Should birth control pills be OTC?
March 11, 2012 8:12 AM Subscribe
Virginia Postrel calls for making birth control pills available over the counter.
This revives the debate as to whether or not the US should john Spain and Mexico in allowing oral contraceptives without a prescription. Preliminary research reveals that many women would prefer such an opinion and that "no significant differences in contraindications exist at any level between those who obtain oral contraceptives at clinics and those who obtain them at pharmacies." However, some worry that this might lead to women getting the wrong kind of pill for them and that the option that the FDA would probably make OTC first, the "mini pill," is much less effective.
This revives the debate as to whether or not the US should john Spain and Mexico in allowing oral contraceptives without a prescription. Preliminary research reveals that many women would prefer such an opinion and that "no significant differences in contraindications exist at any level between those who obtain oral contraceptives at clinics and those who obtain them at pharmacies." However, some worry that this might lead to women getting the wrong kind of pill for them and that the option that the FDA would probably make OTC first, the "mini pill," is much less effective.
The main article seems like it was pretty intentionally misleading as to the effect that this would have on cost. Just because hormonal birth control costs $5 for a months supply over the counter in Juarez doesn't mean it would be $5 in the US. Historically when medications go OTC in the US the price, and particularly the cost to consumer, skyrockets as insurance companies wash their hands of them.
posted by Blasdelb at 8:25 AM on March 11, 2012 [4 favorites]
posted by Blasdelb at 8:25 AM on March 11, 2012 [4 favorites]
I know a girl who killed herself by overdosing on Tylenol PM, which is a horrible way to die and very painful. But I don't think it should become prescription only.
Lots of OTC stuff can kill you if you don't take it correctly. I don't see that birth control would be any different. Slap lots of warnings on it and let's move on.
posted by emjaybee at 8:26 AM on March 11, 2012 [4 favorites]
Lots of OTC stuff can kill you if you don't take it correctly. I don't see that birth control would be any different. Slap lots of warnings on it and let's move on.
posted by emjaybee at 8:26 AM on March 11, 2012 [4 favorites]
Pro: men can buy condoms over the counter for birth control so why not women?
Against: doctors, pharmacies, drug manufacturers who all stand to lose too much money
and the winner is: Against.
posted by Postroad at 8:32 AM on March 11, 2012 [8 favorites]
Against: doctors, pharmacies, drug manufacturers who all stand to lose too much money
and the winner is: Against.
posted by Postroad at 8:32 AM on March 11, 2012 [8 favorites]
Well, condoms are a external device and oral contraceptives are a medication that's taken so it's not THAT simple. Not to say it shouldn't go OTC, but there are perfectly valid reasons for keeping medications that play with hormones as prescription-only.
posted by Lord Chancellor at 8:37 AM on March 11, 2012 [9 favorites]
posted by Lord Chancellor at 8:37 AM on March 11, 2012 [9 favorites]
Although I appreciate what the blogger is saying, I think it's a crap argument that birth control pills are held hostage so that a woman gets a pap smear and develops a relationship with her doctor. As far as I know, the pap smear is unrelated to the birth control pills.
Should a woman get a pap smear? Sure, of course. Should a woman develop a relationship with a doctor? I guess, although annual 7-minute visits don't lead to much that's meaningful. But saying she must put herself at risk for an unwanted pregnancy unless she does these things is not helpful. Birth control is not an "incentive" to get a pap smear. The main article rightly calls this "extortion."
I feel the same logic is applied to the higher-fluoride toothpastes that are prescription only. Pretty safe (toothpaste!) but provides you an incentive to have your teeth professionally cleaned and for you to build a relationship with your dentist. Should you? Of course. Should the prescription be held back as incentive? Not really.
posted by Houstonian at 8:38 AM on March 11, 2012 [7 favorites]
Should a woman get a pap smear? Sure, of course. Should a woman develop a relationship with a doctor? I guess, although annual 7-minute visits don't lead to much that's meaningful. But saying she must put herself at risk for an unwanted pregnancy unless she does these things is not helpful. Birth control is not an "incentive" to get a pap smear. The main article rightly calls this "extortion."
I feel the same logic is applied to the higher-fluoride toothpastes that are prescription only. Pretty safe (toothpaste!) but provides you an incentive to have your teeth professionally cleaned and for you to build a relationship with your dentist. Should you? Of course. Should the prescription be held back as incentive? Not really.
posted by Houstonian at 8:38 AM on March 11, 2012 [7 favorites]
>Historically when medications go OTC in the US the price, and particularly the cost to consumer, skyrockets as insurance companies wash their hands of them.
Do you have links to more about this? My only experience is with allergy medications, and the pill that used to be prescription-only is now 88 cents for a week's supply.
posted by EarBucket at 8:42 AM on March 11, 2012 [2 favorites]
Do you have links to more about this? My only experience is with allergy medications, and the pill that used to be prescription-only is now 88 cents for a week's supply.
posted by EarBucket at 8:42 AM on March 11, 2012 [2 favorites]
"that the option that the FDA would probably make OTC first, the "mini pill," is much less effective."
That's a mistake, I hope, but quite misleading. The link in question says "slightly less effective" and a minute of research will back that up.
posted by ssg at 8:46 AM on March 11, 2012 [1 favorite]
That's a mistake, I hope, but quite misleading. The link in question says "slightly less effective" and a minute of research will back that up.
posted by ssg at 8:46 AM on March 11, 2012 [1 favorite]
Pretty much anything that lowers the barriers to access for safe and effective contraception is a good thing in my book. I've lived in places where birth control pills were over the counter, and whatever downsides there might have been were not visible at all.
posted by Forktine at 8:50 AM on March 11, 2012 [3 favorites]
posted by Forktine at 8:50 AM on March 11, 2012 [3 favorites]
Well, they're hormones, and they come with high-stakes side effects (blood clots being one of the most serious and most common). You really do need a doctor or Nurse Practitioner to help you decide which ones to use, don't you?
I mean, if a 13 year old girl (or unknowing parent) buys Ortho 7/7/7, that could be pretty dangerous.
posted by Malice at 8:57 AM on March 11, 2012 [2 favorites]
I mean, if a 13 year old girl (or unknowing parent) buys Ortho 7/7/7, that could be pretty dangerous.
posted by Malice at 8:57 AM on March 11, 2012 [2 favorites]
Pro: men can buy condoms over the counter for birth control so why not women?
Diaphragms?
posted by Talez at 8:57 AM on March 11, 2012 [2 favorites]
Diaphragms?
posted by Talez at 8:57 AM on March 11, 2012 [2 favorites]
Maybe a low-hormone, even dose could be made available. Just enough to prevent pregnancy. But I don't think all of them should be over the counter.
posted by Malice at 8:59 AM on March 11, 2012
posted by Malice at 8:59 AM on March 11, 2012
EarBucket, this (pdf) article might be of interest to you.
[Summarizing a previous 2002 study] The authors examined out-of-pocket health care costs and medical service use for 4 products newly switched from prescription to OTC status: cromolyn sodium (Nasalcrom), tioconazole (Vagistat), ketoconazole (Nizoral), and terbinafine (Lamisil) and for 3 different insurance scenarios: indemnity/managed care plan, Kaiser Permanente HMO, and Maryland Medicaid.posted by Houstonian at 9:02 AM on March 11, 2012 [5 favorites]
They noted that prescription charges for all 4 products were much higher than OTC retail prices. However, for persons who had prescription drug coverage, out-of-pocket payments for the prescription products were far less than the OTC prices. For all 4 products and all 3 insurance plans, consumer drug costs at point of purchase were higher when products were obtained OTC. Costs ranged from 2% to 113% below consumer OTC costs for the indemnity/managed care plan and 54% to 233% below for the HMO. The greatest difference obviously was for Medicaid, for which copayments were miniscule.
The effect on medical service use varied by product. However, it appeared that OTC approval was associated with elevated rather than reduced medical service use. They suggested that users of cromolyn and tioconazole experienced more-costly visits after OTC approval. This, they postulated, would be consistent with complications resulting from self-care or due to more-costly visits resulting from non–self-treatment by patients because of increased out-of-pocket expenses. The combined effect of increased out-of-pocket medical expenses and out-of-pocket drug costs contributed to higher out-of-pocket health care costs for all categories of consumers. From the perspective of the third-party payer, savings were noted for all insurance plans for these products despite the increase in medical services utilization.
Postroad writes "Pro: men can buy condoms over the counter for birth control so why not women?"
Women have access to all sorts of over the counter barrier methods including the female condom.
posted by Mitheral at 9:05 AM on March 11, 2012
Women have access to all sorts of over the counter barrier methods including the female condom.
posted by Mitheral at 9:05 AM on March 11, 2012
Um, don't you need a blood test before using those? I have a friend who is highly allergic to synthetic estrogen, and can only take the progesterone only ones. I always figured that was the reason they were prescription only, so they could screen for that kind of thing...
posted by Canageek at 9:07 AM on March 11, 2012
posted by Canageek at 9:07 AM on March 11, 2012
As a woman, I mean, we have over-the-counter options. We have spermicidal cream, the sponge (is that still available?), diaphragm, the beads (my personal favorite), so on and so forth. We can use any combination of the above, plus more options like Mirena. It's not like we're devoid of choice over here. My concern is mostly that these hormones aren't necessarily safe to use without a doctor's supervision and guidance.
posted by Malice at 9:17 AM on March 11, 2012 [2 favorites]
posted by Malice at 9:17 AM on March 11, 2012 [2 favorites]
I mean, if a 13 year old girl (or unknowing parent) buys Ortho 7/7/7, that could be pretty dangerous.
Is that just because 13 year olds can't be relied on to take tri-phasic pill cycles properly, or is there a medical reason for that?
posted by atrazine at 9:20 AM on March 11, 2012
Is that just because 13 year olds can't be relied on to take tri-phasic pill cycles properly, or is there a medical reason for that?
posted by atrazine at 9:20 AM on March 11, 2012
Is that just because 13 year olds can't be relied on to take tri-phasic pill cycles properly, or is there a medical reason for that?
