Science
Q&A: The FDA says the abortion pill mifepristone is safe. Here's the evidence
Abortion is back on the docket at the U.S. Supreme Court, with the justices hearing arguments Tuesday about whether a pill used to terminate early pregnancies was properly evaluated by the Food and Drug Administration.
The medication, mifepristone, has been used in the United States more than 5 million times since it was approved for use in 2000, according to Danco Laboratories, the company that sells it under the brand name Mifeprex. Fewer than 0.5% of women who take it experience “serious adverse reactions,” and deaths are exceedingly rare, the FDA says in its prescribing information for doctors.
Mifepristone debuted in France, its home country, and China in 1988. It is now approved in 96 countries, from Albania to Zimbabwe, according to Gynuity Health Projects, a nonprofit that advocates for women’s reproductive rights.
Here’s a closer look at the safety of mifepristone.
What is mifepristone?
Mifepristone is the generic name of a pill that makes up half of the two-drug regimen used in medication abortions in the United States. When used in conjunction with a drug called misoprostol, it can terminate a pregnancy that is in the first 10 weeks of gestation.
The synthetic steroid was originally known as RU-486 (the “RU” stands for Roussel-Uclaf, the French company that developed the pill). It is also sold under the brand name Mifeprex.
How does mifepristone work?
It prevents a natural steroid hormone called progesterone from doing its job, which is to get the inner lining of the uterus ready for an embryo to implant about a week or so after an egg is fertilized.
Mifepristone gets in the way of this process by blocking the receptors that progesterone would normally bind with.
How do we know it is safe?
As with other medications, the Food and Drug Administration has monitored mifepristone’s safety profile in the decades since it went on the market. If problems cropped up that weren’t evident during clinical trials, the agency could have revoked its approval.
Instead, it has expanded access to mifepristone. For example, it was initially approved for use during the first seven weeks of pregnancy; in 2016, that window was extended to 10 weeks. Likewise, after the COVID-19 pandemic accelerated acceptance of telemedicine, the FDA in 2021 stopped requiring patients to see a healthcare provider in person in order to get a mifepristone prescription.
Those two decisions are at issue in the cases going before the court Tuesday.
“Hundreds of medical studies and vast amounts of data have confirmed its safety and efficacy as part of this two-drug regimen,” the American College of Obstetricians & Gynecologists, the American Medical Assn., and other medical societies wrote in a friend-of-the court brief filed on behalf of the FDA and Danco. The brief noted that “major adverse events occur in less than 0.32% of patients” and that “the risk of death is almost non-existent.”
Another sign of the drug’s safety is the fact that medication abortions have overtaken surgical abortions in the United States. Last year, 63% of abortions nationwide were carried out with mifepristone, according to the Guttmacher Institute, a nonprofit research group that supports reproductive rights.
Are there side effects to taking mifepristone?
There can be. According to the FDA, the most common ones include headaches, weakness, dizziness, nausea, vomiting, diarrhea, fever and chills.
The serious side effects to watch out for after using both drugs in the regimen are heavy bleeding (which the FDA describes as “enough to soak through two thick full-size sanitary pads per hour for two consecutive hours”), abdominal pain, a fever above 100.4 degrees Fahrenheit that lasts for at least four hours, and “feeling sick” more than a day after taking misoprostol.
Symptoms like these could be signs of a life-threatening infection, an ectopic pregnancy or another serious problem. Anyone experiencing them should contact a healthcare provider right away.
Can mifepristone be fatal?
The FDA says it is aware of 32 women who died after taking mifepristone between September 2000 (when it was first approved in the United States) and the end of 2022.
However, it’s not clear that mifepristone was responsible for any of these deaths. Two of them were definitely caused by ruptured ectopic pregnancies, several died of drug intoxication or overdoses, and at least two women who took the pill were victims of homicides, the FDA said. As for the remaining cases, patients were taking other medications or undergoing treatments at the same time, making it difficult to pin the blame on mifepristone, according to the agency.
In their legal brief, the medical groups said that in the worst-case scenario, the drug could have caused no more than 13 of the 32 deaths. That makes the drug less dangerous than using “Viagra or getting one’s wisdom teeth removed.”
Science
49ers coach Kyle Shanahan shows performance-enhancing smelling salts aren’t just for players
Football leans on tradition, providing convenient cover for the NFL’s lenient stance on smelling salts, ammonia crystals that players believe enhance performance when inhaled.
