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England Pilots Non-Prescription Birth Control Pill Program

Cara

I’m several weeks behind on this, but I still think the idea is really interesting and worth our attention. England is launching two pilot programs that allow women to obtain access to birth control pills without a prescription from a doctor:

England plans to launch two pilot programs in the London area that will provide women with nonprescription access to birth control pills, the PA/Google.com reports. The pilot programs will begin next year in the Lambeth and Southwark primary care regions of England’s National Health Service, and the results will be used to determine whether the program should be expanded across England. Under the program, women seeking nonprescription oral contraception will undergo an interview with a qualified pharmacist. Strategic health authorities — which manage local health services under NHS — will be required to provide pharmacists with sets of instructions known as patient group directions, including special directions for girls younger than age 16, the PA/Google.com reports. According to the PA/Google.com, patient group directions are required by law to dispense medications without a doctor’s prescription and currently are used for administration of emergency contraception. The directions for dispensing EC to girls younger than 16 include a mental health assessment.

I am, of course, absolutely in favor of making contraception more accessible to all women.  But like others, my immediate reaction was also to worry about some of the potential health consequences of women with risk factors having access to medication that puts them in danger.  I additionally worried that women using the pill for the first time might miss out on some of that vital counseling on how to take it and otherwise practice safer sex.

I’ve concluded that a lot of this is a fairly Americanized concern.  First of all, this kind of pharmacy system is not unusual for other types of medication in England and other countries like Australia (where I lived for a few years and have experienced the system to a small extent myself, while obtaining treatment for a yeast infection).  Further, while birth control pills certainly can cause serious complications, the risks are not particularly high when compared to other medication.  And lastly and perhaps most importantly, the women will not just be picking up a packet off the shelf at their leisure — they will still be getting consultations with medical professionals:

A Department of Health spokesperson said that the department wants “to improve women’s access to contraception and help reduce the number of unintended pregnancies without undermining patient safety” and that the pilot programs will “help to show whether supplying contraception through pharmacies is effective in reducing unintended pregnancies.” The spokesperson added, “We will be receiving quarterly updates from [strategic health authorities] on improving access to contraceptive services and will be working with them to assess the success of the schemes in their areas.” She said that women who receive contraception from a pharmacy without a prescription “can still expect a full consultation with a health professional such as a pharmacist or a nurse.”

I think a lot of it comes down to trusting women to look out for their own health (and after all, it’s just as easy to lie to a doctor as it is to lie to a nurse), and to trusting pharmacists and nurses to do their jobs.  And I think an overwhelming majority certainly can be trusted.

I’m interested to see how the pilot goes, and if all turns out well, I’d be really interested in seeing a similar program instated in the U.S.  American women could benefit from easier access to contraception even more, what with the huge additional complication of our current “you’re all on your own” health care system — where seeing a doctor isn’t just a hurdle in terms of scheduling and finding time to take off work, but also a potentially insurmountable cost.  Unfortunately, our obsession with the idea that only doctors can get any medical task done coupled with inaccessibility to them for most uninsured people is also precisely why it seems less likely to happen.

Your thoughts?

84 thoughts on England Pilots Non-Prescription Birth Control Pill Program

  1. It’s a great idea. I’ve never worried about the “risk factor” problem since when I started on the pill, I really wasn’t advised of anything past the “tsk-you should stop smoking”” bit-luckily I tend to read the pamphlets in the bathroom a lot. 🙂

    Aside from potential contradictions which would be covered by speaking with someone (I would hope) I can’t imagine any real problems. I think it’s a step in the right direction frankly.

  2. I think this is absolutely great news! I just got back from the UK myself, and after having my own run-ins with their pharmacy system, I know that they thoroughly question customers on even purchases on items like Tums (as they did for me as well a Feminax). I found it slightly annoying given the rather benign nature of the meds I was purchasing, but for birth control? The more reproduction options that women are given, the better. Perhaps the US will follow suit once we get that universal health care system. *crosses fingers*

    (Obviously, something like this would be very difficult to do in the US under the current system, and of more concern, seeing as we purchase all kinds of meds without the cashiers batting an eye. )

  3. (Obviously, something like this would be very difficult to do in the US under the current system, and of more concern, seeing as we purchase all kinds of meds without the cashiers batting an eye. )

    How do they do it in the UK? I assumed it was like Australia — and like here with EC — where they keep it behind the pharmacy counter and you have ask for it. Was that an incorrect assumption to make? (Because if so, I need to tweak the post!)

    Also, read your post . . . and totally relate with the Aleve thing. I stock-piled mine from home when I was living in Oz 🙂

  4. It seems like a good idea to me. As long as they have the interview with the pharmacist to make sure they’re not putting themselves in danger (e.g., if they have a family history of breast cancer or whatever), it sounds like it’s just making access to birth control easier and more convenient, and that’s unequivocally a good thing.

    It would be even nicer to have here in the US, where our health care isn’t free, and getting a prescription for birth control often involves a pricey visit to the gynecologist.

  5. Of course, for this to work in the US, we’d first have to once again ensure that the “qualified pharmacist” is not just going to tell you what an irresponsible whore you are. /bittercynic

    Still, I like the idea. I hope it takes off.

  6. When I was in Russia, it was easy to buy birth control over the counter at any pharmacy. You just had to ask for it. There was no counseling. Honestly, it was a relief that I could walk into a pharmacy any time I wanted and get my pills without trouble.

  7. Manon, I had the same thought. Right now we have pharmacists who will deny to fill a prescription on moral grounds. Having to sit with a woman and counsel her before giving out birth control could be too much for these pharmacists.

    I do wonder how it would be priced. Right now birth control (I am thinking mainly the pill, maybe the patch here) can be expensive. Would it be priced to really be available to a wide range of women?

  8. I do wonder how it would be priced. Right now birth control (I am thinking mainly the pill, maybe the patch here) can be expensive. Would it be priced to really be available to a wide range of women?

    What country are we talking about here? In the U.S., I imagine it would still be the same price. In England, I don’t think it’d be nearly as much of a concern. I’m not sure what pricing looks like there — or indeed, if it’s entirely subsidized under their health care system — but I remember that my pills in Australia cost me $10 for 3 months, which was the price under their Medicare system (and though the U.S. dollar is doing a lot worse now, at the time that was about $5 or $6 USD). I don’t know for sure, but can only assume that if hospital stays and the like are covered entirely there, you wouldn’t have to worry much about birth control pill costs.

    Of course, I’m very much interested in confirmation on that. I just don’t have time at the moment to do the necessary research. Any English readers who can help us out?

  9. What would be interesting to see out of this would be what the typical- and perfect-use rates are in countries where you can get the Pill over the counter versus by prescription, as well as the rates of side effects. My guess is that you wouldn’t see much difference. I also wonder whether women would be more or less likely to try several different brands until they (hopefully) found the one that worked for them – people can have pretty wildly different side effects with different formulations, and the one that works like a dream for one person might be a nightmare for others. I can’t really imagine which situation would make someone more likely to keep trying until they found one that worked for them – I guess it would really depend on the woman and her doctor or pharmacist.