777 is pretty strong (for lack of a better word) and using it, to my understanding and from my experience, from what I have been told by multiple Doctor's and Nps, drastically increases your chances of developing a clot, among other side effects.
posted by Malice at 9:25 AM on March 11, 2012 [1 favorite]
777 is pretty strong (for lack of a better word) and using it, to my understanding and from my experience, from what I have been told by multiple Doctor's and Nps, drastically increases your chances of developing a clot, among other side effects.
posted by Malice at 9:25 AM on March 11, 2012 [1 favorite]
I mean, if a 13 year old girl (or unknowing parent) buys Ortho 7/7/7, that could be pretty dangerous.
I started on ON7/7/7 when I was 15 or 16, and had no problems. It's more dangerous than other pills, but radically less dangerous than, say, Tylenol.
posted by KathrynT at 9:27 AM on March 11, 2012 [2 favorites]
I started on ON7/7/7 when I was 15 or 16, and had no problems. It's more dangerous than other pills, but radically less dangerous than, say, Tylenol.
posted by KathrynT at 9:27 AM on March 11, 2012 [2 favorites]
but radically less dangerous than, say, Tylenol.
Is it really? How so?
posted by Malice at 9:42 AM on March 11, 2012
Is it really? How so?
posted by Malice at 9:42 AM on March 11, 2012
I'm extremely pro birth control but I think this is a terrible idea.
posted by agregoli at 9:45 AM on March 11, 2012 [3 favorites]
posted by agregoli at 9:45 AM on March 11, 2012 [3 favorites]
I'm not convinced that all pills should be OTC because I've run into enough complications with some of them that I'm aware are difficult to detect and long-term dangerous, particularly in combination with other medications (e.g., birth control pill + other medication = high blood pressure). On the other hand, anyone mixing long-term medications should have a regular relationship of the more-than-seven-minutes kind with a health care professional anyhow.
posted by immlass at 9:50 AM on March 11, 2012
posted by immlass at 9:50 AM on March 11, 2012
I've run into enough complications with some of them that I'm aware are difficult to detect and long-term dangerous
Yes, same with me. Edema being one of those complications.
posted by Malice at 9:52 AM on March 11, 2012 [1 favorite]
Yes, same with me. Edema being one of those complications.
posted by Malice at 9:52 AM on March 11, 2012 [1 favorite]
Slap lots of warnings on it and let's move on.
And make retailers absolutely immune to civil liability. Warning labels alone don't cut it.
posted by three blind mice at 9:55 AM on March 11, 2012 [2 favorites]
And make retailers absolutely immune to civil liability. Warning labels alone don't cut it.
posted by three blind mice at 9:55 AM on March 11, 2012 [2 favorites]
I started on ON7/7/7 when I was 15 or 16, and had no problems.
Well that settles it. Evidence based medicine is clearly a load of horseshit and Malice's problems are obviously all psychosomatic.
</sarcasm>
posted by Talez at 9:58 AM on March 11, 2012 [1 favorite]
Well that settles it. Evidence based medicine is clearly a load of horseshit and Malice's problems are obviously all psychosomatic.
</sarcasm>
posted by Talez at 9:58 AM on March 11, 2012 [1 favorite]
The best BC pills are aspirin, held between the knees.
Um, wait...someone said that already.
I don't need no steenking birth conrol.
posted by mule98J at 10:00 AM on March 11, 2012 [1 favorite]
Um, wait...someone said that already.
I don't need no steenking birth conrol.
posted by mule98J at 10:00 AM on March 11, 2012 [1 favorite]
Um, don't you need a blood test before using those? I have a friend who is highly allergic to synthetic estrogen, and can only take the progesterone only ones. I always figured that was the reason they were prescription only, so they could screen for that kind of thing...
Yes, and there are other side effects from taking one not suited for you as well.
In the US, OTC means "be your own doctor, medicate yourself". I don't know about all EU nations, but the ones I've spent time in, all sorts of OTC drugs (ibuprophin, proton pump inhibitors, etc) require prescriptions. Which is no problem because seeing a physician is no problem.
This is yet another example of a problem that vanishes when you establish some form of nationalised health insurance.
posted by clarknova at 10:02 AM on March 11, 2012 [19 favorites]
Yes, and there are other side effects from taking one not suited for you as well.
In the US, OTC means "be your own doctor, medicate yourself". I don't know about all EU nations, but the ones I've spent time in, all sorts of OTC drugs (ibuprophin, proton pump inhibitors, etc) require prescriptions. Which is no problem because seeing a physician is no problem.
This is yet another example of a problem that vanishes when you establish some form of nationalised health insurance.
posted by clarknova at 10:02 AM on March 11, 2012 [19 favorites]
It always amazes me how the subject of female sexuality turns some people into radical libertarians, as if there's one particular sphere of life where the individual is capable of making all sorts of complex decisions with potential high stake consequences (as a 13 year old girl!) but move the subject to, say, personal finances, and the same individual becomes an absolute incompetent in need of 24/7 handholding by the state.
posted by falameufilho at 10:03 AM on March 11, 2012 [2 favorites]
posted by falameufilho at 10:03 AM on March 11, 2012 [2 favorites]
I do not understand where this notion that "condoms are for men" in the comments on this post is coming from. Condoms, though worn by men, do not prevent men from getting pregnant. Like other forms of birth control, they prevent women from getting pregnant. Further, women can buy them and ask the men they're having sex with to wear them. Believe me, this is actually a thing that happens.
I'm actually in favor of OTC hormonal birth control, but this notion that "well, men get condoms, so women should get this" is just ridiculous. Men and women both get condoms!
Regular plain old "male" condoms are often purchased by and used with the encouragement or insistence of women (probably far more often tan any of these other non-hormonal birth control methods people have mentioned). They are as much a birth control solution for women as they are for men.
posted by tylerkaraszewski at 10:03 AM on March 11, 2012 [10 favorites]
I'm actually in favor of OTC hormonal birth control, but this notion that "well, men get condoms, so women should get this" is just ridiculous. Men and women both get condoms!
Regular plain old "male" condoms are often purchased by and used with the encouragement or insistence of women (probably far more often tan any of these other non-hormonal birth control methods people have mentioned). They are as much a birth control solution for women as they are for men.
posted by tylerkaraszewski at 10:03 AM on March 11, 2012 [10 favorites]
Is it really? How so?
Pills with synthetic estrogen in them increase the risk of blood clots 3-6 fold -- about the same as pregnancy, by the way -- which raises it up to about 1 in 3,000. By contrast, you can fatally overdose on Tylenol at less than double the standard dose. Tylenol overdose is one of the most common poisonings in the world.
What risks are there to our hypothetical 13 year old that are worse than the risks to her if she gets pregnant?
posted by KathrynT at 10:17 AM on March 11, 2012 [5 favorites]
Pills with synthetic estrogen in them increase the risk of blood clots 3-6 fold -- about the same as pregnancy, by the way -- which raises it up to about 1 in 3,000. By contrast, you can fatally overdose on Tylenol at less than double the standard dose. Tylenol overdose is one of the most common poisonings in the world.
What risks are there to our hypothetical 13 year old that are worse than the risks to her if she gets pregnant?
posted by KathrynT at 10:17 AM on March 11, 2012 [5 favorites]
What risks are there to our hypothetical 13 year old that are worse than the risks to her if she gets pregnant?
Well, purely from personal experience, I've taken Tylenol for years with no complications. I took 777 for six months and developed a blood clot and edema.
posted by Malice at 10:19 AM on March 11, 2012 [2 favorites]
Well, purely from personal experience, I've taken Tylenol for years with no complications. I took 777 for six months and developed a blood clot and edema.
posted by Malice at 10:19 AM on March 11, 2012 [2 favorites]
OK, my anecdote was out of line -- but still. The blood clot increase is real, and it is virtually identical to the increase that you get in pregnancy. Is there something magic about being 13 that makes this not true? Is pregnancy somehow less risky for young teenagers?
posted by KathrynT at 10:22 AM on March 11, 2012 [2 favorites]
posted by KathrynT at 10:22 AM on March 11, 2012 [2 favorites]
Nah, certainly a 13 year old should not be getting pregnant. That still doesn't mean I think they should be allowed unfettered access to hormones that they should be using with strict supervision. They can still get condoms and all kinds of things over the counter.
posted by Malice at 10:23 AM on March 11, 2012
posted by Malice at 10:23 AM on March 11, 2012
Pills with synthetic estrogen in them increase the risk of blood clots 3-6 fold -- about the same as pregnancy, by the way -- which raises it up to about 1 in 3,000. By contrast, you can fatally overdose on Tylenol at less than double the standard dose. Tylenol overdose is one of the most common poisonings in the world.
Poisoning is the most common method of suicide for women. There is an extreme amount of risk associated with keeping Tylenol around unstable women. For happy, healthy women with no suicidal tendencies this risk drops to somewhere around zero. It doesn't average out like you think it does.
Just keep digging. I'm sure you'll hit paydirt with one random statistical anomaly or anecdote sooner or later.
posted by Talez at 10:29 AM on March 11, 2012
Poisoning is the most common method of suicide for women. There is an extreme amount of risk associated with keeping Tylenol around unstable women. For happy, healthy women with no suicidal tendencies this risk drops to somewhere around zero. It doesn't average out like you think it does.
Just keep digging. I'm sure you'll hit paydirt with one random statistical anomaly or anecdote sooner or later.
posted by Talez at 10:29 AM on March 11, 2012
Even though we have demonstrably more dangerous drugs OTC? Like Tylenol, or aspirin (of particular concern to our hypothetical 13 year old, given the possibility of Reye's Syndrome)? Hell, nicotine gum is available over the counter.
posted by KathrynT at 10:35 AM on March 11, 2012
posted by KathrynT at 10:35 AM on March 11, 2012
I think that Tylenol and Aspirin being more dangerous is pretty arguable to be honest. And children can't buy Nicotine gum, plus it's used to quit smoking, which is more dangerous than chewing the gum itself.
posted by Malice at 10:41 AM on March 11, 2012 [1 favorite]
posted by Malice at 10:41 AM on March 11, 2012 [1 favorite]
On what basis do you find it arguable?
And children can't buy Nicotine gum, plus it's used to quit smoking, which is more dangerous than chewing the gum itself.
