"With nearly 40 percent of all pregnancies in the United States unintended, birth control is a critical public health issue."
But check the actual source and:
"Among women who had unintended births in the United States in 1998–2002, about 40% were using contraception"
So that's very misleading reporting.
Note that they tracked women for 4 years - track someone for their entire life and the numbers who had at least one child while on birth control at some point in their life will rise.
Contraception just isn't effective enough to eliminate pregnancy, it can only function to reduce fertility (number of children).
A typical couple using birth control through their entire life will still have one or two children - which is the average (more or less) of people in the US who choose to have children.
The only function of birth control is to reduce fertility from around 10 to around 2.
"Contraception" in those CDC questionnaires includes all methods including the withdrawal method, rhythm, condoms, pill, vasectomy, etc. You can't really draw a conclusion about the effectiveness of any particular method from that study. Effectiveness per method data is available, though I can't figure out what argument it is that you're trying to make so forcefully. Things like IUD and implants are >99%/year effective.
Sure I read what you wrote. The line you quoted With nearly 40 percent of all pregnancies in the United States unintended, birth control is a critical public health issue. isn't claiming birth control is 100% effective, it's saying that there are a lot of people that might benefit from access.
I posted what I posted because I didn't think it was particularly misleading for the article to state a fact that was important enough to the report to appear in the abstract. Your language But check the actual source also sort of implies that the article had misstated the fact. But it did not.
> it's saying that there are a lot of people that might benefit from access.
Not as many as you would think. The number of people who: 1. want birth control, 2. are unable to get it, 3. had an child as a result, 4. and would have preferred not to, is a much smaller number than the article makes it out to be.
I find that misleading. I don't know why you don't.
These apps are about saving time for people, they will do nothing at all to the national birth rate.
On one level you are right: this will probably lead to some people harming themselves with medication obtained without proper medical advice.
On another level: we should not protect people from themselves. If someone is stupid enough to do something harmfull to him/herself we should let them. Natural selection will do the rest.
This comment completely glosses over the cases of people who can be pushing the button but can be affected by circumstances that they really can't control (like a mental illness). To say that they deserve to die for the sake of "natural selection" is insensitive and frankly disturbing.
There is a problem with birth control that the media doesn't like to talk about. While millions of women take birth control, almost all of them eventually (or immediately) hate the side effects. So most women take these awful drugs only because they are seen as the best way to prevent pregnancy.
Cruising over to reddit's /r/birthcontrol now, this submission was from 16 hours ago:
> So because I was losing hair after I got my Mirena IUD like a labrador in summer, my gyno decided to put me on beyaz (the top anti-androgen) to try and stop that. however, we didn't take out mirena because she "wasn't sure that was what was causing it"... so basically I'm wondering if anyone else is in that situation? [...]
>
> - https://www.reddit.com/r/birthcontrol/comments/4orqo1/im_on_...
Beyaz is not an anti-androgen, it is a drug that uses the synthetic xeno-estrogen ethinyl estradiol, and the progestin drug Drospirenone. Progestins are forms of 'fake progesterone', and usually cause the body's progesterone production to decrease dramatically. Progesterone is also a brain hormone, so this is why women on birth control frequently get depressed.
My girlfriend was hurt by her doctor with birth control maybe 10 years before I met her. They said the depo-provera induced bleeding would stop, eventually. She let them give her a second 3-month injection, then a third 3-month injection... Then she decided the doctors were stupid, and stopped after the 3rd injection. That would've been about a year of direct iatrogenic injury. Maybe this drug directly contributed to her later mental health struggles.
She's amenorrheic right now... 3 or 4 years ago, in her late 20's, some stupid endocrinologists said that her hot flashes were because she was "going through menopause" (maybe that's not what the doctors actually said, but they didn't do anything to help resolve the complaints, so their medical advice was quite harmful, imho).
I'm well aware the my girlfriend could very well pop an egg out at any time. I expect her periods will restart as soon as the underlying condition is addressed. So I've taken out my sperm production using the old heat methods. It works, I've checked.
