Re: MOA of Ella

[Guest guest]

THIS IS BIG!! I HOPE WE DON'T SEE THE FOLKS TENDING TO BE ON OUR SIDE OF THESE ISSUES CONTINUE TO MAINTAIN THERE IS NO ABORTIFACIENT EFFECT!!

Sincerely yours,

Dominic M. Pedulla MD, FACC, CNFPMC, ABVM, ACPh

Interventional Cardiologist, Endovascular Diplomate, Varicose Vein Specialist, Noncontraceptive Family Planning Consultant, Family Planning Researcher

Medical Director, The Oklahoma Vein and Endovascular Center (www.noveinok.com, veininfo@...)

Executive Director, The Edith Stein Foundation (www.theedithsteinfoundation.com)

(office)

(cell)

(FAX)

pedullad@...

"[T]he witness of their fidelity to the end was ever more powerful than the inspired words that so many of them spoke before surrendering everything to the Lord. In our own time, the price to be paid for fidelity to the Gospel is no longer being hanged, drawn and quartered but it often involves being dismissed out of hand, ridiculed or parodied. And yet, the Church cannot withdraw from the task of proclaiming Christ and his Gospel as saving truth, the source of our ultimate happiness as individuals and as the foundation of a just and humane society." (Benedict XVI on Newman beatification)

MOA of Ella

Dear Colleagues,

I was reading the opinion article in the December Green Journal (Obstetrics & Gynecology), which happens to be about Ella. The author Mark Nichols, clearly a fan of Ella, talks about the supposed MOAs of the drug. I will summarize it, but also paste the original text below. In sum, he says it's likely that Ella may interfere with implantation, but if that troubles your patients, just remind them that we don't know all of the true MOAs of OCPs, and that they also likely interfere with implantation. !!! As if that should "put your patient to ease!" I was also shocked to see him so casually state that OCPs may have an implantation effect. Although I am fully convinced they do, most of the medical literature refers to that as the third and "hypothetical but unlikely" mechanism.

In a way, I was happy to see him admit that. On the other hand, I was terrified he could do so in such a callous manner.

Excerpt from the original text:

"What is the MOA of ulipristal acetate [Ella] as an emergency contraceptive? Ulipristal acetate appears to precent pregnancy by blocking or delaying the luteinizing hormone surge and follicular rupture when ingested before ovulation. There may also be a delay in maturation of the endometrium, which may interfere with implantation. Its is believed that the primary mechamism of ulipristal acetate is the blocking or delaying of ovulation. However, somem patients and providers may be opposed to the use of ulipristal acetate due to the possible inhibition of implaintation. In this context, it may be helpful to review the uncertainty of the mechanism of action of other commonly used medications, such as OCPs. Given that ovulation sometimes occurs despite consistent use of oral contraceptives, it is likely that some embryos are unable to implant because of the endometrial effects among oral contraceptive users.

What should the provider do who is unwilling to provide emergency contracetion that might affect implantation? The ethical dilemma of conscientious refusal has been addressed by an ACOG Committee Opinion (# 385, 2007). It states that providers have a duty to refer patients ina timely manner if they cannot provide, in conscience, the services their patients request. In the context of emergency contraception, provision of accurate information and referral for patients well before the possibility of unprotected intercourse is important." (Nichols, M. Ulispristal Acetate: a nocel molecule and 5-day emergency contraceptive. Obstet Gynecol 2010;116:1252-3)

Thoughts?

Rehmann, DO

PGY2, Sisters of Chartity Hospital

Buffalo, NY

[Guest guest]

For many of us there is no choice, we don’t prescribe, and we don’t refer, period. We make sure the patient understands what is involved, and if she still wants the drug or procedure she needs to go elsewhere. Despite ACOG’s position, there are still laws against discrimination, although the position is tricky, given ACOG’s links to ABOG. AAPLOG is fighting this actively although so far ACOG has managed to ignore them. By all means register on the Hippocratic Medicine website. Chances are the next Congress may be able to strengthen and expand the Weldon Amendment. Hanna Klaus, M.D., FACOGNatural Family Planning Center of Washington, D.C. and Teen STAR Program4400 East West Highway # 911Bethesda, MD 20814-4510 hannaklaus@...http://www.teenstarprogram.org From: nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of missionaryjaimeSent: Monday, December 13, 2010 8:16 AMTo: nfpprofessionals Subject: MOA of Ella Dear Colleagues,I was reading the opinion article in the December Green Journal (Obstetrics & Gynecology), which happens to be about Ella. The author Mark Nichols, clearly a fan of Ella, talks about the supposed MOAs of the drug. I will summarize it, but also paste the original text below. In sum, he says it's likely that Ella may interfere with implantation, but if that troubles your patients, just remind them that we don't know all of the true MOAs of OCPs, and that they also likely interfere with implantation. !!! As if that should " put your patient to ease! " I was also shocked to see him so casually state that OCPs may have an implantation effect. Although I am fully convinced they do, most of the medical literature refers to that as the third and " hypothetical but unlikely " mechanism.In a way, I was happy to see him admit that. On the other hand, I was terrified he could do so in such a callous manner.Excerpt from the original text: " What is the MOA of ulipristal acetate [Ella] as an emergency contraceptive? Ulipristal acetate appears to precent pregnancy by blocking or delaying the luteinizing hormone surge and follicular rupture when ingested before ovulation. There may also be a delay in maturation of the endometrium, which may interfere with implantation. Its is believed that the primary mechamism of ulipristal acetate is the blocking or delaying of ovulation. However, somem patients and providers may be opposed to the use of ulipristal acetate due to the possible inhibition of implaintation. In this context, it may be helpful to review the uncertainty of the mechanism of action of other commonly used medications, such as OCPs. Given that ovulation sometimes occurs despite consistent use of oral contraceptives, it is likely that some embryos are unable to implant because of the endometrial effects among oral contraceptive users.What should the provider do who is unwilling to provide emergency contracetion that might affect implantation? The ethical dilemma of conscientious refusal has been addressed by an ACOG Committee Opinion (# 385, 2007). It states that providers have a duty to refer patients ina timely manner if they cannot provide, in conscience, the services their patients request. In the context of emergency contraception, provision of accurate information and referral for patients well before the possibility of unprotected intercourse is important. " (Nichols, M. Ulispristal Acetate: a nocel molecule and 5-day emergency contraceptive. Obstet Gynecol 2010;116:1252-3)Thoughts? Rehmann, DOPGY2, Sisters of Chartity HospitalBuffalo, NY

