Medicine has never been immune from politics (as this interesting editorial argues). Indeed, it would be naive to think that health care, which involves matters of life and death (not to mention sex) and costs trillions of dollars annually wouldn't be politicized. But many medical professionals were still surprised by the Obama administration's recent decision to reject the FDA's unanimous recommendation to make emergency contraception (also known as "the morning after pill" and sold as Plan B) more readily available.
In expressing his support of Health and Human Services Secretary Kathleen Sebelius's decision regarding Plan B, President Obama mentioned that as the father of two young daughters, it just seemed to him "common sense" that the contraceptive shouldn't be available over the counter to girls under 17. The invocation of Sasha and Malia Obama outraged many who felt it revealed the President's paternalism, or even "phony paternalism." But, as President Obama presented the Plan B controversy, it didn't seem all that controversial: who wouldn't recoil, after all, at the thought of 13 year-olds cruising the aisles of drugstores the morning after having unprotected sex to find birth control, as the President put it, "alongside bubble gum or batteries?"
The problem is, that the facts are more complicated than this emotionally-loaded image conveys. As the late New York Times columnist William Safire once advised: "Never assume the obvious is true."
What's true about Plan B? Here are the facts:
Plan B, as currently available, is a single dose of levonorgestrel, a synthetic form of the female hormone progesterone, used in oral contraceptives for 35 years and, more recently, in the Mirena IUD.
Plan B is taken within 72 hours of unprotected intercourse or contraception failure (e.g. a broken condom). It works by preventing release of a woman's unfertilized egg from the ovary, or by preventing fertilization of the egg by sperm, or by preventing implantation of a fertilized egg in the uterus (womb). Though this third event is thought to be the least likely, the possibility that a fertilized egg might be destroyed by Plan B has caused opponents of abortion to consider it a form of abortion. If a woman is already pregnant, Plan B does not affect the pregnancy. (And Plan B is not RU-486, mifepristone, the "abortion pill" with which it is commonly confused).
Plan B was first approved by the FDA in 1999 for emergency contraception by prescription. In 2006, it became available to women over 18 without a prescription. It is currently available to women over 17. (For a timeline summarizing the history of Plan B see here).
Plan B costs about $50 for one dose (not exactly a "bubblegum"-type purchase). Currently, if you purchase Plan B in a drugstore, you must ask the pharmacist for it and show ID to prove that you are over 17. If the pharmacy of an all-night drug store is not open, you cannot obtain Plan B--no matter how old you are.
In December, 2011, citing the drug's safety and efficacy, the FDA recommended that Plan B be moved to regular pharmacy shelves to be more easily available, and that the age restriction on purchasing it be lifted. Shortly thereafter, HHS Secretary Sebelius announced that she would reject this recommendation. This is the first time an administration has overturned an FDA recommendation.
So, as things stand, a 10 year-old can buy a bottle of Tylenol (fatal if ingested) without consulting a pharmacist, and a 40 year-old woman must ask a pharmacist for Plan B. Meanwhile, nearly half of all high school students are sexually active , and most are under 17 and unable to obtain emergency contraception. Many, in fact, report sending an older friend to the pharmacy to get Plan B for them--as they might do to obtain alcohol illegally.
Teen sex and its attendant problems including unintended pregnancy, STDs, and sexual violence are serious issues. But, despite President Obama's remarks about Plan B, "common sense" may not be the most serious or effective way to address them. Common sense, gut instinct, and "horse sense" have been revered since our country's founding, but in matters of medicine and science, we should be mindful of Albert Einstein's observation that "common sense" is sometimes simply a more flattering name for our personal prejudices.
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