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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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