Regulation

From Pelvic Torture to Pharmaceutical Freedom

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Writing in Mother Jones, Stephanie Mencimer explains why birth control pills should be sold over the counter:

Note: This is not actually a picture of a pelvic exam.

[T]he US Preventative Services Task Force, an independent group of national experts that makes evidence-based health care recommendations, released new guidelines declaring definitively that women over 30 don't need a Pap smear more than once every three years unless they have a couple of risk factors, which I don't have. The American Congress of Obstetricians and Gynecologists has said that birth control pills can safely be prescribed without a full-on exam.

Doctors, though, don't seem to be in any hurry to give up old habits. After I got back from vacation, I emailed my doctor, citing the new guidelines, and asked if he could give me a new one-year prescription for birth control pills without a pelvic exam. He wrote back, "Yes, one can argue about whether or not you need a pap, but current recommendations are still for an annual exam, blood pressure readings, updating family history, ('torturous pelvic exam,' I'm afraid), etc. So I would still like you to come in. See you soon?"

Making the pill OTC will protect you from invasive doctors, but not from invasive mothers.

The doctor had me over a barrel. As it turns out, my experience isn't unique. Doctors regularly hold women's birth control prescriptions hostage like this, forcing them to come in for exams that research is increasingly showing are too frequent and often unnecessary and ineffective. A 2010 study published in the journal Obstetrics & Gynecology found that 33 percent of doctors always require a pelvic exam and Pap smear for a hormonal contraception prescription, and 44 percent regularly do so, even though there's no medical reason for linking the two….

"'Don't do it' is not a message that the drug industry and the medical device industry is all that excited about," [health policy expert Shannon] Brownlee says. Guidelines from the government trickle down very slowly to doctor's practices. And patients raise these issues at their peril, Brownlee notes. "When you have that conversation with your doctor, you often get labeled as a noncompliant patient." The health care system is also plagued with irrational incentives that reward doctors for doing more rather than less, even when it's in the patient's best interest to be judicious. Doctors need to keep their waiting rooms full to keep their practices open.

There is one way to change the system: Make the Pill an over-the-counter (OTC) drug. If women could get birth control pills from a pharmacy, like they do in other countries, and could decide for themselves whether they should have a pelvic exam every year, the country could experience serious health care savings. Unnecessary health care treatment overall is estimated to cost at least $158 billion a year.

Read the whole thing here. And if you'd like to see some more on the subject, you should plow through the Reason archives: We've been on this beat for years.

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  1. They can’t do that! It would fix two problems at once! It would save tons of money on the useless exams (my girlfriend has successfully duped doctors for the past 3 years by calling with an appointment to get a prescription, then once the script is called in cancelling – they finally caught on). Not only would it save money, be WAY more readily available, and insurance plans wouldn’t need to cover it since it would be OTC (and most plans don’t cover otc stuff without a script). That would be a FAR too sensible approach for these United States…

  2. This is only a debate because baked into the essence of every doctor is a sense that the rest of us are too stupid to live, and only by their good graces does the human race survive.

    I loathe the entire medical community.

    1. There are exceptions. My wife’s doctor just has her call every year, asks if she’s having any problems, and if not, calls in the renewal. I’ve also heard about a doctor in Texas who doesn’t accept insurance and works pro bono for patients who can’t afford to pay. Don’t condemn the entire medical community just because Groovus is an asshole.

    2. I can’t speak for the entire medical community, but I don’t loathe you back. I’m actually pretty much indifferent to you, but if you were sick or dying, I would do all that I could to help you regardless of whether or not you were ever going to pay me for it.

  3. Give me OTC pseudoephedrine!

    If birth control pills are OTC will whiny law students still wnt them for free?

    1. No, they’d want them to be OTC *and* get paid to take them.

    2. There will still be some that are prescription only. And those are the ones they will want. For free.

    3. I did see instructions somewhere online for how to make pseudoephedrine from meth (since meth is more readily available), but I can’t seem to find the link now.

  4. I’m curious how much of this is behavior from doctors is risk aversion.

    “The doctor prescribed me this BC without an exam, and I got cancer/had horrible, painful cramps/whatever. Now I’m going to sue her because she shouldn’t have done that.”

