 Sept. 30 - Oct. 3, 2003 |
| ASSEMBLY EDITION • NEW ORLEANS |
The AAFP Congress of Delegates approved a substitute resolution Wednesday that called on the Academy to support a proposal under consideration by the FDA to make progesterone-only emergency contraception available over the counter.
 Hugh Taylor, M.D., defended the safety record of progesterone-only contraceptives. |
The 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 combined elements of three separate proposals introduced by the New York AFP, the Resident and Student constituencies, and the Joint Constituency of the National Conference of Special Constituencies.
The measure passed hands-down on the Congress floor without debate, in stark contrast to the considerable testimony presented on the issue to the Reference Committee on Public Policy. The committee ultimately decided, after long deliberation, to support the measure.
"I have had a number of patients calling me in the last few weeks requesting the pills," alternate delegate Mary Campagnolo, M.D., of Mount Holly, N.J., told the reference committee. She joked, "Maybe it was the hurricane in recent weeks out East -- everybody staying inside."
Those in favor of the substitute resolution 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.
"I saw a proposal that would give a pharmacist the right to prescribe the pill," he continued. "We felt that was not wise. We felt that making them over-the-counter was the most logical way to go."
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.
Others argued that it was important for patients to take the medication within a limited amount of time to have the most positive patient impact. "If a teenager has a 'whoops' on a Friday or Saturday night, they can't wait until they get to a doctor on Monday," said alternate delegate Susan Kinast-Porter, M.D., of Albany, Wis.
Pennsylvania AFP President Ronda Filer, M.D., of York, Pa., pointed to a poll in her state that showed 23 percent of sexual assault victims weren't offered any emergency contraceptive in the state's emergency rooms.
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.
"A few years ago, a drug company was sued because the patient said a contraceptive jelly did not work," said FP Carol Featherstone, M.D., of New Hope, Minn. "It turned out that she had used it by spreading it on toast and eating it."
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."
Witnesses also disagreed on the mechanism of action of the drug, such as whether it was a form of contraception or an abortion drug. "It does not prevent pregnancy, it prevents implantation," said FP Inis Bardella, M.D., of Pittsburgh. "It is an abortifacient."
One supporter referred to a Sept. 12, 2002, New England Journal of Medicine report that concluded that over-the-counter emergency contraceptives did not undermine the use of traditional nonemergency contraceptives.
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