August 25, 2006
Thesis topic
How many unintended pregnancies resulted from the three-year delay between the time FDA scientists decided that Plan B should be approved for over-the-counter sale and yesterday, when FDA leadership finally stopped dragging its heels and approved an idiotic pseudo-compromise? Of those, how many ended in abortion?
Note that state-to-state variation allows cross-sectional as well as time-series studies; the questions may in fact be answerable. But there's benefit in just asking them, long and loud.
Footnote Why do I say "idiotic pseudo-compromise"? Because yesterday's decision will make Plan B available to anyone over 18, including men. So the only minors who will be deprived of access are those who don't know any grown-up who will buy for them after the fact and lacked the good sense to acquire an emergency dose before the fact.
No doubt they'll make exceptionally fit mothers.
Sorry Mark, nice idea for a thesis but the New York Times says there's no "there" there. Bear in mind that this is after a considerable rewrite -- the quote from this morning was much more dismissive of the idea that Plan B would prevent abortions.
"Studies suggest that both the anti-abortion groups and abortion rights advocates are wrong in their predictions of the pill’s effect on the number of abortions performed each year and on the rate of sexually transmitted diseases. Couples in the United States have so much unprotected sex — half of all pregnancies are unplanned — that even if the pills were passed out like aspirin, they would be unlikely to cause a major change in abortion and disease rates."
The original writing had this paragraph following a quote of a conservative arguing against Plan B by saying it would increase promiscuity and disease, and then a quote of a liberal activist arguing that it would reduce the number of abortions. The implication was that if it didn't have a huge impact on abortion rates, then liberals would have been misguided in advocating its greater availability because it really wouldn't have all that much effect. If I remember correctly, the original version may also have used the image of pills passed out like candy rather than like aspirin....
Posted by: Alex F at August 25, 2006 03:19 AMMy jaw dropped yesterday when the conservative anti-science view hit me square.
J.C. Watts was defending his position that Plan B is not a contraceptive, despite science saying so (to the point of stating that Plan B is ineffective against a fertilized egg).
Saith Watts:
WATTS: Well, it's ironic, Wolf, that we say it's a contraceptive, but you take it the morning after.
Has the conservative position moved? Do they believe that life begins after sex? I think I agree with them, finally, especially as I lie back smoking a cigarette!
Posted by: Rich at August 25, 2006 03:46 AMBy making it an OTC drug, then pharmacies are free to *not* carry the drug. If it remains a prescription-only product, pharmacies, and especially Walmart's pharmacies, *have to* carry it, even if they wish not to.
Posted by: Peter at August 25, 2006 06:53 AMAlex:
If not having Plan B OTC caused an additional 10,000 unwanted pregnancies a year, that would be a very small addition, proportionately, to the number of unwanted pregnancies, but it wouldn't be a small amount of totally unnecessary suffering. This is one case where the starfish principle applies: solving a small part of a big problem is better than not solving it.
Posted by: Mark Kleiman at August 25, 2006 08:09 AMRich, your comment--not Watt's--is the one that's off target. Plan B is effective at preventing the implantation of a fertilized egg. That's one of the ways it is thought to operate. For example, the CBC says: "According to the makers of Plan B and EC pharmacists, it will do one of three things to your body:
1. Temporarily stop the release of an egg from the ovary (ovulation).
2. Prevent fertilization of the egg.
3. Prevent a fertilized egg from attaching to the uterus (by making the uterus inhospitable)."
They can say that in Canada because there's much less public opposition to abortion. In the US the sales process is a bit different.
Mark, if the increased availability leads to greater risk-taking regarding sex and contraception, and particularly if it changes the norms regarding unprotected intercourse, it's entirely possible that we'll see an increase in unplanned pregnancies.
More interesting to me is the suggestion that minors as incompetent as you describe them are capable of evaluating the risks and the morality of their actions here without any parental guidance.
Posted by: Thomas at August 25, 2006 08:48 AMBy making it an OTC drug, then pharmacies are free to *not* carry the drug. If it remains a prescription-only product, pharmacies, and especially Walmart's pharmacies, *have to* carry it, even if they wish not to.
Posted by Peter at August 25, 2006 06:53 AM
-----------------------------------------
Excellent point, Peter. That has been a consistent problem at WalMart and Target. I joined a letter-writing campaign spearheaded conjointly by NOW and NARAL, and the response they (Target) to me was that they would not tolerate such behavior (refusing to fill prescriptions) by any employee. Just for kicks, I sent a friend in to a Tennessee Target with a prescription we had her gynocologist mother write for her. What do you suppose happened?
Mark, sorry if I was a little unclear. I absolutely agree with you. I was criticizing the Times for resorting to the "Pox on both houses" theme, when the only pox they could throw on liberals was so terribly weak. Liberals want to expand access to Plan B so that more people can use it, but even with greater access *not enough people will use it*.
Posted by: Alex F at August 25, 2006 04:06 PMIf I was doing this study, I'd wait until we had at least 3 years of data to find out how Plan B fares in the market. If it's a dud, then nobody would've used it in the last 3 years anyway, so it would've had no effect on unwanted pregnancies.
If it's a hit, then we can begin to extrapolate how consumers would've used it 3 years ago.
Not to mention, in 3 years we'll know how Plan B effects sex habits, and whether it will indeed change behavior.
Posted by: Grumpy at August 25, 2006 06:57 PM"More interesting to me is the suggestion that minors as incompetent as you describe them are capable of evaluating the risks and the morality of their actions here without any parental guidance."
I'm not sure what this is supposed to mean though of course "anything to be contrary to the left" is perhaps what your goal is. The quote:
So the only minors who will be deprived of access are those who don't know any grown-up who will buy for them after the fact and lacked the good sense to acquire an emergency dose before the fact. No doubt they'll make exceptionally fit mothers.
I'm not sure how "incompetent" MK is making them out to be. Does this mean not being mature enough to have a child? Or, who do not know or trust grown-ups willing to get involved? Surely, no teens are troubled in this fashion. And, if they are they clearly are "incompetent."
Likewise, many adults have sex w/o protection "before the fact." Finally, "guidance" is not being addressed here. This isn't a parental notification law or something, is it? They can get plenty of "guidance" from let's say skilled counselors or even parents. This doesn't necessarily mean these people are going to buy it for them. In various cases, such people think this will promotion sexuality. Absistence only programs suggest the ultimate value of this approach.
Anyway, as to more pregnancies, this is a tough calculus, so I will put it aside, except to the degree that modern contraceptives seem to have cut down birth rates, and not just because of prevalance of abortion. Why this one, as compared to birth control pills etc., should increase them is unclear.
I do note that there is some implication that preventing fertilization is "abortion" or fertilization is "pregnancy." Both are dubious. "Abort" what wasn't implanted yet? Also, conception is often scientifically and reguarly seen as a process that ends with implantation.
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