I like this site's take on the problem:
> Women’s unique health concerns are seen by Wall Street as opportunities for obscene profit. The development of the ‘hormonal’ birth control (so-called) started with good intentions. Science’s understanding of the steroid system has advanced since the 1950’s, and real Scientists now know that the fake-hormones used as ‘birth control’ cannot improve women’s health. But Wall Street has FDA-approved pills to sell and investors’ dividends to pay. The drugs are reasonably-effective at suppressing women’s fertility, but are defective if women’s complete health profile is taken into consideration too.
> Apologists for the hormonal birth control peddlers acknowledge that these drugs have potent side effects. The thinking seems to be “the needs of the many outweigh the needs of the few”: while women are still maimed and killed by prescription birth control, it’s more important that the women who (probably) won’t be killed right away are able to use these drugs to keep babies away.
> The most blatant of Big Drug’s ‘hormonal’ rip-offs are the so-called “emergency contraceptive” pills, where profiteers sell women 1.5-cents of active ingredients for $50.
> Almost all of them eventually (or immediately) hate the side effects
Any source on this? My wife took birth control because of ovarian cysts. She had issues with the first few types, but we eventually found one that has worked for nearly a decade, with no issues. I know of several other women with this same experience. Reddit (or any other forum used for complaints) is hardly a good example to support this.
> but we eventually found one that has worked for nearly a decade, with no issues.
Surely you'd agree that fixing the cause of ovarian cysts would be better than putting women on maintenance medication?
> Reddit (or any other forum used for complaints) is hardly a good example to support this.
Women who share their negative experiences are the Canaries in Medicine's coal mine. The few who are overtly harmed should warn us that there are problems with these prescriptions.
I don't think he/she is discounting the warnings, but simply that Reddit cannot be used to support the 'Almost all of them eventually (or immediately) hate the side effects' arguement and he/she is wondering if there is any data on that.
The cysts were the reason for her taking birth control to begin with, not the cause of the cysts. And cysts aren't something that it's easy (or perhaps even possible) to find a "fix" for.
>So I've taken out my sperm production using the old heat methods. It works, I've checked.
What does this mean? That you raise your .. body .. temperature to the point that potentially some sperm die?
In a consultation for a vasectomy, the urologist strongly wanted that alternative forms of birth control be used for several months as sperm already in the system - unless you're naturally not producing sperm, I doubt the viability of your methods.
Almost all? I think you might be falling victim to selection bias. Not many women cruise over to /r/birthcontrol to talk about how they've been on it for years without any side effects.
You're altering your hormones with everything but the paraguard. We know very well that hormone imbalances cause mood changes. We have no long term data about the mental health effects from birth control. People frequently describe feeling like a zombie or hyper aggressive, and only realizing after stopping their medication.
Seconded. My birth control works great for me, so I don't have any particular need to talk about it unless directly asked. If I was unhappy with it, I'd be much more likely to complain about it and ask other people for advice.
AFAIK, there are no long-term (30+ year) studies comparing women who have never-used, briefly-used, and long-term-used hormonal drugs to suppress their menstrual cycle. The Women's Health Initiative found that prescription horse piss (PREMARIN, made from PREgnant MARes' urIN) was not good for women's health.
I have personally used non-prescription Progesterone USP to recover from a head injury, so I'm inclined to believe the heretical scientists who heckle the birth control peddlers.
My wife has had issues with almost everything she's been on. The only thing remotely acceptable to her has been the depo shot but she still had to deal with migraines, mood swings, considerable weight gain, and body hair. I finally said enough is enough and took the high road: I apologized for the last decade she accepted as "normal human life" and requested her to stop her contraceptives immediately. I called up the doctor and demanded a vasectomy. Problem solved. She's much happier now.
edit: the number of side effects for some of these female contraceptives are staggering and many women aren't aware of the entire scope of possibilities. I suspect most women are affected and don't realize it, just accepting it as normal because their friends have the same issues.
Unfortunately, that headache, migraine, loss of sex drive, yeast infections, increased blood pressure and so on are often thought to be "normal". So many side effects are accepted as a fact of life and hormonal contraceptives as the source to those side effects is widely ignored. By both, women and doctors unfortunately.
Yes, but hundreds of millions of women also bounce around between different types of hormonal birth control (variations in pill type versus Depo shots versus NuvaRing versus Mirena versus the patch, etc.) because they have miserable experiences with physical and/or emotional side effects.
