Plan B's Plan B

Kerry Howley | July 8, 2005

A British study demonstrates, for the umpteenth time, that putting the morning-after pill over the counter does not increase the likelihood of unprotected sex.

Meanwhile, state legislatures are defying the FDA and putting Plan B OTC in spite of the agency's refusal to approve the move. Massachusetts and New York have legislation about to pass.

Go2Ec.org has a handy map showing which states are moving forward.

Comments

|7.8.05 @ 4:36PM|#

putting the morning-after pill over the counter does not increase the likelihood of unprotected sex.

Who would honestly believe such a fallacy?

"Gee, honey, why don't we have a lot of unprotected sex now that Plan B is available OTC? We can use it as primary birth control. Does that sound like a good idea?"

"It sure does, sweetums! And it's only $45 a pill! That's less than your trip to the local hooker."

|7.8.05 @ 4:38PM|#

(the fallacy being that putting the morning-after pill OTC increases the likelihood of unprotected sex).

|7.8.05 @ 4:42PM|#

Doesn't the Oregon euthenasia case put pharmcists who sell the pills in Massachusetts in danger of federal prosecution under the Controlled Substances Act?

|7.8.05 @ 4:45PM|#

Pregnancy aside, there is still the risk of sexually-transmitted diseases to account for. Condoms are still the best (if not the only) line of defense for such risks.

|7.8.05 @ 4:47PM|#

if a senator can link gay marriage and dogfucking, ANYTHING IS POSSIBLE.

i am caught between entertainment and horror, as per the usual. it sometimes makes me think gaius has a point.

|7.8.05 @ 4:48PM|#

I wonder if members of the Christian Right remove the seatbelts from their children's cars.

Wouldn't want to diminish the perceived cost of unsafe driving.

|7.8.05 @ 4:52PM|#

Zing! Good one, Joe!

|7.8.05 @ 5:00PM|#

joe,

You're here all week, right? :)

|7.8.05 @ 5:05PM|#

As Nick DiPaolo said, "Sweet. Now I have to put TWO pills in a girl's drink."

|7.8.05 @ 5:16PM|#

Cost of a condom $2
Cost of the morning after pill $45
Cost of an abortion (I have no idea >$45)
Cost of adoption $10,000
Cost of raising a kid $200,000
Cost of Sex Priceless

|7.8.05 @ 5:20PM|#

Just wait for the feds to start cracking down on this one. Justice Department, FUCK YEAH!

Adam|7.8.05 @ 5:23PM|#

This New York shit is patently ridiculous.

The day after Raich, the Senate Majority Leader announced he was withdrawing his support and killing medical marijuana because state law would violate federal law if he passed it.

Days later, (in an effort to shore up his buddy Nick Spano's seat in a contestable district), he passed this Plan B bill...that calls for the distribution of plan B in violation of federal law.

Dirty rat.

Adam|7.8.05 @ 6:01PM|#

Girth - Check out this crazy-ass article about some allegedly DEA guys and their long-term strategy to save their jobs. You were joking, but it's apparently crossed their minds.

|7.8.05 @ 6:29PM|#

"I wonder if members of the Christian Right remove the seatbelts from their children's cars.

"Wouldn't want to diminish the perceived cost of unsafe driving."

You may laugh, but I recall reading reports that the presence of airbags does appear to be correlated with more less care in driving, as the drivers rationally figure they can afford to take greater chances.

|7.8.05 @ 6:31PM|#

that should have been "less care." Sorry about that.

|7.8.05 @ 6:50PM|#

You may laugh, but I recall reading reports that the presence of airbags does appear to be correlated with [less] care in driving, as the drivers rationally figure they can afford to take greater chances.

