Justice For Kids

Chapter 2: SYStEMATIC Reviews: The Trump Card

 

                      ACP (Abortion Cerebral Palsy)

Chapter 2:   Evidence Supporting the ACP risk

       Brent Rooney ( MSc, <fullterm40@gmail.com> )

 

     One might think that in a ACP (Abortion Cerebral Palsy)

law suit that the plaintiff would not only have to convincingly

demonstrate medical negligence on the doctor's part causing

his/her CP disability, but also demonstrate beyond doubt that

prior induced abortions raise future risk of a premature baby

with CP. The U.S. Ninth Circuit Court has ruled that patients

must not only be informed about well accepted risks, but also

informed about POTENTIAL adverse risks (more about this later).

 

Are prior Induced Abortions a POTENTIAL CP risk?

 

     In summary form here is why prior induced abortions are a

very probable factor for increased risk of cerebral palsy (ie. way

above a mere 'potential' CP risk) in a newborn baby:

 

  - 26 significant studies find that prior IAs boost risk

    of very preterm birth or its surrogate, very-low-birth-weight

    (birth weight under 1,500 grams). Opposed to these 26

    significant studies are ZERO significant studies finding the

    reverse (ie. lower very preterm birth risk due to prior IAs);

    list of the 26 studies at:

    http://justiceforkids.webs.com/chapter4130studies.htm

  - VERY preterm newborn babies have 55 times the CP risk as

     do full-term newborn babies according to the 2008 'Himpens'

     'study of studies' (ie. Meta-analysis).[7]

  - Prior abortions of CHILDLESS women boost their chances

     that they will not have a first delivery until after age 30 or 34.

     Advanced maternal age is a significant CP risk factor.

  - Maternal infection is a CP risk factor whether a baby

    is born preterm, full-term, or post-term. It is undeniable that

    prior induced abortions raise maternal infection risk

  - It is extremely rare that a study 'asks' whether prior abortions

    affect future CP risk in newborn babies. The three (3) studies

   of which I am aware that 'asked' that research question reported

    higher CP risk for newborns of mothers with prior abortions.

    [2, 3, 5]

  - 'ICE' (Incompetent CErvix) is a 'smoking gun' risk factor

    for Cerebral Palsy. Surgical abortions raise 'ICE' risk. The

    more modern term for 'ICE' is cervical insufficiency.

 

Informed Consent Sabotaged

 

     I (Brent Rooney) have copies of seven (7) induced abortion

consent forms. One of the 7 admits to possible increased risk of

future preterm deliveries, but mentions zero adverse side-effects

associated with preterm delivery. Preterm side-effects include

higher risk of 'MACE' (Mental retardation, Autism, Cerebral Palsy,

Epilepsy) disorders, plus raised odds of blindness, deafness,

respiratory distress, gastrointestinal injury, & serious infections.

None of the 7 forms mention that induced abortions may increase

a woman's future risk of a newborn baby with Cerebral Palsy. An

October 2001 Austin, Texas abortion clinic consent form warns

of the risk of incompetent cervix, but does NOT inform the reader

that this implies future raised risk of a newborn baby with CP.

Bottom Line: zero of 7 IA consent forms that Brent Rooney has

list raised ACP risk. Ie. proper informed medical consent denied.

 

The evidence from published studies

 

     In the 2nd quarter of 2001, via a published letter in the

European Journal of Obstetrics & Gynecology and Reproductive

Biology, Brent Rooney became the first ever to demonstrate that

since prior induced abortions raise future premature delivery risk,

IAs are a credible factor to elevate a woman's future risk of a

newborn baby with Cerebral Palsy.[1, Rooney] That 2001 letter

has never been directly challenged. One year later (2002)

Swedish researchers, led by Dr. Bo Jacobsson, reported (with

94% confidence) that if a Swedish mom of a preterm newborn

baby also had prior IAs, her baby's CP risk was higher (+60%)

than Swedish moms of 'preemies' with no prior induced abortions.

[2, Jacobsson] (These Swedish researchers were 94% confident

(95% CI: 0.99-2.58) of increased CP risk). Very strangely, this

startling 2002 result was 'buried' in data-table 2 and mentioned

nowhere else in the 2002 'Jacobsson' Swedish study.

 

     In 2014 Egyptian researchers reported that Egyptian women

with prior abortions have 2.45 times the risk of delivering newborn

babies with CP as Egyptian women with zero prior abortions.[3,

El-Tallawy] To support their finding, they cited the December

2008 study by Brent Rooney (MSc), Dr. Byron Calhoun, and

Lisa Roche (J.D.).[4, Rooney]

 

     In a May 2015 study from India Dr. Tatavarti convincingly

showed that premature delivery remains a very important CP risk

factor.[5, Tatavarti] One recent study Dr. Tatvarti cited in support

of this is a 2013 Canadian study.[6, Hardy] Three (3) McGill

University researchers led by Dr. Ghislain Hardy reported the

significant result that women with prior induced abortions have

1.45 times (ie. 45% higher) the risk of a very preterm delivery as

women with zero prior IAs. In the 2015 Tatavarti study, if a

woman in India has a prior induced abortion, her newborn with

CP is 5 times more likely to be among the prematurely born

compared to those born full-term.[5, Tatavarti] The Tatavarti

study was a small one, but it achieved statistical significance.

 

Where are the published studies that address the ACP

     (Ab.-CP) risk and via strong evidence demonstrate that prior

induced abortions REDUCE future risk of newborn babies

with CP? As of October 2015, Brent Rooney (MSc), is not

aware of any study denying the ACP risk with weak evidence,

strong evidence, or any strength of evidence in-between.

 

Preterm Birth and CP risk

 

     In 2008 Evelyn Himpens & colleagues, using data from dozens

of prior CP studies reported that[7, Himpens]:

 

- Very preterm newborns (between 28.0 & 32.0 weeks' gestation)

   have 55 times the CP risk as full-term newborn babies (absolute

   risk = 6.2%)

- Extremely preterm newborns (under 28.0 weeks' gestation) have

  129 times the CP risk as do full-term newborn babies (absolute

   risk = 14.6%)

 

     There are 26 statistically significant studies that reported that

prior IAs raise future risk of very preterm birth or its surrogate,

Very-Low-Birth-Weight (VLBW (birth weight under 1,500 grams)).

URL: http://justiceforkids.webs.com/chapter4130studies.htm .

The Himpens 2008 'study of studies' tells us that these very

preterm newborns have 55 times the CP risk as do full-term

newborn babies. How many significant published studies reported

that prior IAs reduce future risk of very preterm birth (VPB) or

VLBW? Answer: ZERO. If prior induced abortion neither

increase VPB risk (or its surrogate, VLBW) nor decrease VPB

risk, what are the chances that 100% of 26 statistically significant

studies would find higher risk & zero % would find decreased

risk? The odds of this happening are less than 1 in 38,000; (if a

non risk factor is still found to be a significant risk via 'unlucky

data' and the odds are 50/50 that the finding will be significantly

increased risk and 50/50 that it will be significantly decreased

risk, then the odds of all 26 studies finding significantly higher

risk is 67 million to one against this happening). Bottom Line:

the evidence is OVERWHELMING that prior induced abortions

raise future risk of very preterm birth or its surrogate, VLBW

(birth weight under 1,500 grams).

 

Abortion-Preemie risk becomes Settled Science in 2009

 

     It is settled science that 'preemies' have raised risk of CP

compared to full-term newborn babies. It is also SETTLED

SCIECNE, as of October 2009 that prior induced abortions

raise future risk of preterm birth. How the abortion-preemie

risk became settled science: In 2007 the prestigious Institute

of Medicine (IoM) listed fourteen (14) “Immutable Medical

Risk Factors Associated with Preterm Birth”: URL:

http://www.nap.edu/openbook.php?record_id=11622&page=625 .

[8, Behrman] The third listed 'preemie' risk of fourteen is:

Prior first trimester induced abortion”. Undoubtedly, there

were some who questioned the inclusion of the abortion-preemie

risk in the IoM list. Harvard University professors Dr. Robert

Fletcher and Dr. Suzanne Fletcher rank SYSTEMATIC

REVIEWS as the category of medical study providing the

highest confidence, pro or con, about a purported risk factor.

[9, Fletcher] Before Feb. 2009 there had never been a SRMA

(Systematic Review & Meta-Analysis) of the APB (aka abortion-

preemie) risk. The February 2009 Dr. Hanes Swingle et. al.

APB SRMA confirmed the preterm birth risk of prior induced

abortions; a key 'sub-finding' was that prior IAs multiply the

odds of a very preterm birth by 1.64 (ie. 64% higher).[10, Swingle]

In October 2009 Dr. Prakesh Shah had his SRMA published in

the very prestigious British Journal of Obstetrics & Gynaecology

(BJOG).[11, Shah] Both 'Swingle' & 'Shah' confirmed dose-

response (ie. more than one prior IA inflicted ever higher

'preemie' risk than just one prior induced abortion). Dr. Shah

(University of Toronto) found, based on data from 37 prior

studies, that one prior IA multiplies 'preemie' odds by 1.36

whereas more than one prior IA almost doubles (1.93 times)

premature delivery risk. Who owns the BJOG? Answer:

the [British] Royal College of Obstetricians & Gynaecologists,

which includes many doctors who perform induced abortions.

So, BJOG published the October 2009 Dr. Prakesh Shah

study AGAINST the interests of doctors who are part owners

to the BJOG via membership in the Royal College. As of

October 2015 how many systematic reviews (SRMAs) find

that prior induced abortions do not raise future risk of

premature delivery? Answer: ZERO. In 2015 a third APB

(Abortion-Preterm-Birth) SRMA appeared; it reported that

prior D & C (Dilation & Curettage) abortions significantly

increase the odds of very premature delivery (Odds

Ratio = 1.69).[12, Ankum]

 

What would happen to CP rates, if IA rates sharply DROPPED?

 

     This 'theoretical' question has been answered by Poland's

CP experience. In 1989 Poland put into a effect a new law

that very drastically restricted access to induced abortions

with the result that between 1989 and 1993 the number of IAs

per 1,000 births plunged by 98%. On 12 June 2008 Poland's

Deputy Director of the Central Statistical Office, Mr. Witold

Marek Wozniak, emailed to Brent Rooney Polish CP statistical

data for the years 1985 to 2006. Over the time span of 1995

to 2006 the number of Polish children under age 5 with CP

who died in a year dropped by an amazing 70%. What does

this trend strongly suggest? The more severe a young child's

CP condition is, the higher his/her risk of death is. Thus, what

the Polish data strongly implies is that the rate of severe CP

cases in Polish children under age 5 sharply dropped between

1995 and 2006. But 'maybe' the APB risk does not apply to

Polish women. A 1987 study (when Poland was still under

communist rule) study with Polish women as subjects

demolished such wishful thinking.[13, Krasomski] If a Polish

woman has one or more induced abortions before carrying a

first pregnancy to term, her risk of a premature delivery is 1.9

times (almost double the risk) as that of Polish women with

zero prior IAs before a first delivery.

 

Hungary's abortion-preemie epidemic

 

     In the 1960s and early 1970s Hungary was known to have the

highest 'preemie' rate in Europe. In fact, commenting about

Hungary long time & high profile abortion advocate Dr.

Malcolm Potts wrote:

...there seems little doubt that there is a true relationship

between the high incidence of therapeutic abortion and

prematurity. The interruption of pregnancy in the young

(under seventeen) is more dangerous than in other cases...”

[14, Potts] In what medical publication did the 1967 Potts' quote

appear? Answer: a journal that pushed eugenics, namely:

Eugenics Review.[14, Potts] Forty (40) years ago (January

1975) in a U.S. medical journal Hungarian born Dr. Leslie

Iffy warned U.S. medical professionals that the 'preemie'

disaster that Hungary suffered through presaged a preemie

debacle in the U.S. Here is a key paragraph from that 1975

Dr. Leslie Iffy 'letter to the editor' (Obstetrics & Gynecology):

A recent article in the MAGYAR HIREK, a journal sponsored by

the government, contained detailed explanations for the new

legislation. The columnist referred extensively to the research

of Professor Jeno Sarkany, who had presented evidence

considered conclusive by the government, that artificially

induced abortions predisposed to premature births in

subsequent pregnancies. His study of perinatal and infant

morbidity statistics revealed a striking increase in physically

and/or mentally handicapped babies among those born to

mothers who had had a therapeutic abortion previously.

