Birth Control

Why Women Should Be Able to Buy Birth Control Without Seeing a Doctor

There is no obvious explanation why something used safely over half a century by hundreds of millions of women should remain so restricted.

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We all know that every day, people in Mexico come across the border in pursuit of something they can't find in their country. What you may not know is that every day, people in the United States go across the border to Mexico for the same reason. They aren't looking for jobs. They're looking for birth control pills.

Why would that be? After all, Americans can get the pill without leaving their country. The reason is that in Mexico, they don't need a prescription. They don't have to see a doctor and present a scrip to a pharmacist.

They can just walk into a store and buy what they want. The cross-border alternative is cheaper, and they don't even have to go themselves—a friend or relative can pick them up.

Last week, the Obama administration gave up its transparently political effort to enforce an age restriction on over-the-counter purchases of Plan B, the "morning-after pill" that can prevent pregnancy after sex. This helpful development creates an anomaly: Women and girls will be able to get emergency contraceptives without a prescription—but not the regular oral contraceptives that would make them unnecessary.

It's like saying we'll treat you if you come down with the flu, but we won't give you a flu vaccine so you don't get it in the first place.

There is no obvious explanation why something used safely over half a century by hundreds of millions of women should remain so restricted. In most countries, it's not. But the U.S. government presumes that women are incapable of making this decision without the approval of a doctor.

This outmoded paternalism can't be justified by the health risks of oral contraceptives. Plenty of over-the-counter medicines are considerably more dangerous. "Nonsteroidal medicines kill far more people than birth-control pills," Dr. Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico, referring to painkillers like Advil and Motrin, told The New York Times.

Oral contraceptives are not entirely devoid of danger. They can slightly raise the risk of certain cancers, while lowering the risks of others. They can slightly increase the incidence of heart attack and stroke, particularly for women who are over 35, have high blood pressure or smoke. But they are safe enough that doctors often prescribe them even for patients who are chaste as nuns—to alleviate acne, severe cramps and heavy menstruation.

There happen to be a few risks in not taking the pill, like pregnancy and childbirth. Besides being desperately unwanted in many cases, they harbor serious perils of their own: diabetes, high blood pressure, obesity, stroke, kidney failure and depression, and soaring college costs. Each year, some 700 American women die while giving birth.

Many contraceptives can help avert these outcomes. But few are as safe and reliable as oral contraceptives. Women who take them properly have only a 1 in 100 chance of getting pregnant in a given year—much better odds than for those who rely on condoms or diaphragms.

Most women would love to be able to get birth control pills without the trouble and expense of seeing a physician. A poll this year found that nearly two of every three American women favor the idea. Some 30 percent of those who are now using less effective contraception, or none, said they would probably start taking the pill if they didn't have to get permission.

Doctors are warming to the idea as well. Last year, the American College of Obstetricians and Gynecologists endorsed the change as a way to improve access and stem the tide of unintended pregnancies—which, they noted mournfully, have remained stuck at about half of all pregnancies for two decades. Fewer unwanted pregnancies would also mean fewer abortions.

Whether and when the change will occur is anyone's guess. The FDA typically waits for a pharmaceutical manufacturer to ask for reclassification before it considers action. So far, none has.

But Ibis Reproductive Health, an international nonprofit, has discussed that possibility with some drug makers. "After ACOG issued its opinion last year, the interest among pharmaceutical companies escalated a bit," Britt Wahlin, director of development and communications, told me.

Scraping the existing restriction would be a triumph of logic. Though it may pain Michael Bloomberg, a woman currently needs no prescription to have sex. She can do it strictly on her own choice. Now, there's a concept.

NEXT: It Never Ends

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  1. If Julia could get the pill without seeing a doctor, how would her actions be entered into records for inclusion in a national medical database?

    1. because her ovaries would be microchipped and transmitting updates back to base, silly

      1. Chase. even though Dale`s artlclee is neat, last tuesday I got a great Lotus Carlton after earning $9739 this – 4 weeks past an would you believe 10/k this past munth. this is really the easiest-job I’ve ever done. I began this eight months/ago and pretty much straight away began to make over $80 per-hour. I work through this link Click Here

    2. Soon to be scanned by the NSA to protect us from terrorists.

      Who knows what sort of patterns might be detectable from doctor’s visits?

