Broadening the scope of our understanding of mechanisms: lessons from the history of the morning-after pill
- 25 Downloads
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.
KeywordsMechanism Pharmacology Medical epistemology Therapeutic effectiveness Science and values Socially relevant philosophy of science
I gave an earlier version of this paper at the 2017 International Society for History, Philosophy and Social Studies of Biology in Sao Paulo, Brazil, and received many helpful comments from the audience. Special thanks to Elisabeth Lloyd and Jutta Schickore for advice and support. Additional thanks to Robyn Bluhm, Sandy Gliboff, Kate Grauvogel, Nora Hangel, Bennett Holman, Ashley Graham Kennedy, Naomi Oreskes, Emanuele Ratti, David Teira, and two anonymous reviewers for helpful comments and engaging conversations.
This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. 1342962. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation.
Compliance with ethical standards
Conflict of interest
The author declares that he has no conflict of interest.
- Au, Y. C. (2016, April 28). Synthesising heterogeneity: Trends of visuality in biological sciences circa 1970s–2000s. Doctoral dissertation. University College London. http://discovery.ucl.ac.uk/1478180/. Accessed 31 August 2018.
- Bucar, E. (1999). Caution: Catholic health restrictions may be hazardous to your health. Washington, DC: Catholics for a Free Choice.Google Scholar
- Cartwright, N., & Stegenga, J. (2011). A theory of evidence for evidence-based policy. In W. Twining, P. Dawid, & D. Vasilaki (Eds.), Evidence, inference, and enquiry (pp. 291–322). Oxford: Oxford University Press.Google Scholar
- CDD (Chicago Daily Defender). (1967, May 16). Lawyers mull legality of a new pill. Chicago daily defender (daily edition), p. 17. Chicago, IL.Google Scholar
- Chang, M. C. (1967). Physiological mechanisms responsible for the effectiveness of oral contraception. In R. K. B. Hankinson, R. L. Kleinman, & P. Eckstein (Eds.), Proceedings of the eighth international conference of the International Planned Parenthood Federation, Santiago, Chile, 9–15 April 1967 (pp. 386–392). London: International Planned Parenthood Federation.Google Scholar
- Craver, C., & Tabery, J. (2017). Mechanisms in science. In E. N. Zalta (Ed.), The Stanford encyclopedia of philosophy. Metaphysics Research Lab, Stanford University. https://plato.stanford.edu/archives/spr2017/entries/science-mechanisms/. Accessed 31 August 2018.
- Croxatto, H. B. (2005). Nuestra historia: El Instituto Chileno de Medicina Reproductiva (ICMER). http://www.icmer.org/documentos/historia_icmer/nuestra_historia_hbc_02-05-2011.pdf. Accessed 31 August 2018.
- Croxatto, H. B., Brache, V., Pavez, M., Cochon, L., Forcelledo, M. L., Alvarez, F., et al. (2004). Pituitary–ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75-mg dose given on the days preceding ovulation. Contraception, 70(6), 442–450.CrossRefGoogle Scholar
- Daniels, K., Jones, J., & Abma, J. C. (2013a). Use of emergency contraception among women aged 15–44, United States, 2006–2010. NCHS data brief, no 112. Hyattsville, MD: National Center for Health Statistics. https://www.cdc.gov/nchs/data/databriefs/db112.pdf. Accessed 31 August 2018.
- Daniels, K., Mosher, W. D., & Jones, J. (2013b). Contraceptive methods women have ever used: United States, 1982–2010. National health statistics reports, no 62. Hyattsville, MD: National Center for Health Statistics.Google Scholar
- Davis, D. L. (2007). The secret history of the war on cancer. New York: Basic Books.Google Scholar
- Ellertson, C., Trussell, J., Stewart, F. H., & Winikoff, B. (1998). Should emergency contraceptive pills be available without prescription? Journal of the American Medical Women’s Association, 53(5 Suppl 2), 226–229.Google Scholar
- FDA (Food and Drug Administration). (2003). Nonprescription Drugs Advisory Committee (NDAC) in joint session with the Advisory Committee for Reproductive Health Drugs (ACRHD). Meeting transcript. No. 202/797-2525. Washington, DC: U.S. Food and Drug Administration.Google Scholar
- FDA (Food and Drug Administration). (2006). Label, insert, and CARE program proposal for Plan B. Drugs@FDA database. http://www.accessdata.fda.gov/drugsatfda_docs/label/2006/021045s011lbl.pdf. Accessed 21 August 2018.
- FDA (Food and Drug Administration). (2013). Birth control: Medicines to help you. Case documents for the Supreme Court of the United States. https://www.supremecourt.gov/opinions/URLs_Cited/OT2013/13-354/13-354-2.pdf. Accessed 29 April 2016
- FIGO & ICEC (International Federation of Gynecology and Obstetrics & International Consortium for Emergency Contraception). (2011). Mechanism of action: How do levonorgestrel-only emergency contraceptive pills (LNG ECPs) prevent pregnancy? New York, NY: Family Care International. http://www.figo.org/sites/default/files/uploads/MOA_FINAL_2011_ENG.pdf. Accessed 31 August 2018.
