This is amazing, it will help a lot of people have access to a drug that can vastly improve quality of life without being gatekept by their doctor.
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.
There's a bit more nuance here. There is certainly a political angle, but there is a non zero risk with taking something like this that should be discussed with a doctor first, IMO. Bypassing a doctor does open up access, but there may be risks, especially if folks don't take the medicine correctly.
A lot of that ends up being bureaucratic wastes of time though. My partner was on birth control for years and had to jump through so many hoops
- 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
It led to a ton of needlessly frustrating situations since the pill is so dependent on taking it daily.
- 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.
Do you use a smaller pharmacy or a chain? Would highly recommend getting setup with a smaller pharmacy that will value the endless recurring business and work with you to iron out all the seams. It should not be such a big deal to handle these basic things. Some even offer home delivery so you don't even have to lift a finger...
Yeah they do that, way too often. My wife went in to a 32 week OB appointment and the hospital staff were trying to force her to get one, she just left and got a new OB clinic.
Flashbacks to the pharmacy I used to frequent whose head pharmacist consistently failed to autofill my ortho-tricyclin and was shocked when I kept calling in to request new fills.
"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?)
You are the first commenter to relate anything like even a secondhand real life experience with oral 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.
There is a lot of horrid comments in this thread ("Just have lots of kids!" and "Great, now people can live their addictions without worry"). It's a mix of ignorance, intolerance, misogyny and with a topping of "total lack of empathy".
I'm a bit mollified by the number of people responding to all of the horrid comments.
Also, a lot of people don't realize that oral contraceptives offer benefits beyond literal contraception. I've been on the pill since I was a teen because it's the only thing that keeps wicked endometriosis symptoms at bay (and coincidentally have had the best luck on a progestin-only pill similar to the one that just got approved). And this is despite being in a monogamous relationship with a cis woman for the past five years—zero pregnancy risk there :P
Totally agree with your take here, although I would like to offer my perspective/speculation as someone who actually takes oral birth control daily:
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.
Because, naturally, humans can only be informed about a single topic: their career. Therefore, programmers are only capable of being knowledgeable about programming. And doctors are only capable of being knowledgable about medicine. And plumbers are only informed about plumbing topics. Really?
Thanks for this... It's kind of funny considering I've probably done as much reading on nutrition science the past 5-7 years as I have programming (almost 30 years into this career). Mostly in that there's been so much mis/disinformation regarding food and nutrition over the past couple centuries, and I have a lot of health issues as a result.
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).
See this is a great example, you've studied this topic extensively but don't seem to know the absolute basics of the industry.
"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, because I displaced the term dietician with nutritionist conversationally you side step into a diatribe. You do realize that a lot of people have learning disabilities that make it difficult to remember specific terms in their place? It's kind of like a mental block in trying to remember. I have this when it comes to proper names all the time. It doesn't mean that I don't have an understanding of the conceptual base.
So, dieticians never suggested limiting cholesterol, and cutting out all saturated fat?
People mix up the title all the time, it's no big deal. I'm mostly focused on the fact that you were upset by the licensing requirement. I took that as evidence that you were not aware that dietitians are often a clinical facing role, with clinical responsibilities such as writing prescriptions.
Was I incorrect in that assumption? Or do you genuinely want to relax the licensure requirement for people who write IV prescriptions?
I'm not upset about the licensing requirement... I'm upset that said licensing is based more around establishment dogma (standard of care via USDA) than actual known nutritional science.
You're misunderstanding. It's not that they can't know things outside of programming (which is your strawman), it's that they usually don't make the real effort to learn, and think reading a few blog articles makes them knowledgeable about a subject.
At what point does one cross this arbitrary barrier to being proficiently knowledgable in a subject outside their profession?
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.
Yes, I believe all that time I put into learning means I do know more than most. And no, I didn't suggest that I'd have that knowledge without the time, effort and study, never did.
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?
To be honest, it seems like we mostly agree, so I don't see what the issue is.
>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.
Just in general, people on the whole are idiots about drug culture and history. Most people have no idea their drug scheduling system makes no sense, that they have a bunch of dumb cops (DEA) that came up with and maintain that system rather than actual medical experts, that there were racist and economic interests at the root of all this nonsense rather than genuine concern for their well-being, etc. Also the idea that you can use control of a drug as a proxy to control and disempower various marginalized demographics.
Your comment is at the top of the thread, so thank you for pointing this out before I waded further into the comment section. I'm sure you saved me some grief.
> This thread (edit: at the time I am posting this) is full of men with little real knowledge
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.
You're right that women ought to be the ones in charge of dealing with this sort of thing, but I don't think a bunch of guys presenting positions that are generally skeptical of the FDA restricting things that are generally considered safe from being sold OTC (even if not for the right reasons) are the reason that it took a long time for this to be approved to be sold OTC.
> I don't think a bunch of guys presenting positions that are generally skeptical of the FDA restricting things that are generally considered safe from being sold OTC (even if not for the right reasons) are the reason that it took a long time for this to be approved to be sold OTC.
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.
> You're right that women ought to be the ones in charge of dealing with this sort of thing,
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 :)
In liberal democracies, people have a right to get to have their say (on a soap box and at the ballot box) in matters that don't rationally concern them.
In a liberal democracy, a common citizen 'dictating' simply means saying something with a jackass commanding tone. Such advocacy for policy/governance is a protected right in liberal democracies.
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.
read my words carefully: i didn't say anything about the words themselves, nor the act of speaking those words, i said the ideas and positions are antithetical.
The idea to which you responded was the assertion that people have a right to vote in matters that don't concern them. This is the central premise of liberal democracy.
