Asymmetrical Information

Jane - You don't understand. Abortion, a right clearly given to every women in the Constitution is based on the clearly implied right, also in the constitution, to privacy in discussing matters with a medical advisor (doctor, dentist, pharmacist, nurse, etc.). Of course, this right to privacy between a medical advisor and patient ONLY applies to matters involving abortion. Why, clearly this is because the right to privacy (the second right) is derived solely from the right to an abortion (the first right). Which explains why a 16 year old girl can't get her ears pierced without her parent's permission, but may get an abortion without her parent being informed. Clear enough?

You know you can get pregnate with out consulting a doctor.

Jane,
The Plan B and Preven 'Morning After Pill' won't induce an abortion. If you're pregnant when you take it, it won't change that. It just significantly reduces the likelyhood that you'll get pregnant. It's more effective the quicker you take it.

Which it does by preventing the fertilized egg from implanting, NOT by preventing fertilization. With considerably more side effects than my albuterol inhaler.

So, as your comments suggest, lobby your state to permit sale of albuterol inhalers without a prescription. (I personally think they ought to be OTC, too, but...)

Jane - You don't understand. Abortion, a right clearly given to every women in the Constitution is based on the clearly implied right, also in the constitution, to privacy in discussing matters with a medical advisor (doctor, dentist, pharmacist, nurse, etc.).

Really? The right to an abortion, clearly given in the Constitution? And here we wasted a couple of decades arguing the whole Roe v. Wade thing. If only you'd point out where, we could end this whole debate once and for all.

Likewise the right to privacy in consulting a physician. I've only read the entire Constitution a few dozen times, so I'm not as familiar with it as you seem to be. Can you point out to me where that's outlined? I'd appreciate it.

"Likewise the right to privacy in consulting a physician. I've only read the entire Constitution a few dozen times, so I'm not as familiar with it as you seem to be. Can you point out to me where that's outlined? I'd appreciate it."

Woah, settle down there, Hoss! I'm pretty sure that David Walser was being sarcastic when he wrote that. The whole thing screams of sarcasm.

In any case, if you've read the entire Constitution "a few dozen times," then surely you're familiar with this part: "The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people." That means that just because it doesn't explicitly outline a right doesn't mean you don't have it. Or are you going to claim that a right must be explicitly stated in the U.S. Constitution to exist?

I'm just pointing out that this is extremely politicized. Maybe albuterol should be decontrolled; maybe the morning-after pill should be prescription. But I can't see any rational reason for controlling a boring drug with few side effects while making the other OTC. Making that decision on the basis of some political committment to open access to abortion is silly.

The morning-after pill doesn't have any serious side effects that I'm aware of, save for possibly bringing on a menstrual period. I think you're confusing it with the abortion pill (or pills, actually, since it's two separate medications), a.k.a. RU-486, which does have side effects in about 10% of cases.

My two cents: you get your albuterol ovr the counter, I get my Claritin over the counter, and lil' miss the-condom-broke gets her morning-after pill over the counter. But none of us should be able to buy any of these products if we're under 18.

This is typical of the reasoning of the people who now call themselves liberals, progressives, etc. If a needed/desired product does not exist, it could not possibly be because it's technically hard and no one has figured out how to do it yet. It must be because the people with power, hegemony, or whatever don't *want* it done.

This phenomenon can be observed particularly (and amusingly) in the field of energy. Thousands of "progressives" demand "energy efficiency." How? Pass a law, of course. Not one in a hundred of these people would actually lower themselves to study, say, mechanical engineering, and actually *personally* do something about energy efficiency.

What it all really comes down to is infantilism. If you want something, demand it.

Actually, you misunderstand the way that the so-called "morning after pill" works. I am not a doctor, but this is easily verified.
http://www.drdrew.com/Topics/faq.asp?id=1106§ion=1020

Unlike actual abortion methods (such as RU486 and "surgical" procedures), the evidence indicates that the morning after pill prevents an egg from ever being released from the ovary, making it impossible for it to be fertilized. In other words, it prevents you from becoming pregnant at all, rather than terminating a pregnancy that is already in progress.

