It's a typo.
2) The information is accurate.
3) The government is deliberately making stuff up.

I haven't yet contacted the site operator, so the typo explanation remains a possibility.

It's also possible that, while I slept last night, the medical consensus has changed and ECP use is, indeed, associated with a 10-fold increase in risk of ectopic pregnancy. This one is easily verifiable; all we need to do is to look at the relevant literature.

Emma goes on to review the literature.

Synopsis: If failed ECP increases the risk of ectopic pregancy, nobody told science. There is no evidence that failed ECP increases the risk of ectopic pregancy vs. normal pregnancy. Besides which, ECP is just plain effective at preventing pregnancy--which means that it reduces a woman's risk of both the ectopic and non-ectopic varietes.


TrackBack URL for this entry:

Listed below are links to weblogs that reference Is the NIH posting misleading EC info? :


Ah, but it's such an excellent (Rovian) lie. If you take this pill, not only will you get pregnant, you will explode and die. Extra brilliant because it requires one to imagine that there are enough pregnancies using the morning after pill to create a statistically-meaningful sample. You have to stipulate the "pill doesn't work" part in order to debate the "will maim/kill" part.

The site states:

The "morning after pill" is associated with a 10-fold increase in risk of this condition [ectopic pregnancy] when its use fails to prevent pregnancy. (Bold added)

You respond:

Au contraire, ECP is so effective at preventing pregnancy that it reduces a woman's risk of both ectopic and regular pregnancy.

This isn't strictly responsive, is it? The original site is disaggregating the failed uses of ECP from the successful uses, while you are not. It's not claiming that it increases the likelihood, but that for the small set of women for which it doesn't work, the likelihood is higher than it would have been if the drug had not been taken. I have no idea if that's true or not, of course, but your response is not inconsistent with the original statement.

" It's not claiming that it increases the likelihood, but that for the small set of women for which it doesn't work, the likelihood is higher than it would have been if the drug had not been taken."

While that might be true, it is not a rational argument against using the drug. You might as well say that pregnant women who took the drug were hundreds of times more likely than other women to develop ectopic pregnancies. Considering that most of the other women were not pregnant, it would be an accurate but worse than useless statement.

Eli, you're right, that's potentially unclear. Emma is making a two-part claim, both aspects of which she backs up with the relevant literature.

First, there's no evidence that failed ECP increases the risk of ectopic pregnancy. Second, there's ample evidence that using ECP decreases a woman's risk of both ectopic and non-ectopic pregnancy.

Ah. I read the article. It is not a screed against the use of the drug, as I had thought. There is actually a useful purpose in the statistic, if it is true. If a woman uses the emergency contraception, and it fails, she might want more vigilant medical scrutiny.

Taken as a guide for medical practice after the fact, the statistic has relevance. As a guide for the drugs use, it has none.

Emma has made a classic modern mistake by attempting to look soley at the accepted scientific research. Clearly, she failed to take into account the important factual opinions of the religious and political community.

She probably needs to hire a recent college graduate who has worked in political campaigns to review her statements.

I was blathering based on the assumption that the most generous reading of the stat would be right. From the looks of it though, even that is just not so.

Before this administration there was a reasonable authenticity to anything that NIH and the CDC had to say. Might not be right, might be subject to bias or even bribery. But there was an acceptance that the investigatory work was on a par with or better than most other sources.

Now, it is impossible to believe anything that comes out of our government. All is immediately and seriously suspect. To react in any other way, is to regress to believing in the tooth fairy.

There are numerous case reports wherein Levonorgestrel has been associated with ectopic pregancies when it fails to prevent conception, but it still seems to be a rare occurance. I don't know where the "10-fold" number comes from, and it would be nice to have the reference, but it actually seems plausible.

Lindsay Beyerstein is right. You'll see the same kind of statements regarding IUDs, dating from before the Bush administration.

I thought it would be helpful to know what the margin of error is, but... The go2planb website (operated by Barr Laboratories -- I think we can safely assume that this is a non-planb-hostile environment) has the following:

Ectopic pregnancies account for approximately 2% of reported pregnancies (19.7 per 1000 reported pregnancies). Up to 10% of pregnancies reported in clinical studies of routine use of progestin-only contraceptives are ectopic. [...] Health providers, however, should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking Plan B.

Hm. So "up to" a five-fold increase. However, the Feminist Women's Health Center also says this:

EC does not harm an established pregnancy. It acts on the uterus and cannot prevent an ectopic pregnancy.

Aha! So it's not that there's an increase in risk, it's that an ectopic pregnancy is more likely to proceed despite use of EC than a non-ectopic pregnancy. Which actually makes sense. So much sense that the ratio of ectopic to non-ectopic pregnancies among the pregnancies actually experienced by users of Plan B might even be as high as 20%. Or it might just as easily be somebody extrapolating wildly from insufficient data.

