June 30, 2000

8:32 AM

What if you didn't need a prescriptionto get birth control pills? The FDA is thinking about allowing The Pill to be distributed over-the-counter. This would save a lot of effort and money. The concerns over the issue are that women may not continue with their yearly checkups if they don't have to get a prescription; that they may not realize the side-effects of using the pill with other medication, such as antibiotics; or that teenagers might be more likely to start using it without their parents' knowledge. Any thoughts?
posted by daveadams (23 comments total)

If this happens, my wife and I will be happy to save some of the $30/month she pays for birth control, assuming prices go down. It's also a hassle for her to schedule appointments because you have to do it a couple of months in advance. You don't want to be in that situation when you only have a month left on your prescription!
posted by daveadams at 8:34 AM on June 30, 2000

And why would teens taking birth control without their parents' knowledge be a bad thing? They already do all kinds of things that their parents would consider "bad." If they're having sex anyway, I would think avoiding pregnancy would be something parents would want their kids to do.
posted by endquote at 8:42 AM on June 30, 2000

well, i would think that it would be bad if teenagers used the pill as birth control INSTEAD of condoms for obvious reasons. however, if they used the pill IN ADDITION to condoms, they'd be better off for sure.
posted by palegirl at 9:01 AM on June 30, 2000

The bit about having the pill be prescription-only in part to make sure women get their yearly exams pisses me off. You can't force good self-maintenance habits in people but it sure seems like you can punish them for not having them...

A subject near and dear to my heart. I am/was on Depo-Provera, quarterly injectable birth control, instead of the pill, but it's the same thing... sooner or later the doc will stop giving you the shot if you don't have your exam. As I am afflicted with a miserable case of stirrup-phobia, I let my shots lapse... which has some fairly unpleasant side-effects we'll not go into here :> Apparently I prefer that to the speculum and the "little pinch", though...

To me it seems my gynecological health and my reproductive choices are both my own business and should not be tied together. Not even For My Own Good. And if I wanted to get really hysterical over it, I'd make it into a great big sexist conspiracy: no one expects men to get prodded before they purchase a packet of Trojans. ---don't flame me, I *can* see the difference between oral or injectable drugs and prophylactics... but still.
posted by Sapphireblue at 9:14 AM on June 30, 2000

Not congress. Not the FDA. Gov't should make the info available so the public can make an informed choice, but what a woman does with her own body is her choice. Occasionally, when I'm real lucky, a girl will choose to do things with my body. =) I wouldn't want that regulated either. There's a lot more things that should be over the counter besides just 'The Pill.' Marijuana for example. =)
posted by ZachsMind at 9:36 AM on June 30, 2000

I'm in favor of doing away with prescriptions for birth control pills. It would allow this form of contraception to women who may not be able to get it otherwise, because their insurance wouldn't cover it. I have a friend who was told by her insurance company that BCPs (and Depo shots) would not be covered unless prescribed by a doctor for a cause other than just birth control. Yet, this was the same company that would cover prescriptions for Viagra.

Just something to feed the sexist conspiracy theory.
posted by phichens at 9:38 AM on June 30, 2000

Amen. I've been off the pill for a year and a half, chiefly because it has to be prescription. I asked to be switched to a different kind of pill, which didn't work for me, and before I could go back to change the prescription again, I lost my insurance (went to contracting). I didn't get insurance again until a few months ago, but I haven't gotten around to going to my new doctor (different insurance, different HMOs) at all yet, let alone scheduling the pelvic exam so that I can get back on the Pill. Partly this is because I'm planning to move soon, so I'll probably have to change doctors again then anyway. The whole prescription thing just does not take into account the vicissitudes of everyday life-- obviously, the carrot of the Pill doesn't get me to submit to the stick of the exam, and I bet I'm far from alone in that.
If the Pill were OTC I'd be thrilled and delighted to go back on it.
BTW, the sexist conspiracy could be worse: in Japan, the Pill still hasn't made it through their FDA-- but Viagra was approved in six months! Japan, not surprisingly, has the highest per-capita abortion rate in the world.
posted by wiremommy at 3:01 PM on June 30, 2000

Whoops, I'm out of date. Japan approved the Pill-- last year! (Hey, it only took 39 years.)
posted by wiremommy at 3:06 PM on June 30, 2000

And why would teens taking birth control without their parents' knowledge be a bad thing?

I hope you don't think I was in favor of that argument. "The concerns," not "my" concerns. Teenagers can get prescriptions for the pill without their parents' knowledge already. This would just make it cheaper. I'd rather them not get pregnant so that argument doesn't shake me either.