      1. Exactly – you never know. That’s also why the NSA should be able to peer into people’s bedrooms (assuming they yet do that). Islamic fundamentalists (and those even more dangerous Christian ones too) are supposed to adhere to different sexual practices, such as keeping away from a woman who is menstruating lest they too become spiritually tainted. So, you see, the government must be able to snoop into our sex lives. It’s important to protect us all from the threat of terrorism, not to mention keeping those government employees engaged and interested in their jobs!

      2. Of course, this might work in your favor: have a wild and fun sex life and as a bonus get categorized as “not a religious fundamentalist” in the database. Seems win-win to me.

        1. Caroline. I agree that Sylvia`s comment is incredible… on saturday I bought a new Honda from having earned $4452 this past 5 weeks and-also, $10 thousand lass month. this is certainly the easiest work I have ever had. I started this 3 months ago and pretty much immediately started making over $79 per/hr. I follow the details here, kep2.com

      3. That’s how they got Junior Soprano!

    3. If Julia could get the pill without seeing a doctor, how would she get reimbursed for her free Obamacare contraceptives?

  2. Why I should be able to buy Roxies and Adderall without seeing a doctor.

    1. If I was calling the shots you’d be allowed to be your own doctor. Of course, all the responsibility for doing such would have to fall on the self-doctoring doctor’s shoulders. No problem for most of us.

  3. How many other libertarians think( as I do) that as free people we should be able to legally buy any drug without a scrip? Be it aspirin, The pill, coke, MJ , or antibiotics. If you are concerned about the drugs’ effects then by all means see a doc. But there are many instances where I already knew what was wrong with me and knew why to get without having to pay a doctor 80 bucks for him to look at me for 2 minutes and write me a scrip. An example of this would be the antibiotic drops for pinkeye.

    1. I generally agree with you with one exception. Overuse of antibiotics leads to reduced effectiveness for all patients. For this reason alone, antibiotics should be controlled. Everything else, however, should be free to obtain with the manufacturer’s consent.

      1. Couldn’t this be handled in the free market as well, though? By manufacturer’s not wanting their products to lose efficacy or trusted pharmacies earning some 3rd party seal of approval, and so on.

        1. Possibly. But I don’t see how you handle the problem of overused generics in this case. It seems to me to be a tragedy of the commons problem.

        2. It’s not about product efficacy. It’s the nature of infection. If you do not take the antibiotics as directed for the proper amount of time, the weakened bacteria are killed off leaving the strongest to survive and multiply, creating strains of antibiotic resistant bacteria. Also, though broad spectrum antibiotics are widely used, it’s much better to take one that specifically targets the infection you have, if possible, rather than killing off a large portion of the good bacterium along with the infectious kind. A large part of your immune system is the beneficial flora in your gut. Overuse of broad spectrum antibiotics can kill this off causing a temporarily weakened immune system (plus diarrhea).

          Not to mention the fact that many people mistake viruses for bacterial infections.

          1. One cool new thing that is coming to fight our bacterial scourge – phage therapy. It is exceptionally specifically targeted, sometimes only affecting one strain of a bacterial species. Really cool.

            Unfortunately our regulatory apparatus is totally unprepared to handle this new form of therapy. A lot of changes will be required before we will be able to enjoy the benefits of this cool technology. From what I’ve heard the first phage therapy to make it to market here will likely be an anti-acne treatment.

            Countries like Russia and India are likely to have it for things like MRSA long before we do.

            1. It’s not exactly new anymore, but 3M developed a textured surface modeled after shark skin that inhibits bacterial growth. They’re using it on joint replacements now. You can even purchase strips of it to put on surfaces. It’s been found to be remarkably effective. Hopefully will one day be in widespread use in hospitals. Loved the phage therapy- I hadn’t heard of that one.

        3. When I was living in Puerto Rico, you could buy most antibiotics at Walgreens or any other drugstore, you just asked the pharmacist. Kind of like they do allergy medicines now. I’m presuming they do the same in Mexico.

          I never saw lots of Puerto Ricans dropping in the streets from new strains of bacteria. They pretty much figure it out that you only take it for infections, not colds or allergies, etc.

      2. Then wouldn’t antibiotic manufacturers have a strong incentive to maintain their products’ effectiveness by restricting distribution of certain drugs?