Apparently, this unforeseen social burden outweighed the

benefits on economic pressures of free abortion, and the

government, while emphasizing the unchanged importance

of population control, felt compelled to repeal its abortion

laws.”[15, Iffy]

 

U.S. ACP cases yearly

 

     In a 2007 peer-reviewed study led by Dr. Byron Calhoun it

was estimated that in 2002 there 1,096 U.S. newborn babies

under 1,500 grams (3 lbs. 5 ounces) with Cerebral Palsy due to

their mothers' prior induced abortions.[16, Calhoun] The

'Calhoun' study has not been challenged via a 'letter to the

editor' since its October 2007 publication. The 1,096 CP case

estimate did not include an estimate of ACP cases for

newborn babies over 1,500 grams with CP.

 

Summary
It is SETTLED SCIENCE that premature babies have raised
risk of Cerebral Palsy. As of October 2009 it is SETTLED
SCIENCE that women with prior prior induced abortions have
raised risk of premature delivery and more than one prior IA
carries higher 'preemie' risk than one prior induced abortion. As
of October 2015 there is not even one APB SRMA (Systematic
Review with Meta-Analysis) that finds that prior induced abortions
do not increase future risk of premature delivery. Thus, it is
VERY PROBABLE that prior induced abortions raise the
risk of later deliveries of newborn babies with Cerebral Palsy.
No known abortion consent form in the U.S. or Canada warns
about raised future risk of premature babies with Cerebral Palsy.

 

[Note: there are some who will find the above text over

simplified. After the references right below is a more thorough

explanation of the ACP risk and why it is a VERY credible

risk]

 

References

 

1 Rooney B. Elective surgery boosts cerebral palsy risk.

European Journal Obstetrics Gynecology Reproductive

Biology 2001;96(2):239-240

 

2 Jacobsson B, Hagberg G, Hagberg B, Ladfers L, et. al, Cerebral

palsy in preterm infants: a population-based case-control study

of antenatal and intrapartal risk factors. Acta Paediatr

2002;91:946-951

 

3 El-Tallawy HN, Farghaly WMA, Shehata GA, Rageh TA,

Metwally NA. Cerebral Palsy in Al-Quseir City, Egypt: prevalence,

subtypes, and risk factors. Neuropsychiatric Disease Treatment 2014;10:1267-1272 [URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4099193/pdf/ndt-10-1267.pdf


4 Rooney B, Calhoun BC, Roche L. Does induced abortion

account for racial disparity in preterm births, and violate the

Nuremberg Code? J Am Phys Surg 2008;13:102-104.

[ URL: http://www.jpands.org/vol13no4/rooney.pdf ]

 

5 Tatavarti SR, Arimilli V. PRETERM BIRTH ASSOCIATED

with CEREBRAL PALSY. Journal Evidence Based Medicine and

Healthcare. May 2015;2;2476-2479

 

6 Ghislain Hardy, Alice Benjamin, Haim A. Abenhaim.

Effects of Induced Abortions on Early Preterm Births

and Adverse Perinatal Outcomes. Journal Obstetrics

Gynaecology Canada 2013;35(2):138-143 [ URL:

http://www.jogc.com/abstracts/full/201302_Obstetrics_5.pdf ]

 

7 Himpens E, Van Den Broeck C, Oostra A, Claders P,

Vanhaesebrouck P. Prevalence, type, and distribution and severity

of cerebral palsy in relation to gestational age: a meta-analytic

review. Dev Med Child Neurol 2008;50:334-340. [ URL:

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2008.02047.x/pdf ]

 

8 Behrman RS, Butler AS, Alexandar GR. Preterm Birth: Causes, Consequences, and Prevention. National Academy Press,

Washington DC (2007) [URL: http://www.nap.edu/openbook.php?record_id=11622&page=625 ]

 

9 [Book:] Fletcher RH, Fletcher SW. Clinical Epidemiology

The Essentials [Fourth Edition]. Lippincott Williams & Wilkens, Philadelphia, Pennsylvania 2005

 

10 Swingle HM, Colaizy TT, Zimmerman MB, et al Abortion

and the risk of subsequent preterm birth: a systematic review

and meta-analysis. J Reproductive Med 2009;54:95-108.

[ URL: http://johnrodgerssmith.com/MedicalObservations/Swingle/JRM%20Swingle%20paper%202009.pdf ]

 

11 Shah PS, Zao J. Induced termination of pregnancy and low

birthweight and preterm birth: a systematic review and meta-

analysis. BJOG 2009;116:1425-1442. [URL:

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02278.x/pdf ]

 

12 Ankum WM, Lemmers M, Vershoor MAC, Hooker AB,

Opmeer BC. Does dilation and curettage (D & C) increase the

risk of preterm birth in subsequent pregnancies? A systematic

review and meta-analysis. [Abstract URL: http://eshre2015.congressplanner.eu/showabstract.php?congress=ESHRE2015&id=262 ]

 

13 Krasomski G, Gladysiak A, Krajerski J. Fate of subsequent

pregnancies after induced abortion in primiparae. Wiad Lek

1 December 1987;40(23):1593-1595

 

14 Potts M. Legal abortion in Eastern Europe. Eugenics

Review1967;59:232-250

 

15 Iffy L. Abortion Laws in Hungary. Obstetrics Gynecology

Jan. 1975;45(1):116-117

 

16 Calhoun BC, Shadigian E, Rooney B. Cost consequences

of induced abortion as an attributable risk for preterm birth

and informed consent. J Reprod Med 2007;52:929-939.

[Abstract: http://www.ncbi.nlm.nih.gov/pubmed?term=calhoun%20shadigian%20rooney]

 

 

.............................................................................................................................................................................

 

 

TRUMP CARD for ABORTION-PREEMIE

RISK: SYSTEMATIC REVIEWS

+ Meta-Analyses Part 1:

 

 

      A pioneering Feb. 2009 systematic review of the

Abortion-Preemie risk by Dr. Hanes Swingle et al. with

323,893 subjects demonstrated that induced abortions

boost a woman's chances of a premature delivery AND

also increase the risk of VERY preterm birth (under 32

weeks'). This is very important since very premature

babies have 55 times the Cerebral Palsy risk as do

full-term newborns.

 

      What is the category of medical study that provides

the highest confidence that a plausible medical risk is

an actual risk? Answer: Systematic Review (with

Meta-Analysis). Who says? Answer: Harvard University

professors Dr. Robert Fletcher & Dr. Suzanne Fletcher.

In their 2005 textbook (Clinical Epidemiology, page 200)

this husband and wife team of Harvard University

doctors listed ten (10) categories of medical studies and

at the very top ranking #1 in providing strength of

evidence, pro or con, about a plausible medical risk is: SYSTEMATIC REVIEW [with Meta-Analysis]. For

those who may think the Fletchers are mistaken in their

confidence in (competent) systematic reviews for settling

medical controversies, here is what well known UK

medical commentator Dr. Ben Goldacre (UK) wrote

about SRs:

 

      “Systematic reviews are one of the great ideas of

       modern thought. They should be celebrated.” [Book:

       Bad Science (Dr. Ben Goldacre, p. 99)]

 

So What?

 

      'Abortion-Preemie' risk became SETTLED SCIENCE

in 2009 via three (3) SRs.[1, Swingle; 2, Shah; 3,

Oppenraaij] Two of three SRs included a meta-analysis.

Before February 2009 there had never been a Systematic

Review with meta-analysis for the 'Abortion-Preemie' risk.

Thus, in 2009 via two (2) SRMAs (SR with Meta-Analysis)

the Abortion-Preemie risk became SETTLED SCIENCE.

[1, Swingle; 2, Shah] Does 'settled science' (i.e. accepted

medical fact) stay 'settled' forever? No, but once an

adverse medical risk becomes known as a fact, the

BURDEN of PROOF switches onto the 'shoulders' of

sceptics of the medical fact. Sceptics must present very

convincing evidence that an accepted fact is actually not

a fact. Those sceptics who doubt the abortion-preemie

risk have an extremely heavy weight on their 'shoulders'.

Why? Over the last ten (10) years ( 1 Jan. 2005 – 31

December 2014) forty (40) statistically significant studies

reported higher risk of preterm birth or Low Birth Weight

(LBW: Birth Weight under 2,500 grams) and ZERO (aka

naught, zip, none) reported reduced risk of premature

delivery or LBW due to prior abortions; those 40 recent

significant studies are included in the following

significant risk study list (starting in 1963):

http://justiceforkids.webs.com/chapter4140studies.htm

 

Institute of Medicine (IoM)

 

      The IoM (Institute of Medicine) is part of the very

prestigious [U.S.] National Academy of Sciences.

In 2007 in its authoritative textbook the IoM listed

fourteen (14) “Immutable Medical Risk Factors

Associated with Preterm Birth” with the 3rd listed

preemie risk being “Prior first trimester induced abortion”.

[4, Behrman] URL for the 14 'preemie' risks identified

by the IoM:

http://www.nap.edu/openbook.php?record_id=11622&page=625 .

If there was any doubt about this Institute of Medicine

statement, for HONEST preterm birth researchers it was

removed by the 3 systematic reviews of 2009. After

2009 there are ZERO Abortion-Preemie SRs, so the

Abortion-Preemie risk is not even semi-seriously

challenged. If Dr. Gordon Smith (Cambridge University)

believes he can cite a systematic or even a RCT

(Randomized Clinical Trial) study disproving the abortion-

preemie risk, he is welcome to try. Dr. Smith has never

listed any such study or a abortion-preemie SYSTEMATIC REVIEW in any of his co-authored studies.

 

Truth or Consequences

 

      So what if abortions boost premature delivery risk

one might posit. Premature babies have raised risk of

'MACE' (Mental retardation, Autism, Cerebral Palsy,

Epilepsy) disorders.[4, Behrman] In a 2008 published

'study of studies' (i.e. meta-analysis) Evelyn Himpens

and colleagues, using data from many prior studies,

found that those babies born between 28.0 & 32.0

weeks' gestation have fifty-five (55) times the cerebral

palsy (CP) risk as do full-term newborn babies (i.e. at

least 37.0 weeks' gestation). Those newborn babies

under 28.0 weeks' gestation have 129 times the CP risk

as do full-terms.[5, Himpens] The lifetime CP cost of

a U.S. newborn later diagnosed with CP and who survives

childhood likely faces a CP-bill (medical + non-medical

lost wages) exceeding $2 million. If so, that $2 million

falls well short of the lifetime Autism of a U.S. resident

that equals an estimated $3.2 according to Harvard

University researcher Michael Ganz (PhD).[6, Ganz]

Is premature delivery one of the risk factors for Autism?

.__________________________________________...

 

* Note – The list of 10 categories of medical

studies provided by Dr. Robert Fletcher and Dr. Susanne

Fletcher (emphasis added by Brent Rooney):

 

Systematic Review

Randomized Controlled Trial

Multiple Time Series

Non Randomized Trial

Cohort

Case-Control

Time Series

Cross-Sectional

Case Series

Case Report

 

..________________________________________________________..

 

Glossary of Terms

 

Abortion      - EITHER a miscarriage or an INDUCED

                                         miscarriage (aka 'induced abortion')

Cerebral Palsy - A brain injury that manifests as improper

                                                    balance, posture, & movement.

Extremely Preterm – Birth before 28 weeks' gestation

Meta-analysis       - Study that combines data from multiple prior

                                                              studies & computes risk numbers based on

                                                              the combined data

Miscarriage  - A delivery of a dead infant with a gestation of

                                           (currently set at) 20 weeks. “Spontaneous

                                           abortion” = Miscarriage

Odds Ratio - A measure of risk. An O.R. of 1.00 implies

                                         no increase or decrease in risk. An O.R. greater

                                        than 1.00 means increased risk.

Premature Birth - Same of Preterm Birth

Preterm Birth - Birth before 37.0 weeks' gestation

TOP               - 'Termination Of Pregnancy' is a euphemism for

                                                 induced abortion.

