Western states lead effort to let pharmacists prescribe birth control

Groundbreaking laws in two Western states will soon make access to birth control easier for millions of women by allowing them to obtain contraceptives from pharmacists without a doctor’s prescription.

Even as the Supreme Court prepares to consider another divisive case involving access to contraception, public health advocates hope these arrangements could spread across the country, as states grappling with persistently high rates of unintended pregnancy seek to increase access to birth control with measures that so far have been unavailable under federal law.

Most Western countries require a doctor’s prescription for hormonal contraceptives like pills, patches and rings, but starting sometime in the next few months, women in California and Oregon will be able to obtain these types of birth control by getting a prescription directly from the pharmacist who dispenses them, a more convenient and potentially less expensive option than going to the doctor.

Pharmacists will be authorized to prescribe contraceptives after a quick screening process in which women fill out a questionnaire about their health and medical histories. The contraceptives will be covered by insurance, as they are now…

About half of the 6.6 million pregnancies annually in the United States are unintended, a higher proportion than in Europe.

But, EU nations aren’t often controlled by fundamentalist Christian voting blocs.

Reproductive health groups and medical associations increasingly say the ultimate goal should be to make contraceptives available without a prescription, and some worry that the push for pharmacist-prescribed contraceptives could thwart that…

Cost is another possible drawback of over-the-counter sales. The Affordable Care Act does not explicitly require plans to cover over-the-counter medications, so women might wind up paying hundreds of dollars a year for over-the-counter birth control instead of obtaining it free with a prescription…

A New Mexico proposal that failed in 2012 is expected to be revised to reflect the Oregon and California measures, said Dale Tinker, the executive director of the New Mexico Pharmacists Association…

One unanswered question, however, is whether insurers will pay for the time pharmacists spend reviewing women’s questionnaires or helping evaluate options…

And then there will be the states ruled by politicians who believe the Old Testament is a better gauge of how a women’s life should be governed.

See your doctor for a prescription for cigarettes

In the global war against smoking, Europe remains a difficult battlefront. Despite ad campaigns featuring grisly images of rotting lungs and crumbling teeth, “the beautiful continent” continues to have the highest smoking rate in the world.

So forgive Iceland for considering something truly radical — prescription-only cigarettes. Under proposed legislation, only those with valid medical certificates would be permitted to buy cigarettes from pharmacies.

“I think Iceland can be a test tube to try out progressive things because we are a small country and we don’t have a massive lobby for tobacco,” said Thorarinn Gudnason, a cardiologist at Landspitali University Hospital in Rejkyavik. ”We are taking care of people who are dying of this disease in their 40s and we’re fed up with it.”

Iceland’s smoking rate is already one of the lowest in Europe. Just 15 per cent of the population lights up compared to an average of 31 per cent across the continent. However, the story among young Icelanders is more worrisome: 20 per cent of children and teenagers smoke. Dr. Gudnason hopes the new plan will dramatically reduce that figure and cut overall smoking rates to less than 10 per cent…

Tobacco and nicotine would be classified as addictive drugs and second-hand smoke would be treated and controlled like other carcinogenic substances. Lighting up in public places such as parks and in cars with children would be outlawed.

Eventually, smokers who are unable to kick the habit through treatment and various addiction programs — or those smokers who simply refuse to quit — may get a prescription for tobacco from their doctors. Once cigarettes become available only through physicians, the price will go down again — as it would be unfair to tax those unable to quit supporters of the plan say.

“Tobacco is very addictive and we would recognize them as addicts,” said Ms. Fridleifsdottir.

Bravo! Once again the political side of Iceland is willing to experiment with a daring approach to a disgusting problem. It would force a lot of people with lazy personal ethics to confront a personal problem. They can still maintain their addiction if they wish.

Saving their lives is a side effect.

Ready for some depressing news about antidepressants?

Research has shown that antidepressants help about three quarters of people with depression who take them, a consistent finding that serves as the basis for the oft-repeated mantra “There is no question that the safety and efficacy of antidepressants rest on solid scientific evidence,” as psychiatry professor Richard Friedman of Weill Cornell Medical College recently wrote in The New York Times. But ever since a seminal study in 1998, whose findings were reinforced by landmark research in The Journal of the American Medical Association last month, that evidence has come with a big asterisk. Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill—a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.