        No government necessary.

        1. Amoxicillin is in the public domain and is widely available as a generic. Isn’t in the public interest to keep it working as long as possible?

          1. Free enterprise is always superior to control regimes guided and spearheaded by gatekeepers.

            Always.

            1. Not necessarily. I don’t have the background to write the treatise, but my reading in history has given me the strong impression that there is a repeating pattern of networks supplying greater benefit for society as a whole than individual customers are willing to pay for. The history of railroads and rural electrification are two examples.

              I agree that IN GENERAL a free market works better than top-down control. But getting dogmatic about it is likely to blindside you when exceptions rear their ugly heads. The flap over inoculations and autism is a case in point. A doctor, acting on his own free market interest, falsified evidence against immunization and scared a bunch of people into not getting their kids immunized. That weakens herd immunity, putting the whole community at risk. The doctor was fought by a regulatory agency, not a professional organization (which in a free market he wouldn’t HAVE to belong to).

              Government is like fire; you have to watch it every goddamned minute, but life without it, while possible, would be a good deal harder for most of us.

              1. Cost analysis seems conspicuously missing. The argument seems to be, if government does X and X is good, then government is being good. That only applies in judging the action X, but not the institution as a whole. How much did X end up costing?

                markets advocates claim efficiency, not everyone getting everything they want, and a system can be incredibly inefficient while still producing some good effect.

                You could decide to rent a limo every day to take you to work. You’d enjoy a better and safer ride. I wouldn’t argue that it’s the most efficient use of your resources, much less a government forcing you to go to work that way.

          2. The problem with invoking government to solve the tragedy of the commons is that, in a democracy, the government itself is a common. This implies that it results in tragedy.

      3. Overuse is part of the reason effectiveness can be diminished. The other, more common problem, is once people start feeling better they stop taking the antibiotics before they’ve finished the full treatment, allowing pathogens to develop resistance.

        1. I think that is a bit overrated. People almost never follow their regimens correctly and antibiotics are still largely effective. That is because most antibiotics don’t work by actually killing the germs. They work by preventing the germs from reproducing thus allowing your body’s immune system to kill them off or for the germs to die off on their own as their life cycle ends without them reproducing. The life cycle of most germs is around 72 hours. So really, you only need to have your serum levels high for 72 straight hours for most illnesses. They give people longer cycles out of an abundance of precaution and that they know that most people will forget to take their pills. If you tell someone to take the stuff for seven days, there is a pretty good chance they will remember three days in a row and kill off the sickness.

          1. The market has already figured out the solution to the regimen issue for some ailments. There are antibiotics that you only take for 3 days & the “half life” takes care of the rest.

        2. This is why it Is the pharmacists job to inform the consumer if how to use their medication. No doctor needed.

      4. I generally agree with you with one exception.

        This is how liberty dies. Everyone always has that one exception; for the good of all of course.

        1. You know who else generally agreed with you ….

          1. You know who else generally agreed with you ….

            SIV?

            SIV| 6.17.13 @ 7:57AM |#

            Then wouldn’t antibiotic manufacturers have a strong incentive to maintain their products’ effectiveness by restricting distribution of certain drugs?

            No government necessary.

        2. It’s like vaccination or letting people put cesspools in their yards. In principle, yes, free markets and torts could address these problems; you could sue your neighbor for negligently crapping in your water, or not getting a very cheap vaccination, and leave the government out of it except for enforcing the tort.

          In practice this would be locking the barn after the horse had been stolen, not to mention you would have a hard time proving that your neighbor was responsible, if he was not the only one.

          Misuse of antibiotics by one person won’t have public health consequences. Misuse of it by large numbers of people will, and that’s when you can’t figure out who to sue.

          1. Actually, litigation controls a lot of people before the fact, not after the horse has been stolen, so to speak. People frequently avoid behavior that puts others at risk solely due to potential consequences in litigation. In fact, since there is great leeway in who you can sue, while regulations have to be explicitly written by a legislature with limited resources, litigation is much more comprehensive, and effects more decisions.

      5. How does waiting in the doctor’s office and paying him $80 prevent overuse of antibiotics?

        All he is going to do is give you the same 10 second admonition to take the entire course.

