There is a story that Dr. James Patrick Johnston, a family physician, likes to tell about a patient he saw a few years ago: a woman who discovered her pregnancy had gone ectopic, the embryo implanted in her fallopian tube.
Ectopic pregnancies occur in about two percent of pregnancies, and they are the leading cause of maternal mortality during the first trimester. Left untreated, they will tear a person’s organs, causing massive hemorrhaging that will in all likelihood kill both parent and child. The best way to prevent this catastrophic outcome is to remove the misplaced egg with medication or surgery. According to Dr. Johnston, his patient’s OBGYN explained all of this to her. The patient was anti-abortion, believing, like many extremists, that every fertilized egg was a potential life. But given the risk of harm and the likelihood that her fetus wouldn’t survive, she consented to take a dose of methotrexate that would prevent the embryo’s further growth.
The way Johnston tells it, after two weeks of bleeding, the woman went back to the gynecologist for an ultrasound, which “much to the patient’s grief and sorrow” revealed a miscarried pregnancy in the uterus. This led Johnston to “further study,” after which he concluded that either the embryo had naturally made its way from the fallopian tube to its correct place, or that the women had in fact conceived twins—one of which, with a different kind of medical intervention, would have been saved.
“Regardless, evidence shows that the vast majority of the time fallopian tube pregnancies resolve on their own,” Johnston says. “An abortion of the fallopian-implanted pregnancy is unnecessary. Women have the right to know this.”
These beliefs are counter to every conceivable known medical fact about ectopic pregnancies, but it is this anecdote, allegedly relayed through one of his patients, that led Johnston to “further investigate the dishonesty and malpractice surrounding abortion and ectopic pregnancy” and become among the country’s most vocal advocates for the idea that an ectopic pregnancy is not, in fact, a medical emergency requiring immediate care. This activism has led him to circulate medical studies of dubious origin and offer himself to anti-abortion groups as a public speaker discouraging the “unethical” treatment of the complication through traditional means. Recently some of his ideas have been reflected in state legislation. He’s been referring patients to a doctor he found who was willing to perform an imaginary, experimental surgery in which a fertilized egg is “reimplanted” from the fallopian tube to the womb.
The idea that there are alternative treatments for ectopic pregnancies, or that such pregnancies can most often be resolved “naturally,” has intermittently appeared in extreme anti-abortion circles, though the majority of pro-life physicians and advocacy groups reject the claim. Lila Rose, a woman who regularly compares abortion to slavery and the Holocaust, has said the medical termination of an ectopic pregnancy is not an “abortion procedure.” The American Association of Pro-Life OB/GYNS considers an ectopic pregnancy an unavoidable loss of human life separate from the elective termination of a fertilized egg.
But in September a Federalist writer published a story challenging what she called the “false dogma surrounding ectopic pregnancies,” suggesting that death rates for mothers carrying ectopic pregnancies “to term” were inflated, and that if doctors put their resources towards finding a way to “save” “tiny lives” it could be done. (She later recanted her story.) In April, Ohio State Representative John Becker included in an anti-abortion bill a provision that would require insurance coverage for the “reimplantation” of ectopic pregnancy from the fallopian tube to the uterus, a procedure that, as many medical professionals quickly pointed out, does not exist.
Becker didn’t conjure this procedure from the depths of his imagination. “I was given some research material,” he tells Jezebel, that cited “studies” in two medical journals. These studies were one 1917 case report, less than three pages long, written by C.J. Wallace, a doctor who claimed to have performed a reimplantation in order to provide children with the “right to live,” and a letter to the editors in the American Journal of Obstetrics and Gynecology from Dr. Landrum Shettles describing a successful surgery he witnessed at a hospital in Vermont. (Dr. Shettles, a pioneer in early IVF research, resigned from his position at Columbia-Presbyterian in the ’70s after his supervisor discovered the doctor had ignored ethical guidelines around human experimentation.)
It’s difficult to know, precisely, through what process of osmosis these “research materials” landed on Becker’s desk, or how these ideas about ectopic pregnancy ended up synthesized in the Federalist. (Becker declined to clarify who helped him with that part of the bill, and two of Ohio’s most influential pro-life lobbying organizations denied involvement.) But there is one particular doctor who has been advocating for this sort of procedure since at least 2015, when he sent a letter titled “Saving Eptopically Implanted Boys and Girls” to more than two-dozen pro-life leaders and groups.
“Ectopic-pregnancy-uterine transplantation surgery is a long-proven remedy that the contemporary medical community pretends does not even exist,” Dr. Johnston wrote, encouraging pro-life groups to update their policies and encourage “informed consent” on “life-saving options” when ministering to pregnant women and training doctors. He also suggested, as more effective than abortion, a treatment for the hemorrhaging a person experiences during an ectopic pregnancy called “autotransfusion,” in which blood is collected, filtered, and transfused back into the body through an IV—a method that’s been proven useful, though whether it could be said to be “more effective” than the current standards very much depends on a person’s threshold for this sort of intervention, and whether living through the rupturing of a fallopian tube sounds like fun.
