But Will It End the Abortion Debate?

By DAVID VAN BIEMA

Take an abortion clinic. Draw some protesters around it. Someone holding a sign with a fetus on it. Someone else, perhaps, holding a real fetus.

Add the miracle drug: the protesters disappear. So do the signs, the fetus. Why? Because the clinic, too, is gone, replaced by the privacy of thousands of anonymous doctors' offices. That, say some, is the elementary physics of RU 486.

Although the philosophical center of the abortion debate has always been the woman and what was going on in her womb, its public center was the doctor who performs abortions and what was going on in his clinic. RU 486, its adherents hope, will permit medicine to achieve what politics has made problematic: allowing the issue of abortion to be a private matter between a woman and her doctor. "You can't stop a woman from visiting a doctor," a securities analyst who follows the drug industry told the Wall Street Journal. "It becomes a private transaction. And that's the end of the abortion battle." Congressman Ron Wyden of Oregon claims that once the drug arrives, "it will no longer be possible for these extremists to target centralized locations like clinics." Harvard law professor Laurence Tribe, grimly alluding to the murder earlier this year of an abortion doctor in Florida, says, "You won't know whom to kill. You won't know where to lie down."

With the arrival of RU 486 in the U.S. -- especially in a form that requires the woman merely to take pills rather than also get a shot -- the vision of some pro-choice advocates, that the drug could abort the abortion debate, will be tested. Will antiabortion activists find ways to restrict the availability of the abortion pill? And if not, will RU 486 really obviate the clinics and confound the picketers?

Jerry Falwell sits in the chancellor's office of Liberty University, his school in Lynchburg, Virginia, and describes his abhorrence of RU 486. The host of the Old Time Gospel Hour on 200 television stations, he still has the contacts and much of the clout that he enjoyed in his Moral Majority days. He compares unprotesting acceptance of the new drug to the German churches' inaction during the Holocaust: "We can't make that mistake again," he says. "Morally we will have no recourse except to do whatever is available to us."

Peg Yorkin sits in the high-tech Los Angeles office of the Feminist Majority Foundation, an organization she co-founded and into which she has poured $10 million. Her worth has been estimated at up to $100 million. The RU 486 "genie" is "out of the bottle," she says. To get it to American women, "we are prepared to do whatever we have to do."

In the middle, until recently, was the drug's producer, France's Roussel Uclaf. Its corporate parent, Germany's huge Hoechst chemical company, feared a pro-life boycott of its American products if it allowed RU 486 to be marketed in the U.S. And Yorkin threatened a pro-choice boycott if it didn't. In the face of this dilemma and some badgering by the FDA, the company did what a typically cautious multinational would: it passed its burden (or tried to, anyway) onto the shoulders of someone else, in this case the nonprofit Population Council.

Two weeks ago, the council convened a round-table meeting with a diverse group of women's health organizations to discuss the socioeconomic mix of the participants in the upcoming RU 486 trials. It was the first of many such planning sessions. The council, which has not yet finished raising the $4 million it will need to complete the testing, says the trials will involve at least 2,000 women who will probably be a "representative sampling" by race and age. The subjects will not receive injected prostaglandin, but skip right to the new all-pill version. Above all, the council will act deliberately. "When there is something to explain, we will explain it," says a spokeswoman wearily. "It's just that there is nothing more to say now."

The RU 486 ball is in the council's court, and it can control the speed of play. The FDA cannot rule on the pill until the council has filed a new-drug application, and the council cannot file until it has run its tests and found a U.S. manufacturer. But there is reason to believe that once an application has been filed, the agency will do its utmost to streamline the process. It was, after all, FDA chief David Kessler, a Bush holdover kept on by Clinton, who persuaded Roussel Uclaf to allow its drug to be reviewed for use in the U.S. market. And it is Kessler's aggressive advocacy -- plus the relative impregnability of large agencies like the FDA to public pressure -- that has convinced even so devoted a foe as Gary Bauer, an antiabortion leader and former Reagan policy czar, that "if the Administration is intent on bringing RU 486 into the country . . . they can do it."

Not all Bauer's allies are so fatalistic, however. The American Life League has developed a six-point strategy for opposing the pills, including protest rallies, calls for government investigations and plans for deluging the FDA with mail. Pennsylvania Governor Robert Casey, perhaps the country's highest- profile pro-life Democrat, wonders if Kessler's enthusiasm for the new pills could backfire. "The U.S. government is guilty of a flagrant abuse of its authority" in this case, he says. "The FDA should not be an advocate for a drug that hasn't been tested here." He speculates that pro-lifers might use the alleged conflict of interest as the basis for a legal suit enjoining the drug's introduction until the FDA can prove its objectivity.