Hence the moral dilemma. The placebo effect—that is, a medical benefit you get from an inert pill or other sham treatment—rests on the holy trinity of belief, expectation, and hope. But telling someone with depression who is being helped by antidepressants, or who…hopes to be helped, threatens to topple the whole house of cards. Explain that it’s all in their heads, that the reason they’re benefiting is the same reason why Disney’s Dumbo could initially fly only with a feather clutched in his trunk—believing makes it so—and the magic dissipates like fairy dust in a windstorm…

The study’s impact? The number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005.

To be sure, the drugs have helped tens of millions of people, and Kirsch certainly does not advocate that patients suffering from depression stop taking the drugs. On the contrary. But they are not necessarily the best first choice. Psychotherapy, for instance, works for moderate, severe, and even very severe depression. And although for some patients, psychotherapy in combination with an initial course of prescription antidepressants works even better, the question is, how do the drugs work? Kirsch’s study and, now, others conclude that the lion’s share of the drugs’ effect comes from the fact that patients expect to be helped by them, and not from any direct chemical action on the brain, especially for anything short of very severe depression.

RTFA. It’s long, detailed – a thoroughgoing record of physicians continuing to run a marathon in an ethical cul-de-sac. And the pharma manufacturers? They just love it. As the article says, “A triumph of marketing over science!”

Thanks, Mr. Fusion

New Jersey State Assembly approves medical marijuana

The New Jersey Assembly approved a measure on Monday that would make the state the first in the region and the 14th in the nation to legalize the use of marijuana for medical reasons.

The measure was to be voted on by the State Senate later in the afternoon, the final day of the legislative session. If passed, it would allow patients diagnosed with severe illnesses like cancer, AIDS, muscular dystrophy and multiple sclerosis to have access to marijuana distributed through state-monitored dispensaries…

Assemblyman Reed Gusciora, a Democrat from Princeton, said the New Jersey law would be the most restrictive in the nation because it would only permit doctors to prescribe it for a list of serious chronic illnesses. The legislation would also forbid patients from growing their own marijuana and using it in public, and it would regulate the drug under the strict conditions used to track the distribution of medically prescribed opiates like Oxycontin and morphine.

“I truly believe this will become a model for other states because it balances the compassionate use of medical marijuana while limiting the number of ailments that a physician can prescribe it for,” said Mr. Gusciora, who sponsored the bill…

In other words, New Jersey is still run by chickenshit politicians.

Opponents of the New Jersey bill often use California’s experience as a cautionary tale, saying that medical marijuana is so loosely regulated there that the state has essentially decriminalized the drug. Under California law, residents can legally obtain marijuana to treat a list of maladies as common, and undefined, as anxiety or chronic pain…

As the legislators prepared to vote on the measure, more than a dozen chronically ill patients rallied at the State House to urge lawmakers to pass it.

I sincerely wonder if any NJ legislators considered any of the studies on the usefulness of medical marijuana, the absurdity of continuing current criminal practices – or did they just rely on the advice of their friendly neighborhood wardheelers?

Doctors should be required to disclose off-label prescriptions


Doctors should be required to disclose when they are prescribing drugs off-label, argues a new article in this week’s PLoS Medicine. Michael Wilkes and Margaret Johns from the University of California Davis argue that the ethics related to informed consent and shared decision-making provide an imperative for doctors to inform patients about the risks of a medical treatment when their use has not been approved by regulators.

Off-label prescriptions are those that do not comply with the use approved by the Food and Drug Administration (FDA) for the drug. While off-label prescribing is legal and accounts for roughly half of all prescriptions currently written in the US, it is often not supported by sound scientific evidence. Worse, say the authors, off-label prescribing can put patients at risk and drive up healthcare costs.

The public often assumes that all common uses of prescription drugs have been approved by the FDA, say the authors. But current law does not prevent doctors from prescribing a drug to any patient for any use whether it was approved for this use or not.

“From an ethical perspective,” say Wilkes and Johns, “[what is required is] open, honest discussions where doctors tell their patients that the use of the drug will be off-label and thus not approved for this indication, explain the risks, potential benefits, and alternatives, and then ask patients for their permission to proceed.”

As an occasional patient I’m pleased the relationship I have with my physician is ethical and trusting.

Still, you trust your friends; but, you cut the cards. I’d rather have the ethical requirements spelled out in law – instead of having to rely on a trade commission or the AMA providing assurance.