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Analysis of Noem’s Cited Sources Shows Unqualified Advocate, Bias, Plagiarism, and Misread Research

In her grandstanding telemedicine/abortion executive order yesterday, Governor Kristi Noem failed to provide a clear citation for her medically malpractive claim that treating ectopic pregnancies is more dangerous to women’s health than just waiting to see if their ectopic pregnancies burst their fallopian tubes. I had to dig through our part-time Governor’s footnotes to track down the source of that dangerous and incorrect claim. My analysis of all the sources cited in Noem’s feckless Executive Order 2021-12 shows that, still far from reading all the science, Noem is simply cribbing radical anti-abortion sources to justify bad policy for South Dakota.

Gov. Kristi Noem, Executive Order2021.09.07, signatures and cited sources, 2021.09.07; citations highlighted by DFP.
Gov. Kristi Noem, Executive Order 2021-12, signatures and cited sources, 2021.09.07; citations highlighted by DFP.

In an executive order directing the South Dakota Department of Health to write rules concerning medical practice, Governor Noem’s first source, cited in three separate articles, is Tessa Longbons, a research associate at the Charlotte Lozier Institute, an extremist anti-abortion lobbying group that cherry-picks and obfuscates real research to undermine abortion rights and produces occasional original “research” plagued with bias and errors. Ms. Longbons holds no degree in medicine or research; she has a bachelor of arts in communications from Thomas Edison State University in New Jersey.

On lack of qualifications alone, Longbons should be ignored in any serious discussion of state rules for medical procedures. But Noem uses Longbons for talking points, not rigorous science. Longbons’s 2019 opinion column provides no evidence that allowing women to access abortion drugs via telemedicine was harmful to women or required increased regulation. Noem plagiarizes Longbons’s 2021 column for most of the text of her second Whereas clause, without providing quotation marks or a targeted in-text citation to make clear she is using Longbons’s words. Longbons’s third column, a joint effort with fellow Lozier propagandist Hannah Howard, is more secondary opinionating reciting Longbons’s other opinion pieces and Noem’s purported primary sources. Thus, while Noem provides legal background with the passage she plagiarizes from Longbons 2021, Noem doesn’t wring any scientific weight from her citation of these three propaganda pieces.

Noem plagiarizes both Longbons’s text and Longbons’s citation of a Lozier “fact sheet” in this sentence of her third Whereas clause: “The result is likely to be an increase in chemical abortions and resulting complications [iii]“. Longbons sentence is just slightly different: “The result is likely to be an increase in chemical abortions and chemical abortion complications. [2]” (Noem is at least sufficiently attentive to renumber her footnotes.) The Lozier “fact sheet” that Noem/Longbons cite refers to more secondary-source opinion pieces by the institute, another anti-abortion advocacy group, and only two primary sources, the Aultman and Niinimäki papers that Noem cites elsewhere in her order. Thus, like all three Longbons columns, the Lozier “fact sheet” fails to lend scientific weight to the argument Noem makes for her order.

Those two papers and a third are the only primary and seemingly scientific journal articles Noem offers to support her order:

  1. Maarit Niinimäki et al., “Immediate Complications After Medical Compared with Surgical Termination of Pregnancy,” Obstetrics and Gynecology, October 2009.
  2. H.K. Atrash, H.T. McKay, and C.J. Hogue, “Ectopic Pregnancy Concurrent with Induced Abortion: Incidence and Mortality,” American Journal of Obstetrics and Gynecology, March 1990.
  3. Kathi A. Aultman et al., “Deaths and Severe Adverse Events After the Use of Mifepristone as an Abortifacient from September 2000 to February 2019,” Issues in Law and Medicine, Spring 2021.

Noem cites Niinimäki to support her claim that “chemical abortion has a four times greater rate of complications than surgical abortion.” Indeed, Niinimäki’s study of 42,619 induced abortions in Finland from 2000 through 2006 finds that medical abortion produces more “adverse events” than surgical abortion and may not as reliably terminate the pregnancy, but the study indicated no increased risk of infection or death:

The overall incidence of adverse events was fourfold higher in the medical compared with surgical abortion cohort (20.0% compared with 5.6%, P<.001). Hemorrhage (15.6% compared with 2.1%, P<.001) and incomplete abortion (6.7% compared with 1.6%, P<.001) were more common after medical abortion. The rate of surgical (re)evacuation was 5.9% after medical abortion and 1.8% after surgical abortion (P<.001). Although rare, injuries requiring operative treatment or operative complications occurred more often with surgical termination of pregnancy (0.6% compared with 0.03%, P<.001). No differences were noted in the incidence of infections (1.7% compared with 1.7%, P=.85), thromboembolic disease, psychiatric morbidity, or death [Niinimäki et al., 2009].

