Apothecary as Moral Guide?

November 9, 2004 10:27 AM

Pharmacist Refuses to Dispense Birth Control (USA Today link, sorry)
A pharamacist has decided that she's morally opposed to birth control and so has refused to dispense it to her clients. Neverminding the fact that its her job.

"The American Pharmacists Association, with 50,000 members, has a policy that says druggists can refuse to fill prescriptions if they object on moral grounds, but they must make arrangements so a patient can still get the pills. Yet some pharmacists have refused to hand the prescription to another druggist to fill."

If a pharmacist refuses to fill your prescription and you suffer for it (pregnancy or whatever) wouldn't that pharmacy and pharmacist be culpable for your suffering?
Doesn't this just expose these drug stores to massive lawsuits? Or just massive boycotts?
posted by fenriq (90 comments total)

This sounds familiar. Wasn't there a story a while ago wherein a pharmscist refused to dipense birth control in the form of a morning after pill or something like it to a woman who was the victem of a rape?
posted by dazed_one at 10:38 AM on November 9, 2004

This seems to happen a few times per year. I sympathize with the pharmacists plight. I'd hate to be forced to do something that I find morally objectionable as part of my job. On the other hand it's still their job and part of their chosen profession. If they adhere to the APA's policy and make the arrangements in a manner that doesn't cause the customer difficulty I don't have a beef. If they refuse this then they should be disciplined or fired.
posted by substrate at 10:40 AM on November 9, 2004

Sue. Sue. Sue.
posted by bshort at 10:42 AM on November 9, 2004

Yes, it happens several times a year. Nothing new.
posted by justgary at 10:42 AM on November 9, 2004

dazed one, quite right, a story like this one was posted back in June.

This one doesn't have the rape angle though. Just a moralatarian deciding that other people shouldn't be able to not have children.

substrate, why would they become pharmacists if they knew they'd face these moral decisions everyday? And, honestly, no one's forcing them to stay being a pharmacist.

The first comment in the other thread was right on. " Crazy religious people: Quit. Your. Jobs."
posted by fenriq at 10:44 AM on November 9, 2004

Yes, it happens several times a year. Nothing new.

Ah, but it is...it's only the last couple of years that this has really become an issue. And we can't afford to just shrug our shoulders and say "Ah well, what are ya gonna do?"

Maybe if the pharmacist was unwilling to dispense Viagra, or something else that's a penis drug, then we'd see some action...but as long as it's women trying to avoid getting pregnant, then the Christian right-wing is going to continue trying to stop them.
posted by dejah420 at 10:45 AM on November 9, 2004

what substrate said
posted by scarabic at 10:50 AM on November 9, 2004

Perhaps one day, a pharmacist will decide to not dispense viagra to an unmarried man. I'd love to see the reactions to that.
posted by dabitch at 10:53 AM on November 9, 2004

Yep, that was the one. Thanks fenriq.

Also, what substrate said.
posted by dazed_one at 10:54 AM on November 9, 2004

I just imagined the Pill Nazi (like Seinfeld's Soup Nazi) "NO Boner Pills for YOU!"

Hehehe, thanks dabitch!
posted by fenriq at 10:55 AM on November 9, 2004

Ah, but it is...it's only the last couple of years that this has really become an issue.

Well, new is relative. I simply meant its happened before, and has been posted before. Should we make a new post for every instance?

And we can't afford to just shrug our shoulders and say "Ah well, what are ya gonna do?"

Maybe not, but metafilter is 'best of the web' right? I don't see us solving the problem on a discussion board.
posted by justgary at 10:55 AM on November 9, 2004

Kind of beside the point, but birth control pills aren't always used for birth control. For example my sister was on them for years to control her severe menstrual pains.

A pharmacist isn't a doctor and should not have anything to do with deciding who gets which medication. Why in the hell does birth control have anything to do with religion anyway? People are funny.
posted by glenwood at 11:00 AM on November 9, 2004

Sue. and Boycott.
posted by amberglow at 11:10 AM on November 9, 2004

glenwood, some people believe that birth control which prevents a fertilized egg from implanting into the uterus wall is a form of abortion. These individuals then argue that this is murder, using the same arguments that the right to lifers use.

My former sister-in-law ran into this at three pharmacies in one day. Her 15 yr old daughter had snuck out and had sex. She (mom) found out about it and since it was the girl's first time, marched her to the doctor's for an exam. The doc, after speaking with both the girl and her mother, decided to issue a prescription for the morning after pill because all three were in agreement that they did not want a pregnancy. No birth control was used initially. While I feel my former sister-in-law used some pretty heavy scare tactics on her daughter, I still found it offensive that three different pharmacists refused to fill the prescription. She ultimately got it filled and the daughter had a few pukey days which she says was better than getting pregnant.
posted by onhazier at 11:13 AM on November 9, 2004

Simple boycott.

Ask at your regular pharmacy next time if they employ these 'conscience pharmacists.' If they do, take your business - flu medicine, whatever - elsewhere.

It's the only language these corporations understand.
posted by dash_slot- at 11:14 AM on November 9, 2004

In high school I had a friend that took birth control to prevent acne. I’ve surprised she isn’t in trouble with her employer.
posted by Tenuki at 11:16 AM on November 9, 2004

dash_slot, the problem though is what happens when people live in a dinky little one drugstore town and they refuse to fill your prescription?

