Here's a great set of letters from Cristina Alarcon, BSP, pharmacist of conscience in Vancouver, British Columbia, Canada to some small circulation yellow rag called
Georgia Straight.
Enjoy Cristina's sharp logic and the cognitive dissonance of the abortiholic marxist who wrote her emotion-laden rebuttal to Cristina's first letter. Folks we can't make this stuff up if we tried!
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My apologies if you have received this twice. The following is my response to a letter that was published in the Georgia Straight on Feb 9th, 2006. The letter by Ms Duncan is included below, as well as the original article that instigated it.
To: Georgia Straight news
Dear Editor,
I write in response to the letter you printed in the last issue of the Georgia Straight signed Caryn Duncan.
I agree with Caryn Duncan that no one should "make medical claims about drugs and medical procedures to shift the spotlight from their position on abortion". In fact, my stance for not supporting Plan B's becoming available over the counter is not as simple as just being pro-life or pro-choice. It is infinitely more complex than that!
As to Ms Duncan's statements from a McGill University epidemiologist who vouches for the safety of Plan B, I wonder how in the world she could know about its longterm safety when this particular product has only been on the market for a couple of years! Similar claims have been made about HRT (hormone replacement therapy), only to be discarded when studies were eventually carried out years after many women had suffered the consequences of being misinformed.
As to safety for the fetus exposed to Plan B? If the zygote (a new human being with 23 [unique pairs of chromosomes) happens to implant after suffering this hormonal assault then , yes, as far as we know he or she will continue to grow and develop. However, we do know that exposures of fetuses to high doses of estrogens in "birth control" pills have been known to cause male genital defects.
Furthermore, I do not hide the fact that I am pro-life, and take offense at having Ms Duncan imply that I am trying to hide something or trying to "pry" when I counsel my patients according to what I truly believe is the best way to go!
Sincerely,
Cristina Alarcon, BSP
Pharmacist
Feb 9.2006
Letters
Letters Archives
Morning-after-pill story pushes readers’ buttons
Publish Date: 9-Feb-2006
Pieta Woolley’s Plan B story [“Morning-after pill may head over the counter”, Feb. 2-9] ably reflects the complexity of the issues surrounding emergency contraception. However, I take issue with founding member of B.C. Pharmacists for Conscience Cristina Alarcon’s comments. Antichoice crusaders often make medical claims about drugs and medical procedures to shift the spotlight from their position on abortion.
For example, some claim that abortion causes cancer or has long-term health implications. There is no medical evidence to support this.
Ms. Alarcon’s comments about the health implications of Plan B are not supported by medical evidence either. I would be the first person to criticize the pharmaceutical industry for unsafe drugs. Plan B doesn’t warrant this criticism.
Abby Lippman, chair of the Canadian Women’s Health Network and an epidemiologist at McGill University, is on the record stating that Plan B (levonorgestrel) “is safe, will not harm a fetus even if a woman is pregnant, and has no contraindications or serious adverse effects”. The fact is, differing opinions about the availability of emergency contraception is really a debate about whether women should have control over their own bodies.
> Caryn Duncan / Vancouver Women’s Health Collective
Regarding “Morning-after pill may head over the counter”: I am not a pharmacist. Personally, I look at all possible alternatives before swallowing any pill. However, when my husband was very sick, our pharmacist was the one to prevent a catastrophe in the treatment ordered by his G.P., a doctor totally ignorant of the deadly interactions between the meds he had prescribed.
I wonder, then, why pharmacists should not have a say in protecting women from themselves? What if, in a panic, a young girl takes a pill too late and does not abort spontaneously? What intrauterine damage will affect the fetus; what damages will she do to herself?
In this day and age—except in the case of rape—why would a woman have to rely on that pill at all? What about education? Information? Prevention?
But, of course, that does not give the pharmacist the right to act without discretion and compassion.
> Jacqueline Maire / New Westminster
News and Views
News and Views Archives
Morning-after pill may head over the counter
By Pieta Woolley
Publish Date: 2-Feb-2006
Caryn Duncan wants the morning-after pill to become more accessible.
Thirty years ago, Caryn Duncan remembers, you couldn’t buy condoms without first talking to a pharmacist. Ditto yeast-infection cream. That was ridiculous, she said. Now, just as outrageous, Duncan added, the morning-after pill is still stuck behind the counter, with a prying pharmacist sometimes blocking access to the drug.
“Women are smart enough to figure out when and how to take it,” the Vancouver Women’s Health Collective member told the Georgia Straight. “Why can’t we just walk into a store and buy it?”
Buying morning-after pills alongside gossip mags and lip gloss inched closer to reality on January 20. After a meeting of its board, the College of Pharmacists of British Columbia (CPBC) quietly wrote a letter recommending to the B.C. government that Plan B, a morning-after pill used for emergency contraception, become an over-the-counter, nonprescription drug. That means any woman could walk into a pharmacy, verbally answer a couple of questions, pay her money, and take the pills.
The morning-after pill can be taken up to three days after unprotected sex. It’s a high dose of estrogen, about four times the level of a normal birth-control pill. Depending on when during a woman’s cycle it’s taken, the pill may prevent ovulation, fertilization, or implantation of an egg.