  10. Which isn’t to say, in addendum to my last comment, that the Pill is for everyone – but I know I, and some of my friends, had to try several brands/formulations before we found one that worked for us with minimal/no side effects, and I know that even though I had a great OB/GYN who was willing to let me switch every few months until I found the right one, not everyone has that kind of support from their doctors.

  11. i have a lot of trouble being concerned, for the sold and simple reason that – aside from one time at planned parenthood – i have NEVER been counceled about birth control. i have asked for a specific one; i have never even had one RECOMMENED to me. maybe i just have crappy doctors, but most of them women i know get their BC through their family docs, not gyns, and that may also be the reason. i have never had ANY med person get a health history before giving me BC, or even ask what meds i am taking, or talk to me about side affects (well, planned parenthood is again the exception, and that mostly i think because i was asking to get my tubes tied – NO ONE will do that – and so they were trying to get me on an IUD, which i don’t want. no, NeuvaRing it is until i can either get the Implanon or can get someone to tie my freaking tubes)

  12. The big risk here, as I see it, is not that women won’t get counseling on birth control pill risks or safe sex — it’s that they’ll skip the pap smear and thus put themselves at risk for cervical cancer.

    Right now, birth control has most women trapped into yearly pap smears. Who would really get in a hurry to get one if the birth control strings weren’t attached? I keep forgetting my thyroid test and my mammogram, but I can’t forget my pap smear or I won’t get any more pills.

    That said, I’m in favor of more options. Just think it should be addressed, maybe in counseling by the pharmacist.

  13. Cara; all contracreption supplied on the NHS (i.e. not bought over the counter) is provided free on the NHS. Other prescriptions currently cost £7.10GBP per item.

  14. I think it’s a terrible idea – the Pill is not aspirin, for God’s sake. It can (and does) cause blood clots in older women and smokers, and it can raise an otherwise healthy woman’s blood pressure to hazardous levels. If a woman wants to take charge of her health, she should get her medications from a doctor or nurse practitioner, not a pharmacist.

  15. Regarding price, I’m American, but as far as I know, birth control is free in the UK.

    When I was studying abroad there, I had a conversation with my tutor about it. “It’s very difficult to get birth control here,” he said, “for more than three months at a time.” I was like, Chyeah. I get mine for one month at a time. And it’s not free.

  16. I’m not too concerned about women essentially prescribing themselves birth control. I’ve had to take my healthcare into my own hands for years, and doctor after doctor after doctor (last count is 8) has proven utterly incompetent, either by being totally unfamiliar with the side effects of the (very common) medication I’m on, remember the specifics of my case for more than 2 minutes (which is oodles of fun when you have a serious drug allergy), or refusing to see the really obvious diagnosis and wanting to treat me for something else entirely.

    It’s sad, but thus far, once I see my test results I’ve proven invariably better than my doctors at diagnosing myself and prescribing myself medication. At this point doctors are simply the gatekeepers trying to keep me from what I need.

    Perhaps if we had more competent doctors (at least, in my area) I’d be more concerned about such a program, but really if I can do better than most doctors, I don’t see why the average woman couldn’t.

  17. Oh, I forgot about the time 2 doctors turned my inner ear infection into potential MS, had me go to the ER and get an MRI ASAP. So, current count of incompetent doctors is 10. They had reason to worry about MS (due to my age, race, and symptoms), but they could have said “if these symptoms continue for a week, come back and schedule an MRI” and saved me the $100 co-pay and hours sitting in the ER.

  18. I have often wondered why the pill isn’t an endless script. You go to a doctor to get it, to make sure you don’t have contra-indications and you understand about which ones to try under what side effects and so on. Then you just keep getting the script filled indefinitely – with some basic questions and maybe a 3 monthly blood pressure check which would be not a bad idea in general.

    But I would settle for the UK plan, it’s not like I can’t choose to go to the doctor as well.

    The pill may not be aspirin, but it is a lot less dangerous than paracetamol, which you can buy without any queries. Particularly with the differing children’s paracetamol formulations, it is disturbingly easy to give your child a lethal dose. The pill should be trivial to justify taking doctors out of the equation in comparison.

  19. I’m from New Zealand, and although I’d love to go to the pharmacy & get BC just by having a quick chat to the pharmacist, I have several reservations about this.

    a) I can’t take oestrogen based BC, due to a genetic disorder. My GP has my blood test records, but what would happen if I went to a pharmacy and requested a brand-name pill? I doubt the pharmacist would be asking me probing questions about my mother’s history of blood clots and other risk factors.

    b) NZ has Pharmac, a govt subsidised drug purchasing group. Would the pharmacist be able to access the national system to work out that I should only be charged $3 per 6 months for my BC? Or would I end up paying $50 for each 3 month ‘script’?

    I know they’re not identical, but from my understanding, the NHS and the NZ systems are pretty similar. It’s awkward, but even with OTC birth control, I’d still go through a GP.

  20. Oh, in NZ they recommend 3 yearly pap smears, not annual. The only reason I’ve come across for annual smears is HPV infection.

    Of course, I had 3 years going to my university health centre & explaining that I’d had genital warts & had been told by my doctor to have annual smears. And I was saying this to the doctor who’d diagnosed the warts & told me to come back in 12 months. While she was looking at my notes. Ever want to slap the head doctor of a health centre? Been there, mind boggled.

    Long, drunken ramble short: OTC BC is a good idea for those who have sorted out any niggling complications or side effects, and know what they can take. But in my experience, in NZ, these women can get their doctor to phone a script to a pharmacy without a face-to-face appt.

    I’d like the extra layer of checking, thanks

  21. I think this is a great idea. I lived in the UK for several years, and have some experience with the over-the-counter emergency birth control scheme. To those commenters who are worried about the quality of screening and advice one can get from a pharmacist, I can say that in my experience they are every bit as thorough and professional as a doctor. Typically, I was actually taken to a separate room and was asked the whole barrage of questions, from the date of my last period to family history of blood clots and cancer. I have full faith in UK pharmacists to handle regular contraception just as competently.

    Regarding pricing, however, while prescribed emergency birth control is free in the UK, over-the-counter you will have to pay around £25 for a one-off morning-after pill. This is prohibitively expensive, and definitely makes this approach out of reach for many women. I hope that the same pricing strategy won’t apply to birth control pills, but it may well be that buying over the counter will be costly while the same pills prescribed will be free of charge.

  22. @Shae: I’m in Australia, so can’t speak for the UK, but it’s kinda different here with gyn. exams, BC and so on. Unless there’s a specific reason for seeing a specialist, most women have pap smears done by their GP every two years, and GPs do a lot of the regular BCP prescribing. If it’s similar in the UK, birth control and gynaecological exams might not be so tied to one another.

    In any case, I think it’s a great idea. Does anyone know whether pills without prescription will still be at NHS prices?