Very Preterm  - Birth before 32.0 weeks' gestation (but some

                                                 researchers use 34.0 weeks' gestation as the

                                                threshold)

 

References

 

1 Shah PS, Zao J. Induced termination of pregnancy and low birthweight and

preterm birth: a systematic review and meta-analysis. BJOG 2009;116:

1425-1442. [URL:

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02278.x/pdf ]

 

2 Swingle HM, Colaizy TT, Zimmerman MB, et al Abortion and the risk

of subsequent preterm birth: a systematic review and meta-analysis. Journal

Reproductive Medicine 2009;54:95-108. [ URL: http://johnrodgerssmith.com/MedicalObservations/Swingle/JRM%20Swingle%20paper%202009.pdf ]

 

3 Oppenraaij RHG, Jauniaux E, Christiansen OB, Horcajadas AS,

et al. Predicting adverse obstetric outcomes after early pregnancy

events and complications: a review. Human Reproduction Update

2009;15(4):409-421 [ URL:

http://humupd.oxfordjournals.org/content/15/4/409.full.pdf+html

; supplementary data for the 2009 Oppenraaij systematic review:

http://humupd.oxfordjournals.org/content/suppl/2009/03/06/dmp009.DC1/dmp009supp.pdf

]

 

4 Behrman RS, Butler AS, Alexandar GR. Preterm Birth: Causes

, Consequences, and Prevention. National Academy Press, Washington DC

(2007)

[URL: http://www.nap.edu/openbook.php?record_id=11622&page=625 ]

 

5 Himpens E, Van Den Broeck C, Oostra A, Claders P, Vanhaesebrouck

P. Prevalence, type, and distribution and severity of cerebral palsy in

relation to gestational age: a meta-analytic review. Dev Med Child

Neurol 2008;50:334-340.

 

6 Ganz ML. The lifetime distribution of the incremental societal costs

of autism. Arch Pediatr Adolesc Med 2007;161:343-349.

 

...________________________________________________________________..

 

                                                                                                                                                    19 February 2015

 

Abortion-Preemie Trump Card: SRs &

  the 2009 Dr. Hanes Swingle SR (+

  meta-analysis). Part 2

 

As explained in Part 1 of this 'Trump Card' series, SYSTEMATIC REVIEWS are the category of medical

study providing the highest confidence, pro or con, about

a purported adverse medical risk. For the Abortion-Preemie risk the 'score card' is:

 

   3 Systematic-Reviews support the Abortion-Preemie risk

   0 (nada, no, zero) SRs deny Abortion-Preemie risk

 

Before February 2009 there were ZERO (aka nada, zilch, nill,

no) Systematic Reviews (+ meta-analyses ) of the premature

birth risk of prior IAs (Induced Abortions). The February 2009

Dr. Hanes Swingle & colleagues SRMA (Systematic Review

with Meta-Analysis) changed all that.[1, Swingle] Over all, the

Swingle SR found that women with prior IAs increased their

premature delivery risk by about 1/3 ( 32% higher risk (Odds

Ratio 1.32 (95% CI 1.11-1.53)). Dr. Hanes Swingle & colleagues

were over 95% confident of increased premature birth risk for

women with prior induced abortions (that is what the “95% CI”

numbers mean; the bottom number (1.11) exceeds 1.0, meaning

that Dr. Hanes Swingle is at least 95% confidence of higher

'preemie' risk). A total of 323,893 subjects were part of this

'study of studies' (aka systematic review).

 

More important than the overall 1/3 increased in

'preemie' risk, women with prior induced abortions

increase their relative odds of a VERY preterm delivery

(under 32.0 weeks' gestation) by a significant 64%

( 1.64 (95% CI 1.38-1.91)). Although VPBs are only

about 20% of the U.S. preemie population, they account

for a majority of infant deaths (during the first 12 months

of life) and serious disabilities such as Autism & Cerebral

Palsy (CP). Dr. Swingle & colleagues found dose-

response, meaning the more the number of prior induced

abortions, the higher the preterm birth risk is. This

dose-response confirmation gives researchers even more

confidence that a possible adverse risk is an actual

adverse risk. Dr. Hanes Swingle's very premature delivery

finding was confirmed by the 2009 Dr. Oppenraaij systematic review study.[2, Oppenraaij]

 

Dr. Swingle's research team did a thorough literature review to

find all abortion-preemie studies between 1995 and 2007. They

found thirty (30) such studies and for their 'meta-analysis' (numerical

risk estimate) they winnowed down this initial list to 12

studies. Dr. Swingle's 2009 statistically significant published results:

 

- exactly one prior IA: 25% higher PTB risk (O.R.: 125 (1.03-1.48))

- one or more prior IAs: 32% higher PTB risk (O.R.: 1.32 (1.11-1.53))

- 2 or more prior IAs: 51% higher PTB risk (O.R.: 1.51 (1.21-1.75))

[323,893 subjects (from 12 prior studies) in this Feb. 2009 'study of studies']

 

???'Is Swingle' study a small Systematic Review???

 

In figure 1 of the February 2009 'Swingle' study this research group

provided key data including the number of subjects in each of the

12 studies included in their abortion meta-analysis (i.e. numerical

analysis). The total number of subjects involved in Dr. Hanes Swingle's

meta-analysis exceeds 300,000 (exactly: 323,893) So, small this

February 2009 meta-analysis is NOT!

 

Conclusion

 

Dr. Hanes Swingle and his research team performed the first ever

SRMA (Systematic Review & Meta-Analysis) ever to quantify the

abortion-preemie risk. The 2009 'Swingle' SRMA confirmed

statistically significant abortion-preemie risk & more than 1 prior induced

abortion increased premature delivery more than exactly one (1) prior

induced abortion.[1, Swingle] The second Abortion-Preemie SR

was the 2009 'Oppenraaij' paper (without a meta-analysis) and this

study affirmed the abortion-preemie risk.[2, Oppenraaij] The 3rd SR

also occurred in 2009, the October 2009 Dr. Prakesh Shah SRMA

published in the prestigious British Journal of Obstetrics &

Gynaecology.[3, Shah] The 'Shah' SRMA is described in Part 3 of

this 'Trump Card' series.

 

THERE are ZERO SRMAs finding that induced abortions

do not raise premature delivery risk and there has been six

6 years (February 2009 to Feb. 2015) to produce one. The

Abortion-Preemie risk is SETTLED SCIENCE. End of

Story.

 

...____________________________________________________..

 

Appendix

 

First sentence in the discussion section of the Feb.

2009 'Swingle' systematic review & meta-analysis:

 

Our meta-analysis indicate that there is an increased

risk of PTB [Preterm Birth] after either spontaneous

or induced abortion in both case-control and cohort

studies.”

 

..____________________________________________..

 

Brent Rooney (MSc)

Research Director, Reduce Preterm Risk Coalition

3456 Dunbar St. (Suite 146)

Vancouver, Canada V6S 2C2

email: fullterm40@gmail.com

 

References

 

1 Swingle HM, Colaizy TT, Zimmerman MB, et al Abortion and the risk

of subsequent preterm birth: a systematic review and meta-analysis. J

Reproductive Med 2009;54:95-108. [ URL: http://johnrodgerssmith.com/MedicalObservations/Swingle/JRM%20Swingle%20paper%202009.pdf ]

 

2 Oppenraaij RHG, Jauniaux E, Christiansen OB, Horcajadas AS,

et al. Predicting adverse obstetric outcomes after early pregnancy

events and complications: a review. Human Reproduction Update

2009;15(4):409-421 URL:

http://humupd.oxfordjournals.org/content/15/4/409.full.pdf+html

; supplementary data for the 2009 Oppenraaij systematic review:

http://humupd.oxfordjournals.org/content/suppl/2009/03/06/dmp009.DC1/dmp009supp.pdf

 

3 Shah PS, Zao J. Induced termination of pregnancy and low

birthweight and preterm birth: a systematic review and meta-analysis.

BJOG 2009;116:1425-1442. [URL:

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02278.x/pdf ]

......____________________________________________________________________________.....

 

 

                                                                                                                                      19 February 2015

Abortion-Preemie Trump Card: SRs &

the October 2009 Dr. Prakesh Shah SR (+

meta-analysis). Part 3

 

      Before February 2009 there were ZERO 'study of

studies' (systematic reviews & meta-analyses (SRMAs))

of the abortion-preemie risk. In 2009 there appeared

two (2) abortion-preemie SRMAs.[1, Swingle; 2,

Shah]; and there was a third SR (but without a meta-

analysis).[3, Oppenraaij] All three systematic reviews

confirmed higher risk of premature newborn babies for

women with prior IAs (Induced Abortions). [Competent]

SRMAs are the gold standard for confirming a suspected

medical risk.[4, Fletcher]

      In October 2009 the very prestigious med publication

British Journal of Obstetrics & Gynaecology published

the Dr. Prakesh Shah abortion-preemie SRMA.[2, Shah]

Professor Dr. Shah (University of Toronto) is quite

'comfortable' with abortions being performed, BUT with

the very clear & explicit caveat that women receive full

and accurate risk warnings (i.e. informed med consent)

before abortions are actually performed. The October

2009 Dr. Shah SRMA confirmed the February 2009

Dr. Swingle SRMA and also confirmed dose-response,

meaning that more than one prior IA has even higher

'preemie' risk of premature delivery than just 1 prior

IA. Dr. Prakesh Shah's statistically significant results:

 

- 1 prior IA; +36% (Odds: 1.36 (1.24-1.50))

[268,379 subjects for the risk of one prior IA]

 

- 2 or more prior IAs: +93% (Odds: 1.93 (1.28-2.71))

[158,271 subjects for the risk of 2 or more prior IAs]

 

For both results Dr. Shah was at least 95% confident of

increased premature birth risk for women with prior IAs

compared to women with zero previous induced abortions.

Women with more than one previous IA have nearly

double (+93%) the risk of a premature delivery as women

with no prior TOPs (Terminations Of Pregnancy).

 

Who owns the BJOG (British Journal of Obstetrics &

Gynaecology)?

 

     Most of the public in the U.S. & Canada do not know

what RCOG, the owner of the BJOG, stands for. RCOG =

Royal College of Obstetricians & Gynaecologists and

this British med organization has some members

(numbering in the hundreds) who have performed

induced abortions. This organization, RCOG, owns

a publication (BJOG) that has published overwhelming

evidence via an October 2009 systematic review that

induced abortions increase premature birth odds.

 

Any Challenges to the 2 SRMAs of 2009?

 

      One word answer: NO.   Dr. Gordon Smith

(Cambridge U.) could list such a systematic review

(+ meta-analysis) clearing induced abortions of

increased premature delivery risk, if such a SRMA

exists. but Dr. Smith has not done so. Why.? So such

SRMA exists. Game, Set, Match + Checkmate.

The abortion-preemie risk = SETTLED SCIENCE.

 

...._____________________________________________________...

 

Appendix: Quote from the 2009 Dr. Oppenraaij systematic review

 

Despite these methodological drawbacks, it can be

concluded that a history of TOP [Termination Of

Pregnancy = euphemism for induced abortion] is

associated with an increased risk for PPROM

[Preterm Premature Rupture Of Membranes], PTD

[Preterm Delivery], and VPD [Very Preterm Delivery].”

Brent Rooney quoted as saying the Dr. Oppenraaij quote

is 'checkmate' for those denying abortion-preemie risk.

 

References

 

1 Shah PS, Zao J. Induced termination of pregnancy and low birthweight and

preterm birth: a systematic review and meta-analysis. BJOG 2009;116:

1425-1442. [URL:

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02278.x/pdf ]

 

2 Swingle HM, Colaizy TT, Zimmerman MB, et al Abortion and the risk

of subsequent preterm birth: a systematic review and meta-analysis. Journal

Reproductive Medicine 2009;54:95-108. [ URL: http://johnrodgerssmith.com/MedicalObservations/Swingle/JRM%20Swingle%20paper%202009.pdf ]

 

3 Oppenraaij RHG, Jauniaux E, Christiansen OB, Horcajadas AS,

et al. Predicting adverse obstetric outcomes after early pregnancy

events and complications: a review. Human Reproduction Update

2009;15(4):409-421 [ URL:

http://humupd.oxfordjournals.org/content/15/4/409.full.pdf+html

; supplementary data for the 2009 Oppenraaij systematic review:

http://humupd.oxfordjournals.org/content/suppl/2009/03/06/dmp009.DC1/dmp009supp.pdf ]

 

4 [Book:] Fletcher RH, Fletcher SW. Clinical Epidemiology

The Essentials [Fourth Edition]. Lippincott Williams & Wilkens,

Philadelphia, Pennsylvania 2005

....._______________________________________________________________________________....

