The Pill — Lifestyle Drug or Medical Necessity?


A
recent video of John McCain unable to say that it’s unfair for insurance
companies to cover Viagra but not birth control left pro-choicers rejoicing.
  For a long time now, we’ve
been fighting to get the word out that right wing fanatics are hostile
to contraception, and now we have first rate evidence of a politician
pandering to anti-contraception forces.  Now the doubters will
have a lot less ground to work with. Now we’re that much closer
to exposing the agenda of the anti-choice  movement, which is not
just anti-abortion — but anti-contraception, anti-sex education, and
homophobic. 

On this issue, pro-choicers
should have a slam dunk, right?  Ninety-eight percent of women will use contraception
at some point in their lives, and presumably most of the men who have partnered with women who use it support that right as well.  Most advocates
for any issue wish they had that kind of broad base of support. 
When people hear that such a popular right is under attack, surely they
will swarm as one voting bloc that gives new meaning to the phrase "vast
majority" to retaliate against a narrow band of extremists, right?
I’d like to think so.  Most of the time, I do think that we have
widespread support for the right to use contraception, support that
will eagerly fight to support that right under attack from a very small
minority. 

But then I saw this video with
Bill O’Reilly defending McCain,

and I started to feel less sure of how firm the pro-choice ground is
on this issue.  O’Reilly doesn’t come right out and attack
the right to use the birth control pill.  But he does define it
as if it’s a luxury item, in fact putting it in the same category
as eating at a restaurant. (Women’s choice to have sexual intercourse,
according to O’Reilly, is a luxury, but for men, it’s a medical
necessity.  No, really.)  The double standard nauseates, but
the framing of the issue will win over a lot of people who think of
themselves as pro-choice on contraception.  The implication that
sluts have to pay for their own sinful behavior will resonate with a
lot of people, as will the idea that if you can’t afford the $30-$50
a month out of pocket for birth control pills, you don’t deserve to
have sex. 

The rule to remember with anti-choicers
is that they’re crazy but not stupid.  They know that openly
advocating for a ban on contraception won’t work, but they do believe,
with good reason, that they can chip away at the right to use contraception
slowly so that people don’t even see it coming.  After all, they’ve
had a lot of practice doing this to abortion rights, which also enjoy
the support of the majority.   

Most people see that Roe v.
Wade hasn’t been overturned outright and feel secure with the right
to abortion.  Little do they know that the incremental chipping
away at abortion rights has, for a lot of women, meant that Roe doesn’t
exist in any practical way.  If you live far away from an abortion
clinic, or can’t afford an abortion, or have to go through waiting
periods and other forms of legal harassment, the amount of effort and
money you put into getting an abortion doesn’t differ from what you’d
have to put out if abortion was illegal.  For them, the difference
between legal and illegal abortion is a technicality on paper, not a
lived experience.  But with it being technically legal, most Americans
are complacent on the issue. 

Anti-choicers fully intend
to use the same strategy to chip away at your right to contraception,
getting rid of it in practical terms for many women while the rest of
us rest on our laurels, unaware of how much ground we’ve lost. We
know their methods, because of the abortion rights war.  Target
vulnerable populations first, people with little political power, such
as young women, women of color, and poor women.  Redefining hormonal
birth control not as a medication necessary for a healthy life, but
as a luxury that should only be available to those who can pay for it,
is a big step in targeting the young and poor. Age restrictions on
things like emergency contraception also play a role. Young women,
who are the least likely to have adequate experience using condoms (leading
to breakage), and are the most likely to be raped, have the greatest
need for emergency contraception, but if they’re under 18, they’re
out of luck, thanks to anti-choice tactics.  They’ll have to
get that abortion instead, in  many cases.  But they don’t
have much political power, so they need the rest of us to stand up for
them. 

Rural women and poor women
are the main targets of "conscience clauses," which aren’t about
religious freedom as advertised, but about restricting access to birth
control pills, one judgmental horror show of a fundamentalist Christian
pretending to be a professional pharmacist at a time.  For urban
women with a decent amount of money, going to the next pharmacist who’s
willing to do his damn job doesn’t take much effort.  But for
women living in isolated areas, or who don’t have the time or travel
range in the city because of poverty, being refused service in a pharmacy
could mean the difference between getting the pills and not.  

