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A high school student gets caught popping a pill at the lunch table. Had she been taking an illegal drug, Fairfax County's "zero tolerance" policy would have called for a 5-day suspension. But she was taking birth control prescribed by her doctor and purchased by her mother. A student who brings a "controlled substance" into a Fairfax County high school is subject to the same penalties as a student carrying a gun. So the girl was suspended for two weeks and "recommended for expulsion." Last Thursday, The Washington Post reports, "a long table full of school officials weighed her case at a hearing."
I don't doubt that Ortho Tri-Cyclen is extremely dangerous to a certain social order—far more so than is, say, heroin. But it seems like the kind of thing public high schools should be encouraging.
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A new study conducted of 443 women in Britain found they were more likely to indulge in an "impulse buy" and to "overspend" during the days leading up to their period. As this BBC News story puts it, "Almost two-thirds of the 153 women studied who were in the later stages
of their menstrual cycle—known as the luteal phase —admitted they
had bought something on an impulse and more than half said they had
overspent by more than £25." The psychologist leading the study, Karen Pine, speculates that buying is often emotional. Hmm, really? I haven't read the study yet, so I can't tell how scientific it is. But if there is anything to it, it points to just how complicated budgeting in a time of real belt-tightening is. For years, economists acted as though spending were based on rational ideas about value; behavioral economists have shown that the way people actually make decisions seems to have much more to do with psychology. Are psychologists now going to say hormones at the root of everything? If so, should women all go on the pill for the duration of the recession? Maybe it really is time for the government to make the pill available right next to the Advil.
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Emily, thanks for the link to that meta-analysis in cautious support of over-the-counter birth control. For what it's worth, I certainly didn't mean to imply that annual cancer screenings are a waste of time. I am arguing that doctor's visits made solely for the purpose of obtaining permission to access a relatively safe form of contraception are pointlessly and harmfully burdensome. I've had to make quite a few such visits, in part because I move frequently and am incapable of getting an overworked doctor on the phone with an understaffed pharmacy. It's possible that I am overgeneralizing from my own deeply annoying experiences.
I've lived in countries where the pill is kept behind the counter and would be more than happy with such a compromise. But the FDA, unlike its counterpart agencies in England and Canada, only very rarely considers this third option due to complex regulatory barriers. (When the FDA rejected OTC status for Merck's Mevacor, for instance, several panelists said they'd be comfortable with the drug as it is sold in British pharmacies; in other words, behind the counter. They weren't given such an option, so the panel overwhelmingly voted down the application.) It's not clear that the FDA even has the authority to create a third class of drugs. But thanks in small part to Plan B, it looks like our binary classification system might be changing.
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An answer from Slate medical columnist Amanda Schaffer to my question about why the Pill is a prescription drug. Amanda supports, with caveats, Kerry's argument that oral contraceptives should be sold over the counter:
The downside risks of the pill (strokes, breast cancer) are pretty small, especially with newer formulations. And the upside of reducing ovarian cancer risk (as well as preventing unwanted pregnancy, of course), has led some researchers to argue for over-the-counter access; in fact, a meta-analysis in the Lancet from last year had an accompanying editorial making this case. The counterargument is that women who smoke or get migraines should not be on the pill, and a doctor's involvement might prevent that from happening. Plus, since women stay on oral contraceptives for long periods of time, it may be wise to have more medical oversight.
Amanda and I disagree with you, Kerry, that annual visits to the gynecologist are a waste of time. Breast exams, pelvic exams—that's trouble-catching time.
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I, too, applaud the move to make Plan B available over the counter for 17-year-olds, but, Kerry, I have to raise one problem that could accompany making hormonal birth control OTC: insurance. Many insurance plans don't cover OTC medication, unless it's a special program intended to keep costs down, like providing an incentive for people to use a specific OTC heartburn medication instead of an expensive prescription drug that's not more effective. Insurance companies like the checks and balances of going through a doctor and a pharmacist before shelling out. Yaz, which you mention, costs about $60 per month retail, I believe, depending on the store, the state, etc. Planned Parenthood and other resources might step in to help, but those of us who already have high copays on birth control would feel the hit if we had to start paying full price. Considering the battles waged over getting insurance companies to pay for birth control, I can't imagine that many plans would be willing to alter their OTC policies to cover the an over-the-counter pill.
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Back during the ridiculous brouhaha over access to the morning-after pill, regulators compromised by making the pill available without a prescription only to women of 18 years of age or older. A federal judge, noting that this restriction is arbitrary and without medical justification, has ordered the FDA to review the policy and make Plan B available to 17-year-olds in 30 days. I imagine that the policy will change pretty quickly; you know things are looking up when the Washington Post has to go to Concerned Women for America to find some quotable pushback.
All of which allows me to climb astride an old hobby horse: Regular old birth control ought to be available without a prescription. Hormonal birth control meets all of the FDA requirements for over-the-counter access; Plan B, after all, is just a mega-dose of the pill. We've all heard stories of women being denied birth control by squeamish doctors and pharmacists; there is no reason such women shouldn't be able to grab stacks of Yaz off the shelf at Walgreens. The aggregate burden of all those pointless doctor's appointments and hourlong pharmacy waits is surely massive.
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Really, Abby? The clothes washer? Hmmmpf. I can understand why the Vatican might eliminate my nominee from the running for, er, political reasons, but, as lovely as it was to toss the washboard in exchange for an automatic top-loading agitator, it's pretty obvious oral contraception did far, far, more for women's liberation than the washing machine. Birth control pills revolutionized women's sex lives. In a contest for "what contributed most to the emancipation of Western women," laundry doesn't even come close.
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