    1. Make it OTC and cut out the doctor.

      1. so then someone else gets sued. Or we get new regs to guard against the .000001% chance that something may go wrong, sort of like Sudafed requiring ID and the confiscation of your first born.

    2. A lot. I had a CAT scan earlier this year to confirm that I am a freak of nature. My doctor as much as admitted it was so he wouldn’t get sued if he was wrong about that and it turned out my variation was actually lung cancer.

      1. We already knew you’re a freak. You didn’t need a CAT scan to determine that. :-p

    3. Almost all of it. My insurance agent told me that OBGYNs have the highest rate of malpractice suits of any specialty, and that their premiums run around $200K per year (I know: anecdotal, and appeal to authority, but I don’t feel like looking it up). Most times when a kid has a birth defect, the OB gets sued. Sometimes it’s actually the Dr’s fault; usually it isn’t. The difference is, if they practiced CYA medicine, they pay out a small settlement, and if they didn’t they pay out a huge settlement/judgement.

      1. Wasn’t this how John Edwards made his money? Suing doctors who delivered babies with defects, using junk science to “prove” that the doctors were at fault.

        1. Yeah, which is one of the reasons that he is a terrible person.

        2. Yes, cerebral palsy mostly.

          He also was key in killing NC setting up a fund to give money to parents of cerebral palsy kids, because it would have limited damages at the same time. He wanted to keep the gravy train going, even though there’s evidence that what the doctor does doesn’t matter.

  5. I miss bloom county

    1. You and me both, pal.

    2. Bloom County was the most libertarian of comic strips.

      1. Breathed had the good sense to quit while he was ahead. But then he came back with that execrable Outland. My working theory is that he was trying to see if he could beat Trudeau in the awfulness department.

        1. DON’T TALK SHIT ABOUT BERKE

          1. Hey it wasn’t me, I was just quoting Mortimer…

        2. Never seen or heard of Outland. Happy that way.

    3. Indeed. Opus and the gang are sorely missed in this day and age. I tried following the Breathed spin-off but it never had the same bite.

      Steve Dallas was one of the all time great comic characters. One of my personal faves-

      http://abnormaluse.com/wp-cont…..ty1986.gif

  6. Wow, a thoughtful article on medicine in MoJo? Amazing. They should also make pseudoephedrine OTC while they’re at it.

  7. But if I don’t have to go in for an exam, how will they yell at me about quitting smoking and find out if I’m being abused at home? I mean, I don’t see how I could possibly survive…

    Glad to see this was in Mother Jones though, for serious.

    1. If you have sex with a man, you’re being abused. Jezebel says so.

      1. Well shit. At least now I know.

        1. Now, girl-on-girl sex may not be rape as per the Jezebel Handbook, but the fact that all women are the products of male/female sex probably makes it a crime as well.

          1. Parthenogenesis Now!!!

  8. The doctor had me over a barrel.

    Stop with the victimhood. The doctor practices in a time when people sue for things far less than deviating from a procedure that may or may not be useful.

    1. Would “over a barrel” be a eearchable porn topic? Seems like it would be uncomfortable as hell…

    2. The thing that slays me about that, though, is that she never mentioned the possibility of going to a different doctor. Recently, I didn’t agree with my doctor’s course of treatment, and he wouldn’t budge, so I went somewhere else. I called a few docs beforehand to see what their treatment philosophy was and picked one. It’s called the market.

      I agree with her on the very limited point that birth control should be OTC, but like I said downthread, she’s only a libertarian on this point because it affected her personally. Any other time she’s glad to impose her values on the rest of us, and I cannot say there isn’t a bit of schadenfreude on my part.

      1. And what’s the likelihood she supports socialized medicine? Which would insure that no doctor will practice if they have a different philosophy of care…

        1. She’ll continue to let herself be used as a victim by Team Blue, until they ignore her like they did Cindy Sheehan.

          I will laugh my ass off at that point.

        2. And what’s the likelihood she supports socialized medicine? Which would insure that no doctor will practice if they have a different philosophy of care…

          approaching 100%. Look at her article archives. She’s the epitome of a blind squirrel finding an acorn.