- Fridman, E. P. (2002). Medical primatology: History, biological foundations and applications. (R. D. Nadler, Ed.). London; New York: CRC Press.Google Scholar
- Glennan, S. (2016). Mechanisms and mechanical philosophy. In P. Humphreys (Ed.), The oxford handbook of philosophy of science. Oxford: Oxford University Press.Google Scholar
- Greep, R. O. (1995). Min Chueh Chang, 1908–1991. Biographical Memoir. National Academy of Sciences. http://www.nasonline.org/publications/biographical-memoirs/memoir-pdfs/chang-m-c.pdf. Accessed 31 August 2018.
- Guttmacher Institute. (2018). Targeted regulation of abortion providers. Fact sheet. Guttmacher Institute. https://www.guttmacher.org/state-policy/explore/targeted-regulation-abortion-providers. Accessed 31 August 2018.
- Guyatt, G., Rennie, D., Meade, M., & Cook, D. (2015). Users’ guides to the medical literature: A manual for evidence-based clinical practice. New York: McGraw-Hill Education Medical.Google Scholar
- HAS (Haute Autorite de Sante). (2015). NORLEVO 1,5 mg, comprimé, renouvellement de l’inscription. Renewal of registration. French National Authority of Health. https://www.has-sante.fr/portail/upload/docs/evamed/CT-13654_NORLEVO_PIS_RI_Avis1_CT13654.pdf. Accessed 31 August 2018.
- Hatcher, R. A., & Conrad, C. C. (1971). Adenocarcinoma of the vagina and stilbestrol as a “morning-after” pill. New England Journal of Medicine, 285(22), 1264–1265.Google Scholar
- Hughes, E. C. (1972). Obstetric-gynecologic terminology: With section on neonatology and glossary of congenital anomalies. Philadelphia: Davis.Google Scholar
- Illari, P. (2017). Mechanisms in medicine. In M. Solomon, J. R. Simon, & H. Kincaid (Eds.), The Routledge companion to philosophy of medicine (pp. 48–57). Abingdon: Routledge.Google Scholar
- Jackson, M. (1967). Recent developments in the biological control of fertility: Report from the medical session. In R. K. B. Hankinson, R. L. Kleinman, & P. Eckstein (Eds.), Proceedings of the eighth international conference of the International Planned Parenthood Federation, Santiago, Chile, 9-15 April 1967 (pp. 484–486). London: International Planned Parenthood Federation.Google Scholar
- Jasanoff, S. (1990). The fifth branch: Science advisers as policymakers. Cambridge, MA: Harvard University Press.Google Scholar
- Kennedy, A. (2018). Solving antibiotic resistance with the power of evolution. The Prindle Post. https://www.prindlepost.org/2018/06/solving-antibiotic-resistance-with-the-power-of-evolution/. Accessed 31 August 2018.
- Kitcher, P. (2011). Science in a democratic society. Amherst, NY: Prometheus Books.Google Scholar
- Kohorn, E. I. (2009). John McLean Morris: A career in surgery, gynecology and reproductive physiology. Connecticut Medicine, 73(4), 223–227.Google Scholar
- Lader, L. (1966, April 10). Three men who made a revolution. New York Times, p. 181. New York, NY.Google Scholar
- Lalitkumar, P. G. L., Lalitkumar, S., Meng, C. X., Stavreus-Evers, A., Hambiliki, F., Bentin-Ley, U., et al. (2007). Mifepristone, but not levonorgestrel, inhibits human blastocyst attachment to an in vitro endometrial three-dimensional cell culture model. Human Reproduction, 22(11), 3031–3037.CrossRefGoogle Scholar
- Langston, N. (2010). Toxic bodies: Hormone disruptors and the legacy of DES. New Haven, CT: Yale University Press.Google Scholar
- Larimore, W. L., Stanford, J. B., & Kahlenborn, C. (2004). Does pregnancy begin at fertilization? Family Medicine, 36(10), 690–691.Google Scholar
- Longino, H. E. (1990). Science as social knowledge. Princeton, NJ: Princeton University Press.Google Scholar
- Luker, K. (1984). Abortion and the politics of motherhood. Berkeley: University of California Press.Google Scholar
- Lynch, W. A. (1977). Comments on “Medication to prevent pregnancy after rape”. Linacre Quarterly, 44(3), 223–228.Google Scholar
- Marions, L., Hultenby, K., Lindell, I., Sun, X., Ståbi, B., & Danielsson, K. G. (2002). Emergency contraception with mifepristone and levonorgestrel: Mechanism of action. Obstetrics and Gynecology, 100(1), 65–71.Google Scholar
- Marks, L. V. (2001). Sexual chemistry: A history of the contraceptive pill. New Haven, CT: Yale University Press.Google Scholar
- Marsh, M. S., & Ronner, W. (2008). The fertility doctor: John Rock and the reproductive revolution. Baltimore, MD: Johns Hopkins University Press.Google Scholar
