On April 5 of this year, Judge Edward Korman (U.S. district Judge in New York), ordered the FDA to make the Plan B One Step pill (AKA the “morning after pill”) available to all women (actually, men can buy it too) of any age without a prescription. This ruling opened a political can of worms, unlike any I can remember in recent FDA history. It has sparked sharp controversy, igniting debate that crosses into areas of medicine, politics and ethics alike. Just to be clear – while appealing this court decision, the FDA has already widened access to Plan B One Step by allowing sales without a prescription (previously restricted to individuals 17 years and older – and only through a pharmacist) to anyone age 15 and older with proper ID. This move, claimed to be independent of the April 5 ruling, was announced publicly on April 30th. You can read the FDA press release HERE.
As a pharmacist, a blogger and a Christian (have I laid all my cards on the table?) I cannot help but respond and speak out about an issue that affects so many realms in which I am called upon to interact, investigate and inform. This is a big issue and a blog post can never really manage to cover a topic as completely as you would like. One has to pick a few (at best) key points to try and offer a perspective for readers to consider. I’m not interested in a mud-slinging debate, though I invite comments and counter-points. My contention in this post is that we need, as a society, a Plan C. Allow me to explain.
First off, allow me to explain what Plan B is. This alone has caused no small amount of confusion, being sometimes erroneously referred to as the “abortion pill” and other times confused with another product formerly known as RU-486 (mifepristone). Plan B is a progesterone-containing pill (levonorgestrel to be exact) and is marketed as a contraceptive (to prevent pregnancy). Actually, there are 2 different “Plan B” products. The first was Teva’s original version (just called “Plan B”) and involved taking 1 tablet within 72 hours of intercourse, followed by a second tablet 12 hours later. This product is, and has always been, only available by prescription. Plan B One Step is a 1 pill version (it has double the dose) and (like the first dose of the original product) needs to be taken within 72 hours. This version required a prescription for anyone younger than 17 (see above for that discussion) but could be purchased through a pharmacy without a prescription for those 17 years and older.
Levonorgestrel prevents pregnancy primarily by inhibiting the release of an egg (ovulation) from the female ovary. No egg – no pregnancy. It may also work by preventing the sperm from reaching the egg (fertilization) by inducing changes within the uterus. Finally, it has been suggested (though never proven) that levonorgestrel could also prevent the fertilized egg from attaching to the wall of the uterus (implantation). This final point is important for many people. Many drugs, including all oral contraceptives, could “theoretically” interfere with the implantation of a fertilized egg. But in reality, study after study has shown that Plan B in fact cannot and does not prevent implantation. It works, for all intents and purposes, only by preventing the release of the egg from the ovaries. Much of the confusion about how Plan B works is related to a misconception (pardon the pun) about when pregnancy happens. Some parents joke about knowing the “night” when “little Johnny” was conceived. Actually, we don’t know that. Scientifically little Johnny may have been actually conceived several days later (those little sperm have – relatively speaking – a long way to travel).
No issue of this magnitude is simply a “medical” matter. Politicians seeking (I suppose) to justify their own importance make this an issue of government, law and politics. I like discussing issues, but don’t like politics per se. Call me a pessimist, but I tend to agree with Henry Kissinger who said that “90 percent of politicians give the other 10 percent a bad name.” Suffice it to say that the more conservative party (to which I belong) historically lean away from any topic that even appears to be connected with abortion. I’m pro-life (and will gladly tell you why), but based upon the above discussion I hope you can see that much of the political maneuvering on this issue is unwarranted with respect to Plan B. Nevertheless, in politics “perception” is often more important than reality. And so the parties will find a way to make this a platform issue if they can.
I propose a plan C. Well, maybe it is technically more of a dream than a plan. That’s fine. Call me a dreamer. Personally I prefer to dream of better days than wallow in the mire of the status quo. Some folks have to be dreamers in every age. On this issue, I’m proud to be one of them. Plan C stands for Culture, Communication and Character.
Plan C says we need a new Culture. Folks, we need a culture that no longer pressures our kids to become sexually active the moment the first hormone wakes up in their body. This starts at home, by teaching our children about the family and its central place in every successful culture in history (and no, I’m not blaming parents for the choices that children make). Our society pays a lot of attention to what goes in our mouth – and seeks to encourage healthy eating habits for all ages. This is great. But we need to pay even closer attention to what goes in our eyes and in our ears. Parents (and I confess I have often failed here myself), lets be careful in our selection of entertainment and media. All these things contribute to the culture of sexual activity we live in, and when our kids become sexually involved.
Plan C says we need Communication. The availability of Plan B to individuals of any age without parental involvement suggests a situation in which communication has already broken down. This needs to change. I fear (and I point the finger at myself as much as anyone) that our homes are wired for every type of communication – except for the old fashioned communication of talking with one another. Some may argue that by the time Plan B is needed, the communication opportunity has already been lost. But I don’t think so. It may, in fact, be just the time for a new pattern of communication to begin.
And Plan C says we need to focus on Character. As a Christian, the character I aim for (though fall far short of for sure) flows from the Bible and the pattern of Christ. Character teaches our kids to respect themselves and others. Character means that it is okay to swim against the direction of the stream. Character means it is okay to wait to become sexually active, even if it seems like you are the only one who still believes that. I’m not saying you have to embrace the principles of character that I do. But in my dream (and this is still MY dream, right?) we have a nation of folks whose character makes the need for Plan B quite rare.
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Last modified: October 30, 2014