- 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
- 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?)
Which is fucking silly for birth control.
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 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.
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?
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.
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.
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.
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.
This describes every over-the-counter drug that has ever been sold. Keeping contraception prescription-only has always been about politics.
[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.
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.
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.
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.
That is what it is supposed to be and do.
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.
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.
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"
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.
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...
[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.
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.
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.
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.
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.
Taking Tylenol wrong kills you.
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.
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.
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?
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-...
Everything in life involves risks, but I believe on net this reduces risk.
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.
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.
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.
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.
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.
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.
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.