Tony Gosgnach
The Interim

Despite expressions of concern from a cross-section of Canadians, the federal health agency on April 20 approved the immediate dispensation of the so-called morning-after pill levonorgestrel – or “Plan B” – on an over-the-counter basis, without a prescription, in pharmacies across the country.

Pro-life advocates regard the MAP as an abortifacient because, at least part of the time, it functions after a pregnancy has begun by preventing an already-fertilized embryo from implanting in the mother’s uterine wall.

The party line, however, as expressed by Canada’s medical, pharmaceutical, media and political establishments, posits that the MAP functions as an “emergency contraceptive” – somewhat of an oxymoron – in the case of contraceptive failure on the part of other drugs and devices. These establishments further claim the drug has the benefit of lowering the incidence of unwanted pregnancies and abortions.

Groups including Paladin Labs Inc. – the manufacturer of levonorgestrel – the Society of Obstetricians and Gynecologists of Canada, the Canadian Pharmaceutical Association, the Women’s Health Network and the Royal College of Physicians and Surgeons had been involved in a protracted lobbying effort in favour of the reclassification of levonorgestrel.

Some of them – including Paladin, of course – can already smell the money. The CPhA is lobbying to get its pharmacists paid for their “counselling services.” In Quebec and Saskatchewan, that amounts to $16 per consultation – as much as for a family physician. The drug now sells for about $25 at a pharmacy. With pharmacists’ potential counselling fees, that could eventually push the individual cost to over $50.

“This is a landmark day for Canadian women who now have immediate access to Plan B,” crowed Jonathan Ross Goodman, president and CEO of Paladin Labs, which stands to make a financial windfall from the reclassification. He claimed that the drug is “safe and effective.” The MAP “treatment” consists of two small pills that contain 0.75 mg of levonorgestrel.

Mike Izzotti, a national co-ordinator for Pharmacists for Life International Canada, notes that that dosage is an astounding 50 times that of a daily birth control pill. Yet, a press release from Paladin’s public relations agency claims that is only “slightly more hormone than a daily birth control pill.”

Izzotti also points out that medical consequences of MAP usage include increased risks of ectopic pregnancy, blood clots and a kickstart in cervical cancer among women infected with human papilloma virus.

In responding to a Canadian Medical Association Journal editorial in favour of levonorgestrel’s non-prescription status, Dr. Joe Nemeth, assistant professor of emergency medicine at the McGill University Health Centre, charged that “most women will not be aware that (the MAP) can cause a termination of a pregnancy … We need to let women know that this is a possibility when taking this medication. Ignorance is bliss is not an option. By failing to educate women on their choices, we as physicians/pharmacists are guilty of a form of paternalism.”

Mainstream media coverage of the issue has focused on recent research conducted by Judith Soon of the University of British Columbia, who claimed women in B.C. have been using MAPs twice as often since they were made available over-the-counter in that province in December 2000. Soon suggested MAPs have prevented hundreds of “unwanted pregnancies” in B.C. over a two-year period.

Needless to say, however, Canadian pro-life representatives are taking issue with virtually every claim being made regarding morning-after pills.

“Is Health Canada using the media to push a political agenda?” asked Dr. Will Johnston, president of Canadian Physicians for Life, just prior to the drug’s reclassification.

Physicians for Life has submitted briefs noting the health risks to women of MAPs have not been adequately assessed and that provisions for important counselling have been absent in proposals for the reclassification of levonorgestrel.

Physicians for Life also takes issue with Soon’s claims that the MAP is preventing unwanted pregnancies and abortions in B.C. The number of abortions in that province has actually been increasing – from 14,070 in 2000, to 15,820 in 2001 and 16,076 in 2002.

Meanwhile, a study of Scottish women has found MAPs do not reduce the abortion rate, while a Swedish study points out that women using MAPs are at a higher risk of future unintended pregnancies. In Thailand, women are reported to be taking MAPs on a dangerously regular basis, exceeding the recommended monthly maximum dose of four tablets. And a study by researchers at the University of California finds that increased access to MAPs does not lower pregnancy rates, because many women do not use them.

South of the border, the U.S. Food and Drug Administration continues to delay a decision on over-the-counter sales of MAPs. The agency says it needs more time to review the substance.