POLLITT: Censored Birth Control

Imagine that a serious physical condition for which the most common treatment is surgery -- cataracts, say, or appendicitis -- could be remedied, three times out of four, in its earliest stage by a simple prescription for drugs or devices already in common use. Would you not expect a big celebratory hullabaloo? A rush by the medical community to educate health care providers, patients and the public? A P.R. extravaganza by the lucky drug companies holding the patents? The reduction of pain and worry and the risks attendant even on routine surgery, the conservation of time and money and medical resources -- these are no small things, after all.But you don't need to imagine: My hypothetical is real. For twenty years, it has been known that high doses of certain ordinary birth control pills can be used postcoitally to prevent pregnancy. (This is not RU-486, the French abortion pill, but the "morning-after pill," an unfortunate misnomer since depending on formulation it can work 48 or even 72 hours after intercourse.) The copper-T I.U.D. will also prevent pregnancy if inserted as late as seven days after intercourse. Many hospital emergency rooms, university clinics and family-planning clinics prescribe these methods; gynecologists, although surveys show that 99 percent are aware of their existence, rarely do.Why? The Center for Reproductive Law and Policy blames birth control manufacturers, who have not sought permission from the Food and Drug Administration to label and market their products for emergency use, even though the same companies --Wyeth-Ayerst and Berlex -- package and sell the same products as emergency contraception in Europe. (Labeling matters because drugs cannot be advertised for off-label purposes, and because prescribing drugs for off-label uses raises the specter of liability for nervous Ob-Gyns, the most-sued medical specialists.) In November 1994 the C.R.L.P. filed a citizens' petition with the F.D.A. urging it to require the relabeling. Almost a year and a half later, the F.D.A. has yet to act. I realize unwanted pregnancy doesn't rank on the scale of national importance up there with the marketing of Olestrafied potato chips, but a year and a half seems like a long time to me.Whatever the reason for the F.D.A.'s slow pace, it's pretty astonishing that this elementary piece of information is moving so sluggishly through the medical culture. Doctors, after all, do not need to wait for the drug companies. Once the F.D.A. has approved a drug or device as safe, it can be prescribed for any purpose, and often is: Birth control pills themselves are already frequently prescribed for such off-label purposes as regulating menses and controlling acne. There is nothing to prevent gynecologists and general practitioners, public health nurses and other health care professionals from routinely informing their patients about emergency contraception, along with the usual admonitions about smoking and cholesterol and calcium. In fact, there is nothing preventing doctors from giving their patients "prophylactic prescriptions" for emergency contraception, to be filled if needed. This turns out to be a rather controversial idea, with some public-health experts arguing it would promote carelessness about birth control. At $60-80 a pop, plus nausea, emergency contraception doesn't sound like something you'd want to make a regular part of your weekend. Do I sense a certain disbelief in women's common sense percolating here? A certain reluctance to relinquish an opportunity to lecture and embarrass? After all, doctors routinely write prescriptions -- for painkillers, tranquilizers, antibiotics -- to be filled virtually at the patient's discretion. Why not this?More than half of U.S. pregnancies are unintended -- a much higher percentage than in other Western industrialized countries. This unfortunate fact bears directly on those 1.5 million annual abortions bemoaned by bien-pensants. The failure to front-burner emergency contraception -- which has the potential to reduce the abortion rate by an astounding 50 percent and, more realistically, to lower it by several hundred thousand -- shows once again how little the abortion issue has to do with abortion, and how much it has to do with women and with sex.Fortunately, not everyone is waiting around for government to push the appropriate papers and for gynecologists to overcome their bashfulness. On Valentine's Day, the Reproductive Health Technologies Project and Bridging the Gap Communications opened a toll-free hotline (1-800-584-9911) that offers women easy-to-understand information about emergency contraception and provides them with the names of doctors in their area who will prescribe it. I called right away: It works, it's great, it's in Spanish too! (There's also a Web site, http://opr.princeton.edu/ec/ec.html.) Since the initial burst of publicity-articles in Cosmo and Glamour, USA Today and other newspapers, although not The New York Times -- calls have been averaging 250 a day, and more and more doctors are adding their names: 1,600 at last count. All this on a modest $75,000 grant from the John Merck Fund.Direct action is often accused of being old-fashioned, romantic and futile. Are we not living in the era of the Lobbyist, the Adman and the Pollster? The emergency contraception hotline shows that on the contrary, direct action can be practical, ingenious and supermodern, not to mention effective. It also has the advantage of incorporating in its practice the value it champions: self-determination, in this case the right of women to information and up-to-date reproductive medicine.So what are you waiting for? Ask your Ob-Gyn to join the hotline; if she demurs, quit. Send the Reproductive Health Technologies Project a donation (1818 N Street N.W., Suite 450, Washington, DC 20036). Write up and distribute a flier (especially to teenagers, who have been skirted by the project's outreach campaign); make stickers and put them up in public places; start a chain letter. Get the word out: 1-800-584-9911.If you're feeling lazy, you can xerox this page.


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