FDA approves first nonprescription daily oral contraceptive
fda.gov
fda.gov
Just one note about the phrasing of all the headlines: they’re phrased as if the FDA did a good thing, but it’s better to imagine this as the FDA _stopping_ doing a bad thing. The only reason that we haven’t had over the counter oral contraceptive for the last fifty years is because the FDA _didn’t_ allow it over the counter.
This describes every over-the-counter drug that has ever been sold. Keeping contraception prescription-only has always been about politics.
[1] https://theweek.com/articles/470330/birth-control-human-righ...
So I search for the report itself: https://www.unfpa.org/sites/default/files/pub-pdf/AR%202012%...
And the claim is nowhere near the one you are making. What the UNFPA (who can't even declare anything a human right, by the way) is saying is:
>Family planning is anchored in respect for human rights, women’s empowerment, and social justice and quality.
And
>In October, UNFPA published its annual The State of World Population report, which made the case that family planning is a basic human right that unlocks unprecedented rewards for women in terms of health, economic power and gender equality.
Putting medical barriers to access the pill is by no means whatsoever a violation of human rights.
Whether one agrees or disagrees with this, the argument is not strong enough to warrant a prescription requirement.
(Also and separately: human bodies are complex. If you talk to a few women you might discover that IUDs are not universally tolerated and condoms are not an acceptable substitute for a variety of reasons. There are good reasons many women choose to take oral contraceptives, even though they have a daily use requirement.)
This isn't just about kids, it's also about the inconvenience and added cost (to pay for the doctor visits) placed on all women who use oral contraceptives. I'm not sure how it relates at all to this announcement.
The pill is simply one of the safest options on the market. It's not perfect, but it's generally super well tolerated.
[1] https://www.consumersafety.org/medical-device-lawsuits/miren...
Neither of those are a thing someone buying tylenol has to worry about. Disingenuous or poorly considered to think it can _only_ be about politics imo.
Taking Tylenol wrong kills you.
I would highly doubt it. Contraception is already abundantly avaliable, including in online visits. I could see people switching from Rx to OTC. But I really don't think you could have a big enough increase in non-users to OTC to have any significant data.
Emerg docs giving out NAC like candy for acetaminophen overdoses. It would never be approved if released today, but we've got a long history with it being OTC, so I don't see that changing.
Everything you said here you can apply to other behaviors, ranging from alcohol/marijuana consumption, to eating fast food, to skydiving.
OTC here is a result of politics specifically because access is being restricted or in the midst of being restricted. The reason this wasn't OTC was because there just wasn't a need to bother with it. Now there is.
> I wouldn't be surprised if there was a, smallish, correlated increase in STDs, as well.
This is really unsubstantiated and it would be nice if you didn't say things like this in the context of this conversation here unless you're going to provide a legitimate source. Even then if this were true I'm going to guess that an infinitesimal and unsubstantiated risk of higher STD rates is nothing compared to unwanted pregnancies from a public health standpoint.
Condoms and the pill are the most used contraceptive methods in the US, by far. Given that condoms prevent STDs, it would actually be a surprise if, everything else equal, those who use the pill didn't have slightly more STDs.
The problem with the unsubstantiated claim (besides the fact) is that it ignores the broad public health picture (what's worse, 5 more people/year get herpes or 5 unwanted babies in trash cans?) and injects, frankly, useless information and FUD into the conversation.
It's done so intentionally to attach negative externalities that are truth-y to a topic when their relevance and impact are quite trivial.
What I mean here is that this may cause an increase (again on the OP to substantiate this claim) of .0001% in general STD contraction, but in a given paragraph the "fact" is given much more weight than it otherwise deserves precisely because the numbers aren't provided - each piece of the claim has equal grammatical weight.
Cognitively, without the numbers (and probably with them even), you associate birth control negative externalities with "INCREASE IN STDS11!!" and now all of a sudden you find that since you are opposed to increases in STD contraction now you are sort of on the fence and maybe opposed to birth control.
"Just use a condom" (until we find some problem with those) and then it becomes "just don't have sex unless you want a baby".
This may seem conspiratorial but these are very specific debate and discussion tactics used by others to slowly chip away at rights and freedoms that we enjoy which is why it's important to call out items like this and require that if someone is going to make a claim they should provide factual evidence supporting that claim.
Until that's done, I'm going to claim that birth control decreases STD rates.
It’s confusing that you’d focus on that specific point versus everything else I wrote though. It should be obvious that the point was to show that I can make equally valid unsubstantiated claims, not that I was making one - the claim which would be irrelevant here anyway.
This is the political angle I mentioned. You're suggesting that easier access to birth control will result in more unwanted pregnancies than limiting access to birth control. It's so silly it doesn't really warrant a response, but I did want to highlight that logic this flimsy typically only serves political positions.
Also...it's not in FDA's remit to regulate the number of pregnancies in the US. This is really reaching.
In my country abortion access isn't under threat, except in the loose sense that of course there are people who insist it's immoral and would like to ban it and some of them try to intimidate patients. Nevertheless the pill isn't an OTC medication. Emergency contraception (the "morning after pill") is available from a pharmacist but I believe the pill requires a prescription.
My daily pills (my thyroid gland is gradually dying) require a prescription too. I hit "renew" in the app every couple of months, I get two more one month packs, pick them up from a self-service machine a week or so later - rinse, repeat. Seems reasonable.
These medications are safe for everyone. There is noting a doctor does to evaluate whether you're healthy enough to take them. They literally just write the script and explain how to take it. Medications where the doctor visit is a formality should just be OTC with maybe an informed consent paper given to you by the pharmacist.
The opposition is just politically-religiously motivated concern trolling.
