But, But, Religious Freedom

The American College of Obstetricians and Gynecologists just declared that birth control pills should be sold over the counter:

According to the obstetricians and gynecologists, one major reason women at risk for unintended pregnancies don’t use birth control is that they don’t have regular access to a doctor, either for practical reasons or because they are uninsured. And in a 2004 telephone survey conducted by an Oakland based nonprofit, 47% of the uninsured women who currently do not use birth control say they would use it if it were available over the counter, like Tylenol or Benadryl. Another recent survey, conducted by public health experts in Texas, found that 60% of women not on birth control pills would use it if they could buy it without a prescription. Such statistics, they argue, make plain the need to increase access.

I wonder how the bishops’ freedom to roam around in women’s uteri is impinged by this, because Jesus clearly stated that all oral contraception must be dispensed by a pharmacist (1 Gal:23).

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121 replies
  1. 1
    Dave S. says:

    Jesus clearly stated that all oral contraception must be dispensed by a pharmacist (1 Gal:23).

    Actually I believe that’s 1 Galt…

  2. 2
    NonyNony says:

    The bishops should back this full tilt, since their objection to the mandate that contraception needed to be covered by insurance was that they didn’t think that Catholic funds should be used to pay for birth control. If it’s sold without a prescription, most insurance plans that I’ve ever had will tell you “go buy it your own damn self”.

    Why if they didn’t support this measure, I’d just have to assume that they were a bunch of hypocrites who aren’t worried at all about the moral obligation of paying for contraception but rather just saw one more place to wedge themselves into other people’s lives for political gain. And clearly Catholic Bishops would never do that! That would be unpossible!

  3. 3
    Elizabelle says:

    Go ACOG!

    Believe this is how they do it in many other countries, and there’s not a problem with over the counter sales.

  4. 4
    waratah says:

    This would be a win for insurance, they would not have to pay.

  5. 5
    Punchy says:

    The American College of Obstetricians and Gynecologists just declared that birth control pills should be sold over the counter:

    Will. Never. Ever. Happen.

  6. 6
    bemused says:

    Oooh, just watch rightwingers blow their tops. They are going to be so pissed if bc would be so easy for women to get, They wouldn’t like losing the control to mess with women’s personal lives one bit.

  7. 7
    LGRooney says:

    They’re afraid their little angels will become sluts

    In any event, this is the way it is in most of Europe and women weren’t jumping me for access to my delicates wherever I went

  8. 8
    pk says:

    This is not a good idea. So many women will not be able to afford it if they are over the counter. Our insurance does not cover allergy medications which are OTC and are expensive. I can’t imagine daily birth control pills being cheap.

  9. 9
    Patricia Kayden says:

    I can already hear the Righties complaining about parental consent. Imagine all the poor children lining up at CVS to purchse birth control pills. Oh the horror!

  10. 10
    c u n d gulag says:

    Maybe some progressive Priest’s will secretly dispense birth control pills to women instead of wafers at communion?

  11. 11
    The Red Pen says:

    @Dave S.:

    Actually I believe that’s 1 Galt…

    Saw a Freeper with the tagline “CTRL-GALT-DEL” which was kinda funny.

    So, those who don’t read this swill, I have terrible news: none of this Obamacare stuff will matter, because they are all going Galt. They are going to live in their vans (down by the river) and pay cash for everything. They are cashing out their 401Ks and buying ammo.

    Soon, the economy will collapse! Either that, or these idiots will be living in squalor in vans (down by the river) surrounded by various quantities of lead and gold while we enjoy a steadily improving economy.

  12. 12
    Face says:

    This would, in theory, have the support of all the fundy pharmacists, too, as they dont have to “disturb their conscience” handing these out. Of course, that’s assuming that their objection is just handing them out. Which of course, is patently false and they just want the sluts punished with pregnancies.

  13. 13

    I drove by a anti-abortion protest one day where people had signs reading:

    “The Pill Kills!”

    The stupid hurts.

  14. 14
    SiubhanDuinne says:

    @Elizabelle:

    Go ACOG!

    Even though I read the post at top, your use of the acronym flew me back to 1996 and the years leading up to it. To anyone who lived in Atlanta then, “ACOG” will always and forever be the “Atlanta Committee for the Olympic Games” (and what an overbearing, bullying bunch they were!)

  15. 15

    @Face:

    This would, in theory, have the support of all the fundy pharmacists, too…

    The fundy pharmacists should lose their licenses. I guess that is another topic though.

  16. 16
    ploeg says:

    @pk: Birth control pills have been around for 50 years, so they know the tricks for producing the pills inexpensively. The main cost driver currently is that a pharmacist needs to keep tabs on the pills.

    I expect that your allergy medication cost will also drop as manufacturers figure out ways to produce those pills inexpensively.

  17. 17
    Villago Delenda Est says:

    Solves nothing for the wowsers. The entire point, as Face indicates above, is to punish the sluts.

    Likewise, the red beanie brigade is mortally offended by the very idea of contraception in any way, shape, or form, as it again interferes with their asshole invisible sky buddy’s plan to punish the sluts.

  18. 18
    Cermet says:

    If one were to translate the old “Thou shall not tolerate a ‘Witch*’ to live correctly, one could end up with the more correct phase “Thau shall not tolerate a “pharmacist” to live. Will Bishops start spreading that bit of more accurate translation**?

    *The term witch was put in by the writer of the King James bible knowing full well this was an absolute lie. They just wanted to attack woman who practiced herbal medicines.

    **This translation is accurate but only in terms of modern usage. In reality, the original Hebrew writer intent was that one will not allow a person who mixes AND uses poisons to kill to live … . But for those so-called pharmacist that seem to believe it is their job to play God, I like the “pharmacist” translation.

  19. 19
    marcopolo says:

    I certainly support selling birth control pills over the counter with the caveat that insurance companies should still be required to pay for it on women’s health policies since I agree with pk above. However, I thought birth control pills were prescription primarily because they work through adjusting women’s hormone levels & nasty things can happen in some cases when those adjustments don’t work properly. Wouldn’t there be possible medical problems associated with selling birth control pills over the counter? Is there a simple mechanism for dealing with this? I assume so since it is the American College of Gynecologists & Obstetricians advocating for this.

  20. 20
    marcopolo says:

    I certainly support selling birth control pills over the counter with the caveat that insurance companies should still be required to pay for it on women’s health policies since I agree with pk above. However, I thought birth control pills were prescription primarily because they work through adjusting women’s hormone levels & nasty things can happen in some cases when those adjustments don’t work properly. Wouldn’t there be possible medical problems associated with selling birth control pills over the counter? Is there a simple mechanism for dealing with this? I assume so since it is the American College of Gynecologists & Obstetricians advocating for this.

  21. 21
    Percysowner says:

    I think BC being OTC is a great idea. I also hope that Obamacare will still require it be covered by insurance as preventive care. Have it be easily accessible and still covered so women can get the preventative care they need. That said, the Catholic church and those who want to control women will NEVER allow this to happen.

  22. 22
    jrg says:

    @The Other Bob: Wow. They’re so moronic, it’s getting hard to tell the difference between sock puppets and the real thing.