Certainly makes sense given economic theory about incentives. It's not so much that someone thinks to themselves they are going to dive with less caution, but that we set our level of carefulness, if you will, with some regard to our overall sense of risk, even if it is subconscious. If it seems implausible just think of the converse (as Joe was essentially doing), if your car was suddenly rendered very dangerous, say even a slight fender-bender would result in your death (or your children were in fact unbuckled) wouldn't you drive much more cautiously? If so than the opposite is by definition true: making a car safer reduces your level of cautiousness.

|7.8.05 @ 6:53PM|#

Please write your comments with more care. There are no airbags here...

|7.8.05 @ 7:16PM|#

Adam,

Thanks for the heads up to that link, even though it almost made me lose my dinner.

Seamus,

I've seen the same thing in studies with regard to bicycle safety and the use of helmets. The rate of injuries has not gone down since more people began wearing them when riding bikes, simply because people feel safer when wearing a helmet and therefore are more prone to take risks.

|7.8.05 @ 7:31PM|#

A British study demonstrates, for the umpteenth time, that putting the morning-after pill over the counter does not increase the likelihood of unprotected sex.

Anecdotal evidence cannot be used to justify personal use of medical marijuana but it can be used to suppress the availability of certain other scientifically proven medical drugs. Freedom is another word for bullshit!

|7.8.05 @ 9:56PM|#

I would guess that the riskier/safer driving dynamic only applies at the extremes. If you have a Pinto or your floorboards are about to collapse, you drive extremely cautiously. If you have a tank, you let er rip. But if you have a normally-safe car, you drive like a normal person.

|7.8.05 @ 9:59PM|#

Is anyone else put off by the couplet, "unprotected sex"?
I mean sex is to be welcomed with open arms and thighs. Right?

Drug stores don't sell chastity belts, do they?

|7.8.05 @ 10:55PM|#

With all due respect, actually, it's not so nuts to think that having Plan B as a form of back-up birth control would lead to people to engage in more risky sex. Because there is evidence that having seatbelts in cars encourages people to engage in more risky driving.

I think this is what Seamus is referring to, although he's not remembering it clearly.

Economist Steven E. Landsburg wrote about this in the book The Armchair Economist. Seatbelts appear to cause more accidents.

It went something like this: Someone did a study and found that when seatbelts became more common in cars (became mandatory, actually) the fatality rate per driver stayed about the same as when seatbelts were more rare. The chances of a person surviving an accident did go up, but the chances of having an accident also increased, effectively canceling out the increased chances of survival per accident.

As Brian Courts alludes to, it's not as if a driver consciously thinks, "Oh, heck, I've got seatbelts, I've got a much better chance of not dying if I have an accident, so I might as well drive less carefully and have an accident." But at some level, you do relax a little more because you feel safer, and maybe you relax just a little too much.

Landsburg even said, if the government had a goal of reducing the rate of auto accidents, the most effective way it might do this is to mandate the installation of a sharp metal spike in the center of every car's steering wheel, pointed right at the driver's heart. Probably the number of road accidents would go steeply down, because every driver would then drive very, very carefully.

However, because then just about every accident that did occur would be fatal, the total number of driving fatalities would probably stay about the same, because the rate of fatalies peraccident went way, way up.

It's another lesson in perverse incentives and unintended consequences. And it shouldn't be unfamiliar reasoning to most libertarians. For example, I think most of us accept the argument that assistance to poor single mothers from the welfare state has contributed to the increase in children being born outside of marriage to poor single women. "If you pay for something, you get more of it."

Leftists have attacked this reasoning as absurd: "Do you really believe poor single women think, 'Hey, if I have a kid, the government will pay me an extra fifty whole bucks a month to help raise it, so I may as well let myself get pregnant'?" And it does seem highly unlikely that anyone reasons it out like that. But it does seem plausible that the presence of Aide to Families With Dependent Children encourages unplanned pregnancies by making them just a little catastrophic to people's lives.

People do have a documented tendency to freak out irrationally over very minute risks if, should the odds go against them, the results are very catastrophic and spectacular. That's why most people worry about dying in a plane crash more than dying in a car crash, even though the latter is much more likely. Maybe people also have a corresponding tendency to over-relax after being provided with certain "safety nets."

