Tuesday, April 26, 2005

Why Plan B may not work for Plan B

When Barr Pharmaceuticals submitted the Rx-to-OTC Emergency Contraceptive Plan B to the FDA, I doubt they suspected that after jumping through hoops and making a novel suggestion in their submission that they'd still be in political limbo.

The FDA, in it's politically charged Not Approvable letter, did not state any safety concern with the drug's use in women 16 and older. Under the circumstances, there was no reason to hold up the approval of Plan B as an OTC any further (except to continue to play politics to appease the religious right). In the face of regulatory action that was considered to be based purely on politics (the advisory committee vote was overwhelmingly for approval), Barr re-submitted with the the suggestion to make the drug available without prescription to patients 16 and older, but require prescription for girls under the age of 16. To facilitate this idea, the suggested a Plan B for Plan B - keeping it Behind the Counter to would prevent girls under the age of 16 from purchasing the product without a valid prescription. The problem with this suggestion is the same problem facing women trying to fill prescriptions for not only emergency contraception, but trying to fill their prescriptions for routine contraceptives (regardless of whether they're for contraception or to treat a medical condition), some pharmacists will refuse to hand over the medication.

Under these circumstances, pharmacists who wish to impose their religious doctrine on women could still interfere with purchase of the products to those who are legally able to do so without a prescription. In order for Plan Behind the Counter to work, the drug would have to be available behind the register/customer service counter where other drugs like tobacco (and alcohol in states that don't limit sales to liquor stores) are available for purchase by anyone able to show ID to verify they are legally allowed to purchase the item. Additionally, there will have to be some assurance that store managers, customer service employees or check-out clerks will not also be allowed to refuse sell the medication when someone legally attempts to purchase the medication.

I doubt this idea would bode well for Karen Brauer's PFLI since the organization's primary goal is to interfere with a woman's ability to practice contraception, not to avoid their own involvement in something that offends their moral sensibilities. Arizona Kmart Pharmacist Dan Gransinger has suggested that pharmacist's lie to avoid filling valid prescriptions in light of AZ Gov. Janet Napolitano's veto of HB 2541. This, he suggests, can help a pharmacist avoid complicity in someone else's sin and inconvenience a patient (or worse). It's not as though these pharmacist's have a problem with lying since they preach that use of contraceptives is committing an abortion (there is a difference between causing the expulsion of an implanted embryo and the rare possibility that a blastocyst will not implant solely due to the possibility of a thinner endometrial lining). Ironically, these beliefs are based on a literal acceptance of scripture, and they conveniently ignore the fact that bearing false witness (aka telling lies) is one of G-d's big 10 and Proverbs has a lot of not too nice things to say about liars:
Proverbs 14:5 " A truthful witness does not deceive, but a false witness pours out lies."

Proverbs 14:25 " A truthful witness saves lives, but a false witness is deceitful."
People, both pro-choice and "pro-life", were offended by the suggestion. NARAL took it a step further and wrote to Kmart to complain and ask that Kmart remove Gransinger from managing or working as a dispensing pharmacist at any Kmart. Pro-lifers complain this may be harsh, but if someone feels so strongly about an issue such as this, I don't understand why they wouldn't be willing to accept the personal consequences of their actions. Companies who sell items should do so with the plan they will sell them to anyone who is legally allowed to purchase them (and the prescription is what determines if a person can obtain prescription medications). Would Walmart allow a sales clerk to refuse to ring up the sale of a gun or ammo if the purchase was legal without taking action against the sales clerk? Would they be required to hire someone for the camping & hunting section who would refuse to sell guns based on their moral convictions? I doubt it. If you stock an item for sale, be prepared to sell it. If you don't want to subject your personnel to making decisions or selling something they consider immoral, don't hire them for the division/department that sells those items or don't stock the items.

If pharmacies and pharmacies franchises want to capitulate to religious beliefs that allow some personnel to impose their beliefs on someone who does not share them, they should stop stocking these medications and have the testicular fortitude to make public statements saying as much. Pro-choice folks will gladly stop shopping at those establishments, which will leave more for them to sell to right wing idealogues.

If we now allow pharmacists the ability to refuse to do parts of their jobs based on their morals, don't we have to allow a sales clerk to refuse to sell any item they find objectionable as well? Where will this end? Can a managing pharmacist at a pharmacy that does sell contraceptives require other pharmacists on duty to refuse to fill prescriptions (is that managing pharmacist not complicit in sin if s/he allows those working under him/her to dispense the contraceptives)? Can a an individual impose his/her religious views on formulary decisions for Medicaid? Can an individual at an insurance company notify a pharmacy that a prescription for contraceptives is not covered (or is being filled too soon) to interfere with a person obtaining a refill, just because that individual does not approve of contraceptives? Could it go beyond contraceptives and abortion, spilling into religious based refusal of legal and medically acceptable procedures or treatments?

There is no difference between allowing the religious right to subject me to their religious views and my forcing a Fundamentalist Christian woman to use hormonal contraceptives or have an abortion. Both are reprehensible impositions of one's personal beliefs on another and interference in their healthcare. It's about time the practice of medicine got back to being between a physician and a patient without the local church or politician getting involved in something that has nothing to do with them.

As I've said many times before, the Conscience Interference Clause is not about an individual pharamcist's ability to protect his/her mortal soul, it's about the religious right's unnacceptable demand to be able to interfere in the ability of women to fill valid prescriptions for medications.

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