Well, birth control pills are used to prevent pregnancy, which is more dangerous than taking the pill itself. And I didn't see anything in the article suggesting that BCPs should be available without age restrictions.
posted by KathrynT at 10:54 AM on March 11, 2012
And children can't buy Nicotine gum, plus it's used to quit smoking, which is more dangerous than chewing the gum itself.
Well, birth control pills are used to prevent pregnancy, which is more dangerous than taking the pill itself. And I didn't see anything in the article suggesting that BCPs should be available without age restrictions.
posted by KathrynT at 10:54 AM on March 11, 2012
clarknova: "I don't know about all EU nations, but the ones I've spent time in, all sorts of OTC drugs (ibuprophin, proton pump inhibitors, etc) require prescriptions."Confused European here. What I understand as OTC drugs are drugs that you can buy at a pharmacy (or, in some countries, in a grocery store as well) without a prescription. What you describe, I would call prescription drugs since you, well, need a prescription to get them.
In the US, is it an option to get drugs directly from the doctor? The only time that happens here is if the drug is administered by the physician, e.g. vaccines.
posted by brokkr at 10:54 AM on March 11, 2012
Well, it just goes back to what I said before. They're hormones. Tylenol is not a hormone. Hormones effect your body, and effect growing bodies for sure. They're really not comparable at all to taking, say, an Aspirin. You don't take pain Tylenol-like items every day, and unless you have an allergy they're not really going to hurt you. Hormones, however, have side effects that require monitoring. Sure, if they don't hurt you, that is wonderful. But there are many, many brands and many, many dosages that the average person is just not qualified to sort out for themselves.
As I said before, maybe an incredibly mild, very low-dose one could be OTC, just enough to prevent pregnancy, but even then I think it'd be something that would need serious study and thinking about by qualified parties.
posted by Malice at 10:59 AM on March 11, 2012
As I said before, maybe an incredibly mild, very low-dose one could be OTC, just enough to prevent pregnancy, but even then I think it'd be something that would need serious study and thinking about by qualified parties.
posted by Malice at 10:59 AM on March 11, 2012
As far as I know, the pap smear is unrelated to the birth control pills.
In the sense that there is no medical need for a pap smear in order for a doctor to prescribe birth control pills, the two are unrelated. However, everywhere I've been, doctors will require an annual check-up (which includes a pap smear, though some gynecologists are moving toward pap smears only every two years for women at lower risk for cervical cancer/contracting HPV) before writing a prescription. On the other hand, I've never had to take a blood test for a birth control pill prescription.
All the reasons mentioned in the links in the FPP in support of keeping birth control pills prescription-only work fine for the significant percentage of US women who have insurance that covers annual check-ups as well as prescription medications, including birth control pills. It presents a very significant barrier to women who don't have insurance to pay for an annual check-up, or the even larger numbers who don't have prescription drug coverage as part of their insurance (in which case they are paying significantly more for the pill). And radical right wingers would like to increase the number of women who fall into this category (to 100%). I don't see the "we need to keep the pill prescription-only so that women will get annual check-ups" argument as a particularly strong argument given that context. (Creating a socialized medical care system in the US that included free or sliding-scale medical services and prescription drug coverage would change the context and thus the validity of this argument, of course.)
There may well be validity to the argument that the pill needs to remain prescription-only for safety reasons. I'm inclined to believe that women can be trusted to read caution labels for themselves, but I'll reserve judgment on that until I get a chance to see relevant scientific studies and expected value computations for potential harm from side effects for myself. One of the FPP links suggests that approximately 10% of OTC pill users in Mexico have medical conditions that are contraindications for pill use. Does anyone have any data on actual rates of adverse reactions/complications from birth control pill use in Mexico or Spain versus in the US?
posted by eviemath at 11:01 AM on March 11, 2012 [6 favorites]
In the sense that there is no medical need for a pap smear in order for a doctor to prescribe birth control pills, the two are unrelated. However, everywhere I've been, doctors will require an annual check-up (which includes a pap smear, though some gynecologists are moving toward pap smears only every two years for women at lower risk for cervical cancer/contracting HPV) before writing a prescription. On the other hand, I've never had to take a blood test for a birth control pill prescription.
All the reasons mentioned in the links in the FPP in support of keeping birth control pills prescription-only work fine for the significant percentage of US women who have insurance that covers annual check-ups as well as prescription medications, including birth control pills. It presents a very significant barrier to women who don't have insurance to pay for an annual check-up, or the even larger numbers who don't have prescription drug coverage as part of their insurance (in which case they are paying significantly more for the pill). And radical right wingers would like to increase the number of women who fall into this category (to 100%). I don't see the "we need to keep the pill prescription-only so that women will get annual check-ups" argument as a particularly strong argument given that context. (Creating a socialized medical care system in the US that included free or sliding-scale medical services and prescription drug coverage would change the context and thus the validity of this argument, of course.)
There may well be validity to the argument that the pill needs to remain prescription-only for safety reasons. I'm inclined to believe that women can be trusted to read caution labels for themselves, but I'll reserve judgment on that until I get a chance to see relevant scientific studies and expected value computations for potential harm from side effects for myself. One of the FPP links suggests that approximately 10% of OTC pill users in Mexico have medical conditions that are contraindications for pill use. Does anyone have any data on actual rates of adverse reactions/complications from birth control pill use in Mexico or Spain versus in the US?
posted by eviemath at 11:01 AM on March 11, 2012 [6 favorites]
Confused European here. What I understand as OTC drugs are drugs that you can buy at a pharmacy (or, in some countries, in a grocery store as well) without a prescription. What you describe, I would call prescription drugs since you, well, need a prescription to get them.
In the US, is it an option to get drugs directly from the doctor? The only time that happens here is if the drug is administered by the physician, e.g. vaccines.
I think what clarknova meant by OTC drugs are "drugs that here in the US we think of as OTC". Your definition of OTC is the same one we use in the US.
posted by spaceman_spiff at 11:02 AM on March 11, 2012
In the US, is it an option to get drugs directly from the doctor? The only time that happens here is if the drug is administered by the physician, e.g. vaccines.
I think what clarknova meant by OTC drugs are "drugs that here in the US we think of as OTC". Your definition of OTC is the same one we use in the US.
posted by spaceman_spiff at 11:02 AM on March 11, 2012
I think the annual pap-smear is required simply to check for abnormalities in the cervix. Not only can BC pills increase your chance of getting cervical cancer (or making it worse), but they can mask symptoms of underlying conditions by forcing an unnatural cycle to appear natural.
posted by Malice at 11:05 AM on March 11, 2012 [1 favorite]
posted by Malice at 11:05 AM on March 11, 2012 [1 favorite]
but even then I think it'd be something that would need serious study and thinking about by qualified parties.
What makes you think it hasn't been?
posted by KathrynT at 11:12 AM on March 11, 2012 [3 favorites]
What makes you think it hasn't been?
posted by KathrynT at 11:12 AM on March 11, 2012 [3 favorites]
Isn't there some sort of middle ground available? Allow BCPs to be sold in touchscreen vending machines based on the answers to a series of medical questions. Follow up questions can be asked in later months. The experience shouldn't be much different than withdrawing $40 from an ATM.
posted by Missiles K. Monster at 11:22 AM on March 11, 2012 [2 favorites]
posted by Missiles K. Monster at 11:22 AM on March 11, 2012 [2 favorites]
... they come with high-stakes side effects ...
Rogaine has been over the counter for years - in spite of precautions (consult your doctor ... ). -- Soooo ... basically, men can be trusted to read instructions, but we must protect our silly women?
posted by Surfurrus at 11:23 AM on March 11, 2012 [8 favorites]
Rogaine has been over the counter for years - in spite of precautions (consult your doctor ... ). -- Soooo ... basically, men can be trusted to read instructions, but we must protect our silly women?
posted by Surfurrus at 11:23 AM on March 11, 2012 [8 favorites]
You don't take pain Tylenol-like items every day, and unless you have an allergy they're not really going to hurt you.
I know a number of people who take pain relief every single day for a number of reasons. Mostly ibuprofen, but some take Tylenol.
Too much Tylenol, as has been pointed out multiple times, can kill you dead. It's grandfathered in as OTC, it would never make it onto the market in today's regulatory climate.
posted by ambrosia at 11:24 AM on March 11, 2012 [1 favorite]
I know a number of people who take pain relief every single day for a number of reasons. Mostly ibuprofen, but some take Tylenol.
Too much Tylenol, as has been pointed out multiple times, can kill you dead. It's grandfathered in as OTC, it would never make it onto the market in today's regulatory climate.
posted by ambrosia at 11:24 AM on March 11, 2012 [1 favorite]
Two things:
1) When I was a teenager, I was put on the pill to fight my acne (it worked wonders!) Despite the fact that it was prescribed by a doctor, even despite the fact that I read the instructions that came in the box, I never learned how to use it correctly. Specifically, I didn't know how important it was to take it at exactly the same time every day. Possibly as a result, I had horrible morning sickness-like symptoms a lot of the time. And thank god I wasn't using it for contraceptive purposes, as I doubt it would have been fully effective the way I was using it. So getting it prescribed by a doctor certainly doesn't guarantee that people will use it correctly.
2) My local drugstore here in Vancouver has something between prescription-only and OTC. In order to get certain OTC items, you have to line up and spend a few minutes talking with the pharmacist about what you want, what you plan to use it for, your experience with it, etc. I've encountered this for iron supplements, and I imagine this is how they would sell HBC as well. It would go a long way towards mitigating concern about people just picking it up off the shelf with no clue how to use it, or if it's right for them.
posted by mantecol at 11:39 AM on March 11, 2012 [2 favorites]
1) When I was a teenager, I was put on the pill to fight my acne (it worked wonders!) Despite the fact that it was prescribed by a doctor, even despite the fact that I read the instructions that came in the box, I never learned how to use it correctly. Specifically, I didn't know how important it was to take it at exactly the same time every day. Possibly as a result, I had horrible morning sickness-like symptoms a lot of the time. And thank god I wasn't using it for contraceptive purposes, as I doubt it would have been fully effective the way I was using it. So getting it prescribed by a doctor certainly doesn't guarantee that people will use it correctly.
