Posted on 01/06/2004 5:38:39 AM PST by truthandlife
Pharmacists in Australia opposed to selling the "morning-after pill" without a prescription are refusing to do so -- and some say they will also refuse to follow a requirement to refer the customers to other suppliers.
Manufacturers of the morning-after pill -- formally known as the "emergency contraceptive pill" -- say it has a 95 percent success rate in preventing pregnancy if taken within 24 hours of sexual intercourse, and slightly less so if taken within 72 hours.
Although many health bodies have declared it safe, some medical practitioners are concerned about potential health risks, while pro-lifers say it acts as an abortifacient in cases where it prevents implantation of a fertilized egg.
In the U.S., an FDA panel late last year recommended that the morning-after pill be made available over-the-counter. The American medical fraternity will soon be grappling with issues now confronting Australia.
Effective on Jan. 1, the morning-after pill marketed as Postinor-2 is being sold over-the-counter in Australia, following approval last year by a drugs scheduling committee of an application from the manufacturer.
Many groups hailed the decision, but medical organizations and pro-lifers voiced objections. Some pharmacists are concerned about legal, medical and ethical issues.
Hours before the decision was to take effect, the Australian Medical Association released a statement Dec. 31 urging the government to reverse the decision (see earlier story).
The government has yet to officially respond to the appeal, but in the meanwhile, pharmacies are selling the drug.
The Pharmaceutical Society of Australia (PSA) has developed guidelines calling on pharmacists to discuss with customers their medical history and matters relating to their sexual health and ongoing contraception.
The PSA also has protocols on pharmacists refusing to supply drugs to customers. Anyone who has moral objections is not obliged to supply a product, but is expected to refer the customer to an alternative source.
For some pharmacists, however, this is simply passing the buck.
Sydney pharmacy owner John Wilks says there are several sound medical reasons why supplying Postinor-2 is a problem for him.
The morning-after pill is the equivalent of taking 50 birth-control pills within a 24-hour period, "a dose far in excess of what a woman would normally take," he said in a phone interview.
"That's the underlying pharmaceutical problem - you're taking such a large dose."
Problems reported in medical literature include increased instances of ectopic pregnancies - when an embryo is implanted in a fallopian tube rather than the uterus - which can affect future fertility.
Another problem related to blood-clotting, Wilks said. There could be a negative interaction with a commonly prescribed blood-clotting medication, warfarin. Also, about 3 to 5 percent of women have a genetic blood-clotting disorder, and taking the morning-after pill may generate blood-clots, he added.
Yet another worry deals with the virus most closely linked to cervical cancer. Wilks said laboratory studies had raised concerns that for a woman carrying the human papilloma virus unawares - which can happen easily - taking the pill "could theoretically kickstart cervical cancer."
'The unseen patient'
Some women taking the morning-after pill may not know that they are in the early stages of pregnancy (from intercourse that occurred earlier). Unlike doctors, pharmacists cannot examine a woman before deciding whether to recommend the emergency contraception.
In cases where women taking Postinor-2 are already pregnant, morning-after pill supporters say there is no harm to the unborn baby. The PSA guidelines say pharmacists should not supply the pill to pregnant women, but on the grounds of a "lack of benefit," not because of any risk to the pregnancy.
For Wilks, greater consideration should be taken.
"Any pharmacist has to be cognizant of the fact they are actually treating two patients - the patient standing before them, and the unseen patient, that is, the human embryo," he said.
Wilks said the PSA's code of conduct says pharmacists should not supply any product when there is reason to doubt its "safety, quality or efficacy" or where the product may pose a hazard to the patient.
"So we are professionally obliged, under this code of conduct, not to sell this particular medication."
Legal worries
Wilks said it was also ridiculous to expect that a pharmacist could hold a sensitive discussion with a customer about sex and contraception in a busy pharmacy storefront.
Another concern was that the morning-after pill could be used by the perpetrators of sexual abuse such as incest, to cover up the abuse.
"That's been one of the major concerns of a number of pharmacists - you could have a predatory male pretending to buy it for a girlfriend who needs it, when in fact the woman is a daughter, a niece or whatever."
If the abuse later emerged, the pharmacist could be legally liable.