Unfortunately, I can easily
see a huge number of Americans who technically support the right to
contraception rolling over for the incremental strategy.  We are
indeed frogs sitting in pots of water on this issue.  Anti-choicers
aren’t going to turn the heat up to 10 right away, but will gradually
turn it up a little (deprive teenagers and poor women of their access
and then their rights) so that we don’t notice it, until it’s too
late and we’re all boiling in water.  But it doesn’t have to
be that way.  With pro-choicers out there spreading the word and
making the links between things like this John McCain video and the
crazies who are out to take away your birth control pills, maybe we
can turn down the heat. 

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  • invalid-0

    I think I’ve said this before, but it’s worth repeating. The “pill” isn’t just for birth control. It has many other medical uses, including in the treatment of polycystic ovarian syndrome (PCOS).
    -
    I have PCOS. It’s not pleasant. Irregular periods, hair growing where I really don’t want it to, and a tendency toward decreased insulin sensitivity and frank diabetes. (The link between insulin and PCOS is that insulin regulates other pituitary hormones, including the ones that stimulate ovulation.) The pill evens out these hormonal surges and ameliorates some of the symptoms.
    -
    Diabetes scares the heck out of me. I want to do everything possible to avoid it. In addition to losing weight and exercising, I’m also taking the pill. Is some pro-life pharmacist now allowed to deny me medication to treat a metabolic condition? Because that’s what these so-called conscience clauses will do. It’s like saying that antibiotics treat infections, including STDs, and since promiscuity is wrong, we won’t prescribe any antibiotics to anyone. You’ve got pneumonia? So sorry, you’re out of luck.
    -
    The pill also helps protect against ovarian cancer, another very frightening disease. The vast majority of ovarian tumors are diagnosed only when they metastasize, so it’s much better to try to stop them before they occur. Is wanting to avoid a deadly cancer a “lifestyle choice”? If so, anyone in his or her right mind should choose this lifestyle!
    -
    How exactly do these people think they’re being pro-life?

  • invalid-0

    There are alternatives to taking the pill for PCOS. Unfortunately because a lot of physicians don’t understand PCOS, and that it is unique to each woman, they just prescribe birth control pills and call it a day. And if you never used BC pills before you actually increase your risk of ovarian cancer.

  • invalid-0

    First of all, get over yourself. O’Reilly’s argument was that Viagra treats a medical disfunction while the pill, when used for birth control, does not. Insurance companies will cover the pill when it is prescribed for a medical condition. Last time I checked, fertility was not a medical condition. No one NEEDS to have sex; abstinence is FREE!!

    That being said, as a taxpayer I view covering the pill as the lesser of two evils. Pay for the birth control pill until the woman grows up and quits having irresponsible sex or pay for her kids for oh, I don’t know, THE REST OF THEIR LIVES. It is an indisputable fact that the children of unwed poor women (and these would be the women who need free pills) use more government assistance than the children of married women.

    The middle and upper classes are always going to carry the low income class. It’s just a fact of life. So choose the birth control. If enough women use it maybe the social burden will be reduced for the rest of us.

  • invalid-0

    I agree with many of your points but….
    Erectile dysfunction has behavior issues (obesity, lack of exercise) and sometimes can be due to aging with no disease factors. These men can just say no to sex too or improve their behavior.

  • invalid-0

    Seems the crazies on the left see a “fundamentalist Christian pharmacist” at every corner! LOL for being paranoid delusional, but that also is treatable. Got to admit, this “blog” is great for a chuckle or two. The author loves freedom of “choice” for baby killing by surgery or chemical but no freedom of choice for pharmacists who can think for themselves and still have a conscience. She’s right: patronize a serial killer or child molester, they’re so much easier to get along with!

    Bottom line for Dr Dredd: PCOD is treatable with real helpful meds like metformin and the TZDs rather than resort to the powerful abortifacient steroids found in OCs….ya know, the kind that would get baseball players and football players fined and suspended?

    God bless and have a special blessed day!

    • invalid-0

      no freedom of choice for pharmacists who can think for themselves and still have a conscience

      The consciences of the anti-contraception pharmacist or the pro-life ER nurse are sacrosanct;but not the consciences of the doctor who prescribed the medication; or the women who need BC to avoid pregnancy(or treat a medical condition) or the rape survivors who need EC to prevent pregnancy resulting from the assault?

