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For just one example: 33% of doctors always require a pap smear and pelvic exam to renew a birth control pill prescription. This is despite the fact that the W

For just one example: 33% of doctors always require a pap smear and pelvic exam to renew a birth control pill prescription. This is despite the fact that the WHO and ACOG both advise that the pills can be safely prescribed without the exams. 33% certainly counts as more than a "few" in my book. Citation: https://www.reuters.com/article/us-birth-control/women-seeking-birth-control-get-unneeded-pelvic-exams-idUSTRE6AL67X20101122 https://www.reuters.com/article/us-birth-control/women-seeki...

ams6110 8y ago
Well, birth control pills aren't really safe. I guess they're safe compared to a pregnancy, but they do have potentially serious side effects. It seems reasonable to have periodic checks for those, if you're taking them.
- astura 8y ago
  As the GP pointed out, pap smears and pelvic exams are not medically necessary prerequisite to a birth control prescription and adding those procedures don't make prescribing birth control pills safer. They are an artificial barrier to access birth control. Pap smears (when done at the recommend intervals - most doctors overtest) are extremely beneficial screening tool and they save lives, but they have nothing to do with birth control - the purpose of a pap smear is to screen for cervical cancer. In fact, the current recommendation is to wait until a women turns 21 before starting pap smears, yet many (most?) women will require contraceptives before 21. It's also false that "birth control pills aren't really safe." - "potential to have serious side effects" is not even remotely the same thing as "not really safe." Oral contraceptives are not more dangerous than NSAIDs like ibuprofen. Both The American College of Obstetricians and Gynecologists [1] and The American Academy of Family Physicians [2] recommend over the counter access to oral contraceptives based on the availabile evidence [1] https://acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral-Contraceptives https://acog.org/Clinical-Guidance-and-Publications/Committe... [2] https://www.aafp.org/about/policies/all/otc-oral-contraceptives.html https://www.aafp.org/about/policies/all/otc-oral-contracepti...
- Lazare 8y ago
  They're safe compared to Tylenol too. It's a huge step to go from "they're not completely safe" to "...and therefore a doctor needs to be constantly checking up on you". Lost of things have potentially serious side effects, including most OTC medicine. And? I mean, peanuts are pretty dangerous too; they kill people every year, and the side effects are potentially extremely severe. Does that mean a doctor needs to be involved in the process of me buying peanuts? > It seems reasonable to have periodic checks for those, if you're taking them. Reasonable is a low bar. Your suggestion does seem reasonable, inasmuch as I can see a reason why you'd want to do it. I can see reasons why you wouldn't too. We need more than that.
- dragonwriter 8y ago
  > I guess they're safe compared to a pregnancy, but they do have potentially serious side effects. It seems reasonable to have periodic checks for those, if you're taking them. Pap smears and pelvic exams, however, are not checks for the potential serious side effects of birth control pills. It's about like being forced to have a colonoscopy before being allowed to get NSAIDs, because NSAIDs have potentially serious side effects.
- Broken_Hippo 8y ago
  Lots of things that are generally considered safe can have potentially serious side effects. Some of these are available over the counter. This doesn't mean they aren't really safe, it means that some folks have bad experiences. It isn't just that it is safer than being pregnant. It is seriously better for some folks to take birth control because of the severity of their monthly cycle. Some folks can't take tylenol. Ibuprofen can cause ulcers. Folks take heartburn pills (such as Prilosec) without being diagnosed. A body can form a dependence on certain laxatives. This doesn't mean they aren't generally safe for folks when used properly. Having some of these only available after talking to a pharmacist shouldn't shouldn't be a big deal, especially if you have to get the first dose with a prescription from the doctor. What isn't reasonable is folks having to have an actual visit to the doctor every time a prescription runs out. It isn't reasonable to force people to have unnecessary pap screens to get birth control either - so long as your tests are normal and you aren't having other issues, there is no reason to have one every year even. Every 3 years tends to work out just fine.
darkerside 8y ago
There's a generalized problem in medicine that it takes a long time for new standards to trickle into common practice. It often doesn't fully turn over until an older generation of doctors retires. It seems to me that, of many imperfect systems, one where doctors have control is more preferable. They are legally and duty bound to serve their patients. The same can't be said of pharma company marketers, not by a long shot. Let's solve the right problem (updating doctors with new training), not the wrong one (let people but prescription drugs they may not understand). Not all drugs are as cut and dry as birth control pills may seem to be.
- nanagull 8y ago
  Please see this report by the American College of Obstetricians and Gynecologists : https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral-Contraceptives https://www.acog.org/Clinical-Guidance-and-Publications/Comm... It discusses a series of studies on the "ability of patients to self-screen for birth control pill eligibility", and determines that patients are good enough at self-screening that the medication may as well be over-the-counter. It sounds like, from the initial article, that the FDA is taking a similar approach: "Drug companies would have to submit data to the FDA that shows consumers are capable of accurately assessing their need for a medication and their ability to use it correctly." Obviously we'd need to wait to see what the FDA actually approves/disapproves for these purposes, but it actually seems quite likely the approved drugs will, in fact, be restricted to cut and dry ones, such as birth control pills.
  - darkerside 8y ago
    Thanks for the link. I'd like to see intelligent changes to the system in these cut and dry cases where we are unlikely to do harm through action. The problem is, I don't think statins, the first drug in the article, fall under that category. BTW, the 33% number you cite in parent comment doesn't include responses to the pap smear question, only the pelvic exam, and is specific to family doctors.
- yourapostasy 8y ago

ams6110 8y ago

Well, birth control pills aren't really safe. I guess they're safe compared to a pregnancy, but they do have potentially serious side effects. It seems reasonable to have periodic checks for those, if you're taking them.

