Ask and You Shall Receive
In the tradition of peaceful revolutionaries fed up with tyrants, the 49,000-member American College of Obstetricians and Gynecologists unveiled a national prescription-writing campaign last week for the morning-after pill. What makes this group of physicians so irate, according to ACOG's past President Vivian Dickerson, is the "despicable treatment of women at the hands of the FDA."
In 1999, the Food and Drug Administration approved the emergency contraceptive, dubbed "Plan B" by its manufacturer, as safe and effective but only if taken within 72 hours of unprotected sex. Because of the narrow window, the agency's own scientists and its external advisory panel supported the manufacturer's application to make the drug available over the counter so women could get it in the nick of time. But the FDA dragged its heels and eventually turned down the request, prompting an outcry. When the Government Accountability Office delved into the matter last fall, it concluded that the agency had made its call with an unusual amount of top brass involvement. What's more, the FDA used a "novel" rationale for the thumbs down: Ready access to Plan B would encourage young girls to "engage in unsafe sexual behaviors because of their lack of cognitive maturity." A fancy way of saying access to contraceptives would drive young women to reckless sex.
Plan B has also been a political lightning rod for antiabortion activists, even though the drug does not disrupt or harm a pregnancy. Rather, it prevents pregnancy with a high-dose jolt of birth control hormones. Thus it decreases the risk of abortion. In short, spurious concerns both about women's sexual behavior and about abortion fuel the seemingly endless tempest surrounding women's appropriate and lawful use of an emergency drug.
The ACOG campaign, called "Ask me," effectively creates an over-the-counter option that subverts the FDA ruling. Doctors will offer information on the drug and prescriptions to women who, well, just ask. Patients can either keep the paper as Rx-in-waiting or have the prescription filled and ready in their medicine cabinets--which allows them to use the pills at their own discretion. Helping to spread the word are "Ask me" buttons, national ads, and posters for doctors' offices reminding women that "accidents happen" and "morning afters can be tough."
But advance prescriptions may not be enough. Some pharmacies don't carry the drug because of moral or religious objections. Even the behemoth Wal-Mart with its national chain of pharmacies refused for the longest time. After being forced by Illinois to stock the drug, sued in Massachusetts for not providing it, and compelled by that state's pharmacy board to change its ways, the company caved. Two months ago, Wal-Mart announced that all its pharmacies would carry Plan B and restated its policy that individual pharmacists who objected to this, or who felt uncomfortable dispensing the drug, could refer the patient elsewhere. No word about the patient's comfort.
Conscientious objector. This points to another hurdle: Despite a doctor's orders, a pharmacist can decide not to dispense the contraceptive based on moral or religious beliefs. Fine. But there must be an alternative pharmacist or pharmacy to fill the order, or else the conscientious objectors are imposing their beliefs on a woman who then becomes powerless to exercise her own.
Imagine if a pharmacist could block the sale of condoms based on religious persuasion. It's not so far-fetched; the Vatican historically has banned condoms, even opposing their distribution in Africa to protect against HIV. And would there not be an uproar if a pharmacist's own sense of sin used a man's marital status to determine whether or not to fill his prescription for Viagra? The debate over Plan B smacks of a double standard. But worse, without knowing beforehand of the pharmacist's opposition to the drug, a woman requesting it is not only turned away but also humiliated as her privacy is breached and her personal life judged.
As we sort out these ethical issues, let's follow ACOG's lead. Those pharmacies unwilling to dispense the morning-after pill should be mandated to post some version of the "accidents happen" poster, with the caveat "but some other pharmacy will have to help you if you want Plan B." And individual pharmacists who refuse to fill such prescriptions should wear buttons that say simply, "Don't ask."
This story appears in the May 22, 2006 print edition of U.S. News & World Report.