The Sorry Science of JAMA

The Sorry Science And Incompetence Of

The Journal Of The American Medical Association

February 1972

The Journal of the American Medical Association February 21, 1972 published the letter of Dr. Nigro: "Abortion" (reproduced on the next page). This letter began an interesting story. The Editor of the JAMA actually edited out of my letter one of the most glaring defects: included in the articles "Aborted Women"... was one woman who had had a spontaneous miscarriage which in no way should have been included in a study of women who underwent "therapeutic abortions." Some science!

Because the Ford et al article was so egregious in the scientific sense, I formally accused the JAMA's Editorial Board of incompetence. I did this by following all procedures of the American Medical Association for what they called "an original controversy." Accusing the editorial board of "incompetence" was rather drastic, because it was grounds to lose one's medical license.

The correspondence is amazing as I ran across it the other day...the "Board" tried to block the controversy with administrative maneuvers and I finally went all the way to deal directly with all members of the Board of Trustees of the AMA. Through them, I was assured that all my objections and original controversy had been reviewed. All correspondence back to me delicately did not mention my charges but emphatically indicated that such was discussed and appropriate steps were taken.

However, the bottom line was that the Trustees discovered that the Editorial Board, which had been labeling itself as an "editorial board" for decades, had never actually been established formally for the Journal of the American Medical Association. To defend themselves from the accusation of incompetence, they denied their existence as a Board. Thus, my controversy could not legitimately be processed because it was an accusation directed to the "Editorial Board,", something I had to do because they would not tell me which member of the "Board" had reviewed the article in question and allowed it to be published. Since the Board did not exist formally, my original controversy could not be actually processed.

It should be of interest that within a year or two after this "original controversy", the American Medical Association formally established an Editorial Board with much hoopla. Of course, I had resigned from membership by then.

Some time in the future, I hope to publish the full story -- the Church treated Galileo better than scientists treat individuals who object to abortion scientifically.

ABORTION

Published in JAMA, February 21, 1972

The article by Ford et al (218:1173, 1971) is the best I have seen on abortion. However, it has a few factors that warrant comment.

Of the sample, 37% were of racial minority groups, 40% were receiving public assistance, 43% were separated or divorced, 20% were never married, and 43% were from broken homes before the age of 16 years. Thus, it is probable that these patients had pre-existing moderate to severe social problems.

The patients were far from normal. Their abnormalities included masochistic life-styles, narcissism, poor feminine identity, negative feelings about maternal roles, in over half either indifference or overt dislike for sexual relations, and in 47% past psychiatric treatment. The subjective complaints are characteristic for pregnancy: depression, anxiety, insomnia, anorexia, loss of libido, crying episodes, suicidal ideation, and headaches.

Given a high social stress situation for abnormal patients, it is not surprising that the normal symptoms of pregnancy would be heightened as indicated by the preabortion Minnesota multiphasic personality inventory (MMPI) scores. That termination of pregnancy would diminish both the symptoms and the scores is therefore not surprising. All abortion did was to end pregnancy and end the normal crisis feelings about pregnancy appropriate for that group of women. Abortion did little directly for the social situations of these women or their psychiatric problems. The authors' focus appears to have been to study abortion without efforts to help the whole patient. Whereas, most patients in this sample were advised to seek psychiatric treatment, an opportunity was missed to help disturbed women in disturbing social situation at a time when they are susceptible to help (i.e., overlooked is the fact that pregnancy is an opportunity for emotional growth if adequate care is rendered.) From these factors, it should be obvious that a pregnancy base-line evaluation is needed to clarify scientifically whether an abortion is "therapeutic." Otherwise, the most one can say is that the "normal" crisis features of pregnancy were all that were removed by the termination of the pregnancy.

The authors suggest that "more normal" women will benefit most obviously from abortion -- a suggestion unwarranted because their sample is far from normal.

The authors admit that "...chronic characterological, neurotic, or psychotic conditions are not resolved by abortion." Thus, the "improvement" noted in these women with "psychoneurosis and character disorders" (Table 4) must be limited to the disappearance of the exaggerated normal crisis features of pregnancy in these abnormal women.

The authors state: "there is no reason to believe that the women not seen in follow up had different psychological reactions to abortion than those we were able to interview again." But the opposite is just as true. Six women had left the state or moved without a forwarding address, and two apparently had completely rejected the follow up efforts. These eight women comprise about 27% of the total sample.

The MMPI scores that changed were mainly in those scales which primarily reflect symptomatic stress. This underscores the point that "normal" pregnancy symptoms of abnormal women in abnormal social situations will be greater during pregnancy and thus be more easily measured when relieved by termination. The MMPI changes indicate no therapeutic value, just symptom removal from a situation where symptoms are the norm. Delivery may have done the same with and perhaps without intensive social, family, and personal help.

The follow-up interviews do not enhance the credibility of this study. The authors encouraged the patient to talk and then asked specific questions, among them "... whether she felt she had made the right decision in seeking an abortion." But the authors do not give the women's answers to that question except for the three "more disturbed" women. What did the authors expect them to say, particularly to those very people who had arranged their abortion? I have had women patients who did not want to go back to those who arranged their abortion, because they did not want to "hurt the doctor's feelings." Thus, follow-up studies for abortion need a double-blind survey to be scientifically credible and to get away from leading questions asked by persons who were instrumental in arranging the abortion.

This particular article is indeed the best study yet done on abortion. However it does suffer from the deficiencies I have described. The study underscores the unethical nature of abortion insofar as it is a procedure not founded on a scientific basis as required by Section 3 of the Principles of Medical Ethics. Abortion cannot be called "therapeutic." It can only be called "experimental," and thus it should not be performed except as part of a systematic program competently designed, under accepted standards of scientific data, to produce data which are scientifically valid and significant. Abortion is still an experimental procedure, inadequately studied, with no demonstrated therapeutic value, with no clear cut or unequivocal indications, and with unknown future complications.