Plan B Battles Embroil States

[MountainLaurel]

Sigh.

:mad:

Filling a void left by the Food and Drug Administration's inability to decide whether to make the "morning-after" pill available without a prescription, nearly every state is or soon will be wrestling with legislation that would expand or restrict access to the drug.

More than 60 bills have been filed in state legislatures already this year, and that follows an already busy 2005 session on emergency contraception. The resulting tug of war is creating an availability map for the pill that looks increasingly similar to the map of "red states" and "blue states" in the past two presidential elections -- with increased access in the blue states and greater restrictions in the red ones.

Many of the state bills intended to expand access give specially trained pharmacists in states including Maryland, New York, Kentucky and Illinois the right to dispense emergency contraception without a prescription. Other bills require pharmacies to stock and distribute the drug, and to ensure that the pill is made available to women who come into emergency rooms after a sexual assault.

But some bills would make it more difficult for many women to get emergency contraception, which is effective for only 72 hours after a woman experiences a contraceptive failure or unprotected sex. Legislation in New Hampshire, for instance, would require parental notification before the drug is dispensed, and more than 20 other states will consider bills that give pharmacies the right not to stock the drug and pharmacists the right not to dispense it, even to women with valid prescriptions.

http://www.washingtonpost.com/wp-dyn/content/article/2006/02/26/AR2006022601380.html

[sarahlee]

1. Christofascist Neocon Zombie Brigade on Patrol

A must read educational rant:

So, you don't think there's a war against women's medical freedom in this country? You think they'll stop at overturning Roe v. Wade and we can all live unhappily ever after without fear of further encroachment on our private lives? You don't think they'll do everything in their power to make a woman pay for being a sexual person with forced pregnancies and severely limited access to birth control? You think maybe they aren't vicious enough to penalise a woman who needs oral contraception to regulate, say, cysts that might appear should she not take it?

And what's next, after that? A panel of upstanding white Christian men to weigh the evidence presented by a doctor submitting his patient for a D&C to eliminate the cysts brought about by lack of management with oral contraceptives? Make sure they're not trying to sneak in a D&C to get rid of unwanted tissue that ISN'T cystic in nature?

You naive motherfucking fools.

This is the proposed law behind which Governor Matt "Dick" Blunt of Missouri has thrown his full support:


SB 609 "Protects the Conscience Rights of Pharmaceutical Professionals"

More...
http://www.dailykos.com/story/2006/2/27/10558/3124


And all women should bookmark this site:
http://www.sisterzeus.com/

[MountainLaurel]

3. Great links.

We need to be as educated as possible on these topics.

[sarahlee]

4. Here is another

http://mollysavestheday.blogspot.com/2006/02/for-women-of-south-dakota-abortion.html

[sarahlee]

6. Critical Information about Emergency Contraception

More information in a followup Kos Diary at:
http://www.dailykos.com/story/2006/2/28/25814/7830

The following info comes from NancyK and jiffykeen in the comments to the above - posted at:
http://www.dailykos.com/comments/2006/2/28/25814/7830/67#67

=======================

Go to the PubMed search page, enter the search terms "emergency contraception implantation ovulation", and look at some of the abstracts listed. According to current research, Emergency Contraception (EC) doesn't appear to have any post-fertilization effects. (Note that this may not be true for traditional contraception, since dosing regimens are very different; I haven't looked into it.)

Some of the people opposing EC are being very consistent, by their own logic, but this research pulls the rug out from under them. Yet nobody seems to know about it!

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=pubmed


Mechanism of Action

Combined oral contraceptives (what most of us think of as "the pill"):
* thicken cervical mucus to prevent sperm penetration into upper genital tract
* Block the LH (luteinizing hormone) surge and thus inhibit ovulation. "Escape ovulation" or the amount of time ovulation is not suppressed in someone taking the pill regularly is estimated to be about 2%, perhaps higher in the lower dosed pills
* slow sperm motility, which may delay sperm transport.

Some progestin effects additional alter the environment that would be required for embryogenesis to proceed:
* disrupt transport of the fertilized ovum
* induce endometrial atrophy, (changing the womb structure)

So probably 98% of the time, the pill works by inhibiting ovulation. It would be incorrect to say that it never works by preventing implantation

Emergency Contraception:
There are two major forms of emergency contraception: progestin only (Plan B) and combined oral contraception (Preven)-not currently available
In essence EC is giving a higher dose of oral contraception, at one time. Plan B involves .75 mg of Levonorgestrel at one time and is given 12 hours later after the first dose. Studies show that it can be given all at once.

