No Plan, No Worries by Pat Conrad MD

(Note to readers:  This piece is not about the morality of birth control/abortion, nor do I in anyway intend to offer an opinion on that topic.)    
Yesterday, the beneficent central government decreed that the “Plan-B” morning after pill may be sold to those 15 and older.  In late 2011, HHS Secretary Sebelius “said some girls as young as 11 are physically capable of bearing children, but shouldn’t be able to buy the pregnancy-preventing pill on their own.”  Why, Sec. Sebelius, is a 15 year-old allowed to fly solo in the pharmacy, but not an 11-year old?  Clearly you have not dealt with a lot of the tragically ignorant 19- and 21-year olds whose frequent visits to my ER are within the purview of your wisdom.  In a fit of Orwellian hilarity, Sen. Patty Murray, D-Wash said, “It’s also a decision that moves us closer to these critical availability decisions being based on science, not politics.”
I appreciate that the country is now little more than an emotion-driven mob, senator, but please don’t expect me to buy this doublespeak.  This entire move is WHOLLY about politics, and whether or not it agrees with science has never been relevant to you vote herders.
As a physician, who has written a few late-night Plan-B scripts, with pity for the young lady and hope to do good for all concerned, I would be appalled at the further diminishment of my profession, and the loss of ability to help protect patients…if I weren’t so numb to daily such occurrences.  In earlier years, I would protest that the minor girl must have an available adult guardian, and that these are serious medications with real adverse reaction potentials, however infrequent.  I would point out that there is no mandated national data base to judge whether said adolescent is buying a Plan B several times a month, as a prophylactic.  I would wonder at the number of undiagnosed teen pregnancies that will then be unwittingly subjected to the drug, and what the effects might be.  Will there be a new mandatory screening question in ER’s to determine whether the patient is aware of this option, and will documenting such become a future core measure?  Government patients now crowd ERs and urgent care centers for scripts for Motrin in order not to have to pay for it themselves; will this be the preferred access to Plan-B?
As a libertarian, I would wonder about the magic of the number 15, and what this says about our society’s fluid standards regarding statutory rape.  Are males 15 and older allowed to purchase, or just the girls?  If a girl buys Plan B ahead of time, does this in anyway mitigate future criticisms of an amorous 17-year old male who was lured in with foreknowledge?  If  a girl opts not to purchase, does this excuse the bio-father from any further child support liability?  Have we given up on the idea of religious exemption, or will Plan-B not be available for government patients?
As a beaten, callous taxpayer, I might hope for fewer unplanned pregnancies with which to populate the Medicaid rolls.  And as a justified cynic, I note that the very federal government which designs to provide good health care to all and guarantees  its confidential delivery, has now come between doctor and patient once again.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “No Plan, No Worries by Pat Conrad MD

  1. marco
    May 3, 2013 at 7:52 pm

    Make sure that they instruct the users to buy the product prior to the encounter, hold the pill with their knees and not let it go.
    That way I’m sure the effectivity will increase…

  2. J. R. Johnson
    May 2, 2013 at 5:40 pm

    Exhibit A- part B: Here is the link in case you didn’t see the sensationalist segment on 60 minutes about NECC.

  3. J. R. Johnson
    May 1, 2013 at 9:50 am

    I’m not sure I understand your point. You state, “…I would be appalled at the further diminishment of my profession, and the loss of ability to help protect patients…” which sounds like you believe that the FDA has made a mistake by having Plan B be OTC. They you say, “As a libertarian…” which would make you in the camp of little or no regulations or restrictions of medications (legal or illegal). Which is it? Are you for or against Plan B being OTC and are you for or against any age restrictions? BTW, by admitting that you have prescribed Plan B, you have indeed made a comment on your view of the morality of birth control/abortion.

    • Pat
      May 1, 2013 at 1:30 pm

      J.R., as to your last point you are correct, I did make at last a partial, albeit inadvertent, comment. Based on that however, please don’t make further assumptions (well, you can, but I won’t answer them) regarding my stance, as it is not easily categorized.

      To the first point: I would like to see the FDA’s authority reduced, not eliminated, which I think would ultimately do more good than harm for patients and new drug development. As I am absolutely opposed to the War on Drugs, it would be inconsistent to want all legal drugs to be tightly controlled. Where I do draw the line is minors, whose decisions regarding medications should be made by, or in conjunction with their parents. What I’m trying to argue against is the arbitrary nature with which the government will approve this med but not that for this group but not that, based on political expediency. Since physicians value to patients – for advice, counsel, safety – is increasingly defined by government, I note that we have once again been devalued until government decides its time for us to clean up the mess.

      • J. R. Johnson
        May 2, 2013 at 5:31 pm

        My opinion is that if the FDA’s authority is reduced we will have more companies who put patients at risk for the sake of profits. I’m all for the FDA doing a better job, but that shouldn’t mean compromising on quality control.

        Exhibit A:

        In regards to the FDA medication approval process, as you correctly note there is politics involved. Since politics is by nature inconsistent, the approval process is inconsistent but I do not believe it is “arbitrary”.

        • Pat
          May 2, 2013 at 6:33 pm

          Whether one agrees with it, the decision to allow 15- but not 11-year olds to purchase Plan-B was political. Do we really believe that cutoff was scientifically determined?

          If you can find it online, I recommend DeRoy Murdock’s 2005 (?) article in Naional Review Online, detailing a FDA approval process of $800,000 per drug, just to get through testing! Who’s being exploited here?

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