Does the olfactory exhilaration also enhance play-calling, amplifying one’s grasp of X’s and O’s?
Kyle Shanahan apparently believes so.
The San Francisco 49ers coach was caught by a Fox television camera moments before a playoff game Sunday against the Philadelphia Eagles taking several whiffs from a small packet before handing it to an assistant.
Earlier this season, the San Francisco Chronicle reported that 49ers players created a system to make sure everyone has immediate access to smelling salts during games. General manager John Lynch and Shanahan are users, according to the story, which stated that Shanahan “isn’t opposed to the occasional whiff.”
Is the NFL OK with this? The answer is a qualified yes.
Ahead of the 2025 season, the league’s head, neck and spine committee recommended that teams end the longtime practice of providing smelling salts to players. The decision was prompted by a U.S. Food and Drug Administration warning about the potential side effects of inhaling ammonia, which include lung damage and masking signs of a concussion.
Players all but panicked. George Kittle, the 49ers All-Pro tight end, jumped on an NFL Network broadcast to proclaim that smelling salts were crucial to his performance.
“I’m a regular user of smelling salts, taking them for a boost of energy before every offensive drive,” he said. “We have got to figure out a middle ground here, guys. Somebody help me out.”
The NFL came to his rescue, saying smelling salts — also known as ammonia inhalants, or AIs — were not banned. Teams could no longer provide them, but players could bring their own. It’s a compromise that may or may not pass the smell test. Either way, it’s not just the 49ers using them.
An ESPN Magazine piece in 2017 reported that “just a few minutes into the game, the Cowboys have discarded so many capsules that the area in front of their bench looks like the floor of a kid’s bedroom after trick-or-treating.”
Bottom line, legions of NFL players believe AIs enhance performance. They do so by irritating the linings of the nose and lungs, triggering a reflex that increases breathing rate and blood flow, fostering alertness.
Their effectiveness was discovered long before football was invented. Craft beer drinkers know Pliny the Elder as the inspiration for his namesake double IPA. The noted Roman naturalist and historian was indeed an early expert in fermentation, yet he also wrote about “sal ammoniac” — yes, smelling salts — in his encyclopedic work “Natural History,” published in 79 A.D.
Their popularity spread through Europe until, in Victorian tradition, they were used to rouse ladies after fainting spells. Later they were used in battle, with British medics supplying World War II soldiers with a whiff of the substance that doctors say triggers the body’s “fight-or-flight” response.
These days, the Federal Aviation Administration requires that U.S. airlines carry smelling salts onboard in case a pilot needs to be awakened after fainting. Blocking and tackling on a flight, however, remains strictly forbidden.
The NFL’s middling position isn’t curious. Experts say it’s an attempt to reduce liability in case of concussions or other medical complications. But it is their constant use that concerns doctors.
“The use of smelling salts in sports is definitely not their intended use,” Dr. Laura Boxley, a neuropsychologist at Ohio State’s Wexner Medical Center, told NPR. “What’s happening with some athletes is they’re using them with much higher frequency than their intended use.”
Given the relative safety of the sidelines, Shanahan isn’t in danger of a brain-rattling concussion. Shortly after the NFL ceased supplying AIs, he was asked by a reporter whether he had concerns about their prevalence.
“I mean, I don’t,” Shanahan replied with a grin. “If someone gives me one, I’ll take a smell of the salt. I’m not too worried about it. I like to take one to wake myself up and lock myself in.”
Science
AI windfall helps California narrow projected $3-billion budget deficit
SACRAMENTO — California and its state-funded programs are heading into a period of volatile fiscal uncertainty, driven largely by events in Washington and on Wall Street.
Gov. Gavin Newsom’s budget chief warned Friday that surging revenues tied to the artificial intelligence boom are being offset by rising costs and federal funding cuts. The result: a projected $3-billion state deficit for the next fiscal year despite no major new spending initiatives.
The Newsom administration on Friday released its proposed $348.9-billion budget for the fiscal year that begins July 1, formally launching negotiations with the Legislature over spending priorities and policy goals.
“This budget reflects both confidence and caution,” Newsom said in a statement. “California’s economy is strong, revenues are outperforming expectations, and our fiscal position is stable because of years of prudent fiscal management — but we remain disciplined and focused on sustaining progress, not overextending it.”