astura 8y ago
As the GP pointed out, pap smears and pelvic exams are not medically necessary prerequisite to a birth control prescription and adding those procedures don't make prescribing birth control pills safer. They are an artificial barrier to access birth control. Pap smears (when done at the recommend intervals - most doctors overtest) are extremely beneficial screening tool and they save lives, but they have nothing to do with birth control - the purpose of a pap smear is to screen for cervical cancer. In fact, the current recommendation is to wait until a women turns 21 before starting pap smears, yet many (most?) women will require contraceptives before 21. It's also false that "birth control pills aren't really safe." - "potential to have serious side effects" is not even remotely the same thing as "not really safe." Oral contraceptives are not more dangerous than NSAIDs like ibuprofen. Both The American College of Obstetricians and Gynecologists [1] and The American Academy of Family Physicians [2] recommend over the counter access to oral contraceptives based on the availabile evidence [1] https://acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral-Contraceptives https://acog.org/Clinical-Guidance-and-Publications/Committe... [2] https://www.aafp.org/about/policies/all/otc-oral-contraceptives.html https://www.aafp.org/about/policies/all/otc-oral-contracepti...
Lazare 8y ago
They're safe compared to Tylenol too. It's a huge step to go from "they're not completely safe" to "...and therefore a doctor needs to be constantly checking up on you". Lost of things have potentially serious side effects, including most OTC medicine. And? I mean, peanuts are pretty dangerous too; they kill people every year, and the side effects are potentially extremely severe. Does that mean a doctor needs to be involved in the process of me buying peanuts? > It seems reasonable to have periodic checks for those, if you're taking them. Reasonable is a low bar. Your suggestion does seem reasonable, inasmuch as I can see a reason why you'd want to do it. I can see reasons why you wouldn't too. We need more than that.
dragonwriter 8y ago
> I guess they're safe compared to a pregnancy, but they do have potentially serious side effects. It seems reasonable to have periodic checks for those, if you're taking them. Pap smears and pelvic exams, however, are not checks for the potential serious side effects of birth control pills. It's about like being forced to have a colonoscopy before being allowed to get NSAIDs, because NSAIDs have potentially serious side effects.
Broken_Hippo 8y ago
Lots of things that are generally considered safe can have potentially serious side effects. Some of these are available over the counter. This doesn't mean they aren't really safe, it means that some folks have bad experiences. It isn't just that it is safer than being pregnant. It is seriously better for some folks to take birth control because of the severity of their monthly cycle. Some folks can't take tylenol. Ibuprofen can cause ulcers. Folks take heartburn pills (such as Prilosec) without being diagnosed. A body can form a dependence on certain laxatives. This doesn't mean they aren't generally safe for folks when used properly. Having some of these only available after talking to a pharmacist shouldn't shouldn't be a big deal, especially if you have to get the first dose with a prescription from the doctor. What isn't reasonable is folks having to have an actual visit to the doctor every time a prescription runs out. It isn't reasonable to force people to have unnecessary pap screens to get birth control either - so long as your tests are normal and you aren't having other issues, there is no reason to have one every year even. Every 3 years tends to work out just fine.

darkerside 8y ago

There's a generalized problem in medicine that it takes a long time for new standards to trickle into common practice. It often doesn't fully turn over until an older generation of doctors retires. It seems to me that, of many imperfect systems, one where doctors have control is more preferable. They are legally and duty bound to serve their patients. The same can't be said of pharma company marketers, not by a long shot. Let's solve the right problem (updating doctors with new training), not the wrong one (let people but prescription drugs they may not understand). Not all drugs are as cut and dry as birth control pills may seem to be.

nanagull 8y ago
Please see this report by the American College of Obstetricians and Gynecologists : https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Over-the-Counter-Access-to-Oral-Contraceptives https://www.acog.org/Clinical-Guidance-and-Publications/Comm... It discusses a series of studies on the "ability of patients to self-screen for birth control pill eligibility", and determines that patients are good enough at self-screening that the medication may as well be over-the-counter. It sounds like, from the initial article, that the FDA is taking a similar approach: "Drug companies would have to submit data to the FDA that shows consumers are capable of accurately assessing their need for a medication and their ability to use it correctly." Obviously we'd need to wait to see what the FDA actually approves/disapproves for these purposes, but it actually seems quite likely the approved drugs will, in fact, be restricted to cut and dry ones, such as birth control pills.
- darkerside 8y ago
  Thanks for the link. I'd like to see intelligent changes to the system in these cut and dry cases where we are unlikely to do harm through action. The problem is, I don't think statins, the first drug in the article, fall under that category. BTW, the 33% number you cite in parent comment doesn't include responses to the pap smear question, only the pelvic exam, and is specific to family doctors.
yourapostasy 8y ago