So that's why it's available without a prescription--it is only a higher-dose of birth control pills. If you're a fan of lowering the rate of abortion (which one can be regardless of which side of the debate over rights and legality one happens to be on), making emergency contraception widely available and easily procured is an important, safe, and scientifically valid effort.

I think several people should read (and think about) Lee Sliver's essay, which was linked by Mindles a few posts below. Also, it might help to ponder the fact that some 75-80% of all conceptions end in perfectly natural spontaneous abortions, most often without the woman realizing that a conception occurred.

No, it works the same way the Pill does -- by suppressing ovulation, but also by making the uterus hostile to the egg. Otherwise it would be only 50% more effective than doing nothing, since more than half the fertilization window is after the egg has been released.

Also, while the bad side effects are rare, they do exist. The more common side effects include very severe nausea and cramping, as my friends who have taken it can attest.

Just pointing out that the side effects are more severe than albuterol, yet the latter is controlled in all 50 states. Not trying to argue abortion, except to the extent that I think we shouldn't be politicizing such decisions. ;-)

It's entirely possible that both should be decontrolled; I don't know the logic behind controlling them in the first place. But I think it's dead certain that the board wouldn't have decontrolled a massive hormone dose if it didn't prevent implantation, but had some other medical benefit. That's messed up.

I also have asthma, and my Albuterol inhaler goes where I go. Do I wish it was over-the-counter? Sure. Why isn't it over-the-counter? Because doctors make nice large donations to politicians who insure that the doctors get to maintain a completely unjustified monopoly on prescribing medicines. The morning-after-pill exception is one of the rare instances where common sense won out. Hopefully asthmatics will have our day too, but let's be realistic here -- unwanted pregnancy is a much more significant problem than asthma is.

I'd rather that both Preven and Albuterol were available OTC, but if I had to pick only one of the two I'd pick Preven -- and I say that as a male asthmatic. I'd rather risk being rushed to the emergency room with an asthma attack than spend 25 years and $250,000 paying for a child I don't want because my girlfriend couldn't get the pills she needed.

The morning after pill works primarily as an abortifacient, as Jane pointed out. The intention is to prevent a fertilized egg from implanting in the uterus. Regular birth control pills, taken daily, act to prevent ovulation by supressing the pituitary hormones that are responsible for triggering it.

The morning after pill has far more potential side effects than an albuterol inhaler, especially if taken repeatedly. That's what's worrisome about over the counter morning after pills. There's bound to be a certain segment of the population who would use them routinely if they're available over the counter. It would be so much easier than getting a prescription for birth control pills. Heck, even if you have birth control pills, taking a couple of pills after sex is still easier than taking a pill every day.

No doubt about it. Jane's right. The reason there's a movement to make morning-after pills over the counter is pure politics.

Not for the first time, I'll obeserve that doctors oughta be paid for advice, not permission.

"I'd rather that both Preven and Albuterol were available OTC, but if I had to pick only one of the two I'd pick Preven -- and I say that as a male asthmatic. I'd rather risk being rushed to the emergency room with an asthma attack than spend 25 years and $250,000 paying for a child I don't want because my girlfriend couldn't get the pills she needed."

And if your decision was to be binding on every person in the United States, you'd still feel comfortable making it?

"unwanted pregnancy is a much more significant problem than asthma is"

In all but a few rare cases, pregnancy -- even when unwanted -- is STILL the consequence of willful decisions made by the affected parties beforehand. Asthma is more like, say, deafness: One usually does not choose it but nonetheless has to live with the consequences of the condition.

I think we're back to arguing the personal responsibility angle...

Dan -- beg to differ on two counts. As far as I know, more people die from asthma than unwanted pregnancies -- especially if they can't afford a $150 doctor visit for a prescription for a $15 medication. And the ability to get drugs over the counter is not in inverse proportion to the seriousness of your condition, or we'd be able to buy our chemotherapy at Rite Aid.