      2. she’s only a libertarian on this point because it affected her personally.

        Yes. But this describes approximately every American.

  9. The stopped clock is right eventually. I assume they will immediately retract this article and disvow.

  10. 33 percent of doctors always require a pelvic exam and Pap smear for a hormonal contraception prescription, and 44 percent regularly do so

    But isn’t that main reason for becomeing and OB? So that you can stare at vaginas and insert things into them all day? /sarc

    1. Hahaha, I remember when I was in middle school and thought my friend’s dad had the coolest job in the world because he got to look at vaginas all day. Then he informed us that not every woman who comes in the office is hot and that a lot of what he saw looked like diseased raw chicken.

      1. One look (and whiff) of my girlfriend’s yeast infection, and I never wanted to be a gynecologist again…

  11. Why is ANY pharmaceutical by scrip only? I have to pay $500 each year for an examination so that I can continue to get the bp meds I’ve used for years and that continue to work perfectly. Because, after all, only a physician can look at a bp and decide if it’s high or not.

    1. Even worse, why are lab tests by prescription only? Why can’t I order up my own? How am I being saved by not letting me get my own CBC?

      1. Yeah, that is just stupid. You are not allowed to know facts about your own body without a permission slip from a doctor. Primary care doctors have become completely useless, I have concluded.

        1. Aren’t many (if not all) lab tests available without a doctor? Google it.

          1. I found a website for a place in Colorado that says they do it, but I don’t think that it is widely available.

          2. Many are. I know that the FDA was thinking about ending that, but they haven’t yet.

          3. Okay, I also found this site. Looks like you order your own labs and pay for them online, then they email you a form to take to a local lab to get your blood drawn. Has anyone used this site? Is it legitimate?

      2. Even worse, why are lab tests by prescription only?

        I don’t know that its illegal to have labs run without a physician order.

        Insurance won’t pay for it without an order, and by policy I’m sure most labs won’t do it without an order, but I’m not aware of a law against it.

        1. Maybe not in every state, but in the ones I’m familiar with, that’s so. The specimen collection must be via prescription, and the lab, whether in the same or another state, has to be licensed by the state the specimen was taken in.

    2. In some countries, pharmacists are actually allowed to prescribe medicine. Here in the USA, they get a massive amount of education that they’re basically not allowed to use.

      1. I’m sure I’m oversimplifying it, but why exactly is pharmacy school so long/hard when most pharmacists pretty much just put the correct number of pills into the bottle? Couldn’t this be taught at the local CC?

      2. Pharmacists were allowed to prescribe medicine in the US up until the late ’40s, IIRC.

  12. Recommending overuse of their services is not unique to doctors. Shampoo companies want you to triple up on their product, toner sellers think you need a fresh cartridge after printing six pages, lawyers think you can always use a third check on the legal status of that transaction and web designers want you to buy frequent updates. The difference is doctors (and often lawyers and other professions) have some illegitimate leverage because it’s often illegal or very risky to circumvent their stupid suggestions.

    1. The difference is doctors (and often lawyers and other professions) have some illegitimate leverage because it’s often illegal or very risky to circumvent their stupid suggestions.

      That sounds like legitimate leverage to me.

      1. Morally legitimate?

        1. Given that “avoiding illegal activity” is sort of the point of consulting with a lawyer or an accountant, yes. Given that avoiding “very risky” propositions is the point of consulting a doctor…yes.

          This is like saying that the grocery store has illegitimate leverage over me because I get hungry. Thems the breaks.

          1. [Insert “locking up the food supply” gamboling nonsense here]

          2. Your fundamental assumption is that it is morally legitimate to have a legal framework banning individual access to desired medical treatment without the consent of a licensed agent of the state . I’m not sure how you can make that assumption.

            1. Your fundamental assumption is that it is morally legitimate to have a legal framework banning individual access to desired medical treatment without the consent of a licensed agent of the state . I’m not sure how you can make that assumption.

              That is not my assumption at all. Of course I do not ascribe to the notion that “that which is legal is moral” and its converse. I may have had some flawed assumptions about what NL was saying, but it seemed to me he was saying that the level of risk associated with ignoring professionals renders the market illegitimate.