- McCarthy, D. (1977). Medication to prevent pregnancy after rape. Linacre Quarterly, 44(3), 210–222.Google Scholar
- McCarthy, D. (1978). Pregnancy after rape. Linacre Quarterly, 45(1), 8.Google Scholar
- Miller, P. (2015). Good Catholics: The battle over abortion in the Catholic Church. Berkeley: University of California Press.Google Scholar
- Moggia, A., Beauquis, A., Ferrari, F., Torrado, M. L., Alonso, J. L., Koremblit, E., et al. (1974). The use of progestogens as postcoital oral contraceptives. The Journal of Reproductive Medicine, 13(2), 58–61.Google Scholar
- NCCB (National [United States] Conference of Catholic Bishops). (1971). Ethical and religious directives for catholic health facilities. Second edition. Washington, DC: United States Catholic Conference Office of Publishing and Promotion.Google Scholar
- NCCB (National [United States] Conference of Catholic Bishops). (1995). Ethical and religious directives for catholic health care services. Third edition. Washington, DC: United States Catholic Conference Office of Publishing and Promotion.Google Scholar
- Parkes, A. S. (1967). Future trends. In R. K. B. Hankinson, R. L. Kleinman, & P. Eckstein (Eds.), Proceedings of the eighth international conference of the International Planned Parenthood Federation, Santiago, Chile, 9–15 April 1967 (pp. 501–506). London: International Planned Parenthood Federation.Google Scholar
- Population Council. (2005). Emergency contraception’s mode of action clarified. Population Briefs, 11(2), 3.Google Scholar
- Prescott, H. M. (2011). The morning after: A history of emergency contraception in the United States. New Brunswick, NJ: Rutgers University Press.Google Scholar
- Rock, J. (1963). The time has come: A Catholic doctor’s proposals to end the battle over birth control. New York: Knopf.Google Scholar
- Rossiter, M. W. (1982). Women scientists in America: Struggles and strategies to 1940. Baltimore, MD: Johns Hopkins University Press.Google Scholar
- Rothman, D. J. (2003). Strangers at the bedside: A history of how law and bioethics transformed medical decision making. Second edition. New York: Aldine de Gruyter.Google Scholar
- Russo, F., & Williamson, J. (2011). Epistemic causality and evidence-based medicine. History and Philosophy of the Life Sciences, 33(4), 563–582.Google Scholar
- Scientific American (1966, June). Retroactive birth control. Scientific American, 214(6), 56.Google Scholar
- Sjövall, T. (1967). Summary of the conference. In R. K. B. Hankinson, R. L. Kleinman, & P. Eckstein (Eds.), Proceedings of the eighth international conference of the International Planned Parenthood Federation, Santiago, Chile, 9–15 April 1967 (pp. 507–513). London: International Planned Parenthood Federation.Google Scholar
- Stanford, J. B. (2011). Testimonies: Joseph B. Stanford. Mormon Scholars Testify. http://mormonscholarstestify.org/2691/joseph-b-stanford. Accessed 31 August 2018.
- Supreme Court of the United States. (2013). Brief for respondents, on petition for a writ of certiorari to the United States Court of Appeals for the Tenth Circuit, no 13–354. http://sblog.s3.amazonaws.com/wp-content/uploads/2013/10/No-13-354-Brief-for-Respondents.pdf. Accessed 31 August 2018.
- Supreme Court of the United States. (2014). Syllabus: Burwell v. Hobby Lobby Stores, no 13–354 and 13–356. https://www.supremecourt.gov/opinions/13pdf/13-354_olp1.pdf. Accessed 31 August 2018.
- Thagard, P. (1999). How scientists explain disease. Princeton, NJ: Princeton University Press.Google Scholar
- Time. (1966, May 6). The morning-after pill. Time, 87(18), 74.Google Scholar
- Tone, A. (2001). Devices and desires: A history of contraceptives in America. New York: Hill and Wang.Google Scholar
- Watkins, E. S. (1998). On the Pill: A social history of oral contraceptives, 1950–1970. Baltimore, MD: Johns Hopkins University Press.Google Scholar
- WHO (World Health Organization). (2017). WHO model list of essential medicines. 20th list. http://www.who.int/medicines/publications/essentialmedicines/20th_EML2017_FINAL_amendedAug2017.pdf. Accessed 31 August 2018.
- Wilks, J. (2000). The impact of the Pill on implantation factors: New research findings. Ethics and Medicine, 16(1), 15–22.Google Scholar