My goal this week was to bring you one frustrating story and one fun one to wash it down. I started with a new “study” on mifepristone. It’s junk science at its best (or maybe worst). It sounds professional and uses appropriately big words. It relies on seemingly legitimate methods, and no one result is completely outrageous. And it plays into a narrative that was neatly cued up by Republicans. Then I was going to tell you about a recent sperm race because sperm are inherently funny. It was supposed to be a feel-good story about smart teens getting some well-deserved attention and making a statement about infertility. Unfortunately, the more I read, the more I realized that story was also about junk science and a narrative neatly cued up by Republicans. Junk Science Study on Mifepristone is Part of a Bigger PlanMarty Makary, our new FDA Commissioner, recently made headlines by saying he had no plans to restrict access to mifepristone. It sounded shockingly reasonable given how badly the anti-abortion crowd wants to get rid of mife (pronounced miffie by those in the know). But there was fine print. As part of his statement Makary (a name I always read as malarkey which makes me miss Uncle Joe) said:
The irony of that first sentence uttered by someone who works for RFK, Jr. is only surpassed by the foreshadowing in the second sentence. (It’s Chekov’s research study.) Three days later the Ethics and Public Policy Center (EPPC)—whoever they are—released a report on the “dangers” of mifepristone. Look, it’s data we hadn’t see before. Who would have thunk it. Practically immediately, Representative Josh Hawley (still best known for running away from the Jan 6th crowd he riled up) asked Makary to revisit the rules around mifepristone. Hawley explained:
Anyone else think he’d gotten an advance copy of the data? Possibly even before he asked that question in Makary’s hearing, anyone? Would your opinion change if I told you that Hawley’s wife is a lawyer for the Alliance Defense Fund, the far-right legal group that was instrumental in Dobbs? How about if I reminded you that Erin Hawley argued the case against mifepristone in front of the U.S. Supreme Court last year? (She lost but on procedural grounds. SCOTUS didn’t look at the actual arguments around safety.) Now that it had all been properly teed up behind the scenes, all we needed was a “study” that sounds kind of legitimate, and as junk science goes this one’s a winner. The method—analyzing medical records and using insurance codes to determine what happened—are similar to those used in real academic research. The scale—865,727 mifepristone prescriptions between 2017 and 2023—is large enough that it can’t be dismissed as fringe. The language—diagnosis codes, adverse effects, sepsis, hemorrhage, ectopic pregnancy—sounds like something we’d read in JAMA or at least hear on The Pitt. The findings—that 10.93% of women who took mifepristone experienced a serious adverse event—are alarming. And the political sound bites—“[this rate] is at least 22 times as high as the summary figure reported on the drug label”—seem damning. Underneath that all-business facade, however, is your basic bogus manipulation of data. We need to start with the criteria for entry into this study. Cases were pulled into the analysis if records indicated a prescription for mifepristone and/or included insurance codes for induced abortion or elective termination of pregnancy. This is a wide net that likely caught both people who asked for mifepristone because they wanted to terminate their pregnancy and people who were given mifepristone because they were already having a miscarriage. The codes also do not capture whether the women were given misoprostol which is part of the standard medication abortion regimen. These are important distinctions if our goal is to analyze outcomes. The study claims to have found records of 94,604 serious adverse events running the gamut from sepsis to hospitalization to “other abortion-specific complications.” What constituted an event was in part obvious—if a person had sepsis, they had sepsis—and in part entirely subjective. The research team had a lot of discretion in how they categorized events. We don’t know much about that research team. The report says it includes data scientists, engineers, analysts, and, oh, yeah, board certified OB/GYNs. Who and how many is not revealed, but the authors say that the clinical team has a “history of academic research and peer reviewed publications.” We’re so proud of them. This research, however, was neither academic nor peer reviewed. Not surprisingly, the categories that leave little room for ambiguity have low numbers. Far less than 1% of mife users experienced sepsis (0.10%), needed a transfusion (0.15%), or required hospitalization (0.66%). Moreover, only 0.22% of incidents fell into a category called “other life-threatening adverse events.” According to the authors this category included “cardiac, pulmonary, thrombosis, anaphylaxis, and surgery.” The categories with large numbers, on the other hand, are catchalls that don’t give us a lot of information about what really happened. The analysis found that 4.73% of women visited an ER within 45 days of taking mifepristone. EPPC is smart enough not to