On the state level, the right-to-life forces will no doubt fight for the same kind of regulations already used to limit surgical abortions: mandatory counseling, parental consent for minors and a required waiting period -- maybe an extensive one, after the French model. Such regulations might help ease qualms about the pill among the people who make up the vast conflicted middle ground in the abortion debate: those who support a woman's right to choose yet might worry that a pill could, in some cases, lead to choices that are too hasty or unreflective.

In any case, the political debate will certainly make it more difficult to find an American company willing to distribute the drug. After the pill appeared in France, opponents sent 1.5 million critical postcards to Hoechst's U.S. subsidiary, Hoechst Celanese, and they will inevitably call a boycott against all products of any company that gets into the RU 486 business. And that's just the first volley. "Do you think the pharmaceutical corporate executive wants someone picketing in his neighborhood?" asks the Rev. Patrick Mahoney, spokesman for Operation Rescue.

Aware of such potential problems, the pill's inventor, Dr. Etienne-Emile Baulieu, is leading his own effort to establish a nonprofit foundation that would set up a new company both to manufacture and distribute RU 486 worldwide. Since the pill would be its only product, he says, the boycott threat would evaporate. The Population Council has expressed a willingness to discuss the plan with him.

When the pill finds a maker, how will it reach the taker? Its proponents, especially those hoping to make the clinic protesters vanish, agree that France's tightly controlled distribution method was devised, as a New England Journal of Medicine editorial put it, "for political rather than scientific reasons." One common yet radical suggestion is that RU 486 and prostaglandin could be sold to women as prescription drugs and taken at home. "To even suggest that you could do that is ridiculous," protests Judie Brown, president of the American Life League. That sentiment finds some support even from Baulieu. He opposes distribution by prescription because of what he calls "the cousin syndrome" -- the woman for whom the drug was prescribed might pass it on to a cousin or friend, who has not had a gynecological exam. In rare cases, that woman may be having undetected problems, such as a tubal pregnancy, a potentially lethal complication that the pills would not halt.

Baulieu does, however, believe the pill could be administered by gynecologists outside of a clinic environment. He supports the "two-visit" plan: the woman is examined, takes the first set of pills, goes home, takes the second two days later, and returns to the doctor to make sure the process has been completely effective. Advocates of this method make two assumptions about the woman: that she will have the emotional fortitude to go through an experience on her own, and that she will get to a hospital if she becomes one of the rare cases where there is excess bleeding or other complications. Lynne Randall, director of an Atlanta abortion clinic that has volunteered to be an RU 486 test site, sees no long-term obstacle: "The supervision would be a doctor's saying, 'I'm on call. If you get bad cramps, call me and I'll meet you in my office or at the hospital.' "

Randall and other would-be pioneers are also making a scientific assumption: that if a woman takes the first set of pills but neglects the second, and her pregnancy comes to term, the child will be normal. For years RU 486 opponents have warned of Thalidomide-like tragedies, "the absence of hands, a foot grown out of a knee," as one spokesman put it. Baulieu and other informed advocates argue that this is chemically impossible; that in the handful of known cases where RU 486 did not stop pregnancy, the children born were all healthy.

If the process could be as simple as Baulieu and Randall suggest, private physicians, who have shunted off the majority of abortions on clinics, might be willing to perform them again. "I think a lot more private physicians would quietly give RU 486 in their practices," says Susan Hill, head of the National Women's Health Network. "It wouldn't happen overnight, but if they felt it was safe and they weren't going to be protested every day, I think they would start offering it to their patients . . . It's a lot easier to protest 400 clinics than 10,000 doctors."

Not so, says Joseph Scheidler, author of Closed: 99 Ways to Stop Abortion. "We will probably know which physicians are dispensing it," he warns. "We'll send in women to ask for RU 486 . . . There will be doctors who will not deal with it." For those who do, "we'll go to their homes, to their offices, to their hospitals." Bonnie Quirke, president of the Illinois Right to Life Federation, promises "a massive educational effort with physicians and pharmacists."

The two to three years needed for testing and approval of RU 486 could delay its debut until the middle of the next presidential-election campaign. And as Jerry Falwell is happy to conjecture, "I think RU 486 will be a major issue in the campaign if it is not yet distributed." His goal, he says, will be to elect a leader "with different morals than the President." The lifers will talk about death that hides in the palm of a hand; the choicers about empowerment a woman can hold between two fingers. Although the advent of RU 486 could greatly change the nature of the abortion debate, it is unlikely to make it go away.

With reporting by Adam Biegel/Atlanta, Julie Johnson/Washington, Frederick Painton/Paris and Janice C. Simpson/New York