Why Does The Pill Have To Be Prescription?
Virginia Postrel asks the right question at Bloomberg News:
Requiring a prescription "acts more as a barrier to access rather than providing medically necessary supervision," argues Daniel Grossman of Ibis Reproductive Health, a research and advocacy group based in Massachusetts, in an article published in September in Expert Review of Obstetrics & Gynecology.Birth-control pills can have side effects, of course, but so can such over-the-counter drugs as antihistamines, ibuprofen or... Aleve. That's why even the most common over-the-counter drugs, including aspirin, carry warning labels. Most women aren't at risk from oral contraceptives, however, just as most patients aren't at risk from aspirin or Benadryl, and studies suggest that a patient checklist can catch most potential problems.
To further increase safety, over-the-counter sales could start with a progestin-only formulation, sometimes called the "minipill," rather than the more-common combinations of progestin and estrogen...Progestin-only pills, or POPs, have fewer contraindications. Unlike combination pills, they're OK for women with hypertension, for instance, or smokers over the age of 35. The main dangers are fairly rare conditions such as breast cancer or current liver disease. "Not only are POP contraindications rare, but women appear to be able to accurately identify them using a simple checklist without the aid of a clinician," declares an article forthcoming in the journal Contraception.
...Aside from safety, the biggest argument for keeping birth- control pills prescription-only is, to put it bluntly, extortion. The current arrangement forces women to go to the doctor at least once a year, usually submitting to a pelvic exam, if they want this extremely reliable form of contraception. That demand may suit doctors' paternalist instincts and financial interests, but it doesn't serve patients' needs. As the 1993 article's authors noted, the exam requirement "assumes that it would be worse for a woman's health to miss out on routine care than it would be to miss out on taking oral contraceptives."
Going to the doctor is costly in time, money and sometimes in dignity. Not surprisingly, the prescription requirement deters use of oral contraceptives. In a 2004 phone survey, 68 percent of American women said they would start the pill or another form of hormonal birth control, such as the patch, if they could buy it in a pharmacy with screening by a pharmacist instead of getting a doctor's prescription. Two-thirds of blacks and slightly more than half of whites and Latinas surveyed said they chose their current, less-effective method of birth control because it didn't require a prescription.
This ties in with the question of whether your insurance should pay for contraceptive pills; you could suggest that insurance should only cover what a doctor prescribes, you could also suggest that insurance should then cover anything a doctor prescribes. If that's the case, then requiring a prescription would be a way to have insurance cover the contraception pills.
clinky at March 12, 2012 1:43 AM
Sure, why not have the pill sold over the counter? It would defuse the insurance coverage question (the pills wouldn't be insured, if they're over the counter) and the silly "war on women" crap at the same time. Just in time for the election!
mpetrie98 at March 12, 2012 3:14 AM
I agree with the gist, but—
> Two-thirds of blacks and slightly more than half
> of whites and Latinas surveyed said they chose
> their current, less-effective method of birth
> control because it didn't require a prescription.
We should never forget that birth control is one of the things people will tell crazy lies about. Lies, or distortions, or bad data, or forgotten details and on and on. When it comes to fucking, people want what they want, and the work to get it without verbal truths or rational calculation.
So birth control stats are always dicey. How, theoretically, can a condom "fail"? It fails when someone wants a baby anyway, or when it's not at hand, or someone's in a hurry.
The current regulatory scheme for these things is certainly odious, but let's remember that we're talking about known unknowns, no matter what.
Crid [CridComment at gmail] at March 12, 2012 5:38 AM
Amy Alkon
http://www.advicegoddess.com/archives/2012/03/12/why_does_the_pi.html#comment-3063060">comment from Crid [CridComment at gmail]David Buss pointed out that I had a less-than-nuanced view on self-reported sex stats (my thinking that they should always be viewed through a completely jaundiced eye), and while yes, people lie, ask yourself what would they get out of lying to the answer to this question about it not requiring a prescription?
