Ok, this is getting ridiculous

[cloudy]

This country is getting scarier and scarier every damn second....

THE WAR OVER OUR GENITALS

NEW YORK-After a 20-year-old Tucson woman is raped, she wastes three days searching for a pharmacy that stocks the "morning after" pill, each day of her search reducing the chances of the drug working. "When she finally did find a pharmacy with it," reports the Arizona Daily Star, "she said she was told the pharmacist on duty would not dispense it because of religious and moral objections."

In Fort Worth, a CVS pharmacist tells Julee Lacey, 33, that she does not "believe in birth control" and will have to get her refill elsewhere. A San Diego County fertility clinic turns down a lesbian couple's request for artificial insemination not, the doctors say, because of their sexual orientation, but because they're not married. But gay marriage is illegal in California.

The American Pharmacists Association allows its members to refuse to fill prescriptions on moral grounds, as long as they refer their customers to a more open-minded colleague. But thirteen states have proposed or passed laws that would eliminate the referral requirement, and the trend is accelerating. Last year the Michigan State House of Representatives overwhelmingly passed the "Conscientious Objector Policy Act," a statute that would allow doctors, emergency service technicians and pharmacists to refuse to treat patients or fill prescriptions on moral, ethnical and religious grounds.

"The explosion in the number of legislative initiatives and the number of individuals who are just saying, 'We're not going to fill that prescription for you because we don't believe in it' is astonishing," says Gloria Feldt, president of the Planned Parenthood Federation of America.

When a soldier refuses an order to shoot someone, it's virtually impossible to obtain "conscientious objector" status. A soldier who refuses to kill faces a court martial and possible prison sentence. But when a pharmacist refuses to dispense a drug that would prevent a woman from becoming pregnant with her rapist's child, he's merely "following his principles"--and enjoys the support of his state legislature.

Luke Vander Bleek, an Illinois pharmacist who says his Catholic faith led him to fight an Illinois rule that requires him to fill all prescriptions, including those for birth control, says: "I've always stopped short of dispensing any sort of product that I think endangers human life or puts the human embryo at risk."

But Illinois Governor Rod Blagojevich takes the side of patients: "It's not the job of a drugstore or a pharmacist or someone who works in a drugstore to make those decisions or to pick and choose who gets birth control and who doesn't."

How can society reconcile these two competing, yet equally compelling interests? Surely a medical professional should not be forced to perform procedures or dole out drugs that violate his or her personal beliefs. I consider optional cosmetic surgery--face lifts, tummy tucks, boob jobs--degrading and obscene, symptoms of a shallow society's contempt for natural beauty and aging. If I were a doctor, I would refuse to perform these operations or refer patients to a physician that did. On the other hand, people should be able to walk into a fertility clinic with the reasonable expectation of getting help to conceive a baby--whether they're straight, gay, single or married.

Truthful advertising may prove more effective, and certainly more ethically sound, than a sweeping ban on discretion among healthcare professionals. For example, the Target store in Fenton, Missouri that refuses to fill birth control prescriptions--"I won't fill it, it's my right not to fill it," Target's pharmacist told a 26-year-old woman--should be forced to post a large back-lit sign outside its store to save would-be birth controllers the trouble of looking for parking. "No birth control," the sign could read, or perhaps "sluts stay away!" Similarly the St. Louis-area Walgreens that recently suspended its pharmacist-refuseniks for violating Illinois' don't ask, must fill rule could post the chain's support of reproductive rights out front.

Even if Americans embrace my proposal to publicize stores' and physicians' moral scruples for their convenience, the red-blue divide will remain the biggest obstacle to peace in the ongoing war over Americans' genitals. The rape victim who spent three days tracking down the "morning after" pill in Tucson, after all, would have had no trouble at all had she had the good fortune to live in Los Angeles.

 

[zeb1094]

I guess there now will be a black market for the morning after pill, etc., etc. and then the Imperial Federal Government will add that to the war on drugs and such.

