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Medical Maverick : Gynecologist Richard Hausknecht flouted protocol with successful use of abortion drugs. But critics wish he had gone through channels.


NEW YORK — The doctor is taking a call from a longtime patient who recently had a surgical abortion of her 22- week fetus because it was missing critical organs. She is depressed, calling for support.

"Whatcha expect?" the doctor bellows into the phone. "To be happy?"

Then he softens: "Listen, you knew I'd have a wise-ass answer. . . . Of course, you have every reason in the world to be depressed. You went through a horror."

Dr. Richard U. Hausknecht, the Park Avenue gynecologist who aroused the ire of the medical Establishment for providing his patients with two drugs that work in tandem to induce abortion, has been called arrogant, self-involved, a loose canon and a grandstander. Although he rejects those descriptions, his view of himself is hyperbolic.

"Sure, I'm a nut, a maverick and somewhat of a revolutionary. I've been part of radical political movements all my life," Hausknecht says, noting that he helped open New York City's first independent abortion clinic in the 1970s. "I've put my life on the line physically, recreationally and politically. OK, fine. But, I'm a very conservative doc. I don't gamble with the health of my patients."

But that is exactly what critics insist he did by prescribing methotrexate and misoprostol in July, 1994, to dozens of women who found him through an ad in the New York Times. While the drugs had Federal Drug Administration approval for other uses, when Hausknecht began offering them, they had been administered for abortion in rare instances only by university researchers.

"Back then we didn't know if these drugs were safe and effective for abortion but [Hausknecht] just jumped head-first anyway," says Dr. Mitchell D. Creinin, the first researcher to experiment with the drugs for abortion. Since 1992, the University of Pittsburgh School of Medicine professor has conducted more than a dozen mostly small studies on methotrexate abortion; the results of three have been published in scientific journals.

But Creinin never made the nightly news. And Hausknecht did. Several times. While Hausknecht acknowledges that he took risks with his career--and perhaps his life because of threats from abortion foes--he says the women who came to him to end their pregnancies were never at risk.

"I felt safety wasn't the issue: Efficacy was and acceptability, and getting the word out," Hausknecht says. "How do you get the word out? You manipulate the media. So that's what I did, and it worked."

In fact, Hausknecht's bold leap into abortion science and politics illustrates just how eager some activists are to find alternatives to the surgical technique in use for more than 20 years.

With clinics under siege, younger doctors increasingly reluctant to perform abortions, and new methods such as the French abortion pill, RU486, still illegal in America, Hausknecht says he believed he had to forge ahead to find a safe, easy, legal, inexpensive and private technique.

The controversy that ensued, however, reveals the tensions that can arise between academic researchers such as Creinin, who experiment with a few dozen patients at a time, and private physicians such as Hausknecht, who are eager to meet a critical need in medical areas such as abortion and AIDS.

Initially, Hausknecht had no supervision--neither from the FDA nor from Mt. Sinai Hospital, where he has been on the med school faculty for 25 years. But in late 1994, after the media broadcast his 96% success rate in prescribing methotrexate and misoprostol to induce miscarriages in 126 women, both the FDA and the hospital pressed the doctor to get their approval for what he likes to call his "innovative clinical care."

Although he is vice chairman of the committee that approves drugs for use at Mt. Sinai and has done other research, Hausknecht says he was naive about "the red tape" associated with drug research. He also makes it clear he didn't want to learn about some of it.

"If I had gone to Mt. Sinai for approval, some young whippersnapper in my department would have been assigned the task of doing this research project, with me as a very distant political consultant," says Hausknecht, 65. "I wanted to be able to control the project and the political outcome of this myself."

He describes his tangle with authorities during an interview in his office in a pricey Upper East Side area where upper-crust women come to solve their medical problems. His already booming voice gets even louder when he talks about the stir he created. Blue eyes behind wire-rim glasses narrow as he details the hurdles and highlights of his career.

"I could have failed," he says, grimacing and pulling his fingers through a combed-back thicket of white hair. "I could have ended up in serious trouble with colleagues. The media could have disregarded me and thought I was a nut and not important.

"But it didn't happen that way."


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