 

 

 

 


 

..___________________________________________________________________________________..

 

Chapter 2 -     -     - Justice For Kids Now -     -     -     -     -  8 June 2009 -     - Page 1 of 22

-     -     -Do Prior Induced Abortions (IAs) Boost Premature Birth Risk?

-     -     -     -( Brent Rooney (MSc); fullterm40@gmail )-     -     -     -      

 

Your lawyer might ask one of the defendant's expert witnesses the following question:

If the Editor-in-Chief of the British Journal of Obstetrics and Gynaecology (BJOG) were

to say that the evidence supporting higher risk of premature labour [British spelling] for

women with prior induced abortions was “overwhelming”, would that suggest to you that

there is good evidence for that risk?” On 16 January 2006, Dr. Philip Steer (email:

p.steer@imperial.ac.uk ) who is Editor-in-Chief of the BJOG made that concession in an

email sent to Brent Rooney (at his whatsup@vcn.bc.ca email address):

I still feel it was fatally unbalanced because contrary to what the author below says,

they were not trying to establish that the link between TOP and preterm labour (which

none of us dispute, the evidence is already overwhelming ) but to quantify the cost of

the resulting preterm labour .....”

TOP” is medical jargon for Termination Of Pregnancy (i.e. induced abortion). On 28

May 2007 I, Brent Rooney, swore an affidavit in Vancouver, Canada that includes a copy

of the 16 January 2006 email from Dr. Philip Steer to Brent Rooney and I will mail a

hard copy of that affidavit to those who request it. The BJOG publication is owned by the

RCOG ( Royal College of Obstetricians and Gynaecologists of Britain ) which is very

comfortable with TOPs (induced abortions), since hundreds of its members perform IAs

(Induced Abortions). Those convinced that the 16 January 2006 Dr. Philip Steer email to

whatsup@vcn.bc.ca is bogus can request Dr. Steer to swear an affidavit to that effect.

 

[To subscribe to the monthly Justice For Kids NOW Bulletin ezine, send an

email to <fullterm40@gmail.com> with “JFK-NOW” in the subject line.]

 

The objective evidence supporting APB (Abortion Preterm Birth) risk:

 

A. The Institute of Medicine affirmed APB risk in a 2007 textbook; on page 625 Greg R.

Alexander (ScD) listed “Prior first trimester induced abortion” as an “Immutable

Medical Risk Factor Associated with Preterm Birth”.(Preterm Birth: Causes, Conse-

quences, and Prevention ( Behrman RE, Butler AS, Alexander GR, National Acade-

mies Press 2007)); http://www.nap.edu/openbook.php?record_id=11622&page=625

Greg Alexander (ScD) was an eminent scientist in the field of reproductive medicine.

 

B. Four 21st century very extensive APB reviews support higher risk. [Oppenraaij, 36;

Rooney/Calhoun, 5; Thorp/Hartmann/Shadigian, 6; Swingle, 35]

 

C. A recent brilliant review of preterm birth risks in general by Dr. Deirdre J. Murphy

addressed the issue of the APB risk:

 

Induced abortion has been associated with very preterm delivery (<33 weeks) in

the French regional EPIPAGE study (OR 1.5, 95% CI 1.1-2.0)[27] and this was con-

firmed by the International EUROPOP study across ten European countries.[28]

The strength of association increased with decreasing gestational age and was con-

sistent across countries with varying rates of induced abortions. The increased risk

included idiopathic preterm labour, preterm premature rupture of membranes and

antepartum haemorrhage, but not maternal hypertension indicated delivery. In a 2

high-risk population of American women a previous second trimester delivery or

termination before 20 weeks was associated with pre-viable premature rupture of

membranes or labour (14-25 weeks)[29].”[reference #s 27, 28, & 29 are Murphy's]

 

D. The 2009 'Swingle' meta-analysis using data from previous APB studies reported that

women with prior induced abortions significantly elevated their very preterm deliv-

very (under 32 weeks' gestation) relative odds by 64% (OR 1.64, 95% CI 1.38-1.91).

 

E. The world's most respected preterm birth expert, Dr. Emile Papiernik, co-authored

a 2004 Human Reproduction study that reported that prior IAs boost the risk of deliv-

ery under 33 weeks' gestation; one prior IA elevates relative odds by 34% whereas

2 or more prior IAs raise the relative odds of a very preterm birth by 82%.[Ancel, 28]

Dr. Emile Papiernik was the head of a French national program that slashed France's

France's premature birth rate by 52% between 1972 and 1989.[Luke, 30]

 

F. Leading medical researchers in the reproductive health field who support APB risk:

Emile Papiernik (MD), Judith Lumley (PhD), Barbara Luke (ScD), Greg Alexander

(ScD), John Thorp (MD), Elizabeth Shadigian (MD), Carolyn Moreau (MD), Gordon

CS Smith (MD), Byron Calhoun (MD), Deidre Murphy (MD), Manfred Voigt (MD),

Hanes Swingle (MD), Robert Romero (MD), Robert L. Goldenberg (MD), Jay

Iams (MD)

...............................................................................

Counter Arguments Against the APB Risk

 

Defendants in an ABD (Abortion Brain Damage) law suit can counter with many

arguments against the APB risk, including the following (not an exhaustive list):

 

1. The evidence for the APB risk is inconclusive -

 

In medical studies (epidemiology) 100% conclusive evidence NEVER exists!!! Dr.

Philip Steer on 16 January 2006 conceded that the evidence that induced abortions

(termed TOPs) increase preterm labour risk was “overwhelming”. Most court rooms

will be impressed that the APB evidence, according to the Editor-in-Chief of BJOG

(British Journal of Obstetrics and Gynaecology), is “overwhelming”. However,

overwhelming” is short of 100% conclusive. It is safe to say that the evidence that

the evidence supporting APB risk is very strong. Those who want a hard copy of my

affidavit that includes a copy of the 16 January 2006 Dr. Philip Steer's “overwhelm-

ing” email can request a copy from Brent Rooney (email: fullterm40@gmail ).

 

2. No one has ever proven a causal link between prior induced abortions and higher

subsequent risk of preterm birth (delivery under 37.0 weeks' gestation).

 

Saying that no one has ever proven a causal link between prior IAs and elevated risk

of preterm birth is as enlightening as asserting that “fish do not peddle bicycles”. The

medical science of epidemiology NEVER proves a causal link between a possible risk 

factor and an adverse outcome. I.E. demands for proof of a “causal link” are patently

bogus 'red herrings'. In SCIENCE the BURDEN of PROOF is on those making a

claim, NOT upon those disputing the claim. Abortion providers claim that their pro-

cedure is 'safe'; in fact, many abortion providers and supporters have claimed that

induced abortion is many times safer in general than child delivery. So, the abortion

providers have the BURDEN of PROOF of demonstrating safety. That BURDEN of

PROOF is even heavier on providers of surgical abortions (“suction”, D & C, D & E,

D & X), since none of them have ever been demonstrated as safe via peer-reviewed

published animal studies in medical journals to be safe.[Rooney, 7; URL:

http://www.jpands.org/vol13no4/rooney.pdf ]

 

3. Some studies report no APB risk -

 

Yes, there are many SMALL studies that lack enough subjects for the mathematics to

show at least 95% confidence of higher premature birth risk; numerous small APB

studies were performed before 1985. Between 1993 and 2008 all the massive APB

studies (i.e. at least 30,000 subjects or more than 500 deliveries under 33 weeks'

gestation) support the APB risk. For example, the 2005 'Moreau' study reported that

women with prior IAs had 70% higher relative odds of having a delivery under 28

gestation (i.e. an XPB) compared to women with zero prior IAs.[Moreau, 9] Most of

the studies claimed to not find APB risk, in fact, report HIGHER risk for women with

prior IAs, but because they did not meet the threshold of being at least 95% confident,

some have taken the 'leap' of equating this to not finding raised 'preemie' risk. The

super-massive 2008 'Voigt' APB study reported higher very preterm risk.[Voigt, 34]

 

4. Organizations such as the AMA and ACOG do not recognize the APB risk -

 

Yes, the AMA (American Medical Association) and ACOG (American College of

do not recognize the APB risk. However, neither the AMA nor ACOG has published

a very extensive APB review article in the 21st century in a peer-reviewed medical

journal. Thus, neither the AMA nor ACOG has a peer-reviewed credit to support its

position. A very extensive review must cite at least twenty-four prior APB studies

Also, neither the AMA nor ACOG has challenged the 2003 Rooney/Calhoun review

of the APB risk. The 2003 Rooney/Calhoun review listed forty-nine (49) statistically

significant APB studies.[Rooney/Calhoun, 5 ] A 2007 New England Journal of Med-

cine review article by Jasveer Virk et al. asserted that a majority of prior studies

found no APB risk, but the 'Virk' review only listed a half dozen APB studies, 75%

short of 24 listed studies.[Virk, 27] According to Harriet Washington in her book

Medical Apartheid, the AMA in 1946 (less than 12 months before the proclamation of

the Nuremberg Code) passed a ethical principle that a new medical treatment must

be first safety validated on animals before human trials commence.[Washington, 26]

Thus, the AMA must admit that surgical abortions violate their own principles since

no surgical abortion procedure has a peer-reviewed published animal study to validate

its safety, both short term and long term.

5. Virtually all the APB studies are badly flawed - 

 

If the massive APB studies between 1993 and 2003 are badly flawed, then the May

2003 Rooney/Calhoun (R/C) APB review must also be flawed, since R/C highlighted

results from these massive studies.[Rooney/Calhoun, 5] 73 months since publication

of R/C has produced zero letters to the editor (email: editor@jpands.org) to challenge

the R/C review. The Journal of American Physicians and Surgeons Editor-in-Chief

has affirmed that there is no time limit to challenging the Rooney/Calhoun paper; URL

: http://www.jpands.org/vol8no2/rooney.pdf .[Rooney/Calhoun, 5] All four extensive

21st century APB reviews support APB and AVPB (Abortion Very Preterm Birth) risk.

[Oppenraaij, 36; Rooney/Calhoun, 5; Thorp/Hartmann/Shadigian, 6; Swingle, 35]

 

6. D & C (Dilation & Curettage) abortions elevate later risk of preterm birth, but the

newer “suction” (aka vacuum aspiration) abortion procedure does not boost risk -

 

Both D & C and VAA ( Vacuum Aspiration Abortion ) raise the subsequent risk of

premature delivery. In developed countries VAA was the most common IA procedure

by the mid to late 1970s. For the massive APB studies after 1989 well over 70% of

the IAs performed on subjects were VAA, not D & Cs (or D & Es). For example, the

2008 Winter addition of the Journal of American Physicians and Surgeons carried a

peer-reviewed article by Brent Rooney (MSc), Byron Calhoun (MD, MBA), and Lisa

Roche (J.D.), which listed 6 studies reporting that women with prior induced abortions

had significantly higher risk of extremely premature deliveries than women with no

prior IAs.[9-14] The 1980 'Levin' [14] study had a small number of subjects and a

substantial portion of the abortions may have been D & Cs. However, in the other

five (5) studies (all after 1992) VAAs constituted over 70% of the IAs performed.