      By the “logic” of anonymous above,women who want BC or EC either have none, or they aren’t worth diddly.

      Apparently, only anti contraception and anti abortion conciences are important enough to have special laws enacted.

      Could it be because anti-choicers have a DOUBLE STANDARD?? Naw, that couldn’t be it, could it? [snark]

  • invalid-0

    Not to imply that there aren’t legit disease factors causing this in other cases.

  • invalid-0

    There are alternatives, but are they the right ones? Since androgen excess is a hallmark of PCOS, you’d want a medication that blocks that, correct? In order to do that, you need to both decrease androgen (testosterone) production and increase the proteins in the blood that bind and inactivate testosterone. What medication can do that?
    -
    Surprise, it’s oral contraceptives (a.k.a. “the pill)
    -
    I’m not sure what you mean when you say, “if you’ve never used birth control pills before, you actually increase your risk of ovarian cancer.” Anyone who starts taking oral contraceptives for the first time has “never used birth control pills before.” There is no evidence that the risk of ovarian cancer is increased. In fact, a very large study published in 2006 in the British Journal of Cancer showed that oral contraceptive use decreased the risk by about 75%. I can post the reference if people would like.
    -
    So, while oral contraceptives aren’t the only drugs available to treat PCOS, they are certainly a large part of the recommended treatment. As a physician, that’s good enough for me. Keep your laws off my ability to stay healthy.

  • invalid-0

    Viagra is used to treat a medical condition. Let’s take a look at that.
    -
    Viagra is frequently used by people who have erectile dysfunction because of heart disease/high cholesterol or diabetes. The viagra itself does nothing to treat those underlying conditions. What it does is to help men engage in a perfectly elective activity: sex.
    -
    You say that “No one needs to have sex; abstinence is FREE.” I say, absolutely. Don’t cover viagra. The same arguments you apply to birth control pills can be applied to viagra. If sex is not an essential life function for women, then it isn’t for men, either.

  • invalid-0

    “If sex is not an essential life function for women, then it isn’t for men, either.”

    Right, I agree. My thought was that treating a dysfunction is different than preventing ovulation which is a perfectly correct physiological event.

    Not to mention that, as you stated, erectile dysfunction is often caused by other medications.

  • invalid-0

    The dysfunction in question (erectile dysfunction) only becomes relevant when a man wants to have sex. Otherwise the only things are relevant are the underlying causes. It’s like demanding a heart transplant so you can play baseball. The baseball isn’t relevant; it’s the really bad heart disease that makes playing baseball impossible.
    -
    So, if you’re arguing that oral contraceptives are a lifestyle choice because sex is a lifestyle choice, you have to make the same argument for viagra.

  • invalid-0

    I never said that there weren’t other meds available to treat PCOS. What I did say is that oral contraceptives are a very important part of the arsenal and it’s not right to have someone decide they can deny access.
    -
    Your argument about steroids is disingenous. Narcotics such as morphine would also get someone “banned,” but they’re necessary for pain control.

  • invalid-0

    Anonymous @ 9:34am:You know,all your “facts” could easily be debunked by reading of sites like this one.You know,those with actual,scientific facts rather than “spiritual truthiness”.But your kind is immune to education and rejoices in delusion,so why would I bother?Hope you’ll wise up for your own good.Now go troll elsewhere.

  • invalid-0

    There are multiple sites on the causes of ED. Like this one that mentions smoking and aging alone.

    http://www.medicinenet.com/impotence_ed/page2.htm#cause

  • invalid-0

    The world would be a darker place without birth control pills – and that’s even if you eliminate consideration for the fact that it prevents pregnancy. It also helps to prevent cramps, irritability, acne, and a whole other host of medical issues that are caused by female hormones and monthly cycles. For women with painful cycles, it allows them to take fewer sick days from the work place. It helps stay-at-home moms avoid the fatigue that can be a precursor to the monthly period, insuring that they can supervise and support their children more reliably. For many women (some of whom are abstinent), the reasons for taking birth control supercede prevention of pregnancy. It’s about being productive and pain-free in a world that has little sympathy (either rightly or wrongly so) for feminine health complaints.