Then why do European countries require a prescription too?
France still requires a prescription but it's theater since the doctor can't deny you. There's just been little appetite for to reclassify birth control because going to the doctor isn't that much of a burden and most countries have laws against disclosing contraceptive use to parents. But now there's momentum.
The downside of forgetting to take more advil in time is short-term pain. The downside of not understanding that your birth control isn't working is a child.
As we've seen with patients stopping antibiotics early, even though they're prescription!, people make uninformed choices with medication. Depending on what it's for, there are more or less risks of making it OTC.
All of that said, I agree that this has mostly been politics.
[0]: https://www.plannedparenthood.org/blog/is-the-birth-control-...
So hey, the OTC medicine gods giveth and taketh.
This seems antiquated at best. They could've approved some kind of app or process to streamline this. I'm sure it's not the only kind of medication this situation applies to.
The potential danger of forgetting to use a condom or misusing one (like a condom that's too old) is also a child. Condoms are currently sold in truck stop bathrooms.
I really see no distinction between a condom and a birth control pill. Even with misuse, making the pill more widely available will almost certainly be a social good. It will prevent more unwanted children.
Which is why I don't get the point I responded to. "You might get pregnant if you misuse this" isn't something to consider when talking about OTC contraceptives. It's practically a tautological statement "If you misuse a contraceptive, you might get pregnant"
1) Health. Agree that talking to a doctor -- or a nurse, or a midwife, or a well-trained community health advocate -- is quite useful when understanding the practicalities of taking hormonal birth control. Talking to someone helps people understand this; I think you may overestimate the efficacy of an MD per se here.
2) Insurance as gatekeeper. The narrow windows to get a limited supply, whether you can get it locally or must mail order it or can't mail order it or can or can't get a refill -- none of this is medical. It's all insurance bureaucracy. I find no benefit to this bureaucracy.
Good education about the full range of options would be great (from pill to ring to IUD to condom). Universal health care availability would be a good mechanism by which to deliver that, it's hard to accomplish when it's all gatekept by insurance.
I got laid off recently & had a routine physical that took place 2 days after my health insurance thru Company ended, went anyway, got a bill for $552. This is for conversation only, haha, but the type of conversation one would need to get an annual renewal for birth control controlled by prescription.
[1] https://www.health.harvard.edu/pain/acetaminophen-safety-be-...
It’s one of the most popular medications in the world and its use isn’t especially supported by science. To the point of this thread, don’t mistake official policy for rational behavior.
Here’s an NIH meta analysis: https://pubmed.ncbi.nlm.nih.gov/33786837/
There are lots of studies out there, throw whatever symptom + acetaminophen effectiveness into Google for more. Just make sure that if a study is making a big deal about stat sig to check the actual treatment effect.
Anecdotal, but acetaminophen has been my goto for fever reduction. I've never had a problem with it (and it's taken me from 103->98 fairly frequently).
And, unlike most NSAIDs, it's safe(ish) for younger kids.
That said, I've never really noticed the pain killing effects.
That is what it is supposed to be and do.
Ibuprofen is in almost all ways a better drug overall for parents/home use, but because of some rare reaction to it, it's not suggested until 6 months, so most parents assume Tylenol is "safer" and never switch over.
The thing about the weak fever reducing is it’s useful for reducing the suffering from the fever itself, like letting your baby sleep. It’s surprisingly ineffective at reducing febrile seizures. I think it’s that it doesn’t have much against a fever that bad.
My understanding is that for chronic pain the evidence is sparse, but for postoperative pain it definitely works.
Broadly accessible reproductive healthcare is about as impactful as vaccines from a value delivered for the cost perspective. You want to avoid as many both unintended and unwanted pregnancies as possible (which ["unintended"] stands at about half of all US [3] and global [4] pregnancies annually).
EDIT (hn throttling, can't reply): People who don't want children should be enabled and empowered to not have them. I am surprised that is a controversial opinion.
[1] https://www.pbs.org/wgbh/frontline/article/how-poverty-can-f...
[2] https://news.ycombinator.com/item?id=33991744
[3] https://www.guttmacher.org/sites/default/files/factsheet/fb-...
[4] https://www.unfpa.org/press/nearly-half-all-pregnancies-are-...
The question was how/why, not to simply restate it as fact wilit supporting data.
"If the argument is that getting a prescription is such a simple task it should cost almost nothing and be done instantly, then it likely doesn’t need to exist as a barrier at all."
That's not the argument. The argument is that the current system already meets the needs, so what real benefit does OTC provide? It's mostly a counterpoint to someone claiming that it's an overly complicated process. Even if it is cheap and fast, the benefit to an Rx is that someone reads the 6 or so questions off the Epic screen (or the user answers them on online) to ensure there are no interactions or elevated risks.
I'm not saying OTC is the wrong answer, but I'm not seeing any real arguments for real added net benefit from it.
Annual checkup, prescriptions only good for three months, and then typically only allowed to pickup one month dose at a time. That is a huge logistical burden being put on people. Maybe if a prescription was annual and included a year of pills, that would make the OTC case marginally less compelling. Given the status quo, OTC would be an improved quality of life for many.
You can't get a year of pills at one time. These pills expire 1 year from the manufacture date.
'"Likely" isn't enough here'
Why wouldn't it be - just because you say so? Keep in mind the alternative is that they make too much to qualify, which gives them other options.
Keep in mind your definition of unbanked is only about checking and savings accounts. It has nothing covering credit cards or prepaid cards, which are also options. So saying people are unbanked and would likely be burdened isn't enough.
