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paper trail

Who Exactly Is Behind the Supreme Court’s Big Mifepristone Case?

The Alliance for Hippocratic Medicine claims to be an organization of doctors worried about mifepristone. The paper trail is more ambiguous.

Television crews set up in front of the Supreme Court building.
Kent Nishimura/Los Angeles Times/Getty Images
A news television crew outside the U.S. Supreme Court on April 21, 2023, in Washington, D.C.

The biggest abortion rights case since Dobbs, which the Supreme Court is scheduled to hear on March 26, is based around a simple narrative: A group of doctors represented by the professional organization Alliance for Hippocratic Medicine say the drug mifepristone—one of two drugs used for medication abortion—is dangerous and illegal to dispense by mail, and wants the drug pulled from the market. This, at least, is the story told by AHM’s legal filings.

In reality, however, the Alliance for Hippocratic Medicine is a newly incorporated anti-abortion group, hastily established in 2022 following the Dobbs decision in a jurisdiction that would be favorable to their case, where it was all but certain to go before an anti-abortion judge. Their purported scientific claims fall apart under scrutiny; studies they cite in their legal filings have been retracted. And the real force behind the case, known as Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration (which is now consolidated with a case involving drug manufacturer Danco Laboratories) is the Christian-right law shop Alliance Defending Freedom, which also won the Dobbs case overturning Roe v. Wade and which, last term, prevailed in its case 303 Creative v. Elenis.

The 303 Creative case involved the flimsy premise of a plaintiff who wanted the right to turn down same-sex-wedding website clients, even though she had never made a same-sex-wedding website. (The same-sex-wedding website request she claimed to have received, as The New Republic reported last June, came from a same-sex couple who do not exist.) Now, in an analysis of tax filings reported for the first time, it looks like Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration is in fact built on similar lines. But instead of bringing a case with a real plaintiff and fictional injury, this time Alliance Defending Freedom has brought a case involving a plaintiff who seems to exist largely as a piece of paper filed in Amarillo, Texas, about 300 feet from the courthouse where they would bring this case. The Alliance for Hippocratic Medicine, on closer examination, is less a distinct professional organization than a shadow group composed of other anti-abortion groups, including several that ADF has cultivated over many years. Of AHM and its five member organizations contacted by TNR, none responded by publication to detailed questions sent by The New Republic for this piece. The query sent to one of its member organizations was forwarded by that organization to ADF for response. ADF did not provide answers to any of the queries.

“Alliance for Hippocratic Medicine is nothing more than a brand name that Alliance Defending Freedom used to shop this abortion pill case up to the Supreme Court,” said Caroline Ciccone, president of Accountable.US, the watchdog group that analyzed AHM’s tax filings. “It’s deeply concerning that Alliance for Hippocratic Medicine could exist as such a flimsy group on paper and achieve such far-reaching consequences as the ones presented by this case.”

The Alliance for Hippocratic Medicine is a group composed not of individuals but rather of member groups, three of which are listed as co-plaintiffs in the Supreme Court case. (Four individual doctors are also listed as co-plaintiffs. Three of these doctors are in turn members of AHM member-groups.) Bureaucratically speaking, Alliance for Hippocratic Medicine came into being on August 5, 2022, when the group’s articles of incorporation were filed. The address listed by the group is shared by an Amarillo law firm, although AHM’s activities in Amarillo appear limited to this specific case. The case filed three months later, in November, was guaranteed by virtue of being filed in Amarillo to be decided by the U.S. District Court for the Northern District of Texas, and specifically by Judge Matthew J. Kacsmaryk, who had previously served as counsel for First Liberty Institute, another Christian anti-abortion law group that ADF has funded in the past. (Kacsmaryk also had two law clerks from ADF’s intern program for law students.) AHM’s subsequent application for nonprofit status with the IRS in January 2023, which Accountable.US located and shared with TNR, stated that it did not anticipate raising more than $50,000 annually for the next three years. The 1023-EZ form used to apply for this nonprofit status also showed a change in AHM’s first four months of legal incorporation: Now its address was listed as being in Bristol, Tennessee. Google Street View shows the address as being directly off the highway on a short road blocked with a gate, where there is a plaque reading, “Christian Medical and Dental Association,” or CMDA. That group is a member of AHM and a co-plaintiff in the case.

Sure enough, when AHM reported its income for 2022, it reported an annual income of “$50,000 or less.” And again, on this form, its address remains listed in Tennessee at the location of CMDA. These tax forms were filed under the name of the group’s board chair, Donna Harrison. Until March 2023, Harrison served as the CEO of the American Association of Pro-Life Obstetricians and Gynecologists, or AAPLOG, one of AHM’s member groups and another co-plaintiff in the case. Harrison, an obstetrician-gynecologist who was still heading AAPLOG at the time Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration was filed, has not practiced medicine since 2000—the year mifepristone was first approved by the FDA.

In summary, AHM’s paper trail shows it incorporated in Texas weeks after the Supreme Court’s ruling in Dobbs, quickly filed its challenge to mifepristone in Texas, and by 2023, saw its case headed for the Supreme Court. How is AHM able to afford this major, high-profile litigation, given that it reported raising no more than $50,000 the year it brought the case? It doesn’t appear to be raising funds publicly—bread and butter work for any nonprofit. It could be collecting member dues, but if it does, they do not amount to much, given its reported income. Besides, according to the 11 documents the group lists on its website as its “advocacy efforts,” the group’s membership has shrunk from 50,000 members in 2021, as it cited in a letter to the Senate Judiciary Committee opposing the Equality Act (before there are any formal filings as to the group’s legal existence), to 20,000 members cited in a press release opposing Ohio’s abortion rights ballot initiative in April 2023. These 11 documents posted to AHM’s website—position statements, press releases, and a few letters to Senate committees—appear to be the only public record of any activities undertaken by this organization that it wishes to highlight, aside from its role in the Supreme Court case.