Boycotts work only if there are legitimate alternatives.

Not that I'm against boycotts, I am all for them as you are quite right, its the only language Big Business understands.
posted by fenriq at 11:19 AM on November 9, 2004

Call them and complain about this: [phone]

Specifically mention that you are concerned about getting prescriptions filled, and that to make sure that you don't run into any problems in the future, you'll make sure and take your business to other pharmacies until they change their internal policies.
posted by bshort at 11:26 AM on November 9, 2004

Ya know, I have serious objections to sticking my arm up any orifice of a cow. This would be like me becoming a vet, setting up a large animal practice, going out to the barn, and THEN saying "Nope, not gonna stick my arm up that cow." If people refuse to fufill the requirements of their jobs, they should quit or be fired.
posted by Shoeburyness at 11:27 AM on November 9, 2004

some people believe that birth control which prevents a fertilized egg from implanting into the uterus wall is a form of abortion.

they must at all cost block sales of the Sports Illustrated Swimsuit issue and Victoria's Secret catalogues -- I mean, all those precious spermatozoa being spilled are a form of abortion, too!
posted by matteo at 11:31 AM on November 9, 2004

Question: Does anyone who believes that life begins at fertilization do so on other than religious grounds? The two always seem to go hand in hand, but I'm wondering if the connection is real or apparent. Are there any atheist pharmacists who believe birth control pills are a form of abortion?

Don't know really where I'm going with this argument, but it's interesting nonetheless.
posted by GhostintheMachine at 11:32 AM on November 9, 2004

How about: change pharmacists.
posted by eustacescrubb at 11:35 AM on November 9, 2004

How about: change pharmacists.

Better yet. Quit pharmacy, become a missionary.
posted by substrate at 11:38 AM on November 9, 2004

Question: Does anyone who believes that life begins at fertilization do so on other than religious grounds? The two always seem to go hand in hand, but I'm wondering if the connection is real or apparent.

In general, it seems like most absolutist, theoretical-principle-based moral positions that have unpopular consequences are correlated with religion. Or maybe just carrying these principles to their logical conclusion is. I have to kind of respect that. Peter Singer is one of the only nonreligious examples of this kind of thinking I can come up with.
posted by transona5 at 11:45 AM on November 9, 2004

they must at all cost block sales of the Sports Illustrated Swimsuit issue and Victoria's Secret catalogues -- I mean, all those precious spermatozoa being spilled are a form of abortion, too!

YEAH, Yeah and the Sears catalog because some of the women in the.....bra.....section....are....ummmm......hot. Not that. Not that I ever. I didn't. Not that I never have I just didn't...

Every sperm a wanted sperm!
posted by m@ at 11:47 AM on November 9, 2004

I could see how this could be extrapolated to cover other areas of life. What if a particular pharmacist felt a certain way about depression? "Fey, they don't need anti-depressants, they just need to pick themselves up by their bootstraps". How many Christian Scientists become pharmacists?
Can Doctors or anyone else who works as a vital public service refuse to provide that service if they feel like it? Especially in areas of the country where there are few to no options? Absurd. Hell I work with people all the time who make personal decisions I disagree with and wish i could slap them and say "Wake UP" and refuse to help them. But your job is a JOB, it is not you. Have problems with that... find a different job... go wait tables, or shut up and suck it up.
posted by edgeways at 11:49 AM on November 9, 2004

Quit pharmacy, become a missionary.

yeah, those Third World people really do need a baby boom!
posted by matteo at 11:53 AM on November 9, 2004

There was a guy in New England who refused to sell lottery tickets because he believed the lottery was contributing to economic inequality. It was the only store for miles around. He owned the place, though. I don't think there's much of a precedent for employees taking this kind of stand.
posted by transona5 at 11:53 AM on November 9, 2004

So if an abortion clinic is burning down can a fireman refuse to rescue people from it?

I'm not a fan of slippery slope arguements but I can think of a million situations where one can be morally against something but one must still do it because it's the job you signed up for.
posted by bondcliff at 11:57 AM on November 9, 2004

There was a guy in New England who refused to sell lottery tickets because he believed the lottery was contributing to economic inequality. It was the only store for miles around. He owned the place, though.

I don't understand this. If he owns the store, what's the problem? I'm assuming it's not a "Lottery Store", right?
posted by mkultra at 12:08 PM on November 9, 2004

fucking great... as if the "political correctness" movement wasn't bad enough.
posted by bk at 12:12 PM on November 9, 2004

Get used to it. Apparently, pharmacists now know better than you or your doctor in terms of what you need. Won't take long for that to extend to other professions.

I, for one, resent bitterly my fundamentalist overlords.
posted by FormlessOne at 12:13 PM on November 9, 2004

In my case, and, I’m told, in the case of many other young women out on their first gynecological visit, birth control pills are prescribed, not for contraceptive purposes, but to eliminate embarrassing, pesky mid-cycle "spotting" (which, by the way, is horrific), and to regulate the menstrual cycle, whether the woman is sexually active or not (I was not). Women who visit the gynecologist complaining of abnormally painful, heavy periods are often promptly dispatched with a prescription for birth control, as are women with inconsistent periods and, in my case, constant rampant bleeding and subsequent anemia. (Er. Sorry for the detail, but that’s the God-honest medical truth.)

