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Post-Roe Insanity

Susan Estrich on

It was one of those days that you spend most of on hold, waiting for the best health care system in the world (which ours is) to liberate you from all the new automatic choices and let you speak to a real human being. In my case, the real human being was a pharmacist, who might tell me where the refill I need was hiding (in the bushes, as it turned out, but that's another story).

So, as I sat on hold, imagine my surprise to find the newspaper story on my screen with a headline about how "Post-Roe, many autoimmune patients lose access to 'gold standard' drug." The story ran in the LA Times on July 11, 2022.

"What gold standard drug could it be?" I wondered. You got it. The one hiding in my bushes.

I never knew it was the "gold standard," and never in a million years did I ever connect it with pregnancy, but methotrexate is the drug of choice for many autoimmune patients with diseases ranging from rheumatoid arthritis to lupus to Crohn's. It is also used, by millions of people, for psoriasis and cancer.

Who knew that it can be used off-label to end ectopic pregnancies -- which amount to about 2% of the uses to which this medicine is put?

According to news reports, I'm lucky to be in California, where all I have to contend with is the delivery guy's preferences for the bushes and not the threat that my doctor or pharmacist could be criminally punished for treating my rheumatoid arthritis. In Virginia, patients are reporting that their prescriptions are being put on hold; ditto in Texas and Tennessee, where the post-Roe laws are written broadly enough and sloppily enough to leave non-abortion usage of drugs in jeopardy or at least difficult to secure, if you have a uterus.

Now let's talk about the real problem. About 100,000 women a year suffer from ectopic pregnancies. I use the word "suffer" because that's what is involved. An ectopic pregnancy is always fatal for the fetus and can also kill the mother. It must be treated immediately. There is no alternative treatment; delay can permanently block a woman's ability to become pregnant again. At high doses, used off-label, methotrexate induces a miscarriage.

The relatively small number of women who take methotrexate for ectopic pregnancies have every right to receive it. There is not a doctor anywhere who would counsel such a woman to do anything else. Every state has an exception to protect the life of the mother; without one, even this court could not find a way to force a woman to die so as to bear a dead fetus.

 

But in the post-Roe hysteria, all women suffer the consequences. Prescriptions for men pose no problem at all. Unfortunately, most of the conditions that methotrexate treats are found disproportionately in women. Rheumatoid arthritis affects three times as many women as men. For lupus, 10 times as many women suffer as men.

Reports of 8-year-old girls being forced to prove that they need methotrexate for reasons other than an ectopic pregnancy are absolutely ridiculous. So are reports of rheumatologists and pharmacies putting a hold on such prescriptions or requiring women to attest that they are not pregnant.

An ectopic pregnancy is a medical emergency that deserves to be treated in the best and most humane way possible, and if that is methotrexate, so be it. Meanwhile, 98% of us who take methotrexate -- all 5 million of us -- take it for reasons other than pregnancy, and delaying our prescriptions for days or weeks can cause painful flare-ups or worse. For no good reason.

The states that restrict abortion have an obligation to do so clearly, not vaguely; to do so narrowly, and not in an overly broad way. Vagueness and overbreadth are constitutional doctrines applicable to all regulations, including those prohibiting abortion. The requirement of a clear statement is especially critical where, as here, life and liberty hang in the balance, on the other side. An 8-year-old girl who needs methotrexate has a right to receive it, and so does a woman with an ectopic pregnancy. I was lucky to find mine in the bushes. For others, the search is more difficult, and that is simply wrong.

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To find out more about Susan Estrich and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

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