Even the name is misleading: The Alliance for Hippocratic Medicine does not practice Hippocratic medicine. It pledges to honor the “Essential Hippocratic Oath,” which includes the words, “I will not help a woman obtain an abortion. In purity and holiness I will maintain the utmost respect for human life from the moment of fertilization until the moment of natural death, carefully guarding my role as a healer.” This is at odds with the traditional Hippocratic Oath, which involves respect for patient autonomy and a pledge to do more good than harm.

AHM, then, has little existence of its own. Primarily it serves as a brand name its member organizations can use when issuing public statements. As to what else “it” is doing, aside from lending its name to this Supreme Court case, the answer may lie with two of its member organizations and co-plaintiffs, the American Association of Pro-Life Obstetricians and Gynecologists and the American College of Pediatricians.

Like Alliance for Hippocratic Medicine, on its face, the American College of Pediatricians, or ACPeds, resembles a professional organization of doctors, with a name very similar to that of the largest professional association of pediatricians in the United States: the American Academy of Pediatrics, which is nonideological and was established nearly a century ago. But ACPeds is nothing like the American Academy of Pediatrics. In fact, based on the group’s financial records and internal documents, ACPeds would be more accurately described as a religious, anti-abortion, anti-LGBTQ rights group that happens to be composed of some physicians. In contrast to AHM’s minimal public footprint, ACPeds, which is also a client of ADF, has a more substantial paper trail that offers a window into how it operates. As an ADF attorney told the group, according to an ACPeds document, “It was best that the College was not religiously affiliated in order to provide maximum benefit for our message.” Similar to AHM, ACPeds doesn’t seem to have enough money to account for its profile. A nonprofit accounting expert noted the discrepancy to Mother Jones last year, saying that it was “surprising they would have a national footprint” given their relatively tiny annual budget of around $180,000.

In recent years, as ACPeds’ influence in state legislatures and courts has grown, ADF has lent it a range of support. In 2021, ADF and ACPeds signed a contract in which ADF agreed to legally represent ACPeds free of charge. This contract was among more than 10,000 documents inadvertently published by ACPeds in a public Google Drive, first reported by WIRED last year. The magazine described the contract as stipulating that “ADF’s ability to subsidize expenses incurred during lawsuits would be limited by ethical guidelines; however, it could still forgive any lingering costs simply by declaring [ACPeds] ‘indigent.’” ADF also offered direct funding to ACPeds: In 2019, a senior ADF attorney spoke with ACPeds’ executive director about having the group apply for a $10,000 grant from ADF to produce a white paper that “refutes” current standards of gender-affirming care for trans people. Ultimately, ACPeds sought $15,000 from ADF for this “Special Project,” as its board meeting minutes noted. The minutes further stated that “ADF request this white paper for use in litigation and should also benefit many other allies at State and Federal Level.” That is, ADF commissioned research with a predetermined outcome, in order to help it prevail in court.

Even if ACPeds weren’t a nakedly ideological organization and were doing legitimate research, this kind of funder relationship with ADF would give ACPeds, a report by Southern Poverty Law Center’s Hatewatch publication observed, “a potential financial motive for complying with ADF’s anti-trans research requests.” (SPLC has also designated ACPeds a hate group.) At least one federal official appeared to have also understood the nature of ACPeds’ and ADF’s circular relationship; when Trump-appointee Roger Severino was head of the Department of Health and Human Services Office of Civil Rights in 2019 and asked ACPeds to submit a letter on “Freedom of Conscience” as part of his office’s move to permit doctors to deny care to transgender patients and patients who have had an abortion, he acknowledged that the “ACPeds letter would be written by ADF,” according to meeting minutes describing his request.

Both ACPeds and the other AHM member group listed as a plaintiff, the American Association of Pro-Life Obstetricians and Gynecologists, host an annual conference at which attendees can be trained as expert witnesses. AAPLOG offers additional such trainings multiple times each year across the United States and online; some of the trainings, like a series immediately following Trump’s election, have been led by ADF. The trainings mobilize AAPLOG members, as Mother Jones has reported, with AAPLOG doctors serving as expert witnesses in legislative hearings to educate lawmakers on anti-abortion bills they are considering, as well as testifying and submitting briefs in court when those laws are inevitably challenged in court. It was a role AAPLOG played in a prior anti-abortion case, June Medical Services v. Russo, filing an amicus brief in support of the anti-abortion law at the heart of the case and writing op-eds in support.

Alliance for Hippocratic Medicine has a briefer lifespan and leaner finances than its member organizations and co-plaintiffs. But both ACPeds and AAPLOG have received funding from ADF in addition to having been represented by ADF before, though not in any case as high profile as this. It’s likely, according to Accountable.US, that ADF is offering its legal services to AHM for free—as it did to ACPeds. In that case, then, since AHM has no comparable resources to speak of, ADF’s pro bono legal representation would be AHM’s largest source of outside support.

AHM was incorporated in a state in which it does not seem to perform any programmatic activities, aside from its appearance at a U.S. district court in which it filed its legal challenge to medication abortion. “This is not a legal advocacy group organizing everyday Americans in a class action—these are ideological organizations masquerading as legitimate medical associations essentially registering a website and using it to roll back reproductive rights,” observed Ciccone from Accountable.US. “The group targeted a district where a friendly, anti-abortion judge is guaranteed. If this tactic is successful, what’s to stop Amarillo from becoming the new home for every right-wing group with a fringe idea for a lawsuit and the money to register a PO box?” That’s in addition to the immediate implications: Should AHM prevail at the Supreme Court, access to mifepristone could be significantly limited in every state—including those where abortion is legal.