Amy Alkon at March 12, 2012 6:08 AM
I get the whole idea behind not wanting a prescription. However, you really should be going to a GYN once a year anyway, so what is the big deal? You go for an annual exam, and get your prescription re-upped for the next year.
Renee at March 12, 2012 6:13 AM
Well, considering how many people think they can just take it on sex days (and how many people can't read the instructions to use condoms correctly) I think a Dr telling you to take it at the same time each day isn't unreasonable. But I am past the need for them, so I may be biased. I never found a trip to the Dr once a year a hardship. If you need BC then you need a yearly checkup and STD check anyway.
momof4 at March 12, 2012 6:26 AM
> Why Does The Pill Have To Be Prescription?
Because it increases demand for doctors, a very rich and organized voting block, and thus increases their take home pay.
(Note that the AMA also strictly limits the supply by not increasing the number of med school berths despite the rising population).
Next question
TJIC at March 12, 2012 7:03 AM
@momof4
> I think a Dr telling you to take it at the same time each day isn't unreasonable.
No, it's quite reasonable.
The thing is, we the people didn't delegate to the government all sorts of powers as long as they're used in a reasonable way.
No, we delegated a very specific, limited and enumerated set of powers on the theory that adults deserve to be treated as adults, and it's better for people to use their freedom to make occassional mistakes than it is to have their freedom removed.
TJIC at March 12, 2012 7:14 AM
Describing prescriptions as a barrier to getting birth control seems a stretch. Cost is a reasonable argument, but the act of going to the doctor and handing the prescription to the pharmacist does not seem that harrowing. Indeed, they usually phone them in now, so all you need to do is pick it up. And if the lady at the counter is clicking her tongue at you for getting The Pill, imagine what she's doing to all those Valtrex takers.
Costly in time, OK, I see the argument, costly financially, well, okay, to a degree, but if we're talking once a year, it's not quite a staggering disaster. But to dignity? I'm clearly out of touch as to what's a blow to dignity. I'd say "just find a nicer doctor" but I do get that the number of available practices drops as the ability to pay drops, so I know it's not as easy.
But I must say that the number of things that are percieved as barriers or deterrents today make me wonder if some folks are looking just a little to hard for things to inflate into a crisis. I mean, you need ID to buy Sudafed now - is that being called a barrier to health care by anyone? As opposed to just a pain in the ass?
Vinnie Bartilucci at March 12, 2012 7:24 AM
I get the point of, in general, not forcing people to go to a doctor if all the doctor's going to do is whip out a prescription without doing an exam. There are a lot of things that ought to be OTC, yet we seem to be going in the other direction (needing a prescription for Sudafed, and such).
However, I'm not sure BC pills fall into this category. If I were running a pharma company making the things, I'm not sure I'd want them to be OTC. Way too much potential for lawsuits: from women who experience side effects, from women who don't take them properly as M4 said, and from women who get pregnant because the formulation wasn't right for them.
Cousin Dave at March 12, 2012 7:36 AM
Observing the teenagers/young adults in my current mostly rural (Texas) and former (Virginia) rural turned urban area, I see a lot of smartphones (assuming they have a $60+ monthly data plan), newish large cars, expensive car speaker systems (BOOM BOOM), expensive wheels, and obesity.
My conclusion is that they are exercising their right to spend their money as they choose.
I have difficulty believing that obtaining birth control of any type is so difficult for persons capable of purchasing and using these costly items and that I see eating fast food.
I do not have difficulty in believing that obtaining/using birth control is simply not that important to them.
I have seen poverty stricken areas where these items are only present in drug-infested areas and the availability of any kind of health care/education is truly non-existent. That I understand.
Who is being played here with these "excuses".
