Comments on: England Pilots Non-Prescription Birth Control Pill Program

By: Sam

Sam — Sat, 06 Jun 2009 14:29:07 +0000

In response to Shae,
The fact is that doctors are supposed to obtain informed consent from patients for smears.
Cervical screening has nothing to do with birth control – this is an unethical practice adopted by doctors to force women into testing.
The smear is an unreliable test for an uncommon cancer which means lots of incorrect results called false positives and false negatives.
Yearly testing means 95% of US women will have a colposcopy & biopsies – these are unpleasant procedures – some women are harmed psychologically and physically. Some women are left with permanent damage that affects fertility and causes problems during pregnancy. (Two yearly – almost 78%….3 yearly – 65%)
It is for these reasons that the test is supposed to be offered….not demanded – there are risks as well as benefits – informed consent is vital when a test is offered to healthy patients.
Sadly, most women don’t have the facts…hardly surprising….they are withheld from women.
The lowest rates of cervical cancer in the world is in Finland – they don’t commence screening until you’re 30 and then only every 5 years…women are given complete information and the decision to screen or not, is left to them…
Young women have a high risk of intervention for changes that disappear on their own….this cancer is rare in women under 30 and many believe this test does more harm than good in this age group.
Screening every 5 years also minimizes the number of women having biopsies (although it’s still very high at 55%)
To give you an idea of the risk of this cancer, look at statistics released by Dr Angela Raffles (UK cervical cancer screening expert) – 1000 women need regular testing for 35 YEARS to save ONE woman from cervical cancer!
The fact is….smoking or being very overweight or mountain climbing are MUCH greater risks to your health than failing to screen…
Whether women have testing, at what age and how often should be the woman’s decision – we’re not children…we’re all individuals and will feel differently about the type and amount of risk we carry in our lives.
I’m a low risk woman and have declined screening – for me, the risks far exceed the benefits.
I’ll live with the tiny risk of this cancer…
Others may prefer to risk a colposcopy/biopsies to reduce their risk of cancer as far as possible.
Screening does not reduce your risk to zero – one third of the 1% of women who get this cancer have received one or more false negative smear results. These women may be disadvantaged by screening as they may be reassured by the incorrect result and delay seeing a doctor for symptoms….so end up with a later diagnosis. (By the way…just 0.66% of women benefit from screening – DeMay Article)
It is so important to do your reading – doctors are pushing screening tests more and more – they generate HUGE amounts of money…but they ALL carry risks as well as benefits.
The risks associated with mammograms are also, false positives, unnecessary biopsies and surgery and the discovery of ductal carcinoma in situ…a slow moving cancer that usually does not bother a woman, but once biopsied, it can become invasive and once diagnosed, the breast usually comes off…(almost 40% of older women have some DCIS)
Also, new research that suggest regular screening may INCRESAE the risk of breast cancer – perhaps, because of the radiation or the bruising or both….
Prof Michael Baum, UK breast cancer surgeon, helped set up the first breast screening clinic – he now believes the risks of mammograms exceed the benefits. He is also concerned about cervical screening.
In both cervical and breast cancer screening, doctors have ignored the need to obtain informed consent and have used many unethical practices to force and frighten women into testing…this is disrespectful and unacceptable.
The very small number of women helped by screening is at a huge cost to healthy women. Also, the reduction in deaths from cervical cancer does not factor in the large number of women who’ve had complete hysterectomies – in the US, it’s one in four women…that must have an impact on death rates. Yet any reduction is claimed by the screening lobby.
I think the Pill should be available over the counter…once the pharmacist establishes the woman is a suitable candidate (not a diabetic, have high blood pressure etc) and a simple blood pressure check is all that’s required every 3 months. The WHO and many other medical associations have confirmed this is all that’s required (and have done so for many years)
Yet doctors in the States still require women to have annual breast, pelvic and rectal exams and annual screening – all totally unnecessary in asymptomatic women and annual screening exposes you to a high chance of a false positive. (Routine breast exams are NOT recommended in Australia before age 40 due to the high chance of a false positive and because cancer in this age group is uncommon) Also, mammograms from age 40 expose you to a high chance of harm – Australia offer them from 50…although, I’ve already decided not to have mammograms when I reach that age. Routine pelvic & rectal exams are only recommended in one other country…Germany.
Women should therefore be free to decline these exams when they’re not even recommended in other countries. My Dr said they can be harmful and are of low clinical value in the absence of symptoms.
(See: RMDeMay, “Should we abandon pap smear testing” Jnl of Cl Pathology 2000 & L. Koutsky, Cancer Prevention, Fall 2004, Issue 4)
There is also a great article in the Guardian called, “Why I’II never have another smear test”….which contains comments by Dr Raffles and Prof Baum
Hope this information inspires a few women to start reading!