 

[LadyJeanne]

Do pharmacists have the right to refuse to dispense birth control pills prescribed for irregular bleeding and pain? Are they allowed to question women?

I hope this becomes more widely known. I didn't know pharmacists were doing this. I would definitely take my business elsewhere if my pharmacy didn't fully serve women's needs.

 

[R. Richard]

Cloudy: you post:
After a 20-year-old Tucson woman is raped, she wastes three days searching for a pharmacy that stocks the "morning after" pill, each day of her search reducing the chances of the drug working. "When she finally did find a pharmacy with it," reports the Arizona Daily Star, "she said she was told the pharmacist on duty would not dispense it because of religious and moral objections."

OK, Tucson is maybe 50 to 60 miles from Nogales, Mexico. She gets in her car and drives to Nogales, where she can get any medication she wants (NOT heroin, cocaine, etc.) for a cheaper price than Tucson. I am assuming that she has a car/friend with a car.

JMHO.

 

[yui]

Do pharmacists have the right to refuse to dispense birth control pills prescribed for irregular bleeding and pain? Are they allowed to question women?

I hope this becomes more widely known. I didn't know pharmacists were doing this. I would definitely take my business elsewhere if my pharmacy didn't fully serve women's needs.

"In an outrageous move to stop women from preventing unintended pregnancies, some pharmacists across the country have refused to fill prescriptions for emergency contraception and other birth control pills. The reason? It is in conflict with their personal, moral beliefs. However, birth control is basic health care and restricting access to prescribed drugs is nothing short of discrimination. Don't let ideology trump sound science — join our Fill My Pills Now campaign today and urge corporate pharmacy chains to adopt a pro-women’s health policy that will fill prescriptions on site, without discrimination or delay."

Link

"But Target still refuses to support a policy mandating that valid prescriptions for birth control, including emergency contraception, be filled in-store -- without discrimination or delay!"

OK, Tucson is maybe 50 to 60 miles from Nogales, Mexico. She gets in her car and drives to Nogales, where she can get any medication she wants (NOT heroin, cocaine, etc.) for a cheaper price than Tucson. I am assuming that she has a car/friend with a car.

JMHO.

But she shouldn't have to, Richard, eh? And this not a single incident, it's happening all over the place.

 

[cantdog]

I love the idea of a sign.

REAL PHARMACY
We fill prescriptions.

or

We Know Better
(Have You Found Jesus?)

 

[R. Richard]

But she shouldn't have to, Richard, eh? And this not a single incident, it's happening all over the place.

Yui:
I have always thought that medication is a matter solely between patient and physician. Unless there is evidence that the medication is being misused [e.g. a 100 year supply of Oxycontin,] a prescription should be filled by any pharmacist without question.

JMHO.

 

[Rumple Foreskin]

The issue here is bigger than the reported event. And it's fine if folks want to discuss whether one person's right to obtain a particular medication at an authorized dispensing site outweighs another person's right not to dispense something they feel immoral.

HOWEVER.

This story smells. For starters, there's no attribution. There's no way to check on circumstances surrounded the event or whether the event even occured.

As R Richard pointed out, Nogales isn't that far away. There is also a branch of Planned Parenthood in Tuscon.

But Yui is right is saying that begs the bigger issue, the one I mentioned earlier. Still, for this old skeptic, those facts do raise a big question concerning the story's authenticity.

You may now return to your debate.

Rumple Foreskin

 

[yui]

Yui:
I have always thought that medication is a matter solely between patient and physician. Unless there is evidence that the medication is being misused [e.g. a 100 year supply of Oxycontin,] a prescription should be filled by any pharmacist without question.

JMHO.

Agreed, Richard, but that is not the case. They're getting around it based on “Refusal Clauses”:

Four States (Arkansas, Georgia, Mississippi, and South Dakota) have passed laws allowing a pharmacist to refuse to dispense emergency contraception drugs. Illinois passed an emergency rule that requires a pharmacist to dispense FDA approved contraception.

