A drug developed to cure cancer may well end up as an important weapon for abortion rights advocates fighting to keep abortion a viable alternative.
The drug, methotrexate, has been used for 41 years in the treatment of various cancers, including leukemia, as well as for rheumatoid arthritis and psoriasis. Now some doctors are using it for abortions, and several trials involving hundreds of women around the country are either completed, near completion or in the offing.
"I think methotrexate will change the playing field and make it more difficult to restrict abortion," said Dr. Richard Hausknecht, a New York City obstetrician-gynecologist with an office on Park Avenue.
Dr. Hausknecht, a longtime abortion rights advocate, caused a stir last fall when he declared that he had used methotrexate, which works by attacking rapidly growing cells, in conjunction with misoprostol, which stimulates contractions and expels the embryo, to perform 126 abortions.
Using the drugs was not illegal but was done without approval of the U.S. Food and Drug Administration or in conjunction with a hospital. Now he says the FDA has granted him an Investigational New Drug permit, allowing him to conduct a clinical trial. He says he hopes to use the drug combination on 2,000 women in several centers across the country.
In the meantime, a researcher in Pittsburgh, Dr. Mitchell Creinin, says next month he will announce results of his study using the combination on 300 women. In a smaller study published in October in the Journal of the American Medical Association, Dr. Creinin found the combination worked on 28 of 31 patients and had minimal side effects.
But the real impact of using this drug may be social and political. The majority of surgical abortions are done in clinics, many of which have become the targets of increasingly violent anti-abortion protests.
Methotrexate, on the other hand, is widely available as a generic drug and is inexpensive: A combination of methotrexate and misoprostol costs about $6; doctor and clinic visits are extra. Because methotrexate is used for several diseases, presumably a doctor could prescribe it without the social stigma attached to either RU-486 or a surgical abortion.
"I think, for some women, methotrexate will be as important as birth control pills were to women 30 years ago," said Alexander Sanger, president of Planned Parenthood of New York. "It could get abortion out of a high-tech environment and could lead to the de-medicalizing of abortion. . . . It will also go a long way toward solving the problem women have accessing abortion, especially in rural areas or in places where there is excessive anti-abortion activity."
With the possibility of doing a clinical trial with another 2,000 women, Dr. Hausknecht says he feels he'll be able to show that the drug is safe and effective.
But Dr. Creinin said the drug is not without potential side effects. "It's not 'no big deal.' There are things people need to know about this drug. It's not as simple as it seems. We saw some things; we saw them infrequently, but we saw them."
Though there is no indication that methotrexate, which has been used for decades, later causes cancer and no evidence that it has an impact on future fertility, some abortion rights advocates are cautious about its use in terminating pregnancies.
Even if the drug receives the FDA's blessing, they say, it won't have the radical effect others envision.