  23. 23
    ploeg says:

    @The Red Pen:

    They are going to live in their vans (down by the river) and pay cash for everything.

    Cash! Silly person, they’re strictly on a gold and barter basis. Only real things, not fake Obamabucks.

  24. 24
    Walker says:

    @pk:

    I was just about to ask this; I thought most insurance programs do not cover OTC medicine.

    Though with birth control, my wife finds insurance coverage to be a joke. They will only pay for generics. Brand names are 100% out of pocket.

    The problem is women’s bodies are so sensitive to the ingredients of the pill that minor changes have major effects. It is impossible for the generics to be “identical” to the brand names. In particular, most generics cause my wife to have a lot flu-like side effects that the brand names do not. This is compounded by the fact that pharmacies regularly change their choice of generics, preventing your body from ever acclimating to them.

  25. 25
    Elizabelle says:

    You know what else?

    The morning after pill is basically high dose birth control pills. Same mechanism, just stronger dose.

    Emergency contraception is already available over the counter to women 16 and older in many states.

  26. 26
    Count Ulster says:

    Won’t someone think of the zygotes?

  27. 27
    J says:

    @LGRooney: Damn! How disappointing! I’m canceling my trip. Hope you enjoyed the Eiffel tower anyway.

  28. 28
    ding dong says:

    Sexxytime all the time
    !

  29. 29
    magurakurin says:

    Fuck. Birth control over the counter? I think it should be in the water supply…

  30. 30
    gelfling545 says:

    @pk: Ask your pharmacist if they can fill the prescription for you to pay out of pocket & how much it would be. My vitamin d supplement is technically otc but the doctor writes a prescription, the pharmacist fills it & I pay. From the pharmacist I pay $3 for a month’s supply. Pre-packaged, off the shelf costs $15. Now I always check to see if the pharmacist can fill any otc meds I am told to take. Check multiple stores if that is an option for you, too. One store would have cost me $10 (still a savings) but my same old regular pharmacy had the best price on this.

  31. 31
    rachel says:

    @pk: They’re less than $10 a month at most pharmacies I’ve been to here in Korea. Whether that sorts with your idea of expensive or not, I don’t know.

  32. 32
    Lori says:

    It’s over the counter in Brazil, too.

  33. 33
    Persia says:

    True story: If Romney had been elected I was going to do whatever it took to get myself Essure sterilization before he came in and started wreaking havoc. I’m still considering Essure but it seems significantly less urgent now.

  34. 34
    LGRooney says:

    @J: To be honest, it might have been the persistent scowl I wear and the fact that I avoid social scenes that kept them away or, in later years, perhaps it was the wife and child being with me. Whatever it was, I was obviously robbed of my chance to take advantage of all the loose women with easy access to birth control.

  35. 35
    Trakker says:

    Well, this is not going to be received well by the right at all. More birth control means fewer fetuses and we all know how much the right luvs fetuses.

  36. 36
    Omnes Omnibus says:

    @marcopolo: My ex is Romanian by birth and, in RO, birth control is OTC, but one goes to a doctor to get a recommendation for which pill to purchase. It seemed to work out well. Even after she was here for years, she continued getting and using her RO OTC pills. Also too, they were quite inexpensive – along the lines of cold meds. The system seemed pretty workable to me.

  37. 37
    Garbo says:

    @magurakurin: This. I think every teenager should get a contraceptive implant at puberty. It makes more sense to me that people should have to take an overt action to begin trying to get pregnant rather than the opposite.

  38. 38
    Barbara says:

    Not to be a nudge — I am very much in favor of OTC contraceptive pills but I don’t think it should eliminate the need for insurance coverage for non-pill options, and especially the IUD, which is the most effective and safest and least trouble free reversible method of contraception, but it is also one of the most upfront expensive methods — it is really cheap when you consider how long it lasts but you need to get a doctor to insert it, and you need to order it with a doctor’s prescription from one of two manufacturers, with lead time of six weeks or more. It’s truly a hassle but it is so much better than the pill for many women. But without insurance it’s effectively not available to women who can probably most benefit.

    And men, you might suggest that your female partner consider it because it is so unusual that it doesn’t even occur to many women as an option.

  39. 39
    Barbara says:

    @Persia: Persia, see my comment above: consider an IUD, which lasts up to 10 years but is reversible. Depending on your age, an IUD will get you through the rest of your fertile years with a minimum of hassle or complications, and if it isn’t right for you or you otherwise change your mind, it is easily removed.

  40. 40
    hep kitty says:

    women at risk for unintended pregnancies don’t use birth control is that they don’t have regular access to a doctor

    Well, once again, these kinds of observations give me the vapors and must have Viney fetch my smellin’ salts whilst I swoon on the loveseat over such a shocking revelation!

    Who knew? A bunch of doctors with a bunch of facts say these things?! Is it really really real?? It can’t be b/c all the discussions I see on the teevee never connect economics with birth control and the ability (or inability, as the case ma be) to control the size of one’s family (not that women should be allowed to do that, of course)!

    60% of women not on birth control pills would use it if they could buy it without a prescription

    Oh dear, I feel faint. It’s just too much, too much to absorb.

  41. 41
    jon says:

    @magurakurin: It already is in the water, along with antidepressants, heart meds, opiates, cocaine, meth, and everything else that gets consumed by those who then pass it on in one form or another.

  42. 42
    Agoraphobic Kleptomaniac says:

    No no no no no no no no no

    The solution to women not having access to doctors to get birth control is to get them access to doctors.

    How short sighted do you have to be to think that OTC medications is in any way a resolution for women not having health care? Plan B is different, due to the time restrictive nature of Plan B, but otherwise, just make Contraceptive checkups free at any doctor if you’re worried about access to a doctor for these women.

  43. 43
    Bubblegum Tate says:

    Ah, never mind. I see my point was already made upthread. At any rate, let me just say that I heartily endorse this event or product.

  44. 44
    comrade scott's agenda of rage says:

    @Elizabelle:

    Emergency contraception is already available over the counter to women 16 and older in many states.

    Not located in the Neo Confederacy.

  45. 45
    Dork says:

    @jon: Endogenoous catalytic enzymes, hepatic cells, and activated charcoal says LOLWUT?

  46. 46
    Cermet says:

    Tylenol over the counter?! Insane – that killing drug accounts for over six thousand liver failures a year! That poison should never have been allowed to be sold much less over the counter.

    That is bad shit if the dose is in error even by a trivial double dose (for children; for most adults, one drink and a double dose is the level that can be fatal for the liver … lucky, no one combines alcohol with tylenol … uh, wait … they do!!!) That is not a level of toxicity that any medicine sold over the counter should have. Talk about money talking … yes, all you people who take it and have no issues (even overdoses) your livers most certainly have been damaged but luckily, the liver can heal and grow back.

    And, of course, some people can tolerate far higher toxic levels but that is exactly why that shit should be handled only in hospitals by doctors only so the total dose and side effects can be monitored.

  47. 47
    hep kitty says:

    Does this mean we get more poor people by not allowing them to practice a form of birth control (through legislation or economic deprivation) that does not involve an aspirin between the knees? It really presents a conundrum when you hate poor people as much as we do but feel Got has tasked us to protect all fertilized eggs. Perhaps we should rethink this whole thing.

