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Pharmacists say (and have) No Plan B

Some of the readers of this site know that I have a background in pharmacy.  I have a continued interest in the profession - mostly because of the disillusionment I dealt with - and when it crosses with a socially-relevant Christian worldview topic, I just can't resist.

Well, today I found an article that mixes the many facets of the "emergency contraception" (EC) drugs that face pharmacists that claim to be Christians in one tidy article (here). Certainly, there have been PLENTY of articles covering what are generally painted as "renegade" pharmacists in the popular media.  But the one at Christianity Today gave me pause.

In general, I think there's a lot of well-intentioned, yet misguided folks on this topic.  These new EC's are the IDENTICAL drugs (ingredients) contained in regular birth control drugs that these same pharmacists dispense MANY of every day.  These aren't the nasty true (in scientific definition) abortifacients like RU486 that created so much hullabaloo years ago.  This is literally "more of the same" that we do already.  Boosted doses of drugs we have long been comfortable to dispense (unless you're Catholic, of course).  So, while I don't see any value in stating MY view on these, I think it's safe to say that most folks don't really know what they're arguing about...even some pharmacists, unfortunately.

However, this situation has brought to light something I felt when I was in the profession - that pharmacists are not respected members of the medical community nor considered "experts" by society.  Let's look at each of those points.

First, pharmacists have long been second class citizens when compared to doctors and nurses.  They're somewhere above chiropractors and podiatrists, but below psychologists.  Medical docs are, of course, the top of the heap.  They've long been discounted as incapable of writing prescriptions - even though the medicines are EXACTLY what they focus on and know the most about.  Yes, they have less training in diagnosis, but partnered with a doctor (in crisis situations, for example) and it would only serve the patient better.  Pharmacists have had to shoe-horn their way on to the medical rounds team.  Pharmacists have been supposedly replaced by automated solutions in many outlets (retail and hospital) and staffed down only to the minimum level required by law in some cases.

Likewise, there is a perception within society that the pharmacist is basically an "automated pill dispenser..." and shouldn't have the same option to exercise their medical training as their doctor does.  I've literally been berated because we wouldn't dispense a drug that would interact with another they were taking.  While the circumstances are different, the lack of respect for the training and education is the same.  "Who cares if the pharmacist says it - my doctor told me to take it."  Where are the days of people respecting their neighborhood pharmacist and seeing them as not only a "key" part of their healthcare team, but often, the first-line of support with something ails them.

Largely, this is why I became disillusioned with pharmacy.  Working at your neighborhood pillbox isn't healthcare - it's RETAIL.  So, does that mean you check your training at the door and just become a checkout jockey?

That said, I think these pharmacists that refuse to dispense ECs had best NOT be dispensing any birth control pills at all.  Noesen, in the article has this as his standard, but has paid dearly for it.

On the other hand, if this was a story about a true life-killing drug - be it babies, the elderly, the terminal, whatever - the pharmacist should have the respect and legal grounds to use the training they've earned and their expert ('cause they are) opinions to "Do no harm."  Have we heard that phrase before?  Oh wait, pharmacists aren't doctors, right?  So that doesn't apply, I guess.

Later.

Print | posted on Sunday, August 20, 2006 3:54 AM | Filed Under [ God, Country, Politics... ]

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# re: Pharmacists say (and have) No Plan B