Thirteen States (Arizona, Arkansas, California, Georgia, Indiana, North Carolina, Rhode Island, South Dakota, Tennessee, Texas, Vermont, West Virginia and Wisconsin) have introduced legislation that would allow a pharmacist to refuse to provide services.

Edited to add: Pharmacist Conscience Clauses: Laws and Legislation

This is very serious, very scary stuff that people need to be aware of.

 

[Pure]

i think the basics of the story are true. it's parallel with some gynecologists and some hospitals refusing to do abortions.

given that the 'morality' folks are trying a number of approaches (don't tell teens about condoms, at school; don't allow easy access to abortion; they must notify the parents, etc.), finding and encouraging 'conscientious objector' pharmacists and passing laws protecting their 'conscience' does not sound far fetched. 'morality' is furthered in a multipronged approach, e.g., some sources telling that the HIV virus passes through condoms, etc.

----
PS It occurs to me that in this case, the forces of righteousness may not prevail, except in remote areas. a pharmacist does not need to be told the reason for a prescription. SO if there are sympathetic drs. in town X, and a bunch of 'conscientious' pharmacists, the dr simply writes a prescription for one month's pills. the 'morning after' pills are not any different. so the woman takes the four or six she needs, and tosses the rest-- or passes them to a friend. she's out some extra bucks, but it's cheaper than a trip to Nogales. as cloudy says, though, the scenario is outrageous, and i hope US citizens will be pleased with their theocracy.

Perhaps pharmacists who sell condoms, should ask for names, marriage licences and home phone numbers.
AND be permitted to keep wives informed of any condom sales to husbands: The point being to insure he's not using them for adultery.

 

[LadyJeanne]

"In an outrageous move to stop women from preventing unintended pregnancies, some pharmacists across the country have refused to fill prescriptions for emergency contraception and other birth control pills. The reason? It is in conflict with their personal, moral beliefs. However, birth control is basic health care and restricting access to prescribed drugs is nothing short of discrimination. Don't let ideology trump sound science — join our Fill My Pills Now campaign today and urge corporate pharmacy chains to adopt a pro-women’s health policy that will fill prescriptions on site, without discrimination or delay."

Link

"But Target still refuses to support a policy mandating that valid prescriptions for birth control, including emergency contraception, be filled in-store -- without discrimination or delay!"


But she shouldn't have to, Richard, eh? And this not a single incident, it's happening all over the place.

Thank you, Yui!

 

[blondi84]

Our country is so fucked up, let me out!

 

[Pure]

For Rumple and others

Here are a couple refs that seem reasonably objective, and in fact the first does accuse the 'pro choice' folks of overblowing the issue, and possibly manufacturing examples.
--------

http://www.slate.com/id/2117374/

slate magazine article "False pregnancy; who really wants to debate the morning after pill?" stating that the 'choice' folks have overblown the issue and emphasizing how few 'pharmacists for life' there are (1600, world wide). the author, Saletan, opines that it's a lousy issue for pro life forces, and that several 'pro life' websites don't have anything on that issue that's recent. otoh, towards the end of the article some of the basic facts are affirmed, including some states' efforts to protect pharmacists with 'moral scruples'.

A well known legal website

http://writ.news.findlaw.com/colb/20051102.html

has an article by Kolb, "Pharmacists choice and the morning after pill," affirming the reality of the legislation and the problem.

 

[Colleen Thomas]

If my Pharmacist ever refuses to fill my perscrition I'll just take my business elsewhere. I'll also take the valve stems from his/her car, on the grounds my morals say such an asshole should have to walk.

 

[Blackie Malone]

If my Pharmacist ever refuses to fill my perscrition I'll just take my business elsewhere. I'll also take the valve stems from his/her car, on the grounds my morals say such an asshole should have to walk.

I can picture that.

 

[cantdog]

I agree, actually. Beneath my facetiousness, I think the signage a very clever resolution of the difficulty.