In any case, if you've read the entire Constitution "a few dozen times," then surely you're familiar with this part: "The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people." That means that just because it doesn't explicitly outline a right doesn't mean you don't have it. Or are you going to claim that a right must be explicitly stated in the U.S. Constitution to exist?

Well, actually, the Tenth Amendment to the Constitution has been pretty much read out of constitutional law by successive Supreme Court opinions. For all practical purposes, precedent has ruled in meaningless. So if the High Court and abortion-rights activists are going to revive it for the express and specific purpose of justifying the right to an abortion, it would tend to be somewhat inconsistent.

Consequently, and not surprisingly, the Tenth Amendment has never been used as a constitutional justification for the right to an abortion. Rather, the "penumbras formed by emanations" from the Constitution, according to the majority ruling by Justice Douglas in Griswold v. Connecticut, 381 U.S. 479 (1965) was the basis for deriving the privacy right that was used in Roe to define a right to an abortion.

Dang, totally missed the sarcasm. Plus I thought I remembered Mr. Walser as being one of Jane's more liberal foils. If that's the right word. Color me bright pink, tending to red in places.

Jane, we can't let the perfect be the enemy of the good. I agree that that we need more control over ur health-care options, and that more asthma drugs should probably be made OTC. But the availability of asthma drugs OTC has nothing to do with the question of making morning-after pills available OTC.

Phil, if the decision you're talking about is as to morning-after pills, it's not binding on every person in the United States. No one's forcing you or your wife/girlfriend to take the morning-after pill. If you're talking about the decision to deny OTC access to asthma medication, that is binding o everyone, and it may well be wrong, but it's a separate problem.

anony-mouse, I think you're exactly right that it's a matter of personal responsibility. The Government's role should be minimized as much as possible.

I'm surprised no one has pointed out the new OTC availability of Claritin. It was four years ago that WellPoint (an HMO) petitioned the FDA to make Claritin non-prescription. I'm sure it's just coincidence that the FDA finally agreed, just a month before Claritin's patent expires, and a few months after Schering-Plough changed their mind and also peitioned to make it available OTC.

Between S-P and the allergists, the spin on this move is "allergy suffers will have to pay more due to evil insurance companies." Let's ignore the cost of the doctor's visits, and focus on the expected $30/month cost for OTC Claritin and compare it to a $10 copay for prescription Claritin. Pay no attention to the $100/month your HMO was paying for the prescription; everyone knows the HMOs can always print more money...

Sorry, occasionally the illogical way people think about insurance sets me off...

As far as I know, more people die from asthma than unwanted pregnancies

The death rate from asthma is 17.9 per 100,000 victims; for pregnancy, it's 8.3 per 100,000. But that's not really the fair comparison, is it? How many people die from asthma each year because they couldn't get an Albuterol prescription -- that's the real number you should be using. Readily available emergency contraception can prevent 1,700,000 unwanted pregnancies and 800,000 abortions. The number of lives saved is in the ~150 range (or, if you're pro-life, the ~800,150 range). Are more than 3% of asthma deaths (there are about 5000 total a year) caused by people not being able to get Albuterol prescriptions? I doubt it. Then, of course, there are the costs: $200,000,000 for the abortions plus the cost of 1.7 million unwanted children (tens of billions of dollars minimum).