The effect of EC depends on when it is in the women's cycle. Before ovulation has occured, it works by disrupting normal follicle development and maturation resulting in anovulation or delayed ovulation. In contrast, when the treatment is administered after ovulation has occured and fertilzation has taken place, it is unknow exactly the process of prevention of pregnancy. Some of the research suggests impaired endometrial receptivity to implantation, interference with corpus luteum function, alteration of cervical mucus resulting in trapping of sperm, and direct inhibition of fertilization. So it may work by inhibiting fertization or implantation.Analysis of EC effectiveness in relation to the timing of intercourse in relation to cycle day found that effectiveness was substantially higher when intercourse and treatment occurred before ovulation, so inhibition of implantation is unlikely to be the primary mechanism of action of this method.

RU-486 is not an estrogen or progestin but an anti-progestin and blocks the effects of progesterone. It is used in pregnancy termination before 7 weeks of pregnancy, however, it will also prevent pregnancy if it is administered within 5 days after unprotected intercourse.

I think that it would be inaccurate to suggest that ECs do not work by preventing fertiliztion or implantation. It seems pretty clear cut that it works by preventing ovulation when administered to a woman in the pre-ovulatory phase of her cycle. There is not enough evidence, apparently, to definitively say how it works when administered after ovulation.

Almost all combined oral contraceptives can be used as EC if given in the correct doses. If a pharmacist won't fill the script for EC, ask the health care provider to prescribe a month's worth of OC and tell you how to take it.

Example:
Ovral: Take 2 white pills then 2 white pills 12 hours later. (similar to Preven, which is off market)
Ovrette: take 20 yellow pills then 20 yellow pills 12 hours later (same as Plan B)

[sarahlee]

8. THIS SB609 BILL IS MUCH WORSE THAN YOU THINK

THIS SB609 BILL IS MUCH WORSE THAN YOU THINK.
by hekebolos

Posted at
http://www.dailykos.com/storyonly/2006/2/28/25814/7830

Let me start by restating the stipulations of SB609:

Employers cannot refuse to hire, discriminate against, segregate, or terminate a pharmaceutical professional because of their opposition to any service involving a particular drug or device that they have a good faith belief is used for abortions.

Now, of course it's true that most people who hear this are going to believe that all this law does is allow pharmacists not to dispense RU-486 if they don't want to--failing, of course, to realize that pharmacists don't dispense RU-486 to begin with.

MSOC is correct in pointing out that this is an assault on the availability of birth control, but what she failed, in my view, to realize is that this assault isn't being done only by engendering confusion among the populace between RU-486 and the morning-after pill--it's a cold, calculating logical maneuver.

You see, MSOC is of course right about the difference between RU-486 and progestin-based contraceptives: RU-486 ends an established pregnancy, whereas progestin-based contraceptives, like The Pill and the morning-after pill, do not.

<...>

If one defines life as beginning with conception, as the Wingnuts are more than happy to do, the morning-after pill--and even The Pill itself--have the capability to cause a fertilized egg not to implant, and thus TO CAUSE AN ABORTION THAT IS BY THAT LOGIC NO DIFFERENT FROM THOSE CAUSED BY RU-486. It doesn't really matter that at least half of fertilized eggs fail to implant anyway, which by Wingnut logic would mean that God is conducting a perpetual and massive holocaust every single day. It just matters that by the "life begins at conception" logical standard, there is no difference between RU-486 and progestin.

If, at any future point in time, this bill becomes law and any other previous or future bill in the state of Missouri defines life as beginning with conception, any pharmacist anywhere will have the legal right not to dispense birth control--simply because progestin can sometimes prevent implantation.

MSOC is right: This is an assault on the availability of even simple birth control. But it's not coming from the platform of "lack of logic and understanding" that she thinks it's coming from. It's coming from a frighteningly well-calculated logical position. If we want to fight for availability of birth control, we need to realize what angle they're taking on this--and shut it down before it gets a chance to implant.