Newsom’s proposed budget did not include funding to backfill the massive cuts to Medicaid and other public assistance programs by President Trump and the Republican-led Congress, changes expected to lead to millions of low-income Californians losing healthcare coverage and other benefits.
“If the state doesn’t step up, communities across California will crumble,” California State Assn. of Counties Chief Executive Graham Knaus said in a statement.
The governor is expected to revise the plan in May using updated revenue projections after the income tax filing deadline, with lawmakers required to approve a final budget by June 15.
Newsom did not attend the budget presentation Friday, which was out of the ordinary, instead opting to have California Director of Finance Joe Stephenshaw field questions about the governor’s spending plan.
“Without having significant increases of spending, there also are no significant reductions or cuts to programs in the budget,” Stephenshaw said, noting that the proposal is a work in progress.
California has an unusually volatile revenue system — one that relies heavily on personal income taxes from high-earning residents whose capital gains rise and fall sharply with the stock market.
Entering state budget negotiations, many expected to see significant belt tightening after the nonpartisan Legislative Analyst’s Office warned in November that California faces a nearly $18-billion budget shortfall. The governor’s office and Department of Finance do not always agree, or use the LAO’s estimates.
On Friday, the Newsom administration said it is projecting a much smaller deficit — about $3 billion — after assuming higher revenues over the next three fiscal years than were forecast last year. The gap between the governor’s estimate and the LAO’s projection largely reflects differing assumptions about risk: The LAO factored in the possibility of a major stock market downturn.
“We do not do that,” Stephenshaw said.
Among the key areas in the budget:
Science
California confirms first measles case for 2026 in San Mateo County as vaccination debates continue
Barely more than a week into the new year, the California Department of Public Health confirmed its first measles case of 2026.
The diagnosis came from San Mateo County, where an unvaccinated adult likely contracted the virus from recent international travel, according to Preston Merchant, a San Mateo County Health spokesperson.
Measles is one of the most infectious viruses in the world, and can remain in the air for two hours after an infected person leaves, according to the CDPH. Although the U.S. announced it had eliminated measles in 2000, meaning there had been no reported infections of the disease in 12 months, measles have since returned.
Last year, the U.S. reported about 2,000 cases, the highest reported count since 1992, according to CDC data.
“Right now, our best strategy to avoid spread is contact tracing, so reaching out to everybody that came in contact with this person,” Merchant said. “So far, they have no reported symptoms. We’re assuming that this is the first [California] measles case of the year.”
San Mateo County also reported an unvaccinated child’s death from influenza this week.
Across the country, measles outbreaks are spreading. Today, the South Carolina State Department of Public Health confirmed the state’s outbreak had reached 310 cases. The number has been steadily rising since an initial infection in July spread across the state and is now reported to be connected with infections in North Carolina and Washington.
Similarly to San Mateo’s case, the first reported infection in South Carolina came from an unvaccinated person who was exposed to measles while traveling internationally.
At the border of Utah and Arizona, a separate measles outbreak has reached 390 cases, stemming from schools and pediatric centers, according to the Utah Department of Health and Human Services.
Canada, another long-standing “measles-free” nation, lost ground in its battle with measles in November. The Public Health Agency of Canada announced that the nation is battling a “large, multi-jurisdictional” measles outbreak that began in October 2024.
If American measles cases follow last year’s pattern, the United States is facing losing its measles elimination status next.
For a country to lose measles-free status, reported outbreaks must be of the same locally spread strain, as was the case in Canada. As many cases in the United States were initially connected to international travel, the U.S. has been able to hold on to the status. However, as outbreaks with American-origin cases continue, this pattern could lead the Pan American Health Organization to change the country’s status.
In the first year of the Trump administration, officials led by Health Secretary Robert F. Kennedy Jr. have promoted lowering vaccine mandates and reducing funding for health research.
In December, Trump’s presidential memorandum led to this week’s reduced recommended childhood vaccines; in June, Kennedy fired an entire CDC vaccine advisory committee, replacing members with multiple vaccine skeptics.
Experts are concerned that recent debates over vaccine mandates in the White House will shake the public’s confidence in the effectiveness of vaccines.
“Viruses and bacteria that were under control are being set free on our most vulnerable,” Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health, said to The Times.
According to the CDPH, the measles vaccine provides 97% protection against measles in two doses.
Common symptoms of measles include cough, runny nose, pink eye and rash. The virus is spread through breathing, coughing or talking, according to the CDPH.
Measles often leads to hospitalization and, for some, can be fatal.
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