 Hugh Taylor, M.D., defends the safety record of progesterone-only contraceptives. |
BY J. MICHAEL BRODIE
The AAFP Congress of Delegates on Oct. 2 called for the Academy to support a proposal under consideration by the FDA to make progesterone-only emergency contraception available over the counter.
The measure, a substitute resolution, also urged the FDA to approve "appropriate labeling of progesterone-only emergency contraception" packages that would encourage patients to seek guidance from their primary care physicians on proper use of all over-the-counter contraceptives and would include safe sexual practice information.
The substitute resolution passed in the Congress without debate, in stark contrast to the considerable testimony presented on the issue during an Oct. 1 reference committee hearing. The committee had decided, after long deliberation, to support the measure.
Those in favor of an OTC progesterone-only contraceptive told the reference committee about the long-term safety record of the drug and how easy it has been for patients to use. "We do see a need to improve access to the progesterone-only contraceptive pill," said alternate delegate Hugh Taylor, M.D., of South Hamilton, Mass. Making it available on an OTC basis would be a logical way to do that, he added.
Other supporters told the reference committee they wanted to see the drug made more available to the uninsured. "Young people are disproportionately represented among the uninsured, and not many entry-level jobs come with health insurance," said delegate Rachel Wheeler, M.D., of Concord, Mass.
Pennsylvania AFP President Ronda Filer, M.D., of York pointed to a poll in her state that showed 23 percent of sexual assault victims weren't offered any emergency contraception in the state's emergency rooms. All the more reason to support an OTC progesterone-only contraceptive, she suggested.
| Rachel Wheeler, M.D.
"Young people are disproportionately represented among the uninsured, and not many entry-level jobs come with health insurance." |
Opponents of an OTC emergency contraceptive expressed concern to the reference committee that making the drug more available could damage doctor-patient relationships. They argued that there was a danger that some patients would misuse the drug. This could particularly be a problem among teenage girls, who often are not likely to see a physician on a regular basis, they said.
Witnesses also disagreed on the mechanism of action of the drug, such as whether it was a form of contraception or an abortion drug.
Some even questioned the wisdom of having the Academy take a stance on the issue. "The Academy has a policy of staying neutral on contraception," said FP Dave Schneider, M.D., of San Antonio. "This could be the beginning of a slippery slope. This could be a divisive issue."
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