Albuterol is also more dangerous than Preven. If used improperly, for example, Albuterol can actually make your asthma worse, increasing your risk of death. It can also cause seizures or delirium if you overdose (and it's easy to see a panicy asthmatic who's never talked to a doctor overdosing, don't you think?). In contrast, a woman taking Preven can't do any permanent harm to herself, and is very unlikely to overdose since (unlike Albuterol buyers) she's only buying one dose. Now, the real crime here is that you need a doctor's permission for each and every Albuterol canister. But the logical thing to do isn't to get mad at the birth control activists (who have achieved a great and wonderful thing by legalizing OTC Preven), but to get mad at the doctors who keep OTC Albuterol illegal.

one.. i know i have no connection to the real wolrd... but who can raise a kid on 10k a year.. just school fees can come to 15k+ even for pre-school...

as was mentioned above, calritin is now available non prescription... and its not just doctors that fight for the ability to prescribe.. drug companies want their meds to be prescription, as they get higher prices (most people have lower apparent costs for prescription than otc due to insurance voergae.. double bonus for drug companies..)

of course the main reason for prescriptions is that a consumer is not expected to read the packaging or abide by its guidelines.. so its all the trial lawyers fault... i feel like an anti semite always bashing the trial lawyers (cause its just so predictable and seems illogical to blame all the world's ills on lawyers)... but hey they really are the basis for all that's wrong with the world (exhibit one the lawyer that stopped mullah omar from being hit by a predator... he's a jag so he's technically a trial lawyer.. maybe we just expand it and blame all lawyers, seeing as how most pols are lawyers too!)

all i have to say... i'm with shakespeare... whatever the point of the quote was, i just like how it sounds ripped completely out of context!

IIRC, the medical profession defines the start of pregnancy as implantation, not fertilization. It's pretty hard to detect either one of these events, but it's quite likely that more than half the fertilized eggs either fail to implant or die within a few days of implantation. And about 1/3 of those that survive long enough to become a confirmed pregnancy wind up in miscarriages, AKA spontaneous abortions. If I believed in God, I'd have to conclude that He must like abortions, He arranges so many of them...

I think the American legal system is the main reason there has been little progress in birth control since the 60's. Anything powerful enough to actually block conception will have side effects and dangers - and the company that invented the stuff will be sued, even when it is clearly safer than whatever existed before. And it's worse for drugs that aren't lifesavers - such as the pill - than it is when it's easy to argue that the patient would have definitely died without the drug.

I'm having a little memory loss here, but there was a proven effective and safe drug that was pulled from the marketplace a few years ago after several high dollar jury awards, for conditions that the FDA is quite satisfied the drug doesn't cause. I think it was for something like acne...

Couple of points.

Firstly, morning-after contraception has to be done quickly to work, which either means it is easy to obtain (ie. OTC) or women will be carrying the stuff around in their purse on the off-chance that they need it. I don't think anyone wants this to be a standard contraceptive technique, so I prefer the former option.

If this is too lax, consider keeping the easy availability but recording who uses it, and if it is too frequent get that person some proper contraceptive advice. This is intrusive but only to those who choose to use this method of contraception, and a better option than making it harder to get and having additional unwanted pregnancies (and also later abortions).

This case is also different from asthma medication, where you know you have the condition and keeping some around is an elementary precaution.

Secondly, I think (sorry, Megan) that since "abortion" became an emotive issue, people have been using the same term to cover a large number of very different processes. Most would agree that a full-term fetus is a person, killing it is wrong except in extremis, and the fact that it is still within the uterus and dependent upon the mother has small impact on its rights as a human being. At the other extreme, an unfertilised egg isn't a person, has no rights, and can be discarded with no moral consequences.

I don't think that personhood is magically imbued in the egg when it is fertilised, or that the small ball of cells which finally implants has any moral significance whatsoever. It isn't a baby, it isn't a person (it MAY become one if left alone). But we use the same word - abortion - for removing it (or even just preventing implantation, as argued by Megan) and for killing a third trimester fetus, and these two acts are VERY DIFFERENT from the moral point of view.

Whether or not the word "abortion" is technically appropriate is irrelevant, nor should we care as long as the meaning is agreed and we use it in its technical sense without the emotional baggage. But this was not the way Megan used it, she just couldn't wait to get the A-word into her blog just to attach a spurious moral significance to an act which has none (in my opinion). A cute trick in debate, but that's all it is - a trick.

So I have a challenge. Let someone try to rewrite Megan's last sentence without using the A-word or otherwise confusing "preventing implantation" with "killing third trimester babies" and see if it still makes a case against emergency OTC contraception.

