Wednesday, March 21, 2012

Drop Paternalism, Sell The Pill Over-the-Counter

Canadian columnist Margaret Wente writes:

"Virginia Postrel, the American political and cultural writer, has an idea for de-escalating the birth-control controversy that’s sweeping the United States: Sell the Pill over the counter.

After all, that’s the way it works with condoms. Anyone can walk into a drugstore and buy a three-month supply of Trojans for under $30, no questions asked. Nobody argues about who should pay, who’s morally entitled to them or whether they should be covered by health insurance or the government. Make the Pill as convenient and cheap as condoms and the fight would be over. Besides, the Pill is far more effective."

From Virginia Postrel's original Bloomberg column:

"Anyone -- a local teenager, a traveling businessman, a married mother of four, an illegal immigrant, even a student at a Jesuit university -- can walk into my neighborhood CVS any time, day or night, and, for less than $30, buy a 36-count “value pack” of Trojan condoms.

That’s enough to last most Americans at least three months, according to Kinsey Institute surveys. If you want more, you can buy out the store’s entire stock. There’s no limit, and you don’t need to see a doctor for permission and a prescription.

Contrary to widespread belief, there’s no good reason that oral contraceptives -- a far more effective form of birth control -- can’t be equally convenient."

31 Comments:

At 3/21/2012 12:29 PM, Blogger Benjamin said...

But Rick Santorum says contraceptives encourage immoral behavior.

Santorum has not preached that usury is evil or that rich people have as much chance of getting into heaven as a camel has getting through the eye of the needle--but give him time.

Why did Jesus Christ give such low posthumous odds to eternal nirvana on rich people?

 
At 3/21/2012 12:45 PM, Blogger juandos said...

I say pseudo benny and all his fellow liberals should be free to consume birth control pills by the bushel load and for free too!!

 
At 3/21/2012 12:55 PM, Blogger morganovich said...

well, the one issue with a BCP is that it changes your hormonal balance (by design).

i had a girlfriend have a seriously bad reaction to one. if you think a pregnant woman can get a little whimsical in the brain pan, you should see one on the wrong kind of BCP. (we then found one that worked)


they are really not the same as a condom for that reason. i think it's a bad parallel to draw.

personally, i still think that they ought to be OTC, but that is why they won't be.

 
At 3/21/2012 1:07 PM, Blogger Che is dead said...

For leftists like "Benji", a "right" isn't fully realized until someone else is paying for your exercise of it.

I'll tell you what, I'll pay for your birth control when you pay for my ammunition.

 
At 3/21/2012 1:13 PM, Blogger Jon Murphy said...

personally, i still think that they ought to be OTC, but that is why they won't be.

I agree with you, Morganovich. Right conclusion, wrong reason.

 
At 3/21/2012 1:25 PM, Blogger morganovich said...

jon-

yeah. i actually dislike arguments like that because, by making a flawed comparison to condoms, it's shifts the debate to a loser of an issue as opposed to a winner.

you wind up arguing about why BCP's and condoms are not analogs as opposed to the real issue of whether you should need a doctor's permission to use them.

 
At 3/21/2012 1:45 PM, Blogger Benjamin said...

Che is Dead-

Actually, my impulses are libertarian. Please let's both buy our own birth control and ammo.

Practice carefully--you would't want a stray shot to perform a casual vasectomy!

 
At 3/21/2012 1:47 PM, Blogger K Parsons said...

There is that whole real, increased risk of stroke, blood clots, cancer, hormone imbalance, hypertension thing but hey, whatever.

No thanks. My thing is (and yes, I'm a woman) My body, my choice, my responsibility, my bill.

 
At 3/21/2012 2:08 PM, Blogger Ed R said...

One can buy (very effective) knockoffs of Viagra, Cialis, etc made in India on dozens of internet sites. Obviously no prescriptions are required.

Why doesn't Cipla, Ranbaxy etc. make a generic Pill and let female-oriented web sites advertise & sell them?

 
At 3/21/2012 2:24 PM, Blogger morganovich said...

