Labor Drug Assailed

They note that the standard of care -- a benchmark of evidence in malpractice cases -- as well as patients' wishes and the desire to prevent a bad outcome such as premature birth -- all contribute to continued use of the drug.

"There is a current practice [to use the drug] that is the community standard," said Michael Gallagher, a specialist in maternal-fetal medicine, or high-risk pregnancy, who practices at Shady Grove Adventist and Holy Cross hospitals. Gallagher said he regards mag sulfate as a viable and safe option in some cases -- and not as an ineffective and potentially dangerous drug.

"Suppose we don't use it and a patient delivers," Gallagher said, noting that might violate the prevailing standard among OB-GYNs. "You find yourself in lonely places."

"Medical practice," he added, "doesn't move overnight." Nor, Gallagher said, does he think the evidence is "as cut and dried as Grimes says. This is his opinion."

But, Gallagher said, he and many of his colleagues are careful to present the option of using the drug with plenty of caveats.

"We do a lot of 'we think' and 'maybes' and let women decide whether to take it," he noted.

Not surprisingly, few refuse -- fearing the possibility of a bad outcome, he added.

For doctors, "there is pressure to use it from patients, as well as peer pressure" from other physicians, said Dallas OB-GYN Gary Cunningham, a professor at the University of Texas Southwestern Medical Center who noted that doctors are desperate to find something that works to stop preterm labor and prevent a premature birth with possibly devastating results.

"This drug has a powerful constituency," he said, adding that he is not part of it. The drug, he added, is an effective treatment for preeclampsia or eclampsia, pregnancy-induced hypertension that can be fatal to mothers and babies.

Before mag sulfate became widely used in the 1970s, Cunningham noted, doctors gave women intravenous alcohol to quiet contractions.

"All we got was a bunch of drunk patients who vomited and aspirated, and some died," he recalled. Before that, doctors used morphine, which was abandoned for similar reasons.

Alessandro Ghidini said it took him years to persuade colleagues at Inova Alexandria Hospital to stop using mag sulfate after his arrival about a decade ago.

"This is a medicine that American doctors are very familiar with," said Ghidini, a maternal-fetal medicine specialist. "It took a long time" to convince doctors the evidence was lacking, he said.

In their commentary, Grimes and Nanda wrote that the popularity of the drug has been reinforced by "pronouncements in prestigious medical journals or from famous medical institutions." They cite a 1999 review article in the New England Journal of Medicine that stated "magnesium sulfate is safe and has become the first-line treatment for preterm labor in North America."

" 'Overgrazing' of ineffective and harmful practices on the 'medical commons' is a stubborn problem in obstetrics," they wrote.

Cunningham said he still vividly recalls the time years ago that he took the drug to see what female patients experienced.

"It was scary," he said. "You feel like you're burning up." ·

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