  23. RE: the OTC Pill making it possible for women to skip their yearly exams . . . I don’t think a woman’s access to birth control should ever be used as a lever or bludgeon to make her submit to medical testing, whether it is “for her own good” or not. I think that’s wrong. I was severely fucked over by Planned Parenthood once because they had me over a barrel because I had to have my pills. I don’t think anyone should ever be in that position. If some women want to take the risk of skipping Pap smears, let them. They can choose to do so. They’re adults. The whole idea is that we, as adults, can accept or decline recommended medical crap at our discretion. Using the Pill as carrot/stick directly contravenes that vital independence.

    If you want to say that it carries too high a risk for blood clots, whatever, that’s a different kettle of fish. Requiring counseling has its own pitfalls, but it’s an independent issue from using the Pill to force women to go in for yearly — or twice-yearly — exams for which they have to pay, and in which they may damn well be lied to or verbally abused. Bad experiences with GYNs are far from rare.

    In short, if they made it available OTC anywhere, I would be ecstatic. It’s a step in the right direction. We aren’t kids who can’t be trusted with the grape-flavored cold medication, or who have to be lured to get their shots with the promise of ice cream or the threat of being grounded.

  24. I am absolutely shocked about this idea and that people seem to be so positive about it. Yes, if everything is well then there shouldn’t be any problem, but people do not know all the consequences with using the pill. Especially first time users and young women. As with any medication it is a medical doctors duty to explain what it means to use the drug, dangers and side effects. For some people, with medical conditions, using the pill can be fatal. Who is then to blame? I have recently followed a similar conversation in a Finnish news paper where more and more women are starting to talk about the side effects of pills and now refusing to use them. Loss of sexual interest, migraines, depression, weight gain acne… All these side effects never reported by medical companies, gynecologists (often males) refusing to listen and report womens complaints. For the well being of women it is important that we have competent medical doctors who advise them and try to find best solutions for contraception. Pharmacists that ask you openly over the counter each time you buy a drug if you have medical conditions and know of side effects is a lousy system and very degrading for a patient. What happened to patient privacy?

  25. Thanks to those clarifying that birth control is free under NHS . . . and raising the question of whether or not it still would be under this scheme. I’m going to see if I can find anything.

    To those who are concerned about the plan, I think that many (not all) of your complaints can be resolved by remembering that there’s no indication that women will be forced to obtain birth control through this method. It seems to me that women will still have the choice to go to a doctor to get their BC if they want for issues such as privacy. And I agree with Naamah Darling that while of course a regular pap smear is highly advisable (though what counts as “regular” varies widely), no one should be forced into it.

    Loss of sexual interest, migraines, depression, weight gain acne… All these side effects never reported by medical companies

    Huh? Maybe I’m missing what you’re trying to get across, but I’ve seen all these side effects (and more) listed on the birth control information. They certainly do seem to report them.

  26. Just searched all the news sources I could find reporting on this . . . none of them mentioned the pill costing anything under the new scheme. Which of course doesn’t mean that it’s not happening. But it’s not being reported that way.

  27. Helena, I have one of those conditions that can potentially be fatal when I use a certain type of birth control pills (FYI, a history of migraines and Yasmin is bad). Every time I saw a new doctor, I went over my history including my migraines. Not one single doctor has ever made that connection, ever warned me about it. It wasn’t until I started having really bad side effects that I googled it, found out about the link, and threw out the pills immediately.

    Naamah: I totally agree with you. I’m a fan of yearly paps in general, but at this stage in my life I probably don’t need them as often, and I’m considering getting it every 2 years instead of every year. And if you want to experience a barrage of unnecessary tests, just get pregnant. I’ve been pressured to get tests I don’t need because of medication I’m on (long story, but my doctor agrees I’m fine, her nurse doesn’t), and they outright didn’t believe me that I was HIV- and thus didn’t need their HIV test (I’m a blood donor and consequently get tested every 2 months when I donate. I’m REALLY not HIV+, thank everything above).

    Maybe I’m just a magnet for shitty doctors, but seriously I trust my own research far better than that of any doctor, and with good reason.

  28. This won’t ever happen in the US (and I don’t have a lot of confidence universal health care will either).

    We are so steeped in the society that puts doctors on such a pedestal that we can’t imagine making a medical decision with people that might actually be more trained and more qualified: your pharmacist, nurse, etc. Pharmacists are only treated like cashiers with a graduate degree in the US. Nurses have to work for doctors, not because they are less knowledgeable, but because it is a female dominated “semi-profession.” Yet for some reason, we have the highest rates of medical mistakes in the U.S.

    Doctors in the US have been the most successful at professionalizing. We think what they do is a mystery. We think their gazillion years of education is necessary, and was not born out of competition with midwives and homeopaths, and really created for status and exclusivity. We have replaced religious leaders with doctors and they now have the moral authority.

    The rates of cervical and breast cancers are not higher in countries that don’t bribe women to go to the doctor for their birth control.

    The AMA, the insurance industry, and the pharmaceutical companies are more powerful than government in the U.S. Your health recommendations are often political decisions. Screenings and side effects are used as an excuse to get women to go to the doctor, because the medical industry pathologizes normal healthy women because it makes an income.

  29. Helena, do you really think a medical doctor is going to step in where the pharmaceutical company has been irresponsible? During the 7 min they have allotted for you? Medical doctor’s get a lot of perks, and sometimes actual cash from pharmaceutical companies.

  30. Helena: Doctors aren’t nearly as thorough or trustworthy as you seem to believe, and patients aren’t nearly as stupid. I grew up with medical problem, as did a lot of people in my family, and it took a long time for me to get my particular cluster of symptoms under control. In the end, it wasn’t a doctor that found the solutions after a meaningful conversation and the application of his medical training, but rather me doing research and then directing my doctor as to what I had and what scrips they needed to write. The only reason I ever go to see a general doctor is because I don’t have a prescription pad (specialists are a slightly different story, depending on the circumstances).

    At the end of the day the pill isn’t a “safe” drug but very few are. The vast majority of women who are on birth control don’t need their doctors holding their hands through the process or bullying them into using whatever brand their local drug rep was hawking over a free lunch. What women (or patients in general) need is access, agency, and information. There is absolutely no reason I can think of why all women should have to jump through the hoops of seeing a doctor (who, depending on where you are, might or might not write a prescription) and then trying to find a pharmacy that will actually sell them birth control. The fact that some women have preexisting conditions doesn’t justify reducing access for everyone else in the hopes that those women will get caught in the system and warned of potential. You’re effectively infantalizing women by saying that you think they’re too stupid/uneducated/irresponsible to be trusted with such a big decision without someone else’s help and permission.

  31. Last time I went to get another birth control prescription the doctor simply asked if I’d had a pap test done recently and gave me a prescription. Of course more was asked the first time I ever got birth control but I still don’t see how it’s anything a pharmacist couldn’t do. As long as one knows all relevant information about birth control, what is it about being an M.D. that would make one more qualified than a pharmacist?

  32. As with any medication it is a medical doctors duty to explain what it means to use the drug, dangers and side effects. … All these side effects never reported by medical companies, gynecologists (often males) refusing to listen and report womens complaints.