I know this is anecdata, but I know two different young healthy women who suffered strokes or Deep Vein Thrombosis before the age of thirty because of Yaz. (Both fully recovered, thank God, but will never be able to take hormonal pills again for life.)
> I know this is anecdata, but I know two different young healthy women who suffered strokes or Deep Vein Thrombosis before the age of thirty because of Yaz. (Both fully recovered, thank God, but will never be able to take hormonal pills again for life.)
The cause/effect relationship between elevated estrogen levels and clotting disorders is well understood by physiologists. All the old high-estrogen contraceptive pills have been pulled, because the data shows that they were not safe.
Well understood now, yes, but Yaz was heavily marketed to young women as being the latest and greatest thing on the market, and it passed FDA approval and came from major manufacturers -- yet it didn't get pulled off the shelves until 2011, after many deaths and strokes.
I support women having easier access to birth control, but my point is that even today, this stuff has a different safety profile than, like, Pepto Bismol or Advil.
(But then again, so does Tylenol, and that's legal, so...)
The alternative being primarily unwanted pregnancy or menstrual symptoms? I ask because there's a lot of good ways to prevent pregnancy but not as much for the latter.
"Birth control" is ridiculously available. "Hormonal birth control" can have serious side effects and interactions, at least at the level of something like tylenol-fortified opiods or mild antidepressants, to say nothing of any net public-health effects (even after you account for "unwanted pregnancies"). Hell, testosterone, the direct analog, is Schedule III.
But some people have a political interest in promoting infertility, so quasi-OTC it goes.
How do you know this app is reputable and deliverers real medicine? I wish the author had mentioned this. It's not an issue when the app is provided by your health insurance company. But if it's not how do you know?
The app doesn't deliver medicine. Regular pharmacies do. The app just makes it quicker, easier, and more private to get the prescription in the first place.
From the article:
"...a doctor reviews a woman’s medical information and sends a pill prescription to a local pharmacy.
"'I thought it was just a setup to get money,' [a user] said. But after she answered the health questions one evening, 'a doctor actually contacted me after office hours,' and the next morning, she picked up three months’ worth of pills."
Nurx is the one that ships directly to the customer, and the drugs still come from local pharmacies[1]. They're probably connecting the pharmacies to the users with some third-party, last-mile delivery service.
she used the app Nurx for birth control because she felt uncomfortable visiting a doctor
Frankly, this terrifies me. Getting medication which is generally accepted to be mostly safe from a pharmacy because it's cheaper and more convenient than seeing a doctor, sure. But if you're not comfortable seeing a doctor... you should probably be seeing a doctor.
A lot of people have had bad experiences with doctors, and in particular sometimes bad experiences around discussing sex and sexuality with doctors. Teenage girls trying to get birth control are told they are irresponsible or are sluts; parents get involved and send mixed messages regarding relationships with health care providers; and docs can cause a lot of trouble when they're not well-educated about things like endometriosis or aren't good at certain procedures.
A few years back I went to a doc to get a birth control prescription because I couldn't get it without seeing a doc. By various evidence-based(-ish) guidelines I knew I did not need a Pap test, and I also knew the guidelines had recently changed to every five years. I'm healthy and at that time I was still young enough to have no restrictions on birth control prescriptions, and it was just a renewal of the same thing I'd had for years. The doc would not prescribe the pills to me without getting a Pap smear, despite the unnecessary nature of the test. In the process of opening things up with the speculum and shoving that toothbrush up to my cervix, the doc cut me with the metal speculum, thereby turning a stupid unnecessary appointment for a maintenance med into a traumatic bleeding-all-over fiasco. I'm still much more nervous about Pap smears than I used to be.
I know a lot of doctors -- they avoid seeing doctors. I avoid seeing doctors when I'm not sick as much as possible as well. The only reason the health insurance industry in this country ever gets my money is because I have so far had to see a doc for the birth control, while having no health problems. Nurx et al sound like a great solution for healthy people in need of birth control.
These, by the way, are the experiences that make it difficult for men to have any empathy (even if they're open to it) with the actual experience of dealing with sexual health for women.