This said, if I were to go in to have my prescription filled--which I do, monthly--and a pharmacist refused me, intimating my immorality and baby-killin'-ways, I would flip out at the very presumption. It’s true that birth control is primarily prescribed to avoid pregnancy. But people are on birth control for a multitude of fringe medical benefits--a fact I delightfully expounded upon to my frowning mother--and not simply to avoid the miracle of making zillions of babies. And those reasons are, frankly, only the business of the adult with the prescription. I’m unnerved that the respective sides, as described in the article, make this a Christian Moral Issue versus a Women’s Rights Issue, when, in short, birth control isn’t anyone’s business. The reasons for birth control are manifold and varied, and one shouldn’t have to explain herself when she goes to pick it up, or suffer the consequences of being denied her prescription.
posted by jennanemone at 12:18 PM on November 9, 2004

Refusing to fill a prescription because you don't like its use is a slippery slope. We send kids home from the hospital on Viagra. It decreases the blood pressure in the lungs that causes pulmonary hypertension. Most of these kids have heart defects.
posted by whatever at 12:24 PM on November 9, 2004

jennanemone, I can see a fundamentalist arguing that your flow and other symptoms are payback for Eve's original sin. They'd be moonbat crazy but I can see someone saying it.

Its beyond just birth control then, this is a pharmacist deciding what's best for the customer who's not their patient.

This circumvents the whole process of going to see a doctor and getting the potential solution to your problems.

And I second Formless One's resentment. I don't want anyone forcing their religious beliefs on me (unless they shower me in money, hookers, drugs and pudding first). I don't share my religious beliefs (or sexuality) with other people, why do they feel compelled to do it to me?
posted by fenriq at 12:26 PM on November 9, 2004

So, I said it before: if Conscience Clauses are going to be legal for Pharmacists, then there needs to be a way to notify the public. Maybe Pharmacists can put a list next to their picture or there can be a seal on the door. There needs to be some sort of full disclosure.

On the other hand, if you live in a town with only one pharmacy and it refuses to fill your prescription, CVS (and many other pharmacies) will send you your medication by mail. Has anyone used this before? Does it work?
posted by Alison at 12:33 PM on November 9, 2004

Anyone know how the Big Guiuys handle this: ie, Walmart, Sam's Club, Costco? they all sell and dispense drugs...and of course you can get stuff at stores via Net
posted by Postroad at 12:34 PM on November 9, 2004

Perhaps this "legal drugs pusher" should be prosecuted for practicing medicine without a license?

Only a doctor is supposedly qualified to make these kinds of decisions.
posted by nofundy at 12:42 PM on November 9, 2004

Anyone know how the Big Guiuys handle this: ie, Walmart, Sam's Club, Costco?

The USA Today article refers to CVS and Eckerd. When it comes to pharmacies, those are the big guys, aren't they?
posted by Armitage Shanks at 12:43 PM on November 9, 2004

Conscience what-what? That's absurd. Can a firefighter not put the fire out on an abortion clinic? Their job is to count pills that the doctor prescribes to the patient.

To be perfectly honest I'm surprised the profession still exists in the CVS and Revco behind the counter type of way.
posted by Yossarian at 12:46 PM on November 9, 2004

FormlessOne: Get used to it. Apparently, pharmacists now know better than you or your doctor in terms of what you need. Won't take long for that to extend to other professions.

Well, pharmacists are medical specialists. One of their jobs is to evaluate whether a certain combination of treatments may have unintentional side effects. If your urologist and your cardiologist accidently prescribe drugs that are potentially harmful in combination, we hope that the pharmacist would know better than the doctors. (This actually happened to one of my grandmothers.)

Medicine has become a highly specialized field in which individual doctors can't "know better" about every aspect of medical treatment, and frequently a patient might be receiving treatment from multiple specialists who may not be talking to each other.

Granted, I do think that not giving out birth control is a crappy thing to do. But I do think that there is quite a bit more skill involved in pharmacy than just being a checkout clerk for controlled substances.

nofundy: Only a doctor is supposedly qualified to make these kinds of decisions.

Um, no. Doctors have not had an exclusive role in making these kinds of decisions for some time.
posted by KirkJobSluder at 12:57 PM on November 9, 2004

I’m unnerved that the respective sides, as described in the article, make this a Christian Moral Issue versus a Women’s Rights Issue, when, in short, birth control isn’t anyone’s business. The reasons for birth control are manifold and varied, and one shouldn’t have to explain herself when she goes to pick it up, or suffer the consequences of being denied her prescription.

jennanemone, isn't that pretty much the point of the Women's Rights argument, that birth control is purely the choice of the individual woman and is not the business of anyone else?
posted by nave at 1:00 PM on November 9, 2004

Actually, most pharmacists *are* doctors. Most are Pharm.D's. They know a lot more about drugs and their interactions than MDs. But, to my thinking, it's still lame to refuse access to medications based on your own moral grandstanding.
posted by wheat at 1:08 PM on November 9, 2004

I wish there were laws against Morality-Pushers -- you know, the ones who try and get your kids addicted to teh Jesus. I want my tax money to fight the War on God.
posted by Civil_Disobedient at 1:08 PM on November 9, 2004

accidently prescribe drugs that are potentially harmful in combination, we hope that the pharmacist would know better

Isn’t this more of a function of the pharmacist’s computer and customer database software? I’ve never had a pharmacist question me about other drugs I may be taking to compare with the new prescription. But if it’s a pharmacy I’ve visited before they’ve usually got my history right there on the screen.
posted by Tenuki at 1:14 PM on November 9, 2004

BTW, if anyone's worried about finding where to get their prescription drugs, all you have to do is turn off your spam filter.
posted by mkultra at 1:24 PM on November 9, 2004

where is that we are going in a handbasket?
posted by Lizc at 1:28 PM on November 9, 2004

Actually, most pharmacists *are* doctors. Most are Pharm.D's.