    So, women should have to see a medical professional to make sure the *right* kind of person is ignoring them? Having a gynocologist refuse to listen isn’t any better than having a nurse or pharmacist refuse to listen, and the latter’s cheaper and easier. :p I can read the health instructions just fine myself, and the doctor only knows what the patient self-reports anyways, so an actual visit is usually just a time-and-money-wasting extra hoop to jump through.

    Having it available without a prescription would be *much* better than forcing women in for exams and doctor’s visits. I went on birth control when I was about 11 or 12 for cramping control and (if you will pardon some overshare) I was a virgin all through college. The clinic at my college refused to renew my prescription without an exam, even though I told them I’d never had sex, and I was too freaked out to go in (I was also too busy with lab classes to schedule a time during the doctor’s very short available hours.) So I ended up going off my birth control for several years and just put up with the monthly pain until I got fed up enough to go in and try to get back on it. The gynecologist basically was like “have you had sex?” and I said no and she said “okay, that’s all, here’s your prescription” and I thought everything was fine.

    Then I went home for break, ran out, had to get my mom to wheedle a 3-month prescription (for a *different* kind of birth control) for me out of *her* GP, and then when we went to the pharmacy it turned out our insurance only covered 1 per month anyways, so then I had to schedule another appointment with the doctor back at school asap when I got back to get more. Without needing a prescription I could have just gone and bought a few months’ worth and been done with the whole thing in 10 minutes.

  33. This initiative has to be understood in the political context that the British government is consciously encouraging pharmacists to take on increasing responsibility for routine diagnosis and medication (on the model already widespread elsewhere in Europe) as a cost cutting exercise. So, while I agree that on its face it’s a good thing that women who can afford it should be able to buy contraception over the counter, and I don’t think Helena’s concerns are necessarily applicable in this case – pharmacists do get additional training for this sort of thing, and it’s been pointed out that doctors aren’t infallible either – I do worry that at some point the politicians will try to make underqualified people take on diagnoses and so on that they simply aren’t competent for. This one may be short of that line, but coming close, so we need to be vigilant. The government gives, and the government taketh away.

    (New year’s resolution: Every time I see a blog post which says England when it means the United Kingdom, or even Great Britain, I’m going to submit a comment which refers to the United States as Texas.)

  34. Someone was talking about “the yearly exam” and whether this would mean women missing theirs – I can tell you that in the UK, we don’t have yearly exams in that way. You go to a doctor if you think you have a problem. Occasionally you might have a Well Woman check (just a sort-of brand name for a physical) but there is no scheduling and I personally have never had one.

    As for smears, you get a reminder letter to have one once every 3 years, until you hit a certain age when they become more frequent. You certainly don’t get forced, although if you don’t go, the letters do tend to get a bit… urgent.

  35. As with any medication it is a medical doctors duty to explain what it means to use the drug, dangers and side effect

    Really? Because I’ve never had my doctor explain these things to me. In my experience, the doctor just writes the prescription and the pharmacist is the one who explains how to take it, side effects, drug interactions, etc.

    Pharmacists that ask you openly over the counter each time you buy a drug if you have medical conditions and know of side effects

    It’s not openly over the counter, at least not here in Canada where we have that system for emergency contraception. The pharmacist takes you over to a private area for a consultation. The consultation is similar to what you would get from a doctor. And if you feel more comfortable seeing a doctor, you still have that option. You just don’t have to.

  36. (New year’s resolution: Every time I see a blog post which says England when it means the United Kingdom, or even Great Britain, I’m going to submit a comment which refers to the United States as Texas.)

    Is that really applicable here? The article says England, and in fact the trial is concentrated only in London. When it comes to England/UK/Great Britain, I always use the language the original article uses for the best chances of my getting it right.

  37. For some people, with medical conditions, using the pill can be fatal.

    For some people, taking aspirin can be fatal, but we still allow that to be sold over the counter. Any drug is going to have adverse consequences up to and including death for some people; the question is how common those reactions are, and I’ve never seen anything to suggest that they’re at all common for the Pill. Besides, why is it harder for a pharmacist to ask if someone has those conditions?

  38. In Egypt you can get birth control and antibiotics and other stuff that is prescription here, over the counter. It has an up side – you can buy birth control easily. You do have to ask the pharmacist for it. I had some issues with the tricycle kind which caused spotting and the pharmacist gave me a more normal kind which worked. Also the price was subsidized and very very very low. On the down side people are constantly recommending to each other medicines that “worked for them” for things like headaches or the flu which are things I thought there should be more medical advice for, esp antibiotics which people can buy and give their kids without going to a doctor first. I am all for doing this for BC pills. Pharmacists are knowledgeable and can give you advice, but in Egypt they didn’t unless you asked, they just gave you whatever you asked for.

  39. Loss of sexual interest, migraines, depression, weight gain acne… All these side effects never reported by medical companies, gynecologists (often males) refusing to listen and report womens complaints.

    Really? All of those were listed on my packet insert when I was on the pill.

  40. It’s sad, but thus far, once I see my test results I’ve proven invariably better than my doctors at diagnosing myself and prescribing myself medication. At this point doctors are simply the gatekeepers trying to keep me from what I need.

    Perhaps if we had more competent doctors (at least, in my area) I’d be more concerned about such a program, but really if I can do better than most doctors, I don’t see why the average woman couldn’t.

    Get off your high horse. You may know a few wrinkles about your own condition that some of the docs dont, but I guarantee you that you dont have the overall medical knowledge of a doctor. Just to put you to the test though, here’s a pop quiz. Lets see how much of a doctor you really are.

    1. Whats the difference between a troponin leak and a NSTEMI?

    2. Name 5 causes of post-op fevers.

    3. Design an insulin regimen for a 150 lb female using the “500 rule” and the “1800 rule” for carb correction.

    4. Whats the 3 cardinal signs of tamponade?

    5. Which sign of Charcot’s triad is most specific? Which is most sensitive?

    6. Whats the difference between Stage II and Stage III breast cancer?

    7. Hematuria in a patient who smokes is ________ until proven otherwise.

    8. Discuss the role of D-dimer in the evaluation of a suspected pulmonary embolism.

    9. The most specific marker for rheumatoid arthritis is __________.

    10. Name the CD4 count thresholds at which the following HIV opportunistic infections come into play: toxoplasmosis, PCP, CMV.

  41. BTW, requiring an interview with a pharmacist is just about the same thing as requiring a doctor’s script. Its a stupid rule that inhibits reproductive choice for millions.

    OCPs should be available over the counter with simple to read inserts that warn against smoking and other contraindications. Yes, some idiots will fail to read the instructions and will get sick, however that is outweighed the easy/reliable method of birth control that all women should have access to without ridiculous barriers such as “interviewing” with a pharmacist or seeing a doc.

  42. I’m greatly in favor.

    I’m autistic, and have *MASSIVE* difficulties with touch in general and penetration in particular — the required Pap smear alone would be enough to scare me out of the doctor’s office and let my prescription lapse were I not blessed with an understanding nurse/midwife who lets me waive the examination.

    This nurse/midwife also told me all about potential side effects, and gave me a particular kind of Pill with a different estrogen-to-progesterone ratio when I told her I had severe depression and was worried about the Pill’s hormones aggravating it.