  48. 48
    peach flavored shampoo says:

    Sure, you could have a wingnut cashier do so, but I’d think they’d be less commonly found and more easily replaced.

    Replaced? You meant hired, right? If the last line of blastocyst defense skips past the fundacists and into the checkout line, these “GANST MAH REELIGIN!” folks will be sought out and asked to be steadfast in their dickishness.

  49. 49
    Higgs Boson's Mate says:

    I find myself gobsmacked by the fact that birth control is in any way controversial today. If memory serves, there’s more bullshit flying around regarding the practice than there was back then (I’m old, hoping to be damned old some day).

    There is a cadre of white males who are already livid that whiteness doesn’t always carry the day politically. Suggesting that they don’t have complete control of every last cell in a woman’s body infuriates them.

  50. 50
    Bulworth says:

    The American College of Obstetricians and Gynecologists just declared that birth control pills should be sold over the counter:

    Well, that’s it. The end of Freedom in America.

  51. 51
    El Cid says:

    Remember — “sold over the counter” means “free,” especially to all the college sluts, the blacks and browns, because Obamagifts!

  52. 52
    Cassidy says:

    Man this changes things. It’s one thing to troll the cashier with a big tube of lube, huge pack of condoms, and some random item (that is completely nonsexual but you know they can’t help but wonder where you’re inserting that) and tell them it’s going to be a long night, but now I can add OTC BC to the mix and say it’s going to be a busy weekend! Count me in.

  53. 53
    aimai says:

    @marcopolo:

    I actually agree with this. But maybe making them OTC means they can be dispensed directly by your doctor at a single consultation? Hopefully in the long run everyone will have a primary care doctor handling them so the fact that so many women go without any gynecological care at all until they get pregnant will not be an issue.

    aimai

  54. 54
    Cassidy says:

    WTH? Did everything just go dead suddenly? If you’re neighbor is trying to eat your face, somebody better speak the fuck up.

  55. 55
    Mnemosyne says:

    Sorry, but as someone who has had very nasty reactions to certain formulations of the Pill, I’m joining the skeptics’ side on this one. Who is going to be standing in the pharmacy explaining the difference between monophasic, biphasic, triphasic, combination, and progestin-only Pills to women and helping them choose between the dozens of kinds available on the market right now?

    And, as someone mentioned above, the generics can have their own problems. I was switched from one long-time generic to a different one because the first one stopped being produced, and I only found out afterwards that the first one had a common side effect of causing extra dryness and therefore pain during sex, but no one — not my doctor, not my pharmacist — had any clue that could be why I was constantly complaining of that because it only applied to that specific generic formulation.

    What we need is for more people to have access to regular medical care, not more ways for people to try and puzzle out for themselves which of the drugs advertised on teevee is best for them. If we want to do that through making nurse practicioners and physician assistants more responsible for preventative care, that’s fine, but I don’t see how making women research the dozens of pills currently available and buy OTC will make things better.

  56. 56
    Mnemosyne says:

    You know, it would be really nice if we could have conversations about these things without being thrown into auto-moderation for mentioning the name of the stores where you can buy things OTC. For fuck’s sake.

  57. 57
    aimai says:

    @Barbara:

    My mother had an IUD after three children. They were a great technology and still are, from what I hear. Anything as complicated as the pill and as open to tampering–lots of women find their boyfriends hide their pills and/or make holes in condoms in order to get them pregnant/tie them down–is to be avoided, especially for young women. An IUD or an implant (if they are safe) is a better way to go.

    aimai

  58. 58
    cmorenc says:

    @Patricia Kayden:

    I can already hear the Righties complaining about parental consent. Imagine all the poor children lining up at CVS to purchse birth control pills. Oh the horror!

    Many pharmacies and nearly all supermarkets, Wal-Marts etc. with embedded pharmacies sell beer and wine and require I.D.s for proof-of-age to purchase same. There’s no reason whatever that the IDs showing proof of age couldn’t also be required for OTC purchase of birth control pills by anyone not obviously an over-the-hill aged slut :=).

  59. 59
    JackNYC says:

    because Jesus clearly stated that all oral contraception must be dispensed by a pharmacist (1 Gal:23).

    Lighten up Francis, unless you’re advocating for the medication to be available without counseling on side effects to watch for, what to do in the case of a missed dose, etc… or you’re OK with a package insert written by the legal department of a pharmaceutical company in place of a human heath professional.

    But only after you personally go rewire your house and cancel your fire insurance.

    “prescribed by a physician” in place of “dispensed by a pharmacist”? Maybe. Maybe.

    .

  60. 60
    LanceThruster says:

    I think the problem is that the slut shaming might not be performed as effectively by the store cashier whose religious values might not be as judgemental as the helpful xian pharmacist.

  61. 61
    NotMax says:

    Over the counter – out on open shelves?

    Only so long as that aisle is flanked on one side by the aisle displaying crackers and on the other by shelves stocked with wine.

  62. 62
    👽 Martin says:

    @pk:

    This is not a good idea. So many women will not be able to afford it if they are over the counter. Our insurance does not cover allergy medications which are OTC and are expensive. I can’t imagine daily birth control pills being cheap.

    Well, OTC cost for generic birth control should settle down to about $15/mo. That’s not outrageous. Further, anyone struggling to pay the $15/mo almost certainly doesn’t have health insurance. Further yet, anyone struggling to pay the $15/mo who does have health insurance is likely going to have a $10 or so copay on the prescription.

    The downsides to this are unavoidable no matter what you do. Might as well do it.

    And the good news is that Obama doesn’t need Congress to bless the idea. And it should hardly be controversial with the morning after pill already available OTC. The horse left the barn in 2006 under Bush.

  63. 63
    askew says:

    If they are sold over the counter, people will have to pay out of pocket for them. That would negate the change Obamacare made in requiring insurance companies to pay for birth control pills. That’s exactly what happened with a lot of the allergy pills. They used to be $10/month with a prescription. Now, they are around $30/month over the counter. With birth control being even more expensive, I’d guess that they’d be too expensive for most people to purchase OTC.

  64. 64
    TooManyJens says:

    @👽 Martin:

    Further yet, anyone struggling to pay the $15/mo who does have health insurance is likely going to have a $10 or so copay on the prescription.

    No, that’s what all the slut-shamers are so mad about. Contraception got classified as preventive medicine and therefore has to be covered with no cost-sharing (except on certain grandfathered plans).

  65. 65
    👽 Martin says:

    @askew: That’s only because people kept buying brand-name. I buy generic Loratadine for $15 for a year supply.

  66. 66
    cmorenc says:

    @Cermet:

    Tylenol over the counter?! Insane – that killing drug accounts for over six thousand liver failures a year! That poison should never have been allowed to be sold much less over the counter.

    Tylenol is also by far the least effective OTC pain med for many people compared to Ibuprofin or asprin; for me, it’s only very marginally better than outright placebo sugar pills for that purpose. The prime reason Tylenol’s use is pushed by hospitals and doctors is that both asprin and Ibuprofin are much more prone to cause some internal bleeding as a side effect, and to a more modest extent, more prone to inhibt healing of tissues.

