The Imaginarium of Doctor Delgado: The Make-Believe Medicine Behind SB 1318

pillDr. George Delgado, a gynecologist based in San Diego, is probably not likely to win the Nobel Prize in Medicine any time soon — or ever. Delgado’s dubious medical claims have been one of the driving forces behind a piece of legislation, Arizona Senate Bill 1318, that pushes what physician and state Rep. Randall Friese calls “fringe medicine.”

Delgado runs a website called Abortion Pill Reversal, offering 24-hour medical advice to women who have taken the abortion drug mifepristone and regret their decision. “There is an effective process for reversing the abortion pill, called ABORTION PILL REVERSAL, so call today!” the website cheers. Most people have probably never heard that a medication abortion — that is, an abortion performed by administering two pills — can be reversed. If this medical breakthrough sounds new, it’s because it doesn’t exist — at least not within any kind of evidence-based, established medical practice.

So-called abortion reversal is untested for safety or effectiveness.

Unsafe abortions have always been the consequence of the anti-abortion movement. Now unsafe abortion reversals can likely be added to that, thanks to the procedure Delgado has performed and promoted — in spite of scant evidence of its safety and effectiveness. In the two-step process of a medication abortion, a provider first administers a dose of mifepristone and then follows it with a dose of misoprostol. Delgado claims he can intervene in a medication abortion so that the patient’s pregnancy can continue. If patients change their minds after the first step, Delgado claims, they can counteract the initial drug with a dose of progesterone.

For published medical literature, Delgado can claim a 2012 article he co-wrote in the Annals of Pharmacotherapy. The article describes six abortion reversal patients, four of whom, he claims, remained pregnant. Though published in a legitimate medical journal, Delgado’s findings were from a small sample of patients, none of whom were compared in a controlled study to patients who did not undergo the progesterone treatment. Moreover, not everything that’s published in medical journals is well received by the medical community. Dr. David A. Grimes, a physician formerly with the Centers for Disease Control and Prevention, calls the article “an incompletely documented collection of anecdotes.”

Earlier this year, a systematic review of published findings on abortion reversal was published in Contraception, a top journal in the field. The authors scoured the medical literature to find what, if any, evidence existed to support the safety and effectiveness of the procedure. After searching multiple databases for potentially relevant published findings, they reported that only “one article met our inclusion criteria” for the review — the article that Delgado co-wrote. They noted, though, that the article had numerous shortcomings, including a lack of any reported approval for the experimental procedure by an ethics board or institutional review board. They also questioned the effectiveness of chasing mifepristone with progesterone, noting, “Mifepristone blocks the progesterone receptor with a higher affinity than progesterone itself” — in other words, there might not be a compelling reason to believe that progesterone could effectively counteract the effects of the first pill taken to administer a medication abortion. Even Delgado and his co-author, they noted, recommended “further clinical trials before routine use of their protocol.” They concluded that a requirement for abortion providers to inform patients about abortion reversal “transforms an unproven therapy into law” and inappropriately injects lawmakers into the doctor-patient relationship.

Undeterred by the lack of evidence, Rep. Kelly Townsend, one of the bill’s sponsors, included a provision in SB 1318 that requires abortion providers to inform patients about the reversal procedure. In a news release about a legal challenge to the bill, Jodi Liggett, public policy director at Planned Parenthood Arizona, warned, “If this law goes into effect, physicians will be forced to provide patients with information that is not based in science and could put a woman’s health and safety at risk.” It should come as no surprise that when the The Arizona Republic decided to fact-check both Liggett’s statement and the claims of the bill’s proponents, Liggett came out on top. The Republic cited a lack of “controlled studies” and “scientific consensus” to back the bill’s proponents.

Giving currency to Delgado’s empirically bankrupt ideas is the organization Americans United for Life (AUL), which was influential in getting a similar provision passed in Arkansas. AUL’s 2015 model legislation guide includes a recommendation for abortion reversal counseling — a recommendation that was echoed in SB 1318. Thankfully, Delgado’s influence on legislation ends there — but not his questionable medical advice. Shortly after SB 1318 was introduced, a Reddit user and self-described employee in the medical field reviewed Delgado’s commentary on a radio call-in show called Catholic Answers Pro-Life Open Forum. The advice he gives on one episode in particular should be nothing short of shocking. Asked how a married couple should proceed with their intimacy after the husband’s blood transfusion infected him with HIV, Delgado replied that marriage is “a total gift of self, you give yourself totally, including your diseases … [U]sing … condoms is just not acceptable, because it’s intrinsically evil, and we never use an intrinsically evil means to achieve a good.”

To top it all off, Delgado is also an opponent of same-sex marriage. A March 26, 2013, report on Fox 5 San Diego quotes Delgado for commentary at a rally against marriage equality: “We’re not saying they shouldn’t have their relationships. If they want to have those relationships, that’s fine but marriage has a special place in society for the protection of children and for the stability of society.”

There you have it. In Delgado’s world, marriage should be exclusively between a man and a woman — a woman who is willing to forgo condom use and risk contracting her husband’s HIV. Delgado’s inability to prioritize patients’ safety over his strict interpretation of the Bible reveals that, rather than putting people’s health at the forefront, his style of medicine is primarily driven by ideology. His characterization of condoms as “evil” — even when they are proven to save lives — lends credence to the idea that his promotion of abortion reversal isn’t in patients’ best interests, either.

The aforementioned legal challenge to SB 1318 was set to go to trial in October. There was just one problem, though. As the website RHRealityCheck reported, attorneys for the State of Arizona couldn’t produce a physician or scientist who had the “publication and research background” to qualify as an expert witness in support of the bill. That must have been awkward. A federal judge postponed the hearing and ordered a preliminary injunction against the legislation.

In a piece about Americans United for Life and their push for abortion reversal legislation, The Atlantic noted that AUL “takes no position on other policy measures, like birth control or sex ed, that would likely reduce abortions without making life harder for law-abiding doctors … The group seems better versed legally than medically.”

That’s one way of putting it.