It feels to me like there wasn't much investigation or thought involved in the overall process. They're just going to use the safety study from 1973 and a small nonprescription study to bring back a pill that was uneconomical for the company to sell as Rx. Seems a lot like the notorious 510k process they use for medical devices. So I'm not saying it's the wrong thing to do, but I'm skeptical of the benefits. They don't have any compelling reasoning to make me believe there will be a bet benefit when they fail to quantify several of the risks and only provide a comparative analysis with OTC only products of the potential failure rates without any impact analysis on the desired metric of unintended pregnancies.
That might not be a bad idea. In theory, a prescription means that a doctor who has an intimate knowledge of the patient's health works with the patient to make a carefully-considered mutual decision about medication.
In practice, much of the time the process is just a formality which imposes a huge time and financial cost on some patients as well as reducing the time the doctor has for patients who really need more attention. In the past, when access to information was more difficult, this might have been necessary.
In the modern world, a simple automated flowchart on a pharmacy website or in-store terminal can do as good a job selecting appropriate medications, avoiding drug interactions, screening for side effects, and informing patients how to take the drug correctly than a doctor. Of course, not every condition can be treated by merely dispensing pills, nor is this appropriate for medications that require more in-depth monitoring or have severe public health consequences.
Advertising drugs should probably be more restricted than it is now to put such a system in place.
In related news, it is shockingly easy to get messed up real bad by Tylenol. But you can get it in a 500-pill bottle from Costco.
And I'm thinking, maybe? Maybe if you can think of a medication that can wreck you that easily, the problem lies on that medication too?
Should every substance which doesn't mess you as hard as Tylenol be OTC?
- Had to go to yearly appointments to continue receiving it
- Could not pick up more than a month at a time, which created logistical issues since they HAD to take it daily
- Had to get the prescription renewed every three months or so, which often led to delays filling it
This thread (edit: at the time I am posting this) is full of men with little real knowledge of this drug insisting on why it’s reasonable it took 50 years for this to be available OTC. I don’t think the contents of their explanations are likely to be accurate, but I think they still explain why it took 50 years to be approved.
I'm a self taught developer with nearly three decades of experience, still spending 10+ hours a week expanding my craft (reading/experimenting). But in the past 5-7 years have spent twice that time on food and nutrition science study. Part of that understanding research quality, not just quantity, and the value of different types of testing vs study.
To put it another way: if you could have acquired all of that knowledge without spending so much time and effort, then why didn't you?
I'm not sure what you are asking exactly. The initial response above seems to indicate that a person shouldn't speak on something outside their primary career. So my question is, at what point is one able to pass the bar of being able to speak to a subject materially?
>The initial response above seems to indicate that a person shouldn't speak on something outside their primary career.
Already addressed this in the very comment above that you replied to. This is incorrect.
Regarding where the "bar" is exactly, that is of course subjective. But I reject any idea that its subjectivity implies that all opinions are valid or whatever it is you're suggesting, because they're not. Some opinions are uninformed, and I have no problem saying so.
I bring the above up, because even a lot of doctors are ill informed. Not to mention nutritionists that are institutionally trained in dogma first, for licensure. Australia is over a decade ahead of the US at this point, and EU is about half that ahead. US nutrition is too entwined with industrial agriculture.
On TFA, I don't have too much opinion on the specifics. Other than gatekeepers gonna keep gates. It's as likely big pharma ran the numbers that they'd make more with this medication being OTC today, where a few years ago it was better gatekept. And they just, finally, pushed for OTC from the FDA. That mostly comes from my general opinions around the incestuous relationship of the FDA and private industry (similar to USDA).
"Not to mention nutritionists that are institutionally trained in dogma first, for licensure."
Nutritionist is not a protected title in the US or Australia, and actually requires no training whatsoever. It does require training and licensure to become a dietitian, because it's a clinically focused role. In many cases dietitians have prescribing privileges and are prescribing recipes for intravenous or tube fed nutrition.
That's why they're so heavily regulated my dude, I promise you clinically focused dietitians are not using the kind of industry research you're talking about. They are following protocols established over decades of clinical practice.
And if you're wondering why doctors are ill informed, it's because they're not typically trained in nutrition outside of the basics (outside of gastroentorology). Modern medical teams rely on a ton of support staff, one of those being clinical dietitians. Your doctor's job is to know who to consult.
So, dieticians never suggested limiting cholesterol, and cutting out all saturated fat?
Was I incorrect in that assumption? Or do you genuinely want to relax the licensure requirement for people who write IV prescriptions?
That’s almost every reply on HN that isn’t specific enough to let someone shine through with their tech experience. It’s been like this as long as I’ve been here.
EDIT: It occurs to me that I've been here for just over 10 years as of last month. Time really flies.
That's pretty contrary to the typical diversity rationale that suggests out group people have valuable inputs. I think it makes a lot of sense to have society as a whole making decisions about how society as a whole operates. It's not just an individual's choice if they take a drug which may or may not end up being like thalidomide. At the very least it affects fathers, and those born with the side effects.
Of course women should have a voice in this area, but also should many other groups :)
It is my right to say: "I command you to dye yourself blue and dance for my amusement." And it's your right to tell me to fuck off.
Well yeah, the men who prevented it from being OTC for so long didn't do it out of skepticism that it was safe; just like every other time women's rights have been restricted, it's about control. Concern over medical safety is just a convenient political distraction to avoid having to defend regressive social policies. If the people who rules like these actually cared about women's health, they would take into consideration that some women need medication like this for issues that aren't related to trying to avoid pregnancy when having sex. Even labeling medication "birth control" is just a way to ignore the fact that sometimes there are conditions that affect the reproductive system without a woman becoming (or trying to become) pregnant, and sometimes these medications can help with those.