2) My local drugstore here in Vancouver has something between prescription-only and OTC. In order to get certain OTC items, you have to line up and spend a few minutes talking with the pharmacist about what you want, what you plan to use it for, your experience with it, etc. I've encountered this for iron supplements, and I imagine this is how they would sell HBC as well. It would go a long way towards mitigating concern about people just picking it up off the shelf with no clue how to use it, or if it's right for them.
posted by mantecol at 11:39 AM on March 11, 2012 [2 favorites]
Dentists really missed out when they didn't hire enough lobbyists to require a dental exam to purchase toothpaste.
(However, they did hire enough lobbyists to require dental hygienists to work for a dentist.)
posted by JackFlash at 11:42 AM on March 11, 2012 [1 favorite]
(However, they did hire enough lobbyists to require dental hygienists to work for a dentist.)
posted by JackFlash at 11:42 AM on March 11, 2012 [1 favorite]
Dentists really missed out when they didn't hire enough lobbyists to require a dental exam to purchase toothpaste.
Woah. Really? Come on now. You can argue the effects of BC versus OTC drugs, but saying it's the same as toothpaste? I didn't know toothpaste doubled your risk of getting cervical cancer. You learn something new everyday.
posted by Malice at 11:58 AM on March 11, 2012 [1 favorite]
Woah. Really? Come on now. You can argue the effects of BC versus OTC drugs, but saying it's the same as toothpaste? I didn't know toothpaste doubled your risk of getting cervical cancer. You learn something new everyday.
posted by Malice at 11:58 AM on March 11, 2012 [1 favorite]
I think what clarknova meant by OTC drugs are "drugs that here in the US we think of as OTC". Your definition of OTC is the same one we use in the US.
Yeah that's exactly what I meant. My partner's a doctor educated in the EU. She was quite literally shocked to see what you can buy here without a prescription. Not just the drugs I mentioned, but a whole slew of others. In the US you can get even get an annual flu vaccine administered to you by a pharmacist, with no recommendation other than you want one. In fact the pharmacies put out signs advertising them:
FLU SHOTS HERE! AS LOW AS $25! STOP IN TODAY!
You may not be in the risk groups that need them, but you can just have one anyway. No questions asked. Just another shady practice that occurs in our profit-driven medical system.
And don't even get me started on the cash cow medicine show that is dentistry.
posted by clarknova at 12:02 PM on March 11, 2012 [2 favorites]
Yeah that's exactly what I meant. My partner's a doctor educated in the EU. She was quite literally shocked to see what you can buy here without a prescription. Not just the drugs I mentioned, but a whole slew of others. In the US you can get even get an annual flu vaccine administered to you by a pharmacist, with no recommendation other than you want one. In fact the pharmacies put out signs advertising them:
FLU SHOTS HERE! AS LOW AS $25! STOP IN TODAY!
You may not be in the risk groups that need them, but you can just have one anyway. No questions asked. Just another shady practice that occurs in our profit-driven medical system.
And don't even get me started on the cash cow medicine show that is dentistry.
posted by clarknova at 12:02 PM on March 11, 2012 [2 favorites]
Used birth control, very much pro-birth control, but here's my anecdotal story about why this is a bad idea. TL;DR: women's bodies are super fucking complicated and hormone-based medication is a motherfucker.
I was on Seasonale for a couple of years, largely because I was tired of having periods and I knew that I never wanted to reproduce. When I went to the pharmacy to re-up one time, they were out of the brand, and all they had was a generic. I took the generic because, gosh, it's all the same right?
Wrong.
Constipation of epic levels ensued. I was miserable. So I had to stop taking it entirely and wait to re-up when Seasonale was back in. Which was fine because, again, I was taking it to modify my cycle and was in no danger of pregnancy. But for people who take birth control primarily for the purpose for which it was intended, this scenario would suck.
posted by gsh at 12:03 PM on March 11, 2012 [2 favorites]
I was on Seasonale for a couple of years, largely because I was tired of having periods and I knew that I never wanted to reproduce. When I went to the pharmacy to re-up one time, they were out of the brand, and all they had was a generic. I took the generic because, gosh, it's all the same right?
Wrong.
Constipation of epic levels ensued. I was miserable. So I had to stop taking it entirely and wait to re-up when Seasonale was back in. Which was fine because, again, I was taking it to modify my cycle and was in no danger of pregnancy. But for people who take birth control primarily for the purpose for which it was intended, this scenario would suck.
posted by gsh at 12:03 PM on March 11, 2012 [2 favorites]
Never have I ever had a blood test before getting the pill. Never have I ever actually had doctor supervision, either, unless you count "what birth control method are you using? Condoms? You should be on the pill. Here, have a prescription" as doctor supervision, which I don't.
I'm not advocating for BCP to be available next to the condoms in the family planning aisle, but I would love to see BCP available through pharmacists rather than doctors in the same way that Plan B is available through pharmacists. Grab a slip from the aisle, talk to the pharmacist, get meds.
posted by lydhre at 12:07 PM on March 11, 2012 [7 favorites]
I'm not advocating for BCP to be available next to the condoms in the family planning aisle, but I would love to see BCP available through pharmacists rather than doctors in the same way that Plan B is available through pharmacists. Grab a slip from the aisle, talk to the pharmacist, get meds.
posted by lydhre at 12:07 PM on March 11, 2012 [7 favorites]
Dentists really missed out when they didn't hire enough lobbyists to require a dental exam to purchase toothpaste
Pretty sure this was sarcasm or just cynical snark, Malice.
In re: OTC BC. In most places in the US, it is close to being OTC anyways - you can elect to self-medicate via informed consent clinics.
posted by Fuka at 12:07 PM on March 11, 2012
Pretty sure this was sarcasm or just cynical snark, Malice.
In re: OTC BC. In most places in the US, it is close to being OTC anyways - you can elect to self-medicate via informed consent clinics.
posted by Fuka at 12:07 PM on March 11, 2012
In re: OTC BC. In most places in the US, it is close to being OTC anyways - you can elect to self-medicate via informed consent clinics.
What's an informed consent clinic? I've lived in the US all my life and have never heard of one.
posted by Juffo-Wup at 12:12 PM on March 11, 2012 [1 favorite]
What's an informed consent clinic? I've lived in the US all my life and have never heard of one.
posted by Juffo-Wup at 12:12 PM on March 11, 2012 [1 favorite]
I was on Seasonale for a couple of years, largely because I was tired of having periods and I knew that I never wanted to reproduce. When I went to the pharmacy to re-up one time, they were out of the brand, and all they had was a generic. I took the generic because, gosh, it's all the same right?
Wrong.
Sometimes the pharmacy runs out of your BC whether you are taking it for contraception or not. I am currently having to take samples from my doctor because the generic Rx I usually get was recalled, thus not available at the pharmacy. Instead of paying double (or triple or whatever) for the name brand my doc gave me some samples of it.
I don't understand what the prescription vs. OTC has to do with the pharmacy running out.
posted by chela at 12:16 PM on March 11, 2012 [1 favorite]
Wrong.
Sometimes the pharmacy runs out of your BC whether you are taking it for contraception or not. I am currently having to take samples from my doctor because the generic Rx I usually get was recalled, thus not available at the pharmacy. Instead of paying double (or triple or whatever) for the name brand my doc gave me some samples of it.
I don't understand what the prescription vs. OTC has to do with the pharmacy running out.
posted by chela at 12:16 PM on March 11, 2012 [1 favorite]
Wait, why shouldn't flu shots be readily available?
Because they are of questionable efficacy and carry a risk of allergic reaction. They're not recommended unless you're in a category where the risk of reaction * the gamble that this year's serum works > your risk of coming down with the flu * how bad that flu could be for you.
This is why it's essential to be able to see a doctor who has no financial stake in selling you service. They tell you these things.
What's an informed consent clinic? I've lived in the US all my life and have never heard of one.
More socialised medicine foisted upon an unwitting public by freedom-hating Marxist Leninist statist Stalinist... *aneurysm*
posted by clarknova at 12:21 PM on March 11, 2012 [2 favorites]
Because they are of questionable efficacy and carry a risk of allergic reaction. They're not recommended unless you're in a category where the risk of reaction * the gamble that this year's serum works > your risk of coming down with the flu * how bad that flu could be for you.
This is why it's essential to be able to see a doctor who has no financial stake in selling you service. They tell you these things.
What's an informed consent clinic? I've lived in the US all my life and have never heard of one.
More socialised medicine foisted upon an unwitting public by freedom-hating Marxist Leninist statist Stalinist... *aneurysm*
posted by clarknova at 12:21 PM on March 11, 2012 [2 favorites]
I am one of those rare people that needs to stay off the combined oral contraceptives because of blood pressure concerns, but I was taking them under "doctor supervision" for four years before a doctor noticed my blood pressure was high, and only my own detective work at home with a blood pressure monitor lead me to figure out it was the pills. Maybe I'm the poster child for why they shouldn't be OTC, but then again, maybe doctors dispense them so routinely with so little concern for side effects that they might as well be OTC. Rare freak contraindications aside, I trust most women to follow a warning label and listen to their body.
posted by slow graffiti at 12:22 PM on March 11, 2012 [3 favorites]
posted by slow graffiti at 12:22 PM on March 11, 2012 [3 favorites]
It presents a very significant barrier to women who don't have insurance to pay for an annual check-up, or the even larger numbers who don't have prescription drug coverage as part of their insurance (in which case they are paying significantly more for the pill). And radical right wingers would like to increase the number of women who fall into this category (to 100%). I don't see the "we need to keep the pill prescription-only so that women will get annual check-ups" argument as a particularly strong argument given that context. (Creating a socialized medical care system in the US that included free or sliding-scale medical services and prescription drug coverage would change the context and thus the validity of this argument, of course.)
The more I think about this the more I think this is spot-on.
I spent my junior year of college living in Brazil, where one could walk into a pharmacy and get the pill or antibiotics or what have you just for the asking. I'm sure there were some things you needed a scrip for, but I never needed one. And it was great for me- my same OCP cost less than $2 for a 30 day supply; I left Brazil with a three year stockpile. But that system was in place because too many Brazilians did not have adequate access to medical care. So part of me sees this proposal a an acknowledgement that our health-care system is not serving us as well as it ought, and that moving towards doing something Brazil was doing in the 1980's is not the best indicator for our health care system. At the same time, I am all for expanding access to effective birth control- the easier we make it, the better.
posted by ambrosia at 12:23 PM on March 11, 2012 [3 favorites]
The more I think about this the more I think this is spot-on.