This talk of teenagers on the pill reminds me, though. My wife had a friend in high school and she wanted to have sex with her new boyfriend on Valentine's Day. Trouble was she was going to start her period that day. So the two days before she took several days' worth of pills. She didn't start on the normal time, but she did screw herself up for a few weeks. Those hormones will do that to you.

Although its interesting that recently more and more you've been hearing about "keep on taking the active pills" for three or four months straight. The thought is, you can skip your periods for a while, you don't really need to have them. I don't know what I think about that, but I'm not a woman. My wife is uncomfortable with it, too, and she is a woman... ;)
posted by daveadams at 9:00 PM on June 30, 2000

I agree that the pill should be available over the counter. Teenagers have sex no matter what kind of contraception is readily available to them, so why not make it safe? My only concern is the possible misuse that may result from such widespread availability. I guess then it just comes down to more education on the matter, to prevent unwanted side effects and ensure correct usage of the pill.
posted by claire at 9:56 PM on June 30, 2000

this thread is *so* veering into TMI... or maybe it's just me.

I didn't have periods for the 4 years I was on Depo. Unless you count the parts at the beginning and end where I had too many :> They say it's fine, though, and god knows I didn't mind... not having them, that is, the other is pretty damned annoying.

I started on Depo because I heard about it from my mother, who had a 1981 tubal ligation *undone* in the mid-90s, had a couple more kids, and then went on Depo. She said she didn't have periods anymore, and when I expressed concern, said her doc said it was fine...

Works for me. Hip hip hooray for modern medicine.

re: wiremommy's post: i didn't even really think about the insurance issue, but I'm in the exact same boat: lost insurance for a while while changing jobs & moving, and now have a health plan but don't have a clue who my doctor is... bleh. if I had a doc I liked or even *knew* anymore, stirrup-phobia would not be such an issue. and if the pill was non-prescription none of it would be an issue.

and even *with* insurance, the cost of a pelvic exam + the Depo + the pregnancy test that a lot of docs require with each Depo shot adds up fast! When I get around to it, I figure it'll be close to two hundred bucks on my plan...

hey dave, you rule. good post ;)
posted by Sapphireblue at 9:59 PM on June 30, 2000

Although its interesting that recently more and more you've been hearing about "keep on taking the active pills" for three or four months straight. The thought is, you can skip your periods for a while, you don't really need to have them. I don't know what I think about that, but I'm not a woman. My wife is uncomfortable with it, too, and she is a woman... ;)

dave, this gladwell article from march [John Rock's Error] convinced me. in it, he examines 1. why the pill was designed with the seven-day placebo [to satisfy the catholic church, Rock hoped], 2. what a natural lifetime menstrual pattern is [100 periods as opposed to the 'modern' 400] and 3. if perhaps the increased menstruation is causing an increase in related cancers [maybe.] [whether "incessant ovulation" has become a serious problem for women's health]

i'm convinced! cut me off! i'll never bleed for five days and not die ever again! where do i sign?
posted by palegirl at 10:37 PM on June 30, 2000

I'm not totally sure that selling the pill over the counter in the UK would benefit the younger generation. Since prescriptions are free on the NHS it would actually cost them more to buy it over the counter.

But this doesn't mean that I don't think that it is too inaccsesable - it is. It would benefit the general population, if only in convinience, if a prescription were not needed. I'm quite sure that it is a big hassle to have to schedule appointments on such a regular basis and so far in advance. Birth control should fit into people lifestyles, not the other way round.
posted by iamcal at 2:02 AM on July 1, 2000

Not quite free, Cal: £8-something per item when I last needed a prescription, though plenty of people get total exemptions. What I'd like to see, I think, is something closer to the Dutch system, where you can get 24-hour access to doctors, who then issue the prescription on the spot.

My blokey take on this is that there are plenty of latex-based contraceptives available over the counter, if you just want to have sex without discussing it with your doctor. But if you want to take a daily dose of something which has as significant an effect on your body as the pill, then it should be subject to medical supervision. After all, no-one's asking for Prozac or Valium to be sold over the counter, are they?

It's all very well regarding the pill as a "lifestyle" supplement, but it's hardly the same as a daily multivitamin. And when you have scares such as the one five years ago, it's important for doctors to know which of their patients may need to be warned or reassured. Not to mention the risks which come from mixing medications...
posted by holgate at 7:38 AM on July 1, 2000

A good point, but you did misunderstand me slightly. I said "younger generation" meaning people still at school, who pay nothing for prescriptions. Still, I see what you mean.
posted by iamcal at 3:38 AM on July 2, 2000