I'm a bit mollified by the number of people responding to all of the horrid comments.
> And this is despite being in a monogamous relationship with a cis woman for the past five years—zero pregnancy risk there :P
Ha! I can't believe this is the first time this scenario occurred to me!
It may be notable that the pill that got approved is a progestin-only pill that's been on the market for fifty years (so long enough to demonstrate safety/effectiveness) and, crucially, does not contain any estrogen. Because there are risks associated with estrogen-based birth control, to the point where I understand why the FDA might still recommend getting screened by a doctor first—most notably, there's an elevated risk of DVT if you're a smoker.
Granted, given the current, uh, situation in the US, I do think people should be able to make informed decisions about that risk for themselves without needing a doctor's approval. But a progestin-only pill mitigates a lot of that risk anyway while still being a reasonably effective contraceptive.
Which is fucking silly for birth control.
- Have to get pap smears before being granted a prescription
Doctors will withhold birth control to coerce women to get regular pap smears, just because it's a lever they have available, not because it's related to the prescription.
I have to take both ADHD meds and birth control, and while it is much easier to get prescribed birth control, it's a similar level of stress of making sure my medication is regularly available, especially for someone who struggles with staying on top of timely tasks.
"You mean you have to take this every month?"
"...Yes?"
(And I wasn't even taking it for contraceptive purposes, thank god, but can you imagine if I had been?)
Everything in life involves risks, but I believe on net this reduces risk.
Nonsense. I can walk into any store in the country and buy enough Tylenol to kill myself for $5 no questions asked. This is an unqualified good thing.
Yes, both are drugs and can be misused with disastrous or even fatal consequences. The important distinction is that you can use oral contraceptives correctly and still have seriously negative, life-altering side effects. There are alternatives which may be preferable and ideally every woman should have access to a medical expert who can guide them to make the best choice.
Access to an appropriate medical resource is in the other issue, in the absence of a completely safe and effective option. And that seems to outweigh the risks in the the US. I can only hope that, when given the option, women continue to consult medical professionals even though there is now an over-the-counter option available.
At some point you need to have a new avenue for disseminating that type of information, especially when doctors visits are becoming more inconvenient and expensive.
Ideally, as you say, folks should have full access to knowledgeable medical experts who can help guide them. Again, our mechanisms for delivery of care in the US don't allow that, and unfortunately our physician and nurse training doesn't facilitate that either. A lot of medical professionals insist that hormonal BC doesn't have side effects, many insurance companies don't cover experimentation to find the best method for a particular person, non-hormonal woman-controlled methods are underused in the US. Since medicine in the US is built around making money & defending against lawsuits, care gets lost.
If you're concerned, you can talk to your doctor first. No need for everybody to live their lives by your whims.
This costs money in the US. And it costs time and effort everywhere in the world, with doctors frequently using this as a hook to force you to visit them regularly and bill you or your insurance for that. And it's just disempowering bureaucratic bullshit when the risk is far less consequential than most other risks we take in life. Do you have a permission slip from your doctor for sitting in front of the computer all day? That's far worse to your health than oral contraceptives.
This is important for people (commonly women) who regularly use skincare treatments that make their skin extra sensitive to the sun. They want daily facial sunscreen that doesn't feel greasy. We end up buying it on eBay because it's not allowed to be sold in the US.
https://www.pbs.org/newshour/health/fda-finds-sterility-issu...
The people living there, and especially working the low paid jobs in these factories and whatnot, have bigger risks to worry about than safety in drug manufacturing.
It seems that, at least in Mexico, this model leads to massive overuse of antibiotics as people self medicate colds/flu and other things that don’t need them.*
Facing increased antibiotic resistance, letting people decide for themselves when they need antibiotics seems like a mistake, especially given that many Americans already “shop” between doctors until one will prescribe the antibiotics they think they need (prompted in some cases through the perverse incentives of patient satisfaction surveys).
Never mind the decision making around which specific medication may be most effective for a particular condition in light of potential side effects that the average person may not know much about, for example the potential for long term disabling damage from fluoroquinolones–see people preemptively asking their doctor for a Cipro prescription “just in case” they get diarrhea while traveling.
* https://www.thenation.com/article/archive/mexicos-discount-h...
[* I am exagerating but you get the point...]
As an aside, the amount of patronizing in these comments along the lines of "but these women will clearly take the medicine wrong or fail to understand the consequences of their actions if we don't have them speak to a doctor first!" is just... really telling.
I'm terribly sorry to have read your experience. I empathize deeply, though my situation is different (migraine medication vs birth control), in my experiences in having dealt with doctors and insurance companies to get both the medication I need and in an amount that will get me through.
I hope this change and others like it help bring you comfort and safe, affordable access to medicine you need.
Availability and discovery are absolutely massive to health services. Most people don't know about their options, and many more don't even have the option in the first place.
Having this be OTC is a massive step in that regard.
I have a feeling you might be the type of person to think government should get out of the way of most things. Why is it not such a big deal in this case?
That said, I do believe there is a massive overuse of hormonal contraception which is partially contributing to several negative factors in society right now. This should be addressed through education and informed consent (the Rx process isn't really doing this either, so...).
First of all: are you the person affected by this change? If you aren't, try and imagine being a person that was. If you cannot empathize at all with the other side, perhaps it isn't something you should be arguing for or against.
Second: does this vibe with how you would treat someone you normally would disagree with politically, if the position were flipped? Say there is something you think government shouldn't have a say in (apparently not family planning, but you can think of something... guns? business?) then have them argue 'it isn't such a big deal to have to jump through this bureaucratic hoop and the reasons we make you do this is are obviously not as overt as we pretend'. How would you feel about that argument?