  43. I’d be a lot more sanguine about this idea if my follow-up appointment after being on the pill for a year hadn’t revealed that my blood pressure (as a non-smoking, exercising, average-weight 23 year old) was 151/104. I was taken off the estrogen ASAP and was back to 120/80 in short order. If I’d been living somewhere where that exam had been postponed for another two years, I don’t like to think about the possible complications. What’s needed is cheaper, more accessible OB/GYN care, not less care plus DIY pharmacology.

  44. Again, a pharmacist and/or a nurse practitioner (that are not under the pay of a doctor), can both take blood pressure and advise you to check your blood pressure. We really need to question the authority we have given doctors.

  45. The funny thing is, even in the US where we are required (if we want birth control) to go yearly for all of our tests and screenings, we don’t have better health outcomes. The US has the highest rates of medical mistakes, the worst health outcomes, and the highest costs. Part of the credit (insurance companies and pharmaceutical companies can take a good amount of credit) for this goes to the monopoly and moral authority we have given traditional medical doctors over our health care.

  46. Very interesting comments. I am British and live in the UK but have also lived in Nicaragua for many years, where contraception is not freely available and where the emergency contraceptive pill is hardly heard of and abortion has recently been made completely illegal.
    I AM concerned about this decision because, although I agree that access to contraception is necessary and essential to women’s freedom and autonomy, I also believe that chemical contraceptives are dangerous, that misogyny makes women wholly and completely responsible for sexual and reproductive health matters (unless a husband ‘wants a child’ in which case, contraception is ‘banned’) and that for young women, buying the pill in a chemist may become another tool for abuse by men, (peers and older), just as it did with emergency contraception- “Don’t worry, just take the pill….” So I agree with the concerns about health and well-being and consider this decision not to have been taken for the benefit of (young) women (UK has the second highest teenage pregnancy rate in Europe) but for the pharmaceutical comapnies and in order to relieve the govt and other institutions of responsibility for creating a society in which women are truly free.

  47. I think we need to separate our feelings about the medical profession from the reality that taking a drug that deliberately alters a major physical system should be supervised by a doctor. I had the same thing happen to me that AZ Escapee experienced: my blood pressure soared when I was the Pill, and I had no symptoms. None. If I hadn’t gone to the doctor to get my prescription filled, I could well have had a stroke, and since I felt fine I had no reason to go to the doctor except to get my prescription filled.

    I also don’t understand the animosity toward getting a yearly pap smear. It takes all of thirty seconds, and it can (and does) detect cancer well before there are any other symptoms. Yes, there are false positives, but I found out that my ex had given me an STD *solely* because I went in for my yearly pap.

    Women who let their anger at poor medical care are hurting only themselves if they equate “taking charge of their health” with “not going to the doctor unless they feel bad.” The answer is demanding that the doctor answer one’s questions, and switching doctors if one is receiving substandard care.

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  49. I’m not sure if this is the case elsewhere, but my experience in Canada is that pharmacists know far more about drugs than most GPs. Most doctors are pretty clueless about drugs, including birth control, and are often dependent on the information provided by drug reps.
    I take a lot of pills – about 6 or 7 each day when I’m healthy. I have also had to be proactive in seeking appropriate medication, doing my own research, and asking for specific medications, checking out side effects on my own because I don’t trust what the doctor tells me, informing my doctors of side effects or withdrawal symptoms that they were unaware of, etc. The only exception has been working with a psychopharmacologist , a doctor who specializes in medications.

  50. Get off your high horse. You may know a few wrinkles about your own condition that some of the docs dont, but I guarantee you that you dont have the overall medical knowledge of a doctor.

    Sounds like you need to get off your high horse. She didn’t say that she had more overall medical knowledge than a doctor. She said that doctors have failed her. There are many legitimate arguments that could be made against the conclusion that most women could do just as well as a doctor, but if you want to discount the experience of doctors failing a person just for the purpose of being oh so cute and clever, you can do it elsewhere.

  51. OCPs should be available over the counter with simple to read inserts that warn against smoking and other contraindications. Yes, some idiots will fail to read the instructions and will get sick

    Yeah, TOTALLY can’t see a reason for people to get verbal information on birth control or any other form of medication. Screw you, “idiots,” all the millions of you out there, who are functionally illiterate!

  52. The answer is demanding that the doctor answer one’s questions, and switching doctors if one is receiving substandard care.

    I’m not sure where you are, Ellid, but a majority of these commenters are going to be American. And I know that in America, being able to just “switch doctors!” is a huge privilege.

  53. Since I’m serial commenting here anyway, one more thing to add . . .

    I don’t see a doctor when I get my pap smears and birth control prescriptions. I live in the U.S., and I don’t see a doctor now to do those things. I always forget that fact, because I still have to pay the same as if I was seeing a doctor. But I don’t. I see a nurse practitioner who works in a practice with a licensed gynecologist. I’ve only ever seen the actual doctor once — because the nurse was more booked up than she was and I needed to go in right away. And I love Ila. She’s great. In fact, for not actually being a “gyno,” she’s the best gyno I’ve ever had. She’s thorough, informed and informative, gentle, tactful, all of those things you’d hope your doctor to be. Only she’s not a doctor.

    Of course, there are different quality nurses just as there are different quality doctors. There isn’t necessarily going to be a whole ton of Ilas behind the counter at the pharmacy . . . but there also aren’t necessarily going to be a lot of my awesome GP hanging out at doctors offices, either.

  54. Look, I’ve taken myself on and off of birth control, taken my friends’ prescriptions when I had no insurance and the waiting list for the county clinic was too long, sorted out the side effects by myself on the internet, and generally acted like I don’t need to see a doctor anyway. Yes, there are downsides to this approach, but there are more downsides to getting knocked up, and as previous posters have noted, acetaminophen can be more dangerous. And as is, I’m young, I’ve spent time uninsured, I’ve moved around a lot, so even when I did get to see a doctor (or more likely, a nurse practitioner) I have never seen the same one more than once. It’s not like there’s any kind of continuity of care going on anyway. I say let me have the damn pills without the patronizing implication that I can’t be fussed to read a package insert myself.

  55. Cara, I think you’re reading way too much into that comment. I’m sure she/he would have left exceptions to those who can’t read. In fact, that exception is: If you can’t read, ask, plain and simple.

    Actually, the pharmacist should say, “Do you have any questions about this medicine? The information is on the insert provided, but if you have any questions or would like me to explain the information, please let me know.” And there should be a toll-free number provided for those who can’t read/are blind and an option to speak to a human nurse/pharmasist if you have questions.

  56. I see a nurse practitioner, too, Cara and I luff her. But I think you can substitute “doctor” for “medical professional” in a lot of these comments, and I think most people commenting would agree. I’m sure a LOT of people see nurse practitioners instead of “doctors” in most normal exams, including most commenters here.

  57. Another note, they have blood pressure sleeves in pharmacies. Taking your blood pressure is not a special, mystical skill – I have a B.A. in area studies, for pete’s sakes, and I’m trained in how to take blood pressure. If you’re going to do what I did, the responsible thing to do is go to a pharmacy that has a blood pressure machine, get a baseline before you go on it, and then go back to make sure that your blood pressure hasn’t spiked dangerously.