              1. You claimed their leverage was legitimate. Their leverage is rooted in a legal framework.

                1. Their leverage is rooted in a legal framework.

                  We require some breaking out of particulars here. For example: unless you’re an anarchist advocate (and even then), there are going to be laws and lawyers, and there will therefore always be leverage engendered by a “legal framework”. There will always presumably be some form of accounting compliance / tax compliance, meaning that “other professionals” namely, accountants, will always have some form of leverage engendered by a “legal framework”.

                  Now, doctors, hey, let the good times roll and let people ingest and treat the way they feel their bodies can. I was just saying that the fact that ignoring a doctor’s orders carries a significant risk does not thereby render the doctor’s status or career illegitimate.

                  1. doctor’s status or career illegitimate

                    We’re not talking about status or career. We’re talking about leverage.

                    And you’re generalizing the concept of a “legal framework”. I’m not talking about the pure existence of laws and a justice system. I’m talking about the specific body of laws that grant a specific set of individuals (state licensed medical practitioners) rights to control what individuals are allowed to purchase/possess.

                    Those laws are not morally legitimate. And thus neither is the leverage in question.

                    1. Except NL lumped it all together, which is why I said that it needs to be broken out into its component parts.

  13. Stephanie Mencimer explains should’ve explained why birth control pills all drugs should be sold over the counter

    … instead of this namby-pamby stuff about birth control.

    1. Eh, any open door started out as a barely cracked one.

  14. Unfortunately, even if Mother Jones gets the results right, it comes from flawed premises. This author gets it right despite the fact that she is hopelessly enmeshed in Gender Identity Politics. As soon as birth control was OTC, she’d be on Capitol Hill with Fluke advocating for price controls.

  15. I can foresee another scenario which I think is depressing liekly to happen. BC pills become available over-the-counter. A number of women react badly to the pills, have health problems. Not only do the lawyers come out of the woodwork to sue everyone in sight (drug companies and pharmacies), but Very Serious Congressional Hearings are held, and pretty soon there is loud agitation to make the BC pills prescription only, or ban them outright.

    1. That is not ever going to happen. The Pill has been so thoroughly market-tested and is so wildly popular that there is no reason to think that there is ever going to be a critical mass who supports its prohibition.

      1. Psuedophedrine is effective, wildly popular, and requires you to show ID, register with the government, and can only buy a set amount over a given time period.

        I see OTC BC suffering the same fate after some idiot women use their OTC BC improperly.

        The “critical mass” needed to get an OTC drug restricted is like 5 people on a FDA committee.

        1. Psuedophedrine is effective, wildly popular, and requires you to show ID, register with the government, and can only buy a set amount over a given time period.

          I thought this was only a state law; did the Feds hook the states with some kind of medicaid subsidy or something?

        2. The “critical mass” needed to get an OTC drug restricted is like 5 people on a FDA committee.

          Also, the “critical mass” is just one news story, ala Four Loko.

        3. Yes, but people can get high on it.

          I have a hard time imagining recreational female hormones taking off.

          1. Don’t worry about it, let the FDA do the imagining for you.

          2. It won’t be recreational, it will be some dumbass girl who tries to take a month’s worth of them as a substitute for Plan B.

  16. Same with Contact Lenses. I have had the same prescription for 20 years yet to purchase more of them I need to see my eye doc … even contacts.com requires an up to date script.

    1. Get the LASIK already, dumbass. After the 5 minutes of unspeakable horror are over, it’s great.

      1. I’ll wait until I’m 50. I still don’t trust the possible long term side-effects.

      2. After the 5 minutes of unspeakable horror are over, it’s great.

        You had this problem too? I thought it was just me. Mine was actually painful and terrifying. Still worth it, though.

        1. “Eye suction on!”

          *horrifying buzzing sound as the cigar cutter cuts your cornea*

          *horrible clicking and terrible smell as the laser robot eats your eyes*

          No, there’s nothing terrifying about it.

          1. They didn’t numb my eyes enough, either. Think about that for a second!

            1. They gave me plenty of cocaine eydrops or whatever it was. They didn’t give me nearly enough valium and benadryl, though, because I got so freaked out while they were doing my second eye that I forgot to breathe. And then they only gave me two valiums for afterward, so I had to supplement them with a lot of bourbon.

