What's So Risky About the Morning After Pill?
The Morning After Pill: Function
The "morning after pill" consists of synthetic hormones (both estrogen and progesterone types, known as "ethinyl estradiol" and "norgestrol"), along the lines of the traditional birth control pill, although in much higher doses--as much as eight times the dose of the typical oral contraceptive pill. The morning after pill is also called "post-coital contraception," or "emergency contraception."
As indicated above, the word "contraception" is problematic where a drug's primary or dominant function is to prevent implantation. (Anti-implantation drugs and devices cause abortions and are therefore abortifacients.) While there are four possible action modes of the morning after pill ... its principal function is an anti-implantation, or abortion, effect. As the medical textbook, The Developing Human:Clinically Oriented Embryology, explains:
The administration of relatively large doses of estrogens ("morning after pills") for several days, beginning shortly after . . . sexual intercourse, usually does not prevent fertilization but often prevents implantation of the blastocyst. . . . Normally, the endometrium progresses to the secretory phase of the menstrual cycle as the zygote forms, undergoes cleavage, and enters the uterus. The large amount of estrogen disturbs the normal balance between estrogen and progesterone that is necessary for preparation of the endometrium for implantation of the blastocyst. Postconception administration of hormones to prevent implantation . . . is contraindicated for routine contraceptive use.
Thus, calling the morning after pill "contraception" is misleading: While it can have a contraceptive effect, most of the literature on it confirms that it is more likely to act as an abortifacient if fertilization has taken place.
However, the actual function of the morning after pill in any given case depends on where the woman is in her fertility cycle when she takes it: If the woman has not yet ovulated, the drugs may act to suppress ovulation. But if the woman has already ovulated, the drugs obviously cannot have that effect.
Obstetrician John Wilks explains:
To maintain a truly contraceptive action, the morning after pill cannot be given close to the usual day of ovulation. If the pill failed to prevent ovulation, fertilization might occur, with a consequent loss of the fetus. . . . For women at or a few days past ovulation, the morning after pill could not be used as a contraceptive for the same reason: the possibility of fertilization coupled with an impaired endometrium could result in loss of the embryo.
The Morning After Pill: Administration
While there are variations of the morning after pill, two regimens are most widely recognized and both are now available in the United States.
The first consists of a combination of synthetic hormones, or hormone derivatives, taken within seventy-two hours of intercourse, twelve hours apart. Sold in the United States as Preven (marketed as "an emergency contraception kit," distributed by Gynetics Corporation), it is popularly known as the "Yuzpe" regimen. The regimen totals two hundred micrograms of ethinyl estradiol (synthetic estrogen) and either 2.0 milligrams of norgestrel, or 1.0 milligram of levonorgestrel (synthetic progesterone). Nausea, vomiting, dizziness and breast tenderness are common side effects. The FDA approved Preven in 1998.
The second regimen, less often used and available in the United States since 1999, consists of synthetic progesterone pills (levonorgestrel) only. In the methods studied, pills containing .75 milligrams of levonorgestrel are given to a woman no later than eight hours after intercourse; this same dose is then repeated twenty-four hours later. This method is marketed as "Plan B" in the United States and was approved by the FDA in 1999.
The FDA's 1998 approval of the morning after pill has led to an aggressive campaign to promote it not just from the usual contraception and abortion advocates, but from within the medical profession.
Promotion: From Prescription to Over the Counter
This promotion has taken the form of increased publicity (what's called "education" by its advocates) and a very vocal call for the morning after pill to be distributed over the counter (OTC) rather than by prescription. Several websites have actually begun to offer the morning after pill by mail through the Internet and/or by phoning a physician listed on line (without a physical exam).
At its annual convention in December of 2000, the American Medical Association's (AMA) Council on Medical Service proposed that AMA physicians be more assertive in promoting the morning after pill, and that the organization support efforts to drop the prescription requirement. The AMA House of Delegates responded by approving a resolution calling on the FDA to "consider" making the morning after pill available over the counter. Less than six months later, the new head of the American College of Obstetricians and Gynecologists (ACOG), Dr. Thomas Purdon, did one better and proposed to the group's 40,000 members that they offer advance prescriptions for future use.