  • invalid-0

    Here’s some studies on exercise/obesity and its impact/risk for erectile function.

    http://jama.ama-assn.org/cgi/content/abstract/291/24/2978

    http://www.bio-medicine.org/medicine-news/Smoking-and-obesity
    -linked-to-erectile-dysfunction-12079-1/

    **Please Note**, I’m the same Anonymous that added the additional comment at 9:35 to make sure that my post was not misread to imply that there weren’t the cases where erectile dysfunction is a result from a disease.

  • invalid-0

    I agree with Dr. Dredd and the other commenters that agreed with Dr. Dredd. I too have PCOS. I take metformin and Ocella birth control pill to manage the condition. I don’t take the pill for birth control as my husband has had a vasectomy but have found that the pill helps in many ways with my cycle and the PCOS. I think Amanda has many valid points in her post. I have seen the havoc the abortion chipping machine has done on the rural part of WV where I live. I have commented before about it on this site. I myself had to travel hours to get an abortion in a state that didn’t have bias counseling, a wait period and other chipping away methods. I have had to switch pharmacies so I could guarantee I could get my pill every month. In order for my husband to get a vasectomy, we had to visit several different doctors just because of some a**holes who wanted to stick their noses where they didn’t belong our personal life. I consider myself to be neither left or right. I just want the government and these trolls to stay the heck out of my life and my personal decisions. Why can’t people who want to use Jesus as their birth control just accept that others would rather rely on a more scientific reliable method? My husband and I talk about this banning birth control alot. We think but hope not that it is going to take abortion being taken away then birth control to make people see the darkness fall upon women for people to wake up and see what they hath wrought upon us. It’s a battle. I just hope it is one that doesn’t get too ugly.

  • amanda-marcotte

    If we could not throw out that red herring?  It gives comfort to people who want to put "avoiding pregnancy" below other medical requirements.  Not wanting to be pregnant is far more legitimate, just sheer bodily stress-wise, than wanting to avoid headaches or indigestion.  Or even menstrual cramping.  All these things are unpleasant, but not that bad compared to childbirth.

  • amanda-marcotte

    Now you’re getting away with having sex without your due punishment.  Cranky Catholic is losing sleep because you’re not suffering one pregnancy after another as punishment for your slatternly ways. 

  • invalid-0

    My point is that PCOD isn’t the same for every woman. But many physicians don’t know enough about it by the evidence that they throw birth control pills at the problem. They’re like the father in “My Big Fat Greek Wedding” who thinks everything can be solved by spraying Windex on it.

  • invalid-0

    OK, so what do you think of this scenario?
    -
    Ms. Jones, a 36 year old woman with PCOS, comes in to Pharmacy X with a prescription for an oral contraceptive (OCP). She’s been to a good endocrinologist, and together they’ve come up with a treatment plan that includes both OCPs and metformin. She tries to get the OCP filled, but the pharmacist refuses. She points out that the other prescription for metformin indicates that the OCP is for PCOS, but the pharmacist still refuses. How should this be handled?

  • invalid-0

    Absolutely. It would be great if we could get rid of the red herring. Unfortunately, just as the right has been taking incremental steps towards banning abortion and contraception, I think we’re going to have to do the same. First point out the non-pregnancy/sexual uses of the pill to increase awareness and acceptance, then point out the desire to avoid pregnancy.

  • invalid-0

    Possible oops.

    I didn’t realize until just now that there was another Anonymous also @ 9:34 called
    Pill is not contraception.

  • amanda-marcotte

    I knew a lot of Catholic girls growing up who got the medical exemption.  It never translated, as far as I know, into an acceptance of the idea that pregnancy—a medical condition—is something that you have a right to avoid.  I see what you’re saying.  I’m just really concerned that we’re reinforcing the idea that there’s something unseemly about wishing to be sexually active with a man without getting pregnant.

  • invalid-0

    She says, “Screw you!” and goes to Walgreens.

