We agree with Dr. Hoeldtke that systematic reviews of the literature are superior to narrative reviews. However, our article was invited as a primer for internists, not as a systematic or narrative review. Hence, our citation of the literature was by nature incomplete.

Dr. Hoeldtke makes a common error in logic regarding potential late sequelae of abortion: post hoc ergo propter hoc reasoning (after the fact, therefore on account of the fact). That one event (for example, suicide) follows another event does not imply a causal link between the two. In a notable example of this erroneous reasoning, Dr. Reardon, the lead author of the fifth reference in Dr. Hoeldtke's letter, has argued in print that penile amputation with a kitchen knife is a late consequence of abortion (1).

Many pregnant women with serious medical or psychiatric disorders choose induced abortion, as do many who live in abusive or violent relationships. Abortion does not remedy these comorbid conditions, including depression. Such women continue to have higher-than-average risks for morbidity and mortality. A recent population-based Finnish study documents this phenomenon (2). Rates of pregnancy-associated death from natural causes were higher in women who had induced abortions than in women after childbirth. When women who had abortions for medical reasons were excluded from the analysis, the rate was lower than that after birth.

Congressional hearings identified hundreds of counseling centers that deceptively portray themselves as abortion clinics. These centers have been documented to "detain, harass, and coerce women" (3). Regardless of one's views on abortion, such behavior is unethical. Facilities such as Planned Parenthood clinics do not promote abortion; instead, they support patient choice regarding pregnancy options. Planned Parenthood affiliates routinely counsel about adoption, and 21% provide prenatal care.

Because of space limitations, our primer on abortion could not cover abortion for women with medical conditions. Recent texts cover this important issue in more detail.

Dr. Stone accuses us of misrepresenting psychological sequelae; personal experience and church groups in Nashville, Tennessee, constitute his supporting evidence. As Surgeon General C. Everett Koop commented about his 1989 report on abortion, "Anecdotes do not make good scientific material." Thorough (and recent) reviews of the literature refute the notion of long-term adverse emotional consequences of induced abortion (4, 5). This was the conclusion of both the Koop report and a special panel of the American Psychological Association.