>Teenage girls trying to get birth control are told they are irresponsible or are sluts
I'm not from the US nor am I a woman.. but if this happens you should really change your doctor. I don't think that this would be legal / acceptable anywhere in the world.
"But the new websites and apps could reach many more women. They require no legislative approval since clinicians still write the prescriptions. The ventures must follow telemedicine regulations, which vary by state, and can only prescribe in states where their clinicians are licensed."
They are technically seeing a doctor (via telemedicine), but aren't comfortable to do so in person. This enables them to 'see a doctor' from the privacy and (psychological) comfort of their own room, which is presumably more private than them having to travel to their doctor's office and interact with them in person.
Sure, and "medical marijuana" dispensaries technically require that you get diagnosed with something which marijuana can be used to treat.
When doctors are being paid by a company which sells the product they're prescribing, I lack confidence in their ability to render medical opinions in the patients' best interest.
Hey, no, ok, I work in the medical software field (EHR provider who has a number of telehealth options) and the comparison of telemedicine to a dispensary or a pill mill is offensive and ignorant.
Telehealth is extremely effective in a number of cases, generally with the elderly and those with anxiety issues. It's very very cost effective, provides some of the best clinical data on patients empowering better diagnosis and care, and keeps patients engaged.
It is not some profit-fueled sham like a pill mill or a legal trick around the criminalization of marijuana, it is a legitimate technological advancement in achieving better care for more people.
Hell, we're seeing that using telehealth in conjunction with traditional office services creates a lot more successful outcomes than office care alone as people remain engaged in their care plan!
The idea that telehealth is inadequate for birth control prescription is a bit silly to me, do you have any rational reasons against this technology and paradigm or just fear mongering comparisons like dispensary?
Absolutely. I'm quite happy with online pharmacies and telemedicine as separate concepts; it's the conflict of interest inherent in "we'll refer you to a doctor who will give you a prescription so that we can sell you these pills" which concerns me.
This is very different from the concern you expressed in your toplevel comment. A doctor having a profit motive to write prescriptions could very well conflict with their ethical obligation to recommend alternatives where medically appropriate.
On the other hand, it's my impression that most of the medicines people obtain this way - specifically contraceptives and erectile dysfunction treatments - are straightforward enough that an automated decision tree could probably do a reasonable job screening most patients.
This is very different from the concern you expressed in your toplevel comment.
One concern leads to the other. That is to say, if I thought patients were receiving a medical consultation which met the normal standard of care, I would not be concerned about physician-avoidant behaviours; it's the combination of "may have received medication without a proper medical consultation" and "may be unlikely to seek medical care in the event of potentially life-threatening complications" which concerns me.
it's my impression that most of the medicines people obtain this way - specifically contraceptives and erectile dysfunction treatments - are straightforward enough that an automated decision tree could probably do a reasonable job screening most patients.
I agree. And I'd rather have such screening performed by an FDA-approved automated decision tree than by a doctor who has financial incentives in conflict with his ethical obligations.
But regular doctors in non-virtual offices have all kinds of incentives dropped on them to prescribe certain medicine. "Separating" the two hardly does away with incentivized prescription writing.
That's quite often the primary, not the secondary. Protecting against unwanted pregnancy is a nice side-effect of the medicine prescribed to help control literally debilitating menstrual cycles.
Is a ski helmet recreational? Not directly; but it makes a recreational activity safer, so it provides indirect recreational value.
Whether birth control pills are used for recreational purposes is a question of semantics; they have no direct recreational use, but make indirectly support recreational activities.
Data point: I know several women who don't have issues with seeing a doctor in general, but do have strong issues with the particular type of doctor visit that's historically been required to get a prescription for birth control. Those visits can be unpleasantly invasive both physically and emotionally, when there's absolutely no medical reason for them to be that way. So being able to skip that uncomfortable visit is a big deal. The first time I heard a story of "so, yeah, I basically have to let this dude stick his hand up me once a year in order to keep my prescription", I was horrified.
Women should go to a doctor around once a year anyway just to check if everything is allright. Depending on a type of birth control those visits are even more important. There are reasons for them...