I spent my junior year of college living in Brazil, where one could walk into a pharmacy and get the pill or antibiotics or what have you just for the asking. I'm sure there were some things you needed a scrip for, but I never needed one. And it was great for me- my same OCP cost less than $2 for a 30 day supply; I left Brazil with a three year stockpile. But that system was in place because too many Brazilians did not have adequate access to medical care. So part of me sees this proposal a an acknowledgement that our health-care system is not serving us as well as it ought, and that moving towards doing something Brazil was doing in the 1980's is not the best indicator for our health care system. At the same time, I am all for expanding access to effective birth control- the easier we make it, the better.
posted by ambrosia at 12:23 PM on March 11, 2012 [3 favorites]
I read these articles with interest because I remember being in a very bad position in college where I was studying abroad for a year and so my school health insurance was going to stop covering me during that time. I wanted to get all the pills I needed for the year, but the clinic at school wouldn't let me get more than a certain number of months because I required an annual exam every year to renew my prescription and that was due while I was going to be away. So at some point it was just easier for me to make a detour to Spain to buy my pills OTC, because it's not particularly easy for a foreigner to get BCP in Sweden...well, at least I couldn't figure it out. I had a great time in Madrid eating tapas and the whole thing probably cost less than paying out of pocket to see a doctor to get a prescription. But that particular pill I was taking was one I had settled on after having taken other BCP that had some pretty crappy side effects, so I'm glad I initially had seen a doctor to get the right pill prescribed for me.
I'd like to see people be allowed to keep their BCP pill prescription they got from a doctor as long as they like. I also think nurses and physician's assistants are qualified to prescribe them and should be able to. And seeing one should be a simple transaction you should be able to pay for in cash. One can only dream...
posted by melissam at 12:34 PM on March 11, 2012 [1 favorite]
I'd like to see people be allowed to keep their BCP pill prescription they got from a doctor as long as they like. I also think nurses and physician's assistants are qualified to prescribe them and should be able to. And seeing one should be a simple transaction you should be able to pay for in cash. One can only dream...
posted by melissam at 12:34 PM on March 11, 2012 [1 favorite]
Re: flu shots. Most people in the US din't have sick leave or are discouraged from using it. So we do our best to not get sick. And when someone does get sick, they bring it to work and get everyine who isn't vaccinated sick.
posted by [insert clever name here] at 12:34 PM on March 11, 2012 [2 favorites]
posted by [insert clever name here] at 12:34 PM on March 11, 2012 [2 favorites]
While we're at it, let's make everything OTC.
No, I'm not kidding.
posted by Outlawyr at 1:04 PM on March 11, 2012 [2 favorites]
No, I'm not kidding.
posted by Outlawyr at 1:04 PM on March 11, 2012 [2 favorites]
While we're at it, let's make everything OTC.
No, I'm not kidding.
While there are arguments to be made for that (i.e. "at least it's better than prohibition" or "if we're forcing people into destitution with medical bills they should at least be able to attempt their own doctoring") in many respects it's a terrible idea. Antibiotic resistance is a huge public health problem, for example. No one should be taking antibiotics without medical supervision.
posted by clarknova at 1:19 PM on March 11, 2012 [3 favorites]
No, I'm not kidding.
While there are arguments to be made for that (i.e. "at least it's better than prohibition" or "if we're forcing people into destitution with medical bills they should at least be able to attempt their own doctoring") in many respects it's a terrible idea. Antibiotic resistance is a huge public health problem, for example. No one should be taking antibiotics without medical supervision.
posted by clarknova at 1:19 PM on March 11, 2012 [3 favorites]
I don't really mind getting a prescription for the pills I'm on, as I've had adverse reactions to some pills and cycled through a number of generics and name-brand meds to get a decent pill that I'm happy with. [And for anyone who says barrier methods are an obvious solution, they're not if you're prescription BC as hormonal regulation for other issues.] I'm more upset that yes, I have to go back for an entirely different doctor's visits and tests every year and even worse, that I can only get a month's worth of the pill filled at a time, and my insurance only covers it if I get it filled three weeks or later after the last time. It's incredibly inefficient to have to return to the same pharmacy, and if I take a trip or have conflicts, I'm out $80 bucks that month. Having it OTC would obviously solve some of these problems, though I admit I'm glad I had a doctor to help sort out the issues I have had. On the other hand, I probably would have gone to a doctor anyway (because I'm lucky and have insurance) to check over the reactions and I get my blood pressure checked at normal doctor's appointments and blood donations fairly regularly. At JYA meetings, it was very common to hear recommendations for getting BC prescriptions filled abroad, because they were cheaper (or free) and doctors who knew their patients would be heading back to the United States would often give them a year's supply or samples to fill in the gaps with their coverage stateside.
The truth is that there are dangers with the pill, moreso than with some common medications. But being under a doctor's care, especially not when that's often constrained by time or the money to pay for additional visits and tests, doesn't actually prevent many of those side effects, as "blood clot" is something that needs to be addressed immediately, and not eight months later. That's a bigger problem with health care than just the issues around prescription BC. It's clear that it works out okay in other countries.
posted by jetlagaddict at 1:22 PM on March 11, 2012 [1 favorite]
The truth is that there are dangers with the pill, moreso than with some common medications. But being under a doctor's care, especially not when that's often constrained by time or the money to pay for additional visits and tests, doesn't actually prevent many of those side effects, as "blood clot" is something that needs to be addressed immediately, and not eight months later. That's a bigger problem with health care than just the issues around prescription BC. It's clear that it works out okay in other countries.
posted by jetlagaddict at 1:22 PM on March 11, 2012 [1 favorite]
No one should be taking antibiotics without medical supervision.
Why? Evolved antibiotic resistance? Are you checking every one of these people into the hospital? I'm not sure where you're going with your comment or what you might possibly mean.
posted by Fuka at 1:30 PM on March 11, 2012
Why? Evolved antibiotic resistance? Are you checking every one of these people into the hospital? I'm not sure where you're going with your comment or what you might possibly mean.
posted by Fuka at 1:30 PM on March 11, 2012
The main causes of antibiotic resistance are overuse of antibiotics and people starting a course of antibiotics and then stopping as soon as they feel better. Making people go through a doctor for antibiotics means that at least there's some kind of gatekeeper keeping everybody from starting on antibiotics as soon as they have a cold or a sore throat, and increases the likelihood they'll comply with the treatment regimen.
It's a public health issue after all - people misuse antibiotics potentially harm not just themselves but many other people too.
posted by strangely stunted trees at 1:39 PM on March 11, 2012 [1 favorite]
It's a public health issue after all - people misuse antibiotics potentially harm not just themselves but many other people too.
posted by strangely stunted trees at 1:39 PM on March 11, 2012 [1 favorite]
Why? Evolved antibiotic resistance?
Yes.
Are you checking every one of these people into the hospital? I'm not sure where you're going with your comment or what you might possibly mean.
By "medical supervison" I mean
posted by clarknova at 1:41 PM on March 11, 2012 [8 favorites]
Yes.
Are you checking every one of these people into the hospital? I'm not sure where you're going with your comment or what you might possibly mean.
By "medical supervison" I mean
- having a doctor determine that you actually need an antibiotic
- having that doctor determine which antibiotic is indicated, and at what dosage
- having that doctor explain how and when to take it
- having that doctor explain the importance of completing the full course
- having that doctor on hand to do follow up if the first antibiotic wasn't effective
posted by clarknova at 1:41 PM on March 11, 2012 [8 favorites]
OK here's a thought that will never fly.
Every female of reproductive age that wants to go on birth control will be allowed one free private visit to Planned Parenthood or a doctor in her local. This visit will be kept private for the individual--no parental permission required. They will be examined, given the appropriate birth control RX, and then required to attend a class on reproduction, safe sex, and how to take the pills. Every single woman. Age 13 or 30. If you already know it, then sleep through the class. After that, just present your RX card, pay $10, and you're gold. Women having problems with the original RX have one free pass to go back for a second try. After that, it's fee time. Sort of OTC, but not quite.
Just think of the savings in preventing unwanted pregnancies and follow up social services!!!
posted by BlueHorse at 1:49 PM on March 11, 2012 [3 favorites]
Every female of reproductive age that wants to go on birth control will be allowed one free private visit to Planned Parenthood or a doctor in her local. This visit will be kept private for the individual--no parental permission required. They will be examined, given the appropriate birth control RX, and then required to attend a class on reproduction, safe sex, and how to take the pills. Every single woman. Age 13 or 30. If you already know it, then sleep through the class. After that, just present your RX card, pay $10, and you're gold. Women having problems with the original RX have one free pass to go back for a second try. After that, it's fee time. Sort of OTC, but not quite.
Just think of the savings in preventing unwanted pregnancies and follow up social services!!!
posted by BlueHorse at 1:49 PM on March 11, 2012 [3 favorites]
I would be happy if BC was OTC. A few months ago I went in to see my doctor for something else, and asked her if she could re-up my BC prescription while I was there. I don't have health insurance so that visit was $125, but fine, whatever. No, she couldn't re-up my BC because I was due for a yearly pap smear. So she told me to go to Planned Parenthood to get my pap smear because it would be cheaper. So several weeks later I found time to get to Planned Parenthood, who said, "Oh no you don't need a pap smear, it's every two years, here's your prescription, that'll be $60." $60 for a signature on a piece of paper when it would have taken 5 minutes for my regular doc to just call in a year's worth of refills and let me get the pap some other time. Oh man I feel so safe!