“Both methods of abortion are generally safe,” conclude Niinimäki et al. Noem says she’s ordering the the Department of Health “to enhance reporting requirements for this procedure so that we know how often and how harsh the results are,” but the very article she cites in this order seems to answer that question.

I don’t see the citation that points to Noem’s Atrash footnote, but Atrash’s 1990 paper appears to be the source of her irresponsible claim (in her fifth Whereas clause) that “A woman is 30% more likely to die from an ectopic pregnancy while undergoing an abortion than if she had an ectopic pregnancy but had not sought an abortion.” Yet Atrash did not say that the women in his 1971–1985 cohort died “while undergoing an abortion.” Atrash said, “Most of the deaths of women with ectopic pregnancy who underwent induced abortion were attributable to the failure to diagnose the ectopic pregnancy before the woman left the facility where the abortion was performed.” It appears (and I don’t have the full paper, so I’m stepping out on logical limbs) that the increased death-to-case rate arose from doctors failing to check for the ectopic pregnancy and letting the women leave thinking their problems were solved but carrying the ticking time bomb of the ectopic pregnancy. Doctors address the increased death-to-case rate identified in Atrash not by refusing to administer abortion drugs but by checking for signs of ectopic pregnancy and following up after the procedure to make sure they didn’t miss anything. Much more recent research [Bennett et al., 2009] citing Atrash indicates doctors do just that: in its 2001–2005 cohort of 2,550 women, the Bennett study found that “Missed ectopic pregnancies were successfully treated in the inpatient setting without mortality….” The risk Noem misrepresents in her order is already handled better by medical professionals than by her false-alarmism and misinformed/misinforming government overreach.

Noem’s last source, Aultman 2021, supposedly supports Noem’s claim that “women can experience severe and life-threatening side-effects after taking the abortion pills, including heavy bleeding, intense pain, and even death.” But as we well know, women can also experience severe and life-threatening side-effects after becoming pregnant, including heavy bleeding, intense pain, and even death. Where’s our executive order dispatching the Department of Health to patrol the backroads looking for teens who need to be informed of those side effects before they jump in the backseat and risk pregnancy?

The Aultman paper counts up the adverse events from mifepristone reported to the FDA. For its part, the FDA has reviewed these adverse reports and found they do not warrant additional safety guidelines. Dissatisfied that the data did not compel the policy action they desire, Aultman et al. inflate their case by claiming that the FDA reporting system is inadequate. The primary author of the article is another Lozier Institute hack (though at least a retired doctor) who appears to promote the false idea of post-abortion syndrome. The publisher of the Aultman article, Issues in Law and Medicine, appears to be strongly biased toward arguing against abortion rights with occasional forays into anti-vaccination advocacy.

I do appreciate the Governor’s effort to cite her sources for Executive Order 2021-12. Don’t be fooled: footnotes don’t guarantee weightier or reliable conclusions any more than they guarantee the author didn’t plagiarize (quote marks and tighter cites, Kristi!). But Noem’s sources do help us check her work, identify her bias, and see how she’s misreading science.

30 Comments

  1. Gail L Swenson 2021-09-09

    And what grade would you give to a high school debater who turned in this “research,” Mr. Heidelberger?

  2. Mark Anderson 2021-09-09

    But Cory, look at that signature, it’s Presidential for sure. Anyways, the “research” was done by underlings and they always crib. The Noem doesn’t have time to do “research”, she’s saving America. She’s still working off her Snow Queen speech, and that’s enough for the trumpies.

  3. ArloBlundt 2021-09-09

    Well…good work Cory..of course Mrs. Noem’s executive order is half baked and based on dubious research…her whole administration is the same.

  4. Cory Allen Heidelberger Post author | 2021-09-09

    Gail, if I were judging a contest round, the debaters presenting these sources wouldn’t win the round…assuming that the opposing team indicted the sources as I do above.

    If I were grading a paper for class, I’d probably have to give the paper a zero for plagiarism. That one Whereas clause copied verbatim from the Longbons article, without a footnote and without quotes, violates the classroom plagiarism policy. Floating the source in the endnotes without clearly tying it to the originating text is naughty.

  5. Cory Allen Heidelberger Post author | 2021-09-09

    Arlo, I wish my critique could serve as formative assessment for my elected government. I wish Team Noem would look at this analysis, say, “Darn, he’s right, we did cite weak sources and plagiarize that one section. We should rewrite this order with more reliable, scientifically rigorous, unbiased sources.” I don’t like grading papers as much as critiquing them and providing feedback that students can use to improve their thinking and writing.