Frankly, I'm very surprised to hear that the availablility of the morning-after pill does not appear to encourage behaviors that make pregnancy more likely. Perhaps, even though the pill is available, people would still really, really rather not have to use it -- for reasons I don't know -- and still take their usual precautions to avoid having to use it. Maybe it just hasn't been around long enough to change people's behavior. I don't know.

|7.8.05 @ 10:58PM|#

Oops, I overlooked the factor that the pill is pretty expensive. I think the post by MyNameIsAsh at July 8, 2005 05:16 PM may be the answer.

|7.8.05 @ 11:01PM|#

As far as the bicycle helmet issue goes, while the rate of injuries may be the same, have the severity of the injuries gone down? I mean, I'd argue that 5 or 10 broken arms is better than 1 split-your-head-open crack-up. (Is there a technical term for that?)

|7.8.05 @ 11:16PM|#

A British study demonstrates, for the umpteenth time, that putting the morning-after pill over the counter does not increase the likelihood of unprotected sex.

Nonsense. The study merely indicates that selling a morning-after pill OTC does not increase the use of a morning-after pill... it says nothing about a change in the incidence of unprotected sex.

|7.8.05 @ 11:20PM|#

I would guess that the riskier/safer driving dynamic only applies at the extremes... if you have a normally-safe car, you drive like a normal person.

Well I would tend to disagree with the first part and think the second part is essentially a truism, no? Of course the normal person drives a normally safe car; the issue is what happens when the level of normal safety changes? How much effect does it have on what is considered to be driving like a normal person? Since we know that there is a risk/caution trade off at the extremes, a generally upward sloping risk/caution curve must obtain (you have to get from point A to point B on the curve somehow). In the interval it seems unreasonable to expect the unique special case of a totally flat band in some normal zone out of the infinitely many upward sloping curve possibilities based on nothing more than a personal hunch. Based on our economic understanding of behavior and incentives I would expect some positive trade off at all points on the curve. Without giving it much thought I might even expect that curve to be getting steeper as you go due to non-linear effects of risk-aversion.

|7.8.05 @ 11:37PM|#

while the rate of injuries may be the same, have the severity of the injuries gone down? I mean, I'd argue that 5 or 10 broken arms is better than 1 split-your-head-open crack-up. (Is there a technical term for that?)

Devin, I think that's a good point. It seems there are a couple factors involved. First, what is the chance that any given accident is "severe?" Then second, how many total accidents are there?

Helmets tend to reduce the chance that any given accident is severe. But if people are inclined to ride in a less-safe manner with a helmet, then the total number of accidents would tend to go up. Therefore the total number of severe accidents could go either up or down depending on the relative magnitude of each effect.

|7.9.05 @ 12:42AM|#

>The day after Raich, the Senate Majority Leader announced he was withdrawing his support and killing
>medical marijuana because state law would violate federal law if he passed it.
>
>Days later, (in an effort to shore up his buddy Nick Spano's seat in a contestable district), he
>passed this Plan B bill...that calls for the distribution of plan B in violation of federal law.

Soon to be dead cancer patients won't get him reelected. Feminists will. Duh!

|7.9.05 @ 5:41AM|#

Ok, enough with the bad car analogies. Fact is, since Plan B is supposed to be used as an emergency measure, and its price reflects that, (as I mentioned in the very first post on this thread), people are definately not going to use that as regular contraception, or have "riskier sex" because of it. They will probably rely on the same methods of birth control that they used before the morning-after pill became OTC. (Even if those methods include coitus interruptus or the rhythm method).