Doctors also don't particularly care which BC you take or why. They just hand out whichever one their drug rep gave them samples of. If that doesn't work for you come back and we'll try a different one. It's very much trial and error and doesn't seem to involve any kind of knowledge the pharmacist doesn't have.
posted by bleep at 1:55 PM on March 11, 2012 [6 favorites]
Doctors also don't particularly care which BC you take or why. They just hand out whichever one their drug rep gave them samples of. If that doesn't work for you come back and we'll try a different one. It's very much trial and error and doesn't seem to involve any kind of knowledge the pharmacist doesn't have.
posted by bleep at 1:55 PM on March 11, 2012 [6 favorites]
That "I for one trust women to be able to read instructions"-type rhetoric is incredibly misguided. There's been quite a lot of research and thought put into ways of making the directions that accompany medicines more comprehensible, and the reason that's necessary is that tons of people have tons of trouble comprehending them. I vaguely recall a paper from a sociolinguistics class I once took that found that something like two in five of the people studied flat-out misinterpreted instructions of the sort "Take two pills three times a day". That is serious, and people get badly hurt because of it. I just think it's too easy for Metafilter-type people not to realise that the sort of medical and scientific literacy they take for granted is quite alien to a lot of people.
Apart from those who just don't ever pay attention to instructions (which must be especially common when it comes to OTC drugs, since people often don't think of them as powerful or dangerous), there are the patients who are very young or old or forgetful or illiterate, or who have learning disabilities or failing eyesight or just fanciful ideas about the way medicines work (like my granny, who would have us put Vicks Vaporub on all our cuts and bruises). And then there are so many people in America who don't speak or read English (or Spanish). So many people everywhere, really, who don't know whatever the local language is. Personally, it was only after being sick in France at a time when I didn't really speak French yet that I fully understood what I'm saying. The only reason I bothered struggling through the instructions on all the medications I had to take was because I was already so much in the habit of reading them in English. But even I once abandoned the results of some important blood work at a lab because I couldn't understand what the next step was supposed to be, and it was just too humiliating to keep asking. It may feel like a sign of respect to just trust people's ability to look after themselves, but medicine is actually quite complicated, and it's not condescending to make sure people have help they actually need. I don't think hormonal birth control should be available over the counter; I think the solution is really for American women to have easy access to medical guidance. And that's all of them, not just the ones fortunate enough to know English, understand medical language, know something about what to expect and how much to put up with when taking a medication, etc.
posted by two or three cars parked under the stars at 2:37 PM on March 11, 2012 [3 favorites]
Apart from those who just don't ever pay attention to instructions (which must be especially common when it comes to OTC drugs, since people often don't think of them as powerful or dangerous), there are the patients who are very young or old or forgetful or illiterate, or who have learning disabilities or failing eyesight or just fanciful ideas about the way medicines work (like my granny, who would have us put Vicks Vaporub on all our cuts and bruises). And then there are so many people in America who don't speak or read English (or Spanish). So many people everywhere, really, who don't know whatever the local language is. Personally, it was only after being sick in France at a time when I didn't really speak French yet that I fully understood what I'm saying. The only reason I bothered struggling through the instructions on all the medications I had to take was because I was already so much in the habit of reading them in English. But even I once abandoned the results of some important blood work at a lab because I couldn't understand what the next step was supposed to be, and it was just too humiliating to keep asking. It may feel like a sign of respect to just trust people's ability to look after themselves, but medicine is actually quite complicated, and it's not condescending to make sure people have help they actually need. I don't think hormonal birth control should be available over the counter; I think the solution is really for American women to have easy access to medical guidance. And that's all of them, not just the ones fortunate enough to know English, understand medical language, know something about what to expect and how much to put up with when taking a medication, etc.
posted by two or three cars parked under the stars at 2:37 PM on March 11, 2012 [3 favorites]
Yeah that's exactly what I meant. My partner's a doctor educated in the EU. She was quite literally shocked to see what you can buy here without a prescription. Not just the drugs I mentioned, but a whole slew of others.
In Dubai, and throughout Asia, virtually anything that isn't a strong narcotic is available without a prescription. The best thing though is being able to buy real decongestants.
posted by atrazine at 2:49 PM on March 11, 2012 [2 favorites]
In Dubai, and throughout Asia, virtually anything that isn't a strong narcotic is available without a prescription. The best thing though is being able to buy real decongestants.
posted by atrazine at 2:49 PM on March 11, 2012 [2 favorites]
Of course help should be available to all who need it. It's just that for some people the requirement is a tremendous, unnecessary burden. If birth control was over the counter there would be no reason why you couldn't go to your doctor or pharmacist with questions the same way you do now.
posted by bleep at 3:08 PM on March 11, 2012 [2 favorites]
posted by bleep at 3:08 PM on March 11, 2012 [2 favorites]
OK here's a thought that will never fly.
Since women have had the bulk of the responsibility for birth control (and the uncontrolled) since the beginning of time, maybe it is time for men to step up?
How about mandatory classes on reproduction and contraception for every single MAN aged 13-103. They really should know of all possible discomforts and dangers associated with ALL the different kinds of contraception that women use - especially IUDs and pills (i.e., blood clots, decreased fertility, ectopic pregnancies, mood swings, nausea, hemorrhaging, PID, weight changes, increased chance of cancers, decreased bone density, yeast infections, migraines, breakthrough bleeding, decreased libido, perforated uterus ...).
If men had to experience any of these in order to prevent pregnancy, not only would birth control be easily available over the counter, it would be FREE. Not to mention the world would be applauding the men for their great sacrifice for the couple's shared joy.
Needless to say ... I have *never* had any sympathy for any man who whines about condoms.
posted by Surfurrus at 4:16 PM on March 11, 2012 [8 favorites]
Since women have had the bulk of the responsibility for birth control (and the uncontrolled) since the beginning of time, maybe it is time for men to step up?
How about mandatory classes on reproduction and contraception for every single MAN aged 13-103. They really should know of all possible discomforts and dangers associated with ALL the different kinds of contraception that women use - especially IUDs and pills (i.e., blood clots, decreased fertility, ectopic pregnancies, mood swings, nausea, hemorrhaging, PID, weight changes, increased chance of cancers, decreased bone density, yeast infections, migraines, breakthrough bleeding, decreased libido, perforated uterus ...).
If men had to experience any of these in order to prevent pregnancy, not only would birth control be easily available over the counter, it would be FREE. Not to mention the world would be applauding the men for their great sacrifice for the couple's shared joy.
Needless to say ... I have *never* had any sympathy for any man who whines about condoms.
posted by Surfurrus at 4:16 PM on March 11, 2012 [8 favorites]
It may feel like a sign of respect to just trust people's ability to look after themselves, but medicine is actually quite complicated, and it's not condescending to make sure people have help they actually need
But in this country many don't. They can't afford the copay on the visits, or they're uninsured. This reality is hopefully changing, but in the mean time, we're not providing the help, so let's at least make the drugs available. I mean really, if you "OD" on birth control pills, let's say by doing something foolish like taking four at once because you missed pills, what's going to happen? You'll get sick to your stomach and throw up, most likely, if you're a healthy young woman. You may accidentally get pregnant, but that might have happened whether they were Rx or not. The realistic abuse/misuse potential just isn't there compared to so many other things we allow to be OTC.
posted by slow graffiti at 4:17 PM on March 11, 2012 [2 favorites]
But in this country many don't. They can't afford the copay on the visits, or they're uninsured. This reality is hopefully changing, but in the mean time, we're not providing the help, so let's at least make the drugs available. I mean really, if you "OD" on birth control pills, let's say by doing something foolish like taking four at once because you missed pills, what's going to happen? You'll get sick to your stomach and throw up, most likely, if you're a healthy young woman. You may accidentally get pregnant, but that might have happened whether they were Rx or not. The realistic abuse/misuse potential just isn't there compared to so many other things we allow to be OTC.
posted by slow graffiti at 4:17 PM on March 11, 2012 [2 favorites]
But in this country many don't. They can't afford the copay on the visits, or they're uninsured. This reality is hopefully changing, but in the mean time, we're not providing the help, so let's at least make the drugs available.
Yeah that's sadly an unassailable argument. If we wait until we have single payer some girls who need it today may be hitting menopause before it's available to them.
If the right gets swept out of power this election cycle we may be able to mount an "expand Medicare to everyone" campaign, and it may get us something. But in the meantime this is the best idea out there.
posted by clarknova at 4:30 PM on March 11, 2012 [1 favorite]
Yeah that's sadly an unassailable argument. If we wait until we have single payer some girls who need it today may be hitting menopause before it's available to them.
If the right gets swept out of power this election cycle we may be able to mount an "expand Medicare to everyone" campaign, and it may get us something. But in the meantime this is the best idea out there.
posted by clarknova at 4:30 PM on March 11, 2012 [1 favorite]
Levonorgestrel is the most widely prescribed contraceptive progestin in the world. It is the active ingredient in numerous prescription-only birth control pills, including popular brands Alesse, Seasonique, and Lybrel. It is also already available over-the-counter in the United States to women over the age of 18 in doses higher than those that require a doctor's prescription. In fact, you can buy it from vending machines in some places without having any contact with an actual human being, much less a medical professional. You may know it as "Plan-B."
If you believe that people can't follow instructions well enough to take hormones without hurting themselves or need doctor's supervision to protect them from the dangers of contraceptive progestin, you should be advocating for the re-banning of over-the-counter morning after pills. While I know that many Americans (and others worldwide) are in favor of such measures, I suspect that most MeFites were and continue to be in favor of over-the-counter access to emergency contraception for adult women.
What Postrel is suggesting here is that the same drug that is already freely available when packaged with instructions on how to take it as emergency contraception should also be freely available in slightly different packaging with instructions on how to take it as non-emergency contraception. If you believe that adult women can take the former without hurting themselves (and our multi-year experiment seems to indicate that they can), you have a very difficult uphill battle if you want to argue now that the latter poses a danger to women or to society that justifies imposing this burden.
posted by decathecting at 4:38 PM on March 11, 2012 [9 favorites]
If you believe that people can't follow instructions well enough to take hormones without hurting themselves or need doctor's supervision to protect them from the dangers of contraceptive progestin, you should be advocating for the re-banning of over-the-counter morning after pills. While I know that many Americans (and others worldwide) are in favor of such measures, I suspect that most MeFites were and continue to be in favor of over-the-counter access to emergency contraception for adult women.