    • invalid-0

      Cop out! As others have said, there’s not always a Walmart or other chain store nearby.
      -
      I really want to know how you would handle this. Let’s stipulate that yours is the only pharmacy within 200 miles. The woman in question doesn’t have a car, and drives with friends if she needs to go on an errand. The friends are poor, and can’t afford the gasoline to travel 400 miles round trip.
      -
      So, to repeat, Ms. Jones has a prescription for OCP to treat the medical condition PCOS. There’s evidence that the prescription is indeed for PCOS, since she’s having other, related meds filled at the same time. Can you justify not filling the prescription, and if so, what are your reasons?
      -
      We could probably go further. Misoprostol is a drug that was originally approved to treat ulcers caused by drugs like ibuprofen. There are obviously other alternatives, but the chemical mechanism of action of misoprostol directly targets the actions of ibuprofen that cause the ulcers. In other words, it’s almost tailor-made for that purpose. Obviously, misoprostol is also used as part of the medical abortion regimen.
      -
      Now, a woman comes in after having suffered a life-threatening bleed in her stomach. She needs to continue taking an ibuprofen-like medication to treat her rheumatoid arthritis. Her doctor has prescribed misoprostol. Would you deny her this medication? At what point does “conscience” allow one to potentially contribute to someone else’s death?

  • invalid-0

    Cranky Catholic, your priviledge is showing.

    There are millions of Women in the US who do not live within commutable distance to multiple pharmacies. There are also millions of Women in the US who cannot afford to travel to multiple locations to obtain their legal prescription.

    The town I lived in in college had exactly two pharmacies. If both of those could not fill your prescription (and neither one was carrying Plan B for a long time), the next nearest pharmacy was over 45 minutes away if you had access to a car, extra money for gas, and the luxury of taking time off from class/work/family life in order to make the trek to the next largest town.

    What do Women in small or rural or poor areas do when they are turned away from the ONLY pharmacy near to them?

  • invalid-0

    Multiple unwanted (and too often wanted) pregnancies are bad for a woman’s health. A satisfying sex life is good for a woman’s health. Reliable birth-control is health care. Like other medical options, the best methods are between women and their doctors. This is not hard to figure out.

    For men (and women) who believe otherwise – fine. However, if you choose to use medical technology to prolong your life past the natural human death timeline of between 35 to 60, and live from 60 to 90, respect the fact that people are entitled to use medical technology to limit their breeding and have you pitch in just like they have to pitch in and allow you to live a long life.

  • invalid-0

    And if Cranky Catholic wants to use medical technology to prolong his life beyond the 35 to 60 natural timeline, perhaps a health care provider should be able to say no. After all Cranky has the option to say ‘screw you’ and go to Walgreens.

  • invalid-0


    respect the fact that people are entitled to use medical technology to limit their breeding and have you pitch in just like they have to pitch in and allow you to live a long life.

    Right on.

  • invalid-0

    Of course Walgreens isn’t in a commutable distance for everyone either.

  • invalid-0

    or for Cranky.

  • invalid-0

    at least presume that there is no other alternative…perhaps the local Walgreens says no for Cranky and there is no other option commutable.

  • invalid-0

    Here’s my answer to your hypothetical situations. It would never happen unless your physician is an idiot. You have two pharmacies to choose from in a 200-mile radius, and your doctor is THAT DUMB to prescribe you a particular drug the he knows the pharmacy refuses to carry?… because, you know, your doctor ought to know those two pharmacies VERY well and what they carry, being that his patients only have two choices and all. The problem wouldn’t be the pharmacy. It would be your dumbass doctor.

  • invalid-0

    Unfortunately, I think this is part of the problem. I’ve been genuinely trying to engage you in discussing the ethical dilemma, and you’ve constantly skirted the issue by trying to blame either the doctor or the patient.
    -
    Summary so far:
    1.) Hormonal contraceptives are part of the treatment of PCOS. They’re not the whole treatment, but do play an important role in decreasing the harmful effects of androgen excess.
    -
    2.) A woman lives in a rural area and for all intents and purposes only has access to one pharmacy. She has a prescription for an estrogen and progesterone combination pill, otherwise known as an OCP. She wants to use this pill to treat the harmful medical condition PCOS.
    -
    3.) She goes to the pharmacy, where the pharmacist refuses to fill it for religious reasons. She tells him/her that the medication will not be used for contraception, but he/she doesn’t believe her and still refuses.
    -
    Everyone has the right to practice their own religion, but accomodation cannot be endless. When one person’s conscience comes into conflict with another person’s desire to keep themselves healthy, what should happen? If the situation is changed so that the needed medication is now life-saving, then what should happen?
    -
    Like it or not, nobody lives in a vacuum. Your decisions never only affect yourself. I think too many people who cite so-called conscience clauses never acknowledge the larger consequences of their decisions. We don’t live in a theocracy; I don’t think people should be able to avoid at least thinking about how their actions affect others just because “God” is invoked.