- Prescription has been cancelled twice for no real reason.
- Pharmacists have refused to give more than one month at a time more than once.
- Even if everyone is on board and not hostile she's only able to get a few months at a time so she has to do this multiple times a year.
I can't imagine how it'd be if we lived in a more conservative state or in a more rural area.
It's possible it's all imagined, but I don't really understand why a pharmacist would only give one month when the prescription is for multiple months, or why the prescription can't be for longer as to require less doctors visits / bills. We certainly haven't had the same experience picking up other prescriptions.
They aren't just renewing your prescription? Most places see you once, or once per year, and then just keep renewing it.
Most insurances/pharmacies even have partner mail order services where you can turn on auto-renewal and auto-refill. That might be a good option to look into.
My doctor gives me a three month prescription for a scheduled substance and I've had a couple pharmacies reject it because it's "sketchy". Of course, they never offer to call my doctor to confirm anything. They just smirk and cross their arms.
Also, I think you mean OTC amphetamine alternatives since amphetamine is sched I.
https://www.nbcnews.com/news/us-news/cvs-health-agrees-5b-se...
https://www.npr.org/2021/11/23/1058539458/a-jury-in-ohio-say...
https://www.nytimes.com/2021/11/23/health/walmart-cvs-opioid...
- you have no car, how do you get to your doctor's appointment without asking parents for a ride?
- you are a minor, do you have any guarantee that your doctor won't tell your parents? You can't risk them finding out, they are very conservative
- you may not have ever made a doctor appointment for yourself before, maybe don't have access to insurance information etc
Planned Parenthood provides BCPs at a price you can afford with your teenager job (also guarantees privacy) but the closest one is hours away...
What do you do?
Both
And also the more mundane reason that an extra hoop to jump through is unnecessary and does more harm than good.
It took 50 years to make packaging that users could understand?
I'm just saying generic prescription drugs don't necessarily have a huge price uplift vs. OTC.
Price competition across pharmacies is far higher (due to low insurance reimbursement) than cash paying patients.
Once the drugs move out of patent, that doesn't mean it is automatically approved for OTC sale. A drug maker can look at getting FDA approval for making it OTC. But it costs time and money to do so, with no guarantee of success. In the case of Norgestrel it took until now before any drug maker thought it would be worth pursuing.
Of course. Drugs that are approved for OTC are almost always generic by that time.
Most often drug companies look to get approval as prescription, because that is more profitable for patented drugs.
No, it's not approved as prescription because it's more profitable, it's approved as prescription because that's all the FDA allows. The safety requirements for OTC are far stricter than prescription. Most patented drugs could never become OTC, ever.
In the case of Norgestrel it took until now before any drug maker thought it would be worth pursuing.
Norgestrel is a generic. All birth control pills pretty much are. The hormones can be in different combinations or formulations, but generally they are all generic components.
So my point stands, it's often more profitable to be OTC than prescription.
https://www.physiciansweekly.com/is-the-ama-really-the-voice...
Contraceptives have a long-standing problem of people being unable or unwilling to follow the instructions, or not catching little nuances like "this pill lasts for 22 hours, so you really need to take it every day at the same time". For a decent-looking summary, see ex. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533104/ which includes a lot of lines like,
> Hatcher and colleagues report that for both types of pills, the failure rate is less than 1% with perfect use and 7% with typical use.
So no, empirically, it appears likely that people are not capable of understanding "once daily".
An app can deliver periodic reminders about the potential negative effects of birth control pills. It can have a conversational interface for when someone is having issues with a particular pill, thinking about starting a new pill or type of contraceptive, etc…
No, no one explains it. They expect you to read the instructions, which is not an unreasonable expectation.
The pharmacist can explain it. You can put it in huge text on the packaging. You can text or email people.
You could literally make someone DocuSign a single page PDF that just says "THIS ONLY WORKS CORRECTLY IF YOU TAKE IT AT THE SAME TIME EVERY DAY" in order to get their prescription.
All of these options get the exact same message across without being inconvenient and causing people to miss taking their birth control because they couldn't get a doctor's appointment, etc. There are costs to making people go into a medical office that you can't ignore here.
I mean, the alternative already exists - online appointments. You can even get auto renewing prescriptions through the mail.
You could train a dog to pass that message across using some of those buttons that say words when pressed. That would actually probably be much more effective than having it come from a doctor, because the dog thing would be much more memorable.
Hilariously, almost all of the "failure rate" of vasectomies is due to people who don't follow the doctor's instructions for how to handle the first few weeks after (you've still got some live swimmers with access to the outside, for a while). Other reasons for failure are so vanishingly rare they're hardly worth mentioning.
So you're thinking about getting the surgery, see the failure rate and are like, "damn, that's low but still a lot higher than I'd expect, given I'm committing to nut surgery"—but no, as long as you don't do the single thing you're not supposed to for the first few weeks, it's basically 100% effective.
I know people who can't take them because they make them suicidal, of the "spontaneously walking into fast-moving traffic" sort. I don't know if that would happen with this type specifically, but there are reasons to be cautious.
So the design, engineering and implementation of the holistic system around it must prove with extremely high confidence that the default usage of it, with no special education, is in line with the idealized social use of it.
Further, it should be shown that non-intended uses or abuses of the drug are rare by chemical function - not simply regulatory.
And while it might not be 50 years, required as the mathematical minimum time for this to be true for this particular drug, that is the amount of time this society has decided would be appropriate to allow for individual decision making to be the discriminatory function for acquiring it.
If it looks like Trump might win the electoral college and the Dems might lose Congress, it might not be the worst thing to have stocked up on.
