Journalism: What the NY Post Can't Tell Us
When you write an op-ed titled 'PLAN B': What Science Can't Tell Us, you better make sure you know the basic facts about Plan B. That goes double if you use scare quotes for scientific (what does that even mean?) and you end your article with a nebulous statement. But I'm getting ahead of myself.
This is what the author, Abby Wisse Schachter, tells us about Plan B:
...Plan B - the "morning-after pill."... Plan B is basically a double dose of the regular birth-control pill.
First, Plan B is the "emergency contraception pill[s]", or the "postcoital pill[s]", not the "morning-after pill":
The terms "morning after pill" or "72 hour pill" are misleading because emergency contraception (EC) can be used before the morning after -- but also up to five days after sex. It is most effective when it is taken in the first 12 hours after intercourse. But it can still significantly reduce pregnancy risk if it is taken up to 120 hours after intercourse.
Second, Plan B is not a pill, it's two pills. Two 0.75 mg levonorgestrel pills, to be exact.
An actual emergency contraceptive pill, like Levonelle, is one 1.5 mg levonorgestrel pill. This is important information because the current recommendation is to take one 1.5 mg dose (TWO Plan B pills, ONE Levonelle pill) as soon as possible after unprotected intercourse.
Last, but not least, Plan B is not basically a double dose of the regular birth-control pill.
The author doesn't define regular birth control pill, a fundamental omission, but no matter; there are only two possibilities. This regular birth control pill is either a combination (COC) pill [two hormones, estrogen + progestin], or a progestin-only (POP) one [one hormone, a progestin].
A bit of background:
Most combination pill brands have the same type of estrogen, called ethinyl estradiol (EE). The amount of estrogen in each pill is very small--it's usually measured in micrograms (mcg). Different pill brands have different EE amounts--from a high of 50 mcg in the older brands (mostly manufactured and used before 1975), to a low of 15 mcg in newer ones. Brands with 35 mcg EE and less (low dose and very low dose) are most common today. The other estrogen used in combination pills is mestranol.
In contrast to estrogen, the progestins in combination pills are of many types. These progestins are sometimes referred to as first- and second-generation (the older ones) and third-generation (the newer ones). The amount of progestin in each pill is also very small, and it's usually measured in milligrams (mg).
Because different pill brands have different types of progestins, you can't directly compare the strength of the brands. In other words, if two brands have the same dose but different progestin types, the potency can vary widely For example, 0.5 mg of levonorgestrel is equivalent to 1 mg of norgestrel.
So, we have COCs, POPs, and the assertion that Plan B is, more or less, a double dose of either one (?or both) of them. Not even close.
Plan B is a POP; it does not contain any estrogen. So that rules out COCs.
And just in case Ms. Wisse Schachter is confused by the fact that some COC brands, which contain the progestin levonorgestrel, may be used as EC--that still doesn't magically transform Plan B into a COC. [Nor does it mean that it's the OTC sale of COCs, rather then that of Plan B, that's under discussion.] A full dose (two pills) of Plan B is 1.5 mg of levonorgestrel. That's ten pills of Alesse (0.02 mg EE + 0.10 mg levonorgestrel), or eight pills of Levora (0.03 mg EE + 0.15 mg of levonorgestrel), or four pills of Ovral (0.05 mg EE + 0.5 mg norgestrel), etc. [More brands here.]
Plan B is also not basically a double dose of a regular POP, like Ovrette (0.075 mg norgestrel). It's actually forty Ovrette tablets.
So, we know that Plan B is a 1.5 mg dose, progestin-only, emergency contraceptive. We also know what the side effects associated with Plan B use are: nausea and vomiting, bleeding pattern changes, headache, dizziness, fatigue, abdominal pain, and breast tenderness. Unfortunately, this basic knowledge has yet to reach the NY Post and its columnists:
Of course, some of the risks are mild, such as dizziness, weight gain and irregular periods. But others are more serious, if rare - cardiovascular disease, high blood pressure, blood clots, heart attack and strokes.
This is so inaccurate, it's bordering on farcical.
Plan B is not associated with cardiovascular disease, high blood pressure, blood clots, heart attack and strokes. Ms. Wisse Schachter is either ignorant, or making stuff up.
Plan B (progestin-only) is not a COC (estrogen + progestin). When estrogen and progestin are used together, like in COCs, their overall effect can be quite different from the individual side effects. Last, but not least, even if you're a confused journalist who doesn't realize the difference between Plan B's side effects, and those of COC EC regimens, and who, for some reason, wants to list the side effects of COC EC regimens when discussing Plan B, you still need to be accurate.
COC EC regimens have not been associated with cardiovascular disease, high blood pressure, blood clots, heart attack and strokes:
No deaths or serious complications have been causally linked to emergency contraception. According to the latest World Health Organization (WHO) medical eligibility criteria, there are no situations in which the risks of using ECPs outweigh the benefits. WHO notes specifically that women with previous ectopic pregnancy, cardiovascular disease, migraines, and liver disease and women who are breastfeeding may use ECPs. Given the very short duration of exposure and low total hormone content, combined ECP treatment can be considered safe for women who would ordinarily be cautioned against use of combined oral contraceptives for ongoing contraception.*
But wait! There's more. Getting back to Plan B (you know, the topic of the article) and those alleged more serious, if rare side effects. Not only are those side effects not associated with Plan B use, quite the opposite. Plan B is the preferred EC method for patients with a history of blood clots or stroke.
Finally, we have this parting paragraph from our intrepid opiner:
Maybe there's no "scientific" reason not to allow over-the-counter Plan B sales. But that doesn't mean that selling it in every Rite-Aid and CVS won't have serious, even disturbing, repercussions. And it's not just pro-lifers who are nervous.
Pardonne moi? Either she's not sure that there's no reason not to allow Plan B to be sold OTC [in which case she needs to reread her own article; in particular this The FDA's scientists went through the normal process, and found Plan B safe for over-the-counter sales.], or she's not clear on the meaning of the word scientific [in which case, among other things, she needs to review the concept of reality].
Here's the thing, the fact that selling Plan B OTC has been found safe means exactly that making it available in every Rite-Aid and CVS will not have serious, even disturbing [mwahahaaa], repercussions. Pity the same can't be said about the repercussions reading this op-ed has inflicted on my neurons.
*Emergency Contraception: A Cost-Effective Approach to Preventing Unintended Pregnancy. James Trussell, PhD, Felicia Stewart, MD, Elizabeth G. Raymond, MD, MPH. July 2006