If you take the politics and religion out of it (aka. you move outside of the USA) then some oral contraceptives require a prescription and some don't. Preventing pregnancy is quite easy -- screw with pretty much anything hormonal and you'll dramatically decrease the odds -- but doing that without causing unpleasant or dangerous side effects is much harder. Some formulations have had enough testing that we can say that they are generally safe; others should only be prescribed after a physician has ruled out certain risk factors.
The dangerous bit in this case is that there are many formulations which fall into the category of "generally safe, but if you experience X, Y, or Z then you should see a doctor" due to rare but dangerous side effects. In such cases there's no need to consult a physician before taking the drugs; but they should not be given to a patient who is "not comfortable visiting a doctor" and would not obtain medical care if such complications arose.
There are plenty of patients who are "not comfortable visiting a doctor" to get birth control, but who would certainly obtain medical care if complications arose.
Some doctors require a full pelvic and breast exam for birth control prescriptions. Patients who've previously been sexually assaulted can be very uncomfortable being touched naked by anyone other than a chosen and trusted partner, but still accept the need to be treated for complications. Exam-less options are a godsend for anyone who cannot handle their first experience being with a speculum, or who need more time working through trust or intimacy issues.
Birth control pills double the risk of ischemic stroke,[1] and the risk factors are dependent on individual medical factors. Copper IUDs, which avoid some of the symptoms some women experience with hormonal birth control, can increase the risk of ectopic pregnancy when women get pregnant while using it.[2]
One can weigh the cost/benefit of making contraceptives more easily available versus the increased safety of medical supervision, but it's not like the prescription requirement is plucked from thin air.
But the risk of ischemic stroke is still tiny, and the risk of stroke (among many, many other things) is still much higher during pregnancy, which birth control, obviously, helps to prevent. In fact, for a sexually active and fertile woman, birth control will help lower the risk of ischemic stroke, overall.
There are plenty of other OTC medicines which are far more dangerous than birth control. Tylenol, cough syrup, Bronkaid/sudafed/ephedrine, benadryl... Aspirin alone causes thousands of (some sources say more than 10,000) deaths a year. Birth control carries a relatively small risk of problems (especially for non-smokers and/or women under 35), but has a much larger benefit.
And the copper IUD does not, strictly speaking, increase the risk of ectopic pregnancy. It's a matter of survivorship bias. They prevent pregnancies from occurring, but are slightly more effective for pregnancies that implant inside the uterus. 2% of all pregnancies (without an IUD) are ectopic. If a woman does get pregnant with an IUD, she is more likely to have the type of pregnancy that the copper IUD is less effective at preventing -- an ectopic pregnancy (According to Wikipedia, 3-4% of all pregnancies that occur with an IUD are ectopic). However, overall, comparing sexually active fertile women with IUDs and without IUDs, the IUD drastically prevents ectopic pregnancies, and, of course, pregnancies in general.
I have significant social anxiety and see a doctor about it. Yet, buying condoms is up there in the top ten most uncomfortable things I know of.
Your thoughts on this are way, WAY too simplistic. It's incredibly aggravating to see you being upvoted for this nonsense. Maybe in a perfect world with perfect self-understanding, but that's not the world we live in.
I have a friend with social anxiety, I used to buy an extra box when I bought mine though now he gets them online so that's been useful for him, I've never cared, grew up with a single mum so if I went shopping I'd buy sanitary towels etc as part of the weekly shop.
A person you don't know has trust issues with the medical community. If those issues are unfounded and she's being irrational, her choices won't affect you beyond a potential trivial increase in your health insurance premiums and/or taxes. There are many other bad health decisions people habitually make that have a larger impact there than a small number of people having an irrational aversion to seeing their doctors.
Or do you think she might have a rational aversion to seeing her doctor, which would have frightening implications for other people?
What she wants to do is her business. If she wants to use an app or a voodoo magician for health I frankly think it is no body's business to tell her otherwise. Even third world countries have birth control off the shelf.
That's the strict Libertarian view, yes. The consensus among medical ethicists, however, is that medical professionals have a duty to avoid allowing patients to come to harm, and that this duty takes priority even over the patient's wishes; wanting to cut your arm off may be your own business, but you won't find a surgeon offering to sell you tools for that purpose.