What Postrel is suggesting here is that the same drug that is already freely available when packaged with instructions on how to take it as emergency contraception should also be freely available in slightly different packaging with instructions on how to take it as non-emergency contraception. If you believe that adult women can take the former without hurting themselves (and our multi-year experiment seems to indicate that they can), you have a very difficult uphill battle if you want to argue now that the latter poses a danger to women or to society that justifies imposing this burden.
posted by decathecting at 4:38 PM on March 11, 2012 [9 favorites]
you should be advocating for the re-banning of over-the-counter morning after pills.
That's a bit different. You don't take those every single day (I hope) of the month for all of your fertile life.
posted by Malice at 4:46 PM on March 11, 2012
That's a bit different. You don't take those every single day (I hope) of the month for all of your fertile life.
posted by Malice at 4:46 PM on March 11, 2012
you should be advocating for the re-banning of over-the-counter morning after pills.
That's a bit different. You don't take those every single day (I hope) of the month for all of your fertile life.
There's nothing stopping you from doing so other than that the instructions say you shouldn't. You could buy a dozen Plan-B kits and take the pills every day, or take them all at once, or put them in a delicious pot pie and serve it to guests. There is no legal barrier to you doing so, and no chance for a doctor to warn you not to do so. So basically, you're just hoping that if we don't give people instructions advising them how to take these hormones safely on a daily basis, they won't try it.
posted by decathecting at 4:50 PM on March 11, 2012 [2 favorites]
That's a bit different. You don't take those every single day (I hope) of the month for all of your fertile life.
There's nothing stopping you from doing so other than that the instructions say you shouldn't. You could buy a dozen Plan-B kits and take the pills every day, or take them all at once, or put them in a delicious pot pie and serve it to guests. There is no legal barrier to you doing so, and no chance for a doctor to warn you not to do so. So basically, you're just hoping that if we don't give people instructions advising them how to take these hormones safely on a daily basis, they won't try it.
posted by decathecting at 4:50 PM on March 11, 2012 [2 favorites]
My argument isn't about their ability to take the pills correctly at all. It's about the safety of the pills and the fact that the doctors are there to ensure that you are not getting possibly life-threatening side effects from taking them.
posted by Malice at 5:02 PM on March 11, 2012 [1 favorite]
posted by Malice at 5:02 PM on March 11, 2012 [1 favorite]
Do you believe that levonorgestrel is perfectly safe when taken in large doses at irregular intervals, but potentially life-threatening when taken in small doses on a daily basis? If so, can you provide medical or scientific data to back up that belief?
posted by decathecting at 5:16 PM on March 11, 2012
posted by decathecting at 5:16 PM on March 11, 2012
Do you believe that levonorgestrel is perfectly safe when taken in large doses at irregular intervals, but potentially life-threatening when taken in small doses on a daily basis?
Pretty much all hormonal birth control can have side effects in a measurable portion of the population. Elevated blood pressure, thrombosis, permanent reduction in sexual drive, and so on. This is why medical attention is important when taking them. A physician can screen for these.
Yes, in a system where health care is very expensive and access to reproductive medicine is constantly under attack by political criminals, it's immoral to keep it prescription. But it's equally immoral to think that's good enough and universal medical care can wait till some perfect future.
Not saying YOU think that, but simply making it OTC and washing our hands of it is a lesser of two evils/goods.
posted by clarknova at 6:23 PM on March 11, 2012
Pretty much all hormonal birth control can have side effects in a measurable portion of the population. Elevated blood pressure, thrombosis, permanent reduction in sexual drive, and so on. This is why medical attention is important when taking them. A physician can screen for these.
Yes, in a system where health care is very expensive and access to reproductive medicine is constantly under attack by political criminals, it's immoral to keep it prescription. But it's equally immoral to think that's good enough and universal medical care can wait till some perfect future.
Not saying YOU think that, but simply making it OTC and washing our hands of it is a lesser of two evils/goods.
posted by clarknova at 6:23 PM on March 11, 2012
even then I think it'd be something that would need serious study and thinking about by qualified parties.
Luckily there are lots of people who have done just that, and even entire countries which have gone ahead and offered themselves up as giant research subjects as to what the effect of these policies is. It would appear that there are very few downsides to offering birth control as an OTC drug, meaning a consumer would obtain it after consulting with a pharmacist.
As with many questions about drug legalization, we don't have to just ponder hypotheticals all day; there are places where these policies have actually been and currently are implemented, which we can easily look at. And similar to questions of drug legalization, it's not as though the price of doing nothing is zero -- by doing nothing (or doing nothing while decades of politically-motivated and sabotage-prone studies and expert panels are conducted) we make a decision by default, and that decision has consequences, in this case in terms of increased numbers of unintended pregnancies and everything that they lead to.
posted by Kadin2048 at 8:18 PM on March 11, 2012 [6 favorites]
Luckily there are lots of people who have done just that, and even entire countries which have gone ahead and offered themselves up as giant research subjects as to what the effect of these policies is. It would appear that there are very few downsides to offering birth control as an OTC drug, meaning a consumer would obtain it after consulting with a pharmacist.
As with many questions about drug legalization, we don't have to just ponder hypotheticals all day; there are places where these policies have actually been and currently are implemented, which we can easily look at. And similar to questions of drug legalization, it's not as though the price of doing nothing is zero -- by doing nothing (or doing nothing while decades of politically-motivated and sabotage-prone studies and expert panels are conducted) we make a decision by default, and that decision has consequences, in this case in terms of increased numbers of unintended pregnancies and everything that they lead to.
posted by Kadin2048 at 8:18 PM on March 11, 2012 [6 favorites]
Blasdelb: Historically when medications go OTC in the US the price, and particularly the cost to consumer, skyrockets as insurance companies wash their hands of them.
EarBucket: Do you have links to more about this? My only experience is with allergy medications, and the pill that used to be prescription-only is now 88 cents for a week's supply.
Anecdata: I take Prilosec (omeprazole) twice a day and my insurance has stopped covering it. I used to get a month's supply of generic omeprazole from the pharmacy for $10, transferred from a big bottle to a small bottle and labeled with my name. Now I buy it OTC for $30-35 a month and spend extra time punching the pills out of their blister packs and adding all that extra packaging to recycling and trash. This is not an improvement.
posted by swerve at 11:32 PM on March 11, 2012 [1 favorite]
EarBucket: Do you have links to more about this? My only experience is with allergy medications, and the pill that used to be prescription-only is now 88 cents for a week's supply.
Anecdata: I take Prilosec (omeprazole) twice a day and my insurance has stopped covering it. I used to get a month's supply of generic omeprazole from the pharmacy for $10, transferred from a big bottle to a small bottle and labeled with my name. Now I buy it OTC for $30-35 a month and spend extra time punching the pills out of their blister packs and adding all that extra packaging to recycling and trash. This is not an improvement.
posted by swerve at 11:32 PM on March 11, 2012 [1 favorite]
I don't know about all EU nations, but the ones I've spent time in, all sorts of OTC drugs (ibuprophin, proton pump inhibitors, etc) require prescriptions.
Wait, what? Ibuprofen is OTC in every EU country I've ever been in. Here in Estonia, it's basically like this:
OTC - most NSAIDs, some antihistamines, expectorants, decongestants.
Non-OTC - aside from the obvious, anything of the above with added codeine or ephedrine. Also antiviral topical creams are prescription-only (acyclovir, etc).
posted by unigolyn at 12:59 AM on March 12, 2012
Wait, what? Ibuprofen is OTC in every EU country I've ever been in. Here in Estonia, it's basically like this:
OTC - most NSAIDs, some antihistamines, expectorants, decongestants.
Non-OTC - aside from the obvious, anything of the above with added codeine or ephedrine. Also antiviral topical creams are prescription-only (acyclovir, etc).
posted by unigolyn at 12:59 AM on March 12, 2012
Reading through this thread is unexpectedly sad. My immediate reaction to the OTC debate is to think that a good compromise might be that a script that could last say, 2 or 3 years but that a woman should probably get a checkup at that point. The dr's visit at the beginning and regularly later on would, to my way of thinking, have simply been to make sure it's the right type of medication for the particular woman and that there's no other changes or factors in the woman's life that warrant a rethink. To me, it's just a general preventative/maintenance health policy and money/discrimination/etc doesn't come into it.
But then I see how that will affect poor people and people in backwards-ass states (Perry, I'm looking at you in particular) and it reminds me that I have to totally change my mindset when I contemplate US health care services. It's really hard to envision a system without a basic floor beneath the population. So, in that twisted situation, I would be wholly supportive of OTC access to the pill : the reduction or loss of access would be devastating. It's really that simple isn't it?
This is one of the most important reasons it will be worthwhile voting for Obama later in the year. Solidifying the ACA and getting all the programs up and going will make these arguments about the need for OTC contraception moot at a certain point, hopefully.
posted by peacay at 1:20 AM on March 12, 2012 [1 favorite]
But then I see how that will affect poor people and people in backwards-ass states (Perry, I'm looking at you in particular) and it reminds me that I have to totally change my mindset when I contemplate US health care services. It's really hard to envision a system without a basic floor beneath the population. So, in that twisted situation, I would be wholly supportive of OTC access to the pill : the reduction or loss of access would be devastating. It's really that simple isn't it?
This is one of the most important reasons it will be worthwhile voting for Obama later in the year. Solidifying the ACA and getting all the programs up and going will make these arguments about the need for OTC contraception moot at a certain point, hopefully.
posted by peacay at 1:20 AM on March 12, 2012 [1 favorite]
If birth control was over the counter there would be no reason why you couldn't go to your doctor or pharmacist with questions the same way you do now.
The people I know who have burned little holes in their stomachs taking too much Advil, etc. didn't ask their doctors any questions because like many people, they didn't realise that OTC drugs that everybody takes could be dangerous. There are also lots of people who never go to the doctor for something that feels as trivial as asking questions about drugs they can easily buy. (It's fairly easy and cheap to see a GP where I'm from, and for the person I know who's least informed and most reckless about her medication, it's free. But she hates going to the doctor, so she won't.)
If you believe that people can't follow instructions well enough to take hormones without hurting themselves or need doctor's supervision to protect them from the dangers of contraceptive progestin, you should be advocating for the re-banning of over-the-counter morning after pills.