    Of course I wish that better reproductive care was available to everyone conveniently and affordably (or that I lived near a Planned Parenthood! My one experience with Planned Parenthood was amazing) but I’m not putting my future on the line waiting for it to get there.

  58. I’m so glad that Female MD showed up to illustrate exactly why so many women don’t want to see doctors. She clearly doesn’t listen to what people are actually saying, she’s rude, and she thinks we’re all stupid because we don’t have MDs.

    I saw no one claiming that they had more medical knowledge than their doctors. I read commenter after commenter complaining about inconsiderate and abusive behaviour, and dealing with doctors who have misdiagnosed because they can’t be bothered to actually listen to their patients (because we’re all stupid since we can’t tell you the difference between Stages II and III breast cancer off the top of our heads), and doctors who prescribe drugs that they don’t know enough about – we’ve all heard the horror stories about GPs prescribing psych meds, something I’ve personally experienced. But I guess those of us who are complaining about doctors mismanaging our chronic illnesses because they can’t be bothered to listen to us should go to medical school before we offer our opinions?

  59. Cara, I think you’re reading way too much into that comment. I’m sure she/he would have left exceptions to those who can’t read. In fact, that exception is: If you can’t read, ask, plain and simple.

    Except the problem is that a lot of people would be embarrassed to ask. And there are a lot of people, in the U.S. at least, who are functionally illiterate. Which is why I think that the counseling is important, at least for the first time one receives medication. (You don’t usually get a spiel from your doctor each time they refill a prescription either — don’t know how this would work, but asking “have you received this particular medication before?” and giving a spiel if they have not is the most logical solution.) And why it’s important to not call people who don’t read the information that comes with the pills “idiots.” In fact, I think that just calling any group of people who do or don’t do something that you would do differently an insulting name is a bad idea all around. Because you walk into “oh shit, didn’t think about that” situations precisely like this one.

    I see a nurse practitioner, too, Cara and I luff her. But I think you can substitute “doctor” for “medical professional” in a lot of these comments, and I think most people commenting would agree. I’m sure a LOT of people see nurse practitioners instead of “doctors” in most normal exams, including most commenters here.

    Precisely! Which is why I’m annoyed that so many people are acting like nurses are inept, and like seeing one instead of a doctor to get routine birth control is a novel concept. Nurses and pharmacists are medical professionals. And under this scheme, women will be seeing one.

  60. I do see your point, Caraq, but I do think people who do not ask questions regarding their own medical care, while not idiots, are being very irresponsible.

    Every pharmacist I have ever gotten any medication from, even if it’s just a refill, has always asked if I have questions or concerns.

    I do not have a problem with required “counseling” when you get your first prescription — really, the “counseling” should be short and sweet: A quick rundown of possible interactions and side effects (ie, blood clots, antibiotic interactions, etc.), and I’d call it more “information giving” than “counseling”.

    And I don’t think it’s being condesending toward patience, since I know a LOT of otherwise intelligent, intellectually curious people who have no idea that birth control can be affected by antibiotics. It’s just, I think, common sense to provide information when you get your first prescription for ANYTHING, along with the inserts, of course, and a toll-free number to call.

  62. Get off your high horse.

    Maybe you should get off yours. That little quiz was unbelievably arrogant and completely unnecessary.

    BTW, requiring an interview with a pharmacist is just about the same thing as requiring a doctor’s script. Its a stupid rule that inhibits reproductive choice for millions.

    It’s really not the same though. With a doctor, you have to make an appointment, wait until you can get in, and take time off work to make it during doctor hours. And, in the US, pay. And then, the doctor can refuse to prescribe it until you submit to a physical or a pap smear. With the pharmacist, it’s just an extra 15 minutes as part of a trip you were already making.

  63. I don’t know if I like the idea.

    I’m from Denmark. I have a prescription that runs for a year and when I need a new one I call the nurse at my doc’s office and have her renew it, without any charge at all.

    Doctor’s visits here in DK are free – with a few exceptions. If I need a doc to sign that I’m fit enough to dive a car it costs me, if I need a doc’s testimony that I’ll ruin my fingers playing volley ball and should therefore be excused from classes it costs me. I worry that making BC an over the counter drug might give the docs the right to charge those women who do want to consult a doctor about their BC instead of having an extremely private chat with a pharmacist next to the customer who needs advice about her toddler’s diarrhea or something.

    I don’t know. Personally, I’d never consult anyone about my medical health when there’s someone in the room besides myself and the medical professional. If others don’t mind that, fine by me, more power to them. I just wanna be absolutely sure that making it an OC drug won’t limit the access to doctor consultations for those who prefer that.

  64. You know, a few people have mentioned it a bit, but we have largely ignored a big factor in this argument. COST. England is partly doing this because of high rates of teen pregnancy, but also because it is less expensive. Like most progressives, I think health care is a public good, and that we, in the U.S. should have a single payer health care system. But we have to address the fact that countries that do have it are having a hard time paying it. There are cost effective ways to have excellent care, but our knee jerk reactions of wanting the top specialists and the most expensive tests can keep us from it, and actually worsen our care (we do have a problem with over treatment).

    R. N.’s, nurse practitioners, physician’s assistants, and pharmacists are all very qualified. They often have more patient experience than an M.D. They know how to read the methods section of a journal article as well as M.D.’s. M.D.’s take one pharmacology class, pharmacists have a degree in it.

    One of the reasons why health care is so expensive, and there is a shortage of primary care physicians (at least in the U.S.) is because M.D.s go to school for 12+ years and get in massive amounts of debt, learning about the most unusual and abnormal only to become extremely overqualified to treat people who are mostly normal and healthy. They end up bored looking in ears and giving vaccines.

    I think we really need to question why we are so averse to seeing a pharmacist or nurse rather than an M.D. and why we think they need to be under the supervision of a doctor. This, in my opinion is where the real sexism lies. Nursing is a traditionally female profession, and we devalue it.

  65. Hmm, maybe allowing pharmacists to do this could standardize the procedure more. Last time I got a prescription renewed I asked the doctor if he could take my blood pressure because he wasn’t going to. I know The Pill raised my mom’s bp ages ago. He reminded me kindly that a yearly check-up would be a good idea. It would but I haven’t gone in so long that I don’t know if I have a family doctor anymore.

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  67. I’ll be much closer to 100% in favour of this as soon as they use it as a reason to enforce that all pharmacists have facilities and provisions for privacy. At the moment, almost no pharmacists here even have a separate cubicle for interviews, and those that do still require you to ask at the counter for what you want before they’ll consider the chamber.

