The Rest of the Story

Last night, on the way home from work, I listened to a segment of All Things Considered, entitled Alabama Nurses Quit Over Morning After Pill.  This link should open the audio stream:

<http://www.npr.org/rundowns/segment.php?wfId=3627209>

The gist of the story is that state-sponsored public health clinics in Alabama have started to offer emergency contraception (EC) to their clients.  Some nurses objected, and quit.  The state began to offer employees "accommodations," if they object to dispensing EC.  The accommodation is either to transfer them to another job, or to allow them to continue the job without being compelled to be involved with EC. 

As a technical aside, the term "morning-after pill" is a bit misleading.  There is nothing special about the pills used in EC; they are ordinary birth control pills, but they are given in high doses by having the patient take more than one pill.  Also, EC can be used up to 72 hours after unprotected intercourse.  It does not have to be taken the following morning.  See the link Back Up Your Birth Control, in the sidebar, for details.  The product, Plan B, is a specially-packaged product that uses two larger-dose pills instead of multiple small pills.  More details are available at this link  from the Feminist Women's Health Center.  Note that there are some risks with EC, so be sure to consult a knowledgeable health professional before using EC. More technical information can be found in this article  from American Family Physician.

Back to the main point: the broadcast covered a few controversial aspects of EC, although that is not what got my attention.  About 5 minutes, 20 seconds into the broadcast, the commentator, Debbie Elliott, mentioned that EC can be obtained over the Internet.  I object to that statement.  I know that it is possible for people to get all kinds of prescription medications over the Internet, in some cases without a prescription.  In some cases, it makes sense to use the Internet to get medication.  If you see your doctor and get a prescription, and can get it at a lower cost using a well-established pharmacy (such as CVS.com or Walgreens.com), fine.  But not all online pharmacies are reputable.  You could end up getting counterfeit, outdated, or improperly stored medications.  If you bypass the critical step of consulting with a knowledgeable health professional, you put yourself in danger.  For these reasons, she either should not have mentioned the availability of EC on the Internet, or should have mentioned it and  the associated warnings.

Other than that one point, I liked the broadcast.  Ms. Elliott did a nice job of presenting an important issue in a balanced manner.  This encourages public debate, which generally is a good thing.  For example, she presented both sides of the "EC is/is not abortion" issue.  She had interviews with nurses who agree with the provision of EC, and with those who object.  She did not get into the legal issues pertaining to the employment questions, but that would be another story.

The issues regarding emergency contraception have been debated to death in the Blogosphere.  For example, this post on Morons.org: the REAL Fundamentalist Agenda generated over 80 comments:

Fundies everywhere under the employment of the government are refusing to fill prescriptions...

I knew if I gave them enough time, the "American" "Family" Association would start celebrating another attack on reproductive rights. This time it's not about abortion. It's about contraception. Emergency Contraception (EC).

Now, as everyone should know, these folks are not too happy about EC. What many (including myself) can't figure out is why. EC, for those who don't know and have a passing interest, is intended to prevent a pregnancy from occurring. It is not meant to abort a pregnancy or other such nonsense you may hear.

So, the story. Basically, "at least half a dozen" employees of a State Medical Clinic in Alabama decided that, for moral reasons, they wouldn't hand out the EC pill. So they contacted the Christian Coalition of Alabama (CCA), to whine that they were told by their supervisors that they would distribute the pill or they would face disciplinary action.

This flies in the face of optimists everywhere who don't believe that these fundamentalist types are after our right to personal freedom.

The article says that Dr. Donald Williamson, the state health officer of Alabama, told the CCA that employees who had "religious, moral, or ethical objections" to the pills distribution would not be forced to hand it out. Kind of an oops on his part, yes, but I don't believe that was a claim he was entitled to make.

As an employee of the state, you cannot refuse service to a customer on the basis of religion. As an employee of the state, you are not permitted to use your power to force your beliefs upon others. As an employee of the state, you have to put your personal beliefs aside to do your job. If you can't deal with the requirements of that job, then it would be only logical to find another one. [...]