By: Star

Star — Tue, 10 Feb 2009 11:14:44 +0000

That is so amazig for us! Thanks!

By: Rhonda

Rhonda — Wed, 07 Jan 2009 18:51:31 +0000

I’d disagree with anyone telling me I could pick up any long-term drug over the counter without first consulting a doctor. I’d rather speak with a professional about my health, its my body but I wasn’t trained in knowing how the various drugs in various medications would interact with MY body type, family history, and personal health. More power to the women who take advantage of this opportunity but I doubt the FDA would allow for this in the US.

By: Ellen

Ellen — Wed, 07 Jan 2009 18:28:24 +0000

Hey William, You would like this book: Health, Illness, and the Social Body, by Freund and McGuire. It is about the new moral authority of doctors and illness as social dissent. You’re right, I didn’t mention it in that last post, but I did a few posts back. Doctors have replaced religious the moral authority.

By: William

William — Tue, 06 Jan 2009 04:54:14 +0000

All of these specialists are providing equivalent care to a GP yet running up massive costs with all their playtoys.

I think you’re misunderstanding my argument. I’m not saying that we should do away with GPs and just have specialists. My point was that the same argument you’re making for reducing the number of hours specialists bill applies to GPs as well. What I was saying was that we use doctors for a great many things that we don’t really need them for. I don’t really need a GP for much outside of emergencies. I see my GP twice a year to maintain my prescriptions for various nootropics and to get an annual physical. Theres no reason an NP or PA couldn’t do those jobs just as well, and the only reason I even show up twice a year is because one of the prescriptions I’m on is more carefully regulated than usual. Birth control is pretty much the same story, a doctor simply doesn’t need to be involved in the vast majority of cases. We don’t need doctors to act as gatekeepers or to sign permission slips.

And that, in my opinion is the biggest problem, that medicine is driven by politics and profit rather than science, sound research, and health.

You forgot autonomy. No matter who you’re seeing, doctors need to understand that they are sources of expert information rather than authority figures. The issue of power and social control is too often left out of these kinds of discussions. The idea that birth control ought to be by prescription so women have no choice but to get a yearly test for their own good as popped up in virtually every discussion of this program I’ve seen.

By: Ellen

Ellen — Tue, 06 Jan 2009 03:33:46 +0000

PharmD, I completely agree with you about specialties driving the costs up. Hospitals and specialists now advertise all of their playtoys, so that we think we are getting substandard care if we are offered the more rational, and usually more cost effective choice. The same thing is happening with pharmaceuticals. Many of the older drugs (or something novel like exercise) are better than the freshly patented ones in the commercials, but we want the most expensive because we think it means better. All of this is driving costs up.

But I disagree that NPs and PAs have had all restrictions lifted. In Oregon maybe, but in most other states, they still have to work for a doctor, and this, in my opinion, is one thing that keeps costs high. And if the only difference between an MD and the others is the capacity to refer, then that is a problem.