[Guest guest]

mendaci2y as 2he public policy of our profession.

in abou2 1997 2here were 2wo puff pieces in NEJM s2a2ing we all "know" pregnancy begins a2 inplan2a2ion.

2hus, NEJM, 2he flagship journal of american medicine, is willing 2o go alomg wi2h mendaci2y.

2hink abou2 how many of our colleagues whine and ni2pick ar2icles in scien2ific journals.

even 2houigh millions were spen2 on s2udy, s2ill no2 large enough.

was i2 randomized?

blinded 2o who? pa2ien2s? doc2ors? evalua2ors? are 2hey blind enough?

who were 2he con2rols? righh2 or wrong con2rols?

ye2 all scien2ific rigor becomes spineless when 2he sacred cow appears

2hey who would ques2ion any and all religious beliefs,

bow down in rap2 belief when sacred cow appears

wha2 does 2he sacred cow 2hink of 2hem?

i'm only a cow, bu2 even i could see you guys are ...

baggo2

sorry one year was working on 2he keyboard

'

To: nfpprofessionals From: hannaklaus@...Date: Mon, 13 Dec 2010 22:29:56 -0500Subject: RE: MOA of Ella

For many of us there is no choice, we don’t prescribe, and we don’t refer, period. We make sure the patient understands what is involved, and if she still wants the drug or procedure she needs to go elsewhere. Despite ACOG’s position, there are still laws against discrimination, although the position is tricky, given ACOG’s links to ABOG. AAPLOG is fighting this actively although so far ACOG has managed to ignore them. By all means register on the Hippocratic Medicine website. Chances are the next Congress may be able to strengthen and expand the Weldon Amendment.

Hanna Klaus, M.D., FACOG

Natural Family Planning Center of Washington, D.C. and Teen STAR Program

4400 East West Highway # 911

Bethesda, MD 20814-4510

hannaklaus@...

http://www.teenstarprogram.org

From: nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of missionaryjaimeSent: Monday, December 13, 2010 8:16 AMTo: nfpprofessionals Subject: MOA of Ella

Dear Colleagues,I was reading the opinion article in the December Green Journal (Obstetrics & Gynecology), which happens to be about Ella. The author Mark Nichols, clearly a fan of Ella, talks about the supposed MOAs of the drug. I will summarize it, but also paste the original text below. In sum, he says it's likely that Ella may interfere with implantation, but if that troubles your patients, just remind them that we don't know all of the true MOAs of OCPs, and that they also likely interfere with implantation. !!! As if that should "put your patient to ease!" I was also shocked to see him so casually state that OCPs may have an implantation effect. Although I am fully convinced they do, most of the medical literature refers to that as the third and "hypothetical but unlikely" mechanism.In a way, I was happy to see him admit that. On the other hand, I was terrified he could do so in such a callous manner.Excerpt from the original text:"What is the MOA of ulipristal acetate [Ella] as an emergency contraceptive? Ulipristal acetate appears to precent pregnancy by blocking or delaying the luteinizing hormone surge and follicular rupture when ingested before ovulation. There may also be a delay in maturation of the endometrium, which may interfere with implantation. Its is believed that the primary mechamism of ulipristal acetate is the blocking or delaying of ovulation. However, somem patients and providers may be opposed to the use of ulipristal acetate due to the possible inhibition of implaintation. In this context, it may be helpful to review the uncertainty of the mechanism of action of other commonly used medications, such as OCPs. Given that ovulation sometimes occurs despite consistent use of oral contraceptives, it is likely that some embryos are unable to implant because of the endometrial effects among oral contraceptive users.What should the provider do who is unwilling to provide emergency contracetion that might affect implantation? The ethical dilemma of conscientious refusal has been addressed by an ACOG Committee Opinion (# 385, 2007). It states that providers have a duty to refer patients ina timely manner if they cannot provide, in conscience, the services their patients request. In the context of emergency contraception, provision of accurate information and referral for patients well before the possibility of unprotected intercourse is important." (Nichols, M. Ulispristal Acetate: a nocel molecule and 5-day emergency contraceptive. Obstet Gynecol 2010;116:1252-3)Thoughts? Rehmann, DOPGY2, Sisters of Chartity HospitalBuffalo, NY