4 ms·

Couldn't be that doctors wanted all those easy well visits writing scripts for birth control and the recent supreme court ruling encouraged the FDA to finally b

Couldn't be that doctors wanted all those easy well visits writing scripts for birth control and the recent supreme court ruling encouraged the FDA to finally be reasonable? It's that this exact moment is the first time in human history that women are capable of understanding "once daily".

zdragnar 3y ago
Doctors (the ones writing the prescriptions) aren't involved in this process at all.
- foooorsyth 3y ago
  The AMA is absolutely involved in the medical regulation arena. What are you talking about?
  - zdragnar 3y ago
    AMA != Most prescribing doctors. Best estimates are only ~20% of doctors are even members of the AMA, with some as low as 15: https://www.physiciansweekly.com/is-the-ama-really-the-voice-of-physicians-in-the-us/ https://www.physiciansweekly.com/is-the-ama-really-the-voice...
    - giantg2 3y ago
      There are many doctors who really hate the AMA. I know a couple.
giantg2 3y ago
There's more to it than once daily. I doubt the Supreme Court ruling had any logical impact on the FDA decision, unless it was only an empty political gesture (no real contraception restrictions right now). It's more likely that phrama makes more on Rx prescriptions and had no incentive to make it OTC.
ska 3y ago
Doesn’t sound plausible. Doctors aren’t really casting around for work, these visits aren’t particularly or unusually straightforward for a GP - and at a guess a majority of women who stay on hormonal birth control have had some problems with it at some point. The cultural knowledge aspect is real.
yjftsjthsd-h 3y ago
> It's that this exact moment is the first time in human history that women are capable of understanding "once daily". Contraceptives have a long-standing problem of people being unable or unwilling to follow the instructions, or not catching little nuances like "this pill lasts for 22 hours, so you really need to take it every day at the same time". For a decent-looking summary, see ex. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533104/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533104/ which includes a lot of lines like, > Hatcher and colleagues report that for both types of pills, the failure rate is less than 1% with perfect use and 7% with typical use. So no, empirically, it appears likely that people are not capable of understanding "once daily".
- deleted 3y ago
  [deleted]
- keenmaster 3y ago
  Empirically, how much does visiting a doctor change people’s understanding of “once daily”? Measured in percentage terms. Because that’s the important question here.
  - giantg2 3y ago
    They have some data in the links in the article. There could be some bias there (pharma likes to guide subject answers, and they dont provide the methodology details), so we would probably need real world data. But based on that limited data it appears to be no different. In theory, the longer the pill is in use and the more people who use it, then the more likely it is that people in society understand that it's one's a day at the same time of day etc.
    - keenmaster 3y ago
      So literally a vibrating pill box that stays lit and sends smart reminders until someone takes their pill would be 10,000x more effective and cost vastly less than the appointments+opportunity cost+lifestyle cost forced on women by profiteers. Or one of those special purpose reminder apps. Or Google Calendar… An app can deliver periodic reminders about the potential negative effects of birth control pills. It can have a conversational interface for when someone is having issues with a particular pill, thinking about starting a new pill or type of contraceptive, etc…
regularfry 3y ago
Some people react very badly to hormonal contraceptives, to the degree that it makes a lot of sense to have them actively prescribed so the GP can watch for (or at least warn to watch for) side-effects. I know people who can't take them because they make them suicidal, of the "spontaneously walking into fast-moving traffic" sort. I don't know if that would happen with this type specifically, but there are reasons to be cautious.
- peytoncasper 3y ago
  Yeah, I was a bit shocked to see this. Not because it shouldn't be easily accessible, but because most women I've talked to about this has gone through some sort of dialing in process. Whether its for dosage or a different brand. Hormones are not easy.
  - regularfry 3y ago
    I should point out that if this specific type is known to be safe... yeah, dish them out like tic-tacs. Fill your footwear of choice.
    - giantg2 3y ago
      No medication is completely safe. Any medication approved for use has to be "generally safe" when used correctly. So basically all meds can be dangerous or safe. It's all about informed consent and proper use.
      - regularfry 3y ago
        Well exactly. In this case it's more a matter of whether the move to non-prescription introduces significant new risks both that didn't exist before and that the layperson shouldn't be expected to be able to handle.