Some places should indeed be TheoCon Pharmacies. It is not such a crime to wish to draw moral lines. Medicine is not a moral vacuum by its nature, any more than any other endeavor. But if you want a fuckin condom, you'd appreciate a sign on the door to keep you from wasting your time. Same with a morning-after pill, or a wirehead harness, when they become available. People who have a moral objection to these things, however few they may be, shouldn't have to throw away their hard-won credential and leave pharmacy for burger-flipping. Neither should a woman have to canvass the moral temperature of every pharmacy in Arizona in order to fill a legitimate prescription.

Let the prigs label themselves, right on the damn door.

 

[yui]

----
PS It occurs to me that in this case, the forces of righteousness may not prevail, except in remote areas. a pharmacist does not need to be told the reason for a prescription. SO if there are sympathetic drs. in town X, and a bunch of 'conscientious' pharmacists, the dr simply writes a prescription for one month's pills. the 'morning after' pills are not any different.

That's not an entirely true statement, Pure. Until recently, there have been two types of pre-packaged emergency contraception pills, Plan B and Preven. Plan B is a single pill meant solely to be used as emergency contraception.

Also, as I stated in my posts, and as is reiterated in the links I provided, pharmacists are refusing to fill emergency contraception and plain, simple, everyday contraception prescriptions.

Edited to add: plain, simple, everyday

 

[elsol]

How can society reconcile these two competing, yet equally compelling interests?

Interesting... they legalized Reckless Endangerment.


Sincerely,
ElSol

 

[Pure]

yui, i worked at a planned parenthood clinic for several years, in the 80s.
'morning after pills' were birth control pills, but taken for a short time (a day or so) at a high dose. they worked. I suspect that what you're describing is simply a matter of packaging; that now some companies have produced a package. but i'll bet it's the same contents (with possible adjustments for the last 20 years.

while i am concerned, I agree with Saletan that no evidence is produced about refusal to dispense ordinary birth control pills. of course a few more years of evangelical organizing and supreme ct appointments may alter that.

-----
PS after some web search: in general support of what I said, and supporting your point about (what amounts to) new packaging, I offer these sources, the first from the "Plan B" website:

http://www.go2planb.com/section/about/

What is Plan B?

Plan B is an emergency contraceptive that can be used to prevent pregnancy following unprotected intercourse or a known or suspected contraceptive failure (i.e., a broken condom). To obtain optimal efficacy, the first tablet should be taken as soon as possible within 72 hours of intercourse. The second tablet must be taken 12 hours later.

Is Plan B safe?

When used as directed, Plan B is safe for most women. There have been no serious complications associated with Plan B. Common side effects include nausea, abdominal pain, fatigue, headache, and menstrual changes. Women who are pregnant, have undiagnosed vaginal bleeding, or have an allergy to the product should not use Plan B. Plan B cannot terminate an established pregnancy.

How effective is Plan B?

Taken within 72 hours of unprotected intercourse, Plan B can, when used correctly, reduce the risk of pregnancy by 89 percent after a single act of unprotected sex. Effectiveness declines as the interval between intercourse and the start of treatment increases.

Dosage and administration?

Each Plan B packet includes a single course of treatment and consists of two tablets; each tablet contains 0.75 mg levonorgestrel. The first tablet should be taken orally as soon as possible within 72 hours (three days) of unprotected intercourse. The second tablet must be taken 12 hours later. Plan B is not a substitute for routine methods of birth control. Plan B does not provide protection from HIV (the virus that causes AIDS) and other sexually transmitted infections.
-----------

from a health information website

http://www.infoforhealth.org/pr/a9edsum.shtml

OCs for Emergencies

Combined and progestin-only OCs containing the hormone levonorgestrel can be used for emergency contraception: If the correct dosage is started within 72 hours after unprotected intercourse, it reduces the chances of pregnancy. This has long been known, but only recently has the word spread. Now OC tablets are being packaged as emergency contraceptive pills, and levonorgestrel-only tablets, which are more effective and cause less nausea and vomiting, are being introduced especially for this purpose. While not as effective as regular use of OCs or most other modern methods, emergency contraceptive pills meet a crucial need—another important benefit of one of the world's most widely used family planning methods.