This type of hyperbolic proselytizing has no place in reasoned discussion.
FWIW I think the Supreme Court overall does an amazing job upholding the constitution. The Roe v Wade upset made sense from a legal perspective and they have a strong recent history of supporting citizens rights in the face of overreaching LE agencies.
The US is already seeing attempts to pass laws banning Plan B or IUDs, it is not too much of a stretch to think hormonal birth control is at risk too.
The Catholic Church also considers adultery a sin but that doesn't mean Catholics want adulterers executed.
They're not going to stop. They have no intent to. They're going to keep pushing until a legal entity pushes back one way or the other.
https://pulseforlife.org/why-not-contracept/
https://www.catholic.com/tract/birth-control
https://www.prolifewi.org/contraception
https://www.help.senate.gov/chair/newsroom/press/republican-...
https://www.nytimes.com/2023/06/17/us/politics/birth-control...
https://www.pbs.org/newshour/nation/birth-control-ruling-to-...
I'm aware that a significant portion of conservatives are very religious and some religious people object to contraception. But I'm not aware of any concerted effort by Republicans to ban or restrict pre-pregnancy contraceptives in my lifetime.
And while I have plenty of thoughts about Trump, I'm not aware of him ever suggesting an interest in restricting access to contraceptives.
Really? Because Texas has been marching in that direction for some time now. There was a recent ruling that when it comes to contraceptives that agencies cannot protect minor confidentiality from their parents. Multiple republican think tanks push the idea that contraceptives kill babies and should be banned as abortifacients. You can see these attacks starting in multiple locations [1] [2]. The goal is obviously attack anything with dubious claims of abortifacient, then reduce access to anything that is not (by removing contraceptives from sex ed, reducing access, and preventing people from talking to doctors about it).
[1] https://www.cathmed.org/catholic-medical-association-applaud...
That issue is about whether parents should have access to private information about their children, not restrictions to contraceptives.
I already acknowledged there are groups who are opposed to contraception. The Catholic Medical Association and Students for Life of America are examples of such groups. And there are undoubtably Republicans who try to appeal to those groups.
But you have not provided compelling evidence of a concerted effort by the GOP to restrict access to pre-pregnancy contraceptives.
It's like claiming the Republican party wants to restore segregation because many Republicans oppose affirmative action and there are racist groups who vote for them.
> That issue is about whether parents should have access to private information about their children, not restrictions to contraceptives.
No, that is exactly the issue. The issue is you have religious parents that are anti-contraceptives. The goal of this is to prevent people from using contraceptives under the watch of their parents. The ruling is specifically around contraceptives, so you trying to say it's not about contraceptives is incredibly weird.
Those are indeed Republican organizations and I did not claim otherwise. So what? Republicans aren't a hive mind. They don't agree on everything. You wouldn't claim the Democratic party wants to ban vaccines just because JFK Jr. is an anti-vaxer.
Supporters of a party aren't always indicative of that party's stance on all issues.
> The ruling is specifically around contraceptives, so you trying to say it's not about contraceptives is incredibly weird.
How is it weird? Parental rights over their children is a frequent focus of Republican politics. They've recently pushed for similar policies in regards to sexuality and gender identity.
I'm not going to pretend there aren't Republican voters whose support for the policy is motivated by the thought process you just layed out. But it's not reasonable to prescribe that motivation to the entire Republican party when there are other explanations that are more consistent with recent and historical Republican ideologies.
https://www.parsemus.org/humanhealth/male-contraceptive-rese...
Apparently a company's moving forward with an attempt to productize it: https://www.planaformen.com/
With an option like that in the wings, and not yet shown to have any ill effects in men so far, it's hard not to cynically think that hormonal birth control is pushed forward because a monthly or daily pill is far more profitable than a once-in-a-decade injection / flushing.
https://idahocapitalsun.com/2023/04/11/viable-male-birth-con...
Only the woman, at the end of the day, when it comes to men she can't trust, can either avoid getting raw-dogged OR take a contraceptive to be sure, herself, since she's the one at risk of getting pregnant.
The specific one in question here (very dangerous in small doses, do not seek) is https://en.wikipedia.org/wiki/Trestolone
These men also have an extremely high risk of side effects (as they are taking some of the strongest androgens) including:
- Losing fat
- Getting extremely strong and muscular
- Deepening of the voice
- Awful sleep disruption which leads to irritability, with profoundly violent and sexual dreams
- Much lower patience
- A sense of high-energy
- Acne all over the place, that becomes cystic and doesn't respond to typical treatment
- Big increase in body hair
- Big loss of head hair
- Enormously increased chances of death from heart disease or liver or kidney failure
Most guys are taking this for the muscle and energy effects, and consider sterilization a side effect. It's when the same molecule is being looked at from the perspective of temporary sterilization as the desired effect that all the bodybuilder stuff becomes the side effect.
> Side effects of trestolone use in men include low estrogen levels and associated symptoms such as reduced sexual function
> Trestolone may cause sexual dysfunction (e.g., decreased sex drive, reduced erectile function)
Well, that's one way to avoid pregnancy.
It'd be like if we told women they had to have the baby the moment their egg accepts a sperm, regardless of the reasons it ended up there.
And yet Men have 100% liability the moment it leaves our body, potentially including in cases of paternity fraud.
> If women don't like the risk of getting pregnant and not being allowed to have an abortion, they can just sleep with women.
It's both insensitive and obviously not a good argument.
I'm not sure if you're being sarcastic or not here, but that is pretty much what exactly is happening in much of the USA. It's sad, disappointing and, frankly, irrational, at least from the perspective you present.
