Ever since a 22-year-old Carmichael mother crumpled in her driveway and died, her family has been wondering: Did Katie Payne's choice of birth control kill her?
The question began forming in her fiancé Anthony Greenfield's mind when a coroner's deputy asked him whether she had used birth control. It grew as Greenfield went online and found tales of deaths, illnesses and lawsuits.
While a coroner's investigation into Payne's Aug. 13 death is still under way, it's clear that hormonally based birth control can kill, causing heart attacks, strokes and blood clots like the one that took Payne's life.
Such side effects are well-known but "very rare," said Dr. Daniel Mishell Jr., editor of the journal Contraception and a professor of obstetrics and gynecology at the University of Southern California's Keck School of Medicine.
In the stark calculation of risk vs. benefit that helps doctors decide what to prescribe, Mishell and others note that for most young women, pregnancy itself is more dangerous than taking birth control pills.
What's less well understood is the risk of various devices that deliver newer forms of birth control hormones through skin patches or insertable rings, such as the one Payne was using.
One of the dangers comes from blood clots that can form in arms, legs or elsewhere in the body and move to the lungs or brain.
Payne died of a blood clot in her lung, one that essentially shut down her circulatory system by lodging in a key artery.
She had just returned home from a mom-and-toddler trip to the gym and had settled her 11-month-old son Peyton indoors before heading back out, apparently to get his diaper bag, said her stepfather, Jody Cline.
Her fall was recorded by a home security system, and a passing neighbor found her soon after.
Now her whole family is on a crusade to alert other young women that sometimes certain kinds of birth control can be deadly.
"I know this killed her," said her mother, Belinda Payne-Cline, as she cuddled Peyton in her living room and dabbed away tears. "If they can't do better research or get it off the market, then … the information needs to be more in depth about what can happen."
Greenfield fell for Payne's upbeat attitude and nonstop smile while she was still in high school.
He said the couple wanted to wait a little longer before having more children. She was a stay-at-home mom who hoped to go back to school to become a teacher. He is a plumber.
"They were just pacing themselves," said Payne-Cline. "She was young, and it wasn't time to start a big family."
The results of tests that could show whether Payne was genetically prone to clotting are still pending, said Dr. Elizabeth Albers, the pathologist who performed her autopsy for the Sacramento County Coroner's Office.
But when a young, active woman dies of a blood clot, birth control is one of the factors that has to be considered, Albers said.
If no other cause for the clot is found, the death potentially could enter federal databases as another adverse effect of NuvaRing, a disk-shaped hormone-delivery product that is inserted once a month and then removed three weeks later.
Last year, the consumer group Public Citizen asked the Food and Drug Administration to ban oral contraceptives containing desogestrel, a variant of one of the hormones in NuvaRing, because some studies showed it doubles the risk of blood clots.
NuvaRing's Web site and product information warn that one of its hormones, a kind of progestin, may cause more clotting than the progestin in some birth control bills. But it adds that the difference in risk between the ring and some birth control pills is unknown.
That is the kind of language that infuriates David Ennis, whose Florida and Washington, D.C., law firm – Ennis & Ennis – is heavily involved in lawsuits targeting NuvaRing, which is sold by Schering-Plough.
"That is where the public is being misled," said Ennis, who is looking into Payne's death.
NuvaRing's makers rely too heavily on studies of birth control pills, he said, instead of studying their own product more fully before offering it to women eager for something more convenient than a daily pill.
Stronger product warnings make prescriptions and sales plummet, so companies fight them as long as possible, Ennis said.
It took years for the FDA to toughen its warnings about blood clots and the Ortho Evra patch made by Johnson & Johnson. Now thousands of families are suing, 40 to 50 deaths have been alleged and sales have plunged, the New York Times reported in April.
Schering-Plough, which last year bought the company that developed NuvaRing, estimates that about 1 million American women use the ring.
Neither the company nor the FDA would provide product-related death data, but Ennis said he believes a dozen deaths involving NuvaRing may have been reported to the FDA since U.S. sales began in 2002.
Schering-Plough is conducting a large study of potential dangers, with results expected in 2012.
"Because the risk of venous thromboembolism (blood clots) in women who use combined hormonal contraceptives is so small, in order to measure the actual risk one must observe thousands of women for a prolonged period of time," Schering-Plough spokesman Stephen Galpin Jr. wrote in an e-mail.
The study, which is still enrolling participants, will track 30,000 women who are using either NuvaRing or oral contraceptives for four years, he said.
Call The Bee's Carrie Peyton Dahlberg, (916) 321-1086.