[9-13] Rooney/Calhoun/Roche revealed that, in violation of the 1947 Nuremberg Code

suction” abortion has zero published animal studies in peer-reviewed journals to

validate its safety.[Rooney, 7]

 

7. No one has proven that induced abortion is unsafe -

 

Again, this an attempt to shift the BURDEN of PROOF from those making the claim

of abortion 'safety' onto those disputing abortion 'safety'. The United States has legal

decisions affirming the right of informed medical consent before a medical procedure

is performed. Normally, an abortion provider will require that a woman seeking an

IA sign a consent form. An honest & logically minded court may well consider that

a consent form that does not list “increased future risk of premature delivery” has

made an IMPLIED claim of “no raised risk of a subsequent preterm delivery”. In

SCIENCE the BURDEN of PROOF of a claim lies upon those making the claim, not

upon those disputing the claim. Thus, the abortion provider must bear the burden of

demonstrating that the surgical abortion procedure that he/she performed poses no

increased risk of a future preterm birth. The reader will notice the switch from a well

known phrase “BURDEN of PROOF” to a more accurate “Burden of Demonstration”

. PROOFS only apply to pure mathematics and pure logic. 100% absolute proof never

exists in medicine; yes, confidence of a risk can reach 99.9% (e.g. heavy and long

term smoking elevates lung cancer risk), but 99.9% is not 100%. There are many

devices to 'demand' that 'proof' of risk be provided, terms such as DEFINITIVE,

CERTAIN, DEFINITIVE, SURE, CAUSALITY, DIRECTLY LINKED, & CAUSAL

. All of these terms and many more are simply disguised attempts to shift the

the BURDEN of PROOF and that the 'proof' be virtually 100%. If 'you' stepped into

a bus, immediately smelled alcohol in the direction of the bus driver, were ~~~~90%

convinced that the driver was impaired, would 'you' quickly exit the bus, OR would

'you' think, “I need conclusive proof of driver impairment before I'll get off this bus”?

 

8. The APB studies do not show at least a doubling of future premature birth risk and

thus, the APB risk should be dismissed -

 

Some U.S. judges have 'bought into' the concept that unless a risk factor at least

doubles the odds of an adverse outcome, that risk factor should be ignored. If that

'doubling concept' is true, then one would expect that authoritative epidemiological

textbooks would support that concept. No epidemiology textbook, to the knowledge

of Brent Rooney, makes such a claim. Your lawyer should consider asking the

defendant's lawyer to provide a quote from an authoritative epidemiology textbook

supporting the 'doubling concept'. In a 1998 paper lawyer John Kindley explains why

the 'doubling concept' is flawed.[Kindley, 17] Even if a judge honestly accepts the

'doubling concept', is all lost for your plaintiff's case? Hardly! Call the plaintiff's mom

'Alice' and her handicapped daughter 'Beth' (who was born under 32 weeks' gestation).

In 1998 a prestigious European medical journal published the 'Martius' study of 106,

346 singleton births.[Martius, 18] Here are the 'Martius' results for very preterm birth:

 

No. Prior IAs Odds of a VPB (i.e. delivery under 32.0 weeks' gestation)

1 2.5 (relative very-preterm odds boosted by 150%)

2 5.2 (relative very-preterm odds increased by 420%)

3 or more 8.0 (relative very-preterm odds elevated by 700%)

 

Notice that 1, 2, or more prior IAs all exceed the doubling risk threshold and there is

what medical researchers term 'dose-response' (i.e. the more prior IAs the higher the

risk). Consider the 2005 'Moreau' study.[Moreau, 9]

 

No. Prior IAs Odds of a VPB (under 33.0 weeks' gestation in this French study)

1 1.3 (relative very-preterm odds raised by 30%)

2 or more 2.6 (relative very-preterm odds hiked by 160%)

 

If 'Alice' had more than 1 IA before “Beth's” birth, then plaintiff's lawyer can point to

a more than doubling of very preterm birth risk, according to the 2005 'Moreau' study.

[Moreau, 9] In both the 'Martius' study and the 'Moreau' study “suction” abortions

were the most frequent abortion procedure. In the U.S. about 12% of IAs are 2nd

trimester D & Es ( Dilation & Evacuations ), but the D & E rate for U.S. teenagers is

about 30%. The 1999 'Zhou' study reported these preterm birth odds for D & E:

6

No. Prior Odds of a later

D & Es Preterm Delivery

_________________________________________

1 2.27 (relative preterm odds increased by 127%)

2 or more 12.55 (relative preterm odds boosted by 1155%) [Zhou, 20]

 

Your lawyer might suggest to a court wedded to the 'doubling concept', that since

surgical abortions have never been validated via peer-review published animal

studies, these procedures do not deserve such a lofty standard as doubling.

 

Let's consider a 'worst case scenario':

1. 'Alice' (the mother) had exactly one prior “suction” abortion

2. The judge accepts the 'doubling concept'

3. The judge does not see enough evidence to support a doubling of preterm birth

risk for women with exactly one prior “suction” abortion

 

All is 'lost', correct? No! The plaintiff ('Beth', not 'Alice') presumably has a serious

handicap, such as Cerebral Palsy, or else the law would not have been launched.

Maternal infection and neonatal infection are accepted risk factors for CP. For ex-

ample, in 1997 Nelson and Grether reported in the Journal of the American Medical

Association that if the mother of a full-term newborn has an infection (as evidenced

by a maternal temperature of at least 38 degrees Celsius), her newborn has 9.3 times

the odds of CP as a full-term newborn whose mother did not have an infection.

[Grether, 21] Pediatrician Dr. Elliot Gersh in the book Children with Cerebral Palsy

lists infection as a CP risk factor.[Geralis, 22] Look at any induced abortion consent

form and you will see infection listed as a risk. It is accepted that maternal infections

are often passed onto the gestating baby. It was reported in Lancet in 1995 that a

newborn under 32 weeks' gestation with 'chorioamnionitis' diagnosed has 4.2 times

the CP risk as a newborn without associated chorioamnionitis .[Murphy, 24] This

inflammation of the placenta normally implies maternal bacterial infection.

 

9. There may be evidence linking prior IAs to higher premature birth risk, but there are

no studies showing that prior abortions boost CP risk in future newborns -

 

[CP is usually diagnosed between ages 18 months and 4 years] Even if there were

zero studies reporting raised CP risk in infants of women with prior IAs, it is clear

that prior IAs elevate preterm birth risk [Rooney, 5] and that preterm babies have a

higher risk of CP than do full-term newborns.[Behrman, 2]. Swedish researchers in

2002 reported that Swedish women with prior IAs raised their relative odds of deliv-

ering a newborn with CP by 60%; they came within .01 of being at least 95% confi-

dent of increased CP risk; the 95% confidence interval was 0.99-2.58.[Jacobsson,

25] One might have expected that such a key finding to be broadcast in the abstract

or at least be emphasized in the main text.[Jacobsson, 25] That finding was 'buried'

in a table. This might suggest to many that these researchers were fearful of high-

lighting this finding and that other researchers may also be fearful of reporting such 

a high impact result. If thorough animal testing had been done, including possible

neurological damage, for all surgical abortion procedures, abortion providers might

be able to offer some measure of confidence of no neurological damage risk from

surgical abortions. (CP, mental retardation and epilepsy are manifestations of neuro-

logical damage; autism may also be a result of neurological damage.)

 

10. There are only two or three researchers asserting an APB risk, and since they are all

so-called 'pro-life', they are biased and their results can not be trusted -

 

A plaintiff lawyer in an ABD (Abortion Brain Damage) would love to have this

this bogus claim made by the defense. Here's why. Judith Lumley (PhD) disdains

pro-lifers, telling journalists that pro-lifers are only concerned with the morality

of abortion, but are not at all concerned with women's health. Lumley wrote a

2003 review article about a wide range of premature birth risk factors. “Prior preg-

nancy losses are usually perceived as biological risk factors when they are spon-

taneous and as social factors when they are induced. There is increasing evidence

that their impact on the risk of preterm birth is virtually identical.”[Lumley, 29]

What does Lumley mean by a 'prior pregnancy loss that is induced'? That is jargon

for induced abortion. This is clear since the citation in Lumley's quote above was

was reference 11 below which has the title: “The association between prior spon-

taneous abortion, prior induced abortion and preterm birth in first singleton births”.

Two (2) of the six statistically significant studies reporting that prior IAs boost the

future risk of an extremely preterm birth were authored by Australian researcher

Judith Lumley (PhD).[Lumley, 11,13]

 

In the field of premature births the name Dr. Emile Papiernik is 'golden'; Papiernik

led a French government effort between 1972 & 1989 that saw the French premature

birth rate plunge by 52% (from 8.2% to 3.9%). If Dr. Papiernik had ever joined in

any pro-life efforts, this would have been major news and a real eye-opener for many

about the APB risk. However, this has never happened. Dr. Papiernik in 2004 was

was co-author of a Human Reproduction study that reported, “Previous induced

abortions were significantly associated with preterm delivery and the risk of preterm

birth increased with the number of abortions.” This 2004 report with subjects from

ten (10) European countries found that one prior IA boosted relative odds of a delivery

before 33 weeks' gestation by 34%, whereas more than 1 prior IA boosted relative

odds of a very preterm delivery by 82%.[Ancel, 28]

 

Barbara Luke (ScD, RN, RD) is very highly regarded reproduction health expert and

has been a professor at leading U.S. universities (U. Michigan, U. Miami, Michigan

State U.). In 1995 Prof. Luke authored the classic book “Every Pregnant Woman's

Guide to Preventing Premature Birth”. In the preface to Luke's book the giant of the

prematurity field, Dr. Emile Papiernik, wrote, “I wholeheartedly recommend Dr.

Luke's book to every pregnant woman and her family as the “best medicine” to

help ensure a healthy pregnancy.” Professor LUKE covered 60 different premature

birth risk factors in her 1995 book. On page 32 Luke wrote, “If you have had one or 

more induced abortions, your risk of prematurity with this pregnancy increases about

30 percent. If they were done during the second trimester, after 14 weeks, your

subsequent risk of prematurity is greater than if they had been done during the first

trimester, before 14 weeks.”[Luke, 30] In 2005 Barbara Luke received the March of

Dimes Agnes Higgens award in Maternal-Fetal Nutrition. Prof. Luke's profile:

http://www.drbarbaraluke.com/aboutDrLuke.cfm and Luke lists 'preemie' risks at:

http://www.drbarbaraluke.com/prematurity.cfm (sixty different risks).

 

Dr. Philip Steer, Editor-in-Chief of the highly respected British Journal of Obstetrics

and Gynaecology, has expressed his opinion that induced abortions have both benefits

and risks, and has never to the knowledge of Brent Rooney, suggested that IAs should

be entirely avoided by pregnant women. On 16 January 2006, Dr. Philip Steer (email:

p.steer@imperial.ac.uk ) conceded that the evidence for prior IAs elevating premature

labour risk was “overwhelming” in an email to Brent Rooney ( whatsup@vcn.bc.ca ).

Dr. Steer wrote:

 

I still feel it was fatally unbalanced because contrary to what the author below says,

they were not trying to establish that the link between TOP and preterm labour (which

none of us dispute, the evidence is already overwhelming ) but to quantify the cost of

the resulting preterm labour .....”

 

(TOP = Termination Of Pregnancy = Induced Abortion)

 

11. Women who have premature deliveries are more likely to accurately recall prior

abortions than women with full term babies and this better recall makes it appear

that women with prior abortions have higher 'preemie' risk than women with zero

prior abortions -

 

The defendant is very likely to use this argument. In epidemiological studies data is

often gathered via interviews of the subjects. It can be the situation that subjects

with a bad outcome (e.g. cancer) will be more accurate in recalling past events (in-

cluding medical history) than 'control' subjects without a bad outcome. This is

termed 'recall bias'. If there is substantial 'recall bias' and this is not known by the

researchers, they may well report as significant a risk factor that is not truly a risk

factor. The 1999 'Zhou' study avoided this possible pitfall by ascertaining IA history

NOT via interviews, but by accessing Denmark's Induced Abortion Registry.[Zhou

, 20] Australia does not have a national abortion registry, but one can be very con-

fident that both Judith Lumley (PhD) studies are free of 'recall bias'.[Lumley, 11,13]

In both studies Lumley's subjects were women delivering a first singleton (i.e. no

twins or multiple births). Data about prior medical history was collected perinatallty

(i.e. BEFORE a woman's delivery) and thus, 'recall bias' can be, by any reasonable

standard, excluded. The 1998 Lumley study with 243,679 subjects was the largest

APB study before 2008. Both of the Lumley studies and the 1999 'Zhou' study

reported that prior induced abortions significantly elevated preterm birth risk.

