A busy day in the preterm-birth drug drama

A great deal happened today in the amazing unfolding drama of a decades-old drug that has been shown to prevent preterm birth:

* KV Pharmaceutical more than halved the cost of Makena, approved by the FDA in February, which debuted at a price of $1,500 per dose. KV Pharmaceutical dropped the price today to $690, and vowed to make sure clinically eligible pregnant women would be able to afford the drug.

* However, the action wasn't enough to stop the March of Dimes from saying it would "step away from" its relationship with Ther-Rx, a subsidiary of the drug company.

"Access (for women) to 17-P is and always has been our paramount concern," Jennifer Howse, March of Dimes president wrote in a letter today to Greg Divis, president of the Ther-Rx Corp., employing a generic term for the drug, hydroxyprogesterone caproate.

In her letter, Howse acknowledged considerable financial support Ther-Rx has given the March of Dimes.

* Sen. Sherrod Brown (D-Ohio) said he was releasing "previously unreported figures showing the scope of taxpayer investment in the development of preterm pregnancy drugs."

A press release from Sen. Brown's office detailed the $21 million he said went into bringing Makena to market, including these costs:

* An initial trial, showing that the injection prevented preterm births in women who have previously had a preterm birth, cost taxpayers $5 million.

* A second trial, at $1.1 million, showed no side effects in children whose mothers had used the formulation.

* A third trial, costing taxpayers $5.1 million, found that the drug did not work to prevent preterm birth in women carrying twins and triplets; according to the NIH, this study was critical for Makena’s orphan drug status determination because an alternative result could have widened the number of potentially eligible women to use the drug.

* A fourth trial, which is still ongoing, cost $7.5 million through Fiscal Year 2010 and aims to find whether 17P treatments are effective at preventing preterm birth in women with shortened cervixes. This is the largest study of 17P by the National Institutes of Health, and could create another category of women eligible for Makena.

But the cost to the public doesn't end there.

In an article in the New England Journal of Medicine last month, Joanne Armstrong MD laid out the cost of treating the roughly 139,000 women she said were likely to need the drug every year. A course of 20 treatments with 17P at $300, the likely price for the drug compounded by a pharmacist, would cost $41.7 million. A course of treatment with Makena (at the original price of $1,500) for one woman would cost $29,000, or $4 billion for all 139,000, many of whom would need to resort to Medicaid to pay for the drug.

The March of Dimes, as saintly in the public eyes as an organization can be, felt the heat from the public for backing KV Pharmaceutical's push for FDA approval of Makena.

"Only after our threats (to boycott March of Dimes fund-raising events) did the MOD firm up their stance," one man wrote on March 25 on the March of Dimes' Facebook page.

But critics, including the Society for Maternal and Fetal Medicine, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatics, saved their strongest language for KV Pharmaceutical.

Sens. Brown and Amy Klobuchar (D-Minn.) asked the Federal Trade Commission to investigate the drug company for "price gouging at the expense of pregnant women."

Birth photographer is back on Facebook

"I'm BAAAAAAAAAAAAAAAAAAAAAAAACK! : )"

That's what Laura Eckert, a Shueyville, Ia., photographer, wrote today on the Facebook page for her New Creation birth photography business.

Facebook had disabled the page last month because it displayed photos taken during and just after childbirth. Earlier today, though, officials of the social media website apologized to Eckert and restored her company's page.

Eckert, 33, told the Associated Press she was shocked when Facebook notified her before Christmas that they had removed inappropriate photos from her page. Eckert said she had cropped all the photos on the New Creation page so they would meet Facebook's guidelines.

When she tried to log on to find out which photos were gone, Eckert discovered the account had been disabled.

A number of Eckert's supporters put together another Facebook page called "Restore Laura Eckert's account."

The photographer emailed Facebook repeatedly, asking for an explanation and reinstatement, but  the company did not respond until KCRG-TV in Cedar Rapids aired a story about the dispute, she said.

"It's funny it happened after the media got involved," Eckert said. "I sent many polite e-mails asking for information over the course of the last few weeks and got no response. None."

Eckert said she believed the pictures that brought her page down were from a water birth last spring.

Facebook objected to some of the photos when she first posted them because they contained nudity, Eckert said. She then removed some photos and edited others to eliminate any sight of nipples or genitalia, with Facebook's standards in mind.

But then last month, all three of her Facebook pages, including the New Creation one, were gone.

"We make an occasional mistake. This is an example," said Facebook spokesman Simon Axten.

Eckert said she intends to continue to post birth photos on her Facebook page.

"I see the miraculousness of it," she told the AP. "Maybe that clouds my judgment a little bit."

Birth Story’s most popular posts of 2010

Well, go figure. My very most popular post by far this year was one I wrote for Women's History Month that had very little to do with the Birth Story per se.

Anne Hutchinson
Anne Hutchinson at her trial

My top post for 2010 was about Anne Hutchinson, a midwife in the Massachusetts Colony, who deftly though unsuccessfully defended herself against heresy charges in 1638. The colony's governors were so shaken that they embedded into the mission of the new Harvard College the mandate to train religious leaders rigorously enough that they would never again be so intellectually pummelled.

Anne figured in another top post as well, "A monstrous birth," about the danger midwives and mothers alike faced after anomalous births in the American colonies.

My second most popular post was a recent one about Ian Shapira's Facebook-driven story in the Washington Post chronicling the death of new mother Shana Greatman Swers.

Supermodel Gisele Bundchen came in third with a post about her much ridiculed assertion that all new mothers should be required by law to breast-feed.

Here are Birth Story's 10 most popular posts of 2010:

1. Anne Hutchinson, Colonial midwife  3/1/10

2. A sad Facebook story 12/10/10

3. A "boob" on the right side of breast-feeding 8/9/10

4. A "monstrous" birth  3/3/10

5. The Pregnancy Meeting 2/8/10

6. Amniotic fluid embolism 1/14/10

7. Fascinated with blood 6/28/10

8. The Frontier Nursing Service  3/15/10

9. The Goodriches one year later  1/11/10

10. The mother of the Apgar score  3/19/10

A sad Facebook birth story

The Washington Post is carrying a remarkable birth story today by Ian Shapira, called "A Facebook story: A mother's joy and a family's sorrow."

Shapira has shaped the story using the Facebook postings of Shana Greatman Swers, a 35-year-old Gaithersburg, Md., consultant who died just weeks after the birth of her son, Isaac Lawrence Swers, on Sept. 23 of this year.

Within days of Isaac's birth, Swers was diagnosed with peripartum cardiomyopathy, a rare, grave heart disease associated with childbirth.

In a "Story Lab" blog post, and in a live Q&A chat, Shapira describes how he came to write about a colleague of his wife's, a woman who, he writes, not only died from "unusual pregnancy complications," but also "had been remarkably public about her ordeal" in her Facebook postings, some of them sent from her iPhone at the hospital.

Shapira determined to tell Swers' story through selected postings from her Facebook page, beginning with her proud announcement of her pregnancy on March 10, and continuing until her death.

What emerges is a picture of a first-time mom reveling in impending motherhood, then reacting with concern and frustration at the unexpected medical problems, responding to friends' good wishes and offers of food and other help.

At one point, her husband, Jeffrey, asked friends to "post a memory or funny story that lets her know why she is special to you," and began himself with the story of their first Fourth of July together.

It seems impossible to believe, reading the posts, that Swers' condition would not improve, that the last post in the story, from Nov. 3, would be her husband's anguished cry: "I love you wifey wife, I love you, I love you, a million times over I love you!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"

Shapira's story, and the Facebook page itself, are compelling artifacts of our times.