include the roller-skating accident that patient 717,223 had on day 35 because that would be too obvious. The authors promise that their anonymous team of experts only include abortion-related visits, but we still don’t know why these women were visiting the ER. We can surmise that a few of them were there for sepsis or maybe thrombosis because the categories overlap meaning one event could end up in two or more categories. Anyone experiencing symptoms of these problems would likely end up in an ER. But some mifepristone users were probably in the ER for more benign reasons. Some women, for example, may have gone because they were worried about the cramping or bleeding they were experiencing only to be told it was perfectly normal and sent home without treatment. The FDA notes that merely being seen in an emergency room does not constitute a “serious adverse effect.” Instead, it suggests that ER visits that do not end in hospitalization need to be evaluated for one of the other adverse events. We don’t know why these women came to the ER, but we do know that the vast majority of these women did not need surgery, transfusions, or hospitalization. The same logic applies to the 3.31% of women who were categorized as hemorrhaging. It’s unclear exactly what code led to this categorization or what was happening to the women at the time. What we do know is that the vast majority of these women did not require surgery, transfusions, or hospitalization. The analysis also found that 2.84% of patients needed a surgical abortion to follow up. That’s distressing to be sure, but it falls within the expected failure rate for mifepristone. The drug is 87% to 98% effective. To really understand this piece of data, it would be helpful to know how far along the women were in their pregnancies, whether they were seeking an abortion or getting treatment for a miscarriage, and if they were also given misoprostol which helps the body expel the contents of the uterus. Finally, according to the study, 5.6% of mifepristone patients experienced “other abortion-related complications.” This is the largest category to be sure, but all the authors tell us is that it includes codes specifically related to abortion or miscarriage, as well as life-threatening mental health diagnoses. That’s so vague it feels a lot like padding your numbers (and possibly setting up a new unnecessary study on post-abortion stress disorder). I wanted to see how their math would math if you took away the two biggest categories (ER visits & other). Unfortunately, we can’t check their work with the numbers they provide because the same event may or may not be counted more than once. As far as I can tell, they are not sharing their data set. In some ways though the data is irrelevant. Makary didn’t need good science. Hawley doesn’t care that the math doesn’t add up. They just needed a study to point to, and now they have one. The EPPC authors conclude that we have to go back to old rules around mifepristone that made it much harder to get. They’d like to require three in-person doctor’s appointments. I say doctor and not health care provider because they’d also like limit script writing to physicians only (sorry midwives and nurse practitioners, you’re being demoted). Said physicians would also have to certify that they could provide or arrange for surgical follow-up if needed. Finally, the authors would like to limit the use of mifepristone to the first seven weeks of pregnancy as the original FDA approval did. (The Obama administration expanded the use to 10 weeks based on the kind of actual science our government used to believe in.) To be clear, the EPPC doesn’t really care about the ins-and-outs of how mife is prescribed, at least not in the long term. In the long term they just want mife gone, because mife is f**king up their plan to get rid of abortions entirely even in states where they control the legislature. This is just the first step. They have a plan. And while I give them an F for the actual science, they might get an A for strategy and theatrics. (Did I mention that the study is called Stop Harming Women?) Medication abortions account for 63% of the abortions done within our formal health care systems according to Guttmacher. This does not include self-managed abortions because we don’t have great data on them. Clearly, medication abortion has become more popular and more necessary since the Dobbs decision. Taking away access to mifepristone will harm women. Some will stay pregnant against their wishes. Some may buy pills on the black market or try even less safe methods to end their pregnancy. And some will die, because women die without access to safe, legal abortions. On Your Mark, Get Set, Come: Were the Much-Hyped Sperm Races Real?The biggest sporting event in the last few weeks wasn’t the NFL Draft or the London Marathon. It was the much-hyped first-ever sperm race. The event, which featured microscopic athletes and their human hosts, took place at the LA Center. It was live streamed across the globe and gained international media coverage. I’m sorry to report it may also have been a complete fraud. The feel-good story that was spun leading up to the event was that a group of teenagers led by 17-year-old whiz kid Eric Zhu (who