  6. Donald Pay 2021-09-09

    She better make sure that signature matches her voter registration or she might be disqualified from voting or running for Governor again.

    It strikes me that Noem likes to rely on what are called “poof studies,” which are quite commonly done by various righty foundations. These are “studies” where they pull quotes and data from actual scientific or medical studies, but that don’t really reflect the conclusions of the studies. “Poof studies” are also called “junk science.” Good job in running all this down. Yeah, Noem didn’t really write this. It takes someone with a bit higher IQ than she has to wade through the research and fudge it as you described.

  7. grudznick 2021-09-09

    I am sure Ms. Noem’s team is not spending time “analyzing” or “grading” the bloggings here, but if they are it is very likely grudznick’s rate near the top of the scoring. When teachers or debator judges, gravy sucking as they may be, cast down their opinion one must remember it is but an opinion. Subjective.

  8. Guy 2021-09-09

    Grudz, you’re correct. Kristi’s team could care less about “blog analysis”. In the meantime Kristi has 2022 in the bag….UNLESS a viable candidate is willing and confident to take her on in next year’s election. All the blog “grading” of Kristi’s political moves WITHOUT a formidable candidate is meaningless and will not defeat her.

  9. grudznick 2021-09-09

    Mr. Guy, you seem to be righter than right in this regard.

    Viable, in grudznick’s book, does not include Ms. Taffy, Mr. Partridge, or Mr. Jensen, all of the insaner ilk here in Rapid City. It would take a fellow like Mr. Jackley to step back into the ring, but he is doing us all a favor by taking the strange looking and incompetent Mr. Ravnsborg out. That leaves, mayhap, the young Mr. Barnett to challenge Ms. Noem in the primaries. I don’t think Mr. Barnett has the cash to get it done thusly.

  10. Guy 2021-09-09

    Grudz, why is it that I’m right when I do NOT want to be right as is the case of Kristi Noem winning reelection as Governor?!?!? At this point, all I can do is hold out hope that she loses…because being right on this would be a big bummer!

  11. DaveFN 2021-09-09

    At best she’s the people’s choice, not a scholar. Says volumes about “the people.”

  12. Donald Pay 2021-09-10

    Grudz is wrong, completely wrong. Any politician or political consultant is going to analyze what “the other side” is saying. And, trust me, they know Noem is particularly vulnerable on “facts,” or what Christians might call bearing false witness. Of course the cultish Christians she is appealing to are equally fact challenged, so it doesn’t affect her base, but normal people are put off by constant lying. Sure, we understand politicians shade the truth, but Noem and Trump are in a special category. In actual GOVERNANCE a grasp of facts matters. Sure, Noem is great at B.S., and verbally “owning the libs,” but she does that by lying. She’s a complete failure as a Governor, because she can’t grasp facts. So, the question for voters will be whether they prefer a lying bitch or do they want competence.

  13. Gail L Swenson 2021-09-10

    See, you can never take the teacher or debate coach out of the classroom. I concur with your grading/analysis. An “A” for the teacher! Seriously, well done to expose the shoddy work and flimsy research. Too bad your work won’t influence Noem or her team of half-wits. And, the majority of voters in the state won’t care.

  14. Guy 2021-09-10

    Donald Pay, we got all that. So, where is the willfull, confident and formidable candidate that is going to take her on?

  15. mike from iowa 2021-09-10

    One question, slightly off topic, for A-Butt and other delusional magat guvs pertaining to rapes. If A-Butt is so sure he can eliminate all rapists, why hasn’t the lying SOB done so already?

  16. O 2021-09-10

    The one scenario I see for defeating Noem is a candidate from the health care industry. Someone who has seen first hand the destruction that this governor’s disregard for the citizens she was elected to protect. Someone who will give voice to the 136,000 sick and 2,079+ (and counting) South Dakotans who lost their lives to “lazy fair,” pro-business, part-time governance.

    I do not know who that candidate is or could be. I do not know what party he or she comes from. I say that is the voice that will resonate against Governor Noem.

  17. Guy 2021-09-10

    O, that’s the HUGE problem we have. None of us “knows who that candidate is or could be”… or if he or she even exists?

  18. bearcreekbat 2021-09-10

    O – maybe Kevin Weiland, MD. I have no idea whether he would be willing to run, but apparently he has run for public office in the past (and lost), and his brother Rick ran for Congress (and lost). Kevin is a bright, caring family physician in Rapid City and IMHO would make a tremendous governor of the State. I suppose his main SD political weakness is his long standing affiliation with the SD Democratic party.