Bob in Texas at March 12, 2012 7:56 AM
I usually agree Ms. Postrel but this one is a miss. The reason you have to jump through hoops to get birth control is lawyers not doctors. Anything related to women's reproductive health is at risk for a law suit. That is why malpractice insurance for OB GYNs is so high. Lawyers love class action lawsuits and if you tie a dead, deformed, or sick baby into the mix well then you really have something. I don't blame doctors for doing what the have to protect themselves from potential lawsuits. As Crid says, this is one of those things that people lie about a lot. A once year trip to the doctor is just good practice anyway.
Sheepymommy at March 12, 2012 7:58 AM
This starts the main question why is any drug OTC or prescription.
Is it possibly abused drugs? OD hazard? ones needing special directions? politics? lawsuits?
Or is it all of the above?
The last time at the doc, she gave me the option for a prescription or to just take 3 otc since it is exactly the same thing.
Joe J at March 12, 2012 8:27 AM
Describing prescriptions as a barrier to getting birth control seems a stretch. Cost is a reasonable argument, but the act of going to the doctor and handing the prescription to the pharmacist does not seem that harrowing. Indeed, they usually phone them in now, so all you need to do is pick it up.
Not true. Getting an OB/GYN appointment can be difficult in an area with a lack of doctors, and it can be very expensive if you don't have insurance. My GYN would never have phoned in a prescription without an exam. And some doctors can be difficult about the kind they will prescribe. I had to go off of BC in college because the only prescription my doctor would give me was a kind my insurance wouldn't cover.
MonicaP at March 12, 2012 9:40 AM
Now the FDA wants to regulate your phone/tablet/computer if it contains a medical app or any of your medical data?
http://www.breitbart.com/Big-Government/2012/03/12/obamacare-subjects-nearly-every-phone-and-computer-to-government-control
The HIPPA standards for computer security are pretty thorough, too...
I R A Darth Aggie at March 12, 2012 10:01 AM
Not true. Getting an OB/GYN appointment can be difficult in an area with a lack of doctors, and it can be very expensive if you don't have insurance.
True. Now why is that true?
I R A Darth Aggie at March 12, 2012 10:05 AM
This ties in with the question of whether your insurance should pay for contraceptive pills; you could suggest that insurance should only cover what a doctor prescribes, you could also suggest that insurance should then cover anything a doctor prescribes. If that's the case, then requiring a prescription would be a way to have insurance cover the contraception pills.
Posted by: clinky at March 12, 2012 1:43 AM
Sure, why not have the pill sold over the counter? It would defuse the insurance coverage question (the pills wouldn't be insured, if they're over the counter) and the silly "war on women" crap at the same time. Just in time for the election!
Posted by: mpetrie98 at March 12, 2012 3:14 AM
Regarding the insurance debate:
Contraception, the economic miracle drug
EDITORIAL | Joanna Weiss
March 11, 2012
http://articles.boston.com/2012-03-11/opinion/31142449_1_affordable-care-act-family-planning-services-gender-gap
Last four paragraphs:
....As (Adam) Thomas points out, Rush’s rant - which concluded that if taxpayers were paying for women’s birth control, they should be able to see videos of women having sex - missed a fundamental point about Obama’s birth control mandate. The provision in question doesn’t require taxpayers to spend a penny. It applies to private insurers, and it’s part of a long list of preventive services that now must be provided with no cost-sharing from patients. These include hearing screenings for newborns, vaccines for children, cessation programs for smokers, and colorectal cancer screenings for adults over 50.
And it’s striking that, amid all of the noise over the contraception mandates, we haven’t heard much complaint from the insurance industry. In fact, about 90 percent of private health insurers already cover contraception, Thomas said. Birth control is far cheaper to cover than a child.
So, let’s tally it out. Free contraception would reduce health care costs. It would save taxpayer money. It would reduce some of the problems that social conservatives abhor, such as teen pregnancy and abortion.
“There’s a lot here for conservatives to like,’’ Thomas said. And changing the conversation — from gender to money, from shame to sanity — would do everyone a world of good.