Good time to remind people that tylenol dosages as written on the bottle are just within the safety window to avoid toxicity[1]. Having done the math myself, you can't even take the extra strength stuff at the recommended timing without skipping a dose each day. Drugs, even OTC ones, have very real risks, and gatekeeping BC is laughable given the risks of not having it freely available.
Tylenol/paracetamol/acetaminophen also barely works. It increases the effectiveness of an aspirin and caffeine combo to relieve headaches (but not migraines). It’s generally ineffective against chronic pain, back pain, and severe pain. It’s a weak fever reducer.
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.
I also do not like how toxic tylenol is, but I'll echo the other (probably parents) posters pointing out that dropping a fever from 104.2 down to 100.9 is... pretty awesome when you have a screaming 6 month old and panicking mother. Arguably it's best feature is mild fever reducer. I love that feature. My child will peacefully go back to sleep within an hour of taking it and we can go get prescribed antibiotics for her ear infection first thing in the morning, rather than jumping through a bunch of hoops during a midnight run to the ER.
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.
My first paragraph lumped together a bunch of pros/cons. Tylenol definitely reduces fever and eases mild headaches. It doesn’t do some other things that it’s prescribed for.
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.
Yep, if you call the nurse hotline generally they will advise you to dose Tylenol and then if if it doesn't come down, go into the ER. We have not yet had to do the second step.
YMMV but acetaminophen is extremely effective for me. I refuse all opioid/etc prescriptions even after surgeries, and acetaminophen makes this tolerable. It doesn't magic the pain away but it takes the edge off with no risk of addiction.
My understanding is that for chronic pain the evidence is sparse, but for postoperative pain it definitely works.
No, but I refuse to have such drugs placed in my custody to me for me to be responsible for. The doctors can dose me with whatever they think is appropriate while I'm under their supervision, but I won't take that stuff home with me.
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.
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.
I keep it in my first aid kit, since it works some amount for fever reduction and can be used in some cases where ibuprofen is contraindicated (like with dengue).
The FDA regulates both risks and efficacy. The efficacy of hormonal birth control plummets if not taken consistently, which for progestin-only pills (like this) includes the same time of day[0]. Talking to a doctor ensures that people really understand this.
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.
Conversely, the downside of forgetting when you can take Tylenol is maybe needing an organ transplant or dying. Which...is 100% efficacy on pain reduction, I suppose.
In the United States, there are two quite distinct aspects.
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.
They are absolutely different, so we should discuss the actual risks of the pill and not the risks of misusing a contraceptive in general.
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"
> Talking to a doctor ensures that people really understand this.
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.
There are non hormonal options out there like IUDs (and condoms) that may be a better option though. Speaking as a parent, I would rather have my kids come talk to me /my wife about this stuff and work with us and a doctor to figure out what's best for them long term. I recognize not every kid has that kind of relationship with their parents and would benefit from purchasing it directly.
> There are non hormonal options out there like IUDs (and condoms) that may be a better option though.
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.
Your article talks about an annual report, then links another article written 3 years before the one you link, said article doesn't link to the report.
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.
To be fair you can’t even get dick pills in the states without a script (though these days you can get them expensively online via nonsense e-consultation).
Meanwhile in Mexico you can buy generic Cialis and all sorts of drugs over the counter for $20/mo. Insulin and epi pens too.
How do you think the two are equivalent? Hormone medications can have a profound impact on a person across the spectrum from mental to physical health. Secondly, taking BC wrong may lead to a false sense of security and subsequent unwanted pregnancies. I wouldn't be surprised if there was a, smallish, correlated increase in STDs, as well.
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.
Let's get big government nanny state out of the way here. People can make their own decisions. It's not like you can't consult with a physician when taking contraceptives over the counter anyway.
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.
>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.
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.
Sure, and being poor is probably linked to higher rates of STDs too. Oh and alcohol use... and... and...
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.
So you would rather make unsubstantiated claims yourself, taking part in precisely the thing you took a few paragraphs to denounce, because you consider yourself to be right?
Well I know I’m right about the general topic and requiring sources for the unsubstantiated claims.
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.
"Acetaminophen toxicity is the second most common cause of liver transplantation worldwide and the most common cause of liver transplantation in the US. It is responsible for 56,000 emergency department visits, 2,600 hospitalizations, and 500 deaths per year in the United States."
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.
> Secondly, taking BC wrong may lead to a false sense of security and subsequent unwanted pregnancies.
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.
More generously, the unwanted pregnancies can result from assuming your birth control works but actually it doesn't because you didn't read the instructions properly. At the extreme this can be "I didn't realise I need to take the pills every day even when I'm not planning to have sex". A relatively brief consultation can fix that.
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.
And 90% of women have taken hormone contraceptives at some point in their lives and that's not even counting the people who take hormone treatments for PCOS or menopause.
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.
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 wouldn't be surprised if there was a, smallish, correlated increase in STDs, as well."
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.
My cousin is a toxicologist and he was talking about this in the 1980s - that the public had no idea how incredibly toxic Tylenol is and how easy it is to over dose on it and cause significant damage to your liver and other organs.
The worst is that if you "OD" on tylenol, you won't die right away, but instead slowly and increasingly painfully over time, perfectly aware of what's going on.
That's pretty much a USA thing, though. In Europe you'll usually only come across blister packs, and they don't really go beyond 50 / box. It is a lot harder to accidentally OD when you have to individually remove every single pill from a blister pack, rather than just chugging a fistful straight out of the bottle.
Also, ~40% of children born into poverty remain in poverty [1], and it costs $310k per child from 0-18 (excluding daycare and college costs) [2].