  19. Guy 2021-09-10

    Well, Bat, I think your statement says a lot: “I suppose his main SD political weakness is his long standing affiliation with the SD Democratic party.” That is kind of my concern about the “South Dakota Democratic Party” and lack of confidence as I view it. I believe the SD Democrats main issue is where they stand in the state. If they want to regain confidence it will ALWAYS harken back to whether the party becomes a more “moderate” and “reasonable” force again. If they remain extreme, so, goes their confidence and that is the huge underlying issue that angers some when I bring it up. The truth can be a sore point, but, I don’t see this party going anywhere until they face their past and move away from the fringe. The crickets this late in the game broadcast to me their is HUGE lack of confidence in the South Dakota Democratic Party.

  20. kurtz 2021-09-10

    $30 says Troy Heinert will be our gubernatorial candidate and with consensus a primary can avoided.

  21. Guy 2021-09-10

    Kurtz, I’ve also heard some soft rumblings that Troy Heinert has “expressed interest” in running for governor. I do not know too much about Troy. How moderate is he? He isn’t far left, is he? Does he have a moderate voting record in the South Dakota State Legislature? Kurtz, maybe you can lend some additional insight?

  22. kurtz 2021-09-10

    Collectivism is arguably the most important feature binding every surviving human culture on the Earth today yet modern purely socialistic societies have struggled with longevity. Why? Probably because US capitalists have warred against any and all efforts at pure socialism around the globe since it was defined in the modern sense even as those wars are bankrupting America today.

    Although the term “socialist” wasn’t widely used until the nineteenth century it’s of little consequence as it has existed in its purest form for nearly all of human history. Indigenous cultures lived in collectivist economies long before migrating to this hemisphere.

    Here’s Senator Heinert’s Ballotpedia page.

  23. Porter Lansing 2021-09-10

    “Modern Socialism” carries the lies about it’s “political theory” like Jesus carried his cross.

    “Modern Socialism” isn’t political, at all; it’s economic.

    “Modern Socialism” is simply buying things we all need, as a group, to get the best bargaining position and the lowest price.

    The easy example is COSTCO, where members pay a fee and COSTCO shops as a group.

    “Modern Socialism” uses our taxes and our leadership shops as a group.

    Same thing.

  24. kurtz 2021-09-10

    Yes, socialized agriculture, socialized dairies, socialized cheese, socialized livestock production, a socialized timber industry, socialized air service, socialized freight rail, a socialized nursing home industry, a socialized internet and now socialized gas well remediation are all fine with Republicans in South Dakota but then they insist single-payer medical insurance is socialized medicine.

  25. Porter Lansing 2021-09-10

    Governmental aid programs aren’t Modern Socialism.

    Governmental aid programs are wealth redistribution and that’s communism not modern socialism.

  26. kurtz 2021-09-10

    Not just research leader as a subscriber to the Nordic Model Finland is well-positioned to show emerging economies like South Dakota’s how to move beyond moral hazard to a sustainable self-reliance.

  27. Guy 2021-09-10

    Kurtz, thank you for the link. I’ll definitely check-out Mr. Heinert’s voting record! In the meantime, study up on: Cooperative Businesses (Co-ops). These member-owned businesses and more of them might be the answers we are looking for in a mixed economy like ours. In Co-ops there is NO centralized government control, however, whoever is a member is an owner of that co-op. Credit Unions are financial co-ops.

  28. kurtz 2021-09-10

    Here in New Mexico our wireless provider is a coop—using it now!

  29. O 2021-09-10

    Guy, I have to reject your premise that the Democratic Party has become “too extreme” for SD tastes — not when compared to the radicalization of the GOP. From Tea Party to MAGA, the Democrats cannot hold a candle to how far the right has swung. Even more to the point, the fringe left is still the fringe (albeit the part that gets the attention) whereas the right IS all fringe-right. The right – not just the fringe right – is talking about Civil War 2.0; the right – not just the fringe right – talks about second amendment remedies for everything. I cannot name a “moderate” Republican because should one let his or her identity be known, they will be ostracized as a RINO and primaried out from the right. That the right successfully normalized their radicalization is an accomplishment in branding and tribalism, but a detriment to the real middle of American politics.

    Issues, bread-and-butter, family issues like a living wage and safe work environment, affordable health care, decent housing, a life-sustaining environment . . . have somehow been framed as “radicalized” leftist/socialist agendas by right/ultra-right rhetoric.

  30. O 2021-09-10

    I would argue that government taxation policy is wealth distribution policy. The United States creates poverty homelessness and starvation BECAUSE of how it decides to tax its population.

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