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The Supreme Court must consider science, not pseudo-science, in public health rulings

Measles is on the rise in more than a dozen states, an alarming surge for a vaccine-preventable disease eliminated in the United States nearly 25 years ago. Meanwhile, young women exposed to relentless unscientific deception by social media algorithms are abandoning hormonal contraception in favor of significantly less effective methods that result in more unwanted pregnancies. In Louisiana, women with nonviable pregnancies have undergone unnecessary C-sections to preserve the appearance of not having an abortion. And in Alabama, IVF patients struggling to start or grow their families became predictable victims of political and judicial attacks on abortion access in the wake of the Dobbs decision.

Medical misinformation, the politicization of science, and a years-long effort to undermine trust in physicians and medical institutions are the causes of these and other deeply concerning phenomena that risk public health. Social media influencers and the platforms feeding us steady diets of deception, as well as outrageous posturing by politicians seeking to make experts the enemy, have only accelerated the dangers.

This is an especially dangerous time for the U.S. Supreme Court to have heard oral arguments in a case that threatens to pull a delicate thread in the fabric of the entire U.S. health care system – unraveling the science-based drug approval process that doctors and patients have relied upon for decades. The lawsuit, brought by anti-abortion organizations and doctors who have never prescribed the pill in question, centers on access to mifepristone—an exceedingly safe and effective prescription drug approved by the Food and Drug Administration (FDA) more than two decades ago.

A ruling issued in August 2023 by a three-judge panel of the 5th U.S. Circuit Court of Appeals restored outdated restrictions on mifepristone that the FDA removed years ago after thorough reviews of extensive evidence. Turning back the clock by reimposing these limits without any credible scientific basis favors ideology and pseudoscience over facts, harms patients, interferes with the patient-physician relationship, and jeopardizes public health.

That is the message delivered by the AMA and 15 other leading medical societies in an amicus brief filed with the Supreme Court, seeking to preserve not just access to mifepristone but the integrity of our nation’s science- and evidence-based drug approval process. If the nation’s highest court allows ideologically driven plaintiffs and judges without medical or scientific training to brazenly override a drug’s FDA approval, it will no doubt provide a blueprint for politically motivated challenges to a host of other treatments that physicians and patients rely on to improve – and protect – the health of our nation. Perhaps we shouldn’t be surprised that a majority of justices sounded skeptical of opening up this Pandora’s box.

In the wake of massive disinformation and the politicization of science, what would be next? Reckless challenges to approvals for vaccines against COVID-19 and measles? Hormonal birth control? Cancer and arthritis therapies? HIV medications? As this case has shown, it only takes a special interest with a deeply flawed argument and a single judge in Texas to propel a case all the way to the Supreme Court.

Science and evidence seem lost in these politically motivated cases. To be clear, hundreds upon hundreds of studies and decades of research disprove the assertions of the plaintiffs in the mifepristone case – a drug with safety comparable to ibuprofen. There is no medical justification or benefit for the restrictions the 5th Circuit decision would reinstate – requiring patients to pick up the medication in person and have three unnecessary physician visits during the process of a medication abortion and labeling (permitting?) the drug for use only through seven weeks’ gestation. This would have devastating health consequences for people living in states where abortion is still legal — forced pregnancy and denial of abortion care have been shown to lead to worse health and economic outcomes for women and increased exposure to intimate partner violence.

Mifepristone’s role in the practice of medicine extends well beyond its use as part of a two-drug regimen in medication abortion. Nearly one in every five patients who become pregnant will experience a miscarriage, and mifepristone is commonly used for the management of pregnancy loss. Restricting its use will also exacerbate the physical and emotional strains for women enduring a miscarriage, forcing them to use less effective treatments or suffer through up to two months of drawn-out, more severe symptoms.

The rigorous approval process the FDA follows is recognized worldwide as the gold standard for pharmaceutical introduction. Turning that process on its head in the pursuit of a political or ideological agenda would be a grave mistake. It is precisely the wrong path to take at this perilous moment for public health. The current measles outbreaks reported in 17 states underscore the tremendous risks we face when we backslide on science.

Jack Resneck, Jr. served as president of the American Medical Association from June 2022 to June 2023. For more than 20 years, Dr. Resneck has demonstrated an unwavering commitment to organized medicine. He is a passionate advocate for physicians and patients, a prominent spokesperson for innovation, and a champion for a more equitable health care system. Dr. Resneck is the Bruce U. Wintroub Endowed Professor and chair of the UCSF Department of Dermatology and holds a joint appointment as an affiliated faculty member at the Philip R. Lee Institute for Health Policy Studies. In earlier roles, Dr. Resneck served as residency training director and then medical director for dermatology at UCSF.

He can be reached on X @JackResneckMD.

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