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.
When you're doing it explicitly because 40% of their offspring will be poor, I think you've at least entered a gray area. Aligning with the interests of eugenicists is hardly an argument against a policy though.
The point is that an individual CHOOSING to not have a child because they don't want that child to stay poor is NOT EUGENICS, and this policy will not force birth control on anyone who doesn't want it. In fact, all this does is make it easier for people who DON'T WANT KIDS to NOT HAVE KIDS. Enabling personal family planning like that is basically the opposite of eugenics?
Eugenics and choice are not exclusive; eugenics does not have to be administered through force. Singapore subsidized sterilization of poor and uneducated people and that was eugenics, even though people were still able to choose whether they wanted kids. And, to get ahead of 'poor people don't have a choice because they need money to live', Singapore changed tracks and started incentivizing reproduction for educated women, and that is also eugenics. If I don't reproduce because I have a genetic disease that I don't want to pass down, I'm practicing eugenics.
Eugenics doesn't by definition mean all of the horrible abuses that have arisen from it in practice. It's just about 'improving' the human gene pool, and any method of achieving that goal qualifies.
That's true, but there are also very large risks with becoming pregnant. Historically, I believe it is by far the single largest cause of death for young women. Things have improved, but it is still quite risky.
Everything in life involves risks, but I believe on net this reduces risk.
> there is a non zero risk with taking something like this that should be discussed with a doctor first, IMO.
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.
What is your point?
Eating fast food everyday has a non zero risk. Arguably a really high risk.
Do you want a prescription for what you can eat as well?
I agree, and I see a lot of false equivalence comparing BC to the dangers of Tylenol/acetaminophen/paracetamol in this thread.
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.
I think that it's really shitty that one can take hormonal birth control with perfect responsibility and encounter negative side effects. I also think it's really shitty that the US has the highest infant and maternal mortality rates in the developed world. I've had to deal with both sides (taking hormonal birth control, with some side effects; having a "high risk" pregnancy and being confronted with forced surgery that would increase my mortality burden, against empirical medical evidence but for insurance reasons). My philosophy is consistent: given that the hand of cards is shitty, I want to choose how I play the cards.
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.
Sure, and you can use NSAIDs correctly and experience the same. For instance, if you're taking methotrexate.
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.
I'm pretty sure you don't have to "have" a doctor for this. MinuteClinics and such can provide this. I would guess there are websites you can get Rx through too.
That’s still a needless barrier. If you are poor every dollar counts and being required to pay for a medical professional to rubber stamp a prescription does more harm than good.
> If true, we would do away with the prescription process altogether for most drugs.
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.
I agree. Most of the "flow charts" systems already exist and are used today by the doctors and pharmacists. The only real barrier to opening these up to the public is they would need to be translated to layman terms and provided detailed definitions. WebMD and Drugs.com do this, but perhaps not well. We would also need some sort of guidance or check by the pharmacy just a to rule out the classic "WebMD says I'm dying" panick, or to order/interpret diagnostic tests.
Having a doctor rubber stamp a prescription does more harm than good. 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.
"Having a doctor rubber stamp a prescription does more harm than good."
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.
Net benefit is the enormous hassle a woman has to go through to get an approved treatment.
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.
Those are not restrictions under the Rx process. One can easily access hormonal Rx birthconrtol online - virtual appointment and mailorder pharmacy with auto renew. If people are unhappy with their service, there are other providers able to provide a convenient experience.
You can't get a year of pills at one time. These pills expire 1 year from the manufacture date.
You're talking about a theoretical "one" that can easily get birth control. In practice, this does act as a significant barrier for a large portion of the population. It's easy to forget this in an Amazon/Doordash/Instacart world, but online ordering doesn't work for everyone. For example, 4.5% of US households are unbanked.
No, it's a great argument because it disproves your claim "One can easily access hormonal Rx birthconrtol online". It seems you have a new claim that this doesn't matter because they likely qualify for free or reduced healthcare. I don't find that very convincing. "Likely" isn't enough here and a doctor's appointment, even for free or reduced cost, is still a significant burden.
No, the point is that you can get birthcontrol online using Medicaid or insurance without needing a bank account.
'"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.
This is false equivancy. We would need to view that on an individual basis. Just because we have done it for one type of drug, doesn't mean the concerns are the same for another type. This is especially true when considering alternatives during evaluation.
In my opinion, they are not taking a systems thinking view when considering the alternatives. They mention risks associated with cancer recurrence, but then say it is unknown how high the risk is. There doesn't seem to be any mention of the probable increase in risk of developing certain cancers, like gliomas. They mention that STD rates will go up if condom usage decreases, yet didn't measure if there was an increase or decrease in condom usage associated with the product. They also seem to ignore that making the pill OTC may influence some people to rule out higher efficacy prescription options like IUDs. They talk about almost half of pregnancies being unplanned, yet there was no real analysis on how many of those would be prevented by this OTC pill.
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.
There are a lot of OTC meds that are literally more dangerous or side effect heavy or have objectively worse risks, or are more damaging with long-term use than their superior prescription-only counterparts. Even within prescription medications, it is ironic that they often schedule more leniently based on the potential toxicity+lack of abuse potential (stick+ lack of carrot).
Wait, what exactly has a zero risk? Drinking water has a non zero risk. Breathing air has a non zero risk. I once looked up at the sky. Pretty sure the risk wasn't zero.
What's the problem? Theranos committed fraud and their founder is in prison. Meanwhile, you can order blood tests. Early in the COVID pandemic I thought I had it at the very start. I got myself an antibody test and found that I didn't. Good data, and I didn't need to go wait in a doctor's office with a bunch of COVID patients.