  67. 67
    Mnemosyne says:

    @👽 Martin:

    My co-pay for generics is $4, so an increase to $15 a month would be a huge hike for me. One of my coworkers is constantly complaining that her allergy medicine went OTC, because it went from $4 for a bottle of 50 to $20 for a bottle of 50 (Zyrtec).

    And, as TooManyJens pointed out, my co-pay is supposed to go away entirely since it’s now considered preventative care, so I’m supposed to be happy at the thought of paying $15 a month out of pocket rather than no additional money out of pocket?

  68. 68
    👽 Martin says:

    @TooManyJens: Ah, okay. I still assert that $15/mo is far from a deal-breaker to expand access. It’s possible it’ll go lower – I know that you can guy generic birth control in Mexico for as little as $10/mo. Walmart and Target currently sell it for $9/mo with no insurance billing.

    I don’t see this being a serious issue.

  69. 69
    ruemara says:

    My only issue is that there needs to be doctor recommendations. 13 years ago, I had a DVT within a month of starting BC and it ruined my career. Nearly killed me too, but really, I’m still suffering from the career thing, the death would have been much faster.

  70. 70
    Mara Holbrook says:

    I am long past needing birth control pills, but I certainly went through decades of aggravation to be sure those little pills were in my medicine cabinet! They are PRESCRIPTION medication, which means at least a yearly trip to the doctor’s office, various tests (hello, pap smear!) and jumping through whatever hoops the doctor’s office required. If I hadn’t met my deductible yet (I’m pretty healthy, lucky me!)then that whole trip would be out of pocket. Sometimes I had no insurance at all. Some offices would only write a script for three months of pills at a time. Better be sure you followed the rules for a refill! Some offices insisted they had to see you every six months, to at least check your blood pressure, and rake in another co-pay.

    The pills themselves are cheap, it’s all the nonsense to obtain them. Covering contraceptives as preventative care under Obamacare is an excellent idea, but making it OTC might be even better.

  71. 71
    Barbara says:

    @👽 Martin: OTC medications typically go down in cost, but apart from that, it isn’t only the out of pocket expense for either medications or doctor’s visits, but time lost from work for many people who are not paid when they do not work. This discussion was had at the time that Claritin went from being a prescription drug to being OTC, and for most (but not all) people, OTC is more cost-effective, so long as the cost goes down sufficiently. I do think that it is more problematic for OC than it is for other medications, and I also dislike the idea that lack of access to doctors should be the pivotal factor here.

  72. 72
    👽 Martin says:

    @Mnemosyne:

    so I’m supposed to be happy at the thought of paying $15 a month out of pocket rather than no additional money out of pocket?

    And right there is the point where conservatives win elections. Seriously.

    Expanding access is a HUGE benefit – and it’s the right thing to do. Every single argument surrounding women’s health for my entire life has been around the need to expand access. So here’s the offer, and the complaint now is that it will cost some people a little more out of pocket – so that longstanding principle to help every woman was apparently built on a pretty weak foundation if nobody was willing to pay anything to achieve it. Expanding access is going to carry certain costs – this is one of them. Hell, even TANF should be able to be used to cover this.

  73. 73
    The Very Reverend Battleaxe of Knowledge says:

    I thought all that was necessary for something to be sold over the counter was Ralph Nader saying it was “completely ineffective”.

    A long time ago, when I needed Actifed for hay fever season (One batch would do the job for a year) I had to get a prescription. Then it showed up on a list of prescription drugs that Saint Ralph said were completely ineffective. Immediately, it started being sold OTC.

    Of course, the pseudoephedrine (all that’s in Sudafed for example) is completely ineffective. But Actifed has another ingredient, triprolidene, which apparently is what works. Ralph Nader doesn’t know his ass from a hole in the ground? Say it ain’t so!

  74. 74
    TooManyJens says:

    @Barbara:

    OTC medications typically go down in cost, but apart from that, it isn’t only the out of pocket expense for either medications or doctor’s visits, but time lost from work for many people who are not paid when they do not work.

    Not only that, but the difficulty in even making and getting to a doctor’s appointment if your employer is one of the many we talked about yesterday where employees don’t know from one week to the next when they’ll be scheduled.

  75. 75
    Ash Can says:

    @Agoraphobic Kleptomaniac: I don’t disagree with your point, but getting all women access to doctors involves protracted fights involving politicians and their constituencies, an insurance industry that doesn’t want to pay for it, the AMA that doesn’t want to Increase the number of doctors, a business world that doesn’t want to give women time off work to see doctors… Did I miss anyone? In the meantime, these women needed contraceptives yesterday. So making them available OTC is a good move In the meantime.

  76. 76
    Ella in New Mexico says:

    @marcopolo:

    As a nurse, I know there would be some real public safety problems with oral contraceptives being 100% OTC. Blood clots are not funny, my friends. At their least, they cause extensive misery and medical costs, at the worst, they kill. And even doctors have trouble prescribing which BC Pill formula will work best for which women–it’s a mix of medical training and trial and error. It will be an enormous task to do the public education needed to help women be good consumers of these types of medications. Jeezus–people are still overdosing their kids with Tylenol and cough syrup these days!

    This ACOG statement is a solution for the wrong problem. Instead of trying to work around all the limitations our current system has, fix the damn system. Give all people in this country access to medical care and free contraceptives.

  77. 77
    Villago Delenda Est says:

    @The Very Reverend Battleaxe of Knowledge:

    Ralph Nader doesn’t know his ass from a hole in the ground? Say it ain’t so!

    This was established beyond all doubt in 2000.

  78. 78
    👽 Martin says:

    @Ella in New Mexico: But unwanted pregnancy carries just as significant risks, no? Until such time as we can fix the system, the short-term answer may well be to trade out the increased risks for OTC birth control for the then-avoided risks from unwanted pregnancy. My guess is that from purely a health basis, the latter equal or outweigh the former, and outside of the medical costs, the economic costs of an unwanted pregnancy push the case decisively toward reducing the pregnancy rate. We’ve been holding out for decades to fix the health care system, and we’ve finally made a bit of progress, but this is a change that could be put in place this year.

  79. 79
    askew says:

    @👽 Martin:

    Not all allergy medicine has generics available and not all allergy medicines work for everyone. My OTC allergy medicine doesn’t have a generic equivalent yet.

    As for BC, you can’t just sub in a generic for a brand name as they aren’t identical. And some of the new BC pills don’t have a generic. Same problem with my thyroid medicine. I can use a generic, but it has to be a specific one and it can’t be changed.

  80. 80
    jenn says:

    @👽 Martin: My guess is they might treat buying birth control like they do pseudoephedrine. The pharmacist has them behind the counter, and the person buying them has to sign something. Folks can get them without a prescription, but know what warning signs they need to watch out for.

  81. 81
    dr. luba says:

    This is what the ACOG Committee Opinion says:

    In the interest of increasing access to contraception, and based on the available data, the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice makes the following conclusions and recommendations:

    Weighing the risks versus the benefits based on currently available data, OCs should be available over-the-counter.