        Maybe there should be *some* sort of restriction, but it doesn’t need to require you to pay $80 for a useless doctors visit ot tell you something you already know.

      6. We have a massive problem of antibiotics resistance due to overuse at clinics and as part of animal feed. Those should be restricted, but they are not.

        I doubt individual abuse is much of a contributing factor to resistance: most antibiotics are expensive and have unpleasant side effects. Anybody who really wants to abuse them gets them cheaper by badgering their doctor into prescribing them than if they had to pay for it on the free market.

    2. Antibiotics seem to be getting less effective even with them requiring a doctor’s approval. Here is the thing about antibiotics, they don’t get you high and often make you feel ill. I think concerns of people over using them are greatly exaggerated.

      1. Your assessment seems spot on. And also, the problem with antibiotics becoming resistant also has more to do with the users ceasing taking them before the treatment is finished. What can be done about that? Only prescribe antibiotics with a guard who will make certain the patient completes using the prescription fully?

        1. I think it also has to do with the nature of antibiotics. Germs are very adaptive things. There is a physical limit to how powerful antibiotics can be. Even if every antibiotic were used perfectly, we still would eventually run into resistance.

          I think, hope, that in the next few decades medicine will move into the post anti-biotic era and into true designer drugs that are made just for you and act like your immune system.

          1. “…medicine will move into the post anti-biotic era and into true designer drugs that are made just for you and act like your immune system.”

            That certainly appears to the direction pharmaceutical developers would like to go. Hard to know at this point just how much of a hindrance to that goal the socialization of medicine in the U.S. will ultimately be, though.

            1. ^^^^^This!

          2. Let’s just hope superbugs don’t kill us all before that happens.

            Or (formerly) routine surgery. The costs of minor surgery would go way up if antibiotics don’t work anymore-you’d had to have OR conditions for just about everything.

            1. Yes. That is a really good point. A lot of stuff is now “outpatient” because they can just put the patient on a round of antibiotics to eliminate any risk of infection. If antibiotics didn’t exist or were no longer effective, they couldn’t do that.

        2. Antibiotics resistance probably mostly has to do with their use in animal feeds for healthy animals and misuse in hospitals, where sick patients with weak immune systems frequently get infected by mistake and become breeding grounds for resistant bacteria.

          In most normal infections, antibiotic resistance is rare, since the antibiotic only needs to kill off some of the bacteria before the immune system takes care of the rest.

      2. I don’t know about that. It seems like the entire generation of baby boomers are still under the impression that the cure-all for everything is a course of antibiotics. My MIL is constantly berating me for not taking kids to the doc immediately when they are running a fever.

        That said, docs these days are doing less and less. Recent pediatric data shows that Tylenol is ineffective for infants because its metabolized in the liver and their livers are not fully mature. Which is bullshit as anyone with a teething or feverish infant can attest. Now they are saying antibiotics shouldn’t be prescribed for ear infections. Supposedly it’s better to just let the infection run its course and let the eardrum perforate. It certainly doesn’t inspire me to bring the kids in when I’m going to get fleeced for a copay and sent home without treatment.

        1. I don’t know why Tylenol is the first choice for fever and pain anyway. Aspirin is more effective, and also takes care of inflammation. Plus it doesn’t affect the liver like Tylenol.

          When I had an appendectomy, they gave me an unlimited morphine drip in the hospital, but would only give me two Tylenol in any 24 hour period. They hate lawsuits.

          1. For kids, there’s the danger of Reyes Syndrome when fever is present, but you’re absolutely right about Tylenol being hard on the liver and the stomach lining too. When someone ODs on Tylenol, it gets ugly really fast.

    3. Right on, Locke! Your suggestion is one of the approximately 30 things that need undoing so that we can have cheaper medical care and medicine.

  4. antibiotic drops for pinkeye

    Racist!!

    1. Is Albino a race?

  5. What you may not know is that every day, people in the United States go across the border to Mexico for the same reason. They aren’t looking for jobs. They’re looking for birth control pills.

    Given the US Government’s previous actions, I’m assuming the solution to this is to ever-so-politely ask Mexico if it wouldn’t be in their best interest to start requiring a prescription or maybe don’t sell to dirty foreigners.