"Why doesn't Cipla, Ranbaxy etc. make a generic Pill and let female-oriented web sites advertise & sell them?"

i'm guessing, but probably because there is little demand.

BCP's are a major change in hormonal balance all the time. you want a doctor for that and guaranteed quality. a lot of the foreign boner pills are very low quality. it's also an embarrassment issue for men. they buy online because they don;t want to tell a doc that my happy can;t stand up straight anymore, whereas asking for BCP's from a doctor does not have the same shame factor attached.

 
At 3/21/2012 2:31 PM, Blogger Mike said...

"well, the one issue with a BCP is that it changes your hormonal balance (by design)."

Totally true.
My wife had a serious case of "the crazies" (seriously, it wasn't my fault) brought on by a slightly different dosage than what she ended up using. This would never work as traditional OTC.

What irritates me is the black and white handling of meds. In the age of computers, a patient should be able to get a single prescription and have that managed by the pharmacy as a "permission-granted-otc"....so, if you aren't filling for the first time, pharmacy info must be given to keep track. I have to go through my doctor to get allergy meds, antibiotics, etc...serious waste of time/money.

 
At 3/21/2012 2:39 PM, Blogger morganovich said...

mike-

antibiotics pose some challenging issues.

in places like mexico, they are readily available OTC.

people massively over and mis use them. they try to cure the flu with them. they take 5 days of a 10 day run, feel better, and stop taking them because their stomach is upset.

while i don't care at all so long as it only effects them, it doesn't.

taking a half a run breeds superbugs. it's a huge kick in the but for antibiotic resistance. then, you get MRSA etc and it spreads all over the world. the % of non treatable ghonnorea has gone up by an order of magnitude to maybe 3% over the last 5-10 years. if we get another such jump in the next 5, we have a VERY serious health issue.

this same dilemma existed around AIDS meds, especially in africa. a protease inhibitor needs to be taken EXACTLY correctly. 2-3 times a day, every day, NEVER miss a dose. if you think a patient cannot comply with that, then not only will the drug work poorly (if at all) but they are breeding resistant strains that may propagate making the drug less useful for everyone else.

it's a really tricky issue.

allergy meds seem fine, as that just affects you and if you use them poorly, it's only your lumps, but not every drug category works that way.

 
At 3/21/2012 2:52 PM, Blogger Walt G. said...

Flawed argument here. They currently sell female condoms OTC, and I am not aware of male oral birth control pills.

 
At 3/21/2012 3:09 PM, Blogger Mike said...

Morg,

"antibiotics pose some challenging issues."

I understand that and you're right. I feel a one-time prescription (or maybe every 5 years?) and monitoring from the pharmacy (consultation, like any prescription) wouldn't make the problem any bigger than it is now....it may make it better. Every pharmacist I've spoken with is far better at giving you drug info than the actual doctor (but maybe that's just my experience). For example, you walk in with the flu and want Z Pak, the pharmacist accurately tells you that's not the right drug, go to the doctor... marks you file and/or freezes your accessibility. They may lie the next time but that behavior wouldn't be any different in a doctor's office.

Part of the reason we go to Puerto Vallarta every year is to stock up...I'm not saying it should be that free, but non-narcotics (and other, less serious drugs like birth control) could surely be handled in a more efficient way.

 
At 3/21/2012 3:30 PM, Blogger Benjamin said...

True, some BCPs might make women act crazy. So will alcohol. So will being deprived of coffee (in my case). So might pot, or being cut off from nicotine.

Should not adults be responsible enough to know they are suffering from the effects of alcohol, cigarettes, caffeine etc without a mommy state deciding for us?

Really, if you let the state decide for you the drugs you can take, where does that stop?

 
At 3/21/2012 3:40 PM, Blogger Jon Murphy said...

While I agree with you Benjamin, I think the discussion going on here is whether or not birth control pills are analogous to condoms.

 
At 3/21/2012 3:57 PM, Blogger Mike said...

