Missouri Politicians Abolish Professional Duties, Standards for Pharmacies

Missouri politicians just passed a law that strikes a serious blow to Communism on American soil.

The Missouri House on Tuesday voted 115-43 to approve HB 226, an amendment that [s]pecifies that no pharmacy can be required to perform, assist, recommend, refer to, or participate in any act or service resulting in an abortion and it will be immune from liability for refusing to do so.

By definition, when it comes to women of reproductive age, refusing to provide professional services to patients you deem undesirable is an inalienable right. As such, there's nothing special about politicians enacting laws to shield medical professionals from liability. These politicians are just doing [insert deity of choice]'s work. (Hear that malpractice lawyers!)

What is remarkable about Missouri's HB 226 is that it represents a quantum leap forward from the noble pursuit of playing games with your untouchable patients' trust, dignity, and health without any professional or legal liability.

This law HB 226 allows pharmacies and pharmacists to take advantage of all the benefits of having a monopoly on the sale of drugs without any requirements to abide by those pesky professional duties and standards that are usually a condition of being granted a State monopoly.

Like so:

No licensed pharmacy in this state shall be required to perform, assist, recommend, refer to, or participate in any act or service...

No duty to dispense drugs, talk to or advise patients, refer them to another pharmacist, or refrain from stealing taking a patient's prescription and refusing to return it to her.

...in connection with any drug or device that is an abortifacient, including but not limited to the RU486 drug and emergency contraception such as the Plan B drug...

No requirement to adhere to the professional standard of using science when dispensing drugs. (The medical definition of abortifacient is out, the personal definition is in.)

No duty to dispense drugs to *pregnant* patients, since most prescription medications are Category C. (Good luck with that asthma attack if you're a pregnant woman in Missouri!)

...not limited to the RU486 drug...

No requirement to stock or dispense a drug, RU-486, that cannot be legally stocked by pharmacies or dispensed by pharmacists to begin with.

No duty to provide pain meds or antibiotics to a patient who's been administered misoprostol and RU-486 by her physician, or, for that matter, to a patient who has an IUD, is already using birth control pills, or to men who are wearing tight underwear. (Hey, when you legislate science out of medicine, defining man panties as a device that is an abortifacient is perfectly valid.)

You tell me, what is more anti-communist than having the State grant a monopoly to an enterprise, remove duty and standard requirements, and then shield the entity from liability?

Here is the full text oh HB 226; read it and weep:

338.575. 1. No licensed pharmacy in this state shall be required to perform, assist, recommend, refer to, or participate in any act or service in connection with any drug or device that is an abortifacient, including but not limited to the RU486 drug and emergency contraception such as the Plan B drug.

2. No civil or criminal cause of action shall accrue against a pharmacy due to a refusal to perform, assist, recommend, refer for, or participate in any act or service in accordance with subsection 1 of this section.

3. No board, commission, or other agency or instrumentality of this state shall deny, revoke, suspend, or otherwise discipline the license of a pharmacy, nor shall it impose any other condition of operation due to a refusal to perform, assist, recommend, refer for, or participate in any act or service in accordance with subsection 1 of this section.

4. No pharmacy shall be denied or discriminated against in eligibility for or the receipt of any public benefit, assistance, or privilege of any kind due to a refusal to perform, assist, recommend, refer for, or participate in any act or service in accordance with subsection 1 of this section.

One last thing. I have a question for Rep. Ed Emery, Rep. Cynthia Davis, and all the other Missouri politicians who passed HB 226. Since you've removed the professional duty and standard requirements for the sale of drugs, can I haz street stand for the glorious, Capitalist selling of Plan B in your state?


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Over-the-Counter Misoprostol (Cytotec)

Photo by SliceofNYC

The New York Times has an interesting article about the overt-the-counter availability of misoprostol (Cytotec) in small, family-run pharmacies in the city:

Amalia Dominguez was 18 and desperate and knew exactly what to ask for at the small, family-run pharmacy in the heart of Washington Heights, the thriving Dominican enclave in northern Manhattan. “I need to bring down my period,” she recalled saying in Spanish, using a euphemism that the pharmacist understood instantly.

It was 12 years ago, but the memory remains vivid: She was handed a packet of pills. They were small and white, $30 for 12. Ms. Dominguez, two or three months pregnant, went to a friend’s apartment and swallowed the pills one by one, washing them down with malta, a molasseslike extract sold in nearly every bodega in the neighborhood.

The cramps began several hours later, doubling Ms. Dominguez over, building and building until, eight and a half hours later, she locked herself in the bathroom and passed a lifeless fetus, which she flushed.

I suspect the number of repro aged women "suffering" from gastric ulcers will skyrocket once abortion is banned.

On a slightly more serious note, one thing that stood out for me in the article is the mention of two women, Amber Abreu, an 18-year-old Dominican immigrant from Massachusetts, and Gabriela Flores, a 22-year-old Mexican migrant farm worker from South Carolina. Both women have been arrested and charged with illegally performing an abortion and sentenced to probation and therapy (?), and 90 days in jail, respectively.

