Asymmetrical Information

Re question number one -- I would guess that the possible side effects of one dosage of several birth control pills are far fewer than long term usage of birth control pills (blood clots, stroke, etc.). Alternatively, it may be a paternalistic policy designed to get women to the gyno at least once a year.

And no, I'm not a doctor. Just guessing here.

yeah as far as I know it's a way of ensuring women get a few annual tests... these are directly related to the activity that requires the pill...

I imagine that doctors with male patients of a certain age wish that they could require PSA tests and maybe a few other thigns to get ED treatment.

Are the possible birth control pill side effects worse than those of (advil, tylenol, sudafed, insert-your-favorite-otc-drug-here)? My headache doctor told me that advil has as high a percentage of heart problems as my badly missed Vioxx. (And yes, I'm still bitter that one of the few drugs that worked for my headaches was taken off the market for my own good. My heart is perfectly healthy, and I'd be happy to take the tiny risk of potential heart problems over the certainty of being in pain now.)

Was a severe asthma sufferer for several years ( reaction to chemicals) and still have allergies.

Guesses:

1) Inadequate exhalation;CO2 buildup
2) Cough/gasp mechanism reducing bloodflow ro brain
3) Drug side-effect? Doubtful, I have used and applied a lot of bronchial dilators and haven't seen it.

It's darn near impossible to hurt yourself with an overdose of birth control pills. The worst you might experience would be vomiting. Compared to say, an overdose of OTC Tylenol, which can kill (and does kill people regularly) birth control pills are a non-issue.

http://www.nlm.nih.gov/medlineplus/ency/article/002599.htm
http://www.nlm.nih.gov/medlineplus/ency/article/002598.htm

DC the commenter did make a good point that long-term use of birth control pills can lead to things like blood clots, etc. especially if a woman smokes. Even this is fairly rare.

As for Plan B, I've actually used it. My personal opinion is that it does need to be available without a prescription because that way you can take it much faster. Time is of the essence when it comes to Plan B being effective. HOWEVER. I do think that some kind of medical supervision would be ideal. In some European countries they require that women using Plan B consult with a pharmacist, who talks with them about possible side effects and ways to prevent needing Plan B again (avoiding more sex or using a birth control method). The pharmacist also discusses sexually transmitted diseases.

For girls under the age of 18, I think think required meetings with a pharmacist are the idea solution. (We allow them prescriptions of birth control without their parents' knowledge, and we sell them condoms, so I think it's hypocritical to not allow them Plan B. - Discussing whether any birth control options should be available without their parents' consent is a whole different conversation.) However, I think it would help underage girls to have to have a conversation with an adult who makes a point of telling them about the risks they are taking. If you need Plan B, you've already screwed up. (Or you've been an unfortunate victim of violence and you don't need any nanny-state crap.)

Within our current system, this makes the most sense to me.

re question #3, a likely cause might be breathing down co2 from hyperventilation; might cause lip/around mouth tingling as well...

Well, one doesn't OD on birth control pills, as such, but women have died due to blood clots and strokes due to use of regular birth control pills. Recently, it came out that Ortho Evra (the patch) has a stroke/blood clot rate three times as high as regular birth control pills (due to differences in how the hormones get into the bloodstream and leave it). The worst problems are for women who smoke.

It seems to me, the requirement for all these things to be prescription only is a way to force women to get Pap smears. Cervical cancer at its most deadly tends to show up in younger women. Now, if they get that HPV vaccine widespread, perhaps they won't require prescriptions for artificial hormones as the need for Pap smears will decrease. The OB-GYNs won't like that, but how big is their lobby, anyway? You're more likely to get objections from the "religious right", which does have a larger lobby... though one not large enough to prevent federal funds from going to Planned Parenthood right now. So I'm guessing that eventually they'll go OTC.