    Women should self-screen for most contraindications to OCs using checklists.

    There are concerns about payment for pharmacist services, payment for over-the-counter OCs by insurers, and the possibility of pharmacists inappropriately refusing to provide OCs.

    Screening for cervical cancer or STIs is not medically required to provide hormonal contraception.

    Continuation rates of OCs are higher in women who are provided with multiple pill packs at one time.

    …….WRT costs, they would only go up for those with good insurance, and then only somewhat. Those of us without prescription coverage love it when meds go OTC, as the prices really go down. If you buy generics (and not the name brand), you can buy a year’s supply of Zyrtec or Claritin for about $10.

    (Also, too, generics–Singulair, an asthma drug, went from several hundred dollars a month to 20 dollars a month now that its generic. The same is true with many other generics, which is why you get all those ads urging you to speak to your doctor about some brand name drug. That’s where the money is.)

    Most women do well no matter which pill they go on, hormonally speaking. And very, very few have any serious complications, even when compared to other OTC drug users. The pill is quite safe, although some of the newer pills do not have quite as good a safety profile as the old (generic) ones.

    The biggest problem with access in this country is that a doctor’s visit and prescription are needed. If you are uninsured (and if Planned Parenthood has lost funding in your area), chances are you don’t have an OB/GYN or PCP who can get you a prescription. If you’re a teen, you may be afraid to see a doctor because you don’t want your parents to find out you’re sexually active. (Yes, confidentiality is the law, but teens don’t know this.)

    And then there is the problem of expired prescriptions. I used to get calls all weekend from women who just discovered their prescription had expired, and needed to start a new pack of pills. (In the old days, everyone started their pills on a Sunday.) I suspect many pregnancies are the result of running out of pills.

    Anyway, the full text of the Committee Opinion is here.

  82. 82
    dr. luba says:

    @Ella in New Mexico: “This ACOG statement is a solution for the wrong problem. Instead of trying to work around all the limitations our current system has, fix the damn system. Give all people in this country access to medical care and free contraceptives.”

    ACOG recognizes that we live in the real world, where the House of Representatives is still controlled by the GOP. Theirs is not a perfect solution, but one grounded in reality.

    Yes, we should fix the damn system. But we need to take care of people in the meantime.

  83. 83
    aimai says:

    @👽 Martin:

    I think that’s a bit glib. Unwanted pregnancy carries a huge risk, of course, but only a small percentage of women who could take BC when it was over the counter would get accidentally pregnant (they aren’t having sex every day, they could be using condoms) while 100 percent of the women taken the pill without medical supervision are at risk for complications which will also be unattended since they don’t have a doctor. In addition: you can get pregnant on the pill if you are not an organized and educated consumer of medicine and self care in the first place. In other words: some percentage of the kind of people who would self prescribe the pill are probably also the kind of person (teenagers) who wouldn’t take it responsibly thus falling prey both to 1) the risks of blood clots etc… and 2) unwanted pregnancy.

    I’m pro birth control and pro pill but I’d rather see a system in which it was easier for women to get primary care and BC than one in which it was easy for BC to be handed out to uninformed consumers whose medical reactions would be unmonitored.

    aimai

  84. 84
    NotMax says:

    @jenn

    The reason for the behind the counter and have to sign regimen is because ingredients in those items can be used in meth labs (and also provide a slight high), the concept being to limit amount purchased, not because of contraindications. That everyone and anyone purchasing those items is presumed guilty of being involved in illegal drug manufacturing and must be entered into a database is an affront. Regular household bleach can be used in meth labs, too – no regulations on that.

    Prior to the instigation of that bogus ‘war on drugs’ requirement, ephedrine and pseudoephedrine were readily available on open shelves.

  85. 85
    Mnemosyne says:

    @👽 Martin:

    So here’s the offer, and the complaint now is that it will cost some people a little more out of pocket – so that longstanding principle to help every woman was apparently built on a pretty weak foundation if nobody was willing to pay anything to achieve it.

    Er, no, it’s included IN PPACA that birth control is preventative care and there is no co-pay for it under any form of insurance. So now what you’re proposing is to take that away from millions of women and instead put everything OTC so they can pay out of pocket.

    Since PPACA is designed to get everyone coverage, your concern for women who don’t have health insurance coverage is false. Your “solution” is to take us back to what we had prior to PPACA, except that women will have less access to medical care. And your solution is better because, what, Free Market Solves All?

  86. 86
    Mnemosyne says:

    @dr. luba:

    So my friend’s non-smoking sister who had a stroke at 28 from taking birth control is such a freak of nature that we can’t even take her into consideration when it comes to putting birth control pills over the counter?

    And, frankly, I’m surprised that a doctor is advocating less access to doctors for people. Once these go OTC, there’s no putting that genie back in the bottle, so I find it highly unlikely that doing it will magically increase women’s access to medical care.

  87. 87
    Another Halocene Human says:

    @NotMax: Correct. That was the DEA, not the FDA. Pills were being stolen in stores (but also straight off the loading dock where they were manufactured). This followed an attempted banning of ma huang/ephedra by the FDA following a number of deaths. It was marketed as a diet pill/fat burner. The herb is very high in both ephedrine and pseudoephedrine. However, because of the terms of DSHEA, even after showing that ma huang causes fatal heart attacks, the FDA failed and it went right back up on the shelves. Separately, the DEA decided to crack down on Sudafed, and “herbal meth” was no more.

    The stuff is dangerous. It was common to mix anti-histamine with pseudoephedrine because that shit WILL stop your nose from running, even if the anti-histamine in question is doing nothing for you. I cottoned onto that scam quick. After Clar1t1n failed to work for me, the doc tried to write me a script for Cl____-D. Bullshit.

    I was a young person when I was taking that stuff and nobody warned me not to take it with coffee. I started having heart palpitations. My dad has allergies from hell and had no effective treatment so he used to buy the bottles (before they went to blister packs) and live on the damn red pills. They were giving him high blood pressure.

    I disagree that ephedra makes you high, but let’s not pretend it’s some totally benign substance.

  88. 88
    Glidwrith says:

    @👽 Martin: Where the hell do you go? I haven’t managed to find anything that wasn’t $7.00 for maybe a 2 week supply.

  89. 89
    👽 Martin says:

    @aimai:

    I think that’s a bit glib.

    Is it? I’m not so sure. Reliable data is pretty hard to get around this issue because it’s so politicized, but complications from birth control (VTE, etc) seem to be around 10/10,000 patients. The unintended pregnancy rate is around 500/10,000 patients, and about 200/10,000 unintended births. That’s a lot. And that rate dropped by 20% once new forms of birth control hit the market back in the 90s. Expanding access seems to have a significant effect here. 50% of unintended pregnancies are from women that aren’t using birth control.

    For pregnancies, it appears that non-trivial complications to the mother occur at a rate of about 500/10,000 pregnancies – hypertension, diabetes, hemorrhaging, etc. These are arguably as significant as the complications from OC.

