Broadening the scope of our understanding of mechanisms: lessons from the history of the morning-after pill

Abstract

Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the connections between mechanistic processes and more fundamental reasons for (or against) medical interventions, particularly moral, ethical, religious, and political concerns about health, agency, and power. This paper uses debates over the controversial morning-after pill (emergency contraception) to gain insight into the deeper reasons for the production and use of mechanistic knowledge throughout biomedical research, clinical practice, and governmental regulation. To practice socially relevant philosophy of science, I argue that we need to account for mechanistic knowledge beyond immediate effectiveness, such as how it can also provide moral guidance, aid ethical categorization in the clinic, and function as a political instrument. Such insights have implications for medical epistemology, including the value-laden dimensions of mechanistic reasoning and the "epistemic friction" of values. Furthermore, there are broader impacts for teaching research ethics and understanding the role of science advisors as political advocates.

Grappling with Issues of Motherhood for Women with Schizophrenia

“…New tools are now available that can make the choice of motherhood, in some ways, easier for women. Should a woman prefer to wait before conceiving, she has a variety of contraceptive and "morning after" choices that no longer rely solely on the co-operation of male partners [32,33]. One important caveat when women with schizophrenia choose contraception is that medical advice be sought because there are potential interactions between hormone prescriptions and some of the psychiatric drugs they are taking [34].…”

Now is the time to safeguard access to emergency contraception as abortion restrictions sweep the United States

“…At the policy level, speculative language on the FDA-approved labels about how EC pills may work is used to justify far-reaching restrictions on EC access. It is highly unusual for labels to hypothesize about how a product might work, or for OTC labels to include mechanism of action language at all [18] . Nine words on the EC labels -(may also prevent) "attachment of a fertilized egg to the uterus (implantation)" [19] -have provided false scientific cover for anti-abortion groups that oppose EC.…”

“…A change to the mechanism of action language on EC products is long overdue [18] . In the face of increasingly urgent need for expanded EC access, it is well past time for FDA to approve a change that updates language to align with the evidence that EC pills work before ovulation, and not after.…”

Imposing Values and Enforcing Gender through Knowledge: Epistemic Oppression with the Morning-after Pill's Drug Label

“…Even more sizable resistance to the switch came from antiabortionists for this late-acting, postcoital contraceptive that they equated with abortion (see Wynn and Trussell 2006a; 2006b). Critics’ focus on the abortifacient potential of the morning-after pill is as old as the medicine itself, and its precise mechanism of action has been hotly debated for nearly half a century (ChoGlueck 2019).…”

“…I grant that my analysis is unlikely to convince the most avid antiabortionists. For over half a century, doctors and researchers have debated the mechanism of the morning-after pill because of its ethical and religious significance (ChoGlueck 2019). Today, there remains a small minority of influential scientists and physicians who advise the powerful Catholic Medical Association and maintain that Plan B may have a postfertilization effect (Raviele 2014; Kahlenborn, Peck, and Severs 2015; Raviele et al 2015).…”