(end)
If anyone sees any holes in Weiss' op-ed, please point them out - not that I'm anxious to find any.
lenona at March 12, 2012 10:49 AM
Free, really? Somebody needs remedial Econ 101. Somebody pays, and it isn't the insurance company.
New York State has mandated coverage for physicals for college-bound students. Health Insurance is, unexpectedly of course, expensive in New York.
MarkD at March 12, 2012 11:22 AM
> Costly in time, OK, I see the argument, costly
> financially, well, okay, to a degree, but if
> we're talking once a year, it's not quite a
> staggering disaster.
You sound like a white guy. With a steady, flexible job. And reliable transportation. And a budget for this kind of thing.
Is "staggering disaster" what it takes for this to be wrong?
Crid at March 12, 2012 1:46 PM
Ever notice how ninety percent of the women who claim birth control pills failed are in the overweight to obese range?
This is because birth control pills are supposed to be increased in dosage for your size. This is something that a good percentage of doctors don't actually do, and most overweight women haven't been informed or don't actually care enough to inform themselves about the medication(s) they are taking.
I firmly believe that the size/dosage ratio is the reason why birth control pills are prescriptions instead of OTC.
Cat at March 12, 2012 4:52 PM
On one hand, I think for most women, the cost of getting the prescription (making the appointment, taking time off work, securing child care, etc) as well as the inconvenience is more of a disincentive than actual cost. So making the process easier would have a greater impact on usage than making it free, and then everyone's happy. And the abuse potential is pretty low.
On the other hand, birth control isn't always used for, well, birth control. When I was in high school the majority of girls I knew took birth control but only maybe half of those using it were sexually active--the others took it to mitigate PMS-related mood swings, to manage irregular, painful, or unusually long/heavy periods, to clear up their skin, or to manage a hormonal imbalance. For all those things you'd want a doctor's supervision especially if you need to experiment to find the right brand, type, and dosage. Also it seems like in those cases insurance should cover it. When I went on Accutane in high school it was required to be on birth control for a month first, and the dermatologist said that often girls would come back after a month and their skin would have cleared up from the birth control so they wouldn't need Accutane after all. I was also having mood swings in high school and started to see a psychologist, but as soon as I started birth control the mood swings went away. Insurance paid for my Accutane and it would have paid for the psychiatrist and any antidepressants or medication, so why shouldn't it pay for the birth control which is a much cheaper, easier, and safer solution to the problem?
Shannon at March 12, 2012 5:30 PM
I have a friend with no desire for kids, who was at one point very large. She said she was too big for the pill. I don't think she knew it could be compensated for-I'd never heard it could be. It's not simply the weight, but the fat percentage too.
Would OTC pills have a big ol' "if you're too fat!" warning on them?
momof4 at March 12, 2012 6:08 PM
"The provision in question doesn’t require taxpayers to spend a penny. It applies to private insurers, and it’s part of a long list of preventive services that now must be provided with no cost-sharing from patients. "
So, instead of tax money, we'll just have the government commandeer private property and force the property owners to implement the government's preferred policy at their own expense. Yeah, that's so much better.
Cousin Dave at March 12, 2012 7:33 PM
I would assume that birth control is prescription for the same reason anti-depressants are prescription. Hormones and the like aren't a really good choice for DIY healthcare. And they are not a one-size fits all kind of med like ibuprofen where you can just take an additional tablet if you feel it isn't quite working.
LauraGr at March 13, 2012 4:00 PM
Hormones and the like aren't a really good choice for DIY healthcare. And they are not a one-size fits all kind of med like ibuprofen where you can just take an additional tablet if you feel it isn't quite working. --Cousin Dave at March 12, 2012 7:33 PM
Why is this different than Insulin? Many states you can get insulin OTC. It is a hormone. What is different?
Anonymous Coward at March 13, 2012 11:49 PM
Leave a comment