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    Sunday, September 15, 2002

    Passion’s Regret: The morning after pill is in the news again. This time, its advocates are agitating to make it over-the-counter. The Reuters story was spurred by a Sounding Board article (the equivalent of an op-ed piece) in the New England Journal of Medicine by David A. Grimes (requires subscription to access). Dr. Grimes is a gynecologist and oral contraceptive advocate. He’s gone on record promoting the continuous use of birth control pills to abolish menstrual cycles (periods are so annoying don’t you know). His NEJM article is an outstanding piece of Pill boosterism. You could call it a Pill manifesto.

    He calls for the FDA to waive their usual standards before approving the drugs for over-the-counter use, largely on the basis that the morning after pills are safe and innocuous. He goes so far to claim that they’re as safe as aspirin, and to accuse the FDA of jeopardizing women’s health by delaying the decision to make them over the counter.

    Now, it is certainly true that if taken correctly, the emergency contraceptive pills, Plan B and PREVEN™, have a low rate of serious side effects, and are effective at preventing pregnancy (1% and 3% failure rates respectively). They do have a high rate of nuisance side effects, most noticeably nausea (as high as 50%) and vomiting. But the greatest concern with making them over the counter is the potential for abuse. They are essentially high dose oral contraceptives. If made available over the counter, there is a good chance that many young women ( especially teenagers and college students) would use them regularly in place of safer long-term daily oral contraceptives. Dr. Grimes argues that this hasn’t turned out to be the case in European countries and some parts of Canada where it’s already available over the counter, but he’s ignoring one crucial factor that plays heavily in the use of medication in our country - advertising.

    Both Preven and Plan B already have direct to consumer advertisements directed at college age girls and teenagers. Plan B has a campaign centered around posters of hunks that urge young girls to have a back up plan (Plan B) if the hunk fails to protect them. Preven has gone the route of appealing to everyone’s stronger inner woman, relying on Rosie the Riveter to get their message across. The message, however, is clear in both campaigns - back up your condoms with the morning after pill. It will be all too tempting for young women to use the pills every time they have sex, rather than in the occasional “emergency” as they were intended. The pills may be safe for occasional use, but taking them two or three times a week would raise their risks and side effects substantially. It would also give women a means for obtaining birth control pills while forgoing their regular pap smears and pelvic exams. (Exams that women loathe more than going to the dentist.) If this should turn out to be the case, then we can expect to see more cases of pelvic inflammatory disease and cervical cancer because screening exams were deferred. Casually making oral contraceptives over-the-counter could, in the long run, be far more dangerous to women’s health than the unintended pregnancies that worry Dr. Grimes.

    As for Dr. Grimes, one has to wonder why he is such an unremitting Pill booster. His article identifies him as a member of a group called Family Health International, a nebulous organization devoted to promoting and researching world reproductive health. That certainly sounds admirable and non-profit, but the descriptions of the organization on their website are all quite vague when it comes to the details of who started the group and how they are financed. They aren’t a government agency, but they also aren’t a charity. They say they are a “vehicle for new business ventures, including research and development services for pharmaceutical, biotechnology and medical device companies.” Could they (and he) be representing the interests of the pharmaceutical companies?
     

    posted by Sydney on 9/15/2002 08:33:00 AM 0 comments

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