If the ridiculously high price is not a convincing enough argument, get this: women who need to use Plan B will typically get 2 periods (menstruate twice) in one month. I know because I used it once. And believe me, no woman wants to even have one period a month, much less more than one. Speaking from personal experience, it was a total pain in the ass (literally!) to bleed twice as much as is naturally neccessary. So even if money is no worry for a couple, I guarantee that after a woman has 2+ menstruations in one month's time span, they ain't going to be running to Plan B very often for help. So stop trying to suggest that people are going to have more unprotected sex. Either they will or they won't, but making that pill OTC won't make much of a difference either way.

|7.9.05 @ 10:44AM|#

Scott's observation that the study really found that OTC availability of Plan B dies not increase its use (regardless of its effect on sexual behavior) might actually be pretty important. I just had someone tell me that they heard Plan B might increase the risk of tubal pregnancy (note that I have NO idea whether this is true AT ALL! It could be total crap). But they thought that meant that Plan B should stay prescription, since if it were OTC, more people would use it, and more people would be exposed to this risk that may or may not exist. Such is the logic a lot of people apply to prescription drugs.

|7.9.05 @ 10:54AM|#

Plan B will typically get 2 periods (menstruate twice) in one month

I guess that's what the researchers would call the "confounding variable". Thanks for settling that one for us clueless guys Smacky.

|7.9.05 @ 11:25AM|#

Brian and Devin--

How much does the increased popularity of mountain biking have to do with the injury rate? A lot of mountain bikers don't consider it a good day if they're not bleeding at the end of it. I haven't looked at the actual numbers, but if a rate is initially low, the addition to the population of even a small group that has a high rate can have a significant impact on the overall rate, especially if the increase is reported as a percent increase.

Here's a simple example: suppose there are initially 100,000 bikers, and the injury rate is 2%: that's 2,000 injuries. Now add in an additional 2,000 gonzo mountain bikers, who have an injury rate of 50%. That makes a new population of 102,000, with 3,000 injuries, so the new rate is just under 3%, which represents a nearly 50% increase in the injury rate.

I know this is somewhat OT, but it illustrates some of the problems with trying to compare rates of things while accounting for confounding variables.

Amy Alkon|7.9.05 @ 5:23PM|#

I have about five packs of "morning-after" pills, all bought OTC in France, and I haven't used one of them since I've bought them..about four years ago. But better safe than...enormously inconvenienced in America, where you're treated, not like an adult woman, in charge of your own body, but a blithering idiot who must go to the doctor's office (kind of counterproductive if it takes you weeks or months to get an appointment -- or, at the very least, a multi-hour wait in urgent-care)...instead of going to the pharmacy and saying, "Hey there, I'll take some of those." PS I believe the pills were about 11 euros in France -- far less than the price of involving the doctor needlessly!

PS The pharmacist did come to the counter when the clerk told him I was buying more than one. "Madam, these are not to be used as regular birth control!" I told him I knew -- but I live in a Puritan country, so I was buying them for myself and my friends -- just in case.

|7.10.05 @ 11:47PM|#

Stevo,

I don't buy your Armchair Economist. There are a number of reasons why the drop in the fatality rate lagged the introduction of the seat belts.

First of all, it takes a couple decades for the last cars to lack seatbelts to get off the roads. Second, the fatality rate per mile has been steadily dropping for decades - I don't what expected change the author didn't see. Third, the relevant variable to fatalities per 100,000 miles, not fatalities per driver.

|7.11.05 @ 9:36AM|#

joe, I was summarizing from memory what I read 5 years ago, so I probably got the variable of "fatalities per _____" wrong. And it may be that the study cited corrected for the other things you mention. I just remember the basic point and that I found it convincing.

I think the main thing is that:

1) Reducing risk often imposes some "cost" in terms of effort, convenience, cost or comfort. To use the car analogy one last time, driving carefully demands more attention; seatbelts can be uncomfortable; airbags add to the cost of an automobile, etc.

2) People's risk tolerance appears to be a constant, or at least slow to change. Therefore, if we gain a factor that reduces risk, we tend to relax on the other factors that might reduce the risk even further than we're used to.

However, smacky's info that Plan B imposes an extra round of menstrual bleeding is VERY enlightening, and seems to explain why nobody'd want to increase their risk of having to use it. That's a very relevant datum and it casts the whole argument in a different light.