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Emergency Contraception

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American Academy of Family Practice quotes me on Plan B without restrictions

plan b packShould all girls “of child bearing age” be able to walk into the corner pharmacy and buy Plan B without ID, age restrictions or parental supervision? I don’t think so!

However, my professional organization, the American Academy of Family Practice, issued a statement this week advocating for just that. Our online newsletter included my comments in an article published today:

On the other hand, family physician Beverly Nuckols, M.D., of New Braunfels, Texas, said she has issues with the Academy statement because it is inconsistent with its own Family Medicine, Scope and Philosophical Statement.

“Family physicians not only treat the patient within the context of her family, we also strive to treat the whole patient — ‘biological, behavioral (and) social,'” Nuckols said. “In this case, the ‘disease’ we are trying to prevent is the high-risk behavior of unprotected sex. Parental involvement is vital to the health of children and is the best prevention for high-risk behavior, including adolescent sexual activity.

“The AAFP normally and correctly advocates parental involvement and intervention to prevent other high-risk activity, such as driving without a license, the use of guns without adult supervision, smoking, or overeating, etc.,” she said. “What is the rationale for treating adolescent sexual activity any differently than we would treat other risky behavior or preventable risk factor?”

Nuckols, who serves as chair of the Christian Medical & Dental Association’s Family Medicine Section, said she also has concerns about OTC Plan B One-Step because there are few controlled, randomized studies that prove levonorgestrel to be medically safe and effective for adolescents at the dosage given.

“The published data on emergency contraception don’t break out the numbers of adolescent girls, but the numbers appear to be low,” she said. “The closest I’ve found are small studies for treatment of menstrual disorders and inherited bleeding disorders by chronic use of oral or intrauterine levonorgestrel, with the youngest age at 14.”

via AAFP Disagrees With Justice Department Blockade of OTC Access to Plan B One-Step — AAFP News Now — AAFP.

(BTW, The author quoted my written statement, exactly, so any errors are mine.  I goofed in identifying myself to the author: Much to my relief, our CMDA Family Medicine Section elected a new Chair and I’m now the Past-Chair. I didn’t realize we had passed the turn-over date. Oh, and “data” really is plural, so “data … don’t” is not terrible grammar, just awkward.)

Plan B, Minors, and the Obama FDA Appeal

Just after I hit “publish” on yesterday’s effort to explain the mechanism of Plan B and why we still shouldn’t allow minor girls to buy it over the counter, I found the news that the Obama Administration has decided that the FDA will appeal the ruling by a New York Federal Judge Edward Korman that gave the FDA 30 days to remove all age restrictions on Plan B, the “morning after pill.” This will not change this week’s decision to move the age requirement down to 15 years of age, it is a good, if minor, move.

USA Today has an article that’s typical for those who object to the appeal, written by Cecile Richards, the former National president of Planned Parenthood (and the daughter of the late Texas Governor Ann Richards).

The comments on CBS News’ coverage of the appeal point out one big problem that teens who have unplanned sex may also have: the “emergency” aspect of “emergency contraception.” One person suggests that Plan B should be available in vending machines and restrooms, as condoms often are. Several readers are concerned that teens who have unprotected sex plan won’t ahead or be able to find a pharmacy open when they need it..

Obviously, the writer of that comment doesn’t understand that the pill can be useful up to 5 days — and is still very effective (if it’s going to be) for at least a day or two. As I responded, there is a difference between a condom and Plan B: the latter is ingested and will have an effect, however small, on the hormonal balance of whoever takes it. Condoms don’t make people nauseous or throw up!

Plan B appeal angers W.H. allies – Kathryn Smith – POLITICO.com

I didn’t expect this!

President Barack Obama’s administration on Wednesday angered allies in women’s groups by appealing a judge’s ruling that the morning-after pill must be available over the counter to girls of all ages.

The administration has argued that the pill should not be readily available to young teens, so the appeal is consistent with that position.

via Plan B appeal angers W.H. allies – Kathryn Smith – POLITICO.com.

Plan B and Minors (Updated!)

Update 5/02/13: The Obama Administration has decided to appeal the judge’s ruling that the age restrictions must be removed completely from Plan B sales.