I wouldn't agree with that, Benjamin. Believe it or not, these hormonal imbalances are like a mental illness, in the sense that the person suffering doesn't really understand that there's something wrong. With the constant flow of meds, it's nothing like a 'tequila crazy'. If you ever witnessed it, you'd know what I am talking about....it's the kind of thing that could cause suicides in normal people.

 
At 3/21/2012 4:00 PM, Blogger morganovich said...

mike-

but what about all the incorrect usage? working antibiotics are somehting of a common good. if a given system allows people to destroy that, it's a tragedy of the commons.

i have no issue with allergy pills, bc pills, or any manner of other drug that just effects you. but things like antibiotics and anti virals are different.

your (hypothetical) misuse harms me.

how do you handle the externality? there is no coasian solution nor any provable culpability/causality to any individual.

there is no obvious way to protect the common good or make restitution other than control of the drugs.

i oppose governmental control of pretty much everyhting, but antibiotics/virals may be one of the very few cases where there really is no better alternative.

 
At 3/21/2012 4:08 PM, Blogger Mike said...

Morg,

I totally understand your point, I included them in my list because I understand the potential harm, but it's true that many don't....and they went to a doctor. Maybe they don't make the final list, but going to the doctor hasn't stopped antibiotic abuse. Maybe I'm wrong, but it seems that doctors who stand to gain a hundred-plus-dollar, easy office visit give out more unnecessary drugs than the guy who isn't making anything but a paycheck and stands to lose that. I think there's a chance that this could be one of those counterintuitive (partial) solutions to antibiotic abuse.

 
At 3/21/2012 4:28 PM, Blogger morganovich said...

mike-

docs in the US are not paid to prescribe drugs. in fact, that is illegal here (unlike japan where they get paid per script which, unsurprisingly, makes them the highest per capita consumers of drugs anywhere)

i think there was a period when antibiotics were over prescribed, but i also think it has ended as doctors caught up with the issue.

having them as gatekeepers is a definite help on not having over and mis use. there are a hundred antibiotics, many useful for different things and in different cases with differing counter indications and reactions etc.

antibiotic allergies and rare but severe side effects (i had a friend literally have half his skin fall off from one in a VERY rare reaction) are also a big deal.

staying on them for long periods can also have severe health effects.

personally, i'd rather deal with the hassle of seeing a doc to get them than the risk of having them not work when i needed them.

 
At 3/21/2012 4:35 PM, Blogger Mike said...

I don't disagree with you...except that docs don't get paid to prescribe things. If they didn't, mine wouldn't make me come in and pay them, only to see me long enough to hand me the prescription (no exaggeration).

As I said earlier, I don't think the prescription goes away, I just think they should be closer to regulated otc AFTER the script has been given by a doctor...maybe for a limited time, but better than a refill. I could cut 2 or 3 unnecessary visits out every year that way.

 
At 3/21/2012 5:20 PM, Blogger Benjamin said...

Mike-

Okay, people might hurt themselves or others with drugs.

People might hurt themselves or others with guns.

Do we draw the line somewhere, and on what principle.

 
At 3/21/2012 7:40 PM, Blogger jorod said...

This isn't about contraception. The government would just make drug stores give them away. This is a war on religion. And war by the left wing feminists who regard morality as male domination over females.

 
At 3/21/2012 8:47 PM, Blogger T J Sawyer said...

I believe that the increased risk of breast cancer associated with oral contraceptives would make it illegal to be sold OTC.

Presumably, the doctor is involved to warn the prospective of the cancer risk and stroke/heart disease risks.

After that discussion, the patient then weighs the risk versus benefits and plays the odds.

 
At 3/21/2012 10:23 PM, Blogger Benjamin said...

TJ Sawyer:

And there is no risk associated with cigarettes?

Come on, if we "allow" (I hate that word, as it is a right) people to smoke cigarettes, what is the point of state mommyism on nearly any other kind of drug?

BCP should have labels and warnings, written in plain English (Spanish) that they may have side-effects, and list the common ones. Let adults decide what they want to buy.