              1. They gave me enough valium that I was having a hard time staying awake.

            2. The procedure was freaky and terrifying, but this genius decided he could just take a cab home afterward by myself. 10 minutes later I’m in torturous pain in the back of a cab, eyes squirting tears, holding one eye open with my fingers so I can figure out which bottle holds the pain-relief drops and trying not to scream. I threw the first bill I pulled out of my pocket at the driver, fumbled inside my condo, then punched the couch and tried to keep the screams to a tolerable volume for about 45 minutes until the pain subsided enough to lie down.

              When they tell you someone should pick you up and stay with you after LASIK, listen to them.

              On the plus side, I had vampire eyes for about 3 years. Now they’ve settled in right around 20/20.

          2. Holy shit that eye suction was weird. It’s like having your eyes probed by aliens.

        2. Mine wasn’t painful or terrifying, but that might have been the valium. I did develop chronic dry eyes, but I still don’t need to use drops as often as I did with contacts. Plus 20/10 in the right eye and 20/15 in the left kind of feels like a superpower.

  17. If BC was offered as OTC, what would women bitch about then?

    1. Ha ha, you obviously aren’t married.

    2. Kind of backwards; making birth control OTC would just leave room for more bitching, and probably about something that relates to me not getting a blowjob any time soon.

    3. Money, children, housework, co-workers, weight, food, dogs, cats, other drivers, patients, shit they hear on the radio, clients, random women at the grocery store, the grocery store, the weather, the temperature, neighbors, you get the picture.

      1. any other female anywhere ever…

      2. curiously, you left out husbands. Or men in general.

  18. Ms. Stephanie if you make birth control pill OTC and don’t mandate (the unecessary) pelvic exams, just who will go to Planned Parenthood? Easier access to birth control is bound to cut into the very lucrative abortion business not to mention PP’s other services. Women have the right to choose only when it benefits the left and Planned Parenthood. Duh.

  19. Don’t worry; soon we’ll all be bent over the barrel for simple cold meds we already get, because hey, those doctors are going to have to get paid somehow.

    Sigh. Maybe I’ll be dead by that time.

    OT: It’s easier to get prescription drugs on the black market than it is to visit your doctor and get a prescription anyways.

  20. The doctor had me over a barrel. As it turns out, my experience isn’t unique. Doctors regularly hold women’s birth control prescriptions hostage like this, forcing them to come in for exams that research is increasingly showing are too frequent and often unnecessary and ineffective

    Dickhead Mode ON:

    So, lesse, with the pervasive liberal mindset we have an all-encompassing healthcare state where the government is or will eventually be involved in every health decision you make, and will at some point simply be making those decisions for you.

    We’ve got a war on Drugs, War on Trans Fats, War on Obesity, War on Synthetic Marijuana, War on Pharmeceutical Companies, War on Insurance Companies, War on Cigarettes, War on Tobacco in General, all in the name of healthcare, and someone writing in MoJo is shocked, SHOCKED at the institutions are getting between her and her beloved birth control pills.

    Frankly, I’m just bored with the whole fucking thing.

    You fought for the Healthcare State, now live with it.

    Dickhead Mode OFF.

  21. Kinda crazy when you think about it dude. WOw.

    http://www.Deep-Web.tk

  22. She is 100% correct.

    Asymptomatic women do NOT need pelvic exams.

    HPV tests (likely with cell collection in the HOME or in the bathroom at your physicians office) should be first mass screen for women over 30 and PAP should be secondary (when HPV positive). The data is unequivocal. More sensitive and specific. It’s a travesty this hasn’t already happened.

    ACOG doesn’t serve patients but its membership (which is one reason it could only be bothered to issue the 3 year PAP recommendation 22 years after the American Cancer Society did it).

    Wellness from sex organ surgeons? Put it this way, there’s a reason the #1 killer of women is CV disease and men don’t have “wellness” exams.

    Every male doc that insists on pelvic exams and too frequent PAP smears should be forced to undergo an annual needle biopsy of his prostate. The rationale isn’t any weaker and I guarantee they’ll lose the hoky theatrical act (“now try to relax”).

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