No, pharmacists are not doctors. They cannot prescribe drugs, nor have they gone to medical school. Many Pharm.D programs only require an Associate's (2-year) Degree. There is also no equivalent of Residency.

Not to disrespect pharmacists (I work with several), but at all but the highest levels, there's a significant gap between them and doctors.
posted by mkultra at 1:28 PM on November 9, 2004

Another comment on this question:

"Question: Does anyone who believes that life begins at fertilization do so on other than religious grounds? The two always seem to go hand in hand, but I'm wondering if the connection is real or apparent."

What I find really ironic about all this is that, as far as I know, nobody up until historically recently - including rabid religious fundamentalists - believed that life began at fertilization of a human egg...

... because nobody knew how the process actually worked until after the invention of the microscope.

The mechanism of sperm cell meets egg cell and fertilizes it was not really figured out (recalling fuzzily here) until what, the 1800s? Of course, everyone knew that sex made babies, but had no idea of how it really worked until after science studied the process at length.

Therefore, it seems to me that the Biblical stand on life would be that it begins from birth, since nobody who was around when it was being written would have had any clue otherwise. Does it mention or imply any such thing in the Bible anywhere? I never looked for anything of the sort in my studies of it so I don't know.

The fundies are using information, solely and recently revealed by science, upon which to base their contention that abortion is murder - the same science they usually discount for many of its other discoveries, like evolution, global warming and environmental concerns, or the actual age of the earth and universe, for example. I find that rather amusing. Sorry, kids, you don't get it both ways.

Imagine if someone had stumbled upon birth control drugs by accident, long before we understood how fertilization and implantation worked. They would "magically" keep women from getting pregnant, and nobody would care why.

(I suppose the fundamentalist stand that sex is only for procreation purposes would sort of negate the irony, since they don't want anyone doing anything that even has a chance of making a baby unless it's done within marriage to make a baby. Since they know sex makes babies, they can avoid the issue by forcing everyone to not have any, and thus "abstinence education." Riiiiiight.)

Anyway, my solution to this particular incident would be two words:

"You're fired."
posted by zoogleplex at 1:40 PM on November 9, 2004

(Not a lawyer, standard disclaimers apply, this info may be outdated or superceded, etc. etc. etc.....)

Minnesota statutes have several interesting regulations:

UNPROFESSIONAL CONDUCT

Subpart 1. Prohibited conduct. Unprofessional conduct shall include, but is not limited to, the following acts of a pharmacist or pharmacy:....

...C. Refusing to compound and dispense prescriptions that may reasonably be expected to be compounded or dispensed in pharmacies by pharmacists, except as provided for in Minnesota Statutes, sections 145.414 and 145.42. ...

... E. Discriminating in any manner between patients or groups of patients, for reasons of religion, race, creed, color, sex, age, national origin, or disease. ...

... F. Refusing to consult with patrons or patients, attempting to circumvent the consulting requirements, or discouraging the patient from receiving consultation concerning contents, therapeutic values, uses, and prices of prescription or nonprescription drugs, chemicals, or poisons. ...

...G. Requiring an individual patient to be a member of any organization, association, or other group as a condition for obtaining the professional services of a pharmacist. ...

However:

If you follow the exceptions under C, guess what they are:

145.414 Abortion not mandatory.

(a) No person and no hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion for any reason.

So. It appears that a Minnesota pharmacist could be legally disciplined for refusing to fill pretty much any valid, legitimate prescription....except a morning-after pill. I have absolutely no idea whether any of this has ever been tested....

There could also be professional standards that are more stringent as well.
posted by gimonca at 1:42 PM on November 9, 2004

zoogleplex: Actually, a recent Discover had a nice article summarizing research that there is quite a bit of important development that occurs with the ovum before fertilization as well. Part of the problem is that the microphotographs of ova usually involve removing the clusters of what had been considered to be junk cells on the outside.
posted by KirkJobSluder at 1:47 PM on November 9, 2004

I'd find this particularily infuriating, because as others have mentioned, birth control pills are frequently prescribed for things other than birth control. I took them to end my somewhat over a hundred day long period, and given how bitchy I was after having been in full on PMS mode for 3 and a half months, I'd have probably skipped asking for my prescription back and just, I dunno, killed the nearest handy overly moralistic pharmacist.
posted by jacquilynne at 2:13 PM on November 9, 2004

Do they sell hangers at CVS?
posted by jellybuzz at 2:23 PM on November 9, 2004

Does anyone who believes that life begins at fertilization do so on other than religious grounds?
I believe it does not on religious grounds.
posted by thomcatspike at 2:27 PM on November 9, 2004

To echo jacquilynne , jennanemone, and glenwood, it's particularly infuriating to have religious politics interfere in this way. I have a friend whose Catholic health plan won't pay for her pills even though she's ONLY taking them to keep from getting ovarian cysts!