Parallel,

Just as you believe that personhood is not imbued in teh egg when it is fertilised, others believe that it is. So using the term "abortion" for the elimination of a fertilized egg or a zygote, or whatever, may not be a simple rhetorical trick, but an indication of the actual beliefs of the speaker.

Bolie IV

Indeed, there is no clear line of demarcation between Parallel's "ball of cells" and a baby at term. When is personhood conferred? when the cells begin to differentiate structurally? First heartbeat? When limbs begin to appear? Brainwaves? When the ball of cells has taken on all basic human structural elements (10 weeks)?

Take whatever moral view you will, Parallel, it's your prerogative. But please don't hold me accountable to pointless semantics. Barrring specific disfavorable circumstances early in the pregnancy (spontaneous abortion, induced abortion, death of the mother, etc.) that ball of cells always does otherwise result in an infant nine months or so later.

Since the 1970s, your local women's center, rape relief facility, crisis center, or whatever they call them in your area have been telling rape victims to take three to five contraceptive pills as soon as possible to prevent pregnancy. The three to five depended on the type of pill. I don't know how effective this is or how bad the side effects are, but I am absolutely certain this has been going on because I know people who have worked in these places.

So, as I understand it, and I could be wrong, an equivalent to the so-called "morning-after" pill has been fairly readily available for the past thirty years. As for the asthma medication, I don't see why it shouldn't be available also. Is there an underground culture of inhaler abuse?

Just my $.02 worth.

As I say, I don't actually have an opinion on the prescription system, because I simply don't know anything about the logic behind it. So I don't know why albuterol is regulated. But I don't see any medical logic behind regulating the one and not the other. Surely we can agree that abortion politics should not be driving medical decisions?

As a medical student, I have learned a bit about the prescription system. Basically, it exists to keep people from getting dangerous drugs with marginal benefit. Whether it actually does so may be a different matter.

As I noted above, albuterol is a pretty damned safe drug, and I'm really not sure what Dan's talking about when he says it can exacerbate asthma. That's certainly not in any of the literature I've ever looked at. Besides, we sell epinephrine inhalers OTC, and that's a much less selective drug than albuterol, with real cardiovascular side effects. I'd suggest pulling the epi and letting albuterol go OTC.

The only thing that will slow that down is that asthma is a chronic disease, and if people start treating shortness of breath like they do a headache, there's a good chance they'll end up with permanent (and bad) consequences. That, I think, argues mostly for extended-duration prescriptions (e.g., you have to be checked out every 2-3 years until age 15, after which you can wait 8 years between visits, getting inhalers as needed).

I go to my pulmonologist roughly every two years, and that seems to work. My lung function's pretty stable, but he checks, tells me about new stuff, harangues me about breast self-exams (that's just my pulmonologist, not everyone's), and generally makes sure I don't need more or less of whatever it is I'm taking.

On the other hand, I can easily see that if albuterol were OTC, people would buy it rather than treating their underlying disease, which would be bad.

In Canada, clinics have been advising a high dose of contraceptive pills as a "morning after pill" for years. Claritin has always been over the counter, and for a while Preven was too (effectively -- available from pharmacists).

Oddly enough, not enough people bought it and the manufacturer pulled it off the market in 18 months due to lack of sales. This despite a huge publicity due too opposition by pro-life groups.

BC and Quebec allow an alternative morning after pill, "Plan B" tobe sold over the counter. There has been some push to make that a national rule, but given the lack of demand for PReven, I'm not sure it will happen.

So maybe you guys are making a huge fuss over a non-issue.

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Jane Galt wrote:
"Surely we can agree that abortion politics should not be driving medical decisions?"

How about flipping the statement: Surely we can agree that drug company lobbing should not be driving medical decisions?

