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she used the app Nurx for birth control because she felt uncomfortable visiting a doctor Frankly, this terrifies me. Getting medication which is generally acc

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.

eli 10y ago
Agreed, though I was under the impression that the reasons birth control still requires a prescription is not entirely based in science.
- cperciva 10y ago
  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.
  - mynameislegion 10y ago
    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.
- rayiner 10y ago
  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. [1] http://abcnews.go.com/Health/story?id=118178 http://abcnews.go.com/Health/story?id=118178. [2] http://www.mayoclinic.org/tests-procedures/paragard/basics/risks/prc-20013048 http://www.mayoclinic.org/tests-procedures/paragard/basics/r....
  - erroneousfunk 10y ago
    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.
- WildUtah 10y ago
  Public health bureaucrats are trying to eliminate birth control pills and making them available over the counter won't help that goal. That's science.
tn13 10y ago
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.
- cperciva 10y ago
  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.
  - jessaustin 10y ago
    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".
  - srtjstjsj 10y ago
    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.
    - zaroth 10y ago
      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.
  - aianus 10y ago
    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.
niftich 10y ago
From the article: "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.
- cperciva 10y ago
  They are technically seeing a doctor 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.
  - criley2 10y ago
    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?
    - cperciva 10y ago
Zak 10y ago
Why does this terrify you? 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?
kaitai 10y ago
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.
- themartorana 10y ago
  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.
  - kaitai 10y ago
    I figured I'd share it here because I don't think most men have any idea what many of those visits involve. They are not so fun to talk about.
- brusch64 10y ago
  >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.
deleted 10y ago
[deleted]
bpchaps 10y ago
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.
- noir_lord 10y ago
  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.
  - bpchaps 10y ago
    Thanks for being a good person. The small things like this matter. :)
ubernostrum 10y ago
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.
- emp_zealoth 10y ago
  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...
  - ubernostrum 10y ago
    Rather than re-state it I'll just link you to this comment, which is spot-on accurate: https://news.ycombinator.com/item?id=11935777 https://news.ycombinator.com/item?id=11935777

eli 10y ago

Agreed, though I was under the impression that the reasons birth control still requires a prescription is not entirely based in science.

cperciva 10y ago
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.
- mynameislegion 10y ago
  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.
rayiner 10y ago
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. [1] http://abcnews.go.com/Health/story?id=118178 http://abcnews.go.com/Health/story?id=118178. [2] http://www.mayoclinic.org/tests-procedures/paragard/basics/risks/prc-20013048 http://www.mayoclinic.org/tests-procedures/paragard/basics/r....
- erroneousfunk 10y ago
  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.
WildUtah 10y ago
Public health bureaucrats are trying to eliminate birth control pills and making them available over the counter won't help that goal. That's science.

tn13 10y ago

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.

cperciva 10y ago
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.
- jessaustin 10y ago
  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".
- srtjstjsj 10y ago
  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.
  - zaroth 10y ago
    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.
- aianus 10y ago
  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.

niftich 10y ago

From the article: "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.

cperciva 10y ago
They are technically seeing a doctor 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.
- criley2 10y ago
  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?
  - cperciva 10y ago

Zak 10y ago

Why does this terrify you? 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?

kaitai 10y ago

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.

themartorana 10y ago
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.
- kaitai 10y ago
  I figured I'd share it here because I don't think most men have any idea what many of those visits involve. They are not so fun to talk about.
brusch64 10y ago
>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.

deleted 10y ago

[deleted]

bpchaps 10y ago

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.

noir_lord 10y ago
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.
- bpchaps 10y ago
  Thanks for being a good person. The small things like this matter. :)

ubernostrum 10y ago

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.

emp_zealoth 10y ago
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...
- ubernostrum 10y ago
  Rather than re-state it I'll just link you to this comment, which is spot-on accurate: https://news.ycombinator.com/item?id=11935777 https://news.ycombinator.com/item?id=11935777