By the Georgia Straight’s deadline, the government had not yet considered the college’s recommendations, which would bring B.C.’s treatment of Plan B in line with other provinces.
“This is a pipeline process; it wouldn’t happen overnight,” CPBC spokesperson James Nesbitt told the Straight. “But the wheels have been set in motion.”
The changes will affect a vast number of women. In 2005, B.C. pharmacists prescribed 22,689 sets of Plan B pills to 18,819 women, according to B.C. Ministry of Health spokesperson Sarah Plank. That’s one Plan B prescription for every 40 women between the ages of 15 and 45 last year, if you divide the number of prescriptions into Statistics Canada’s population record of females in that age bracket in B.C.
The new regulations, if they’re accepted, will have two immediate consequences. First, extended health plans and the low-income government insurance plan Pharmacare would probably stop picking up the tab, Nesbitt confirmed. That means women may be out-of-pocket about $60 per Plan B set. It also means the government could save up to $1.4 million per year by offloading those costs to the consumers. Second, the Ministry of Health and the provinces’ doctors will no longer be able to keep track of the number of times a woman uses the drug because, as Nesbitt explained, purchases will no longer be recorded on Pharmanet.
Currently, pharmacists prescribe the pill directly to women after asking three questions: the date of her last period, the date she had unprotected sex, and if a contraception method failed, what that method was. The prescription is recorded on her Pharmanet file, according to Victoria’s director of the Office of Information and Privacy Commissioner (OIPC), Mary Carlson.
The change would eliminate the third question and the recorded information.
Duncan said she welcomes the change but thinks it doesn’t go far enough. She pointed out that without the pharmacist intervention and attendent fees, if Plan B were just available on the shelf the drug’s cost would drop from about $60 to about $25 per dose. The new, nonprescription status of Plan B won’t really hurt women’s wallets, she argued, because most women don’t have an extended health plan and are already paying the full cost.
“This is about controlling women’s bodies and choices,” she said. “Pharmacists are trying to preserve their role in the health-care system. They’re overreaching their role.”
The change wasn’t initiated by pharmacists though; it was a January 6 letter from Victoria’s OIPC to the college that got things started. Director Carlson told the Straight that the commissioner’s job is to minimize government collection of individuals’ information, and this looked like it stepped over the line.
“You can get it [Plan B] anonymously in every other province,” she said. “We asked, ‘Why would you collect this information? Why can’t there just be a dialogue [between the client and the pharmacist]?’?”
In March 2005, Carlson pointed out, Ottawa opened the door for the provinces to offer Plan B as a nonprescription drug. Most provinces did so immediately. At the time, B.C. didn’t change its legislation because local rules offered similar benefits. (In 2000, the B.C. Ministry of Health had already begun to offer Plan B through a pharmacist—the first province to do so.) It’s still considered a prescription, though, and it is not anonymous. The nonprescription format offers better privacy, Carlson said, adding that the OIPC deals only with privacy issues, not ethical or safety issues.
But Cristina Alarcon, a pharmacist for 16 years, told the Straight that safety should be at the top of the decision makers’ minds when changing access to Plan B. She said there’s little information about the long-term consequences of morning-after pills, and especially their repeated use.
“I think this is a really bad idea [to provide the drug over-the- counter],” she said. “I can’t sell hemorrhoid suppositories without a prescription, but this is much more harmful. It’s a potent hormone.”
Alarcon compared Plan B to the menopausal hormones doctors formerly prescribed to women. After years on the market, studies determined that the estrogen-progestin mix was linked to increased risks of stroke, breast cancer, and heart problems. Although the hormones in Plan B are different, Alarcon thinks it’s worth more study before they are offered over-the-counter.
“I foresee women taking it as though it were nothing,” she said. “This is giving the wrong message to the public, that this is as safe as baby Aspirin, which is also over-the-counter.…If it’s so easily available, why would women restrict themselves to using it just once?”
Apart from the health issues, Alarcon has other trouble with the drug. Eight years ago, she helped start B.C. Pharmacists for Conscience, a professional group that advocates for pharmacists to act within their own ethics. A life-long Catholic, Alarcon chooses to not distribute Plan B at all.
“I don’t think it’s good for society to have something as readily available to solve something so complex,” she said. Plus, “if a woman has conceived, this will act to impede implantation. And I believe life begins when fertilization takes place.”
Alarcon claimed that more and more young women come to see her, looking for natural methods to prevent pregnancy—ones that don’t include ingesting hormones. Most doctors don’t explain to their young patients the rhythm of their bodies or how their hormones work and when they are and are not fertile in a month, she said. Understanding those rhythms is the first step to girls and young women respecting their bodies, Alarcon noted.
“We treat our bodies as though our fertility is pathological, as though it’s a disease. It’s not.”
Duncan, however, believes it’s the pharmacist’s role to dispense the drugs, not counsel the consumers. Asking a woman too many questions can be a barrier to access, she said, and in this case that can mean more abortions or unwanted pregnancies.
“This drug has a high success rate. It needs to be available to women when they need it, affordable, and women can figure out for themselves whether they need to take it or not.”
Neither the CPBC nor the Office of the Information and Privacy Commissioner have received complaints about access to the drug or complaints from women who believe pharmacists ask too many questions.
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