Maybe it's time for the FDA to just do quality checks but otherwise screw off. I'm tired of having to order 100% safe drugs from Indian pharmacies. No question they are colluding with Big Pharma. Is there any reason the "Farmacia" model of Latin American countries, where you go in and pay per-pill for whatever you want wouldn't work here?
The plant in India’s southern Tamil Nadu state produced eyedrops that have been linked to 68 bacterial infections in the U.S., including three deaths and eight cases of vision loss. Four people have had their eyeballs surgically removed due to infection. The drops were recalled in February by two U.S. distributors, EzriCare and Delsam Phama.
If you have ever lived in, been to, or even seen videos of life in India, then this would not be shocking.
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.
> Is there any reason the "Farmacia" model of Latin American countries, where you go in and pay per-pill for whatever you want wouldn't work here?
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.
Sunscreen! Korea and Japan have great sunscreens that don't feel oily or icky on your skin because they're able to use more modern ingredients. The FDA hasn't approved new sunscreen ingredients since 1999.
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.
For the longest time, something as simple as Voltarin was not available OTC in the US, but could easily be obtained from other countries. It's an anti-inflamatory cream used for joint pain that you don't have to eat, so lower risk of side-effects to stomach, liver, and kidneys.
I dont know what "Famarcia" model you refer to, but in Argentina isn't like that, but the contrary. You need a prescription from your doctor to buy most of the meds. Last time I was in NYC, I was surprised by the meds section, a lot of choices without prescription. I wish we had something like that in here, the only thing that doesn't need a prescription is ibuprofen*
In Mexico, Colombia and Peru I have bought individual pills, exactly as many as needed. I’ve done this for stomach issues and antibiotics (yes, I had a bacterial infection). In Mexico, I saw a doctor in the same building as the pharmacy after a 10 minute wait to get a prescription for something else.
What's odd is that in most of the middle east all non abusable drugs are over the counter . Not sure why it's not a thing in the US . Insulin was recently non otc because body builders abuse it ( deaths )
When you refer to the doctors as gatekeepers is it because they are doing something other than ensuring you have a safe experience with the drug, or is it more a comment on inability to access doctors due to US private medical system?
I've had some prescription issue for other meds as well. Usually an issue of the insurance or pharmacy, not a political motive. They don't like to give long term supplies given the expiration is 1 year from manufacture.
At least once she's been lectured about starting a family by pharmacists when trying to pick up her prescription which caused us to switch to a different pharmacy.
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.
"why the prescription can't be for longer as to require less doctors visits / bills."
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.
Your original question was whether there were barriers. Now you're clarifying you mean political barriers determined by the intent of the provider, which is of course opaque to us. Is it possible under these constraints to describe a barrier you'll accept?
Generic issues are not barriers, especially if they are not universal. There are online services that can cheaply provide these services conveniently. Just because someone uses a provider that provides poor service is not a barrier when alternatives exist.
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.
Well what do you really expect from pharmacies, when failure to exercise such discretion can get them sued for millions or even billions of dollars? Blame lawmakers and lawyers.
I guess you're suggesting that they rejected my prescription because of supply issues, they openly said it was because it was suspicious (3-mo in cash), and also Vyvanse hasn't had shortages like generic amphetamine in 2022-2023.
Also, I think you mean OTC amphetamine alternatives since amphetamine is sched I.
Amphetamine (Dexedrine) is schedule II, not schedule I. Doctors cannot generally prescribe schedule I substances like LSD. Pseudoephedrine is a substituted amphetamine so referring to it as "an OTC amphetamine" is technically reasonable although potentially misleading.
These pharmacists have very real personal liability if they end up getting fingered as being a supplier of components used to make illegal drugs. That's why they look askance at this prescription.
Its more about needing the Dr appointment. A Dr appointment isn't cheap if you are poor and lack insurance, and many places have wait time of a year to get an appointment.
You can get birth control from places that don't require insurance like MinuteClinics and online for a cost of about $20 for the visit. I'm pretty sure the online option does not have long wait times.
In some states in the US, sure. But that requires you to both be in a state that is served by the service, know that it exists and is available, and still pay out of pocket.
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.
Let's make people go to a clinic to get any medicine then. If it isn't such a hassle, you won't mind?
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?
I generally am in favor of government getting out of the way. I'm not necessarily against this being OTC either. I think a lot of the arguments being made here are not applicable and this won't be as big of a deal as people are making it out to be. I'm skeptical that this will bring any real net benefit over the current state.
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...).
You are letting one ideological belief conflict with another and yet you don't realize it. When you feel strongly about something, don't excuse it like "I think a lot of the arguments being made here are not applicable and this won't be as big of a deal as people are making it out to be."
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?
Last time i had to pay out of pocket (because insurance won't cover more than 3 months at a time and I was going out of the country for 6) my GENERIC BC was 89.99 per month. The brand name is something like $189. I can't take cheaper forms because they have negative interactions with my brain chemistry that make me suicidal. BC is offensively expensive and needlessly difficult to obtain.
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.
One of the routine problems I see around this place is how the folks who flock to "intellectual" spaces are both the intellectual and the ignorant who fancy themselves the former's equal.
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.
You are a teenager who needs oral contraceptives because you are sexually active. You don't want your parents to find out. Since you're a teenager, you have a few constraints:
- 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...
You still require payment for OTC. You can get birth control from places that don't require insurance like MinuteClinics and online for a cost of about $20 for the visit.