zdragnar 3y ago

Doctors (the ones writing the prescriptions) aren't involved in this process at all.

foooorsyth 3y ago
The AMA is absolutely involved in the medical regulation arena. What are you talking about?
- zdragnar 3y ago
  AMA != Most prescribing doctors. Best estimates are only ~20% of doctors are even members of the AMA, with some as low as 15: https://www.physiciansweekly.com/is-the-ama-really-the-voice-of-physicians-in-the-us/ https://www.physiciansweekly.com/is-the-ama-really-the-voice...
  - giantg2 3y ago
    There are many doctors who really hate the AMA. I know a couple.

giantg2 3y ago

There's more to it than once daily. I doubt the Supreme Court ruling had any logical impact on the FDA decision, unless it was only an empty political gesture (no real contraception restrictions right now). It's more likely that phrama makes more on Rx prescriptions and had no incentive to make it OTC.

ska 3y ago

Doesn’t sound plausible. Doctors aren’t really casting around for work, these visits aren’t particularly or unusually straightforward for a GP - and at a guess a majority of women who stay on hormonal birth control have had some problems with it at some point. The cultural knowledge aspect is real.

yjftsjthsd-h 3y ago

> It's that this exact moment is the first time in human history that women are capable of understanding "once daily". Contraceptives have a long-standing problem of people being unable or unwilling to follow the instructions, or not catching little nuances like "this pill lasts for 22 hours, so you really need to take it every day at the same time". For a decent-looking summary, see ex. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533104/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533104/ which includes a lot of lines like, > Hatcher and colleagues report that for both types of pills, the failure rate is less than 1% with perfect use and 7% with typical use. So no, empirically, it appears likely that people are not capable of understanding "once daily".

deleted 3y ago
[deleted]
keenmaster 3y ago
Empirically, how much does visiting a doctor change people’s understanding of “once daily”? Measured in percentage terms. Because that’s the important question here.
- giantg2 3y ago
  They have some data in the links in the article. There could be some bias there (pharma likes to guide subject answers, and they dont provide the methodology details), so we would probably need real world data. But based on that limited data it appears to be no different. In theory, the longer the pill is in use and the more people who use it, then the more likely it is that people in society understand that it's one's a day at the same time of day etc.
  - keenmaster 3y ago
    So literally a vibrating pill box that stays lit and sends smart reminders until someone takes their pill would be 10,000x more effective and cost vastly less than the appointments+opportunity cost+lifestyle cost forced on women by profiteers. Or one of those special purpose reminder apps. Or Google Calendar… An app can deliver periodic reminders about the potential negative effects of birth control pills. It can have a conversational interface for when someone is having issues with a particular pill, thinking about starting a new pill or type of contraceptive, etc…

regularfry 3y ago

Some people react very badly to hormonal contraceptives, to the degree that it makes a lot of sense to have them actively prescribed so the GP can watch for (or at least warn to watch for) side-effects. I know people who can't take them because they make them suicidal, of the "spontaneously walking into fast-moving traffic" sort. I don't know if that would happen with this type specifically, but there are reasons to be cautious.

peytoncasper 3y ago
Yeah, I was a bit shocked to see this. Not because it shouldn't be easily accessible, but because most women I've talked to about this has gone through some sort of dialing in process. Whether its for dosage or a different brand. Hormones are not easy.
- regularfry 3y ago
  I should point out that if this specific type is known to be safe... yeah, dish them out like tic-tacs. Fill your footwear of choice.
  - giantg2 3y ago
    No medication is completely safe. Any medication approved for use has to be "generally safe" when used correctly. So basically all meds can be dangerous or safe. It's all about informed consent and proper use.
    - regularfry 3y ago
      Well exactly. In this case it's more a matter of whether the move to non-prescription introduces significant new risks both that didn't exist before and that the layperson shouldn't be expected to be able to handle.