In any event it doesn't "increase the risk" ten fold. That part is just plain crap.

0-litre common-rail four-cylinder turbo-diesel unit found in the Holden Captiva>hummer Mr Walsh also hinted at an even smaller model beyond the H4, if market trends – driven by spiralling fuel costs and increasingly punitive legislation against heavier SUVs – dictate a need for it>hummer los angeles However, a greater emphasis on luxury, as well as right-hand drive engineering, should see the H2 II challenge vehicles such as the Range Rover Vogue and Lexus LX570 in markets outside North America>hummer chicago Mr Walsh points out that buyers are surprised by the relative compactness of the H3, claiming that it has the same turning radius as a Toyota Camry sedan>hummer h3 AM General continues to build the H1 and is contracted by GM to produce the H2>hummer houston in every single vehicle application" according to one company spokesman>hummer h2>hummer dallas "There is still a high lack of awareness of what (today’s Hummer) truly is," Mr Walsh laments>phoenix hummer <>] Hummers at the Port Elizabeth plant will be built both for local South African consumption and for export to Australia (for the 2008 model year), Europe, the Middle East, and Japan>hummer orange county In 1990, two matching white Hummers were driven from London to Beijing over the rough roads of central Soviet Union>new york hummer As of October 2006, Hummer vehicles are marketed by about 300 dealers in 34 countries>riverside hummer Known as the H4 – although this may change by the time it appears around 2010 – it will give the Hummer brand a vital weapon in the United States against premium-priced compact SUVs such as the Nissan Murano>hummer washington dc "We have to offer legitimate off-road capability – that’s where the real challenge is>hummer atlanta <>] GM CEO Rick Wagoner has said the Hummer brand of trucks will run on Biofuel Powertrains in Last Year's Los Angeles International Auto Show>hummer limousine>hummer of miami Meticulously handcrafted from aircraft grade lightweight aluminum, the bike folds in less than 30 seconds - without the use of tools>hummer h1 <>] Today, more than 200 owners have undergone HOPE certification and many even assisted during the Hurricane Katrina disaster>hummer accessory The H2 is also assembled in Kaliningrad, Russia, by Avtotor, starting in June 2004>fort worth hummer Also due out by about the end of the decade, it will again be developed off GM’s full-sized 1500/2500/Suburban truck platform>detroit hummer Together, the two organizations train Hummer owners with CPR and First Aid skills, and basic off-highway skills so that they may assist victims during a disaster situation>hummer philadelphia In fact, within the next three years, Hummer will offer bio-fuel powertrains ">oakland hummer>las vegas hummer Central to this will be engineering and design input from General Motors’ global outposts, including Holden, but perhaps Hummer’s most ambitious plan involves a vehicle that sits below the H3 – currently the company’s smallest offering>hummer san diego However, in our future product plans we are incorporating the move to bio fuels and even more fuel efficient options as well>hummer of tampa Hummer Owners Prepared for Emergencies (HOPE) was created by the efforts of The Hummer Club, INC>hummer of orlando "As we grow smaller, we must ensure that (Hummer) maintains these two characteristics," Mr Walsh emphasises>hummer sacramento Since all Hummer vehicles have heavy-duty capabilities, they have been employed by owners for aid in large disaster situations>hummer charlotte north carolina "At GM, we work together like it’s one engineering organisation, so I can tell you that on various programs – not particular with Hummer – I’m in conversation with Holden on a weekly basis," he revealed>hummer san jose california 2 or even 2>fort lauderdale hummer>hummer dealer The plant produces a few hundred vehicles annually, and its output is limited to local consumption (five dealers in Russia initially)>hummer st louis
In 1998, AM General sold the brand name to General Motors but continued to manufacture the vehicles>hummer nassau it all fits together seamlessly>hummer san antonio "It will be another GM platform that will allow us to build a smaller vehicle," he says>hummer seattle Schwarzenegger has subsequently had one of his Hummer's converted to run on biofuel and now promotes this approach>hummer minneapolis Led by off-road racing legend Rod Hall, Team HUMMER competes in the Stock classes of both BitD and SCORE, which feature production-based vehicles with stock frames, stock suspension designs and production-based engines>hummer columbus ohio HUMMER will consolidate its upcoming H3 range in Austr