This post, on Kautilyan, discusses the political pressure applied to the FDA when they were reviewing an application for approval of an EC product:

Shame on you Mark McClellan

Recently I posted on the Rovian tactics that have been used at the FDA to stifle unwanted scientific findings regarding anti-deppressant use. The Wall Street Journal now reports that there has also been politicization regarding emergency contraceptive use. This latter example of FDA shenaningans ought to be receiving much more coverage than it has. This account was buried on page B4 of the Journal and as far as I am aware has not been brought up as a new source of embarassment for the Administration. This issue ought to be exploited by the Kerry campaign as a major issue to rally women voters. Aside from politics the misuse of science for political gain should be considered beyond the pale.

Kautilyan posted again on the same topic the following day, and Brad DeLong chimed in:

No One, No One Gets Out with Their Reputation Intact

Mark McClellan--former CEA member, former FDA head, now head of CMS--was one of the very, very few people who looked like they might get out of the Bush administration with their reputation intact. But now Kautilyan directs us to a Wall Street Journal story saying that this is not so: that McClellan has been corrupted into making FDA decisions that are inconsistent with its scientific and medical regulatory mission:

Jeanne, at Body and Soul, wrote a post  regarding her objections to the "oral contraceptives = abortion" argument, with 14 comments added.  She included quotes from a variety of sources to support her position.  She concludes:

I'm beginning to think Democratic politicians need to spell out more clearly what they mean when they say they support a woman's right to choose. The phrase has become so bland that virtually everyone mentally translates it -- pro-abortion. What pro-choice politicians support is not allowing abortion to be re-criminalized, and birth control methods to be decided by Rick Santorum.

The threat to women's health that these people represent is a lot bigger than the issue of abortion.

This is an important nuance to the debate.  Aaron, at Uppity-negro.com adds a comment:

Their logic does not in the slightest resemble our Earth logic.

Caroline Bollinger, at her Livejournal site, wrote a thoughtful piece about the implications of limiting access to oral contraceptives.  She points out that these medications have medical uses other than contraception, and there is no way for a pharmacist  -- or a politician, for that matter -- to know for what purpose a woman is getting the medication.  Her article generated a great many responses, too numerous to count.  Some pertinent quotes:

Lacey's pharmacist and Kelley's doctors are among hundreds, perhaps thousands, of physicians and pharmacists who now adhere to a controversial belief that birth control pills and other forms of hormonal contraception--including the skin patch, the vaginal ring, and progesterone injections--cause tens of thousands of "silent" abortions every year. Consequently, they are refusing to prescribe or dispense them.

Scenarios like these--virtually unheard of 10 years ago--are happening with increasing frequency. However, until this spring, the issue received little attention outside the antiabortion community. It wasn't high on the agendas of reproductive rights advocates, who have been preoccupied with defending abortion rights and emergency contraception. But when Lacey's story was picked up by a Texas TV station and later made the national news, Planned Parenthood Federation of America and others took notice.

Limiting access to the Pill, these groups now say, threatens a basic aspect of women's health care. An estimated 12 million American women use hormonal contraceptives, the most popular form of birth control in the United States after sterilization. The Pill is also widely prescribed by gynecologists and family doctors for other uses, such as clearing up acne, shrinking fibroids, reducing ovarian cancer risk, and controlling endometriosis.

"Where will this all stop?" asks Lacey. "And what if these pharmacists decide they suddenly don't believe in a new lifesaving medicine? I don't think pharmacists should be in a position to decide these things."

[...]  What's more, oral contraceptives aren't only used to prevent pregnancy. The Pill may cut the risk of ovarian cancer by up to 80% and is used by women at high genetic risk for this hard-to-detect and usually fatal cancer. "There are easily more than 20 noncontraceptive uses for the Pill in common practice," says Giovannina Anthony, MD, an attending physician of obstetrics and gynecology at Beth Israel Medical Center in New York City. "This drug saves women from surgery for gynecological conditions like endometriosis, fibroids, and severe bleeding and pain."  

The All Spin Zone picked up on this topic, with Woman's Womb and Politics.  Agape Press wrote an article on the Alabama story, Ruckus in 'Bama Over State-Mandated Distribution of Morning-After Pill, with more detail than can be found in the NPR broadcast.  In a bit of investigative reporting, the Sacramento News and Review discovered that many pharmacies (44%) in the Sacramento area do not stock EC. 

Overall, it appears that the majority of bloggers support the notion of women having access to oral contraceptives in general, and EC in particular.  They object to political influences at the FDA, and seem to feel that health care providers should not have the right to decline to provide contraceptives.  I know that opposing views are out there, but searching on "emergency contraception" did not turn up many hits that indicate such opposite views.