I was quoted on a Fox show. While this is somewhat surprising, the fact that I was put in the same category as Jon Stewart (apparently we are both liberal ideologues) actually left me feeling honored. The issue, of course, is the four methods of birth control that Hobby Lobby is no longer required to cover under their employee health plan due to the recent Supreme Court ruling. Megyn Kelly of Fox apparently took issue with Jon Stewart calling out claims that Plan B is an abortifacient—a drug causing abortion—as “not true” (he is correct) and my statement that “three of the four contraceptives do not lead to abortion, even using the conservative definition of when life begins,” which appeared in The New Republic. Ms. Kelly claims that Plan B and ella (levonorgestrel and ulipristal acetate postcoital contraception, respectively), and Mirena IUS and ParaGard (both intrauterine devices or IUDs), “Can and do end fertilized eggs.” She is wrong.

Unlike my piece or the myriad posts I have written on the subject on my own blog, Ms. Kelly offers no scientific articles to bolster her claims, but rather rests her case on product monographs—basic descriptions of the drugs—and the opinion of the Supreme Court majority. These are five men whose last biology class was likely 40 or more years ago (i.e., before the basic science evaluating these methods of contraception existed) and who do not practice medicine.

Let’s first dispense with the idea that a product monograph should even be considered. Product monographs do not contain the latest research; they are a compilation of FDA labeling requirements and corporate legal lingo used to deflect lawsuits. As more and more data emerges after a product goes to market, monographs become outdated because updating them offers no financial gain. Since I’m a doctor, not a lawyer, I’ll leave the specifics of how the case was argued to lawyers, but if the product monographs of Plan B, ella, Mirena IUS, and ParaGard were used as evidence to support the government’s case, then the government was relying on outdated and inaccurate information.

As a board certified OB/GYN, I’ll stick to what I know. The medicine.

The International Federation of Gynecology and Obstetrics (FIGO) issued a statement in 2008 indicating that a post-fertilization effect for Plan B was not consistent with the mechanism of action and thus should be removed from the product labeling. There is a plethora of medical evidence (this 2013 review article has many excellent references, as does this 2011 FIGO statement) showing no post-fertilization effect on either the embryo or on the endometrium (lining of the uterus). Plan B works by inhibiting a specific hormonal surge that happens before ovulation. It doesn’t work when given on or after the day of ovulation. In one study when Plan B was given after its window of efficacy, the number of pregnancies was exactly what would have been expected had no method been used (i.e., it didn’t work). Were there a lining-of-the-uterus effect, Plan B would be expected to work after ovulation has occurred, but it doesn’t.