my letter to Medical Marketing & Media

I just sent a letter to the editor of Medical Marketing & Media (no idea why I get it, let alone read it), complaining about a column written by a NYU internist in favor of restricting emergency contraception to “by prescription only.” He feels if it were available to teens over the counter, it would be “a mistake.” The FDA disagrees with him, as do I. Sadly, the Obama Administration overruled the FDA.

To the Editor:

While I have always considered Dr. Marc Segal’s column in Medical Marketing & Media to typically represent views that are conservative and thus quite the opposite of mine, I was particularly taken by his remarks against making emergency contraception (specifically, Plan B) available over the counter to young women under the age of 17. In contrast to the findings of the FDA committee that recommended its approval, Dr. Segal puts forth several rationales for his decision that fly in the face of medical evidence. 

For example, he maintains that OTC status would pose a risk of ectopic pregnancy, as he postulates that young women might assume Plan B has worked and fail to heed signs of an ectopic. There is no data to support this, and even if Plan B were not available, women of all ages may have an undiagnosed ectopic pregnancy regardless of the availability of emergency contraception. Taking EC does not make one more likely to “ignore” signs of an ectopic pregnancy.

I suspect his issue is more with the primitive, and unproven, notion among some people that anything that prevents undesired pregnancy will somehow corrupt our youth. This is suggested by his assertion that making Plan B available without prescription to teens would lead to “Undiagnosed sexually transmitted diseases that often accompany unprotected sex in teens.” I realize that Dr. Segal is not a gynecologist, but even he should know that STDs may accompany unprotected sex regardless of whether or not emergency contraception is available. The availability of emergency contraception does not increase licentiousness or STDs. It does, however, decrease the incidence of undesired pregnancy, and also can decrease the need for abortion. Indeed, one of the sad things is that despite the availability of Plan B to adults, many do not take advantage of it. 

I do not disagree with Dr. Segal’s assertion that “A discussion about sex and pregnancy is an opportunity for a discussion between a doctor and a teen…” But in reality, such discussions often do not take place in medical offices. Nor do many teens (and adults, for that matter) heed a physician’s advice about sexual intercourse, smoking, or many other lifestyle matters. 

All drugs have side effects. That includes all medications that are available over the counter. The known side effects cited by Dr. Segal, such as “Allergy and facial swelling” and “Nausea and vomiting” are also side effects common to many OTC drugs. Aspirin can be nephrotoxic and induce gastric bleeding and platelet dysfunction; acetaminophen is well known to be hepatotoxic at higher doses. Does Dr. Segal suggest those drugs be restricted to “by prescription only?”

Teen pregnancy is difficult and generally undesirable. We need to do more to prevent it. Emergency contraception is one approach, and I’m disappointed that any physician would propose in a national magazine that EC not be made available to teens under OTC status. Again, the FDA had recommended Plan B be made available over the counter, and regrettably the Obama Administration, probably for political reasons, chose to ignore their evidence-based recommendation. Unproven speculation about treatments with an important benefit for public health should not be given credence by publication in a magazine such as yours.