As to #2, in many cases of spontaneous abortions, doctors never can figure out the cause (I know family members who have had miscarriages, and most of them never figured out what happened.) Most likely, if abortion is made illegal, only doctors and pharmacists will get prosecuted and not the women seeking abortions. That's what old-timey abortion law tended to be like. And generally, it wasn't a criminal conviction but loss of license. So the question is, what's the doctor's incentive to report that an abortion was procured -- consider that few doctors report cases of statutory rape now when they come across pregnant girls. Why would it be more likely that they'd want to investigate this?

"As to #2, in many cases of spontaneous abortions, doctors never can figure out the cause (I know family members who have had miscarriages, and most of them never figured out what happened.)"

Is it that doctors can't find out what happened? Or that it is not worth the resources it would take to find out, given that (1) most miscarriages do not predict problems with subsequent pregnancies and (2) a high percentage of miscarriages are believed to be due to a fetal abnormality such that the baby never would have survived?

The dizziness could be a reaction to the propellant used in the inhaler. It also could be the result of heightened blood pressure or heart rate brought on by nervousness and excitement.

As for why Plan B might be made available over-the-counter while birth control pills aren't: because Plan B is an emergency medication and birth control pills aren't. Making women wait to get birth control pills doesn't significantly lower their effectiveness, but it does significantly lower the effectiveness of Plan B.

For #3, I'm guessing it could be heightened heart rate and shock, which could result in restricted blood flow to the brain.

EMT guess:
The meds: albuterol. Looking at that link and other sites suggests that albuterol can produce dizziness and lightheadedness. I would say that the effect of opening airways may transfer to opening or expanding blood vessels, thus lowering blood pressure and bringing on temporary dizziness.

That link will also provide a list of other meds that can conflict.

Albuterol is a beta agonist, that is, it fires up the beta system. It focuses on the beta 2 receptors, which dilate the bronchioles. The opposite is that class of blood pressure meds beta blockers. They can worsen breathing in cases of asthma.
Dan, a minor point, but delaying access to birth control pills would make a small percentage of women do without. The easier it is to get meds, or to take them, the greater the percentage of folks who do so.

Not a doctor, but ditto on the #3 comments on hyperventilation. It happened to me once during a coughing fit that happened in the doctors office, and he was able to identify it.

Only with mild snark, but I'm actually wondering about how FDA priorities work--does anyone have the stats on the birth control pill causing strokes and blood clots? How does that stack up to say Vioxx?

If Abortion becomes illegal in the U.S. (it won't), I think you will see a huge rise in the number of "spontaneous miscarriages" (WINK WINK WINK).

I just read through the abortion posts, and I see what sort of bankrupt logic and morality allows a liberterterian to support this administration.

Okay, let me explain my contempt of Jane Galt based on her abortion posts.

Here is what seems to be a fair assessment of Jane's posts, given the context of the previous posts, the content, and some of the crass, offhanded comments that assume the law is being applied to people like Meghan, that is, people of means:

I realize Samuel Alito is about to be put through a nomination fight. This will cause the government to oppress women in a sort of way. However, I can get around it. Since all I'm concerned about is the government being off "my" back, well, that it will be on the back of underpriviliged women, sucks to be them. They should have been born to richer families. I still get the liberterianism of federalism, economic liberterianism, which is important (hey, look at my taxes!).

This is, of course, a broader problem with many liberterian Republicans. When these Republicans worship at the alter of Scalia and Thomas, they should realize that this does mean less economic regulation, and less gun control, but it means that at the cost of weaker rights in the criminal field (incl 4th-7th amendments), as well as weaker rights on 1st amendment stuff.

But since liberterian bloggers are unlikely to be poor, accused of crime, subject to searches (including racial profiling), unable to see a doctor to get plan B, etc., this isn't even a tradeoff. And I think that attitude towards government regulation, given their core beliefs, is not just amoral but immoral.

Going through her posts, it seems like laws such as parental and spousel consent, prescriptions for plan b. Also highly apt, is the throwaway line that its okay if we outlaw abortion, since (only people of means) can get outlawed abortions anyway, and nobody will know!