As it happens, the two studies Johnston cited in his letter were the same ones sent to Representative Becker, and the doctor’s analysis of the autotransfusion method was a central argument in the recent Federalist piece. He was the only medical professional quoted. Johnston says he wasn’t aware of the reimplantation provision in Becker’s Ohio bill—but if the ideas threaded through these arguments originated from another medical professional’s advocacy, it’s a perplexing coincidence. As Dr. Patrick Baggot, a longtime anti-abortion gynecologist recently told me, the issue of ectopic pregnancies amounts to the sort of thing certain doctors might kick around in private, when they’re relaxing or brainstorming after a pro-life conference. But over the last decade, Johnston has made understating the risks of ectopic pregnancy and researching potential treatments something of a pet cause.
Dr. James Patrick Johnston is an osteopathic doctor and family practitioner who worked in central Ohio until recently, when he moved his family to North Carolina and opened a Christian membership-based clinic specializing in home visits: “It’s what family medicine used to be, before bureaucrats and socialists took over,” the pitch on his website reads. The practice is “herbal-friendly,” “pro-homeschooling,” and “comfortable with vaccine-wary patients.” Johnston’s wife, Elizabeth Johnston, goes by the name “Activist Mommy” and blogs prolifically about the “perversion” of the “homosexual agenda,” among other topics. The couple has 10 children, all of whom are homeschooled: They have committed to giving God as many children as possible. The family regularly visits Mexico and India to “evangelize and sing.”
Dr. Johnston has written 10 novels and innumerable booklets; he’s been writing about abortion since he was an undergrad in Florida in the early ’90s. His “2020 Trilogy” imagines a world in which an anti-abortion president is killed in a terrorist attack, sparking a civil war between a righteous “Coalition of Free Christian States” and an army of “young anarchists and Marxists” under the command of a liberal college professor, and where “preachers and pro-life activists are hunted like terrorists, forced into re-education classes, and persecuted.”
The trilogy opens with a Texas sheriff saving an “18-year-old beauty” from an abortion doctor with a “thick foreign accent” and charging him with murder. Johnston also runs a film company, Fervent House Media, which produced a “faith-based action film” spun out of one of his books in 2017. As a promotional stunt, the production team hosted an AR-15 giveaway.
Johnston has said he is the child of missionaries; he also appears to have been “converted” as an undergraduate studying biology at Florida State University by the infamous campus preacher Brother Jed, the kind of figure who sets up in public spaces with homemade hellfire-and-damnation signs. This alliance lasted through Johnston’s medical training in Florida and into his residency at the Southern Ohio Medical Center: In 1999, he was identified as as a “follower” of Jed’s, and himself preached the sins of homosexuality on campus. Johnson’s zealotry did not go unnoticed by his fellow students: Two years into his medical residency, he prepared a lecture providing a “scientific defense for the humanity of the pre-born,” including graphic photographs. In Johnston’s telling of it, an administrator told him he was a one-issue physician using science to mask his religious objections, and prevented him from repeating his efforts annually, as he’d planned.
Johnston deployed a street preacher vernacular to make various arguments against abortion, publishing scripture-heavy, call-and-response essays on his website. Among these were arguments for executing abortion providers and acquitting James Kopp, the man who killed physician Barnett Slepian in 1998. For example, in the latter argument:
The basis of my statement is the laws of our land. That’s right. The laws of our land! The laws of our land are two-fold: the laws of God, and the Constitution. The laws of God make up the laws of our land because the laws of God are universal: they are without boundaries. God’s law reigns supreme over the laws of every land, over all man-made statutes and edicts. When any King contradicts the King of Kings, guess who’s right? When the Supreme Court and the most Supreme Court conflict, the Supreme Judge of the world overrules.
Though his message has stayed remarkably consistent, over time Johnston seems to have cleaned up his tone to be more palatable to a broader audience, running for Senate to “restore our nation to biblical principles” on a platform of “life, liberty, and jobs!” and testifying on official letterhead “as a physician” in favor of abortion bans in a handful of states. He has used the names Richard Johnston, James R. Johnston, and J. P. Johnston, depending on which medical or activists circles he was in.
It was a bit of a problem for this mainstreaming of his image, however, that in 2004 Johnston was featured in a gallery of “heroes” on the website for The Army of God, a violent far-right group that since the ’80s has compiled “hit lists” of abortion doctors, as well as kidnapping physicians and bombing clinics. Though Johnston has denied involvement with the group, the connection was occasionally noted by political opponents once the doctor set up a family practice (and weight loss clinic) in Ohio and began pursuing more institutional avenues for ending abortion, regardless of its impact on a woman’s health.