    I’ve overheard some conversations I really, really didn’t want to in pharmacies. In my experience as a GP working with many young people, the birth control consultation (which was readily accessible and either very inexpensive or no out-of-pocket with us) was often a consultation where young women could and did use it as a “ticket” to bring up many other concerns – about sexuality, sexual practices, safe sex, abuse, STDs and contact tracing – things that most wouldn’t for a second ask a pharmacist over the counter, and often things that they wouldn’t specifically book a consultation to discuss de novo. (Often, the birth control conversation is the time they use to “check out” the GP and see if they felt they can trust them with the more sensitive issues). This is just not going to happen over the counter in a public space, and pharmacists are typically not trained to thoroughly evaluate or deal with the issues arising.

    Nurse practitioners, on the other hand, could be a terrific option in that a sexual-health trained NP can cover all of these bases, and would only need to refer in more complicated circumstances.

  68. Maybe the privacy issue with pharmacists needs to be addressed. Birth control is certainly not the only drug that people discuss with a pharmacist. And they should be able to feel comfortable talking with him or her regarding every drug, not just birth control. But that makes it a separate issue entirely.

  69. I think it’s a pretty good idea.And about cost.I used to moonlight in planned parenthood.Prices were very reasonable,and the Wal Mart generics($4) have been a real boon.I think the pharmacists will end charging a consultation fee,and It may decrease the # of Yearly’s but Gardasil’s really decereases the risk of cervical cancer.

  70. The BMJ ran two articles on this topic arguing both sides. Worth looking at:

    Head to Head

    Should the contraceptive pill be available without prescription? Yes http://www.bmj.com/cgi/content/full/337/dec23_2/a3044

    Daniel Grossman, senior associate , assistant clinical professor1,2

    1 Ibis Reproductive Health, San Francisco, California, USA, 2 Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco

    Should the contraceptive pill be available without prescription? No http://www.bmj.com/cgi/content/full/337/dec23_2/a3056

    Sarah Jarvis, women’s health spokesperson

    1 Royal College of General Practitioners, London SW7 1PU

  71. great post mitchel! according to Jarvis’ argument, condoms should need a prescription because the IUD is better. If we can get condoms over the counter without a paternalistic sex education lecture and cancer screening, we should be able to get the pill as well.

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  73. Typing this under a non-standard email address for privacy purposes. My BCP is no longer what the doctor ordered, but a variation. As a woman who smokes, I take non estrogen pills only. I know that non estrogen BCP is the only thing I could take, however paying $37 month for the generic became way too expensive. I now order Cerazette from overseas for $9/month. Cerazette isn’t even an option in the US even though it has more flexibility than other mini-pills, i.e. I don’t start spotting the next day when I’ve missed a one hour window. Since I’ve not been sexually active since my divorce years ago, I skipped they gyn visit for the first time in years. I still have other docs and even the dentist takes my blood pressure.

  74. R. N.’s, nurse practitioners, physician’s assistants, and pharmacists are all very qualified. They often have more patient experience than an M.D. They know how to read the methods section of a journal article as well as M.D.’s. M.D.’s take one pharmacology class, pharmacists have a degree in it.

    As a pharmacist who decided to become a doctor and go to medical school, you are wrong about this.

    Its true that PharmDs have more training in medications than MDs do, but pharmacists get ZERO training in diagnosis and pathophysiology. MD schools start pharmacology training from day one. Its not as much as PharmDs, but you are wrong when you say “its just one class.”

    There are roles for MDs, PharmDs, NPs, PAs, and others in the healthcare system. All of them are unique roles and its silly to suggest that one of them is superfluous and unnecessary. We need all the different parts to make the system work.

  75. I never said MD’s were superfluous, but I do think that the AMA lobbies to control every aspect of medicine, which is not only not necessary, but drives the cost of health care up.

  76. PharmD in TX: I think there certainly are parts of the medical field that are superfluous. Doctors are necessary for a great many things, but those things are generally specialties. When I go to my GP they’re essentially interchangeable with an NP; they are going to ask the same questions, order the same routine blood tests, use the same metrics in the office, and cull pretty much the same information from my medical history. For drugs without many risks (or even for drugs with significant but easily avoided risks) the involvement of an actual MD is make-work for the medical field. England seems to have figured out that this is the case with a lot of drugs and is investigating whether or not birth control might be another thing that an actually doctor doesn’t generally need to be involved in.

    Too often the government and the medical establishment collude to limit the choices of patients under the theory that we’re just too stupid, irresponsible, and ignorant to be trusted to make our own decisions without adequate supervision. There seems to be this belief, and it is most prevalent amongst doctors, that the average person needs to be treated like a child. Even people who claim to believe that the average person doesn’t necessarily need to be treated like a child quickly defend pretty much every infantilization and restriction upon patient autonomy as being vital to protect the tiny portion of the population which might have an adverse reaction or do something foolish. The end result is more billable hours for physicians and less agency for patients.

  77. What you guys dont understand is that PAs and NPs can already do anything a doctor can do, yet costs havent gone down, they continue to go up.

    An NP can script for any drug that a doctor can script for.

    An NP can open up a clinic just like a doctor can.

    Do you think pharmacists are just going to counsel patients for free on birth control? Dream on. They are going to charge money just like a doctor or NP would. Some of you seem to think that pharmacists are just going to be nice and cheery about it and volunteer to do the counseling for free. You’ve got a shock coming to you.

    OCPs should be over the counter, with NO interference by anybody, whether it be pharmacist or MD.

  78. Doctors are necessary for a great many things, but those things are generally specialties. When I go to my GP they’re essentially interchangeable with an NP; they are going to ask the same questions, order the same routine blood tests, use the same metrics in the office, and cull pretty much the same information from my medical history.

    there’s one difference, and its that when compared to family physicians, midlevels do a lot more referrals to specialists.

    The incursion of specialists is a HUGE reason as to why healthcare costs have skyrocketed. Any time you introduce a specialist = invasive expensive testing thats uncalled for. Its the 45 y/o stable angina patient getting cathed every 6 months instead of doing risk factor modification first. Its the

    In 1995, the average Medicare patient saw approximately 3.2 doctors per year. Now in 2008 the average number is over 10, DESPITE the fact that NPs and PAs have seen virtually all of the restrictions on their practice lifted.

    Referrals to specialists have skyrocketed, and all these specialists are doing unnecessary expensive procedures to patients that in previous years would be treated just fine with just a family physician.

    Now everybody with OA has a rheumatologist. Everybody with HTN has a cardiologist. Everybody having a baby has an OB/GYN MFM subspecialist. All of these specialists are providing equivalent care to a GP yet running up massive costs with all their playtoys.

  79. PharmD, I completely agree with you about specialties driving the costs up. Hospitals and specialists now advertise all of their playtoys, so that we think we are getting substandard care if we are offered the more rational, and usually more cost effective choice. The same thing is happening with pharmaceuticals. Many of the older drugs (or something novel like exercise) are better than the freshly patented ones in the commercials, but we want the most expensive because we think it means better. All of this is driving costs up.

    But I disagree that NPs and PAs have had all restrictions lifted. In Oregon maybe, but in most other states, they still have to work for a doctor, and this, in my opinion, is one thing that keeps costs high. And if the only difference between an MD and the others is the capacity to refer, then that is a problem.