The "unfairness" post, in the end, seems most apt. Life is unfair. If the government WANTS TO MAKE IT MORE UNFAIR, thats okay. Never understimate the bravery of people in the face of pain felt by others.

All of this bothers me slightly less than the silly straw men in her "why I'm posting about this" which is why I reject her simplistic explanation. Let's talk about the immorality of ALL single issue lobbyists, why don't we (is environmental deregulation really MORE IMPORTANT THAN CIVIL RIGHTS?).

BTW, I believe Roe v Wade was wrongfully decided, and am personally pro-life though believe abortions should be legal as a matter of policy (since as a liberterian-sympathetic person I don't believe we regulate self-behavior unless we come to a general consensus, rather than 50%+1, and that my morality is not a fair substitute for the morality of others). But a pro-lifer who is ok with parental notification is, at the heart of it, ok with it BECAUSE SHE IS OK WITH ALL BARRIERS TO ABORTION. There doesn't seem to be a moral flaw. A pro-choice person like Meghan who is ok with parental notification because it doesn't seem like that big of a deal to her, is only okay with it BECAUSE SHE IS WILLING TO SELL OUT OTHERS WHEN SHE DOES NOT BEAR THE COSTS.

There was a part in there that got accidentally deleted in the run-on sentence portion that discussed how Galt's "sensible" abortion policies tended to be policies that were at most minor inconvenience for people of means, but were prohibitively expensive for people in low socioeconomic conditions (the poor, the mentally ill, the abused, immigrants, those who lack health care, children of single parent households, etc.) Pretend it's still there, you've all heard the rant, you don't need to hear it again.

A young gal I know was talking to me recently about her pregnancy and how hard it was to get on Medicaid (she is jobless and living with her boyfriend's mom, BUT she is white and articulate). She asked if something or other (I think prenatal vitamins) were made prescription-only to force women to seek medical care for their pregnancy. And I pointed out that if that was really their priority, they'd have got busy and given her medical care by now (she has literally been in the system for weeks).

Now I don't really approve of welfare, but she is a decent young woman with a good job history who is going through a temporary setback. What is taking so blasted long, I wonder.

Justin,
When these Republicans worship at the alter of Scalia and Thomas, they should realize that this does mean less economic regulation, and less gun control, but it means that at the cost of weaker rights in the criminal field (incl 4th-7th amendments), as well as weaker rights on 1st amendment stuff.

Huh? Say again? Scalia and Thomas have been among of the strongest defenders of suspects' rights (infrared imaging case, luggage-squeezing case), and on the 1st they are among the strongest defenders of freedom of speech (campaign finance).

Not that I have any personal experience with birth control, but I imagine that doctors have a responsibility to talk women through the day-by-day routine of taking pills, and drilling in them what to do if they miss a day and why it's important to follow the schedule with the real pills and placebos.

Whereas with Plan B, it's a one-shot deal, no issues of maintenance or routine.

Justin,
There's too many erroneous assumptions in your post to cover in this short space so I'll ask to you to only defend one of them. In regard to you appearant opposition to parental notification, name one non-emergency medical procedure that a doctor/hospital can preform without parental/guardian consent. Are you saying that minors should be able to seek any elective medical procedure without consent? Do you really believe that the same minor who did not realize or believe that she could get pregnant will have the ability to comprehend the risks/rewards/consequences of an abortion?

#1) Personally I think OCP's should be over the counter. I don't require my patients to come in for the Pap before I'll renew them, but I do remind them. I figure its up to them to make that choice. There are risks, but very small for things like blood clots. But they're much safer than other OTC meds like ibuprofen, Primatine, or even things like Ma Huang/ephedrine. Plan B should have been ok'd, but was derailed by the Bush admin. I doubt you could get OCP's over the counter with the current administration either. By the way the "3 times higher risk" with Ortho Evra was something like an increase from 1/100,000 to 3/100,000, not that big a change when you look at the big picture.

