The Washington Post Botches Article On Plan B

The Plan B article by Rob Stein in the Washington Post is a joke.

Here are the top 5 reasons why:

1. Use of incorrect and misleading terminology.

Plan B is not so much the morning-after pill as it is the emergency contraception pill.

When your article opens with The popularity of the morning-after pill Plan B has surged... without an indication that morning-after is an incorrect term, you are giving your readers misleading information. [And, no, having controversial emergency contraceptive (controversial?) in the same phrase doesn't count. "Morning-after" has to do with dosage timing, "emergency contraceptive" refers to the name of the contraceptive class.]

You take Plan B after an act of unprotected intercourse in order to prevent an unintended pregnancy. The sooner you take it--ideally, immediately after sex or within the first 12 hours--the better it works. But, and this is very important, you can use Plan B up to 5 days (120 hours) and still reduce your pregnancy risk. Referring to Plan B as the "the morning-after" pill without a qualifier is detrimental because it leads to incorrect usage.

You don't have to wait until the morning after to use Plan B. You can take it right away (preferably) or up to 5 days after unprotected sex.

2. Passing off a consistent position as evidence of a surge in controversy.

Rob Stein asserts that approval of Plan B OTC sales and the resulting increased use has lead to a surge in controversy about making Plan B available without a prescription. One piece of evidence he offers to support his assertion is that conservative groups that fought the change say they are disturbed by the surging use...."We think [the surging use] is putting women's health at risk."

Use of a drug (prescription-only or OTC) known to have detrimental side effects can put users' health at risk. Plan B is a drug. Like any drug Plan B has side effects. That Plan B has no serious or long term side effects is a medical fact.

The surging use of Plan B, a drug without serious or long term side effects, is not putting women's health at risk.

Now, conservative groups like the Family Research Council have never based their discussions about Plan B on medical evidence. They have been consistent in their use of propaganda--Plan B puts women's health at risk--and their ignorance, real or feigned, of science. Conservative groups used propaganda to feed to gullible reporters elicit controversy about Plan B when the drug was available by prescription only. And now that Plan B is available OTC, they continue to use the exact same propaganda.

How is maintaining a consistent position--continued ignorance of science and use of propaganda--on the part of conservative groups evidence of an increased surge in controversy?

3. Incorrect information about Plan B's ingredients.

It's possible Plan B consists of higher doses of the hormones found in standard birth control pills in mirror-Spock's universe. But if we're limiting our discussion to Plan B's ingredients here on planet Earth, we need to be accurate.

Plan B consists of a higher dose of one of the hormones [levonorgestrel, a progestin] found in standard combination birth control pills. Alternatively, Plan B consists of a higher dose of the hormone found in standard progestin-only birth control pills.

And just in case Mr. Stein was confusing Plan B with Preven, an emergency contraceptive pill which actually consists of higher doses of the hormones found in standard birth control pills: Preven is no longer available in the US, and this is an article about Plan B, not Preven.

4. Misleading readers about questions asked and answered.

Mr. Stein tells us that Conservative members of Congress and advocacy groups questioned the drug's safety and argued that easier availability could encourage sexual activity and make it easier for men to have sex with underage girls. They also maintain the pill can cause the equivalent of an abortion.

Approving a drug for OTC sale when there are questions about its safety, public health impact, and mechanism of action. Now that's one juicy controversy!

Except science has already asked and answered these questions.

Plan B has no serious or long term side effects. [See #2.]

The impact of OTC use is well documented in the medical literature. Progestin-only emergency contraceptive pills like Plan B have been in use without a prescription for years (in Europe, of course). The evidence shows that easier availability does not increase risk taking, either for adults or adolescents (projection fantasies about Plan B and men having sex with underage girls notwithstanding).

Finally, Plan B does not cause abortion.

Just because Conservative members of Congress and advocacy groups pretend-question the evidence about Plan B in an attempt to mislead the public does not mean you report their questions and leave it at that. Since you have an obligation to be factual, you have to note their deceit and give your readers the correct information about Plan B's safety, impact, and mechanism of action.

5. Misrepresenting the FDA's findings on Plan B.

The FDA did not say there was too little safety data to approve the drug for teenagers younger than 18.

What the FDA actually said is that for women 17 and older the existing Rx dispensing requirements for Plan B are not necessary to protect the public health and that an Rx-only to non-prescription switch for those consumers is authorized under 21 U.S.C. 353(b)(3) and 21 CFR 310.200. (emphasis mine)

Note to Mr. Stein: 17 and 18 are not one and the same. But then, what's a year here and there between political ideologues. In any case, when you report on what the FDA said, even if the agency's statement is just propaganda, you still need to insure you are reporting the propaganda accurately.

And speaking of the FDA, why exactly is what the agency said about Plan B OTC sales propaganda?

Since, clearly, just reading the Washington Post won't provide you with this information, allow me. Because the age restriction is not based on any scientific evidence that Plan B is not safe for women under 17. It is a purely political decision.

From the GAO report, Decision Process to Deny Initial Application for Over-the-Counter Marketing of the Emergency Contraceptive Drug Plan B Was Unusual (.pdf):

There are no age-related marketing restrictions for safety reasons for any of the prescription or OTC contraceptives that FDA has approved, and FDA has not required pediatric studies for them. All FDA-approved OTC contraceptives are available to anyone, and all FDA-approved prescription contraceptives are available to anyone with a prescription. For hormonal contraceptives, FDA assumes that suppression of ovulation would be the same for any female after menarche,13 regardless of age. FDA did not identify any issues that would require age-related restrictions in its review of the original application for prescription Plan B, and prescription Plan B is available to women of any age.

And from the FDA's Director of the Center for Drug Evaluation and Research, the person in charge of making public health decisions about Plan B, Dr. Steven "I'm Not Familiar With Plan B's Side Effects" Galson:

[Dr. Galson] said that the age restriction (which was originally set at 16) was changed to 18 to make it less confusing for pharmacists to enforce.

Mustn't.Confuse.The Pharmacists.

So, there you have it. A Washington Post article on Plan B which manages to misreport both basic medical facts about Plan B, as well as the less-than-subtle political propaganda directed at Plan B by some Conservatives and the FDA. Well done!



(via Our Bodies Our Blog)