The plaintiff's lawyer in an ABD (Abortion Brain Damage) law suit can inform the 

court, “Your Honor, one of the important reasons for performing animal testing is

is that 'recall bias' is never, repeat never, an issue, since unlike in many human

studies interviews of the subjects are never employed to gather data. This again

brings to light the tragedy and bioethical outrage of the failure of abortion doctors

to safety validate surgical abortions on animals. Let me further inform the court that

the Institute of Medicine in a 2007 textbook identified non-human PRIMATES as

the most relevant test animals for human reproduction.”[Behrman, 2]

 

The 2005 'Stang' study collected data perinatally as did Lumley, but not all of the

deliveries were FIRST deliveries.[Stang, 12] The chance of significant “recall bias”

is very low but not as extremely low as in the Lumley studies. There are other APB

studies in which data was collected perinatally (e.g. 'Voigt' 34).

 

12. All of the APB studies fail to use the right control group, which is women without

prior IAs who delivered a first singleton newborn. If this control group had been

used, none of these studies would have reported elevated 'preemie' risk -

 

The largest APB study before 2008 with 243,679 Australian subjects was the 1998

study by Judith Lumley (PhD).[Lumley, 11] Prof. Lumley's (Latrobe U.) subjects

were women with no prior induced or spontaneous abortions delivering a first

singleton newborn.[Lumley, 11] I.E. Lumley's control group is exactly the control

group demanded by the researchers such as Carol JR Hogue (PhD). Everything

else being equal a woman's first term pregnancy has the highest prematurity risk

(less than 37 weeks' gestation). Thus, one might suspect that Carol Hogue and others

want an APB control group that will minimize the relative risk reported. Judith

Lumley (PhD) used precisely the control group they demanded. One of the results

of the 1998 Lumley study was that women with more than 3 prior IAs had nine

times the risk of a delivery under 28.0 weeks' gestation as women with zero prior

abortions (spontaneous or induced).[Lumley, 11]

 

13. APB studies are invalid because of what is termed in medical studies “confounding”

(some other 'hidden' risk factor really accounts for the raised preterm birth risk,

not the prior induced abortions) -

 

Confounding in general can best be described via a hypothetical example. A study

is done to see if coffee consumption increases the risk of lung cancer. The results

very unexpectedly showed that those who drank coffee had 4 times the lung cancer

risk as non coffee drinkers. In this hypothetical study the researchers did not ascer-

tain whether coffee drinkers are were more likely to be cigarette smokers compared

to the non coffee drinkers. Thus, the 'study' was 'confounded' by cigarette smoking,

since it is indeed the case that coffee drinkers are more likely to be smokers than

coffee abstainers.

 

The assertion that a study may be subject to confounding is quite common, since

it is quite easy to suggest possible risk factors that were not considered. Can the 

APB risk be much discounted due to possible confounding? Judith Lumley (PhD)

addressed this issue in a 1993 study.[Lumley, 13] Lumley reported the following

relative risk of extremely preterm birth by number of prior IAs:

 

No. Prior Relative Risk of Delivery

IAs Under 28 Weeks' Gestation (XPB)

1 1.55 (55% increase in relative risk)

2 2.46 (146% boost in relative risk)

3 or more 5.58 (458% boost in relative risk)

 

Lumley asked readers to consider the effect of multiple prior IAs on XPB risk:

Increased relative risks of the magnitude of +146% and +458% clearly can not be

explained by socio-economic status, parity [i.e. number of births], maternal age,

or substance abuse, etc., since none delivers such a large risk boost.[Lumley, 13]

Lumley could have also pointed out that confounding does NOT explain why there

is what is termed 'does/response' (the more the number of prior IAs the higher the

relative risk). Lumley's full 1993 quote addressing confounding is found in the May

2003 Rooney/Calhoun APB review.[Rooney/Calhoun, 5; URL:

http://www.jpands.org/vol8no2/rooney.pdf] Extremely preterm newborns have 129

times the Cerebral Palsy risk as full-term newborns according to a 2008 meta-

analysis (i.e. study of studies) by Himpens et al.[Himpens, 3]

 

Confounding in animal studies is very drastically less of a problem than in human

studies. This reminds us yet once again of the unforgivable ethical violation of

abortion pioneers in failing to publish animal studies of preterm birth & mammary

tumor risk for animals with prior surgical abortions.[Rooney, 7]

 

14. There is no mechanism by which “suction” abortion, etc. can cause preterm risk -

 

In their May 2003 review article Rooney and Calhoun listed five (5) side-effects

of induced abortion that make future premature births more likely:

a. Infection b. Incompetent CErvix ('ICE') c. Uterine adhesions [scar tissue]

d. Increased maternal age e. Mental distress [Rooney/Calhoun, 5]

 

The most consistent assoications and highest risk for preterm birth have been
reported with bacterial vaginosis, with the majority of relative risks between 1.5
and 2.5, but ranging as higher as 6.9”.[Kramer, 37] Surgical IAs cause infections.
IAs also boost PTB risk via higher odds of substance abuse, and uterine anom-
alies. In an ABD law suit the plaintiff should have a copy of the consent form that
she signed and which she is legally entitled to have. It would be a very rare IA
consent form that does not list infection as one of the risks; surgeries employing
a sharp edged instrument that enters the human body impart an increased infection
risk; (perhaps, laser surgery (not currently employed in induced abortions) does not
elevate infection risk).

15. The medical journals reporting raised preterm birth risk for women with prior 

induced abortions are obscure publications and clearly out of the main stream -

 

The 'Big Four' medical journals, in terms of prestige are:

BMJ (British Medical Journal),

JAMA (Journal of the American Medical Association),

LANCET (Published in Britain),

NEJM (New England Journal of Medicine)

 

All of the 'Big Four' have published statistically significant APB studies. Here is a

partial listing of other medical journals to publish significant APB studies:

American Journal of Public Health, American Journal of Obstetrics and Gynecology,

Obstetrics and Gynecology, British Journal of Obstetrics and Gynaecology, Epidem-

iology, International Journal of Epidemiology, Journal of Reproductive Medicine,

American Journal of Epidemiology, European Journal of Obstetrics & Gynecology

and Reproductive Biology

 

Medical researcher Brent Rooney is unaware of even one peer-reviewed medical

journal to publish an statistically significant study finding that women with prior

surgical abortions, in general, have LOWER (not higher) risk of preterm delivery

than women with zero prior surgical abortions. Those who can cite such a study are

cordially invited to send the purported citation of the article to Brent Rooney (email:

( fullterm40@gmail.com ). Even if one or two such studies are 'unearthed', they are

still wamped by the more than 58 significant studies reporting higher 'preemie' risk.

 

16. The latest research does not support APB risk -

 

By far the most massive APB study in the last 30 years (1,065,202 births) was con-

ducted in Germany. In Febuary 2008 Dr. Manfred Voigt et al. reported the following

results for VERY PRETERM BIRTH (VPB, delivery under 32.0 weeks' gestation):

A woman with one prior IA boosted relative VPB risk by 30%

More than one (1) prior IA raised relative VPB risk by 90%

 

Certainly, many previous APB studies ascertained IA history via the researchers

and their associates interviewing women subjects. It can be claimed that women who

deliver preterm may not accurately recall their IA history. 'Voigt' avoided this possi-

bility by obtaining IA history from the German Perinatal Database.[Voigt 34] Between

1998 and 2008 there were three statistically significant APB studies using German

women as subjects and all three reported that prior IAs increased risk of a delivery

under 32 weeks' gestation.[Voigt, 34; Martius, 18; Stang, 12]

 

17. If there is an APB risk, it applies to women in Europe or Asia, not American women -

 

This argument implies that Boston women are not American women. 'Levin' and

'Lieberman' both used Boston women and both reported higher preterm birth risk

for women with prior IAs.[Levin 14;Lieberman 15] And there are other studies using 

U.S. women as subjects. Even if there had never been any statistically significant

APB studies with U.S. women subjects, we return to the issue of BoP (Burden of

Proof). Those who provide surgical IA procedures normally imply that there is no

APB risk (via NOT listing such a risk on the consent form). Thus, they shoulder the

BoP of demonstrating no raised risk of premature birth from prior surgical abortions.

As for 'chemical abortions' (aka 'medical abortions'), there are not even animal studies

demonstrating no raised risk of neurological damage in newborns for animals with

prior chemical abortions. Neurological damage in a newborn is associated with higher

risk of Cerebral Palsy, autism, epilepsy, and mental retardation.

 

18. Recent improvements to “suction” abortion make the procedure safer with one bene-

fit being no risk of preterm birth -

 

This is known in advertising as 'bait & switch'. When D & C was the most common

abortion procedure, D & C was claimed to be 'safe,. but when “suction” abortion

became popular, it was admitted that D & C had some risks, but that “suction” was

safer; in fact “suction” abortion in the late 1960s and early 1970s was 'very safe'. In

the 1970s sea weed (laminara) was tried to more safely open the cervix, which means

that previously “suction” abortion posed a risk a damaging the cervix. What test

animals were used when new techniques were first tested, monkeys, chimpanzees, or

or gorillas? No, the test 'animals' were always human women, human 'Guinea pigs'.

The Burden of Proof that improvements to an abortion technique has eliminated a

risk rests on the abortionists.

 

19. Some recognized medical experts, such as Carol Hogue ( PhD, Emory U. ), claim

there is no APB risk -

 

Carol JR Hogue (PhD) goes further than that and says it is “settled science”, that

there is no APB risk. Let's say that a PTB 'expert' such as Carol Hogue is on the

witness stand. Here are some questions that could be put to such a witness ( call

her Dr. Ham) by the plaintiff lawyer (call him Mr. Irish); plaintiff is “Miss Jones”.

[For most readers the following will be very BORING, but lawyers may find some

of the text useful:]

 

Irish: Dr. Ham, is it true that statistically significant studies carry much more

intellectual weight, in general, than studies that are not statistically signifi-

cant?

Ham: Yes. [ She may hem and haw, but if she says anything other than 'yes', she

will discredit herself ]

Irish: A statistically significant study is one in which the researchers are at least

95% confident of higher risk or are at least 95% confident of decreased

risk. Is that correct?

Ham: Yes, but on occasions a lower standard of 90% is used instead of 95%.

Irish: In the 2007 'Calhoun' study in the Journal of Reproductive Medicine fifty-

eight studies reported statistically significantly higher risk of preterm birth 

for women with prior surgical abortions were listed. How many statistically

significant published studies report that women with surgical abortions

have a lower, not higher risk, of a later preterm delivery than women with

zero prior induced abortions? ['Calhoun' is reference 31 in this document]

Ham: There may be one. [It is possible she may not know of any]

Irish: So the 'tale of the tape' for the statistically significant studies of surgical

IAs is: 58 report higher preterm risk for women with prior surgical IAs

1 reports lower preterm risk for women with prior surgical IAs

Is that correct?

Ham: Yes. [Ham might also say she has not read the 'Calhoun' study]

Irish: Is fifty-eight (58) 5,700% greater than one?

Ham: Yes.

Irish: One of the 58 studies listed by 'Calhoun' was the 2004 study by Pierre

Ancel with one of the co-authors being Dr. Emile Papiernik (France) in

the medical journal Human Reproduction. Is it true that Dr. Emile Papiernik

is a world renowned preterm birth expert?

Ham: Yes.

Irish: In this 2004 Human Reproduction study Ancel, Papiernik et al. reported

that women with one prior IA had 34% higher relative odds of a very pre-

term birth and women with more than one prior IA had a 82% higher rela-

tive odds of a very preterm birth. Is that correct, Ms. Ham?

Ham: Yes, but the odds are less than doubled by prior induced abortions.

Irish: These French researchers used a definition of under 33.0 weeks' gestation

as 'very preterm', but most other countries use a definition of under 32.0

weeks' gestation as very preterm. Is that correct?

Ham: Yes.

Irish: Very preterm newborns have much higher risk of serious disabilities such as

mental retardation, cerebral palsy, blindness, serious infections etc. than

those 'preemies' born between 34.0 and 37.0 weeks' gestation, is that right?

Ham: Yes.