Because of a ruling by a Court in New York on April 5, 2013 and the April 30, 2013 announcement that the Obama Administration has published its intent to allow 15 year olds to buy Plan B over the counter without a prescription or adult supervision, the news is full of the controversy about whether or not Plan B is an abortifacient because it kills the embryo or blocks implantation.

(How about that: she’s old enough to buy over the counter emergency contraception, but she’s still young enough for her parents to buy her insurance until she’s 26!)

There is quite a lot of evidence that Plan B does not interfere with the embryo if fertilization occurs and none that it does. If, as the evidence supports,  it doesn’t cause the death of the human embryo, before or after implantation, Plan B is not an “abortion pill.”

But it still shouldn’t be sold over the counter to minors.

I don’t know anyone who thinks it’s healthy for 12, 14 or 15 years olds to have sex – whether boys or girls. While Texas does have the “Romeo and Juliet” defense ( when there’s no force, both are over 14 years old, opposite sex and within 3 years of the same age), 15 year olds can’t legally consent to sex. Texas law deems it a “crime of indecency” to have sex with a minor under 17.  Our State has also decided that 15 year olds can’t drink alcohol, can’t buy tobacco or Sudafed, and they usually can’t get a driver’s license.

We do this to protect them, because we know that they are not prepared to make good decisions. Their brains are not mature enough and they don’t have the experience and knowledge to adequately judge the difference between immediate gratification and future benefit. The fact is that most parents are their children’s best protectors and advocates. We are legally responsible for our children, but we are also morally responsible for them. We love them and don’t want them to hurt!

Parents need – and have the right – to know what our dependent children are doing and what medicines they are taking. By changing these regulations, the Federal government is moving between the parent and child — a much more sacred relationship than “a woman and her doctor.”

There is very strong evidence from good scientific experiments published in the last 10 years that Plan B does not interfere with the implantation or development of an embryo.

Plan B only works, when it works, by preventing fertilization for 4-5 days in the middle of the month – before ovulation – it delays ovulation so there is no egg to fertilize and by preventing the sperm from getting to the egg.

Plan B is a high dose of progesterone, the main hormone produced by the ovaries during the second half of a woman’s monthly cycle. Before ovulation, Progesterone or Plan B delays ovulation (the release of the egg from the ovary) and makes it difficult for the sperm to get to the egg.  At or after ovulation,   progesterone appears to slow the sperm’s travel to the egg (prevents fertilization) In nature, this prevents fertilization of an old egg – and its effect is one of the signs used by women who use “Natural Family Planning.”   Progesterone normally encourages the development of the lining of the womb after ovulation. In fact, doctors sometimes give Progesterone to women who have repeated miscarriages.

 It wouldn’t be ethical to conduct experiments on women who are ovulating and having sex, because those women might be carrying a human embryo that hasn’t implanted or who could be harmed. While it is true that there have been no experiments on women who might be pregnant, there are good studies which were done on ovulating women who have their tubes tied or who agree to abstain from sex during the experiment. Then, they were studied by checking repeat exams, blood work, ultrasounds and biopsies of the womb.  No evidence that Plan B interferes with implantation or damages the embryo has been found.

Current evidence is that Plan B decreases the risk of pregnancy for those women who take it properly, Plan B cuts the risk of pregnancy by 50- 70%. At the population level, it does not decrease either the pregnancy rate or the abortion rate. In fact, even women who have the pills in their medicine cabinet – who don’t have to pay $45 when they have unprotected sex – don’t use the pills consistently. This is true in countries like Scotland, the UK and Jamaica where teen girls can obtain the medication without a prescription or are provided the medication in advance of need.

I am a pro-life doctor who, like Texas law, believes that the individual begins at fertilization. I spend much of my time advocating for laws that protect the human right not to be killed and for traditional medical ethics. Yes, I am a Christian , but I prefer to make my arguments from the science side because I’m convinced that science will prove me right in the long run. After all, the “Nature’s Creator “ cited in the Declaration of Independence created science!

For the science, see these articles:

Added 8:00 PM 5/2/13 One of the best and oldest. I can email a copy of the entire article to anyone who needs it http://www.contraceptionjournal.org/article/S0010-7824%2805%2900045-4/abstract

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