#2) No there is no way to tell the difference between a spontaneous miscarriage and one caused by meds like RU486. And no, most miscarriages are not investigated because the baseline risk is so high. Depending on age & how closely you test for pregnancy, the risk fo miscarriage is ~ 25-50% with each conception. That is way to many people to justify testing (chromosomes, sperm counts, ultrasounds, etc.). Most don't advocate any workup until the 3rd miscarriage, unless you're older and your clock is ticking.

#3)When you get an asthma attack, you have to compensate by breathing faster to get adequate oxygen. This lowers your pH and CO2 in your blood stream which can make you feel week and dizzy. Also, bronchodilators (e.g., albuterol) increase your heart rate and lower your potassium, both of which can make you feel anxious and/or dizzy.

Typo in prior comment: #3) breathing faster raises your pH.

#1) Politics
#2) You could probably test for the Mifepristone (one of the 2 drugs in RU-486) in the mother but you couldn't tell just from the fact of the miscarriage or looking at the fetus.
#3) Dr. Bob pegged it, hyperventilation and decreased CO2. The following is from the Wikipedia entry: If carbon dioxide levels are high, the body assumes that oxygen levels are low, and accordingly the brain's blood vessels dilate, to assure sufficient blood flow and supply of oxygen. Conversely, low carbon dioxide levels (e.g. from hyperventilation) cause the brain's blood vessels to constrict, resulting in reduced blood flow to the brain and lightheadedness. Doctors sometimes artificially induce hyperventilation after head injury to reduce the pressure in the skull, though the treatment has obvious risks (Stocchetti 2005).

The high pH value resulting from hyperventilation also reduces the level of available calcium (hypocalcemia), which affects the nerves and causes the numbness or tingling of the hands.

I saw a lot of "I'm not a doctor but..." comments. Here are answers from a real doctor.

1) One time use of the stupidly named "Plan B" is much different than regular use of a birth control pill for years. Birth control pills do have side effects. Women differ greatly in their response to birth control pills, which is one reason why there are many different pills with different dosages and hormone combinations. Birth control pills can alter the metabolism of other medications resulting in either overdose or inadequate effect. This could be very serious for an epileptic or for someone taking antibiotics.

That being said, I favor letting pharmacists dispense birth control pills after asking appropriate questions of the patient before selling the pills and asking relevant side-effect questions at each of the first few refills.

2) A physician could not tell the difference between an RU486 (mifepristone) abortion and a spontaneous miscarriage. However, a toxicology laboratory could detect mifepristone in a blood sample. Mifepristone has a long halflife (approximately 33 hours) and the drug or its metabolites would be detectable for at least 6 days after use. Thus, if such methods of abortion became illegal, women might have to avoid formal medical care for well over a week after taking RU486. This would result in many unnecessary complications and probably some deaths.

3) Lightheadedness and dizziness can occur due to hyperventilation. In an effort to get more oxygen, asthmatics often hyperventilate. This lowers the concentration of carbon dioxide in the blood and makes the blood more alkaline. Other symptoms associated with hyperventilation include tingling or numbness in the fingertips and around the mouth, muscle spasms (especially in hands and feet), weakness, and a feeling of unsteadiness. Relaxation and regular breathing will correct the carbon dioxide problem, and the symptoms will go away within minutes.

My specialty is laboratory medicine. You can confirm my Tennessee licensure at http://www2.state.tn.us/health/licensure/index.htm

I'm very fuzzy on Plan B because my situation and methods kind of preclude its use - isn't it pre-implantation? I understood that it had to be taken within about 3 days of the unprotected incident in order to be effective. In that case, wouldn't the only clue to its use be a period at the wrong time? (Barring tests for metabolites, which seem to me to be a kind of "probable cause" thing - you wouldn't give them to every woman whose cycle wobbled, even if you were the most draconian pro-lifer ever.)

I had a very early miscarriage years ago that was basically that way. It was accompanied by strong cramps that scared me, but only because I never actually get cramps normall
y. (Lucky me.) If I hadn't taken a pregnancy test, and if I normally had cramps, I would just have thought my period was off-schedule by a week or so.

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