Likewise, in instances where a women takes the morning-after pill and later suffers serious side-effects, the pharmacist could face legal problems.
"So many issues have not been sorted out, and one of them is, who is going to be responsible if something goes wrong? There's no doctor involved. The pharmacist is going to be solely and exclusively responsible."
Won't sell, won't refer
Wilks said he would neither supply Postinor-2 to customers, nor refer them to another source.
"Many pharmacists would think, how can I on-refer something that I consider to be an unsafe medication?"
Because of the medical concerns, he said, the requirement to refer the customer elsewhere "becomes null and void."
"I will be saying, I don't supply it because of the health implications for women and for the unborn human embryo, nor can I on-refer exactly for the same reason."
By referring a customer elsewhere, he explained, "you're still in one sense applying your professional approval ... it's watering down the gravity of the concern."
Wilks has produced a fact-sheet outlining the scientific evidence and health concerns, and will hand it to customers asking for the morning-after pill.
"They can then make a prudent decision rather than a rushed one. Most of the times the decisions we make in haste turn out to be less than wise decisions."
It's difficult to establish how many Australian pharmacists have problems with selling the morning-after pill.
An online professional discussion list carries a current poll asking whether pharmacists are "ready to handle requests" to sell Postinor-2, but only 16 respondents had taken part by Tuesday. Of them, 56 percent said yes and 25 percent said no.
In an earlier poll, in mid-2003, 52 percent of pharmacist respondents felt the emergency contraception should be available from a pharmacist without a prescription, and 45 percent wanted it to remain prescription-only.
Wilks belongs to a pro-life pharmacists' group, but he said many pharmacists who don't share those views nonetheless are also concerned about the morning-after pill.
Letters in various pharmaceutical journals in recent months had been strongly critical of the decision, he said.
On the Internet discussion list, one objecting pharmacist suggested that those not wanting to sell the morning-after pill simply say they are out of stock.
"I reckon from casual conversation that at least 60 percent of the profession are uncomfortable with MAP," she wrote.
Another pharmacist accused "anti-abortionists and other ill-informed fringe groups" of spreading misinformation, such as the charge that the morning-after pill can prevent implantation and thus constitute an early abortion.
"Implantation occurs at the 7th or 8th day after fertilization, so, although large-dose progestogens can prevent implantation, this is not relevant to use of the [MAP], in the 0-72 hour time following intercourse," he argued.
Pro-life campaigners frequently point to a U.S. public health service leaflet (#1066) which defined an abortion as follows: "All the measures which impair the viability of the zygote [newly-conceived embryo] at any time between the instant of fertilization and the completion of labor constitute, in the strict sense, procedures for inducing abortion."
And, of course, nobody has sex more than once in 8 days.
If anyone wants on or off my ProLife Ping List, please notify me here or by freepmail.
It's kind of like Russian Roulette. Most of the time your brains don't get blown out, but every once in a while, they do.
Late-term abortions don't always kill the child either, until after it is born and neglected to death. But you are basically saying that the morning-after pill is to abortion what randomly shooting a gun into a crowd is to shooting a person with a sniper rifle. In the big moral scheme of things, do you really find it more acceptable to fire a gun randomly into a crowd than to target and kill a single person or do both fall into the "never a good idea" category?
Jesse Jackson is said to be headed to Austrailia in order to combat this blantant drug benefit disenfranchisement.
Film at 11.
Exactly.
Guess who the lawyers are going to blame when they sue for the death of the dear daughter or wife of their grieving client?
A. The politicians who approved this.
or
B. The pharmacist who did not chase down the girl in the drug store parking lot to warn her about the possible risks?
Spookie, check this out!
No, but there is an expectation of a possible pregnancy. If they woman doesn't consider pregnancy a real option, then why would she take the pill? So perhaps the odds are better than shotting into a crowd but I wouldn't say that they are as bad as shooting into the air. And even with the awful odds of hitting someone just by randomly shooting a gun in the air, would you recommend that someone do it and would you hold them responsible if they did kill someone that way?
I also think you should consider what it might do to a woman who decides to use these things like Pez candies if she has a lot of sex and decides to use them as her preferred method of birth control. Taking 50 birth control pills a few times a month can't be good for a woman.
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