A study at the center of the abortion pill fight was just retracted

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Scientific publisher Sage Journals has retracted three papers on abortion — including a controversial 2021 study on mifepristone, the drug at the center of a US legal battle.

A 2021 study found that mifepristone, one of two pills used in medication abortion, significantly increased women's risk of going to the emergency room after an abortion. The study, along with another retracted paper from 2022, were cited by U.S. District Judge Matthew Kaksmarick in an April 2023 decision that invalidated Food and Drug Administration approval for the drug.

Mifepristone was approved in 2000 by the Food and Drug Administration, the federal agency that evaluates the safety and efficacy of drugs, and has since been used by at least 5.9 million women in the US. The drug blocks a hormone called progesterone which is essential for pregnancy to continue. It is used with another pill, misoprostol, to induce an abortion within 10 weeks of pregnancy.

Three retracted studies were published in the journal Health Services Research and Managerial Epidemiology In 2019, 2021 and 2022. In July 2023, SAGE issued an “expression of concern” about the 2021 paper, saying it was launching an investigation into the article.

According to Sage, a reader contacted the journal with concerns about misleading presentations of data in a 2021 article on mifepristone. The person also questioned whether the authors' affiliations with pro-life advocacy organizations, including the Charlotte Lozier Institute, presented a conflict of interest, which the authors should have disclosed in the article.

In a retraction notice published on 5 February, Sage said that an independent reviewer with expertise in statistical analysis evaluated the concerns and concluded that the presentation of data in some figures in the article leads to incorrect conclusions. According to SAGE, the reviewer also found “there are problems with the composition of the group studied that may affect the article's findings.”

As part of the publisher's investigation, two subject matter experts conducted an independent post-publication peer review of the three articles and found that they “demonstrate a lack of scientific rigor,” Sage said. In the 2021 and 2022 articles, reviewers found problems with the study design and methodology, errors in the authors' analysis of the data, and misleading presentations of the data. In a 2019 article, experts identified unsupported assumptions and misleading presentations of findings.

“The retraction is not as scientifically warranted as it is readily apparent to any trained, objective scientist,” James Studnicki, lead author of all three studies, told WIRED via email.

Studnicki, vice president and director of data analytics at the Charlotte Lozier Institute, shared with WIRED a copy of the point-by-point rebuttal that he and his co-authors submitted to Sage in response to the recall.

In a 2021 study on mifepristone, Studnicki and his co-authors used data from Medicaid claims for 423,000 medication and procedural abortions between 1999 and 2015. Of those, more than a quarter visited a hospital emergency room within 30 days of the abortion. During the study period, they found that emergency room visits associated with medication abortion increased much faster than rates after surgical abortion.