alia from 2009 with a variety of new models that will include a compact SUV, diesel, ethanol and hybrid power, and a new full-sized H2>denver hummer He insits that Hummer needs to maintain its 4WD reputation by ensuring that all its vehicles have a separate chassis, short overhangs, class-leading approach, breakover and departure angles, ample ground clearance and signature Hummer styling cues>bergen hummer John Heinricy, General Motors director of high performance vehicles, told GoAuto that GM’s engineering plants across the globe are intertwined in their new-model developments>hummer 3 and the American Red Cross>hummer part As we reported last week, first up will be the long-awaited V8 version of the H3, to address this model’s single biggest criticism – its lack of perf
ormance punch>used hummer GM is responsible for the marketing and distribution of all Hummers produced by AM General>boston hummer " In the United States alone, Mr Walsh believes that a smaller vehicle line-up could add between 30,000 and 40,000 sales to the 70,000-odd units (split between 56,000 H3s and 14,000 H2s) Hummer shifted in 2006>baltimore hummer As a result of its commercial use, features introduced in the civilian Hummer have been incorporated into improved military versions>cleveland hummer ohio Holden does engineering for the US>connecticut hummer stamford Hummer general manager Martin Walsh revealed that the H4 will be twinned with an upcoming compact General Motors pl
atform, although he stopped short of saying which one it would be>hummer san francisco He adds fuel consumption is on par with most of its mid-sized SUV competitors>tacoma hummer Only specialized racing shock absorbers, tires and other minor modifications are allowed, along with the required supporting components and mandatory safety equipment>austin hummer Minor modifications are allowed to the powertrain, although the rules stipulate it must be based on the stock engine and transmission combination>hummer oklahoma city On May 12, 2006, GM announced it would cease production of the original H1 Hummer>newark hummer In 1992, AM General began selling a civilian version of the M998 High Mobilit
y Multipurpose Wheeled Vehicle (HMMWV or Hum-Vee) vehicle to the public under the brand name "Hummer">hummer kansas city Developed by VM Motori of Italy and produced by GM DAT in South Korea, a size increase to 2>pittsburgh hummer " However, a Hummer insider admitted to fearing that its hard-won hardcore off-road image may be irreparably harmed if GM decides to go "soft" with the H4>albany hummer new york "We’re sharing knowledge, we’re sharing engineering>hummer jersey monmouth new At the other end of the spectrum is the development of an H2 replacement>hummer middlesex Dubbed H3 Alpha and on sale in North America from June, right-hand drive production for the V8 will co
mmence at General Motors’ plant in South Africa early next year, with Australian sales following by the end of 2008>portland hummer oregon " Nevertheless, he cites Hummer’s "iconic design" and leading off-road ability as keys to its success>hartford hummer "Longer term I think we can get between 20 and 25 per cent," Mr Walsh forecasts>hummer h4 According to sources, they began doing so after Arnold Schwarzenegger asked them to; apparently, he was impressed by a convoy of HMMWVs that drove by during his filming Kindergarten Cop in 1990>west palm beach hummer The H3’s short nose precludes most V6 installations, so talk is rife that Hummer will fit a derivation of the 2>hummer car Hummer is also
looking at E85 ethanol versions of its two petrol engine choices, as well as a move to biodiesel technology>delaware hummer wilmington The former initially affected H3 sales in America in its first year>hummer norfolk virginia Despite these developments, Mr Walsh believes that it is the smaller vehicles that will drive Hummer sales in Europe, the Middle East and Australasia, as the Americans drive into new markets and add more dealers in existing ones>florida hummer jacksonville Around the same time, a diesel-powered H3 is in line for introduction, although exactly which engine it will employ remains a mystery>hummer for sale Buyers incorrectly assumed it cost significantly more, simply because of its similar design to the larg
er and costlier H2>stretch hummer limousine The team's latest victories came in February 2007, with the H2 and H1 Alpha earning class wins at the Parker 425>hummer salt lake city "We are going hard trying to change consumer’s perceptions>hummer cincinnati The highlights of this journey were broadcast in the United States on ESPN>military hummer The H1's electrical system is 12 volts, with the two batteries wired in parallel>hummer picture 173 of those are in the U>h3 hummer 2007 However, the drive-train, frame, body, suspension, etc>hummer tulsa He declared
that the three biggest issues facing Hummer are incorrect perceptions of price, size and fuel economy>hummer h3 accessory We feel we don’t have anything to apologise for>hummer island providence rhode , are exactly the same>hummer truck Further into the future, hybrid technology – including a predominantly electric powerplant with occasional fossil-fuel engine back-up as per GM’s 2007 Detroit show-stealing Volt concept car – could find its way into Hummers>gary hummer indiana " Responding to criticism that his vehicles are out of step with the fuel consumption and environmental concerns of today, Mr Walsh vehemently defends Hummer’s place in this world>richmond hummer Current