There doesn't seem to be a free lunch when it comes to biological modifications. :(
Main downside is reversals are 1) another surgery—and maybe not covered by insurance—and 2) often fail. Not a great option if you do want kids, just not right now. I guess that's the not-a-free-lunch part.
Excellent option if you are certain you're forever-done with having kids, though.
You're right that there are women who maybe severely impacted mental-health wise. But I think the benefits outweigh this as the lack of ability to control one's reproductive life can also be debilitating, mentally. And I like to think that impact is not much worse than what alcohol, drugs, even cough syrup can do to one's mental health. At least birth control can be stopped and is not addictive.
From my reading of this comment thread in general the issue really seems to be that you can’t see a doctor for free (at the point of use) in the US. Anecdotally I know a few people who have had difficult side effects on the pill, or medical issues which preclude them from using specific types. Speaking to a doctor once to get put on the best one for you, and then picking them up from the pharmacy monthly seems to work well and doesn’t seem like the “gatekeeping” people are ranting about in this thread. The idea that your pharmacist or doctor would have political or moral views on contraception that impacts their ability to do their job is crazy (to me). If that’s the case the entire system needs reviewed as opposed to making drugs available OTC.
Do you want to know how I know you're not from the US?
Medicine is stupidly fucking political and religious here in the US.
The system will be reviewed by your Christian elected official and validated by your Catholic hospital and affirmed by the SCOTUS and deemed satisfactory.
But there could be many scenarios where one doesn't have access to such care - think of the uninsured, think of teenage girls who don't want their parents to know, think of women in abusive relationships who don't want to get pregnant, the list goes on. If you were on your partner's/parent's plan, there is no way you could visit an OBGYN without them knowing. In addition to this, like the other commenter mentioned, this has also somehow devolved into a political issue here.
* depo shot - which she did not have great experience with * the pill - which had barriers going to the doctor, to continue getting the prescription. This included a mix of planned parenthood, before we had insurance to get the prescription, and finally getting insurance and finding a doctor. * Finally an IUD
For the pill, a once daily med all the information to know is given with the prescription. Having a pharmacist give this OTC, like say pseudoephedrine, giving the basic instructions for it is enough.
There has to be some other methods of birth control available that will easily allow couples to effectively manage pregnancy without weird side effects.
I always though Vasagel was an interesting form of contraception (easily reversible procedure for men), but I haven't seen much progress.
https://www.pbs.org/wgbh/americanexperience/features/pill-po...
That caused a population explosion everywhere, but especially Central and South America, which were predominantly Catholic.
IMHO it all comes down to patriarchy. When I hear certain wealthy people and billionaires worrying about population collapse due to low birth rates, it reeks of that same male-dominated worldview. The same good ol' boy power structure which went to such great lengths in 2016 to block the first woman president and capture the Supreme Court to overturn Roe v. Wade.
It's amazing to me that in 2023, women still had to get permission from their doctor to not get pregnant. And that the thousand whatabouts in the details of that are still discussed online and in otherwise polite conversation, as if that's anyone else's business.
'The Pill, Humanae Vitae declared, "... Man, growing used to contraceptive practices, may lose respect for the woman and come to the point of considering her as a mere instrument of selfish enjoyment, and no longer as his respected and beloved companion."'
This statement seems pretty prophetic when you take a look at the dating scene today.
And you think this never, ever happened pre-Pill?
At least in today's dating scene, women are free to do the same thing.
I personally think respect for women has never been higher than today - though there's still a long way to go. Because women have been able to achieve much more, now they have more choice over if or when to become a mother.
Unfortunately, that's not the case, so getting them over the counter is an improvement.
It’s great that the medicine will be easier to get, but generic prescriptions are only $5. I pay $5 for a month of oral contraceptives, prescribed by doctor, and $10 for 90 days.
My fear is that will be $40 at CVS and will actually be harder for people to use.
For comparison, my 16g nasal spray (120 sprays) is $5 by prescription but much more over the counter.
Burden has always been on the women to take the contraceptives. Aren't their reproductive systems more complicated than men's anyway? Will there ever be a pill that can make me shoot blanks for a while?
I'm sure the women who live in the areas where it has been made illegal are happy that the "doomsayers" over estimated the number of places.
IIRC there are currently laws on the books in many states that ban contraception (even condoms in some states). Those laws are (potentially temporarily) invalidated due to Supreme Court opinions. The current Court has expressed the desire and willingness to overturn longstanding precedent. QED it's entirely possible we will see oral contraception and even condoms become illegal in some states.
This is a topic that is extensively documented, so you can look up the viewpoints of the groups that have campaigned for decades to overturn Roe v. Wade and to make abortion illegal. As it turns out, they do oppose birth control, and they have explicitly declared that Griswold (which legalized birth control) is one of their next targets.
You could believe they can't achieve those goals, I guess, but believing they want to is not a fallacy in this context come on.
Edit: why disagree?
Many of them want to ban contraceptive methods they view as “abortifacient”. We can argue about whether they are right to give certain methods that label-but there are contraceptive methods nobody calls that, such as condoms. People are ignoring the distinction between “want to ban some methods of contraception” and “want to ban all methods of contraception”-almost nobody belongs to the second category. Few other than conservative Catholics are completely morally opposed to condoms, and very few of those want the state to enforce that particular moral judgement. From the logic of their own beliefs, condoms are a sexual sin but not the taking of innocent life, so there is not the same need for the state to ban it.
I also don’t agree that the “far right succeeds in its wildest dreams”-I think that kind of talk relies on nonsensically grouping together Clarence Thomas with David Duke, Trump-supporting Orthodox Jews [0] with neo-Nazi antisemites such as Andrew Anglin
[0] https://www.timesofisrael.com/orthodox-jews-back-trump-by-ma...