In the 2000s, Johnston helped organize the national conference for Operation Save America, a dominionist group, and became the vice-chairman of the Constitutional Party of Ohio. He also formed a group he called the Association of Pro-Life Physicians which he used to assist anti-abortion initiatives in other states, offering his expert testimony on the medical definition of when life begins. Through all this, Johnston continued to blog at an impressive pace, both on his own site and for fringe religious outlets: Subjects of interest included the need to ban lawyers to combat the scourge of malpractice suits, teaching children to cry quietly while you beat them, the coming “doom” brought on by low birth rates and high levels of immigration, how to to secede from the United States in the correct way, and why God doesn’t want you to be fat.
In 2012, Johnston ran for Senate on the platform of overturning Roe v. Wade by banning abortion entirely in Ohio. He lost. The same year, as the director of “Personhood Ohio,” he attempted to gather enough signatures to petition for an amendment to the Constitution of Ohio that would declare that life begins the moment an egg is fertilized. It made no exceptions for women who were at medical risk, or for instances of incest or rape. As part of the effort to raise money, Johnston sold his guns, comparing the “sacrifice” of firearms to sacrificing animals to God. The group collected only 30,000 of around 385,000 signatures it needed, lacking the support of other pro-life groups in the state, including Ohio Right to Life.
Even among staunch anti-abortion activists in a decidedly conservative state, Johnston’s views could be comparatively extreme. Around the time Johnston launched his various campaigns, he wrote a response to Janet Porter, the architect of Ohio’s “heartbeat bill,” accusing her of promoting a “counterfeit moral standard” by making exceptions for the termination of a pregnancy when a woman’s health was in danger, or preventing mothers for being prosecuted for the death of their children. “It is not right or necessary to kill the baby to save the mother,” he wrote.
Other pro-life activists had taken on the idea that ectopic pregnancies could be saved, or left to “naturally” pass into the correct place: Typically, these arguments have relied on the individual stories of miraculous births: deemed “ectopic pregnancy survivors,” in the vocabulary of some groups. But perhaps because of his opposition to the idea that laws might include provisions for a woman’s health, and his grounding in the language of medicine,
Johnston expended significant energy finding something resembling proof that the risks of ectopic pregnancies had been overstated.
The doctor tells Jezebel he became interested in “ectopic pregnancy survival” after an anti-abortion patient of his was “pressured” by her OBGYN and dermatologist to get an abortion when she became unexpectedly pregnant while taking Accutane, a drug with a high risk of producing birth defects. “When I investigated further, it turns out doctors frequently recommend therapeutic abortion not to protect the mother or the baby, but to protect themselves from litigation,” he says. Around 2009, he began publicly relaying the story of his other patient, the one with an ectopic pregnancy who experienced an additional miscarriage, though he tells me he has been researching this particular pregnancy complication for “five to 10 years.”
While the specifics of his stories about women with health concerns varied, the substance—and Johnson’s focus on his highly credentialed opinion—remained consistent: In one video taken in his office, stethoscope around his neck, he used similar logic to argue that most women with a serious blood-clotting and liver complication would carry a child to term without incident. “I’ve had to, as a physician, address the ‘life of the mother’ exception,” he says, telling a story about a woman he met at a homeschooling conference who had given birth to two healthy children despite being diagnosed with HELLP.
Johnston’s honorarium as doctor, and his involvement with the anti-abortion association of physicians he’d founded himself, allowed him to frame his conviction that there were reasonable alternatives as if they established a conclusive medical fact. Osteopathic doctors are licensed professionals with an emphasis on preventative medicine and whole-body health: Johnston is neither a medical researcher or OBGYN. The doctors first mentioned the case studies he came to frequently cite around 2015, when he wrote about the 100-year-old ectopic reimplantation experiment in an article for the now-defunct Personhood Ohio, of which he was the director at the time.
A year later, he expanded on this in an article in “Celebrate Life Magazine,” arguing for “expectant management” of ectopic pregnancies—monitoring them continually rather than treating them immediately, as physicians now do. Along with the idea that a woman whose body was ruptured and hemorrhaging due to an ectopic pregnancy could be more effectively treated by a doctor who pumped her with her own filtered blood, he cited the two case studies that would eventually land on Representative Becker’s desk. The conclusion of the article suggested a “conspiracy” keeping doctors from treating ectopic pregnancies using the untested reimplantation method, in the form of malpractice suits.