> The contraceptive efficacy of norgestrel was established with the original approval for prescription use in 1973. HRA Pharma applied to switch norgestrel from a prescription to an over-the-counter product. For approval of a product for use in the nonprescription setting, the FDA requires that the applicant demonstrate that the product can be used by consumers safely and effectively, relying only on the nonprescription drug labeling without any assistance from a health care professional
It took 50 years to make packaging that users could understand?
Yep, because it's relying on the cultural knowledge that has been built up over the years through things like health classes and society talking more openly to share knowledge. And people really don't understand all the potential risks for most medications they're on, whether Rx or OTC.
Couldn't be that doctors wanted all those easy well visits writing scripts for birth control and the recent supreme court ruling encouraged the FDA to finally be reasonable? It's that this exact moment is the first time in human history that women are capable of understanding "once daily".
> It's that this exact moment is the first time in human history that women are capable of understanding "once daily".
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".
How does the pill being prescribed by a doctor help this? Do you think doctors are actually explaining this to patients? They are not. They don't have time. The PE firms who own them won't let them take the time.
I would expect someone to explain it; if not technically a doctor then a nurse or such, which is consistent with my experience of medical appointments.
Sure, it should be explained, but the point is that there's no value in only enabling a scarce resource (doctors) to explain something that doesn't require any medical training (take this once a day at the same time).
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.
"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.
What is the need for any kind of appointment with a doctor? There is literally no medical expertise required for what we're talking about here. There is the need to relay an instruction that almost anyone can understand. Why is it a good idea to force patients to make any kind of appointment and to take up the time of very highly trained medical professionals, in order to say "TAKE THIS AT THE SAME TIME EVERY DAY"?
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.
Depends on the result we are expecting as to if it's unreasonable. I would guess at least half of people do not read the paper you get with the medication (any meds).
> So no, empirically, it appears likely that people are not capable of understanding "once daily".
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.
Empirically, how much does visiting a doctor change people’s understanding of “once daily”? Measured in percentage terms. Because that’s the important question here.
They have some data in the links in the article. There could be some bias there (pharma likes to guide subject answers, and they dont provide the methodology details), so we would probably need real world data. But based on that limited data it appears to be no different. In theory, the longer the pill is in use and the more people who use it, then the more likely it is that people in society understand that it's one's a day at the same time of day etc.
So literally a vibrating pill box that stays lit and sends smart reminders until someone takes their pill would be 10,000x more effective and cost vastly less than the appointments+opportunity cost+lifestyle cost forced on women by profiteers. Or one of those special purpose reminder apps. Or Google Calendar…
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…
Doesn’t sound plausible. Doctors aren’t really casting around for work, these visits aren’t particularly or unusually straightforward for a GP - and at a guess a majority of women who stay on hormonal birth control have had some problems with it at some point. The cultural knowledge aspect is real.
Some people react very badly to hormonal contraceptives, to the degree that it makes a lot of sense to have them actively prescribed so the GP can watch for (or at least warn to watch for) side-effects.
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.
Yeah, I was a bit shocked to see this. Not because it shouldn't be easily accessible, but because most women I've talked to about this has gone through some sort of dialing in process. Whether its for dosage or a different brand. Hormones are not easy.
No medication is completely safe. Any medication approved for use has to be "generally safe" when used correctly. So basically all meds can be dangerous or safe. It's all about informed consent and proper use.
Well exactly. In this case it's more a matter of whether the move to non-prescription introduces significant new risks both that didn't exist before and that the layperson shouldn't be expected to be able to handle.
There's more to it than once daily. I doubt the Supreme Court ruling had any logical impact on the FDA decision, unless it was only an empty political gesture (no real contraception restrictions right now). It's more likely that phrama makes more on Rx prescriptions and had no incentive to make it OTC.
IDK what culture you're referring to but where I grew up in the US it is not legal for the education system to inform students about what contraceptives are and how to use them. So I find this argument of yours completely bogus.
Generics at least aren't big moneymakers. With totally pedestrian insurance I pay next to nothing (or nothing) for the variety of meds that I take. Would probably cost more if I could buy them OTC.
Given the 50 years, I'd say the original investment has paid off many times over, and all the generic brands got their cut. It's more than fair to society to allow the medicine to go over the counter.
Oh I'm not disagreeing in general. There are probably some classes of drugs like antibiotics which probably lend themselves to overuse/misuse and are probably best kept prescription only for the most part (agriculture overuse notwithstanding). But in general, if there's no good reason something shouldn't be OTC, it probably should be.
I'm just saying generic prescription drugs don't necessarily have a huge price uplift vs. OTC.
I think you are looking at the cost of generic prescription drugs vs their generic OTC counterpart. When a drug is first invented it is patented, not generic. The drug company has to look at whether to apply for FDA approval as a prescription or OTC. Most often drug companies look to get approval as prescription, because that is more profitable for patented drugs.
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.
I think you are looking at the cost of generic prescription drugs vs their generic OTC counterpart.
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.
It could also be that public familiarity with medication procedures and language has changed over time allowing the FDA to believe that this can be used safely now, whereas the same instructions would not have been as effective 20 years ago?
The same people who hate and politicize abortion also usually hate and politicize contraceptives. I don't know if that had an impact in the choice to seek approval or not, but I wouldn't be surprised.
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.
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.
> But I'm not aware of any concerted effort by Republicans to ban or restrict pre-pregnancy contraceptives in my lifetime.
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).
> There was a recent ruling that when it comes to contraceptives that agencies cannot protect minor confidentiality from their parents.
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.