Why is it nonsensical to group thomas and duke? Because thomas is black? To the extent they share values and goals and are acting on and succeeding in them it absolutely makes sense to group them. It doesn't mean I think they are friends, but I am acknowledging domains where they work towards the same ends.
Okay, but you spoke of "liberals caring about the norms of civil discourse while the far right succeeds... by ignoring them". Now you seem to be saying something different – that norms of civil discourse don't matter, only the outcomes do.
You obviously don't agree with the opinions of the conservative SCOTUS majority, but they are all very civil in how they talk and write. I don't think it is fair to accuse them of ignoring the norms of civil discourse
> Why is it nonsensical to group thomas and duke? Because thomas is black? To the extent they share values and goals and are acting on and succeeding in them it absolutely makes sense to group them. It doesn't mean I think they are friends, but I am acknowledging domains where they work towards the same ends.
It is nonsensical to group them because their values and goals and ends are very different.
In Thomas' brief dissent in Lawrence v Texas [0], he said that although he did not agree with the majority that Texas' sodomy law was unconstitutional, he thought it was "uncommonly silly" (quoting Potter Stewart's dissent in Griswold) and "If I were a member of the Texas Legislature, I would vote to repeal it". Do you think if David Duke were a Texas state legislator (actually he was one in Louisiana from 1989–1992) he would have voted to repeal its sodomy law? I really doubt that.
Duke is pro-Nazi and pro-KKK (indeed, he used to be the leader of a faction of the KKK); there is zero evidence that Thomas has any sympathy for Nazism or the KKK. Duke says virulently antisemitic things all the time; when did Thomas ever say anything like that? His critics point to a 1981 speech in which he praised Louis Farrakhan – however, he was praising Farrakhan's teachings on Black empowerment, not his Jew hatred (in any event, that was over 40 years ago; when was the last time Duke said something antisemitic? probably today)
These are just a few of the reasons why Duke is accurately called "far right", but Thomas isn't "far right", he's just "right".
It's not a slippery slope fallacy if you've already climbed the hill and someone greases it behind you. People said similar things about Roe v. Wade before the Supreme Court recently overturned it.
Additionally, some state abortion bans have been interpreted as impacting birth control, causing access disruptions (this happened in Idaho with their trigger ban, but clarifying language was passed after the impact began being felt.)
I’m not aware of any state lawmakers in the US proposing to ban contraception in general. There have been proposals to ban ”abortifacient contraceptives”-although in those cases there is disagreement over whether certain contraceptive methods are “abortifacient” - which I think is mostly semantic, many of these methods have some (small but non-zero) probability of preventing implantation or causing post-implantation spontaneous abortion, which causes their opponents to label them as “abortifacient”; defenders disagree with using that word that way, and insist a contraceptive method should not be labelled “abortifacient” if spontaneous abortion is not the primary method of action (more a rare side effect). Putting those semantic disputes aside, there are methods of contraception which are universally agreed upon as being non-abortifacient, such as condoms. The laws struck down by Griswold were bans on contraception in general, not bans only on specific forms of it. Unless SCOTUS was really eager to overturn Griswold (Thomas is but I doubt Roberts and Kavanaugh are), SCOTUS can uphold those laws by distinguishing them from Griswold, by narrowing it, rather than overturning it altogether.
Also, women generally have a larger friend group than men and their friends are more encouraged to stage interventions if their lives are spinning out of control than men.
> Also, women generally have a larger friend group than men and their friends are more encouraged to stage interventions if their lives are spinning out of control than men.
This is a nonsense argument even if the premise may be true. This, in no way, makes the harm ok.
Most women I've spoken to about it have had bad experiences with at least one hormonal birth control, especially in mood, appetite, sex drive, energy levels, depression & anxiety, fitness, bleeding. The range of things hormones can affect is wide and sometimes subtle. There are dozens of different formulations and a lot of women are very particular about the one they take, having found one with tolerable side effects.
IUDs have a similar range of experiences too, though they're less popular so I hear less about them.
These effects are not taken seriously/acknowledged by the vast majority of medical professionals, so I don't see how it is relevant to whether the pills have to be prescribed. It is a separate issue.
People should be free to make their own choice without going through a gatekeeper who adds no value. Most often, women making the choices are more informed (by their social network) of the wide range of potential side effects than their doctor is, who may or may not have a uterus and may or may not take reports of side effects seriously.
This is what is so baffling about so many of the ridiculous comments here. It's so disturbingly common for doctors to ignore bad individual interactions and just call women dramatic. It's shockingly hard to find anyone who will even so much as listen. Prescribers will throw some random BC pill at you and if it doesn't work for you, tough, try your luck with another doctor/NP. The system doesn't provide any protection, it frankly just makes it worse.
Typical testosterone levels (perhaps not just humans either but in other mammals as well) have been dropping significantly since approximately the time hormonal birth control became widely available. The drugs pro
Before you snicker and make jokes, reduced testosterone in men has a strong correlation with depression, which leads to increased use of antidepressants which ALSO get into water supplies. I wonder what effects 50 years of microdosing an entire population with those will have.
I believe it is possible that these drugs will someday become illegal or significantly restricted.
Smoking increases testosterone levels[0].
Like any drug, nicotine has a variety of side effects, and one of them seems to be increasing testosterone levels (the exact measures here are complicated, read the article for more info).
So, trying to untie the decease in smoking to a total decrease in male testosterone seems to be an active area of research and one that the literature is still working on. Maybe there is a falling amount that is not due to less smoking, maybe there isn't.