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TAG | Paternalism



On The Economics of the Pill (2)

In an article for Bloomberg News, Virginia Postrel asks why certain types of oral contraceptive require a prescription. Here is an extract:

Requiring a prescription “acts more as a barrier to access rather than providing medically necessary supervision,” argues Daniel Grossman of Ibis Reproductive Health, a research and advocacy group based in Massachusetts, in an article published in September in Expert Review of Obstetrics & Gynecology.

Birth-control pills can have side effects, of course, but so can such over-the-counter drugs as antihistamines, ibuprofen or… Aleve. That’s why even the most common over-the-counter drugs, including aspirin, carry warning labels. Most women aren’t at risk from oral contraceptives, however, just as most patients aren’t at risk from aspirin or Benadryl, and studies suggest that a patient checklist can catch most potential problems.

To further increase safety, over-the-counter sales could start with a progestin-only formulation, sometimes called the “minipill,” rather than the more-common combinations of progestin and estrogen…Progestin-only pills, or POPs, have fewer contraindications. Unlike combination pills, they’re OK for women with hypertension, for instance, or smokers over the age of 35. The main dangers are fairly rare conditions such as breast cancer or current liver disease. “Not only are POP contraindications rare, but women appear to be able to accurately identify them using a simple checklist without the aid of a clinician,” declares an article forthcoming in the journal Contraception.

Aside from safety, the biggest argument for keeping birth- control pills prescription-only is, to put it bluntly, extortion. The current arrangement forces women to go to the doctor at least once a year, usually submitting to a pelvic exam, if they want this extremely reliable form of contraception. That demand may suit doctors’ paternalist instincts and financial interests, but it doesn’t serve patients’ needs. As the 1993 article’s authors noted, the exam requirement “assumes that it would be worse for a woman’s health to miss out on routine care than it would be to miss out on taking oral contraceptives.”

And let’s not forget how these requirements fit in with the even more interfering instincts of the nanny state.

The consequences are predictably malign:

Going to the doctor is costly in time, money and sometimes in dignity. Not surprisingly, the prescription requirement deters use of oral contraceptives. In a 2004 phone survey, 68 percent of American women said they would start the pill or another form of hormonal birth control, such as the patch, if they could buy it in a pharmacy with screening by a pharmacist instead of getting a doctor’s prescription. Two-thirds of blacks and slightly more than half of whites and Latinas surveyed said they chose their current, less-effective method of birth control because it didn’t require a prescription.

If you think that the costs involved in all this are incurred solely by those looking to get obtain oral contraceptives, you are a very trusting soul.

And, as I discuss in a different context over on the Corner (the availability of the emergency anti-allergy EpiPen), unnecessary insistence on prescriptions is not confined to contraceptives.




More Guidance Needed?

The New Atheists are much too shrill for my decidedly agnostic tastes. In many respects, they are on a hiding to nothing. The religious impulse will always be with us and so will be a belief in the supernatural. But not all atheists are new atheists: It’s also quite possible for an atheist to admire much of the structure, cohesion and sense of tradition that some religions bring to society, not to speak of the happiness they can bring to many of their adherents.

Nevertheless these comments by Alain de Botton, an atheist playing nice, go too far:

The starting point of religion is that we are children, and we need guidance. The secular world often gets offended by this. It assumes that all adults are mature – and therefore, it hates didacticism, it hates the idea of moral instruction.

Oh come on: I suspect that there are many secular folk who are very far from convinced that “all adults are mature”.

De Botton continues:

But of course we are children, big children who need guidance and reminders of how to live. And yet the modern education system denies this. It treats us all as far too rational, reasonable, in control.

Really? Has he any idea about the stifling speech codes, the numbskull impositions of zero tolerance, and, to name just one more example, the endless environmentalist nagging that pollute today’s schools and universities.

Wait, there’s more:

We are far more desperate than secular modernity recognizes. All of us are on the edge of panic and terror pretty much all the time – and religions recognize this.

Who is this “all”, I wonder? I do agree that religions recognize that profound anxiety can be part of the human condition. But then so do pharmaceutical companies, and for many people their remedies will be a better route to take, either with the additional help of religion, or without.

De Botton:

Religions are fascinating because they are giant machines for making ideas vivid and real in people’s lives: ideas about goodness, about death, family, community etc. Nowadays, we tend to believe that the people who make ideas vivid are artists and cultural figures, but this is such a small, individual response to a massive set of problems. So I am deeply interested in the way that religions are in the end institutions, giant machines, organizations, directed to managing our inner life. There is nothing like this in the secular world, and this seems a huge pity.

A pity? Nope, I would say that it is a cause for celebration. There was plenty of talk about engineering the soul back in the old Bolshevik days. No-one needs that lot back in town. For those who are looking for the sort of guidance de Botton is discussing, but who believe that the religious route is not for them, there are many other places to look, from family, to tradition, to history, you name it. But to be able to look in that way does require a broadly rational education. And a broadly rational education ought never to deny our own immense capacity (for good or bad) for irrationality.

H/t: Andrew Sullivan

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