Students for Life is a republican non-profit organization, same for the Catholic Medical Association. They are pushing concentrated efforts to restrict access to pre-pregnancy contraceptives. You're trying to pull a no true scotsman here and it isn't working.
> 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.
That's not a "no true scotsman" argument. It would be if I claimed something like "they're not real Republicans" but I'm not.
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.
The slippery slope you're presenting doesn't hold water. There's a pretty clear difference between abortion and pre-pregnancy contraception. Republicans' stance on the former is not a strong indication of their stance on the later.
The contingent of people who want abortion restrictions and those who want to ban daily preventative contraception is incredibly minimal. There is no serious mainstream movement whatsoever to ban this type of medicine.
This type of hyperbolic proselytizing has no place in reasoned discussion.
The Catholic Church might consider it a sin but that doesn't correlate with American Catholics wanting to ban contraceptives. I'd wager most American Catholics don't agree and then even more don't care about it's legality.
The Catholic Church also considers adultery a sin but that doesn't mean Catholics want adulterers executed.
You're assuming a fundamentally democratic decision-making process that doesn't exist in reality. It's entirely conceivable that a 5-4 Supreme Court majority could outlaw or restrict something that enjoys broad acceptance in the population at large, for example.
In what way would they ban something? I mean, what would that mechanism look like? Honest question. It seems that they would only be able to rule some legislation unconstitutional or to rule on a case to set a precedent.
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.
Yes, because it’s an incredibly important drug that has massive social implications on it.
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.
This reminded me to look up Vasalgel again (a single-application, non-hormonal, long-lasting, reversible male contraceptive that is unfortunately not yet commercially available), and I see that it seems to have taken a meaningful step forward:
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.
There are tens of thousands of men taking injectables in the US and worldwide today who completely bypass the medical gatekeeping establishment. These injectables have been shown to reduce fertility to nil and last for up to 6 months.
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.
One thing that has occurred to me about these types of medications is men are seemingly more willing to lie than women about being on contraception. IMO that's just a reason to criminalize that type of deceptive behavior and not prevent people from having access to the drug.
I don't believe that would be politically tenable. The state / society wants fathers (or at least someone) to pay child support. This kind of law would have a chilling effect on mothers who claim or simply allow someone to take the child's role as a father, even if they're not sure.
That doesn't make much sense to me since you can lie about a vasectomy or, more simply, about pulling out.
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.
Are you talking about condoms or hormonal birth control? Are there results on a study I can read somewhere about how often people lie about contraceptive use? Can't find anything.
It's often funny to me how there will be such a massive gnashing of teeth about whether or not something is prescription or OTC available to women, when Men essentially have no contraceptive choice and have 100% liability the moment it leaves our body, potentially including in cases of paternity fraud.
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.
> 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.
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.
A majority of Americans still have access to abortion that is _less_ restrictive than most EU countries. The Supreme Court did not outlaw abortion. In my state, abortions can be legally performed right up until birth.
Telling this to other Europeans who comment stuff like "I can't believe they outlawed abortion in the US" just doesn't get old. From "Damned brutal patriarchy" to "Damned children murderers" in less than 5 seconds.
I always wonder why the truth gets buried. What I said was accurate, but it does go against several popular narratives. Nobody wants nuance, but these things are entirely comprised of nuance.
Oh, I thought it meant when courts require the non biological father to pay child support.
I can see your description being relevant, but at that point you should probably be getting video testimony of consent before engaging in sex, preferably with a notary type witness. I am just half joking, I do not really know what any other solution would be to a he said she said scenario.
Not really, as a woman’s pregnancy affects her body and life quite a bit more drastically than it affects a man.
Ideally, men would be equal in this regard, but nature does not work like that so we have to work with what we have.
If you can come up with a better solution that does not violate a woman’s autonomy over their body and also does not let men off the hook for providing for their kids, I am all ears (or eyes I guess).
Perhaps the government provides for everyone’s kids?
Oh, I agree it's complex and there are meaningful differences in how the whole pregnancy thing is experienced, and that the needs of kids maybe should override weird selfish libertarian-adjacent "pft, totally unfair to make me pay for any of this!" attitudes (cases of actual fraud being... another matter, potentially).
I was just caught off guard by that particular argument being employed in that way. "Well it's easy for a man to simply not have sex, if they don't want kids they shouldn't have sex, that's the end of that" is... not usually well-received (and shouldn't be) when the positions are reversed, even when the context is entirely about consensual sex.
> even when the context is entirely about consensual sex.
I thought this context was about ensuring women have access to over the counter birth control, which can be a benefit in the case of consensual and non consensual sexual. Especially in non consensual sex.
As a woman, I fear most people don't understand how much hormonal birth control can increase blood clots, cancer risk, mood changes, and all sorts of side effects.
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.
Chronic post-vasectomy pain syndrome negatively impacts quality of life in 1-2% of cases. Even a small chance of chronic pain should be weighed carefully against the benefits and alternatives.
I agree. What are the chances that a young person taking this for the first time will recognize the side effects and know that it is from this vs something else. I guess they can always go to the doctor after the fact, but in some cases the harm will have already been done.
The pill can have pretty severe mental health impacts on women. I think as long as these are clearly signposted so that women know what they might be getting themselves into, then fair enough. Also tons of other side effects, some of which are pretty severe if taken in combination with the correct (eg most unlucky) underlying health issues.
I was on birth control for 5 years and had some friends on it too. My very anecdotal data is that: while none of us faced any mental health changes, there were some physiological changes that I did not like.
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.
Unless you’re an addict you’re not taking alcohol/drugs/cough syrup on a daily basis though.
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.
You're absolutely right that, ideally, this would be a conversation with a professional, non-moralizing doctor.
