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EC/MAP “Plan B” Battles in Many States

Wal-Mart to Carry Plan B

MN Start Process to Let Pharmacists Follow Their Conscience

Study Finds A Link Between Oral Contraceptives and Migraines & Other Headaches (Neurology 2/06)

The Pill: Some Recent Research


PLAN B BATTLES EMBROIL STATES; PROPOSALS MIRROR RED-BLUE DIVIDE. Filling a void left by the Food and Drug Administration’s inability to decide whether to make [EC/MAP] the “morning-after” pill, termed “Plan B” by its makers, available without a prescription [OTC], nearly every state is or soon will be wrestling with legislation that would expand or restrict access to the drug.

More than 60 bills have been filed in state legislatures already this year, and that follows an already busy 2005 session on emergency contraception.

The resulting tug of war is creating an availability map for the pill that looks increasingly similar to the map of “red states” and “blue states” in the past 2 presidential elections — with increased access in the blue states and greater restrictions in the red ones. Many of the state bills intended to expand access give specially trained pharmacists in states including Maryland, New York, Kentucky and Illinois the right to dispense emergency contraception without a prescription. Other bills require pharmacies to stock and distribute the drug, and to ensure that the pill is made available to women who come into emergency rooms after a sexual assault.

But some bills would make it more difficult for many women to get emergency contraception, which is effective for only 72 hours after a woman experiences a contraceptive failure or unprotected sex.

Legislation in New Hampshire, for instance, would require parental notification before the drug is dispensed, and more than 20 other states will consider bills that give pharmacies the right not to stock the drug and pharmacists the right not to dispense it, even to women with valid prescriptions.

“Basically, every state now has an effort going to either make Plan B more easily available or to slow it down or make sure that pharmacists don’t have to dispense if they oppose it,” said Edward R. Martin, a lawyer and lobbyist with Americans United for Life, who has helped put together some of the proposed “conscience” clauses.

The makers of the morning-after pill, known commercially as Plan B, asked the FDA for the right to sell the drug over the counter in April 2003, four years after it was first approved for use. FDA leadership first rejected and then deferred decision on the proposal.

The agency has raised scientific and regulatory objections…With the application in regulatory limbo, a growing number of states have passed bills that allow pharmacists working in conjunction with doctors to dispense Plan B to women who do not have a prescription — with Maine, New Hampshire, Massachusetts, New Mexico and California acting most recently.

But Plan B usage is not determined by legislative and regulatory decisions alone. The company has found that extensive publicity about the drug has increased sales dramatically — up more than 200 percent since the FDA first turned down the application for over-the-counter status in early 2004…While proponents are achieving some success in the more Democratic blue states, their efforts have not been as well received in Republican-leaning red states — and Barr’s lobbyist said the company spends little time pushing legislation in those more conservative states. The director of the Kentucky Right to Life Association said that a Plan B pharmacy access bill introduced this year is not expected to succeed.
“We’re confident that our legislature will not approve the bill because we are strongly pro-life here,” said Margie Montgomery. “Doctors tell us that Plan B can cause a very early abortion, and we oppose that.”

Wendy Wright, president of Concerned Women for America, has testified against Plan B before the FDA and in numerous states because, she said, easier access [to EC/MAP] jeopardizes women’s health and welfare.

Women need a prescription to buy birth control pills, she said, and it makes no sense for them to buy Plan B, a stronger version of the pill, without one.

[Other major problems are that EC is a dream-come-true for sexual predators, has increased sexual activity among young people in many European nations, & increases STD infections; abortions, which we are told by EC/MAP promoters will cut abortion numbers by 50%, have actually increased in nations where EC is easily available.

[Kaufman, Washington Post, 27Feb06; A01;   N Valko RN, 27Feb06]

WAL-MART TO CARRY PLAN B [EC/MAP] CONTRACEPTION. In a major turnaround, Wal-Mart will begin stocking Plan B contraceptives — commonly referred to as the “morning-after pill” — at all of its pharmacies. “We expected more states to require us to sell emergency contraceptives in the months ahead,” said Ron Chumiuk [VP, Pharmacy for Wal-Mart]. “Because of this, and the fact that this is an FDA-approved product, we feel it is difficult to justify being the country’s only major pharmacy chain not selling it.” The company said it will maintain its conscientious objection policy, which lets employees who don’t feel comfortable dispensing a prescription to refer customers to another pharmacist or pharmacy. [; 3March06,]

MN VOTE TO LET PHARMACISTS FOLLOW THEIR CONSCIENCE.  A Minnesota House panel jumped into the debate over pharmacists, contraception and abortion, voting to let druggists refuse to fill prescriptions on moral or religious grounds. Rep. Emmer [R-Delano] said his bill attempts to accommodate both pharmacists and patients. Pharmacists would have to give their employers written notice of their objections to filling certain prescriptions, and pharmacies would have to provide patients with “timely access” to prescriptions if a pharmacist refused to fill them.