Irish: And so the fact that Dr. Pierre Ancel, Dr. Emile Papiernik et al. reported

significantly higher risk of VERY preterm birth implies a credibly higher

risk of newborn with mental retardation, cerebral palsy, and serious infec-

tions, correct?

Ham: Yes. [But Ham can downplay this by saying the APB risk has not been

proven conclusively, implying that conclusive proof is ever possible.]

Irish: Is it true that Dr. Emile Papiernik headed a French national program

between 1972 and 1989 that saw the French preterm birth rate plunge by

52%

Ham: Yes. [“Dr. Ham” may not know the 52% figure]

Irish: Dr. Ham, here is a copy of the abortion consent form signed by Miss Jones on

3 July 2008 [ handing expert witness “Dr. Ham” a copy of the consent form].

Does that consent form list infection as a possible side-effect of the procedure

[which could be a “suction” abortion, D & C, D & E, or D & X]?

Ham: Yes. 

Irish: Could such an infection be within the uterus, vagina, ovaries, or fallopian

tubes?

Ham: Yes. [If Ham should answer “NO”, lawyer 'Irish' should ask Dr. Ham to pro-

reliable authorities who assert that a surgical abortion does not elevate risk

of infection of the uterus [womb], vagina, ovaries, fallopian tubes, or the uro-

genital tract. It would be to the advantage of 'Irish', if Dr. Ham claims no such

infection risk, since that would discredit “Dr. Ham”]

Irish: Does a urogential infection in a pregnant woman, in general, elevate her odds

of delivering a preterm (i.e. under 37.0 weeks' gestation) newborn compared

to a pregnant women without a urogenital infection?

Ham: Yes. ['Irish' would not mind if “Dr. Ham” answers “No”, so she can discredit

herself as a reproductive health expert.]

Irish: In the 2007 edition of an Institute of Medicine textbook Greg R. Alexander

(ScD) in Appendix B identified fourteen ( 14 ) “Immutable Medical Risk

Factors Associated with Preterm Birth” and one of the 14 is “Urogenital

infections”. So, Dr. Ham, are you in agreement with eminent scientist Greg

Roy Alexander that a “Urogenital infection” elevates preterm birth risk?

Ham: Yes. [A “No” would contradict “Dr. Ham's” prior answer]

Irish: Since urogenital tract infection is a preterm birth risk and the abortion

procedure “Miss Jones” underwent increases the risk of infection, which in-

cludes the urogential tract, the consent form signed by “Miss Jones” implied

that the abortion procedure would elevate her risk of a future preterm birth,

is that correct?

Ham: The odds of “Miss Jones” still having a serious urogenital tract infection or

any other infection as a result of a surgical abortion in a subsequent preg-

ancy is very slight. Postabortive “Miss Jones” can be treated successfully

with antibiotics as many women in her position have.

Irish: Is the American Journal of Obstetrics and Gynecology a respected mainline

medical journal in the field of reproductive health?

Ham: Yes.

Irish: Please read the one sentence conclusion section of the abstract of a 1998

published study by medical researchers Marijane A. Krohn et al published in

American Journal of Obstetrics and Gynecology [Irish hands Dr. Ham a copy

of the five page study [Krohn, 23]].

Ham: In the Conclusions section of the abstract it reads, “Women who have had a

spontaneous abortion or an elective termination have an increased risk of

intraamniotic infection infection regardless of previous successful preg-

nancy outcome.”

Irish: It is important to know how much a prior induced abortion elevates the odds

of a subsequent intraamniotic infection (an infection of the amniotic sac that

encloses the gestating baby). The results section of that same abstract is only

2 sentences long. Does the results section claim that a prior “elective termin-

ation” multiplies a woman odds of a intraamniotic infection by a factor of 4?

Ham: Yes.

Irish: Are researchers Krohn et al. at least 95% confident of increased risk? 

Ham: Yes.

Irish: If the amniotic sac is infected (via the intraamniotic infection), does that

increase the risk that the gestating baby inside will have an infection?

Ham: Yes

Irish: If the amniotic infection leads to a infected gestating baby in the first or

or second trimester, could those viruses or bacteria enter the baby's brain?

Ham: Early in the first trimester the baby does not have a brain.

Irish: After the gestating baby has a brain in the first trimester, could the micro-

organisms from the intraamniotic infection enter the gestating baby's brain?

Ham: Yes.

Irish: Is Cerebral Palsy a malady due to damage to the human brain?

Ham: Yes.

Irish: Can viruses or bacteria cause damage to the human brain?

Ham: Infections of the brain are rare because entry of micro-organisms into the

brain are normally effectively blocked by the 'blood-brain barrier'..

Irish: Surely that applies to adults, Dr. Ham. Is it true that viruses and bacteria

have much easier entry into the brain of a first and second trimester gestating

baby than that of an adult?

Ham: Yes.

Irish: In modern times a new surgery or new drug that has failed to undergo animal

testing, as evidenced by published studies, yet is claimed to be beneficial

to humans, would be termed quackery, am I correct?

Ham: I would term it imprudent medical practice, others may have stronger terms.

Irish: “Dr. Doe” performed a vacuum aspiration (aka “suction”) abortion on “Miss”

Jones”. Would it have been unethical of Dr. Doe to perform a surgical pro-

cedure on “Miss Jones”, if that procedure had never been safety validated

via published animal studies in peer-reviewed medical journals?

Ham: I am not qualified to answer that, since I am not a bioethicist.

Irish: Have you ever read a published animal study of “suction” abortion?

Ham: No.

Irish: You are considered to be one of the foremost experts on induced abortion pro-

cedures. Please tell the court approximately how many articles you have read

relating to the subject of induced abortions.

Ham: Many hundreds, perhaps over 1,000.

Irish: In any of those hundreds, if not 1,000 or more induced abortion studies, do

you remember even one referring to a published animal study of “suction”

abortion?

Ham: I can not recall any particular citation.

Irish: You, “Dr. Ham” have written extensively on induced abortion and you surely

know what you yourself have written. In any of the articles with you as

lead author or a co-author, did any of those articles refer to published animal

studies of “suction” abortion?

Ham: No.

Irish: May it please the court, I submit the following copy of 1947 Nuremberg

Code as “Exhibit N”.[The Court accepts the document .......]. There are ten 

ethical principles in the 1947 Nuremberg Code, the third of which states:

 

3. The experiment should be so designed and based on the results of animal

experimentation and a knowledge of the natural history of the disease or other

problem under study that the anticipated results will justify the performance

of the experiment.”

 

Dr. Ham, as a doctor concerned with the health of women, would you not

be outraged if a new surgical technique was performed on women without

validation via published animal studies?

Ham: Yes, but vacuum aspiration abortion is not a major induced abortion innova-

tion and thus, no animal testing is required.

Irish: Could you elaborate of why you claim “suction” (aka vacuum aspiration)

abortion is not a major innovation?

Ham: Surely, before VAA ( Vacuum Aspiration Abortion ) entered the medical

arena, D & C (Dilation and Curettage) was the most common induced abor-

ion procedure. The main difference between “suction” and D & C is that

with “suction” the 'products of conception” are vacuumed out of the uterus

whereas with D & C pieces of the 'products of conception' must removed

the mother's body, one by one. So, “suction” abortion is much safer than D

& C.

Irish: Can you cite published animal studies showing the “suction” abortion is

safer than D & C?

Ham: No, but it's well known within the profession that “suction” is safer than D

& C.

Irish: Is it true that the key element in a “suction” abortion is termed the “suction

curette” which is a hollow tube (termed a cannula) with a sharp tip termed

a curette?

Ham: Yes.

Irish: Is this element, the “suction curette” also employed in a D & C procedure?

Ham: No.

Irish: Does the D & C procedure apply a vacuum force?

Ham: No.

Irish: Are the actions performed by the abortion doctor the same in “suction”

abortions that same as those performed in a D & C?

Ham: No.

Irish: To sum up, “suction” abortion differs from D & C in the instrument used

and the actions performed by the abortion doctor, is that correct?

Ham: Yes.

Irish: “Dr. Ham” you claim that there is only a trivial difference between D & C

and “suction” abortion. You have not cited published animal studies of

suction”. Can you cite any published animal study demonstrating that

animals with prior D & C abortions do not have elevated future risk of

premature delivery?

Ham: No. 

Irish: Let me see if I understand you correctly. For neither “suction” abortion

nor D & C abortion are there published animal studies in peer-reviewed

medical journals demonstrating no raised risk of preterm delivery for

animals with either one of these induced abortion procedures, is that

correct, “Dr. Ham”?

Ham: There may be such animal studies; I can not cite any such study or studies.

Irish: Previously you testified, that it would be in your words “imprudent medi-

cine” to perform a medical procedure for which there were no published

animal studies, is that correct?

Ham: Yes.

Irish: Certainly, after 1950, if not many years previous, reputable pharmaceutical

companies in developed countries would test all drugs intended for market

on animals before any human trials commenced, is that correct?

Ham: Yes, but there are certain rare exceptions where animal testing is not feasible.

Irish: If no doctors providing “suction” abortion can cite even one peer-reviewed

animal “suction” abortion study, then by the criteria of “Dr. Ham”, such

doctors are practicing “imprudent medicine”, is that correct?

Ham: Yes, but there may be such animal studies. The anti-choice people have not

proven that there are no such published animal “suction” abortion studies.

Irish: “Dr. Ham”, is it not an iron clad convention of science that the burden of

proof lies upon those making a claim, NOT upon those disputing the claim?

Ham: Certainly.

Irish: “Dr. Ham”, if abortion providers claim that they adhere to the Nuremberg

Code and very specifically rule 3 which insists that a new procedure be

safety validated on animals before it is applied to human, is not the burden

of proof of there being published animal “suction” abortion studies on the

shoulders of the abortion providers?

Ham: The burden of proof would be on the abortion providers, if “suction” abor-

tion was markedly different from the D & C procedure, but “suction” abor-

tion is but a very small step up from D & C.

Irish: We will let the court decide whether “suction” abortion is little different

than a D & C. Let's move on. “Miss Jones” “suction” abortion was elective,

not a medically necessary procedure. Can you tell the court what a 'blind'

surgery is?

Ham: The surgeon can not directly visualize exactly where his surgical instrument

is.

Irish: So when the surgeon is cutting or scraping inside a woman's body, if the

surgery is a 'blind' one, the surgeon can not see precisely where his sharp

instrument is or what the effect on the woman's body is?

Ham: Yes.

Irish: Are “suction” abortions 'blind' procedures?

Ham: Some are and some are not. Sonograph guided abortions are not 'blind'.

Irish: Since there was no sonography used in “Miss Jones'” “suction” abortion,

the abortion performed on “Miss Jones” was blind, correct?

Ham: Yes, but the abortion doctor is skilled and no side-effects from the 'blind' 

nature of the abortion are likely to occur.

Irish: After the gestating baby is suctioned out of a woman's womb, to reduce

maternal infection risk, the womb is scrapped with the sharp curette end of

the 'suction curette', is that correct?

Ham: Yes.

Irish: Without sonography the scrapping of the womb is done in a blind fashion,

the abortion doctor could puncture a hole in the woman's womb, correct?

Ham: Yes, but the odds of that happening are no more than one in 1,000 or one in

10,000 .

Irish: Dr. Steven Kaali was a abortion doctor for many years and was the lead

author of a published 1989 study of the perforation risk of “suction” abor-

tions. [see reference 32 below] Would Dr. Steven Kaali be a source likely to

be biased against the 'safety' of “suction” abortions?

Ham: No, but that is not a recent study.

Irish: A copy of the 1989 Dr. Steven Kaali study was given to the defendant in

advance of this trial. “Dr. Ham”, did Dr. Kaali find that women who had a

suction” had very close to a one chance in fifty of having a perforated

uterus as the result of a “suction” abortion?

Ham: Yes, but that is only one study. Other studies report much lower risk of

uterine perforation.

Irish: Did those other studies use a laparscope to detect uterine perforations?

Ham: I do not know.

Irish: In the 1989 Dr. Steven Kaali et al. study [reference 32 below] a laparscope

was used to view the uterus after the first trimester abortions. Would the use

of a laparscope allow accurate detection of uterine perforations?

