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OVER THE COUNTER AND THROUGH THE WOMB
Mary G. Barry, MD
Louisville Medicine Editor editor @ glms. org
Dr. Hal C. Lawrence of ACOG, writing in the July 5th Annals of Internal Medicine, makes a bold point for his College that women’ s unfettered access to over the counter( OTC) oral contraceptives is both necessary and desirable. The ACOG has helped to lobby for laws permitting the purchase of birth control pills( BCP) without a prescription. The College has pointed out that almost 90 percent of American women at some point use them, and that we have a five decade safety record for women, with far lower risks of thromboembolism on the Pill, compared to those for pregnancy and the postpartum. Uninsured women and those whose employers’ policies have religion-based bans on payment for BCP still must pay cash, but otherwise, the ACA has mandated coverage for multiple different methods of birth control, including BCP.
He says,“ BCP enable women to have more control over their lives by timing pregnancy around education, career, and other life situations.” He notes that two states, Oregon and California, now allow pharmacists to prescribe and dispense BCP, but he and ACOG maintain that this just exchanges one prescription barrier for another. I looked up a couple of the multiple studies available. Interestingly, Shotorbani et al writing in the Dec 2005 Contraception show that women and their BCP clinic prescribers agree, nearly exactly, on the safety of these meds for themselves. In six public health clinics in Seattle, both women and their clinicians filled out a 20 point questionnaire about health history and habits related to the risk of using BCP. 392 out of 399 pairs completed the questions, and 96 percent of the matched pairs agreed on their assessments. Dr. Lawrence says,“ Women can make these decisions ….. that would ensure reproductive autonomy and privacy.”
I applaud this move, since many youthful, unplanned pregnancies might have been prevented if teens could access reliable contraception without involving the authorities. Of course, we must teach them all about safe and consensual sex beginning very early, and convince their parents to vaccinate them against HPV very early; the role of doctors here is clear. But in just moments on my phone, I could access multiple YouTube presentations on the physiology of the menstrual cycle, the types of contraception, the benefits of each varied BCP formula, the side effects, and so on. The internet giveth without cease.
What else should be over the counter that isn’ t?
I have several nominees: Atorvastatin, for one, which reduces the burden of disease from heart attacks, strokes and vascular dementia. Pfizer, the maker of the branded Lipitor, in 2015 gave up the effort to make it OTC when consumer pilot studies showed that regular folks took the medicine without sending themselves for“ appropriate labs and monitoring.” Yet the American College of Cardiology in 2012 cited numerous studies supporting the removal of timed monitoring labeling for statin drugs regarding potential liver problems. Liver biopsies of people with non-alcoholic fatty liver have shown improvement in inflammation though not in fibrosis, and regularly people with fatty liver show extensive improvement in their liver enzymes after months of statin therapy. Statins have been used solely for their anti-HCV activity as enhancement to other antiviral treatment. We use them safely in people who have had cardiac, kidney and liver transplants. Most hepatologists no longer consider statins a foe, but a friend. The potentially staggering profits from OTC Lipitor supported the effort to change the FDA labeling, but I am guessing that the legal department at Pfizer got cold feet, and torpedoed the effort. According to your television( the main oracle for our once-literate country), these medicines“ cause diabetes and muscle damage and hurt your liver.” What cautiously pinstriped, handsomely paid corporate lawyer could stand up against that?
My second nominee is Montelukast. As a( continued on page 24)
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