These ideas also appeared, neutered and professionalized and generously footnoted, in the letter Johnston sent out to two dozen pro-life groups the same year, naming himself as an acquaintance of a prominent pro-life OBGYN. In the letter he offered himself as a “public speaker and lecturer” who might encourage doctors to “perform these life-saving procedures,” and provided guidelines for other pro-life groups to follow suit. By the spring of 2019, the case studies he dug up had been added to a fact sheet on the Personhood Alliance’s website—where Johnston is prominent a member—and Representative Baker had added what he calls an “experimental” surgery to his bill. It remains in committee. Once it was discovered by doctors the surgery was described as “pure science-fiction.” The only above-board research being performed on the issue is in a study of lab rats overseen by Dr. Stephen Sammut, a professor of psychology. He is also currently involved in a study on how abortion affects rats’ bodies and minds.
Around the time Johnston was publishing his articles on ectopic pregnancy, he was contacted by Dr. Patrick Baggot, an anti-abortion doctor in California. At the Guadalupe Medical Center, founded by the Catholic actor Eduardo Verastegui, Baggot offers “abortion reversals” and prenatal care with a focus on pregnancies that are high risk. An OBGYN with a background in genetics, Baggot, like many doctors who receive training in natural fertility matters at the Pope Paul VI institute, funds his research through pro-life organizations and publishes the results in ideologically affiliated journals like the Journal of American Physicians and Surgeons, the in-house publication of a conservative organization devoted to applying free-market principles to matters of health.
Baggot focused on developmental disorders: He’s done research on using large doses of vitamins, in-utero sound therapy, and chelation therapy—a treatment for heavy metal poisoning thought by some anti-vaxxers to cure autism—to reduce the symptoms of Down Syndrome while a child is still in the womb.
Johnston says Baggot was willing to try to reimplant fallopian ectopic pregnancies into the uterus—he was familiar with the research from his years in the field. Baggot has spoken at length to “a few” women interested in the experimental surgery on Johnston’s referral. The women, according to Baggot, were “surprisingly adamant” and saw their diagnosis as “being forced to give up pregnancies that they wanted.” They’d seen Johnston’s work; they’d contacted him desperately hoping to try the solution he’d offered.
So far, according to the doctors, there have been a few roadblocks: the risk of traveling across the country with a potentially deadly condition, for one, and Baggot says the efforts have stalled somewhat as his central funding mechanism, an anti-abortion medical research fund called The Michael Fund, closed down. He didn’t feel comfortable performing the surgery without the approval of the Institutional Review Board, which vets medical research: He’s worked on his application, but it hasn’t yet been submitted, he says. And this is in addition to the fact that, as Baggot tells it, people who have attempted to “help” women with similar issues in the past have faced “quite a bit of persecution” from the medical establishment. “If one was trying to help patients,” he says, “one might endure attacks.”
Baggot says he’s been hearing about the case studies Johnston cited since the late ’90s, when he was at the Pope Paul VI Institute: “Everyone would like to make this happen,” he says. Later he tells me the reason this surgery hasn’t been offered, and that there’s so little conclusive research, is a matter of “pure political attack.” (Baggot appears to have some disdain for standardized medical bodies: Last year, testifying on behalf of a colleague, he referred to his own unnamed medical board peer review as a “sham.”) And when I ask Johnston why, for instance, the Association for Pro-Life Gynecologists is reticent to embrace his stance that the termination of an ectopic pregnancy is an elective abortion best treated with an unproven surgery, he tells me that “groups like the AAPLOG are not beyond political pressures.” He’d like them to look more carefully at the studies, and perhaps commission their own. It’s in everyone’s interest, even feminists’, to “salvage unborn babies,” he says.
Johnston didn’t single-handedly craft this small rebellion to the existing medical consensus. But his writings over the last decade do appear to have launched this narrative about ectopic pregnancy into, if not the mainstream, something adjacent to it. Verbalizing a niche theory engineered out of political need and adopting the language of peer-reviewed study and conclusive research, the doctor managed to reinvigorate a debate so thoroughly settled it’s been unsuccessfully circulating for more than 30 years.
This was possible in large part because of the community that straddles the anti-abortion movement and established medical practice, iterating on treatments to create a second health system balancing just slightly adjacent to the one most Americans occupy: If you want to claim that abortion or contraception or the treatment of a life-threatening pregnancy complication isn’t healthcare, it’s important to be able to offer an alternative. Even, or especially, if its exact execution and side-effects are unknown. “I used to work in the healthcare business,” says Representative Becker. “I understand there is no CPT code. That doesn’t mean it doesn’t exist. That means it’s experimental.”
Johnston is still practicing family medicine, now in North Carolina: He’s making house-calls to the anti-abortion and vaccine-wary, and is working on various anti-abortion initiatives in the state. When I ask him in an email exactly what form his activism is taking these days, he tells me he’s writing books and making movies. And, he adds: “Making the world pro-life one stubborn obstacle at a time. :-)”