Of course I don't believe that all people can follow instructions that well. I don't know how anyone could. And my inclination to believe that hormonal contraception needs more supervision when used on a regular basis than in an emergency seems fine to me in light of the fact that fewer women will take Plan B than will take the pill (presumably); that Plan B is a single, well-studied formulation as opposed to the many different ones that are available for everyday use; that it's taken on one occasion which gives people the opportunity to be more alert to any serious side effects than they might be with a pill after they've been taking it every day for 15 months; similarly, that people are less blasé about it than they are about the pill; and, yes, definitely the fact that women spend much less time exposed to those hormones than they do to those of their regular contraception. My little sister was friends with a girl who died of a stroke because of her birth control - it took much more than a day for that to happen. (I mean, I only have two more minutes to spend on this post before I leave home, so I can't look up any studies, but the implication of the question "Do you believe that levonorgestrel is perfectly safe when taken in large doses at irregular intervals, but potentially life-threatening when taken in small doses on a daily basis?" that the dose of hormones should be more relevant than the length of exposure to them seems absurd to me.)
You know, I acknowledge that there would be advantages to making birth control pills more accessible to women, and it might be that they would outweigh the dangers. What I resent, and what I was objecting to in my earlier post, is the idea that a desire to be cautious with these drugs must come from a place of not respecting women's intelligence, and that only people who share Postrel's opinion "trust" women enough. It's a really dishonest way to talk.
posted by two or three cars parked under the stars at 2:09 AM on March 12, 2012 [1 favorite]
The people I know who have burned little holes in their stomachs taking too much Advil, etc. didn't ask their doctors any questions because like many people, they didn't realise that OTC drugs that everybody takes could be dangerous. There are also lots of people who never go to the doctor for something that feels as trivial as asking questions about drugs they can easily buy. (It's fairly easy and cheap to see a GP where I'm from, and for the person I know who's least informed and most reckless about her medication, it's free. But she hates going to the doctor, so she won't.)
If you believe that people can't follow instructions well enough to take hormones without hurting themselves or need doctor's supervision to protect them from the dangers of contraceptive progestin, you should be advocating for the re-banning of over-the-counter morning after pills.
Of course I don't believe that all people can follow instructions that well. I don't know how anyone could. And my inclination to believe that hormonal contraception needs more supervision when used on a regular basis than in an emergency seems fine to me in light of the fact that fewer women will take Plan B than will take the pill (presumably); that Plan B is a single, well-studied formulation as opposed to the many different ones that are available for everyday use; that it's taken on one occasion which gives people the opportunity to be more alert to any serious side effects than they might be with a pill after they've been taking it every day for 15 months; similarly, that people are less blasé about it than they are about the pill; and, yes, definitely the fact that women spend much less time exposed to those hormones than they do to those of their regular contraception. My little sister was friends with a girl who died of a stroke because of her birth control - it took much more than a day for that to happen. (I mean, I only have two more minutes to spend on this post before I leave home, so I can't look up any studies, but the implication of the question "Do you believe that levonorgestrel is perfectly safe when taken in large doses at irregular intervals, but potentially life-threatening when taken in small doses on a daily basis?" that the dose of hormones should be more relevant than the length of exposure to them seems absurd to me.)
You know, I acknowledge that there would be advantages to making birth control pills more accessible to women, and it might be that they would outweigh the dangers. What I resent, and what I was objecting to in my earlier post, is the idea that a desire to be cautious with these drugs must come from a place of not respecting women's intelligence, and that only people who share Postrel's opinion "trust" women enough. It's a really dishonest way to talk.
posted by two or three cars parked under the stars at 2:09 AM on March 12, 2012 [1 favorite]
unigolyn: "Wait, what? Ibuprofen is OTC in every EU country I've ever been in."It's a prescription drug in Denmark. I think it is in Germany as well.
posted by brokkr at 3:16 AM on March 12, 2012
There's been quite a lot of research and thought put into ways of making the directions that accompany medicines more comprehensible, and the reason that's necessary is that tons of people have tons of trouble comprehending them.
You know, I find that a compelling argument. (I've never had a doctor give me any verbal instructions about how to use medicine, but that's a separate issue.) I hadn't thought about the many people who can't read instructions but it's a larger group than I would have imagined. News article about the National Assessment of Adult Literacy: "A long-awaited federal study finds that an estimated 32 million adults in the USA — about one in seven — are saddled with such low literacy skills that it would be tough for them to read anything more challenging than a children's picture book or to understand a medication's side effects listed on a pill bottle."
posted by Houstonian at 3:23 AM on March 12, 2012
You know, I find that a compelling argument. (I've never had a doctor give me any verbal instructions about how to use medicine, but that's a separate issue.) I hadn't thought about the many people who can't read instructions but it's a larger group than I would have imagined. News article about the National Assessment of Adult Literacy: "A long-awaited federal study finds that an estimated 32 million adults in the USA — about one in seven — are saddled with such low literacy skills that it would be tough for them to read anything more challenging than a children's picture book or to understand a medication's side effects listed on a pill bottle."
posted by Houstonian at 3:23 AM on March 12, 2012
It's a prescription drug in Denmark. I think it is in Germany as well.
Low-dose ibuprofen (200 mg.) is OTC in Denmark:
posted by katemonster at 9:57 AM on March 12, 2012
Low-dose ibuprofen (200 mg.) is OTC in Denmark:
In Denmark, all nonaspirin NSAIDs except low-dose ibuprofen (200 mg per tablet) are available only by prescription. Although low-dose ibuprofen is available without prescription, pensioners and regular users of this drug, eg, patients with chronic diseases or pain requiring prolonged treatment, are presumably all registered in the Prescription Database because they receive a 50% refund when the ibuprofen is prescribed by a physician.That's pretty much the same as in the U.S., where 200 mg. is the dosage available OTC and higher doses are prescription only and are eligible for insurance coverage.
posted by katemonster at 9:57 AM on March 12, 2012
The main article seems like it was pretty intentionally misleading ... Historically when medications go OTC in the US the price, and particularly the cost to consumer, skyrockets as insurance companies wash their hands of them.
Blasdelb, you're going to have to back that claim up with data. Every instance I'm aware of (from an admittedly small pool of meds I use that have gone OTC during my adulthood) got cheaper OTC. And market assumptions - increased sales due to increased market drives more efficient manufacturing, and competition - make that seem more likely.
posted by IAmBroom at 10:38 AM on March 12, 2012 [1 favorite]
Blasdelb, you're going to have to back that claim up with data. Every instance I'm aware of (from an admittedly small pool of meds I use that have gone OTC during my adulthood) got cheaper OTC. And market assumptions - increased sales due to increased market drives more efficient manufacturing, and competition - make that seem more likely.
posted by IAmBroom at 10:38 AM on March 12, 2012 [1 favorite]
I'm in my waning reproductive years. Still need the birth control, so I use the ring. Piece of cake, easier than pills, etc. I buy it from Canada because it's 40 percent cheaper over there. But I still have to see my doctor once a year (and for those of you who say a pap smear isn't required, shut up. Of course it is, if you don't have any evidence that you've had one in the last 12 months. It's always a package deal at the ob/gyn). I'm perfectly capable of handling putting the ring in and then 3 weeks later, taking it out. Most of the women I know who complain about the complications of the pill...they are overweight, have high blood pressure, and a lot of them smoke. Of course, they never tell their doctors they smoke.
OTC. Without a doubt. Good grief, prenatal care isn't required by law and that has much more serious implications than complications from the pill.
posted by Kokopuff at 11:26 AM on March 12, 2012 [5 favorites]
OTC. Without a doubt. Good grief, prenatal care isn't required by law and that has much more serious implications than complications from the pill.
posted by Kokopuff at 11:26 AM on March 12, 2012 [5 favorites]
I would be equally as happy with a compromise. Fine, if we can't have OTC birth control does it have to be such a huge pain in the ass to get a new prescription every year. Or how about we permanently couple prostate exams with Viagra prescriptions. Not going to happen.
I wish the answer to people on the whole not being able to understand their medications was "Teach this country how to read for God's sake" and not "Make medications difficult to obtain". That's the larger problem apparently. It's horrifying.
posted by bleep at 5:49 PM on March 12, 2012
I wish the answer to people on the whole not being able to understand their medications was "Teach this country how to read for God's sake" and not "Make medications difficult to obtain". That's the larger problem apparently. It's horrifying.
posted by bleep at 5:49 PM on March 12, 2012
I appreciate the concern for women's health, but no doctor who has ever prescribed me birth control has said more than "here's ya birth control." In fact, they've spent the most time telling me that birth control won't protect me from STDs, which is true and important, but I don't see why it necessitates a doctor's appointment, especially when that shit ain't free.
Pap smears are great, obviously, but at this point in my life I have about four pap smears a year, and if I could streamline the whole birth control thing a bit that would be nice. I'm lucky to have a Planned Parenthood nearby where I can get these things for free, but if I couldn't, this would be incredibly frustrating.
posted by stoneandstar at 6:52 PM on March 12, 2012 [1 favorite]
Pap smears are great, obviously, but at this point in my life I have about four pap smears a year, and if I could streamline the whole birth control thing a bit that would be nice. I'm lucky to have a Planned Parenthood nearby where I can get these things for free, but if I couldn't, this would be incredibly frustrating.
posted by stoneandstar at 6:52 PM on March 12, 2012 [1 favorite]
The way some people on the left have been talking about this issue reminds me of the way people on the right like to talk about business. These rules regarding birth control may be needed to protect people who haven't had the privileges that would have made them as able as some of you in navigating the worlds of health and medicine in the same way as regulations are needed in business, real estate, banking, etc. to protect people who haven't had the privileges that would have made them as able as greedy rich people to navigate those worlds. It seems like there are ways the process of obtaining medicine could be made less expensive and difficult, but the right thing to do is to work on those, not to just totally deregulate because it would make it so much easier for people like yourself who already know what they're doing. I don't even know what something like "Most of the women I know who complain about the complications of the pill...they are overweight, have high blood pressure, and a lot of them smoke" is supposed to imply. So to hell with those women? The fact that there are women whose health status or life choices combine with the pill in a way that is dangerous to them and causes them complications seems to me like a great reason doctors should be involved in distributing these medications.
posted by two or three cars parked under the stars at 2:29 AM on March 13, 2012
posted by two or three cars parked under the stars at 2:29 AM on March 13, 2012
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