Sunday, July 15, 2007

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)

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At 1:46 AM, Blogger RoseAG said...

I don't think he is the best health reporter.

When the Elizabeth Edwards/Tony Snow cancer stories came out I felt that his reporting was unduly negative.

I think The Post is not the paper to go to for health news.

At 3:33 AM, Blogger Spoony Quine said...

` My usual explanation for aberrant fundie/conservative/religious right behavior: They is afeared!

At 4:11 AM, Blogger ema said...


But don't you think The Post should be the paper to go to for *accurate* news?

see quine,

They might be afraid, or they might not be. The problem is that they are quite skilled at propaganda and trickery, and that the continued refusal of journalists to report accurate medical facts contributes (greatly, in my opinion) to the public's vulnerability to said propaganda and deceit.

At 10:19 PM, Anonymous Anonymous said...

I absolutely love your break-downs of media disinformation. I really hope that you send this to the author, publisher, & editor.

At 11:04 PM, Blogger ema said...


Thank you. I did email Mr.Stein but haven't heard back from him (nor do I expect to). I'll see if I can find the info for the editor and publisher and I'll email them.

At 1:21 AM, Blogger RoseAG said...

Well the odd thing is that usually they aren't on the conservative side and this article seemed slanted that way.

Sometimes I think they just parrot whatever kind of press release they got without looking into the issue in any real way.

Which is why you should contact them!

The article ran last week so it may be too late. I find that you need to send them things pretty promptly. (I have a lot of opinions I've shared with them :) )

At 1:28 AM, Blogger RoseAG said...

Of course I think they should go in for accurate news. Normally the Post runs towards the liberal, but this isn't slanted that way. They did run an article about a woman who tried to get Plan B via prescription and had a rotten time because it was so hard to get in with a Dr. and then find a pharmacy in time. Of course she was working and couldn't just devote her whole life to it, but still, that was kind of a pro-Plan B article.

I have to agree that sometimes they just seem to parrot whatever press release they might have gotten without looking too hard at the issue. I felt that way about Elizabeth Edwards.

Usually you need to contact them right away after something you have something to say runs. They like to publish letters the next week.

Sometimes you get an answer back and sometimes not. He may have gotten a lot of mail about that article. That's where sending a letter to can be good.

I'm kind of opinionated!

At 5:08 PM, Blogger cynicalgrad said...

A great article (of the academic sort) on the political struggle in getting Plan B approved is by Wynn and Trussell (2006) in Medical Anthropology Quarterly -- I highly recommend it for an insightful reflection on how outrageous many of the objections to the approval were. (I realize not everyone might have access to these sorts of journals, but this article is really worth trying to get your hands on.)

At 5:23 PM, Anonymous Anonymous said...

I'm not sure you can e-mail the Post's Editor (like a letter to the editor), but you can definitely e-mail the ombudsman (who is actually a woman). I've done it and gotten very prompt acknowledgement of my comments.

At 9:02 PM, Blogger NewsCat said...

I totally remember this article and remember reading it and remember remarking on some of the things you highlighted. Especially #4 caught my eye at the time.

I think the problem with #1 is that it's not just a Washington Post problem. Reproductive Rights groups also refer to Plan B by THREE NAMES in their press material and website.

It's called Plan B, Emergency Contraception and the Morning-After pill. I remember I was writing, or going to write a blog post about how it's time for reproductive rights groups to totally abandon the term "Morning After pill" and I got sidetracked from doing it. I think the big three, NARAL, Planned Parenthood and Feminist Majority all have differences. National Planned Parenthood does not use the term Morning After at all, but some state PP's do. I know Feminist Majority has used both recently.

I'm not saying the terminology isn't confusing and the Post shouldn't have just called it Plan B. But the fact of the matter is that even reproductive rights groups are still occassionally calling it the so-called Morning After pill because that's how the public was first introduced to the idea. (Which then naturally was deliberately confused with RU-486 the abortion pill because anything with "pill" and reproductive in nature in the name is confusing and controversial.)

At 1:52 AM, Blogger ema said...


Thank you for the pointer. I'll try to get my hands on that article.

roseag & anon,

I did email the ombudsman as well but no reply. So, next time, I'll follow roseag's advice and go with the one.


As much as I'd love for the "morning after" term to totally disappear, I'd settle for the next best thing: an obligatory disclaimer. And that's what I was trying to get at with #1. There isn't even a hint in the article that "morning after" is a commonly used, yet incorrect, lay term.


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