Now Jason, you know I can't keep my mouth shut....
As a previous "almost" pharmacist you know many mechanisms. You know the mechanism of Micronor- a progestin only pill (mostly used in breastfeeding mothers) and Ortho-Cyclen a monophasic, estrogen/ progestin combination birth control pill. For those of you reading, each pill prevents pregnancy with a low dose of hormone by prohibiting ovulation (release of an egg). These pills mimic pregnancy by "tricking" the body with exogenous hormones. When your body "thinks" it's pregnant, no eggs will be released, therefore there's no way to conceive (hence the name contraception.)
While it is TRUE that these hormones are the same hormones in emergency contraception (EC) like Preven and Plan B, the doses are significantly higher. I hate to refer to it as "emergency contraception" because the mechanism is actually contra-IMPLANTATION. Get ready now, this is what the pro-choice activists DO NOT want you to know. Unlike regular birth control pills (low-dose hormones), these high doses of hormones "slough-off" the uterine lining, which is where a fertilized egg (embryo) would implant. The pro-choicers enjoy saying that EC prevents ovulation, which may be true IF the woman has not ovulated. But if she has ovulated and the egg has been fertilized, then in my opinion, she has a baby. Seventh grade health books will tell you that an egg plus a sperm equals an embryo. Therefore, preventing an already fertilized egg from implanting in the uterine lining, is killing a living being.
Just as with drinking alcohol: some Christians do not think it's wrong to drink, while other Christians are strongly against it. Everyone has their own opinion. I am a pharmacist who DOES dispense contraceptives and DOES NOT dispense the morning after pill. I base my opinion and decision on text books as well as the word of God. And when I stand before the Lord and am judged for what I've done on this earth, I will not be condemned for assisting in terminating the life of a baby. The community can scoff me, Rod Blagojevich can take my license, the FDA can go around me and make the drug over the counter. Any way, I stand firm. My OB/GYN does not write scripts for the morning after pill; why should I be required to fill it?
8/23/2006 4:36 PM | Amanda
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# re: Pharmacists say (and have) No Plan B

Hey Amanda...

Thanks for posting. I knew new it was coming (thanks Mom!)

I don't disagree in what you stated, but the sloughing of the uterine wall can be part of regular birth-controll pills too - hence the reason some women spot or "breakthrough" bleed even while on the pill.

My point is that it's NOT as clear-cut as either side would like to make it, and there are really two issues at stake here: First, are we killing babies? Second, do Pharmacists have the right to exercise their own knowledge and opinions as a healthcare provider?

The first, contrary to what either side states, isn't clear cut, so I won't debate it. We both agree that it should be avoided because life is to be cherished at all stages - the pre-born to the eternal.

The second, however, is an insult to the education pharmacists receive AND a double-standard. People fail to acknowledge the training that pharmacists receive and assume that decisions made NOT to dispense a prescription is simply a personal preference or in some way, just to annoy the patient. In fact, there are methods to the madness - expired or no refills on a script, addictions, interactions, better alternatives, price-points/insurance coverage, etc. Yet, I had been yelled at plenty of times for not dispensing something that may had caused a problem (sometimes small, other times more significant) for the patient.

These two problems SHOULD be separate. But they're not and it muddies the water to consider them as a single issue. What happens if euthanasia becomes legal?

Yes, in many cases, the pharmacist is LEGALLY BOUND to withhold medication. But that's not the same as ALLOWING THE PHARMACIST to withhold based on a set of reasons. It's a point that needs clarification. If society prizes the services that pharmacists offer, it should allow you, Amanda, to make the choices that you believe "do no harm".
8/23/2006 8:12 PM | Jason
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# re: Pharmacists say (and have) No Plan B

Jason, all good points. However muddy it is, the clear cut issue for me is my conscience. And if I don't adhere to my ethical, moral or religious standards, what kind of person (or pharmacist) does that make me? Whether we're dealing with dispensing drug interactions, early controlled meds, or the morning after pill- it should be my call. While I'm there to help the patient, I will not compromise myself.
It's amazing how from 1990-1996, pharmacists were chosen in the Gallup poll as the #1 most trusted profession. Now, we're supposed to be robots just doing as everyone tells us. I think it's funny how people will call the pharmacist for advice before their doctor, due to our knowlege, availability and honesty. However, folks like Rod Blagojech say pharmacists are not really "health care providers" as covered in the Health Care Right of Conscience Act.
Now, the issue will be if my pharmacy will have to carry Plan B. The FDA just voted to make it available OTC to women 18 and over (just like Sudafed). While some people say that will relieve me of the duty to dispense, it also requires me to hand the drug over the counter. The problem with this is what Plan B will do to those women who repeatedly take it, over and over, in place of birth control pills. I don't know if you know anyone who has taken this med, but the two women I know both got extremely sick. Both said, "I thought I was dying." I'm afraid it will be abused and cause many women problems in the future. Who knows what it will do to the women who do take it over and over? Safety has not been established with long term, repeated use. I honestly believe those women will really have problems when they do want to get pregnant! All of this is another soapbox that I'll leave for another day.
8/24/2006 6:46 AM | Amanda
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# re: Pharmacists say (and have) No Plan B