Birth control pills (and Depo Provera) alter the body's normal chemistry in serious fashion -- preventing ovulation, altering or preventing menstruation, changing the nature of the endometrium, all via unnatural changes to the user's hormonal balance. This isn't like taking an Ibuprofen for a headache, or putting Neosporin on a cut finger, this is serious stuff. In addition, there are serious warnings in place regarding use of BCP if you are a smoker, have certain blood disorders, fibrocystic syndrome and so forth. As such, to remove any and all physician intervention before someone commits to use of birth control pills seems a bit foolhardy at best, and reckless at worst -- especially if they become free-for-purchase by teenagers who aren't likely to consider the potential risks of using the drug and aren't likely to consider the potential risks of relying on BCP and ignoring use of condoms.
posted by Dreama at 8:29 AM on July 2, 2000

Any drug, over-the-counter or otherwise, can have ill effects, due to misuse or due to unusual reactions in a small percentage of people. Are birth control pills *more dangerous* than cough syrup or ephedrine or laxatives... or paint thinner? Proper use of any of these things requires some knowledge, some education, some caution, or else they can all be dangerous, and I don't see how the Pill is much different in that regard.

Personally, the idea of OTC Pills is less frightening to me than the widespread availability of OTC "herbal supplements" which are often promoted as "not a drug---all-natural!" As if drugs can't be natural. There are millions of people spending millions of dollars on untested, unregulated drugs whose efficacy and risks are not nearly so well documented as those of the Pill, and which don't have nearly the track record and history of the Pill, to boot.
posted by Sapphireblue at 11:57 AM on July 2, 2000

More dangerous than cough syrup? I don't know, can 44D used normally and within guidelines cause pulmonary embolism? Can ephedrine increase the size and hasten the growth of painful and potentially disfiguring cystic growths?

I can't use The Pill due to a condition (not uncommon in women of my ethnic background) which would be worsened dramatically by the introduction of the Pill's hormones. I had no clue that I had the condition, and never would have had I not gone to the doctor for that pre-prescription pelvic exam and history session. After I answered affirmatively to a series of questions on a checklist, my MD red-flagged me, did a test to confirm the condition, and help me to find suitable and workable alternative that would not be harmful to me in the long run. Had I purchased The Pill OTC, I would not have known the harm I would've done myself until I began to experience acute problems.

So I'm led to ask, how many women could be placed at similar risk if the move to OTC status is carried out? How many is acceptable?
posted by Dreama at 4:16 PM on July 2, 2000

And isn't that an argument for greater regulation of "supplements" with dubious side-effects, rather than less regulation of the medicines currently on prescription?

(Tangentially: I'm always amazed by the commercial advertising of prescription meds in the US. It seems to cater to a climate of "drugs on demand", when medication is possibly the last thing you want as an impulse purchase...)
posted by holgate at 5:10 PM on July 2, 2000

... you most likely can't get lung cancer by playing with rattlesnakes, either.

I am led to answer that if it's a choice (and it will be for some women) between not going to the doctor ever and not using birth control ever, and not going to the doctor ever and using birth control, I like the second option better.

In a perfect world we'd all get checkups twice a year, birth control or not, and be able to catch all illnesses, diseases, allergies, and everything else before they're ever an issue. This is not that world.

holgate---oh, I wasn't saying that because no one regulates herbals, they shouldn't regulate birth control pills either---rather saying that there's all *kinds* of stuff out there (where herbals are just an example) whose risks aren't nearly so well known as that of the Pill, or are actively marketed as being safe when maybe it's not or maybe no one ever ran any tests to see---I suppose the only ironclad solution there is to require by law prescriptions and counselling for purchase of everything from bug bombs to eyeshadow. For the good of the People, you know. 'Cause what would we all do without Congress to guide us down the path to healthy, happy living.
posted by Sapphireblue at 8:35 PM on July 4, 2000

Whatever rattlesnakes and lung cancer have to do with this issue eludes me, but the question still remains unanswered: how few/many women need to be at risk of developing serious complications from the use of the Pill in order for the OTC/no medical intervention needed model to be worthwhile?

That's all I want to know.
posted by Dreama at 1:08 PM on July 5, 2000

Well, you see, I was confused too: to spell it out, what does "ephedrine doesn't give you cysts" have to do with the issue of whether it's the gubmint's responsibility to assure my health---or my own?

But I repeat myself, and since I am unable, moreover unwilling, to come up with an arbitrary Magic Number at which risk justifies government paternalism, I shall recuse myself from further circular debate on the subject, and leave all four MetaFilterites still paying attention with a pithy quote upon which to chew:

"Liberty not only means that the individual has both the opportunity and the burden of choice; it also means that he must bear the consequences of his actions.... Liberty and responsibility are inseparable." --- Friedrich Hayek, Nobel Prize Winner, The Constitution of Liberty, 1960

Rhetoric? Sure. Pertinent? That too.

posted by Sapphireblue at 3:15 PM on July 5, 2000