 

[cantdog]

I love the way this thread has wandered.

 

[yui]

yui, i worked at a planned parenthood clinic for several years, in the 80s.
'morning after pills' were birth control pills, but taken for a short time (a day or so) at a high dose. they worked. I suspect that what you're describing is simply a matter of packaging; that now some companies have produced a package. but i'll bet it's the same contents (with possible adjustments for the last 20 years.

while i am concerned, I agree with Saletan that no evidence is produced about refusal to dispense ordinary birth control pills. of course a few more years of evangelical organizing and supreme ct appointments may alter that.

-----
PS after some web search: in general support of what I said, and supporting your point about (what amounts to) new packaging, I offer these sources, the first from the "Plan B" website:

http://www.go2planb.com/section/about/

What is Plan B?

Plan B is an emergency contraceptive that can be used to prevent pregnancy following unprotected intercourse or a known or suspected contraceptive failure (i.e., a broken condom). To obtain optimal efficacy, the first tablet should be taken as soon as possible within 72 hours of intercourse. The second tablet must be taken 12 hours later.

Is Plan B safe?

When used as directed, Plan B is safe for most women. There have been no serious complications associated with Plan B. Common side effects include nausea, abdominal pain, fatigue, headache, and menstrual changes. Women who are pregnant, have undiagnosed vaginal bleeding, or have an allergy to the product should not use Plan B. Plan B cannot terminate an established pregnancy.

How effective is Plan B?

Taken within 72 hours of unprotected intercourse, Plan B can, when used correctly, reduce the risk of pregnancy by 89 percent after a single act of unprotected sex. Effectiveness declines as the interval between intercourse and the start of treatment increases.

Dosage and administration?

Each Plan B packet includes a single course of treatment and consists of two tablets; each tablet contains 0.75 mg levonorgestrel. The first tablet should be taken orally as soon as possible within 72 hours (three days) of unprotected intercourse. The second tablet must be taken 12 hours later. Plan B is not a substitute for routine methods of birth control. Plan B does not provide protection from HIV (the virus that causes AIDS) and other sexually transmitted infections.
-----------

from a health information website

http://www.infoforhealth.org/pr/a9edsum.shtml

OCs for Emergencies

Combined and progestin-only OCs containing the hormone levonorgestrel can be used for emergency contraception: If the correct dosage is started within 72 hours after unprotected intercourse, it reduces the chances of pregnancy. This has long been known, but only recently has the word spread. Now OC tablets are being packaged as emergency contraceptive pills, and levonorgestrel-only tablets, which are more effective and cause less nausea and vomiting, are being introduced especially for this purpose. While not as effective as regular use of OCs or most other modern methods, emergency contraceptive pills meet a crucial need—another important benefit of one of the world's most widely used family planning methods.

Thanks for the info, Pure! I wasn't going to Google for the ingredients, but I did understand that the high dose method of the past often made women sick and that with the newer, single pill ECs that was much less like to occur.

I'm not certain what sort of evidence you are looking for regarding the refusal to dispense ordinary birth control; you are free to agree with whomever you like, but it has already happened in places like Nevada and Washington State. If someone's statement that it happened to them isn't evidence, then what is? Not challenging, just asking.

And people should simply read the wording of the Pharmacist Refusal Clauses; once something becomes law, just because it is not acted upon every time, doesn't mean it can't, or that it won't be.

 

[Lord DragonsWing]

I was going to read the article until I saw the title of War Over the Genitals.
I think I'll just sit here cringing with my legs crossed until the next hike. lmao

 

[Pure]

Hi yui,
This is a better summary, below; in the case of Preven the situation is clearly one of packaging only. And yes packaged Preven did not exist when I was in that field.

