August 10, 2006

Plan B Emergency Contraception: Doctors Out of Their League, Again

"In a long overdue concession to science, the Food and Drug Administration could finally, grudgingly, be ready to allow an emergency contraceptive to be sold without a doctor's prescription." (USA Today Opinion 8/2/06)

"Concession to science?"  Wow!

I have admittedly almost zero interest in the way Plan B has become a proxy war for anti/pro abortion armies.  But when  doctors become social policy analysts I take note.  

Why are "scientists" saying that this drug should be sold without prescription?  Why should oral contraceptives require prescription, but this should not?  Or, to reverse it, if this doesn't need a prescription, then what does?  How do we decide what needs a script and what doesn't?  Expediency?  Political advantage?

The argument that this is an important option in the event of a pregnancy scare is premised on the notion that Plan B will be rarely used.  This is false. It overlooks a very key point: every unprotected sexual intercourse is a pregnancy scare.  And people usually have a lot of sex.

Look at it this way:

Before Plan B: you're a woman, you have sex.  You're worried-- not really worried, it's not the "right time of the month," he pulled out, etc, etc, but it's in the back of your mind.  But there's nothing you can do, too late now, so you just wait it out.

After Plan B: you're a woman, you have sex, etc, etc, but now exists a safe, non-prescription way to ensure you don't get pregnant. Why wouldn't you take it, just in case?  Even if the chances you are pregnant are really small-- Why not?  What does it hurt?  It's safe, the FDA said so, and even put it over the counter.  A little nasuea to guarantee you don't get pregnant?

See?  It's a no-brainer.

But what about the next night?  And the next?  What if you have sex-- 10 times a month?  It's not frequent enough to embark on the oral contraceptive-- after all, you don't have that much sex, you can't afford to go to the doctor, you don't have the time, etc-- but you know, Plan B is available in seconds...  Why not?

I know men who take Viagra "just in case."  (And that requires a prescription.)  You think this will be different?

Look, Plan B might actually be safe, even if taken every day.  But isn't every-day-Plan B chemically identical to an oral contraceptive-- which requires a prescription?  And if it isn't safe taken daily, why wouldn't a prescription be required?  I should point out that Plan B actually has three times more hormone in it than an oral contraceptive.  Hmm.  Is taking three birth control pills a day safe?  Anyone?

Again, this isn't about whether Plan B is moral or a social necessity-- something on which doctors are no better equipped than lumberjacks to pass judgment.  This is about whether Plan B should need a prescription, based on the drug's safety.

This isn't about women's rights or abortion or anything else.  It's about "scientists" picking and choosing what they want to believe; about becoming intoxicated with the power to drive social policy, and manipulating the infrastructure of the discipline to generate a smokescreen of science to support them.

Remember: these are the same people who discovered (read: decided) Vioxx causes heart attacks and Zoloft drives people insane-- years after their release-- but Plan B is so safe it doesn't need a prescription.

If I were a class action lawyer, I'd start clearing my desk...



Levonorgestrel: WHO recommends 1.5mg as a single dose; "Plan B" is .75mg in two doses (12hrs apart.)

Assume the average OCP has 0.25mg of levonorgestrol. (a levonorgestrol-only OCP, called Microval, has only .03mg).


Addendum 11/24/06:  Turns out that  Plan B emergency contraception does not reduce pregnancy rates.  Big surprise.  But the one difference was that those with easy access took it more often.  (News article here.) My post about this here.

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