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Sunday, Nov 8, 2009
Charlie Esser worries about overuse of Plan B, and about people using it instead of the Pill, which requires a prescription. This is hard to imagine. Plan B is quite expensive (around $50 a pop). Also, it has side effects, like nausea. Also, it has a significant failure rate. Why would anyone use it as their regular method of bc? Instead of, say, the Today sponge, which only costs $3.50, is non prescription and available at the drug store?
Lots of things currently on sale in the drug store can be misused, for example Tylenol, which can cause liver failure if you take too much, or laxatives, which can be part of anorexia/bulemia. These are not theoretical but actual problems--yet the FDA trusts people to use these products sensibly. It's only with Plan B that they come up with outlandish scenarios that then become the reason why everyone must be deprived. That's not science, it's politics.
I'm in favor of Plan B being OTC because its side effects are unpleasant and one-time-only. You don't take cumulative damage from one dose of Plan B; it just makes you sick as a dog for a few days and then you're done with it.
However, I nearly killed myself because Ortho-Cyclen makes me paranoid and depressed, and neither my gynecologist nor my psychiatrist seemed to have any idea that my pills could even be in the running for my condition. If two doctors can't advise me that my pills are killing me, what happens if I don't have to see a doctor at all to get the stuff?
Also, the Pill is not $50. I have spent most of my adult life buying Pills (Ortho-Cyclen, Nordette, Levlen, and Yasmin) which were less than the $30 co-pay my insurance plan mandated for them on their formulary. And I live in the Northeast, where stuff is expensive in general. Admittedly even $30 may be a stretch if you're a teen; that's six Big Mac meals or two CDs, and teen priorities being what they are, I can see this being problematic. The trip to the doctor or NP to get the prescription is probably the bigger hurdle. I'm sympathetic to this. But there are so many different formulations of the Pill that there is no possible one "generic"; a generic of Nordette is not the same as a generic of Ortho-Cyclen is not the same as a generic of Mircette. It's hard enough for ordinary people buying OTC medications to keep track of what has pseudoephedrine or acetaminophen in it, and I can't tell you how many times someone has handed me acetaminophen when I asked them for ibuprofen or aspirin (acetaminophen does next to nothing for my headaches). Are ordinary women supposed to keep track of what has estrogens and what has progestins and in what dosages? There would be twenty generic Pills, all different, and women wouldn't know that they all have very different side effects which vary wildly from individual to individual, that the side effects can include not just weight gain (which I think everyone knows about) but exotic problems like depression and blood clots, and that they're not interchangeable (good luck with getting halfway through a pill pack, losing it, and deciding to pick up a mini-pill to replace it...) Teens, the very people going OTC is supposed to benefit, would be least savvy and understanding about what pill they need and what it can do to them without the advice of a doctor or nurse practitioner guiding them.
On the other hand, Plan B is consistent. It has, to the best of my knowledge, one basic formulation. Its side effects are well understood (although somehow never manage to be mentioned in the popular media, or we could kill this "teen sex cult" meme with "yeah, because every teen wants to spend three days with cramps and nausea all the time. Get a life.") And it's an emergency medication -- if you need it odds are you do not have time to get to a doctor and you don't have time to screw around with obnoxious pharmacists who won't fill it for you. Birth control, you have time to get -- it takes seven days to kick in anyway so it's not like you have to get it in a big rush because you're having sex tonight.
I'd like to see BC get cheaper too, but it's not like condoms are cheap -- my husband and I saved a lot of money when we were first dating and we switched from condoms to the Pill. If you have an active and monogamous sex life, the Pill is an infinitely better bargain than condoms even *if* you aren't insured, in my experience. (Of course, if you're active and non-monogamous, condoms are better because they protect from disease.) And given how many different Pills there are and how much every individual woman varies in her reaction to the different kinds, I think making it OTC is foolish. I am also not sure the price would drop much, given the sheer number of different formulations. Plan B, as an emergency med, has a much better rationale for going OTC than a maintenance med like BC.
I admit, my understanding of the exact mechanics of Plan B, and the deleterious effects there of were lacking, however I think my central argument remains.
Plan B should not be the primary method of birth control available to young women over the counter.
There are better and less deleterious methods of birth control that should be made available first.
Focusing on Plan B when a better case can be made for other pharmaceutical methods of birth control to be sold over the counter is counterproductive and a waste of resources.
My issue was never that Plan B shouldn’t be made available over the counter (that is something that should be determined by a panel of disinterested scientists who would hopefully not be under the influence of any political agenda), but that a better argument can be made for over the counter status for the Pill, and as such a push for that should be a higher priority for those concerned about women’s reproductive health.
In addition, with regard to the idea that the pain involved with the use of Plan B would prevent it from being a regularly used method of birth control, I am not convinced.
If the first dose of Plan B causes the rapid onset of an intense menstruation, what would a second dose a week later result in? Will the woman’s body have replenished all that it had recently shed? If not, perhaps repeated dosing would result in a lesser effect, and would in fact encourage such use to prevent the harsh effect experienced when taken infrequently. Additionally, if there is an equally unpleasant effect each time the drug is used would that not encourage women to simply cross their fingers and hope, that this last time they weren’t fertile and as such Plan B is unnecessary?
Approval of Plan B for over the counter use, without first having the Pill approved would result in women (especially those who are economically disadvantaged) receiving less, and less safe medical care.
The purpose of Roe v. Wade was to ensure that safe access to reproductive health products and services would be available to women without government interference. It would seem a shame if this good was undone by the hubris of its own supporters.
This issue must be approached as a whole, a half solution (Plan B with out the Pill) may well be worse than no solution at all.
Again, I thank you for your consideration of my humble opinions.
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