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.
Very interesting. It sounds like the issue is the healthcare system. When I was a teenager I could make a doctors appointment without my family knowing and without paying anyone or leaving a trace. It’s a side of the US system I hadn’t considered before (lack of privacy) so thanks for explaining it. Great that this will help some people but fixing the system seems much more important than letting people buy medicine OTC without advice and a review of their history.
>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)
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.
This is great. My own experience with my wife and birth control have included
* 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.
I'm amazed that with the level of technology we have, the main form of birth control outside of condoms are adjusting hormones.
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.
This is a bigger deal than it might seem. When birth control pills arrived in the 1960s, they were seen as a tool of liberation that would free women from forced pregnancy. Then the pope came out against them in 1968:
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.
> Man...may...come to the point of considering her as a mere instrument of selfish enjoyment
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.
I wish that everyone in the US had affordable, convenient, and private access to a doctor who could help them choose contraceptives and ensure no side effects.
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.
When will they come up with one that men can take?
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?
sure but the previous comment made it sound like it was already illegal which would have been really surprising to me. I’m no fan of recent regressions in abortion law but the arguments made by pro-lifers that I’ve heard would not apply to birth control (ie that abortion is essentially killing a human). so I would actually expect them to favor birth control as a way to prevent abortion. that’s assuming their position is really based on their stated beliefs and not something else unstated or irrational (and I decline to take a position on this question at this time).
The largest Christian denomination has a long-standing prohibition on all forms of contraception. (This is in addition to its prohibition on abortion.)
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.
> I’m no fan of recent regressions in abortion law but the arguments made by pro-lifers that I’ve heard would not apply to birth control (ie that abortion is essentially killing a human). so I would actually expect them to favor birth control as a way to prevent abortion
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.
Some state lawmakers have publicly targeted that after abortion, hoping to use it as the lever to get the Supreme Court to toss Griswold the way they did Roe with Dobbs.
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.)
> Some state lawmakers have publicly targeted that after abortion, hoping to use it as the lever to get the Supreme Court to toss Griswold the way they did Roe with Dobbs.
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.
No - historically the Comstock laws in the US banned distribution of contraceptives and contraception information and abortifacients and information on abortion. This is something that the US has done in the past and has support among many of the current day anti-abortion crowd.
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.
It is not. Significant minorities of the anti-abortion movement are also anti-contraceptive. There are articles and even draft legislation published by these groups from 15+ years ago detailing the ultimate goal being bans on contraceptives.
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.
> It is not. Significant minorities of the anti-abortion movement are also anti-contraceptive.
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.
What the fuck business is it of the government or other people not directly involved in the sex act what birth control I am using so long as it is not harmful to the people using it or the public at large?
Who cares though? It makes no difference to the people whose lives are affected by the banning of contraceptives. This sort of sophisticated model of their interiority is simply not valuable to me. I don't care if they're internally consistent I care what they want to do.
I think it is important to steelman one’s opponents rather than strawman them, to seek to present their position accurately rather than oversimplifying it. To me that is an important norm of civil discourse, and I care about the norms of civil discourse. That increasingly many people don’t doesn’t bode well for society’s future.
One really distinct american political dynamic of the last decade or two is liberals caring about the norms of civil discourse while the far right succeeds in its wildest dreams by ignoring them. There's no referee to call when they do that, there's no virtue in losing civil rights but keeping the moral high ground.
Is that what has actually happened? One can point to plenty of liberals/progressives defying those norms, and plenty of conservatives respecting them. Both “sides” contain civil and uncivil people; claims that one side is worse than the other rely heavily on ignoring the faults of one’s preferred side while highlighting those of the other
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
Yes that is what happened. Major revanchist victories across wide swathes of cultural and civil advances: abortion, queer rights & safety, affirmative action, retributive justice system. Adhering to civil norms in this context is itself a fault, that's my point. To the extent democrats are my preferred "side" I condemn them for this.
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.
> Yes that is what happened. Major revanchist victories across wide swathes of cultural and civil advances: abortion, queer rights & safety, affirmative action, retributive justice system. Adhering to civil norms in this context is itself a fault, that's my point. To the extent democrats are my preferred "side" I condemn them for this.
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".
I can see that. It's very similar to significant minorities in the gun control movement. On either issue, premature movement to counteract them could bring more harm than good.
Hmm idk. My anecdata of one wife had a really bad time with oral contraceptives. I feel like behavioral side effects are pretty insidious. She got pretty bad anger problems that would only appear to manifest with those she was very close to (and 95% of the time was me). It was difficult to convince her that her emotions were being selectively biased. Which is a bit of a causality minefield to get into. I worry that many women could just start taking this and have it derail their lives invisibly to them. Not that the doctors prescription step made this better per se. But it’s hard for someone to take a drug that can potentially materially alter your perception of things in ways that are not intuitive for you to observe. Switching birth control methods sucks. But this shit is not talked about enough. I lean towards believing the pill is riskier than it’s worth. Hormonal IUDs or copper IUDs feel like they’re a much safer choice (higher switching costs though and probably daunting for the very young).
Counter anecdata: I know several women where oral contraceptives noticeably improved their lives, because their hormones were now being regulated. They got less mood swings and were way more stable.
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.
That’s not a counterpoint. It’s a possible upside, but these things don’t net out across patients.
> 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.
Oral contraceptives do have side effects, including effects on mental health. Sometimes the effects seem to be positive. Often, they are quite negative.
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.
There's an association with "needs a prescription" that people have about the seriousness of the medication that they are taking. "Over the counter" sortof implies that you can't mess it up, or that it isn't really dangerous
>These effects are not taken seriously by the vast majority of medical professionals
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.