  • invalid-0

    Thank you Curtis for bringing up a valid point–multiple pregnancies are very bad for one’s health and having loving sex is very good for us! Cranky Catholic’s online name says it all–why should cranky religious people get to make decisions about anyone eles’s body! I personally beleive there are better options than the pill–I use almost exclusively natural treatments–food, herbs, acupressure etc and I also think the pill causes problems. But we live in a free country Cranky Catholic–with separation of church and state!!! So your religious beliefs are not legally allowed to trump anyone eles! If a pharmacist does not believe in say pain killing drugs (there are religious people that beleive suffering pain is a virtuous thing!) and you went to get a script filled after a major car accident with multiple injuries and you are in severe pain and he refused to fill it how would you feel? Pharmacists who do not think they can do their job properly should find some other career!

  • invalid-0

    The Constitution guarantees freedom of religion. It doesn’t say that religion is a “get out of jail free” card. Sometimes there are consequences to one’s actions that must be faced (e.g. if a pharmacist does not practice according to the standard of care, he/she should have to deal with the results. The same holds true for doctors and nurses.)

  • invalid-0

    Look, dispensing medication (ANY medication that a doctor deems necessary for his/her patient) is the job of a pharmacist. If you can’t do that job, get another career. A Quaker wouldn’t sign up for the Army because he/she’s against violence and war. A fundamentalist or Christian Scientist shouldn’t become a pharmacist, since they object to the process of doing their job. An recovered alcoholic doesn’t have to take a job in a bar. A Hindu doesn’t have to take a job at a meat-packing plant. A person who hates kids has no obligation to become a teacher. An environmentalist has no obligation to work for a lumber company. See my point? There are literally hundreds of jobs that one could object to for moral or ethical reasons. If you object to a job for moral or ethical reasons, DON’T TAKE THAT JOB. Take another job, that doesn’t violate your personal code of belief. But do not for a second think that your personal belief system allows you to fail to perform your duties at whatever job you do choose to take. That makes no sense, and giving only right-wingers the right to not do their jobs is prejudiced. If they don’t have to do their job, then I can teach whatever I want in the classroom, curriculum be damned. Say my views tell me that God is a flying spaghetti monster. Do I have a right to impose that on my students? Certainly not. And A pharmacist has no right to impose his/her crazy views either.

  • http://www.unratedunfiltered.blogspot.com/ invalid-0

    Great article – super important to expose McCain and the pro-life stealth attacks on abortion and birth control. Joan Malin of Planned Parenthood of New York City published an opinion article in today’s METRO newspapers in NYC/Boston/Philadelphia addressing Bush’s proposed HHS regulation change that would be catastrophic to women in this country.
    You can find it here… http://www.unratedunfiltered.blogspot.com/

    Roger

  • invalid-0

    Hormonal birth control has been the only treatment that works for me and many women I know for more than just one medical issue. I have chronic ovarian cysts that happened even on certain pills until we found the right one and in two years on this pill I have had NONE. This has prevented several surgeries and thus saved money and time off work. Other MEDICAL issues solved for women include endometriosis, uterine fybroids and PCOS. This IS medical, and not any sort of moral issue. The pill also for me has reduced depression, anemia, severely painful cramps and numerous other very real problems. I am offended that people find it necessary to tell others that their effective medical treatment is somehow wrong because it also prevents contraception. Until you have had surgery for a cyst the size of a grapefruit, who are you to tell me my medical condition is just an inconvenience but your lack of erection is a medical emergency?

  • invalid-0

    Birth control is a “lifestyle” drug in exactly the same way that closed sewers are “lifestyle” infrastructure. Pregnancy is risky. A large number of pregnancies over a lifetime is far riskier. Ensuring that women are able to easily and reliably control their fertility is undeniably beneficial both to their health and to the health of their children.