    And William, I agree with you that the government and medical establishment collude to limit patient choices too often. It is amazing how many medical decisions are based on politics rather than science. I don’t think they think we are stupid. But the AMA, the pharmaceutical industry, and the insurance industry are all very powerful, have a lot of money and power at stake, so they spend millions lobbying the government. And that, in my opinion is the biggest problem, that medicine is driven by politics and profit rather than science, sound research, and health.

    Another huge problem is that through professionalization, medical school became too long (in the US), too competitive, and too expensive. By the end, many doctors feel entitled to huge salaries, to be in control of the other medical professions (with nobody in control of them), and in the end don’t really relate to patients anymore. There are many great individual doctors out there, but they have usually had to fight the process to get that way.

  80. All of these specialists are providing equivalent care to a GP yet running up massive costs with all their playtoys.

    I think you’re misunderstanding my argument. I’m not saying that we should do away with GPs and just have specialists. My point was that the same argument you’re making for reducing the number of hours specialists bill applies to GPs as well. What I was saying was that we use doctors for a great many things that we don’t really need them for. I don’t really need a GP for much outside of emergencies. I see my GP twice a year to maintain my prescriptions for various nootropics and to get an annual physical. Theres no reason an NP or PA couldn’t do those jobs just as well, and the only reason I even show up twice a year is because one of the prescriptions I’m on is more carefully regulated than usual. Birth control is pretty much the same story, a doctor simply doesn’t need to be involved in the vast majority of cases. We don’t need doctors to act as gatekeepers or to sign permission slips.

    And that, in my opinion is the biggest problem, that medicine is driven by politics and profit rather than science, sound research, and health.

    You forgot autonomy. No matter who you’re seeing, doctors need to understand that they are sources of expert information rather than authority figures. The issue of power and social control is too often left out of these kinds of discussions. The idea that birth control ought to be by prescription so women have no choice but to get a yearly test for their own good as popped up in virtually every discussion of this program I’ve seen.

  81. Hey William, You would like this book: Health, Illness, and the Social Body, by Freund and McGuire. It is about the new moral authority of doctors and illness as social dissent. You’re right, I didn’t mention it in that last post, but I did a few posts back. Doctors have replaced religious the moral authority.

  82. I’d disagree with anyone telling me I could pick up any long-term drug over the counter without first consulting a doctor. I’d rather speak with a professional about my health, its my body but I wasn’t trained in knowing how the various drugs in various medications would interact with MY body type, family history, and personal health. More power to the women who take advantage of this opportunity but I doubt the FDA would allow for this in the US.

  84. In response to Shae,
    The fact is that doctors are supposed to obtain informed consent from patients for smears.
    Cervical screening has nothing to do with birth control – this is an unethical practice adopted by doctors to force women into testing.
    The smear is an unreliable test for an uncommon cancer which means lots of incorrect results called false positives and false negatives.
    Yearly testing means 95% of US women will have a colposcopy & biopsies – these are unpleasant procedures – some women are harmed psychologically and physically. Some women are left with permanent damage that affects fertility and causes problems during pregnancy. (Two yearly – almost 78%….3 yearly – 65%)
    It is for these reasons that the test is supposed to be offered….not demanded – there are risks as well as benefits – informed consent is vital when a test is offered to healthy patients.
    Sadly, most women don’t have the facts…hardly surprising….they are withheld from women.
    The lowest rates of cervical cancer in the world is in Finland – they don’t commence screening until you’re 30 and then only every 5 years…women are given complete information and the decision to screen or not, is left to them…
    Young women have a high risk of intervention for changes that disappear on their own….this cancer is rare in women under 30 and many believe this test does more harm than good in this age group.
    Screening every 5 years also minimizes the number of women having biopsies (although it’s still very high at 55%)
    To give you an idea of the risk of this cancer, look at statistics released by Dr Angela Raffles (UK cervical cancer screening expert) – 1000 women need regular testing for 35 YEARS to save ONE woman from cervical cancer!
    The fact is….smoking or being very overweight or mountain climbing are MUCH greater risks to your health than failing to screen…
    Whether women have testing, at what age and how often should be the woman’s decision – we’re not children…we’re all individuals and will feel differently about the type and amount of risk we carry in our lives.
    I’m a low risk woman and have declined screening – for me, the risks far exceed the benefits.
    I’ll live with the tiny risk of this cancer…
    Others may prefer to risk a colposcopy/biopsies to reduce their risk of cancer as far as possible.
    Screening does not reduce your risk to zero – one third of the 1% of women who get this cancer have received one or more false negative smear results. These women may be disadvantaged by screening as they may be reassured by the incorrect result and delay seeing a doctor for symptoms….so end up with a later diagnosis. (By the way…just 0.66% of women benefit from screening – DeMay Article)
    It is so important to do your reading – doctors are pushing screening tests more and more – they generate HUGE amounts of money…but they ALL carry risks as well as benefits.
    The risks associated with mammograms are also, false positives, unnecessary biopsies and surgery and the discovery of ductal carcinoma in situ…a slow moving cancer that usually does not bother a woman, but once biopsied, it can become invasive and once diagnosed, the breast usually comes off…(almost 40% of older women have some DCIS)
    Also, new research that suggest regular screening may INCRESAE the risk of breast cancer – perhaps, because of the radiation or the bruising or both….
    Prof Michael Baum, UK breast cancer surgeon, helped set up the first breast screening clinic – he now believes the risks of mammograms exceed the benefits. He is also concerned about cervical screening.
    In both cervical and breast cancer screening, doctors have ignored the need to obtain informed consent and have used many unethical practices to force and frighten women into testing…this is disrespectful and unacceptable.
    The very small number of women helped by screening is at a huge cost to healthy women. Also, the reduction in deaths from cervical cancer does not factor in the large number of women who’ve had complete hysterectomies – in the US, it’s one in four women…that must have an impact on death rates. Yet any reduction is claimed by the screening lobby.
    I think the Pill should be available over the counter…once the pharmacist establishes the woman is a suitable candidate (not a diabetic, have high blood pressure etc) and a simple blood pressure check is all that’s required every 3 months. The WHO and many other medical associations have confirmed this is all that’s required (and have done so for many years)
    Yet doctors in the States still require women to have annual breast, pelvic and rectal exams and annual screening – all totally unnecessary in asymptomatic women and annual screening exposes you to a high chance of a false positive. (Routine breast exams are NOT recommended in Australia before age 40 due to the high chance of a false positive and because cancer in this age group is uncommon) Also, mammograms from age 40 expose you to a high chance of harm – Australia offer them from 50…although, I’ve already decided not to have mammograms when I reach that age. Routine pelvic & rectal exams are only recommended in one other country…Germany.
    Women should therefore be free to decline these exams when they’re not even recommended in other countries. My Dr said they can be harmful and are of low clinical value in the absence of symptoms.
    (See: RMDeMay, “Should we abandon pap smear testing” Jnl of Cl Pathology 2000 & L. Koutsky, Cancer Prevention, Fall 2004, Issue 4)
    There is also a great article in the Guardian called, “Why I’II never have another smear test”….which contains comments by Dr Raffles and Prof Baum
    Hope this information inspires a few women to start reading!

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