PIP: Vaginal spermicides are a widely used form of contraception either alone or in combination with other techniques. H. Jick and coworkers studied the records of a health maintenance organization (HMO) in Seattle and identified 763 infants born to women who filled a prescription for spermicide within about 20 months before delivery. They also identified records of 3902 infants whose mothers had not filled such a prescription. Among infants whose mothers had a possible spermicide exposure before or during pregnancy, 17 (2.2%) had malformations, compared to 39 (1.0%) among the women with no record of spermicide purchase. The excess in malformations in the spermicide group was attributed to infants with limb deformities, neoplasms, Down syndrome, and hypospadias. The authors noted that "the absence of a single, well defined syndrome among the infants whose mothers used spermicides raises doubt about a causal connection between these agents and the disorders noted." According to Dr. Howard W. Ory, several major shortcomings make the results of this study unpersuasive. Complete monitoring of congenital defects at birth usually identifies defects in 3% of children. The Jick study identified defects in 1.6% of children, suggesting that either the Seattle HMO is composed of a very select group of women or that there was substantial (50%) underascertainment of children with defects. If the "missing" children with defects were included in the study, the results would be impossible to predict. The 2nd major shortcoming relates to the vagueness of defining use, as opposed to purchase. No evidence is provided that the spermicides were actually used during pregnancy. The 3rd major shortcoming relates to the diversity of defects. One is asked to accept that merely filling a prescription for a topically applied detergent can result in 3 completely separate types of major congenital problems: malignancy, chromosomal errors, and defects of early embryogenesis. Based on the results of 1 study such conclusions are unwarranted.