    So, if unintended pregnancy rate can drop by 20% again due to this, that would create about 10/10,000 complications from OC balanced against reducing 100/10,000 unintended pregnancies (and 40/10,000 births) which would carry 5 complications out of that population. So it might double the complication rate (from 5 currently through the unintended pregnancy/complication rates to 10 from the OC that would be picked up). Toss in economic benefits for avoiding those pregnancies (and births) and secondary benefits (pregnant women are twice as likely to be victims of domestic violence – which I imagine is even higher in the case of unintended pregnancies) and I don’t see that statistically this is any worse than break-even.

  90. 90
    👽 Martin says:

    @Glidwrith: Amazon.

    It’s a bit more right in Costco, but not much, IIRC.

  91. 91
    Glidwrith says:

    @👽 Martin: Thanks!

  92. 92
    TooManyJens says:

    @👽 Martin:

    and secondary benefits (pregnant women are twice as likely to be victims of domestic violence – which I imagine is even higher in the case of unintended pregnancies

    FWIW, most of the causation on this goes the other way. Women in abusive relationships are more likely to experience unintended pregnancy than women who are not. Some of that has to do with birth control sabotage, as mentioned above, or other forms of reproductive coercion. A lot probably also has to do with the general chaos of life under those conditions, the inability of the woman to control her life enough to schedule and get to doctor’s appointments, etc. (So this is one of the scenarios where OTC BC would be helpful, although of course the ultimate goal is to end the abuse.)

    Abuse sometimes starts during pregnancy, but that’s not the typical scenario.

  93. 93
    👽 Martin says:

    @TooManyJens:

    FWIW, most of the causation on this goes the other way.

    Ah, good to know. Thanks.

  94. 94
    Ruckus says:

    This is a very interesting discussion with 2 sides both trying to get women better access to medication they want and many times need.
    I get Martin’s more access is better but this is a problem that is being solved. Not rapidly enough of course but ACA does have a pretty good chance of resolving a lot of it.
    On the other hand, I hear many good arguments about Dr. access, which financially ACA answers. Probably not perfectly of course but that still leaves actual access, finding a Dr., being willing to go to the Dr.(teenagers?), all the hoops that Dr. put women through which for many sounds like padding the bill. And Dr saying that most women don’t need that level of support for BC.
    Does anyone have a better answer than OTC as problem ridden as that may be?

  95. 95
    jenn says:

    @NotMax: Really?! Pseudoephedrine’s a precursor to meth?! Who knew?! In all seriousness, however, I’m saying that if one is looking for a hybrid of over the counter access but with some control over ensuring a baseline level of knowledge of potential side effects, there is a model in place. As someone who has 2 friends who have developed life-threatening blood clots as a complication of birth control pills (both of whom are fine now), that extra hoop could be worthwhile.

  96. 96
    Seanly says:

    You can get reimbursed by FSA (and I assume HSA?) for most OTC medications. While that wouldn’t alleviate all the concern for low cost BC, it would help. In addition, if the price drops & no prescription would be required, Planned Parenthood & other groups may be able to dispense more.

  97. 97
    👽 Martin says:

    @Ruckus:

    I get Martin’s more access is better but this is a problem that is being solved.

    It is, but is it entirely?

    PPACA does get health coverage for everyone and does get OC covered as preventative, but it leaves a lot of access gaps. It doesn’t guarantee that women can get time to go to that appointment. It leaves the problem of expiring prescriptions – those appointments need to be regular and well-timed. It leaves the problem of teens who will need to go through their parent to fill that prescription. It leaves the problem of limiting the number of retail locations to those that can fill prescriptions – some of whom will refuse to fill the prescription – located in the same areas where there is a shortage of pharmacies and a shortage of women’s health clinics.

    OTC solves all of these problems. It also solves some logistical issues – like when you forget to bring your prescription on a trip, or your medication is lost or destroyed and you need to replace it. Prescriptions aren’t arbitrarily refillable.

    Medical decisions like these are statistical decisions. If statistically you get better outcomes overall by doing this, even if you’re going to trade one risk group out for another risk group, then you do it. Period, and you shift your focus toward the new, smaller, or less severe risk group. Seriously, even if we’re just trading out the 10 complications for the potential of 40 unintended births – with all of the costs that come with having a child that you may not be economically prepared for, that alone is no small thing.

    And I didn’t even address the cost of that 500 unintended pregnancies turning into only 200 unintended births. That’s 300 miscarriages and abortions against those 10 complications. That’s a huge number. PPACA will do a hell of a lot of good here, but it doesn’t fix everything.

  98. 98
    👽 Martin says:

    @jenn:

    As someone who has 2 friends who have developed life-threatening blood clots as a complication of birth control pills (both of whom are fine now), that extra hoop could be worthwhile.

    The statistics say that blood clots only occur attributable to hormonal birth control at a rate of less than 5/10,000. Either you have a LOT of friends, or your friends just drew from the poor end of the statistical deck. It’s a much more rare thing to develop than you’ve witnessed. Further it appears to be more common with embedded or shots over OC, and those would require a doctor still, of course.

  99. 99
    YellowJournalism says:

    @Mnemosyne: That risk of blood clots is one of two reasons I stopped taking BC pills. The other was the hideous mood swings I had with three different types I tried. The one that worked for me was taken off the market because of the higher risk of blod clots. I really don’t understand this recommendation being a long-term benefit to promoting women’s health, as great as it may be in helping to prevent unwanted pregnancies. I already know so many women who do not get yearly checks with a general practitioner or gyno and numerous more who only go to get the pill. If they could go get something OTC, then there goes the dr visit that ends up being necessary for their overall reproductive health. In other countries, this may not be much of an issue because visits to the dr for gyno check-ups are covered under universal care.

  100. 100
    Jay in Oregon says:

    @ploeg:
    There was a Planet Money episode where they went to Porcupine Freedom Festival, some kind of libertarian gathering, where no one uses “fiat money”; it’s all barter or small quantities of silver, etc. (one guy was trying to tout copper as the next big thing).

    My favorite part was how one guy sells silver “currency” (thin strips of silver laminated to cardboard) at the beginning of the festival, but not everyone accepted it; finally one guy was willing to buy it back at 80 cents per strip less than the reporter bought them for.

    http://www.npr.org/blogs/money.....ummer-camp

  101. 101
    YellowJournalism says:

    @👽 Martin: First, can I say how nice it is to be reading a conversation of opposing or slightly dissimilar views rather than a flame war?

    It leaves the problem of teens who will need to go through their parent to fill that prescription.

    I have to say I would be very surprised that even with OTC pills there isn’t some barrier to teens having access without parent permission. If this recommendation becomes more than just a recommendation, then we are going to see OTC pills requiring signatures and a few more hoops to jump through, including age restrictions. In fact, I would expect something like a prescription being necessary for teens to purchase.

    Okay, I just got an image of the minor beer-buying scene from Dazed and Confused happening in a pharmacy in preset day with a young girl. Same old guy behind the counter, though.

  102. 102
    NotMax says:

    @jenn

    that extra hoop could be worthwhile.

    Does not compute. When I purchase pseudoephedrine products, the clerk provides no pharmaceutical information. Zero. Zip. Nada. Signing your name and having your info entered into a database is not a medical prevention measure.