Medically Irresponsible
These offensive steps to increase the morning after pill's availability and circulation--even eliminating physical exams--are startling, given the high dosage of the pills, and the severity and frequency of side effects. As one pharmacological textbook explained:
These high doses of estrogens frequently produce serious side effects, including cramps. Nausea and vomiting occur routinely and often are severe enough to warrant anti-emetics. Because of the severity and frequency of side effects . . . post-coital [drug] is not appropriate for routine use and is normally reserved for emergency situations such as rape and incest.
One is left to wonder why the medical profession is pushing a drug regimen that has thus far been "reserved for emergency situations." It also appears strange that there is no parallel effort to change the status of the traditional birth control pill, which is much lower in dose and potency. Typically the change from prescription to over-the-counter occurs for lower-dose drugs.
The need for a structural check on morning after pill use--whether by prescription or otherwise--is fairly plain. Oversight allows for verification of health conditions, so that patients are screened for contraindications. It is also a way to guard against repeated use, which OTC status obviously cannot prevent--and may encourage. (The advance prescription proposal is no less worrisome on this point, since drugs, once in hand, can easily pass from one user to the next--an especially likely prospect among teenagers in frightening and seemingly desperate situations.)
Finally, serious--even life-threatening--side effects can occur with the morning after pill: blood clots, strokes, and heart attacks. Given these risks, the advisability of medical oversight should be obvious. One can only conclude that those doctors advocating its indiscriminate distribution are acting irresponsibly.
CULTURAL IMPACT
The development and promotion of anti-fertility drugs for adolescent females have had serious consequences. The degradation of the medical profession--becoming more obvious, but still little discussed--is just one.
Equally serious is the misrepresentation by Dr. Purdon and others about the actual function of certain drugs (in this case, the abortifacient action of the morning after pill). The failure on his part, and on the part of the profession generally, to raise questions regarding the potency, and therefore the safety, of this drug regimen (especially to a vulnerable population) is also seriously negligent. While positions on controversial issues may compromise professionalism (such as the AMA's abortion stance), misrepresentation and omissions of this sort violate medical ethics. This is by definition a disservice to patients, and to the public at large.
Second and more broadly speaking is the degradation of human sexuality in modern society, with all the physical and spiritual problems that entails. One seldom even hears the word "promiscuity" anymore, since it sounds unacceptably judgmental. Instead, the mechanical, even positive-sounding phrase "sexually active" is the preferred term, suggesting that those not engaging in indiscriminate sexual relations are passive and sickly. Few, even within medicine, seem to realize that the stigma of promiscuity (which is simply the flip side of honoring chastity) was born of both moral and practical considerations. Practically speaking, sexual promiscuity has meant enormous societal problems, including (perhaps especially) problems of public health. While everyone contends with the effects of rising illegitimacy, doctors more than anyone else must contend with sexually transmitted diseases, abortion and related injuries, and the consequent infertility. Given this, one might expect the medical profession to speak out against promiscuity, if only to prevent the disease and destruction it causes. Instead, public health professionals have not only made peace with sexual license (against society's practical interests), but now virtually advocate it. The campaign for the morning after pill is just one case in point.
Excerpted from Little Pills: Targeting Youth with New Abortion Drugs Issue No.: 236 by: Mrs. Teresa Wagner from The Family Research Council.
My Comments:
What a novelty - Doctors acting irresponsibly?! Believe me, it happens all the time. Again, it appears that money is the bottom line -- kickbacks from drug companies for promoting drugs are a major incentive to some doctors. It is also obvious to me that in advocating irresponsible sexual behavior that results in sexually transmitted diseases, abortion and related injuries, and the consequent infertility, some physicians appear to be using people for their own financial advantage and benefit. If they were truly concerned about their patient's health and well-being, wouldn't they be more interested in promoting preventive medicine rather than pushing off highly dangerous drugs which could result in the death of their patient?