Ham: Yes, of course.

Irish: [Handing “Dr. Ham” a copy of the Dr. Kaali's 1989 study] Dr. Kaali et al.

reported that the uterine perforation rate was not one in 10,000, not one in

1,000, but was one in 50. Defendant Dr. Doe was given a copy of the Kaali

study prior to trial, so you have had access to it. Can you identify a major

fundamental flaw in the 1989 Dr. Kaali et al. study?

Ham: No, but there are still other studies reporting a much lower perforation risk.

Irish: Are uterine adhesions (i.e. scar tissue) a preterm birth risk factor?

Ham: Uterine anomaly increases premature birth risk, and uterine scar tissue is

is surely a uterine anomaly.

Irish: The tip of the 'suction curette' is a sharp curette used to scrape the uterus

near the end of the “suction” abortion. If this curette tip is sharp enough to

perforate a woman's womb, is it sharp enough to cause uterine scar tissue?

Ham: A highly skilled and experienced abortion doctor will very rarely cause

uterine adhesions via curettage in a “suction curettage” procedure.

Irish: Yet, Dr. Kaali et al. reported a perforation rate of 2% (in 50), is that correct?

Ham: Yes.

Irish: Dr. Ham, is Australia an advanced nation that employs up-to-date abortion

techniques?

Ham: I believe so. 

Irish: Please examine the first page of a first trimester induced abortion consent

form that was posted online on the Internet by Planned Parenthood of Aus-

tralia in 2007 [Irish hands “Dr. Ham” a copy that form that was previously

entered as 'exhibit P']. In 'exhibit P' do you see the following three risks

listed among other risks on the first page:

1. Infection 2. Incompetent cervix 3. Uterine adhesions

Ham: Yes.

Irish: Of those 3 risks, which does not elevate a woman's future risk of a preterm

birth?

Ham: Uterine adhesions may not be a strong preterm birth risk factor.

Irish: So, you can not identify any of those three potential side-effects as not

increasing a woman's future risk of a preterm birth, am I correct?

Ham: I do not disagree with that.

Irish: Since the Planned Parenthood of Australia online consent form listed three

possible side-effects of a “suction” abortion, each a premature birth risk

factor, can you provide a strong reason why that form nowhere informs the

reader that a “suction” abortion elevates a woman's future risk of a preterm

delivery.

Ham: There is no conclusive proof that “suction” abortions increase preterm birth

risk.

............

............

[End of point 19 which is theoretical testimony of an expert witness in a future ABD

law suit. For a short excerpt of REAL testimony in a 1999 law suit about ABC (Abor-

tion Breast Cancer) visit Chapter 3 for the cross-examination testimony of Lynn Rosen-

berg (ScD) who concedes ABC risk.]

 

The preceding list of 19 counter arguments to the APB risk is NOT exhaustive. Medical

studies can be subjected to dozens if not hundreds of potential challenges. Your expert

witnesses should be able to suggest some potential challenges not listed above. If they

can not provide a strong response, readers of this article can present such challenges to

Brent Rooney (MSc, email: fullterm40@gmail).

 

[To subscribe to the monthly Justice For Kids NOW Bulletin ezine, send an

email to <fullterm40@gmail.com> with “JFK-NOW” in the subject line.]

 Brent Rooney (MSc, Preterm Birth Researcher)

RPRC (Reduce Preterm Risk Coalition)
3456 Dunbar St. (Suite 146) Vancouver, Canada V6S 2C2
web: http://www.jpands.org/vol13no4/rooney.pdf
http://www.jpands.org/vol8no2/ronney.pdf
email: fullterm40@gmail.com stopcancer@yahoo.com whatsup@vcn.bc.ca

 

References

 

1 Winter S, Autry A, Boyle C, Yeargin-Allsopp M. Trends in the Prevalence of Cerebral

Palsy in a Population-based Study. Pediatrics 2002;110(6):1220-1225

 

2 Behrman RE, Butler AS, Alexander GR. [Book] Preterm Birth: Causes, Consequences,

and Prevention. National Academies Press 2007

[ URL: http://www.nap.edu/openbook.php?record_id=11622&page=625 ]

 

3 Himpens E, Van den Broeck C, Oostra A, Calders P, Vanhaesebrouck P.

Prevalence, type, and distribution and severity of cerebral palsy in

relation to gestational age: a meta-analytic review. Developmental

Med Child Neurology 2008;50:334-340


4 Strauss LT, Gamble SB, Parker WY, Cook DA, Zane SB, et al. MMWR Surveillance

Summaries. Abortion Surveillance (United States, 2004) November 23, 2007/56 (SS09):

1-33 [ URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5609a1.htm ]

 

5 Rooney B, Calhoun BC. Induced abortion and risk of alter premature births. J Amer Phys

Surg 2003;8(2):46-49 [ URL: http://www.jpands.org/vol8no2/rooney.pdf ]

 

6 Thorp JM, Hartmann KE, Shadigian E. Long-Term Physical and

Psychological Consequences of Induced Abortion: Review of the

Evidence. Obstetrical and Gynecological Survey 2003;58(1):67-79

 

7 Rooney B, Calhoun BC, Roche L. Does induced abortion account for racial disparity in

preterm births, and violate the Nuremberg Code? J American Physicians Surgeons 2008;

13(4):102-104 [ URL: http://www.jpands.org/vol13no4/rooney.pdf ]

 

8 Annas GJ. The Rights of Patients: the authoritative ACLU guide to the rights of patients.

New York University Press, New York, NY 2004

 

9 Moreau C, Kaminski M, Ancel PY et al. Previous I induced abortions and the risk of very

preterm delivery; Results of the EPIPAGE study. British J Obstetrics Gynaecology 2005;

112:430-437 [ Abstract URL:

 

10 Smith GCS, Shah I, White IR, Pell JP, Crossley JA, et al. Maternal and biochemical

predictors of spontaneous preterm birth among nulliparous women: a systematic analy-

sis in relation to the degree of prematurity. International J Epidemiology 2006;35(4):

1169-1177

 

11 Lumley J. The association between prior spontaneous abortion, prior induced abortion

and preterm birth in first singleton births. Prenatal Neonatal Medicine 1998;3:21-24

 

12 Stang P, Hammond AO, Bauman P. Induced Abortion Increases the

     Risk of Very Preterm Delivery: Results of a Large Perinatal 

    Perinatal Database. Fertility Sterility Sept. 2005:S159

 

13 Lumley J. The epidemiology of preterm birth. Bailliere's Clinical Obstetrics and

       gynecology 1993;7(3):477-498           

 

14 Levin AA, Schoenbaum SC, Monson RR, Stubblefield PG, Ryan JA. Association of

Induced Abortion with Subsequent Pregnancy Loss. JAMA 1980;243(24):2495-2499

 

15 Lieberman E, Ryan KJ, Monson RR, Schoenbaum SC. Risk Factors Accounting For

Racial Differences In The Rate Of Premature Birth. N England J Medicine 1987;31:743

-748

 

16 MacMahon B, Cole P, Brown J. Etiology of human breast cancer: a review. J National

Cancer Institute 1973;50:21-42

 

17 Kindley J. Fit Between The Elements For An Informed Consent Cause Of Action And

The Scientific Evidence Linking Induced Abortion With Increased Breast Cancer Risk.

Wisconsin Law Review 1998;6:1596-1644 [URL:

http://www.kindleylaw.com/lawreviewarticle.htm ]

 

18 Martius JA, Steck T, Oehler MK, et al. Risk factors associated with preterm (<37+0

weeks) and early preterm (<32+0 weeks): Univariate and multivariate analysis of 106,

345 singleton births from 1994 statewide perinatal survey of Bavaria. European J Ob-

stetrics Gynecology Reproductive Biology 1998;80:183-189

 

19 Zhou W, Sorensen HT, Olsen J. Induced abortion low birth weight in the following

pregnancy. International J Epidemiology 2000;29:100-106

 

20 Zhou W, Sorensen HT, Olsen J. Induced Abortions and Subsequent Pregnancy Duration.

Obstetrics Gynecology 1999;94:948-953

 

21 Grether JK, Nelson KB. Maternal Infection and Cerebral Palsy in Infants of Normal

Birth Weight. JAMA 1997;278:206-211

 

22 [Edited by] Geralis E. Children with Cerebral Palsy. Bethesda, MD: Woodbine House 1998

 

23 Krohn MA, Germain M, Muhlemann K, Kickok D. Prior pregnancy outcome and risk

of intraamniotic infection in the following pregnancy. American J Obstetrics Gyne-

cology 1998;178:381-385 [ URL:

http://pt.wkhealth.com/pt/re/ajog/abstract.00000447-199802000-00029.htm;jsessionid=

JntMM85CgQXvLwv0ChHH1vVGTbQRWd49yMJVPwqrM3JzlqhD0F0t!2138746202!

181195629!8091!-1 ]

 

24 Murphy DJ, Sellers S, MacKenzie IZ, Yudkin PL, Johnson AM. Case-control study of

antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies

. Lancet 1995;346:1449-1454

 

25 Jacobsson B, Hagberg G, Hagberg B, Ladfors L, Niklasson A, Hagberg H. Cerebral

Palsy in preterm infants: a population-based case-control study of antenatal and intra-

partal risk factors. Acta Paediatrica 2002;91:946-951

 

26 Harriet Washington. [Book] Medical Apartheid. Doubleday New York 2007

 

27 Virk J, Zhang J, Olsen J. Medical Abortion and the Risk of Subsequent Adverse Preg-

nancy Outcomes. New England J Medicine 2007;357:648-653

 

28 Ancel P-Y, Lelong N, Papiernik E, Saurel-Cubizoilles M-J, Kaminski M. History of

induced abortion as a risk factor for preterm birth in European countries: results of the

EUROPOP survey Human Reproduction 2004;112:734-740 [ Abstract URL:

http://humrep.oxfordjournals.org/cgi/content/abstract/19/3/734?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=%22History+of+Induced+Abortion+as+a+risk+factor+for+preterm+birth+in+European+countries%22&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

 

 

29 Lumley J. Defining the problem: the epidemiology of preterm birth. British Journal of

Obstetrics and Gynaecology 2003;110(Supplement 20):3-7

 

30 Luke B. Every Pregnant Woman's Guide to Preventing Premature Birth. New York:

Times Books 1995

 

31 Calhoun BC, Shadigian E, Rooney B. Cost Consequences of Induced Abortion as an

Attributable Risk for Preterm Birth and Informed Consent. J Reprod Med 2007;52(10)

:929-937 [URL: http://www.ncbi.nlm.nih.gov/pubmed/17977168 ]

 

32 Kaali SE, Szigetuari IA, Bartfan GS. The frequency and management of uterine perfor-

ations during first-trimester abortions. American J Obstetrics and Gynecology 1989;

161(2):406-408 [Abstract URL: http://cat.inist.fr/?aModele=afficheN&cpsidt=6584960]

 

33 Murphy DJ. Epidemiology and environmental factors in preterm labour. Best Practice &

Research Clinical Obstretrics and Gynaecology. 2007;21(5):773-789

 

34 Voigt M, Olbertz D, Fusch C, Krafczyk D. Briese V, Schneider KT. The influence of

previous pregnancy terminations, miscarriages, and still-birth on the incidence of babies

with low birth weight and premature births as well as somatic classication of newborns.

Z Geburtshilfe Neonatol 2008;212:5-12; [ abstract URL:

http://www.ncbi.nlm.nih.gov/pubmed/18293256 ]

 

35 Swingle HM, Colaizy TT, Zimmerman MB, Moriss FH. Abortion and the Risk of

Subsequent Preterm Birth: A Systematic Review and Meta-Analysis. Journal of

Reproductive Medicine 2009;54:95-108

 

36 van Oppenraaij RHF, Jauniaux E, Christiansen OB, Horcajadas JA, Farquharson RG, et al.

Predicting adverse obstetric outcome after early pregnancy events and complications: a

review. Human Reproduction Update Advance Access 7 March 2009;1(1):1-13

 

37 Kramer MS, et al. Socio-economic disparities in pregnancy outcome: why do the poor fare so

poorly? Paediatric Perinatal Epidemiology 2000;14(3):194-210