(She asked them to bottle them differently and call them Cyst-blocker or something, but of course she was refused.)
posted by small_ruminant at 2:34 PM on November 9, 2004

I would just like to add to the chorus of women with evidence that birth control pills aren't used just as birth control. I have polycystic ovarian syndrome. I don't ovulate on my own (normally). I take birth control pills in order to have the right balance of hormones in my system. Additionally, I am a lesbian. So, honestly, really seriously, I'm not using them as birth control.

I couple of years back I was in a doctoral program where drugs were covered under the graduate drug plan, but birth control pills were not. Presumably because, you know, you could just not have sex or something. That really ticked me off.

And even though I already knew this kind of thing was happening, I'm glad to see this issue coming up in the news again. I would have missed it if it hadn't been posted. It reminded me to ask at my local pharmacy and make sure I don't patronize a place that allows this kind of silliness. And I agree with what some others have been saying; if a pharmacy employs a person who refuses to dole out birth control, they should have a big brightly-coloured cross on the front door with the words "MORAL CLAUSE IN EFFECT HERE" on it.
posted by Hildegarde at 2:34 PM on November 9, 2004

I believe that life begins at fertilisation on non-religious grounds, but I still support a woman's right to abort zygotes, embryos and fetuses. After all, there is "life" in my shit if you count the epithelial cells that fall off onto it, but I don't feel bad about flushing.
posted by Pseudoephedrine at 2:36 PM on November 9, 2004

I think the issue of when life begins is a bit of a problem. Biologists have failed to come up with a good definition of "alive" having been confronted with things like viruses, prions and Bacillus spores. I think the basic problem is when does something start having moral value. I have a hard time putting that line onto undeveloped embryos.
posted by KirkJobSluder at 2:38 PM on November 9, 2004

hahaha... "moral value." After all the election threads, that one's REALLY ironic, KJS... ;)

Sorry to inject a bit of politics here, but you can bet this will start happening a lot more. And how many women contributed via their vote to perpetuating and expanding this?

Sigh. Two steps back...
posted by zoogleplex at 2:45 PM on November 9, 2004

I think there's also the anti-choice argument that, if we don't know when life begins, it's better to be safe than sorry.

(This courtesy is not often extended to the potential mother, of course....)
posted by occhiblu at 2:48 PM on November 9, 2004

jellybuzz Yikes!
posted by dabitch at 2:48 PM on November 9, 2004

jellybuzz, they do but I'd bet they're the plastic kind that are decidedly not appropriate for the procedure you're alluding to.

And, sadly, if Roe v. Wade does get overturned, we will be facing another situation where abortions are performed in back rooms by questionably trained "practitioners".

And then things like this will happen again (warning, that link is a graphic cautionary tale about home abortions).
posted by fenriq at 3:08 PM on November 9, 2004

Sorry for the tangent, but zoogleplex's comment got me wondering along the same lines: Were people back then really wise to the pattern of 1. Have sex 2. Have baby 3. Teh gold, teh frankincense and teh myrrh? I feel like, without years of research and microscopes and such, it's a stretch to think people back in biblical times made the connection between sex and conception. Did people back then truly understand the Immaculate Conception to be Immaculate because Mary and Joseph hadn't had sex?

As for the pharmacist who refuses to do his job well, if I were the customer, I would immediately take my business elsewhere.
posted by emelenjr at 3:08 PM on November 9, 2004

People sure did know that (heterosexual) sex produces babies. The complicated part was when they acknowledged a pregnancy; normally it was "quickening", when the baby first moves and the mother is certain there's something in there. That's about three months along.
posted by Hildegarde at 3:20 PM on November 9, 2004

I think any jury would acquit you, jacquilynne.
posted by five fresh fish at 3:24 PM on November 9, 2004

Mailmen who refuse to deliver credit card applications with bad rates?

Pizza delivery guys who refuse delivery to the homes of Jews?

Garbage collectors who won't pick up trash bags from a homosexual's house?
posted by waldo at 3:30 PM on November 9, 2004

mkultra, pharmacists that have completed a Doctor of Pharmacy degree are in fact doctors. To be specific, they are not physicians. A lot of Pharm.D programs do not require an undergraduate degree, but they generally have the same requirements as medical schools in terms of science background, i.e. five semesters of chemistry, a year of biology, microbiology, biochemistry and physics, not to mention the traditional English, math and social science requirements. The Pharm.D program itself is a four-year professional program that is very rigorous, much like medical school. And there are a great number of general practice and specialty residencies available to those who complete a Pharm.D program, but they are optional, as they are intended for pharmacists who choose to work in a clinical setting, as opposed to a retail setting.

As a hospital pharmacist, I am often asked by physicians to prescribe therapy for patients when they don't know what drugs to prescribe or in what doses. This happens most frequently in infectious disease cases and emergency medicine. As such, I don't feel like there is a significant gap at all between physicians and pharmacists in the hospital setting. However, I have never worked in retail pharmacy and I imagine that there is a lot less autonomy at that level.
posted by mokujin at 3:38 PM on November 9, 2004

Catholic health plan
Unaware that religions have health plans, yikes for your rprivacy. Yikes, as to having your health reasons divulged for a prescription, that should be private, no questions asked.

