A State Department-sponsored report, which concluded that oral contraceptives have "not contributed substantially to death from most circulatory system diseases in women," has been ordered shredded by State.
The order has touched off an acrimonious debate within the department, with charges of book-burning and bias.
The report, prepared in part by Dr. T. Ravenholt, a leading advocate of the pill as a family planning tool in the Third World, traces the relationship between pill use and death rates from circulatory system diseases for young women in the United States, England and Wales, Denmark, and Japan.
It was to have been published as the January issue of Population Reports, a magazine-style bulletin put out by the George Washington University Medical Center under contract to the Agency for International Development.
Last year, two long-term studies in Britain found that women over 35 who use the pill, and women over 30 who use the pill and smoke, are five times more likely to die from circulatory system diseases - heart or blood vessel disease - than women who have never used it.
Ravenhot is the director of the office of population in AID, which supplies millions of contraceptive pills each year to women in developing nations as part of those countries' population control efforts.
Late last year, only hours before a press conference scheduled to announce the report, AID's assistant administrator, Sander Levin, abruptly canceled the press conference and banned the report's distribution.
In the ensuing months, almost all 26,000 copies of the report have been fed to a shredder. A substitute report was prepared - without the consent of all the original authors - and later discarded, and the report has become an element in what Ravenholt, at least, sees as a coordinated attack on the family planning policies he has championed for a lifetime.
Ravenholt said he undertook his studies, which he called "a spate of alarmist articles."
"The bottom line conclusion one can make is that the ordinary woman in the developing country is hundreds of times more likely to die if she gets pregnant than if she uses the OC [oral contraceative] for a year and avoids pregnancy," he said.
The British doctors, starting from the perspective of an individual deciding whether to take the pill, found that if a woman is over 35, a heavy smoker and/or obese, there are substantially more dangers for her than for other women.
Ravenholt, whose field is world population problems, found that pill use is not a significant danger for most women.
The two conclusions are not mutually exclusive; the arguments are over interpretations and politics.
In a telephone interview, Levin said he had no objection to the substance of the report. However, he said, its introduction and conclusion - which most of the media would have relied on to interpret the report - "seem to understate the possible risks" of pill use.
As an example, Levin cited this sentence from the report's introduction: "The fact that, for the most part, OCs [pills] have not had obvious effects upon mortality patterns from circulatory diseases does not rule out the possibility that their use may substantially affect mortality among certain subgroups particularly at risk of circulatory diseases, such as women over age 35 who are heavy cigarette smokers."
"Look," Levin said, "what he's saying is 'we found no adverse effect on most women, but women over 35 who smoke and take the pill are risking their lives.'
"The report seem to gloss over the major finding of the British study while it's trying to say that the study doesn't apply to all women. There's a lack of directness here. The language trips the mind."
Ravenholt was sharply critical of Levin for ordering a second version of the report, one that "was full of glaring errors," and for ordering the shredding of the first version - an order Levin said he never gave.
Ravenholt also charged Levin's participation in the incident was politically motivated. A series of occurrences, among them personnel shifts and the cancellation of the contract with George Washington University have convinced him that the world population program he heads is being phased out.
"They're removing the kernel of the program, while leaving the husk," he said. "They keep on mouthing the same phrases, while castrating the program."
Levin emphatically denied the charge. He pointed to recent testimony of AID Administrator John J. Gilligan before a House committee pledging continued support of the family planning program, as an element of a broadened population control effort.
U.S. appropriations for "population commodities" - mostly pills destined for overseas use - rose from $29.5 million in 1977 to $38.7 million this year to a requested $44.5 million next year, Levin said.
Ravenholt is currently working on a third version of the report.