John B. Shea, MD FRCP(C)
The Interim
On March 31, 2005, an article appeared in the Toronto Star, in which N. Jane Pepino et al. advocated the sale of “Plan B,” a “morning-after” pill, without either a prescription or the need to consult a physician or a pharmacist. The article claimed that Plan B (levonorgestrel), when used as a MAP, does not abort, reduces the rate of surgical abortions and is medically safe. These claims are not correct.
Plan B can act as a contraceptive. It can also act to prevent an embryo from implanting in the uterus five to seven days after it has come into existence. This is an abortion that surreptitiously kills the embryo before the mother is even aware that she has conceived. Human embryologists everywhere agree that a human being, a human person, comes into existence at fertilization. This is an objective scientific fact, known to embryologists for over 100 years. Yet, strange to say, it is either unknown or conveniently ignored today by many physicians, research scientists and pharmaceutical companies, which may have a conflict of interest.
On Dec. 16, 2003, the U.S. Food and Drug Administration review committee questioned Plan B’s manufacturer on whether MAP users understood that it has an abortion-inducing effect. Dr. Joseph Stanford of the review committee referred to the Plan B Label Comprehension Study, which tabulated answers to the question, what is Plan B used for? Plan B’s manufacturer included as correct answers: an abortion-type of thing if you think you are pregnant and an abortion-type of thing for the day after.[1]
The scientific evidence
Despite the claims of the Canadian Medical Association Journal[2], Plan B does not decrease the number of surgical abortions. A study in 2004 from Nottingham University in Scotland confirmed that teens who have access to the MAP engage in higher rates of sexually promiscuous behaviour, contract more sexually transmitted infections and have higher rates of abortion than do teens who do not have such access.[3]
A Swedish study in 2002 showed an increase in the adolescent abortion rate from 17 per 1,000 to 22.5 per 1,000, despite widespread use of the MAP.[4] A British Medical Journal study found that teenagers whose pregnancies ended in abortion were more likely to have used the MAP.[5] A study in Glasgow, Scotland, where MAP prescriptions increased 300 per cent from 1992 to 1997, showed that the number of abortions did not decrease.[6] In Lothian, Scotland, where schools handed out condoms and sent pupils to clinics for the MAP, teenage pregnancies among 13 to 15-year-olds jumped 10 per cent in one year.[7] A study by David Paton of Nottingham University has shown that between 1998 and 2001 in England, increases in family planning services and the availability of the MAP without a physician’s prescription were associated with an increase in the rate of sexually transmitted infections from 93.08 to 119.27. The incidence of chlamydia infection and of gonorrhea increased by 24 per cent. This suggests that easy access to the MAP may encourage young people to engage in risky sexual activity.[8]
Authoritative warnings
Despite claims by the World Health Organization, the Canadian Public Health Association and the Canadian Society of Obstetricians and Gynecologists that the use of Plan B is safe, there is no proof that the use of Plan B as a MAP is safe over the long term. There is a lack or absence of scientific studies on the MAP’s long- term effects; repeated usage of the drug; effects on adolescents and the effects of high hormone dosage. On May 6, 2004, the FDA rejected a plan to allow the MAP to be sold over the counter at American pharmacies, citing concern that it might be unsafe for girls under the age of 16. On May 7, 2004, the FDA decreed that levonorgestrel could not be sold over the counter until more studies are done.
It should be noted that levonorgestrel is the active principle in both Plan B and Norplant (an oral contraceptive). When used as a regular contraceptive, Norplant can occasionally cause weight gain, depression, gall bladder disease, increase in blood pressure, blood clots and blindness. Physicians recommend that levonorgestrel should not be used as an oral contraceptive if a woman is pregnant or has a history of unexplained vaginal bleeding, allergy to the drug, blood clots, breast cancer, pelvic inflammatory disease or active liver disease.
Health consequences
The governments of British Columbia, Saskatchewan and Quebec have made Plan B available by delegating authority to pharmacists to write prescriptions. How is the pharmacist expected to assess the medical history and status of his clients with any degree of accuracy? N. Jane Pepino et al., the Canadian Womens’ Health Network and Health Canada want to go a lot farther, however. They want Plan B to be made available without the assistance or intervention of either a physician or a pharmacist. This, they claim, will reduce “needless barriers” to access and will respect a woman’s privacy. They ignore the fact that this use of Plan B (levonorgestrel) will rule out the proper medical counselling of many of those who engage in promiscuous sexual activity. The result will inevitably be a sharp increase in the rate of known sexually transmitted infections and other, as yet unknown, health risks to women, as well as the unrecorded killings of countless innocent, newly conceived human beings. As so often happens, we will learn only too late about the devastation wrought by the morning-after pill.
Notes:
1. Briefing Document: FDA Transcript, Non-Prescription Drugs Advisory Committee in Joint Session with the Advisory Committee for Reproductive Health Drugs Meeting, Food and Drug Administration, Dec. 16, 2003, pages 288, 289. Transcript available at : http://www.fda.gov/ohrms/dockets/ac/03/transcripts/4015T1.pdf.
2. Editorial: Canadian Medical Association Journal, March 29, 2005; 172(7), doi: 10. 1303/cmaj.050260.
3. “Action on teenage sex backfiring,” Edinburgh News, April 5, 2004. This study was presented at the Royal Economic Conference, Swansea, by David Paton, professor of industrial economics, Nottingham University Business School.
4. K. Edgardh, Adolescent Sexual Health, Sexually Transmitted Infections, July 19, 2002 78: 352-356. Available at: http://sti.bmjjournals.com/cgi/content/full/78/5/352
5. Dick Churchill, et al., Consultation Patterns and Provision of Contraception in General Practice Before Teenage Pregnancy: Case Control Study, British Medical Journal, August 19, 2000; 321 (7259): 486-489. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27465&rendertype=abstract.
6. Susan E. Wills, “Deconstructing Rosie.” The National Review, March 28, 2002.
7. Graham Grant, “Birth Control of Teens So Pregnancies Go Up 10 Per cent,” Daily Mail (London), Dec. 1, 2003. E D_ Sci. p.10.
8. See number 3 above.