The "morning after pill" consists of synthetic hormones (both estrogen and progesterone types, known as "ethinyl estradiol" and "norgestrol"), along the lines of the traditional birth control pill, although in much higher doses--as much as eight times the dose of the typical oral contraceptive pill. The morning after pill is also called "post-coital contraception," or "emergency contraception."
As indicated above, the word "contraception" is problematic where a drug's primary or dominant function is to prevent implantation. (Anti-implantation drugs and devices cause abortions and are therefore abortifacients.) While there are four possible action modes of the morning after pill ... its principal function is an anti-implantation, or abortion, effect. As the medical textbook, The Developing Human:Clinically Oriented Embryology, explains:
The administration of relatively large doses of estrogens ("morning after pills") for several days, beginning shortly after . . . sexual intercourse, usually does not prevent fertilization but often prevents implantation of the blastocyst. . . . Normally, the endometrium progresses to the secretory phase of the menstrual cycle as the zygote forms, undergoes cleavage, and enters the uterus. The large amount of estrogen disturbs the normal balance between estrogen and progesterone that is necessary for preparation of the endometrium for implantation of the blastocyst. Postconception administration of hormones to prevent implantation . . . is contraindicated for routine contraceptive use.
Thus, calling the morning after pill "contraception" is misleading: While it can have a contraceptive effect, most of the literature on it confirms that it is more likely to act as an abortifacient if fertilization has taken place.
However, the actual function of the morning after pill in any given case depends on where the woman is in her fertility cycle when she takes it: If the woman has not yet ovulated, the drugs may act to suppress ovulation. But if the woman has already ovulated, the drugs obviously cannot have that effect.
Obstetrician John Wilks explains:
To maintain a truly contraceptive action, the morning after pill cannot be given close to the usual day of ovulation. If the pill failed to prevent ovulation, fertilization might occur, with a consequent loss of the fetus. . . . For women at or a few days past ovulation, the morning after pill could not be used as a contraceptive for the same reason: the possibility of fertilization coupled with an impaired endometrium could result in loss of the embryo.
The Morning After Pill: Administration
While there are variations of the morning after pill, two regimens are most widely recognized and both are now available in the United States.
The first consists of a combination of synthetic hormones, or hormone derivatives, taken within seventy-two hours of intercourse, twelve hours apart. Sold in the United States as Preven (marketed as "an emergency contraception kit," distributed by Gynetics Corporation), it is popularly known as the "Yuzpe" regimen. The regimen totals two hundred micrograms of ethinyl estradiol (synthetic estrogen) and either 2.0 milligrams of norgestrel, or 1.0 milligram of levonorgestrel (synthetic progesterone). Nausea, vomiting, dizziness and breast tenderness are common side effects. The FDA approved Preven in 1998.
The second regimen, less often used and available in the United States since 1999, consists of synthetic progesterone pills (levonorgestrel) only. In the methods studied, pills containing .75 milligrams of levonorgestrel are given to a woman no later than eight hours after intercourse; this same dose is then repeated twenty-four hours later. This method is marketed as "Plan B" in the United States and was approved by the FDA in 1999.
The FDA's 1998 approval of the morning after pill has led to an aggressive campaign to promote it not just from the usual contraception and abortion advocates, but from within the medical profession.
Promotion: From Prescription to Over the Counter
This promotion has taken the form of increased publicity (what's called "education" by its advocates) and a very vocal call for the morning after pill to be distributed over the counter (OTC) rather than by prescription. Several websites have actually begun to offer the morning after pill by mail through the Internet and/or by phoning a physician listed on line (without a physical exam).
At its annual convention in December of 2000, the American Medical Association's (AMA) Council on Medical Service proposed that AMA physicians be more assertive in promoting the morning after pill, and that the organization support efforts to drop the prescription requirement. The AMA House of Delegates responded by approving a resolution calling on the FDA to "consider" making the morning after pill available over the counter. Less than six months later, the new head of the American College of Obstetricians and Gynecologists (ACOG), Dr. Thomas Purdon, did one better and proposed to the group's 40,000 members that they offer advance prescriptions for future use.
