Medical schools have stood on the sideline long enough.
What makes a good physician? Along with communication skills, empathy and integrity, medical schools teach their students science rooted in evidence-based medicine and patient care skills that emphasize patient autonomy. The ongoing legal battle over approval and access to mifepristone, a widely used abortion pill, threatens to undermine these basic tenets of medicine.
Last month, Judge Matthew Kacsmaryk of Texas issued a hold on federal approval of mifepristone, and the Fifth U.S. Circuit Court of Appeals upheld restrictions on access to mifepristone. While the Supreme Court paused these lower court rulings until a full appeal could be heard, the case challenges the Food and Drug Administration’s (FDA) long-standing approval of mifepristone, hopes to curtail mifepristone’s availability and may even diminish the FDA’s authority in regulating drug approval altogether.
But it will also have generational effects on the way we learn and practice medicine. The lower court rulings undercut the foundational framework of our medical education, severely threatening our understanding of evidence-based medicine and patient autonomy.
We spend our first two years of medical school learning about basic science and the underlying mechanisms of disease. We learn how genetic mutations or breakdowns in different pathways cause disease. We learn about how different treatments, informed by decades of research, can potentially improve the symptoms of or cure disease. This learning generally culminates in taking the United States Medical Licensing Exam Step 1—our first board exam, one composed of material rooted in scientific knowledge.
Similarly, mifepristone is one of the most studied medications, with overwhelming scientific evidence to support its efficacy and safety. The mifepristone-misoprostol combination treatment is over 99 percent effective. And mifepristone is safer than common medications like Tylenol, penicillin and Viagra (or even pregnancy itself). Relying on the decision of Judge Kacsmaryk or the three-judge panel of the appellate court—all political appointees with no scientific background—to undermine the FDA’s authority constructs a harmful narrative to students that medicine, though tested and validated, can be challenged without scientific rationale.
We then spend our final years in medical school applying this scientific knowledge to direct clinical care. While this involves using our medical education to diagnose and treat patients, we are also taught to prioritize patient autonomy and choice. With mifepristone potentially off the shelves and not even being offered as an option to patients, especially in states where abortion remains legal, medical students will be forced to develop their foundational clinical knowledge based on political interests rather than patient autonomy.
The restrictions on patient autonomy are most concerning for Black, Indigenous, Latinx and other marginalized communities. We often learn how medicine has historically ignored or silenced their voices and inhibited their autonomy. Most notoriously, Dr. Marion Sims, a gynecologist, was known to torture Black female slaves by experimenting on them without consent or anesthesia. The court’s attempt to take mifepristone off the market further complicates this history, restricting our ability to provide patients the care they want, reversing progress in giving marginalized communities a voice, and disproportionately harming the most vulnerable.
The Alliance for Hippocratic Medicine—the lead plaintiff in the mifepristone lawsuit—argues that judicial oversight over the FDA is simply a system of checks and balances. To that point, some say that the FDA misused its authority when it approved mifepristone by reviewing it under an “accelerated approval program.” Others say providers that prescribe medication abortion can switch to only using misoprostol, the second drug in the two-step regimen to terminate a pregnancy.
However, the FDA actually added extra safety restrictions, limiting who could prescribe the medication and further ensuring its benefits outweigh its risks. The approval of mifepristone also took four years—far from “accelerated approval.”
The ongoing legal battle against mifepristone’s approval challenges evidence-based medicine and patient autonomy, the fundamentals by which we are taught and practice medicine. The lower court rulings will likely have ramifications for how future providers perceive medicine, teaching students that legal authorities can overrule our attention to scientific evidence and listen to the needs of patients.
Medical schools have stood on the sideline long enough. It is time for them to fight these challenges head-on and educate their students on the legal complexities of health policy. Until then, medical students may be left to rely on political decisions that undermine our understanding of evidence-based medicine and significantly harms our patients’ autonomy.
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