Gonna preface this post by saying I got all fired up after listening to the Science Friday broadcast, got more fired up when I looked into this Dr. Hager guy, felt strongly enough about the subject to start a post about it, then felt silly about actually posting it because I know I'm well behind the bandwagon at this point. So yeah, here's what I had to say, even though it's more of an irrelevant rant at this point than actual news:
On last week's Talk of the Nation, Science Friday, the evening's topic was the FDA's move to indefinitely stall a decision on whether Plan B - the morning-after pill - should be sold over-the-counter. (You can listen to the broadcast here. Also, if you haven't heard much about this issue, here's a pretty good background article.) Anyway, Ira Flatow had 3 guests on, one of whom was Dr. David Hager (warning: long article from this past spring, but worth reading if you haven't already). In late 2002, Dr. Hager was appointed by the Bush Administration to the Advisory Committee for Reproductive Health Drugs in the FDA. He's a medical doctor - a gynecologist, of all things - who "has established himself as a leading conservative Christian voice on women's health and sexuality." And it would be all well and good to have a voice of opposition on a committee to decide if Plan B should be available OTC, except that the whole situation has turned into a quagmire of political horseshit in which the democratic process is ignored and the minority opinion is the one being followed.
Let me back up a minute. For the record, Plan B (or other emergency contraceptives like it) is already available over the counter in 41 countries and 7 states within the US. There is no question that the drug is safe to sell OTC; the FDA's advisory committee (Hager included) voted unanimously that this is the case. The question has remained whether or not it should be sold without a prescription. The most common arguments against OTC availability are 1) that it's already available via prescription, so there's no need; 2) that young girls will be able to get it more easily, thus encouraging them to engage in risky behavior without fear of the consequences; and 3) that if women don't have to see their doctor to get a prescription for it, they will quit going in for pap smears. There is also the question of whether or not it technically causes an abortion, which as we all know is a touchy subject in this country.
Okay. Let's review what this drug is. It is an emergency contraceptive. It is a high dose of the hormone progesterone that, if taken within 72 hours of unprotected intercourse, will prevent ovulation from occurring or, if ovulation has already occurred, will prevent implantation of a fertilized egg into the uterine wall. It should not be confused with RU-486; if a fertilized egg has already implanted, Plan B will not cause an abortion. It is no more an abortifacient than your typical birth control pill. It's just that the dose of progesterone is higher, so it doesn't take a week to get into your system and take effect. Sure, if you believe that life begins when sperm and egg join, and that preventing a fertilized egg from implanting is equivalent to ejecting one that's already latched on and ready to grow, fine, but the purpose of this drug is primarily to prevent ovulation (and thus fertilization) from occurring in the first place. It is only if the patient is prevented from taking the drug in a timely manner that you start wandering into "is it abortion or not?" territory.
Timing is absolutely critical. Emergency contraceptive. That's like emergency snake bite repair kit or emergency evacuation route. Only used in an emergency, when time is of the essence. Condom breaks, woman gets raped, something like that - precisely the instance in which a woman should be able to go to the drugstore on the weekend and buy what she needs, instead of having to wait for a doctor's appointment, doctor's approval, pharmacist's approval, etc. The more hoops a person has to jump through to get this product, the worse its chances of effectiveness are, so no, I don't think that just because it's available via prescription (provided your doctor will even prescribe it...Dr. Hager won't, and he's the one advancing the argument that women can get it from their doctors!), there isn't a need for it to be available over-the-counter.
As for whether its availability will encourage risky behavior among teens, I've got news for you (Dr. Hager): teenagers need no encouragement to engage in risky behavior. They are going to behave however they're going to behave. The same argument is made about the availability of condoms when, statistically, teens are no more likely to have sex if supplied with condoms and told how to use them than they are if just provided with abstinence-only education. Except the abstinence-only kids will have unsafe sex and end up diseased or pregnant or at the abortion clinic. So weighing the options, I think we're much better off with a combination of education and availability of contraceptives than just trying to tell kids no.
For the final argument - women will quit getting pap smears if they can just buy Plan B without a prescription - all I've got to say is that if a woman is actually dumb enough to ignore the need for regular cervical cancer screenings, maybe it's a good thing she has access to emergency contraceptives so she doesn't bring any more children into the world, much less unwanted ones! Any reasonable woman is going to give a damn about her health, and OTC availability of Plan B won't stop her from getting checked up when she should.
So ultimately, the reason I'm so incensed about this whole situation is that, despite the fact that scientists and doctors have come to the logical conclusion that selling Plan B over the counter would be a good idea, one fanatic and a few of his cronies have enough political clout to trump science and logic. Hager stated at one point in the SF broadcast that he "was asked" to write a minority opinion paper, as a civilian, encouraging the FDA to keep Plan B as a prescription-only drug. The FDA's decision to ignore the recommendation of its committee is based in no small part on this paper. Ira Flatow asked him who told him to write the paper, and Hager declined to comment. Ira replied that Hager was on a public committee, and the public has a right to know who is directing him to write a recommendation that's completely counter to the committee's decision, and Hager still refused. So yeah, I got mad about that. That's not the way things are supposed to work. Never mind the fact that the self-righteous Hager is a complete slimeball (read that long article I linked at the top of this post...you'll see). And yet, what can anybody do? Susan Wood, head of women's health at the FDA, resigned in protest, but what good does that actually do? And since the resignation of a high-level FDA employee doesn't have much of an effect, what can I even hope to do to change the situation? Whoooole lotta nothin'.
And that is what makes me the most angry.