I wasn't familiar with their cases, nor with the fact that "performing an abortion" on yourself and "procuring an improper miscarriage" for yourself are criminal offenses. [In Massachusetts the charge could carry up to seven years in state prison.]

I guess when various zealots propose legislation banning abortion they really are most magnanimous when they include a clause to exempt women who obtain abortions from prosecution.

Vaginal vs. Oral Misoprostol

Interesting report on misoprostol regimens. I don't have access to the study on the computer I'm on, but according to the article:

In this study, Dr. Helena von Hertzen, of the Department of Reproductive Health and Research at the World Health Organization, and her colleagues studied 2,046 women who were divided into four groups that received misoprostol either vaginally at three- and 12-hour intervals, or under the tongue at three or 12-hour intervals.

Among women who took misoprostol at 12-hour intervals, pregnancy continued in 9 percent of those who took the drug orally and in 4 percent of those who took it vaginally. Among those who took the drug at three-hour intervals, pregnancy continued in 6 percent of those who took it orally and in 4 percent of those who took it vaginally.

Side effects such as nausea and vomiting were more common among women who took misoprostol under the tongue and vaginally at three-hour intervals than among those who took the drug at 12-hour intervals. Side effects such as pain, diarrhea, chills and shivering were slightly higher among women who took the drug orally.

"Administration interval can be chosen between three hours and 12 hours when misoprostol is given vaginally. If administration is [oral], the intervals between misoprostol doses need to be short, but side effects are then increased. With 12-hour intervals, vaginal route should be used, whereas with three-hour intervals either route could be chosen," the study authors concluded.

A couple of points.

1. You could use misoprostol (Cytotec) alone, but you shouldn't (for now, anyway. Once abortion is outlawed, we'll revisit the recommendation.). Adding mifepristone (RU-486, Mifeprex) to the regimen improves efficacy and reduces side effects.

Note: I'll have more on the misoprostol/mifepristone (RU-486) drug regimen in Part II of my post exposing Senator Jim DeMint (R-SC) lies in support of his amendment to regulate mifepristone (RU-486). [Part I, here.]

In the interim, and without looking it up, try to answer this question: Why do the two drugs work better together? What's more likely: A) the drugs have different actions, or B) the drugs have similar actions, and one potentiates the other?

2. Vaginal misoprostol is not part of the FDA-approved regimen. FDA approved 600 mg mifepristone (RU-486) and 400 mcg misoprostol, both administered orally.

Medical Abortion, Misoprostol, and Latin American Pharmacies

Well, isn't this a grand combination: Abortifacient provision is common at pharmacies [in Latin America] but knowledge about medications is low among pharmacy staff.

A number of studies have documented that women seek and that pharmacy staff distribute drugs intended to induce abortion at pharmacies in Latin America. Abortion is legally restricted in almost all of Latin America. Nonetheless, the region has one of the highest abortion rates in the world. In the 1990s, reports that women were using the prostaglandin analog misoprostol to self-induce abortion in Brazil emerged. Interviews with Brazilian women revealed that they tended to use misoprostol because of its lower price as compared with other medical alternatives, its immediate availability, the fact that the process seems more like a natural miscarriage and its apparent safety. In Brazil, prior to the drug's removal from the market, pharmacies were the main source of misoprostol.

Some evidence suggest that the availability and use of medical methods to terminate a pregnancy may contribute to declining complication rates from clandestine procedures, yet little is known about the role of pharmacist provision of medical abortifacients. We performed this study to learn more about pharmacists' knowledge and provision of medical abortifacients, particularly misoprostol, in a large Latin American city. Although the legislation of the country where the study was performed requires a prescription to purchase misoprostol, in practice, this law is not enforced and misoprostol is commonly sold without a prescription in pharmacies. Moreover, misoprostol is not approved for use as an abortifacient and legal abortions are very rare in the study country. We elected not to identify the study location because of the sensitive nature of the topic.

...

Similar to a study on pharmacies in Mexico City in 1993, our study found that the most frequently recommended abortifacients were hormonal injectables in both the survey (67%) and the mystery client encounters (71%). Although there is no scientific evidence to support their efficacy, it is widely believed both by pharmacy staff and the general population in Latin America that hormonal injectables are effective abortifacients. In our study, the second most common abortifacient was misoprostol: 33% of pharmacy staff mentioned it in the survey and 39% recommended it in the mystery client encounters. However, knowledge about adequate dosage, route of administration, side effects, complications and effectiveness was poor. In fact, no information was offered (even when requested) on any of these topics in at least half of the mystery client encounters in which misoprostol was recommended. Few pharmacy staff had received formal training regarding misoprostol use; most had consulted a drug reference guide or learned about the medication from colleagues, which could explain why so little information was known about dosage, side effects and complications.

Read the whole thing.