But the bill doesn’t define what “timely access” means — or even mention emergency contraception or oral contraceptives, which some abortion opponents define as a form of abortion because they prevent a fertilized egg from implanting in a woman’s uterus. “Some people, like myself, consider life beginning at conception,” said Michael Barrett, a pharmacist. “For me, besides my education, my morals and ethics are the most important assets I bring to my job.”

At least two Minnesota pharmacists have refused to dispense birth control pills because they were morally opposed. If the legislation passes, that number could grow, said Erin Matson [pres, MN chapter, National Organization for Women]. “This means more pharmacists will refuse to fill basic birth control prescriptions here,” Matson told lawmakers on the House Health Policy and Finance Committee. She urged the committee to defeat the bill, but it passed on a voice vote and now heads to the House floor.

Planned Parenthood Minnesota (pro-abortion): “A pharmacist’s beliefs should never supersede a patient’s right to timely, in-store access to their prescriptions.”

Under Emmer’s bill, pharmacies would have to develop a plan to help a customer get a prescription if a pharmacist refused to fill it. That could mean having another pharmacist dispense the drug, transferring the prescription to another pharmacy or giving it back
o the customer so they can go elsewhere to get it filled.  [Associated Press, 8Mar06,]

STUDY FINDS ORAL CONTRACEPTIVE-MIGRAINE LINK.  Women who take oral contraceptives [OCs] have increased chances of suffering from both migraines and non-migraine headaches, a large new population-based study shows.

Some women have migraines during menstruation, when levels of estrogen drop, Dr. Karen Aegidius [Norwegian National Headache Center, Trondheim, the study‘s lead author]. These women also are more likely to have migraines while taking OCs; these pills can boost estrogen levels up to four-fold above normal, resulting in a particularly steep estrogen drop-off with menstruation.

Aegidius and her colleagues studied data from 13,944 women included in the Nord-Trondelag Health Study in Norway who responded to questions on both OC use and headaches.

Migraines were 40 percent more common among women taking OCs, the researchers report in the medical journal Neurology, and non-migraine headaches were 20 percent more common. However, the team could find no link between the amount of hormones contained in the pills and headache risk.

Physicians whose patients suffer headaches while on the pill could prescribe an estrogen patch to be used 2 to 3 days before menstruation, Aegidius suggested, so that estrogen levels wouldn‘t drop so steeply.

Another possibility, she added, is for women to stay on estrogen for 3 consecutive months, so they experience headaches just 4 times a year rather than every month.

Finally, she pointed out that the fall in estrogen with Mircette, an OC available in the US but not Europe, is gradual rather than immediate, which could reduce headache risk. [4 March06, Anne Harding 2Mar06 New York, Reuters Health; Neurology, 14Feb06; N Valko RN, 5Mar06;]


THE PILL. A world leader in cancer causes and prevention has warned that the so-called birth control pill is “the largest unregulated human trial that’s ever been conducted.”

Dr. Sam Epstein

told the CBC’s Marketplace that exposure to the hormones estrogen and progestin, as found in the pill, increase breast cancer risk.

Marketplace author Wendy Mesley, herself a breast cancer survivor, explained that the World Health Organization’s International Agency for Research on Cancer last year re-classified hormonal contraceptives as carcinogenic to humans.

Dr. Chris Kahlenborn, M.D. demonstrated that a woman who takes birth control pills before her first child is born has at least a 40 percent increased risk of developing breast cancer and a woman who has taken the pill for 4 or more years prior to the birth of her first child has a 72 percent risk factor in developing breast cancer.

Dr. Kahlenborn’s book, “Breast Cancer: Its Link To Abortion And The Birth Control Pill,” is based on six years of study and a meticulous analysis of hundreds of scientific papers and other sources.

A European study, which looked at 103,000 women aged between 30 and 49 in Norway and Sweden found the risk of developing breast cancer rose by 26% for women who had taken the pill over those who had never used it.

Moreover, women who had used the pill for long periods of time increased their risk of breast cancer by 58%. The study also found that women over 45 still using the pill had an increased risk of 144%.

The British Medical Journal revealed that the pill increases a woman’s risk of developing cerebrovascular disease by 1.9 times while increasing the tendency to cervical cancer by 2.5 times. The 25 year follow-up study with 46,000 British women also noted that the enhanced risk of death lasts for 10 years after women have stopped taking the pill. [, 7Mar06, By Terry Vanderheyden]