ly Hummer sells only 12 per cent of its output outside of North America>hummer ventura california The Hummers made the trip with ease, for they were built to drive on off-road terrain>hummer h2 sut Many Hummer clubs have also developed local collaborations with law enforcement, fire, search and rescue and civil air patrol squadrons>milwaukee hummer 2006 Hummer lineup: H3, H1, and H2 (L-R)As of 2006, Hummer has gone international with selected importers and distributors in Europe and other markets>2006 hummer h3 "We respect the right of people not to choose a Hummer as much as we respect the right for people to choose our product>hummer rental "Hummer is a niche vehicle>hummer indianapolis An SUT (Sport Utility Truck) version of the H3 is on the cards, for a US launch in 2008>raleigh hummer>2007 hummer>hummer 2 Since October 10, 2006, GM has been producing the Hummer H3 at its Port Elizabeth plant in South Africa for international markets>hummer h2 accessory Developed for extreme riding, the HUMMER Tactical Mountain Bike can be stored inside your HUMMER, car, boat, plane, closet or wherever else you stash your gear>california hummer stockton 5 litres is a possibility>hummer limousine rental " The HUMMER Tactical Mountai
n Bike shares many similarities with its big brother, the HUMMER vehicle: military heritage, off-road capabilities and innovation in design>hummer memphis tennessee This four-door crew-cab model, with may be joined later on by a two-door utility with an extended bed for greater commercial-vehicle applications>hummer h1 for sale "Our growth will be downwards in terms of size," Mr Walsh says, adding: "Opportunities will lie in smaller segments>hummer colorado springs S>fort hummer pierce In the next few years, GM introduced two new homegrown models, the H2 and H3, and renamed the original vehicle H1>greensboro hummer The HMMWV runs on a 24V system, where the two batteries
are run in series to generate 24 volts>hummer of new orleans>hummer h2 picture The Hummer H1 is basically a HMMWV built for civilian use; it has no armor or weapons fittings>hummer buffalo Hummers were originally built by AM General Corporation, formerly the military and government vehicle division of American Motors, in its South Bend, Indiana assembly plant>sarasota hummer The H1 differs from the HMMWV in having a civilian interior, including trim, comfortable seats, stereo, and air conditioning as standard options>albuquerque hummer Team Hummer Racing was created in 1993 and showcases the Hummer's abilities>fort myers hummer This publicity would pale in comparison to the attention that the HMMWV received for its service in Operation: Desert Storm the following year>hummer ohio toledo The H3 is built in Shreveport, LA alongside the Chevrolet Colorado and GMC Canyon pickups>h2 hummer However, this does not mean that Hummer will be standing still with the H3, the brand’s sole global ambassador for the time being>3 hummer Mr Martin also admits that distancing the Hummer from the old military HMMWV (and its civilian H1 counterpart) might aid the company in gaining greater social acceptance in some markets>h1 hummer All HUMMER Tactical Mountain Bikes use Montague's patented military folding system, developed to allow
Paratroopers an easy exit from military aircraft with a full-size mountain bike>hummer video AM General had planned to sell a civilian version of the Hummer as far back as the late 1980s>hummers>accessory hummer>hummer accessories>h3 hummer photo>hummer parts>hummer limo>hummer used>2006 h3 hummer>hummer limousine stretch>hummer h2 accessories>hummer sale>hummer h2 parts>h2 hummer sut>h3 hummer>dealer hummer>hummer h2 wheels>2 hummer>3 h hummer>car hummer>hummer military>hummer stretch>hummer wallpaper>h2 hummer picture>h3 hummer price>hummer rent>accessory h2 hummer>custom hummer>hummer new>hummer military sale>h3t hummer>hummer lynch>hummer vehicle>2005 hummer>h3 hummer picture>hummer pic>hummer sale used>hummer photo>h2 hummer limousine>2006 hummer>h3 hummer review>hummer wheels>2005 h3 hummer>com hummer>hummer kit>hummer pink>cart golf hummer>hummer s>h2 hummer part>hummer limousine stretch super>army hummer>hummer tuning>forum hummer>hummer sut>h4 hummer>car hummer kit>hummer yellow>georgia hummer jonesboro>hummer rim>h1 hummer sale>h1 hummer used>h3 hummer pic>gas hummer mileage>hummer suv>history hummer>2005 h2 hummer>harley hummer>1 hummer>hummer news>hummer jeep>davidson harley hummer>bike hummer>college hummer>hummer price>hummer military used>gm hummer>hummer pimped>control hummer remote>hummer limousine picture>hummer quote>2 hummer picture>cat dog hummer stretch>canada hummer>hummer limousine sale>hummer spinner>hummer low rider>hummer military surplus>diego hummer limousine san>angeles hummer limousine los>h2 hummer wheels>club hummer>black hummer>hummer toy>hummer rc>h3 hummer new>hummer mini>gmc hummer

The comments to this entry are closed.