    1. When it comes liberty and prescription medications, Mexico is a great model for the USA.

  6. Some Docs have moral issues with handing out the morning after pill. Making it OTC places the responsibility where it belongs.

  7. Why Women Should Be Able to Buy Birth Control Without Seeing a Doctor

    Becaue unfuck you, that’s why.

  8. Chapman has a Libertarian bone in his pinky toe? Women and birth control are the only areas where adults should have the Liberty to make their own decisions?

    How in the fuck is this terrible writer a “libertarian”? There are conservatives over at National Review who are more libertarian than Chapman, especially on this issue, plus he just plain sucks.

    Who does he blackmail to get his articles posted here? It is simply unpossible for it to be a result of the quality of his work.

    1. Who does he blackmail to get his articles posted here?

      Same guy Chip Bok and Henry Payne blackmail. Or bribe.

      1. For all we know, Chip Bok and Henry Payne could be passable writers. Sure, we know they’re terrible cartoonists, but I don’t think we know anything about their writing skills.

        1. Payne is passable

          1. He writes, too. Learn something new everyday.

      2. Too bad the Friday Funnies can’t be a daily thing. Man can not live on Gilligan’s Island and the Beverly Hillbillies alone.

    2. Who does he blackmail to get his articles posted here?

      Whom. And you accuse other people of being crappy writers. :-p

      1. Ah, but crappy writing and crappy grammar are not the same thing!

        Also, while critiquing my grammar you began a sentence with the word “and”. Joez Law?

        1. There is no rule in English that says you can not begin a sentence with a conjunction. See also split infinitives and ending a sentence with a preposition. Most of these are hold overs from when scholars thought it would be a good idea to use Latin grammar with English. /grammarnazi 🙂

  9. Now that I’ve clicked on this article with “Birth Control” in the title, the new pages I’m opening have Tampax ads on them. Google Chrome is watching.

    1. I’m getting ads about entering Canada with a DUI. So birth control is like drunk driving?

      1. iPad. No ads. The downside is I can’t post links either.

  10. If you made all drugs over the counter, trained pharmacists could do a whole lot of work that people are currently paying PAs and doctors to do. Right now at least I doubt people will ever agree to make everything over the counter. But a possible compromise would be to let pharmacists issue the stuff out. That way people could go to the pharmacy for minor illnesses and avoid the cost of going to a doctor. A degree in pharmacy is pretty serious training. I think letting pharmacists give out drugs would go a long ways to getting where we need to be, save a lot of money, and avoid the harms the opponents of otc drugs worry about.

    1. How many doctors could we replace with pharmacists and nurses at 1/4 the price? A lot of them.

    2. I’d be all for it.

    3. Exactly. My friend is a pharmacist, had pretty intense training, but is now just a scrip filler. Let these people make recommendations on what to take.

  11. How do doctor’s know which birth control to prescribe? Is it based upon the pharmaceutical companies? Is it trial-and-error? Am I ignorant to believe that a woman can choose her own birth control just as well as the doctor?

    1. There can be conflicts with other medication a woman takes (resulting in a pill that is not preventing pregnancy), and different pills have different side effects, or even other beneficial effects.

      In a typical scenario, that should be a 5-10 minutes visit to the doctor before the first prescription, albeit in some cases a follow up check to confirm the pill is working might be necessary. After that, no doctor is necessary anymore.

      1. a follow up check to confirm the pill is working

        That’s what pregnancy tests are for.

  12. Don’t forget the invasive sex questionare their give you when you get an annual exam.

    Have you ever had anal sex? Do you use protection? How many men have you slept with in the last year, you slut?

    Remember the first season of Mad Men, where when she goes to the doctor to get her exam so she can get birth control (too late, apparently), the doctor gives her a lecture on how she shouldn’t be a big slut. They’re basically still doing that, only it comes in the form of a purity test.

    1. And now they ask if you own a gun too….because we all know how firearms are connected to gynecological health.

  13. It’s like vaccination or letting people put cesspools in their yards. In principle, yes, free markets and torts could address these problems; you could sue your neighbor for negligently crapping in your water, or not getting a very cheap vaccination, and leave the government out of it except for enforcing the tort.

    In practice this would be locking the barn after the horse had been stolen, not to mention you would have a hard time proving that your neighbor was responsible, if he was not the only one.