I would just like to add to the chorus of women with evidence that birth control pills aren't used just as birth control.
As a male teen I knew about birth control being used in other female health care areas. Adding that’s been over 20 years and I have never lived with a sister. So today hearing women explain other uses for birth control, I’m surprise more men don’t know and alarmed a woman would have to be informed.
posted by thomcatspike at 4:21 PM on November 9, 2004

"I think there's also the anti-choice argument that, if we don't know when life begins, it's better to be safe than sorry."

Though I'm far from what anyone would call "religious," I certainly see the merit in that concept. I suppose I ought to make my personal position clear that I don't think abortion is a great thing to do (unless there's a threat to the mother's life from the pregnancy, which happens), especially as a method of birth control - in this time where we have cheap, safe, and extremely reliable methods of contraception (provided by science, of course) and widespread public awareness about the whole process, I think abortions should be pretty rare just from the effects of those factors - and I feel very certain that compared to pre-contraception/"sexual revolution"/women's reproductive rights, they ARE in fact a lot rarer (don't have data to back that up unfortunately). But, on the other hand, I think it's rather foolish try to eradicate abortions by making them illegal and enforcing sexual abstinence - that doesn't work any more than Prohibition or the War on Drugs. Which is why I'm pro-choice, even though I'm pretty uncomfortable with the ambiguity of when a zygote/embryo/fetus becomes a person.

Education, good parenting, and availability of effective contraception works, as much evidence makes clear. Why not stick with what works?

Here's a question - since things like condoms, diaphragms, spermicidal foam, the sponge, etc. do not cause the potential ethical difficulties of keeping a fertilized egg from implanting and growing (thus in some's view "killing a baby"), why do so many religious types have a problem with these contraceptives? Would this particular pharmacist have a problem selling customers condoms or foam as well as birth control pills - on moral or religious grounds?

See, there's no justification there other than "God says you're not supposed to have sex unless you're married and making a baby."
posted by zoogleplex at 4:53 PM on November 9, 2004

[off-topic] Immaculate Conception has nothing to do with Mary being a version. It's a doctrine in which Catholics believe that she herself was born free of original sin [/off-topic]
posted by willnot at 4:56 PM on November 9, 2004

virgin even.
posted by willnot at 4:56 PM on November 9, 2004

Uh, I should add that pregnancy from rape is a good reason for abortion. Though I actually know someone who has a child from that awful circumstance who is doing quite well - but the rapist was a close friend so there's a lot of ambiguity there too.
posted by zoogleplex at 5:00 PM on November 9, 2004

Yep, actually there is a scientific process called parthenogenesis that is, effectively, the Immaculate Conception (that is, an egg fertilized without sperm) but it wouldn't produce a boy. It would have to produce a girl.

That is, if I'm remembererating my biology properly.
posted by fenriq at 5:01 PM on November 9, 2004

I remember the same thing so we must've fallen asleep in the same class.
posted by dabitch at 5:15 PM on November 9, 2004

mkultra, pharmacists that have completed a Doctor of Pharmacy degree are in fact doctors. To be specific, they are not physicians.

When Americans say "doctor", they mean "medical doctor", or "physician". The one major exception would be in courtesy titles: i.e. Dr. John Doe. Standard practice is for medical doctors to use this title in most contexts, whereas people with other doctorate degrees use it mainly in professional contexts. Do pharmacists in the U.S. refer to one another as Dr. So and So?

This varies widely from country to country, of course. In Germany, for example, it's typical for medical doctors to be referred to simply by the standard honorific (e.g. Herr) while people with research doctorates are referred to by the courtesy title (e.g. Herr Doktor).

Personally, as someone with a research Ph.D., I avoid using the title Dr. outside of professional settings. One reason for this is a (possibly apocryphal) story I once heard: An academic on a cross-country trip had checked in for his flight as with the title Dr. prefixed to his name. Midway through the flight, he was approached by a flight attendant with a request to tend to a fellow passenger who was experiencing sudden chest pains. Needless to say, embarrassment ensued...
posted by mr_roboto at 6:07 PM on November 9, 2004

A few hours ago I was on a rant at my web site about a House Bill that was filed today in the Texas Legislature ... HB 16:

relating to the right to object to participation in an abortion procedure or to the dispensing of an emergency contraceptive.

I'd wondered about how long it would be if this passed into law before someone tried to apply it to birth control pills as well. Guess they aren't going to wait that long, and I'll be watching to see if this bill changes to include birth control (and whether or not it passes).
posted by Orb at 6:15 PM on November 9, 2004

>>I’m unnerved that the respective sides, as described in the article, make this a Christian Moral Issue versus a Women’s Rights Issue, when, in short, birth control isn’t anyone’s business. The reasons for birth control are manifold and varied, and one shouldn’t have to explain herself when she goes to pick it up, or suffer the consequences of being denied her prescription.