Dan wrote:

The death rate from asthma is 17.9 per 100,000 victims; for pregnancy, it's 8.3 per 100,000.

to which I respond:

Actually no, the asthma death rate for 1999, according to the National Vital Statistics Report (vol. 49, no. 8, 9/21/01) from the National Center for Health Statistics, is 1.7 per 100,000 (4,657 total deaths that year). In the same report for the same year, the death rate for deaths related to pregnancy is 0.1 per 100,000 (437 deaths), and the death rate for deaths in "certain conditions originating in the perinatal period" (a catch-all for different diseases) is 5.2 per 100,000 (14,259 deaths).

I'm a pulmonary specialist, and like most in my field I believe that most asthma deaths are preventable. It's not lack of access to albuterol that is the problem -- it's too-easy access to albuterol, with over-reliance on rescue inhalers and not on controller medication (like inhaled steroids). I can't speak for the OB docs, but at least some of the conditions we associate with maternal death would be preventable with better medical care.

You can access the NVSR at the NCHS web site.

Regards to all,

I am going to restate others opinions here since they are a few messages up. Apologies in advance if I get it wrong.

Bolie Williams IV writes that "abortion" is a legitimate term to use for "prevention of implantation" if the speaker actually believes the latter is morally equivalent to killing a healthy term baby.

Interesting point, and one which I hadn't considered. If the people the speaker was speaking to also held that belief, then I guess it would be legitimate communication, just as it would be legitimate for a PETA member to talk of killing chickens for food as "murder", when talking to another member. It just means they share an odd definition of the word "murder". But if they use it when talking to me it is illegitimate in pretty much the same way that Megan used the term "abortion". In the PETA case, it also means that they have no word for the particular horror of killing a human being... and perhaps they don't feel that horror (certainly true of some of them).

anony-mouse correctly points out that I haven't provided a demarcation between personhood and non-personhood. This is not fatal to my argument because any demarcation which falls after implantation would suit, but more properly because I don't consider "personhood" to be a binary property, but rather a continuum where the needle doesn't just above zero until some time after implantation.

She also writes "But please don't hold me accountable to pointless semantics" which I am not going to address because I don't know what it means, or even what it was intended to mean (that was a joke. I think.)

The last line of her posting implies that since a fertilised egg is likely to become a full term baby, it has the same moral status as one. I disagree strongly, both in likelihood and morality, but I won't argue it now because I am not certain I have understood it correctly.

I used abortion because as far as I know, the medical term for a drug that prevents implantation is an abortifacient.

Wishing there was a genetic biologist who could wade in at this point, I am just wondering: under the right conditions, with the right materials and technology, don't *all* cells have the potential to become life via genetic manipulation? Granting the strictest of terms of some prior posts (the combining of DNA in an egg cell resulting in, barring technical difficulty, a fully formed human) would that make me a murderer for having cosmetic surgery, scratching an itch, getting a piercing, any action that would kill living cells? Perhaps this a strictly in vivo arguement? Curious...

Sorry....meant, "...don't all human cells have the potential to become fully formed human life..."

Megan writes,

I used abortion because as far as I know, the medical term for a drug that prevents implantation is an abortifacient.

I don't think that's true - technically, it is a contraceptive ("prevents conception") rather than an abortifacient ("aborts a pregnancy"). But I'm not a doctor, I could be wrong.

However, my argument wasn't whether the phrase "induce an abortion" is technically correct or not, but that its use in this context appeared to me to be an illegitimate rhetorical trick, for reasons I explained above. If this effect was unintentional, I apologise for implying otherwise - anyone who writes comes up with the occasional logically infelicitous phrase. The effect is certainly unfortunate whether it is technically defensible or not.

Well, but if it's the medical term, it's not an illegitimate rhetorical trick -- trying to put it off limits because you like the sound of the word "contraception" better than "abortion" is. Conception is what takes place when the sperm enters the egg. The "morning after" pill doesn't prevent that. It's far too late to prevent ovulation by the time you take it; nor is it spermicidal. If you don't call it abortion, I don't know what the word is -- but the correct term is certainly not "emergency contraception".

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