    Misuse of antibiotics by one person won’t have public health consequences. Misuse of it by large numbers of people will, and that’s when you can’t figure out who to sue.

  14. Has anyone, as an aside, ever been on these Reason cruise junkets to the Caribbean? Reviews to provide?

  15. If doctor’s made the best choice of birth control, we wouldn’t see so many birth control advertisements trying to sway women to use a particular product. Let the women decide!

  16. Say what Stevie?

    Birth control drugs can have very serious side effects – they are not aspirin. It’s actually sensible for a doctor to discuss the different options available to you. If you’re morbidly obese and diabetic there are probably some pills you really should steer well away. Once you have some idea wtf you’re doing then by all means waltz over to Juarez and pick up your shizzle from Jose.

    1. How do doctors prescribe birth control? Do they try one and if there are side affects, they try another? If so, can’t women do the same thing without a doctor’s intervention?

      What methods/procedures do doctor’s use to prescribe birth control?

      1. Some docs get kickbacks for prescribing certain brands. I have worked everything from dialysis to cardiology. The drug reps come in, buy everyone in the office lunch, tell the docs all about how their brand is different than the competition and give them free samples to hand out to patients.

        Sometimes offices get compensation for every prescription they write (though I don not know the logistics of this, I didn’t work admin), just as often, the doc prescribes that brand because its fresh on his mind. Every now and then a doc legitimately thinks a certain brand is best and prescribes it.

  17. That said, the current situation where literally everything effective requires a prescription is ludicrous. But what’s really fun is trying to buy Sudafed now. You’re basically treated like a crook, have to sign some BS federal threats, and show photo ID. This has done precisely F-all to stop the meth problem of course.

  18. I need a Vets prescription for my dogs ear drops and heart worm pills…It’s a racket people.

  19. “MacKlingon| 6.17.13 @ 11:44AM |#

    I need a Vets prescription for my dogs ear drops and heart worm pills…It’s a racket people.”

    Nah, you can use petmeds.com if you really want to but their Heartguard tabs are usually near end of use date and they allegedly don’t store a lot of stuff in a climate controlled environment.

    Find a new vet – mine matches their prices and makes a profit of about 2 cents probably.

  20. And btw, if you give a dog Heartguard and it has a heartworm infestation already – you’ll kill that dog as surely as putting a bullet in its brain.

    Happens all the time.

  21. But the U.S. government presumes that women are incapable of making this decision without the approval of a doctor

    They are. If I’m incapable of buying cold medicine without an ID and getting my name on a government list, they can’t buy an abortion pill.

    You see how this total state thing works?

  22. “The FDA typically waits for a pharmaceutical manufacturer to ask for reclassification before it considers action. So far, none has.”

    This is bullshit. Does anyone really expect the drug companies to ask for reclassification when they can continue charging inflated prices? Why can’t the FDA simply make the change? Wait, let me guess, the drug companies “lobby” (aka bribe, pay off, etc.) the politicians who strongarm the FDA to keep the status quo. Is any part of government not corrupt?

  23. Women yes; girls no.

  24. I’ve been trying to tell pro-life people that if we really want fewer abortions, then we should help as many women as we can to avoid the choice in the first place. I would even argue for subsidizing contraception, as an investment towards a healthier future tax base, because it would be way cheaper than new prisons and welfare payments. We don’t really want more poor people, do we?

    1. “I would even argue for subsidizing contraception”

      We do through Planned Parenthood.

      Why any Libertarian thinks tax money should be used to subsidize someones sex life is beyond me. Next you’ll be saying we should invest in solar panel companies like Solyndra.

      1. My participation here doesn’t make me hardcore big-L Libertarian. You can call my idea “subsidizing someone’s sex life” if you want, but I’d much rather do that than help grow an already out-of-control prison industrial complex, to say nothing of myriad health issues that arise when we leave people entirely to their own devices. Some people are just too damn stupid to choose their partners, and you know it.

  25. I applaud the article, but what’s the big deal about birth control? Why should we need a prescription from a Doctor to buy ANYTHING. As libertarians(?) Reason writers should understand that in a free society there is no need to get a permission slip from someone in order to buy a product. We don’t require a doctor’s prescription before we engage in sex or extreme exercise do we? How about before we go drinking at the local bar? Why don’t we need a prescription for that?

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