>jennanemone, isn't that pretty much the point of the Women's Rights argument, that birth control is purely the choice of the individual woman and is not the business of anyone else?

nade: Yes. You’re right. It’s a women’s reproductive rights issue: a woman was denied medication—should be her choice, not the pharmacist’s, a woman’s right to choose, and all that--because the pharmacist just assumed her pill prescription was to stamp out pregnancy. But was her prescription for birth control, or for menstrual control? To folks who recognize the side benefits of birth control (and thanks to those gals for pointing it out), the moral assumption that pharmacist made is absolutely insulting. If someone commented on my prescription for Yasmin, I would absolutely bristle. But this incident isn’t merely illustrative of a Women’s Rights issue. Everyone should be freaking out. It is dangerous when someone begins applying his ideas of morality on your already-prescribed medication. To extrapolate:

Narcoleptics have no ‘drug of their own’; instead, they are prescribed a host of ‘orphan drugs.’ If a narcoleptic goes into a pharmacy asking for pemoline, suppose the pharmacist says no, because he is against doling out stimulants commonly prescribed to children for ADHD (pemoline comes in chewable tablets!). That might seem extreme, but where does it stop? That's the same as a woman with a menstrual-related health problem entering a pharmacy and asking for Yasmin, and the pharmacist saying no, because he is against doling out pills that interfere with baby-making.

I’m incredibly unhappy with that USA Today article. The second half of it is entirely about a battle between stereotypical Christian Right morality and women’s reproductive rights. USA Today’s implication that this incident is emblematic only of a Women’s Rights issue, denies it its fullest gravity. If a pharmacist is offended by a controversial medicine, whether by the means by which the medicine was obtained, or perhaps by its original use prior to becoming an “orphan drug,” does that mean he is able to simply refuse you the drug when it’s a matter of health? Of cataplectic seizures? Of life and death?

posted by jennanemone at 6:40 PM on November 9, 2004

Won't someone think of the sperm?
posted by JanetLand at 6:51 PM on November 9, 2004

It absolutely boggles me that such an event could occur. I simply can not imagine a Canadian pharmacist refusing a prescription.

And as for laws being passed saying it's okay for a pharmacist to refuse? It... it just isn't possible. Not in the realm of the possible. Unthinkable.

I'm pretty sure that if it happened in Canada, there'd be a huge march on the Capital, and politicians would get a real sharp awakening.

Why the hell aren't US citizens rioting about this sort of thing?
posted by five fresh fish at 7:08 PM on November 9, 2004

Like I said to someone else I was discussing (arguing) with today about this, in a large or even medium sized town, this isn't going to be a huge problem (though it still shouldn't be happening). If someone at one pharmacy decided that whatever it was I was prescribed morally offended them, I would snatch back the 'script (and they better give it to me) and hop across the street to another one. In one small town I lived in though, there was exactly one pharmacy and one pharmacist, and the next nearest one was over 100 miles away ... and it seems to me that you'd be likely to find this sort of moralistic thinking on birth control to be even more commonplace in smaller, rural villages. A 200 mile round trip to buy drugs that are legally prescribed would be ridiculous.

I once had to fill my prescription for birth control pills at my mom's hometown pharmacy (small town) when I was about 19 years old, and he felt the need to lecture me on the "fact" that as a young unmarried woman, I really shouldn't be having sex. I'm sure if back then he'd thought he could have denied me the pills, he would have ... and I wasn't taking them to avoid pregnancy either. I wasn't even having sex yet. My doctor was using them to try and even out my hormone levels which were completely screwed up due to late puberty and low body weight (imagine no period for months and then a month long period with the associated health risks that brings - it was hell).

Why the hell aren't US citizens rioting about this sort of thing?

Because I don't think many of them actually know these laws are being passed. It doesn't exactly make front page news ... which is why I keep a careful eye on what my state legislature is doing, so I can inform others when things get overlooked by the masses or the media. So many laws slip through without anyone even knowing about them (at least here in Texas). I'll be making a stink at our statehouse when the bill in Texas comes up for discussion/vote, you can be sure. I just hope I am not out there screaming by myself, and I sure hope it doesn't pass in any form.
posted by Orb at 7:14 PM on November 9, 2004

"I think there's also the anti-choice argument that, if we don't know when life begins, it's better to be safe than sorry."

Though I'm far from what anyone would call "religious," I certainly see the merit in that concept.

The problem is that there are two concerns involved with conflict with one another. If the fetus were just in some pod somewhere, and it was up to us whether we let it grow or not, that'd be one thing. But pregnancy seriously interferes with a woman's life and a woman's body. For nine months you're dealing with nausea, decreased vitamins & minerals (as they're rerouted to the baby - a lot of pregnant women start having dental issues, eg), extra weight constantly, foot swelling, back problems, fatigue, dizziness - well, basically any form of discomfort or exhaustion... and then birth is famously not-so-fun, and giving up something you carried all that time for adoption is pretty tough, so that means pregnancy can majorly interrupt life plans. So, "just to be safe" doesn't cut it in this case. There's more than the fertilized ovum's concerns to consider.
posted by mdn at 7:32 PM on November 9, 2004

Besides, to "just be safe" we also have to allow for abortion in the other direction. Say, to about age 13. No false negatives that way: no would-be-good people aborted, no would-be-bad people dragging down society.

Really, it'd be best for everyone.
posted by five fresh fish at 7:44 PM on November 9, 2004

It absolutely boggles me that such an event could occur. I simply can not imagine a Canadian pharmacist refusing a prescription.