    As for a baseline knowledge of possible effects, the box and/or pamphlet included with it provide that. As does most any competent, professional pharmacist, who answers such questions for free and can be readily consulted prior to purchase.

    Perhaps not what you intended, but sounds like just adding another layer of inconvenience, intrusion and Big Brotherism.

  103. 103
    Mnemosyne says:

    @YellowJournalism:

    In other countries, this may not be much of an issue because visits to the dr for gyno check-ups are covered under universal care.

    Given that all of the countries that have been cited here as having OTC birth control also have universal healthcare systems, I think you’re probably right.

    I could see that at some point it might make sense to have birth control be OTC once people have the ability to get regular check-ups and have the ensuing potential health problems caught early, but right now this seems like a solution that would cause more problems than it’s currently worth.

    @👽 Martin:

    I’m pretty sure that my complication, a major depression, is not included in those statistics, because it wouldn’t be considered “serious” (ie I didn’t end up in a mental hospital or in a psychiatric emergency room). Still, it was pretty debilitating and I ended up losing a temp job over my “non-serious” reaction to the triphasic version of the pill.

  104. 104
    Ruckus says:

    @👽 Martin:
    I think your heart and head is in the right place here but look at the people posting here. A number of them are users of BCP and some think this is a bad idea and with good reasons. Maybe the Dr and drug cos have underestimated/under reported the effects. Maybe women are willing to risk or even live with some of the side effects not to be pregnant. Shouldn’t they have the best info possible for that risk? With ACA will OTC be less expensive? If 60% of the women who don’t currently use BCP were willing to take them how would that change the stats? Would it be easier for winger drugstores to just not carry an OTC item than to have their pharmacy not fill a prescription?

  105. 105
    kc says:

    If it’s OK with the ob-gyns, it’s OK with me.

  106. 106
    dr. luba says:

    @Mnemosyne:

    So my friend’s non-smoking sister who had a stroke at 28 from taking birth control is such a freak of nature that we can’t even take her into consideration when it comes to putting birth control pills over the counter?

    I am assuming your friend’s sister got a prescription for the BCPs, and then stroked. How did having them as a prescription item prevent her stroke? How would having them OTC have changed her outcome?

    I am not advocating for less care. I am a supporter of single payer and have worked to elect politicians who advocate for it. But in today’s world, this is not an unreasonable approach.

  107. 107
    Ella in New Mexico says:

    @dr. luba:

    I understand your feeling regarding this particular situation, (although I still think it’s dangerous and a slippery slope towards insurance companies not paying for BC pills since they are available off the shelf).

    But–your argument should logically mean that we go ahead and pretty much make most currently presciption-only medications available OTC–if you can’t go to a doctor and get a scrip, or don’t have insurance coverage for them, diagnose and treat yourself. Why have any physician control over drugs in the first place?

    Fifty miles south of my community, Mexico sells pretty much all drugs OTC in pharmacies. I see the results of this fairly frequently in patient’s who attempted to treat themselves-they take them improperly, or take the wrong or worse yet, dangerous medications. Another group of patient’s I see are Type I diabetics who have no insurance and attempt to self treat with OTC insulin. They end up in the hospital where I work, sick as shit.

    Sorry, I still think this is a short-sighted solution with major slippery-slope implications to harm good health care in the future.

  108. 108
    Mayken says:

    @waratah: Yeah, while I applaud it not having to be a prescription (boy am I sick of the yearly Dr. shuffle just to get BC pills!) but it doesn’t resolve the some-women-cannot-afford-BC issue.

  109. 109
    Mayken says:

    @bemused: Oh, don’t worry, they’ll just pass more conscience clause type laws. Pharmacists and pharmacies already refuse to dispense whatever it is Plan B is going by now…

  110. 110
    Mnemosyne says:

    @dr. luba:

    I am assuming your friend’s sister got a prescription for the BCPs, and then stroked. How did having them as a prescription item prevent her stroke? How would having them OTC have changed her outcome?

    The fact that she had a doctor who was able to get her admitted to the hospital after her stroke made a huge difference, as opposed to someone taking the drug OTC who would go to the emergency room and not have a medical and prescription history that could be referred to. Having the drug be prescription didn’t prevent the stroke, but it absolutely affected the care she got after the stroke, because she had an existing medical history that could be looked at.

    I am not advocating for less care. I am a supporter of single payer and have worked to elect politicians who advocate for it. But in today’s world, this is not an unreasonable approach.

    Simply as a layperson, it seems to be a very short-sighted approach to remove BCP from being automatically covered by PPACA and make it an over-the-counter consumer product rather than making it part of an overall preventative care plan.

    As Ella in New Mexico said above, how do you justify having anything be prescription-only if there’s no problem making BCP over the counter because consumers will be able to navigate everything by themselves with a little guidance from the pharmacist on duty?

  111. 111
    Ruckus says:

    Another point I wanted to make @Ella in New Mexico: and @Mnemosyne: made for me. Some well know that a lot of drugs that are now OTC once were prescription. They have a long history and relatively well known side effects. Benadryl for example. It is a product that one can try and it works or not. BCP is a changing product of which there are many versions. How does a layperson decide? The cheapest or the most expensive? Something from the middle? The one with the best commercials? How about the one their friend takes.
    I could see OTC if there was one effective and safe product for everyone. It is obvious that that is not the case. I see this as one more band aid on our crappy healthcare system, one that has more possible bad outcomes than the crappy status is now. Better to think about this long term and fix that(which we can actually do now with ACA) than apply one more band aid to a broken arm.

  112. 112
    👽 Martin says:

    @YellowJournalism:

    First, can I say how nice it is to be reading a conversation of opposing or slightly dissimilar views rather than a flame war?

    Well, being of the penîs persuasion, I know I must tread lightly here (as Ruckus rightfully notes). My only direct experience with OC is via Ms Martin who suffered from the same kinds of mood swings as others here. Nothing debilitating, but not pleasant either. She tried various brands – none were particularly better. After #2 was born she said I could go get snipped or she’d do it in my sleep, because she’d dutifully done her part. On that I agreed wholeheartedly.

    I have to say I would be very surprised that even with OTC pills there isn’t some barrier to teens having access without parent permission.

    I’m sure there will be some. But those are easily bypassed – most notably by the OB. Once you’re 14, you can tell mom and dad to shove it. Just as the doctor can prescribe now, he can in the future. The problem now is that either the teen needs to pay the quite high out-of-pocket price or go through the insurance, which is where mom and dad will bust them. In an OTC future, they can just pay out of pocket at the lower rate. It’s not significantly different than now except that there should be considerably more outlets to buy. No big deal in a city, but out in the weeds it can be a really big deal.

    Remember, we still have our abstinence-only battles to fight, and restricting access is part of how the right fights that battle.

    @Ruckus: As Dr Luba notes, the presence of prescriptions didn’t prevent any of the outcomes that everyone here has reported. In spite of my wifes mild adverse reaction, the doctor never suggested she not take them – only offered up alternatives, and kept all forms on the table. That seems to be true for everyone else commenting here. If there is some pre-existing condition that the doctor is looking for that would prevent the prescription, that’s an argument against going OTC. Nobody has raised that, though – even anecdotally.