had already started one company) wanted to call attention to male infertility and dwindling sperm counts. To do this, they put together what they hoped was the first of many live events in which actual sperm would go head-to-head (there’s a pun in there somewhere) on a high-tech racetrack. In an interview with TMZ, Zhu explained that sperm speed is a marker of overall health, and they wanted to promote men’s health by gamifying it. TMZ really bought into the wholesomeness of this event. In an article that featured clips of the interview, the site noted, “The tech teen dream team’s swimming in strategy—giving us every juicy detail of the donors’ prep, from tailor-made vitamins to pineapple-juice chugging. This isn’t a half-baked stunt—it’s a well-seeded plan.” The article went on to say, “They’re so serious about it, in fact, that during our entire interview, a scientist from their team was hard at work with test tubes in the background...” That’s not how I saw it. Please watch the video and tell me if there really is a scientist at work behind the teens or if there is just video of a scientist at work playing behind them. My eyes see green screen. Regardless, the actual event—for which the boys got one million dollars in VC money and a contract with Polymarket which allowed for betting—had a very different tone: less adorable nerdiness, more toxic masculinity. Dorie Chevlen of Slate, who attended the event, said it felt like a boxing match. There was a DJ playing super loud music and scantily clad women pacing the back of the stage. The first race was between the sperm of influencers Noah Boat and Jimmy Zhang (who wore white face paint and a “NUT KING” costume). The emcee told Zhang “No bitch wants you,” and then Zhang and Boat got into a fist fight that may or may not have been staged. The second race was between two college athletes who came out in boxing shorts. The event last three hours; eight minutes of it involved actual sperm. The biggest indication to me that we’re taking a Tucker Carlson approach to male fertility, however, was the stats listed behind the athletes which included their weight, their testosterone levels, and their no fap score. As we’ve discussed, the no fap movement frowns on masturbation and hates women. One of the athletes also said he tried light therapy to improve his sperm’s speed. (Remember Tucker’s Testicle Tanning?) According to Zhu, they had invented a microscopic racetrack that mimicked the female reproductive system including its fluid dynamics and chemical cues. Race masters with syringes promised a synchronized starts, and the course had two sides so the swimmers could stay separate. The pre-race material also noted, “For added entertainment value, the live positions of the sperm are mapped onto a dynamic 3D model of the track, creating an engaging visual experience.” And this is where it goes from cute to hypermasculine to totally fake. River Page of The Free Press explains that he was bought in as he watched the live stream until his video editor, who attended the event in person, overheard some drunk attendees talking about how the outcome was predetermined. The editor did a little poking around backstage (there’s a pun there too) and found prerecorded clips labeled with the winner’s name. Zhu later “admitted” that they did the real races an hour before showtime and played them in a different order to increase the tension. That’s pretty unethical given that people were betting on the event thinking it was live. Some experts, however, think it’s even more bulls**t than that. Page spoke to Dr. Steven Palter, an IVF specialist in upstate New York who said what was shown on the screen was clearly animation, “Sperm swim erratically. They go in circles. They wander. Their tails spin when they swim.” What viewers saw was tiny tadpoles swimming in straight lines. “Nothing about their movement and shape is the way sperm are. This has to be computer-generated,” Palter told Page. We may never know whether the tech teens set out to fool LA with computer generated images passed off as real or if they tried to build the real thing and simply couldn’t pull it off. But I’m getting the sense that their motives weren’t entirely pure. It's also worth noting that sperm speed isn’t the problem that has everyone upset, it’s sperm count. Moreover, not all experts agree that the sperm count is really down among men. In fact, some experts see the discussion of dwindling sperm counts as part of the very same pronatalist movement we talked about a couple of weeks ago that wants us to have more [white] babies. Unfortunately, that tracks with the hyper-masculine tone and ultimate deception of the sperm race. What could have been an adorable (if sticky) science fair project that hit it big turned out to be a testosterone-soaked, dishonest bro-fest. Still, people are talking about follow ups. Apparently, Zhu was asked if he’d consider inviting mega-breeder Nick Cannon to participate. He replied, “I don’t know who that is.” Sex on Wednesday is free today. But if you enjoyed this post, you can tell Sex on Wednesday that their writing is valuable by pledging a future subscription. You won't be charged unless they enable payments.
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