And William, I agree with you that the government and medical establishment collude to limit patient choices too often. It is amazing how many medical decisions are based on politics rather than science. I don’t think they think we are stupid. But the AMA, the pharmaceutical industry, and the insurance industry are all very powerful, have a lot of money and power at stake, so they spend millions lobbying the government. And that, in my opinion is the biggest problem, that medicine is driven by politics and profit rather than science, sound research, and health.

Another huge problem is that through professionalization, medical school became too long (in the US), too competitive, and too expensive. By the end, many doctors feel entitled to huge salaries, to be in control of the other medical professions (with nobody in control of them), and in the end don’t really relate to patients anymore. There are many great individual doctors out there, but they have usually had to fight the process to get that way.

By: PharmD in TX

PharmD in TX — Tue, 06 Jan 2009 01:13:39 +0000

Doctors are necessary for a great many things, but those things are generally specialties. When I go to my GP they’re essentially interchangeable with an NP; they are going to ask the same questions, order the same routine blood tests, use the same metrics in the office, and cull pretty much the same information from my medical history.

there’s one difference, and its that when compared to family physicians, midlevels do a lot more referrals to specialists.

The incursion of specialists is a HUGE reason as to why healthcare costs have skyrocketed. Any time you introduce a specialist = invasive expensive testing thats uncalled for. Its the 45 y/o stable angina patient getting cathed every 6 months instead of doing risk factor modification first. Its the

In 1995, the average Medicare patient saw approximately 3.2 doctors per year. Now in 2008 the average number is over 10, DESPITE the fact that NPs and PAs have seen virtually all of the restrictions on their practice lifted.

Referrals to specialists have skyrocketed, and all these specialists are doing unnecessary expensive procedures to patients that in previous years would be treated just fine with just a family physician.

Now everybody with OA has a rheumatologist. Everybody with HTN has a cardiologist. Everybody having a baby has an OB/GYN MFM subspecialist. All of these specialists are providing equivalent care to a GP yet running up massive costs with all their playtoys.

By: PharmD in TX

PharmD in TX — Tue, 06 Jan 2009 01:06:02 +0000

What you guys dont understand is that PAs and NPs can already do anything a doctor can do, yet costs havent gone down, they continue to go up.

An NP can script for any drug that a doctor can script for.

An NP can open up a clinic just like a doctor can.

Do you think pharmacists are just going to counsel patients for free on birth control? Dream on. They are going to charge money just like a doctor or NP would. Some of you seem to think that pharmacists are just going to be nice and cheery about it and volunteer to do the counseling for free. You’ve got a shock coming to you.

OCPs should be over the counter, with NO interference by anybody, whether it be pharmacist or MD.

By: William

William — Mon, 05 Jan 2009 05:56:41 +0000

PharmD in TX: I think there certainly are parts of the medical field that are superfluous. Doctors are necessary for a great many things, but those things are generally specialties. When I go to my GP they’re essentially interchangeable with an NP; they are going to ask the same questions, order the same routine blood tests, use the same metrics in the office, and cull pretty much the same information from my medical history. For drugs without many risks (or even for drugs with significant but easily avoided risks) the involvement of an actual MD is make-work for the medical field. England seems to have figured out that this is the case with a lot of drugs and is investigating whether or not birth control might be another thing that an actually doctor doesn’t generally need to be involved in.

Too often the government and the medical establishment collude to limit the choices of patients under the theory that we’re just too stupid, irresponsible, and ignorant to be trusted to make our own decisions without adequate supervision. There seems to be this belief, and it is most prevalent amongst doctors, that the average person needs to be treated like a child. Even people who claim to believe that the average person doesn’t necessarily need to be treated like a child quickly defend pretty much every infantilization and restriction upon patient autonomy as being vital to protect the tiny portion of the population which might have an adverse reaction or do something foolish. The end result is more billable hours for physicians and less agency for patients.

By: Ellen

Ellen — Sun, 04 Jan 2009 21:06:29 +0000

I never said MD’s were superfluous, but I do think that the AMA lobbies to control every aspect of medicine, which is not only not necessary, but drives the cost of health care up.