In the comments....

What segregate means

It's hideous. What it is saying is that employers cannot separate out the delivery of drugs by different pharmacist employees, so as the faith-based folk never work with the drugs in question.

It is a backdoor way of preventing any pharmacist from delivering any drug which even only one pharmacist "has a good faith belief is used for abortions."

It can exclude a chain of a thousand pharmacies from delivering birth control pills because one and only one pharmacist in South Milwaukee objects.

It has nothing at all to do with civil rights in the sense of the 1950s and 1960s.

by TarheelDem

http://www.dailykos.com/comments/2006/2/28/25814/7830/44#44

What this seems to mean is that if you hand your script to a pharmacist who has a moral objection to filling it, you can't take it back and hand it to another pharmacist, standing 2 feet away, who has no problem filling it.

[Megahurtz]

9. No Fucking Way!

These Religious-Zealot-Control-Freaks will not turn us into a bunch of breeding cattle!
They can try but too fucking bad!!!:mad:

[Ayesha]

2. Grrrrr

I wish these idiots would get it through their thick skulls that this drug PREVENTS the very abortions they so despise.

There is no way that a two-cell fertilized egg has consciousness, awareness, or suffers if it is killed. At this stage it's basically an amoeba with human DNA. But of course, they'd rather punish a woman with pregnancy than prevent an unwanted child, even if abortion is not required to do so.

[Nobody]

5. I question how good someone would be as a parent

who sees children as being punishments.

[MountainLaurel]

10. Too many people do

How many times have you heard someone, when speaking of a pregnant teenager, use the phrase "You made your bed, now you have to lie in it"? Hell, a high school friend of mine has a cop tell her that when she reported her boyfriend for trying to kill her -- she still had bruises in the shape of his hands around her neck. But apparently, poor teenage mothers from the hills don't deserve safety.

[Nobody]

11. Way too many times

The favorite phrase in England was: "She's no better than she should be" especially in the 1800s after the pregnant servant girl who was raped by the man of the house ("seduced" is the euphemism used - could she really have said no to him? Would she have been believed if she reported his assault?) was thrown out without references, and in service, no references means no more honest work ever again.

The TSKers in my opinion are the ones who regard children as a punishment far more often than those who are TSKed at. And these TSKers are the ones I'm grateful not to be the daughter of.

[sarahlee]

7. Dr. Comments on Missouri Bill

A bit of background... )

...sadly, I live in Missouri (ironically, it's because one of the best medical schools in the country is in St. Louis. Don't get me started on the contradiction in terms that is St. Louis. Or Kansas City for that matter.)

This bill, I'm sure, has been in the works for a while, but the reason it's coming to the forefront now is because our neighboring state of Illinois is cracking down hard on these fundy pharmacists. I think they recently passed a law requiring the pharmacies to have pharmacists on staff at any particular time to fill valid prescriptions. And if they don't, the pharmacies (not the pharmacists) get hit with very heavy fines for each violation. Which means what 4 pharmacies have done in the Metro East region (the population center in Illinois immediately east of St. Louis) is essentially to fire (or place on leave) the fundy pharmacists who were refusing to dispense plan B.

So, this gets big press in St. Louis and I'm sure elsewhere in the state, and to the wingnuts around here, these 4 pharmacists are something of a cause celebre. So, that's why this bill is coming up now, essentially it's a wingnut way of saying "screw you Illinois." (which if the state's denizens had no ability to constantly disparage either Illinois or Kansas, they would cease to exist)

In any case, both MSOC and the diarist are completely on mark here, this bill has been very carefully crafted and I'm sure, if passed, will be one of the new SCOTUS tests to see which way the Catholic bloc votes. It may be their way around Griswold, which means if you strike down Griswold, you strike down Roe by extension.

Of course, that means all you MDs out there may as well hang up your stethoscopes now, because if Griswold is no more, that means the state can have complete control over what people do with their bodies, and by extension that means they can dictate to doctors what treatments patients can and cannot have. Insurance companies could essentially codify into law strict guidelines for certain medical and surgical procedures and pharmaceuticals, if the patient is unable to pay for said services.

People should not be afraid of their governments. Governments should be afraid of their people.

by viget

http://www.dailykos.com/comments/2006/2/28/25814/7830/85#85