 
At 3/21/2012 10:30 PM, Blogger Rand said...

The reason oral contraceptives - other than the word NO - require a prescription is that they interfere with the normal hormonal events which a woman has. These need to be medically monitored.

 
At 3/21/2012 11:26 PM, Blogger T J Sawyer said...

Benjamin.

Cigarettes are not covered by the FDA. (Also Tobacco still gets federal subsidies - must be good stuff!)

Besides, the carcinogens in Tobacco are "natural" so could be allowed just like Alflatoxin is in various foods.

I'll admit that Oral Contraceptives might be able to slip through as GRAS (Generally recognized as safe)

In other words, some carcinogens are OK, some are not. Consult your local lobbyist for best results.

 
At 3/22/2012 10:49 AM, Blogger NormanB said...

I remember when you could only get reading glasses with a prescription. Our fears on these issues, like Ibuprophen, are always exaggerated.

 
At 3/22/2012 2:58 PM, Blogger Ron H. said...

"Okay, people might hurt themselves or others with drugs.

People might hurt themselves or others with guns.

Do we draw the line somewhere, and on what principle
"

If people hurt others with drugs, guns, or anything else, they can be prosecuted for that harm.

If they harm themselves, why are "we" involved?

Please don't use the "we pay for their medical treatment" response. Think of an actual reason, if you can find one.

It's fine to express your concern, and try to influence people you know and care about, but please don't ask for restrictions on people you don't even know.

 
At 3/22/2012 5:00 PM, Blogger c5c5 said...

TJ Sawyer,

If I increase my intake of high fat foods my risk for breast cancer goes up.

If I increase my sugar intake my risk for diabetes goes up.

So if we can regulate via prescription bc pills because they MAY cause an increased risk for breast cancer, why not regulate food and sugar?

Where does regulation end and responsibility begin? Apparently we are all children to the elites and statists of this country.

 
At 3/22/2012 9:58 PM, Blogger Methinks said...

c5c5,

The reason your GYN will haul you in for an pap smear annually before renewing your BCP prescription is not because of the tiny increase in the risk of breast cancer (which disappears the moment you stop ingesting it) but because of the much more significant risk of cervical cancer. No GYN will force you to have a mammogram before renewing your prescription.

Taking the pill is not as simple as popping an aspirin. Like Mike's wife, I suddenly found myself 20 pounds heavier and suicidal because of the new pill I was prescribed. It's not as simple as just trying them all. They all screw with your hormones slightly (and not so slightly) differently. So, the doctor bases her next prescription on your current symptoms and her clinical evaluation.

This is not a hard prescription to get and the cost is minimal. Hell, planned parenthood gives the suckers away as well as providing the annuals on a sliding scale. At least they did when I was young and poor - and there were only about 2 different ones available.

I have no idea whether the pill should be sold over the counter or not. I don't know where that bright line between what should remain prescribed and what should be made widely available is. I suspect a complicating factor is possible lawsuits by morons who don't take the time to learn anything about them, have a bad experience with one and then sue the pharmaceutical company. A lot of medicine is ass covering.

Although I don't know where the bright line is, I would never take a new pill without discussing it with my doctor because I know it's a rather more complicated process than just buying a rubber. The pill has many side effects for many women and you'll want a doctor to deal with all that when you first start on a new prescription.

I'd be delighted if I could just buy Claritin D without the fuss. You know acetaminophen kills 460 people every year in the United States. Maybe Tylenol should be prescription only. I guess it's not because you can't make fun stuff like meth out of acetaminophen. I've never tried drugs, but I hear they're fun (coming out sedation after a procedure I thought I got a glimpse of why people like them). So, I guess where the FDA draws the line is fun. If you can kill yourself with fun stuff like meth, then it must be regulated. If you can kill yourself by destroying your liver in a very un-fun way, then have at it. So, I conclude the FDA is really just against fun.

Sex is fun. The pill facilitates this fun activity, so the FDA must regulate it. Makes government sense.

 

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