• Plan C?

    It seems odd to not comment on yesterday’s decision by the administration to veto the FDA’s ruling to allow all girls of childbearing age to purchase Plan B (emergency contraception) over the counter, without a prescription.

    Let’s back up. Until now, all adults could buy it without a prescription. Those who are 17 years old could also buy it without a prescription if they could prove their age. If you’re 16 and younger, you need a prescription. There aren’t a lot of medications that fall into this odd category. Pseudoephedrine is one, and that’s cause people were buying it to make crystal meth. Meds to help you quit smoking are another, because theoretically you shouldn’t be able to buy cigarettes until you’re 18 (again, see head under sand). But almost every other medication is either completely over the counter, or by prescription, regardless of age.

    My go-to wonk on issues of women’s reproductive health is Sarah Kliff. So I suggest you go read her thoughts on the issue.

    Me? From the perspective of a pediatrician, I can tell you that no matter what you think, girls are having sex before they are 18. There are plenty of 16 year olds (some even younger) out there doing it. You can legislate against it, educate against it, and moralize against it, but it’s happening. I think that preventing an unwanted pregnancy from happening in the first place is better for everyone than dealing with whatever choices are made after the fact. That’s what Plan B does, and the FDAs recommendation was to allow girls an easier path to avoid getting pregnant.

    The wonk in me understands the competing arguments, and the political issues intertwined with them. Since I have the luxury of not running for office, I’ll tell you that I believe the evidence supports the FDAs decision. But what I find fascinating is that this is the first time ever that the secretary of HHS has overruled the FDA. There have been plenty of controversial decisions, but it pains me that an administration that promised to shield science from politics chose this decision to make a stand.

    I’m sure the debate is far from over. I also look forward to hearing more details about the administration’s rationale for this unprecedented move. I have no doubt they will be fielding lots of angry questions.

    • Aren’t you missing another (also non-political) side to this issue — namely what are the health consequences of repeated use of Plan B?

      • That has been studied. And, if you’re concerned that it hasn’t been studied in 11 year olds, then restrict the sale to 11 year olds without a prescription.

    • So, if you’re 16 and don’t want to involve your parents, you get one of your 17-year old friends to buy it for you. Just like you get your beer and your cigarettes.

      I, too, am outraged that a Democratic administration would use anything other than science in making this decision. It sets a really, really, lousy precedent.

      However, I don’t think the practical impact on young women is as great as the advocacy groups are making out.

    • @Dr. Carroll–

      You wrote: “The wonk in me understands the competing arguments, and the political issues intertwined with them.”

      I read your linked article by Sarah Kliff. The only arguments I saw against the relaxation of the rules as recommended by the FDA was the following sentence: “Opponents of easier access, meanwhile, hailed the decision, saying relaxing the rules would have exposed girls and women to risks from taking high doses of a potent hormone and misusing the medication; interfered with parents’ ability to monitor their children; and made it easier for men to prey on vulnerable minors.” These arguments appear to be typical fear mongering rather than medically or scientifically sound arguments.

      When you indicated that you “understand the competing arguments” I am not sure what you mean. You acknowledge that the evidence supports the FDA but make it sound like a close call. Is this issue really a close call in your opinion? If so, what do you see as the genuine arguments against the FDA position and in favor of the Secretary’s action? If not, then what “competing arguments” do you really “understand” (medical or scientific,that is, rather than moral or political)?

      In other words, do you really think there is a meaningful risk that relaxing the rules for minors would “exposed girls and women to risks from taking high doses of a potent hormone and misusing the medication”? Do you really believe that the new rules would improperly “interfered with parents’ ability to monitor their children”? And are you really saying that you think that a valid argument is made by people asserting that this change would have “made it easier for men to prey on vulnerable minors”?

      Please clarify. I have been following you for some time now, and I would be surprised to find that you would think these arguments are persusive. I would have thought that you would recognize them as nothing more than “cover arguments” (in terms of the actual medical risks) and the expression of certain people’s desire to impose their moral view of the world (no matter the negative real world consequences) rather than following scientific findings regarding the risks and efficacy of medical usage.


      • I understand the competing political/moral/ethical arguments. You can understand something without agreeing with it.

        As I stated in the post, I think the FDA was correct in their interpretation of the science.