Jason
I forgot to mention that euthanasia is already an issue. I believe in California (don't quote me) there are many legal issues regarding euthanasia. One pharmacist refused to dispense a lethal conconction for a MD that is well known for prescribing "death drugs." They've been in a court battle ever since.
On the contrary, in Florida, a pharmacist is being sued for dispensing, Oxycontin, two benzodiazepines, and Soma together on an early refill and the patient used these to commit suicide. We can't win either way.
Blagojevich says, "Just fill it. No hassles, no lectures, just fill it." And when the pharmacist in Florida does just that, the patient commits suicide and then he gets sued. Amazing! Make up your mind!
8/24/2006 6:56 AM | Amanda
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# re: Pharmacists say (and have) No Plan B

Yep. Amanda, I'm fairly confident that we agree on about 98% of this discussion - and not surprisingly, in my opinion.

My beef has been that this problem is much older than the recent cases you cite indicate. For too long, Pharmacists have allowed themselves to be pushed around by doctors - even when the public respected Pharmacists.

The problem is that now, the issue of respect is getting confused with the issue of ethics and religion, which is muddied by a lack of understanding of what a particular class of drugs (in this case "EC" drugs) do. Each is separate and requires its own consideration and deserves NOT to be lumped in with the other topics.

At the end of the day (or "the End of Days", as it will be) you're correct that ultimately you are accountable to Someone bigger than that moron governor you people elected. :)

Something else you point out that I hadn't previously discussed, but considered is that while it used to be quite common for pharmacists to transfer their licenses from state to state, maintaining multiple licenses in many cases in the states they've worked, given the current trend for STATE litigation bodies to be deciding the fates of these cases will limit (for conservs such as ourselves) where you can practice. Until a FEDERAL mandate is enacted, there will be NO unity. I'd submit that it'll largely fall along our political lines (Red state/blue state).

Of course, if today's Federal government continues the current path, that Federal mandate probably won't fall in your favor. You could be forced to look at a situation like Noesen (from the article above) did - practicing in some other country!

Come sweet Jesus, no? :)
8/24/2006 10:39 AM | Jason
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# re: Pharmacists say (and have) No Plan B

Interesting article today -

Christianity Today just posted this list of current topics that is relevant:

Their discussion is a slightly different angle than mine - why aren't more pro-life groups up in arms over contraception drugs if they're being so fussy about the "EC" meds (Plan B, etc).
8/24/2006 3:45 PM | Jason
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# re: Pharmacists say (and have) No Plan B

It makes me want to vomit that Pres. Bush stood there on Mon and encouraged the OTC status of Plan B. He is supposedly pro-life, anti-abortion, anti-embryonic stem cell research. He has been very vocal in the past. However, now that his nomination is up for FDA big-wig, he is "going with the flow" and saying what the puppeteer wants him to say. I've never seen an instance where he was TRULY politically motivated until this. So he cares about the embryo that is discarded for research but doesn't care about the embryo that was washed out of the mother's uterus by Plan B. I am SO disappointed in his actions.
8/24/2006 9:14 PM | Amanda
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# re: Pharmacists say (and have) No Plan B

Well, the Plan B people aren't happy yet...

What I find particularly interesting is this:

"As a condition of approval, the drug's manufacturer, Barr Pharmaceuticals Inc., agreed to use anonymous shoppers and other methods to check whether pharmacists are enforcing the age restriction."


That was awful nice of Barr to offer to police the pharmacists. So, who gets in trouble in this arrangement - not Barr! The Pharmacists are left holding the bag. Lovely.

All that, and before long (and I'm fairly confident they'll eventually win) we could see an 11 or 12 year old girl buying a box of Plan B with her stinkin' ALLOWANCE MONEY!

...and who comes out smelling like a rose? Stupid Planned Parenthood!


"Anything that makes it harder for teenagers to avoid unintended pregnancy is bad medicine and bad public policy."


...yeah, we'd HATE to encourage them to actually AVOID SEX!
8/25/2006 6:31 AM | Jason
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