Actually, it is happening in Canada. There was a bit on it on CBC one a few months back, actually, a panel of pharmacists. No marching on Ottawa.
posted by Hildegarde at 8:13 PM on November 9, 2004

OMG. Now I'm gonna have to go kill someone. Shit.
posted by five fresh fish at 8:32 PM on November 9, 2004

Sweet zombie jesus, Concerned Pharmacists for Conscience is exactly about this:

Although pharmacists are told by the APhA [Alberta Pharmaceutical Association] that they are granted the right of conscientious refusal in Alberta, they are presently forced to refer.

They want to be able to refuse to even refer a patient to a pharmacist who would fulfill the prescription!

Anyone already got information on who to contact to protest against the CPC?
posted by five fresh fish at 8:39 PM on November 9, 2004

fff, a few years ago (when I was somewhat punkish) I had a bad case of bronchitis, and the doc prescribed codeine cough syrup. (In Canada you can get codeine syrup otc, but I think this was meant to be extra strong.) Anyway, the elderly pharmacist nearby made me show him my arms, and made up the bitterest, nastiest syrup you can imagine, on the premise I was a druggie looking for a cheap high. I felt too lousy to give him hell about it - bugged me more in retrospect.
posted by zadcat at 8:41 PM on November 9, 2004

fff: That's just insane isn't it? They don't want to do it themselves, and they don't want to let anyone else do it, which I imagine works in their moral framework (I'm sorry, but I can't even let you go get the evil drugs somewhere else.) It doesn't work within the realm of what I expect a pharmacist to do ... either give me the drugs I was prescribed or tell me where to acquire them if they don't or won't carry/sell them.
posted by Orb at 11:23 PM on November 9, 2004

She needs to get her dumb ass canned, because she's poking her life into another persons life, and she needs to different profession. What a bitch.
posted by Keyser Soze at 11:30 PM on November 9, 2004

?I, too, had other medical reasons for taking birth control pills. At 15 I was getting my period every 2 to 3 weeks, making me feel like a blood-drained zombie so my doctor prescribed birth control pills to regulate my periods. Now I am 47 and religiously taking the pill because I have high blood pressure and a history of difficult childbirth, meaning it would be very dangerous to get pregnant.

But these arguments won't persuade Karen Hughs and the others who agree with her. They believe that preventing a fertilized egg from implanting is murder and they want to prevent any chance of murder.

The real problem is that this country is undergoing a massive shift in how we represent our views on women and reproductive rights to the world. While birth control pills, emergency contraceptives and abortion are still legal in this country, the Bush administration acts like they are not.

While George Bush has been in office, he has filled as many judicial positions as possible with judges that are pro-business and pro-church but most important of all, they must be anti-abortionists. He has also:

Reinstated the “Global Gag Rule” on his very first day in office. This rule prohibits American foreign aid from being given to any family -planning clinic that mentions abortion.

Sent the Secretary of Health and Human Services, Tommy Thompson, to a U.N. session on children who sided with the Vatican, Iran, Syria, Libya, and Iraq against sex education for adolescents, and against STD and contraceptive information for married couples. The United States also objected to a section that called for services to children in a “post-conflict situation” because our delegates were afraid that might include offering emergency contraceptives or abortion to girls who had been raped.

Sent Elaine Jones to an international population-policy conference in Bangkok where she threatened that The United States would drop out of a treaty signed in 1994 unless references to “reproductive Health services” and “reproductive rights” were eliminated. She advocated the use of natural family-planning methods such as the Billings birth control method which relies on checking the viscosity of the cervix. It was an Iranian doctor who spoke against this, showing that the Billings Method has a high rate of failure as reported in textbooks from the United States.

Replaced the physicians from the AMA and the Public Health Association who are usually sent to the World Health Organization with two women who have no public health experience: Beverly LaHaye, the wife of apocalyptic evangelist and author, Tim LaHaye and Janice Crouse, an anti-abortionist activist.

Sent delegates to the World Summit on Sustainable Development who again aligned The United States with The Vatican and the Islamic Fundamentalists to block the condemnation of female genital mutilation, forced child marriage, and “honor” killings.

This is the face that we present to the world: Stoning rape victims is OK by us. Just don’t allow women use birth control pills, emergency contraceptives or abortions.
posted by Secret Life of Gravy at 7:28 AM on November 10, 2004

mkultra,

> No, pharmacists are not doctors.

Pharm.D = "Doctor of Pharmacy"

> They cannot prescribe drugs,

Actually, that could change. There's some debate about allowing them to prescribe certain sorts of drugs. No telling if that will happen or not.

> nor have they gone to medical school.

I didn't say they were MDs. Your dentist hasn't gone to medical school either.

> Many
> Pharm.D programs only require an Associate's (2-year)
> Degree.

Pharm.D programs require that you have certain pre-requisites met before you start. It generally takes two to three years to knock those out.

You can't just cop a 2-year Associate's degree in Communication or Studio Art or something and apply to pharmacy school. Quite a few people who enter Pharm.D programs already have a 4-year degree, usually in a hard science (often Chemistry or Biology).

Pharm.D programs themselves generally take four years to complete and many students do a residency after graduation. But all students do rotations in various pharmacy settings. The last year of study is devoted primarily to that sort of work.

Pharmacy school is tough work. You make it sound like cosmetology school or something.

Also, what mokujin said.
posted by wheat at 3:28 PM on November 10, 2004