The following is the second collection of questions asked by Senator Joyce and subsequent responses during the Senate Inquiry.
Senator JOYCE—I agree with you. I think this is a triumph for underhandedness over transparency. As a parliament, we are shirking the true nature of the debate—that it should be about termination of life and not some discussion about the rights and responsibilities of the TGA. Nonetheless, we have to go through this whole farce of talking about abortion—that it is really there to take away a life and not to treat an ill, and we will somehow flick that off to the TGA. I will ask you a question and hopefully you will be able to clarify one issue. Earlier today the AMA said that there is no differentiation between the repercussions of a surgical abortion and those of RU486. However, it is on the record in other places, such as The Annals of Pharmacotherapy, that the anti-glucocorticoid actions that are taking place throughout the body inhibit the defence mechanisms through chemical regulators known as cytokines. In effect, this basically impairs the defence mechanism of the body to fight off an infection—because of the hormonal effects of the drug. That in itself exacerbates the effects of possible putrification. We do not get mummification of the foetus if it goes through the process of putrification and the inception of septic shock. So we have two completely different points of view. We have the AMA saying that there is no discernible difference—they have said it; it is on the record; the question was asked and they gave the answer—and we have the article in The Annals of Pharmacotherapy which has been reviewed by a journal for physicians and pharmacists, and there was a peer review. They are not pushing a position either way; they are just making a statement of fact. Who is telling the truth?
Dr Graham—That is why it will be very hard for the TGA to come to a conclusion. It is not cut and dried. I will answer your question, Senator Joyce. Do you know how much I want to avoid an auction about side effects and whether this is better or worse than surgical? That is to miss the point of this bill, which is about whether we keep parliamentary oversight and responsibility or abandon it. One thing does need correcting. I will give an example of how murky this whole business of assessing risk will be. Dr Tippett made an erroneous statement earlier, only because the paper that she was referring to was published in November and this has come out only this week in the New England Journal of Medicine. The example concerns four Californian women who in the last two years alone died within a week of taking RU486. They died from the same overwhelming infection of the uterus, clostridium sordelii—a very rare condition.
The New England Journal of Medicine points out that the figure that Dr Tippett quoted of one in 100,000 deaths from RU486 is the same as the figure of one in 100,000 deaths from surgical abortion. She said it is the same risk—that the infections from surgical abortion result in the same rate of deaths. But the New England Journal of Medicine article of 1 December, ‘Fatal Infections Associated with Mifepristone-Induced Abortion’, makes the point that the more appropriate comparison is not with all surgical abortions but with surgical abortions in the same age bracket—that is, under eight weeks. The figure of one in 100,000 deaths from surgical abortions applies to all of them, from six weeks to 36 weeks. But if you look at the figure for under eight weeks, which is when mifepristone is recommended and used, it is only one-tenth—it is 0.1 in 100,000. That is the death rate from surgical abortions at under eight weeks. Therefore, the death rate from RU486 is 10 times that.
That is one point. It is part of the tangle that the TGA would have to face. I can table those papers—the New England Journal of Medicine editorial and the associated article on the four deaths in California—if that would be of value. But the point is that the FDA, the Food and Drug Administration, which is the equivalent of our TGA, as you may have heard, is convening a high-level scientific conference early in the new year with the Centre for Disease Control in Atlanta to untangle these questions of this extraordinarily high cluster of deaths in California, because as the drug company Danco said: ‘We have no answers.’
I am not wanting to get into an auction of side effects. That is for the TGA. That is for the O&G college. It is nothing to do with politicians, respectfully. It is nothing to do with GPs, in a way, because we are not full-time epidemiologists. We leave that to our proper bodies. I am sure the TGA would be the last people in the world to say: ‘We are the ones to rule on those higher criteria and we are the ones to decide on when it is justifiable to take a life, whether it is because of financial stress or whether it is for no reason or all or whether it is for serious emotional upset.’ They would not be the least interested in that. That is not their job. That is not their brief. They will not even define what is medically justifiable. That is for the learned colleges.
Senator JOYCE—So when you are comparing apples with apples, it is 10 times more likely that you will die from RU486 than a surgical abortion, if that is the level of debate you want to go to?
Dr van Gend—I could not even be firm on that. That is certainly the fact from these figures, but the numbers are small. You cannot make firm conclusions on small numbers. I quite agree with that. It is not for us as GPs to pretend to know the balance of risk/benefit. I am saying that the balance of risk/benefit is not the main question.
Senator JOYCE—I agree with you.
Senator JOYCE—We established earlier on that abortions are 10 times more dangerous under the auspices of RU486 than surgical abortions in the same time frame. If we went by the TGA analysis, that should end the debate, but it has not, because the debate is not really about that at all: it is about bringing further validity to abortion. Just so we can step away from it being some Catholic thing, are you aware of any other churches or groups that have an issue with RU486 apart from the Catholic Church? Can you procure an abortion at the Wesley Hospital and, if not, why not? Are you aware of any philosophical views from other faiths or other churches or other providers of health facilities?
Mr Sullivan—I cannot speak for the Wesley Hospital or other ecumenical hospitals. There are some other hospitals. I know that within the tradition of most of the Christian churches there is a strong current that is anti abortion. The main issue among the churches is when life begins. I do not think there is much argument in the Christian churches about the taking of innocent life—they are pretty well one on that. The issue has always been around when life actually begins, and that debate, to some degree, ranges over some hours, not weeks. You will find that, generally speaking, most Christian denominational leaders would be opposed to abortion.
Senator JOYCE—Maybe that is peculiar to Christian churches. What about other faiths? What about Hindus or Buddhists or Jews?
Mr Sullivan—I am not an expert on other religions.
Senator JOYCE—Obviously, if Ventolin brought about fatality to almost 100 per cent of unborn children under eight weeks, I imagine they would ban Ventolin as well. You believe strongly that this responsibility should be vested in the Therapeutic Goods Administration.