    Again, one of the better advances in medicine was the shift away from anecdotal decision making and toward trials and statistical analysis. Statistically, if the outcomes are better by changing, you change, and you put the costs of that change out for everyone to see and deal with them straight up. There’s a growing number of women now getting their OC from Mexico, without prescription. Morning-after medication is also available OTC which carries similar risks. Sometimes there’s no landmark moment when something magically becomes safer. Often times it happens because you lose control of some part of the situation, and you realize what’s left being controlled is making things worse rather than better. We might be quietly slipping over that line here.

  113. 113
    👽 Martin says:

    @Ella in New Mexico:

    But—your argument should logically mean that we go ahead and pretty much make most currently presciption-only medications available OTC—if you can’t go to a doctor and get a scrip, or don’t have insurance coverage for them, diagnose and treat yourself. Why have any physician control over drugs in the first place?

    Because there’s no diagnosis for OC. It’s not like they’re breaking the news to you that you’re a female of child bearing age. That’s the only condition OC is treating for most people (yes, range of other conditions that hormonal contraceptives treat, doctors will still be able to prescribe for…)

    And that’s the difference between OC and just about every other medication – we don’t want people to self-diagnose except for quite minor things that have minimal likelihood of complications. And the reason is that we generally suck at self diagnosing – most people don’t even understand the difference between viruses and bacteria. But even I’m smart enough to pick out with pretty good accuracy who would benefit from birth control and who wouldn’t.

    I’m at a bit of a loss to think of any other prescription that fits this definition. Even ED often is the result of some pre-existing condition requiring treatment.

  114. 114
    👽 Martin says:

    @Ruckus:

    How does a layperson decide? The cheapest or the most expensive? Something from the middle? The one with the best commercials? How about the one their friend takes.

    The counter-question is “How does a physician decide?” I think best case, they know which ‘families’ these hormonal contraceptives fall in and recommend leaving one family and trying another. But I’m pretty sure outside of that, the physician is tossing darts along with the rest of us.

    My GP once was recommending one of an array of treatments for something – I forget what – might have been some kind of injury. He pointed out that there’s a dozen or so different products to choose from that are all a bit different. He also said that when you see that, it means none of them work particularly well for everyone, but none are particularly harmful either, you just have to try them and see what works for you. If they figure out one true cure, there will be only one product left.

    I think birth control is likely the same way. You just have to try them out. That certainly was true for my wife. She went through almost a dozen different kinds. In fact, what worked for her when she was younger didn’t work so well as she got older and she changed. Her OB certainly shaped her decision making, but I don’t think he was able to give any definitive recommendation. I don’t think any form ever got decisively ruled out by the doctor, either.

  115. 115
    kabiddle says:

    Hey hey hey. Birth control contraception strong enough to be used for that purpose on a daily basis is pretty heavy medicine. It’s not to be handed out without some kind of supervision of medical consequences. And it should NEVER be considered OTC. That is insane. You are throwing out the baby with the bathwater when you go all uninformed about it. Step back. Look at Yaz and its ilk. Please.

  116. 116
    Ruckus says:

    @👽 Martin:
    I’ve had the same experience with Dr and drugs. Here are some samples, try each one for 2 weeks with a week off between products. The trick was that I had someone to give results to about which ones worked best and could be prescribed. (One didn’t work as intended but I did get high off it. Dr calmly asked how many I wanted. I liked that guy)
    I’m not saying you are wrong but lets say that tomorrow the evil government decided to make them OTC. How long would it take to open the pipeline and get this into consumer hands? Would ACA have taken a huge step towards solving the problem with better access before that happened? Or would we see the same thing as allergy meds? Once many became OTC the prices didn’t fall much except for generic, which means many of the most effective are still(last I checked) relatively expensive. And the newest stuff is still prescription only till a large enough sampling done with at least a little control.
    You pointed out that a Dr was probably still having to chose between competing meds. But Dr have to study and keep up with this stuff to a much better degree than us. I have several years of college chemistry, statistics, life sciences and I still have to trust someone who is closer to the info than me. Unless I’m studying the info in depth, it just isn’t that easy to make anything other than an semi-educated guess.
    BTW I think making all forms of contraceptives widely and cheaply available to both men and women is of paramount importance. If one is old enough to need/want them(and I don’t mean religiously, morally or any other type of restriction other than health, physical or mental of the individual) they must be available. You have made the point a few times that the issues with BCP are still less overall than an unwanted pregnancy and that may be, and I think it is true, I’m just asking are we fixing a problem or trading it for another that is potentially as big?

  117. 117
    jon says:

    Those who mentioned complications: that happens,. And the doctors who wrote the scripts got it wrong and changed it and eventually got it right. Having to not have to go to the doctor would make this less complicated in what way, exactly?

    If they were emergencies, other doctors handled that.

    I’m really not following the need to go back if the doctor gets things wrong. Sounds like more opportunities for CYA than opportunities to change medication come up under the current doctor-visit-needed system.

    Am I missing something very important or am I just being obtuse?

  118. 118
    jon says:

    @Dork: Sure, the medications can be strained out, but are they? I would like to think so, but I’m not sure.

  119. 119
    dr. luba says:

    @Ruckus:

    Or would we see the same thing as allergy meds? Once many became OTC the prices didn’t fall much except for generic, which means many of the most effective are still(last I checked) relatively expensive.

    I’m not getting your point. Generic drugs are generally just as good as the brand name drugs, if they are chemically the same drug. There are generic forms of claritin, zyrtec, and now even allegra IIRC. I would never waste my money buying brand name antihistamines. I can spend 20 bucks for a year’s supply of the generic, or for a month’s supply (if I’m lucky) of the brand name.

    Brand name drugs are NOT more effective, despite anything the drug companies would want you to believe.

  120. 120
    👽 Martin says:

    One last point. The drug companies aren’t stupid. They love having insurers between them and the physician – it’s where most of their profits comes from. They’re going to find a mechanism to keep some OC on prescription, and doctors with patients that can’t afford the copay will be prescribed this stuff. It’s always worked this way, and it will continue to. Somewhat unfortunately because this is where a lot of our overpayment for healthcare comes from – by gaming the system in well meaning ways.

    So I really don’t expect the cost issue to really manifest itself in a negative way.

  121. 121
    Ruckus says:

    @dr. luba:
    Wasn’t knocking generic, that’s all I get at the VA or when I had insurance and purchased. My point was not well made that drugs stay on patent for quite a while and so if they become OTC the latest and possibly better drugs will be more expensive. I have in the past been on allergy meds and the older off patent drugs did not work as well as the newer on patent ones. I had to resort to buying from Canada, you know the inferior drugs made in the same factory by the same people with the same ingredients but costing less.
    I think a good part of the resistance is where do we draw the line on drugs needing prescription or not. Mexico seems to have no line, we seem to error on the side of too broad a line. How is an non trained person supposed to make that call? I don’t have any answers so I suppose that is why I’m being cautious. Show me I’m wrong with some evidence. I don’t think you have any but that may be because we make that line so broad. As some have pointed out in other countries BCP is sold OTC but they have ready access to health care including preventive care. We don’t have that here and that is one more reason I am cautious.

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