Women talk about this a lot, you probably just don't have the sort of relationship where it would come up with very many women besides your wife.
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.
Good bye, USA. In 20-30 years all those celebrating this decision will be sitting in the assisted living facilities wondering who will be repairing the robots that are taking care of their parents. Demography is destiny.
> Opill should not be used by those who have or have ever had breast cancer. Consumers who have any other form of cancer should ask a doctor before use. Opill also should not be used together with another hormonal birth control product such as another oral contraceptive tablet, a vaginal ring, a contraceptive patch, a contraceptive implant, a contraceptive injection or an IUD (intra-uterine device).
Yes, I also wonder why you'd take that to mean it caused cancer.
The thing you quoted doesn't indicate anything about it causing cancer. It says people with a certain medical condition shouldn't take it. Hormones can influence how fast certain cells get replicated, and it's important to not encourage cancer cells to replicate even more.
It's because cancer treatment fucks you up, big time, permanently, and a lot of your healthcare thereafter is going to need to be changed to accomodate it.
This is a big part of it. Most cancer treatment is literally "we're going to get as absolutely close to killing you as we can, and then stop at the last second, over and over and over again, and hopefully get you into remission."
You can't do that and then turn around take drugs that mess with your hormones and expect everything to be totally fine without even a single conversation with a physician.
You did not. Some breast cancers are highly responsive to hormones. One of the ways these are treated is by altering the production of certain sex hormones.
Hormone therapy is fairly common for shrinking the cancer tumors prior to surgery or chemo, and also for post-treatment to reduce the chances of the cancer coming back. Birth control pills target those same hormones, and thus there can be unforeseen or dangerous interactions.
The cancer warning in this post strikes me as the usual "do not take X if you're taking Y" warning they do in drug ads on TV in the US. Like when they used to show ads for SSRIs, they usually had a "Do not take $DrugName if you are already taking a MAOI"
Interesting never knew they had an ascribed mechanism in place. I like how the article funneled in from the generic physical causes MECHANISMS OF VENOUS THROMBOSIS to the particular HORMONE-INDUCED THROMBOTIC STATE, that was a great transition.
There are so many issues with your post that I feel like I'm on reddit?
It's not a radical idea, or really even unpopular, to incentivize child birth through tax policy.
Insane initial implication that having children is a duty we all innately have to society aside: you can't tax an age bracket differently let alone at point of sale.
I forget which country has this policy, but basically your income tax is reduced by 25% for each child you claim. So, have 4 kids and no income tax. It seems like more effective policy to promote births rather than punish contraception.
I am under 30. At current trajectory, my government (USA) will be unable to fund social security, medicaid, and medicare to care for me in my old age due to worsening working-youth:retired-elderly population ratio. I am concerned about unsustainable tax burden on the next generation youth. This problem will be worse in countries which don't attract immigrants.
Why are you suggesting that problem is caused by contraceptives? Birth rates in industrialized nations are cratering because the social and economic conditions in these countries have evolved to be fundamentally hostile to those who choose to have children. Pregnant women are almost universally punished by their employers especially in the private sector, childcare costs have gone through the roof, while the "career above all" koolaid is being shoved down our throats every single day.
If people take contraceptives, it's because they don't want to have kids at that moment. Forcing these people to have kids will create broken parents and broken kids, who go on to become broken parents themselves and perpetuate the cycle. Most of modern society's problems can be traced to parents who should not have been parents in the first place. We don't need more of that.
The problems you mentioned are real, but I am not convinced they are the root cause for low birthrates. Do you think that Sweden, Norway, and Finland are hostile to parenthood?
For career-oriented people, yes. Those countries operate on the same market economy principles as every other industrialized nation. Extensive welfare and benefits coverage not reversing the birthrate decline only further reinforces my argument that the root cause lies deep within how our society functions.
Are you saying that a free market economy is incompatible with high birth rates? How did even less generous free market nations have high birth rates in the past? Don't you think being forced to choose between having a free market and having high birth rates an even more extreme idea than the one in my OP?
>Are you saying that a free market economy is incompatible with high birth rates?
Industrialized free market economies are incompatible with high birth rates.
>How did even less generous free market nations have high birth rates in the past?
Because those nations were not yet fully industrialized nor did they respect basic human rights for every individual. Even in the U.S. it was not possible to have a no-fault divorce until the 1970s.
>Don't you think being forced to choose between having a free market and having high birth rates an even more extreme idea than the one in my OP?
Do you also think stock buybacks is an "extreme idea"? It's the nature of every business in a free market economy. This is why they punish employees who take leave instead of continuing to work.
I don't think birthrates are strongly tied to the economic system. I don't believe every human being before BC was having their human rights violated just because it didn't exist yet. I think that BC is an extremely powerful tool to fight poverty, but that the tradeoffs it could have on society aren't fully understood yet either. We should be open to the idea that there are tradeoffs here.
Yeah, more estrogen will be added to the water supply unfortunately. 90% of birth control isn't metabolized and comes out in the urine. This can have effects for wildlife and possibly humans.
There's some interesting data on how contraceptives are changing the behaviour of people. Sounds straightforward given it's a hormone, but at the same time it's a bit alarming it's not any kind of discussion point when this topic is brought up
Hormonal birth control and its consequences have been a disaster for the human race.
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.
Before everyone goes asking : Source?, I want to caution one thing.
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.
I wasn't familiar with that but very interesting. The other factor besides pharmaceuticals and apparently decrease in tobacco use seems to be increased use of plastics.
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.