I'm not saying no US woman ever got refused birth control pills. I'm saying the evidence (or incidence) is scattered and small scale; we don't have numbers, we have some personal accounts.


http://www.crooksandliars.com/stories/2005/04/18/emergencyContraceptionPlanB.html

Two Pills, Less Nausea
Oral contraceptives fall into two categories: pills containing a mix of progestin and estrogen (combination pills) or those with progestin only (known as mini-pills). Both types of pills effectively block conception when used for regular birth control. For emergency measures, a woman takes more pills than normal to flood the system with excess hormones. Progestin-only tablets have the benefit of minimizing the stomach upset that combination pills can cause when used in emergencies.

But until Plan B® was approved, women wishing to avoid estrogen and its unpleasant side effects had to take 40 progestin-only pills for emergency use. Plan B® contains more progestin than traditional mini-pills, which is why only two pills do the job that previously required 40.

Approximately 33% to 50% of women who take estrogen-progestin pills for emergency use experience nausea, whereas only 23% of women taking Plan B® reported nausea. Vomiting is also a less common side effect with Plan B (6% versus 20% in those taking combination pills).
After taking Plan B®, most women will have a normal period at the expected time, give or take seven days. Heavier than usual bleeding occurs in roughly 12% of users, while around the same percentage of women experience a lighter flow. A few woman notice spotting a few days after use. If a period doesn't start when expected, a pregnancy test should be performed.

Other Emergency Contraceptives
In September of 1998, the first product developed exclusively for emergency contraception became available in the United States. Sold under the brand name Preven, it includes four combination pills (each containing 0.25 mg progestin and 0.05 mg estrogen). Two are taken within 72 hours of unprotected sex followed by the second two-pill dose 12 hours later. Although marketed as "the first and only emergency contraceptive product approved by the FDA," Preven's ingredients and dosing instructions have been known widely for years as the "Yuzpe regimen" a standard emergency contraception protocol used with estrogen-progestin pills.

Using this regimen allows doctors to prescribe taking multiple pills of almost any birth control pill. The exact number depends on the brand of birth control pill. The treatment schedule is usually one dose within 72 hrs after unprotected intercourse and another dose 12 hours later.

-------

 

[Pure]

For cloudy and yui,

here's a side of the issue not mentioned so far; today's paper:

New rules on pill privacy
Dec. 16, 2005. 04:44 AM
ELAINE CAREY
HEALTH REPORTER


New made-in-Ontario guidelines have been issued for pharmacists dispensing the morning-after pill, emphasizing they are not to collect or store sensitive personal information about women's sexual activity except in "rare instances."

Ontario Privacy Commissioner Ann Cavoukian released the guidelines yesterday, a week after she complained, following a report in the Star, about a controversial screening form pharmacists were asking women to fill out before giving them the behind-the-counter drug to prevent pregnancy.

The form asked women for their name, address, phone number, the date and time they last had unprotected sex, and the number of times they had unprotected sex since their last menstrual period and what form of birth control they used. The information was to be stored in the pharmacy computer.

The guidelines emphasize pharmacists should not "collect, use or disclose personal health information if other information will serve the purpose." The only time information should be recorded is if it's requested for insurance purposes or "in those rare instances where it is deemed important for continuity of care of the patient," it says.

Pharmacists should only seek the information they need to clarify if the drug is appropriate "keeping in mind the need to respect the individual's right to remain anonymous and to decline responding to personally sensitive questions."

The emergency contraceptive levonorgestrel or Plan B moved from being a prescription to a behind-the-counter or Schedule 11 drug in April. Pharmacists do not normally collect any personal information when dispensing those drugs.

Cavoukian said in an interview the wording was "the best we could do" because pharmacists are governed by the Ontario College of Pharmacy which sets standards of practice and the privacy commissioner can't override that.

"I can't undo the college's work but I am assured it would be rare that they would need to record this information," she said. Pharmacists "would have to justify to me why they collected that personal information," she said.

Deb Saltmarche, vice-president of policy for the pharmacists' association, said the "continuity of care" issue would only arise if the pharmacist believed the patient may be using this product too frequently."

 

[SEVERUSMAX]

Fascinating. I'm pro-life, but only starting with the 2nd trimester. I have nothing against the birth control or "morning after" pills. Better contraception than abortion.