This attitude is incredibly patronizing and "harm" is very subjective.
I feel like having a child is 100x more harmful to me than never having one, but urologists in the US almost unanimously disagree and refuse to perform vasectomies on the childless.
The consensus among medical ethicists is that medical professionals have a pretty bad track record of treating womens' health issues. The (over-)medicalization of childbirth, for example, has had a notable impact.
The medicalization of childbirth isn't doing so bad overall. We did well going from 1 in 100 maternal deaths to 1 in 10,000. Something has gone off the rails however as that rate doubled in the US since then to 2 in 10,000.
Similarly for IMR, an impressive drop from 1 in 10 to better than 1 in 100.
The medical ethicists can apply their ethics on their own self and not on others. A doctor should be free to refuse to treat a patient if it goes against his/her ethics. Giving few men power over other people's health seems evil to me.
You seem here to blur the distinction between "women can't expect physicians or pharmacists to give them birth control with certain side effects" and "women can't get birth control with certain side effects".
This is really good news for women (and men in long term relationships with women). The amount of hoops you have to jump through to get birth control is ridiculous. Have you ever been in a planned parenthood? It's basically the DMV (with an equal level of cleanliness). Women have to make at least yearly visits to this place to get absurd and intrusive medical evaluations just to get the pill.
Birth control should be over the counter, full-stop.
I agree that birth control should be available over the counter, but any PP I have ever been in has been clean, friendly, efficient, and dedicated to making sure people have access to whatever reproductive health services they need. source: I'm a man, and I go to PP for STD tests, and other men's reproductive and sexual health issues.
"five million Canadians do not have a family doctor as their first point of contact when they need to access medical care and of those people, almost two million reported they have tried to find a family doctor in the past year and failed. Even people who do have doctors are having trouble getting timely care"
read the article @refurb, information shows lack of primary medical care but why? cost, lack of GPs, remoteness and dispersion of patients? I know the US and Canada are both vast countries with unequal distribution of population. The root of inequity in Australia is cost, remoteness & dispersion of the population. Most live in the cities, in the bush you cop poor quality of access and service even though primary health care is mostly free (Medicare).
That does not seem to be an evidence-based recommendation. Pap smears are recommended every 3-5 years, pelvic exams are not recommended by the American College of Physicians for healthy asymptomatic adult women, HPV test is recommended every five years in adult healthy women. Pap smears and pelvic exams more frequently than every five years are associated with a high false positive and false negative rate, incidental findings that lead to additional testing or treatment but turn out to be benign, discomfort, and higher cost.
Overscreening is a real problem, and since HN has a lot of male readers I'll do a public service announcement (PSA, get it?!!) that prostate cancer overscreening doesn't lead to a mortality benefit on a population level (if you look at all-cause mortality) and leads to interventions that leave a lot of men incontinent and unable to enjoy their previous sex life [1]. If you have any symptoms, definitely go to the doctor -- screening in men with symptoms saves lives. Prostate cancer can be a killer. But just screening all healthy people of a certain age for breast, prostate, and cervical cancer every year actually leads to poorer health outcomes because we don't yet understand when to treat cancer aggressively and when to just ignore it.
[1] http://annals.org/article.aspx?articleid=1216568 Per 1000 men, screening all every 1-4 years for 10 years and then following through their treatment saves about 1 guy from dying, kills about 1 guy and puts 2 in the hospital from complications of biopsy and treatment, gives 3 heart attacks, and leaves 35 with bladder or sexual dysfunction problems.
Pap and HPV are only two of several elements of well care.
Since GPs often don't do gyno, but gynos can do GP care, a gyno often serves as a woman's GP.
But check the actual source and:
"Among women who had unintended births in the United States in 1998–2002, about 40% were using contraception"
So that's very misleading reporting.
Note that they tracked women for 4 years - track someone for their entire life and the numbers who had at least one child while on birth control at some point in their life will rise.
Contraception just isn't effective enough to eliminate pregnancy, it can only function to reduce fertility (number of children).
A typical couple using birth control through their entire life will still have one or two children - which is the average (more or less) of people in the US who choose to have children.
The only function of birth control is to reduce fertility from around 10 to around 2.