Medically Irresponsible
These offensive steps to increase the morning after pill's availability and circulation--even eliminating physical exams--are startling, given the high dosage of the pills, and the severity and frequency of side effects. As one pharmacological textbook explained:
These high doses of estrogens frequently produce serious side effects, including cramps. Nausea and vomiting occur routinely and often are severe enough to warrant anti-emetics. Because of the severity and frequency of side effects . . . post-coital [drug] is not appropriate for routine use and is normally reserved for emergency situations such as rape and incest.
One is left to wonder why the medical profession is pushing a drug regimen that has thus far been "reserved for emergency situations." It also appears strange that there is no parallel effort to change the status of the traditional birth control pill, which is much lower in dose and potency. Typically the change from prescription to over-the-counter occurs for lower-dose drugs.
The need for a structural check on morning after pill use--whether by prescription or otherwise--is fairly plain. Oversight allows for verification of health conditions, so that patients are screened for contraindications. It is also a way to guard against repeated use, which OTC status obviously cannot prevent--and may encourage. (The advance prescription proposal is no less worrisome on this point, since drugs, once in hand, can easily pass from one user to the next--an especially likely prospect among teenagers in frightening and seemingly desperate situations.)
Finally, serious--even life-threatening--side effects can occur with the morning after pill: blood clots, strokes, and heart attacks. Given these risks, the advisability of medical oversight should be obvious. One can only conclude that those doctors advocating its indiscriminate distribution are acting irresponsibly.
CULTURAL IMPACT
The development and promotion of anti-fertility drugs for adolescent females have had serious consequences. The degradation of the medical profession--becoming more obvious, but still little discussed--is just one.
Equally serious is the misrepresentation by Dr. Purdon and others about the actual function of certain drugs (in this case, the abortifacient action of the morning after pill). The failure on his part, and on the part of the profession generally, to raise questions regarding the potency, and therefore the safety, of this drug regimen (especially to a vulnerable population) is also seriously negligent. While positions on controversial issues may compromise professionalism (such as the AMA's abortion stance), misrepresentation and omissions of this sort violate medical ethics. This is by definition a disservice to patients, and to the public at large.
Second and more broadly speaking is the degradation of human sexuality in modern society, with all the physical and spiritual problems that entails. One seldom even hears the word "promiscuity" anymore, since it sounds unacceptably judgmental. Instead, the mechanical, even positive-sounding phrase "sexually active" is the preferred term, suggesting that those not engaging in indiscriminate sexual relations are passive and sickly. Few, even within medicine, seem to realize that the stigma of promiscuity (which is simply the flip side of honoring chastity) was born of both moral and practical considerations. Practically speaking, sexual promiscuity has meant enormous societal problems, including (perhaps especially) problems of public health. While everyone contends with the effects of rising illegitimacy, doctors more than anyone else must contend with sexually transmitted diseases, abortion and related injuries, and the consequent infertility. Given this, one might expect the medical profession to speak out against promiscuity, if only to prevent the disease and destruction it causes. Instead, public health professionals have not only made peace with sexual license (against society's practical interests), but now virtually advocate it. The campaign for the morning after pill is just one case in point.
Excerpted from Little Pills: Targeting Youth with New Abortion Drugs Issue No.: 236 by: Mrs. Teresa Wagner from The Family Research Council.
My Comments:
What a novelty - Doctors acting irresponsibly?! Believe me, it happens all the time. Again, it appears that money is the bottom line -- kickbacks from drug companies for promoting drugs are a major incentive to some doctors. It is also obvious to me that in advocating irresponsible sexual behavior that results in sexually transmitted diseases, abortion and related injuries, and the consequent infertility, some physicians appear to be using people for their own financial advantage and benefit. If they were truly concerned about their patient's health and well-being, wouldn't they be more interested in promoting preventive medicine rather than pushing off highly dangerous drugs which could result in the death of their patient?
Thank you so much for this information. I am printing this for my collegues in my community.
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