Standard Mischief

Well, they have gone and done it. After three ladies (and their supporting groups Planned Parenthood Massachusetts, NARAL Pro-Choice Massachusetts, and Jane Doe Inc.) sued to bring media attention to their ?plight?, the Board of Registration in Pharmacy in the state of Massachusetts has arbitrarily ruled that emergency contraceptive is a medicine that is ?commonly prescribed?, and therefore must be stocked at Massachusetts’ 44 Wal-Marts and four Sam’s Club stores.

Again, I have to chew out the lapdog media. In the debate that was in the public forum, absolutely no one found the need to demand proof that emergency contraceptive is indeed ?commonly prescribed?. Those who sued to get their way failed to provide any lies, damn lies, or even any statistics. I’ve checked the three pro-choice group’s websites and a number of the press sites and found nothing.

The best coverage award goes to the Jurist. They linked to not only the pharmacy board, but to the regulation as well. (No word count on the legalese though.)

Just so you know where I stand, here’s the mutant-libertarian scorecard. Pharmacies have the right to decide, in most cases, what they want chose to stock. Individual pharmacists have the right to refuse to fill prescriptions if it’s against their moral beliefs. Pharmacies have the ability to fire pharmacists who refuse to fill valid prescriptions, or for any other case of insubordination (this has to be this way, otherwise I’m converting to Pastafarian, where you get every Friday off as a religious holiday). Fired pharmacists do not have their First Amendment rights restricted, they are free to go work for the ?Vatican Pharmacy? if that’s what they chose.

I’m not opposed to emergency contraceptive, I’m not even opposed to a law that plainly states that all pharmacies in the state of Massachusetts must carry emergency contraceptive, if a law like that was clearly needed. But CVS has already stated that it stocks emergency contraceptive in all of it’s 300+ stores that are located in Massachusetts. There are 1,045 other pharmacies, besides Wal-mart, in Massachusetts, including a mail order pharmacy run by Planned Parenthood League of Massachusetts. Hmm, I wonder if I could sue Planned Parenthood to ensure Viagra was carried by their pharmacy. That’s got to be commonly prescribed medication.

Heck, I’ve even posted a blog entry on how emergency contraceptive is the same exact drug as regular birth control pills. So if your doctor writes out you prescription a little differently, and gives you different dosing instructions you can even get your emergency contraceptive at Wal-Mart, if that’s your only option.

I hashed this out with tgirsch over at SayUncle’s place, but I have little to add to this specific argument. (There are other issues that I’ve promised to address.)

tgirsch Says: But again, this is where our philosophies differ. I think that all that should matter is that a product has been proven safe (FDA approval), that the patient wants or needs it, and that a physician has recommended it (via a prescription). You, however, would add profitability to this equation. In other words, if a patient needs something, and a doctor agrees that the patient needs it, you would allow the market to decide (based on profitability) whether or not the patient actually gets it. That?s why I make my complaint that the market ought to serve us, rather than the other way around.

Yea, I probably didn’t make that too clear. There is no demonstrated need to meddle in this case. Again, the Free Market is working just fine here. Using your argument, pharmacies would also be required to carry medical grade oxygen and radiological imaging drugs. Those last drugs would be useless without expensive and expansive imaging equipment, which (to carry your argument to absurdity) you probably would require Wal-Mart to carry too. My only question is when Wal-Mart drives the medical equipment supply store and the local imaging center out of business, are you going to whine about that too?

A less absurd example. A few years ago I went to a Dermatologist and was provided with a script for a ?commonly prescribed? ointment. I took the prescription to CVS, but was unable to get it filled. Same with the grocery pharmacy and even Wal-Mart. The problem was that it was a compounded prescription, and they only did those during 9-5 weekdays at a central pharmacy location. I was trying to fill my prescription Friday evening before a holiday weekend and was told that I could not get it filled before next Tuesday. The crazy thing was that the pharmacist had the two ointments needed to compound the Rx right on the shelf, but he could not sell me the ointments, a jar, and a stirring stick, because the prescription said otherwise. Should we require a pharmacy to have a compounding pharmacist on hand during all business hours? If so, I’d imagine they would cut back their pharmacy hours instead of keeping the store open 24 hours a day.

I also made some comments over at Feministe for some strange reason. zuzu fell for the same logical fallacy, just like tgirsch did. Well, I’ll let her speak:

zuzu Says: And if Plan B is the same as commonly-prescribed birth control pills, tell me again why it wouldn?t fall under the definition of commonly-prescribed medication?

Standard Mischief Says: Clearly if the notion of ?commonly prescribed drug? includes standard birth control, then the fact that wal-mart does carry standard birth control (they do, I checked) means that it is complying with the law. (excuse me, I meant ?that stupid law?)

Laurie did make a good point about a misassumption I made on birth control pills. A cycle of birth control consists of 21 pills with hormones, 7 ?spacer? pills, and that the newfangled tri-phasic sort have different levels of hormones in each week. You can tell I’m not a consumer here. Thanks Laurie, but when you further complain about guessing and throwing away perfectly good pills I have to say that you don’t guess, you talk to a doctor or a pharmacist, and you don’t worry about throwing away two weeks of pills (only if you have the tri-phasic sort) because it’s an, um, emergency.

I wasn’t invited to the media event, so I was unable to ask the tough questions for my world-wide audience, But instead of just swallowing whatever slop was fed to me, or regurgitating the Associated Press wire report, I decided to do some actual legwork. My procedure was this: I printed out the my other post that had the list of birth control that could be used as emergency contraceptive and took it to a few pharmacies for a price quote. Then I looked them all up in my Physician’s Desk Reference, to be sure that they weren’t the tri-phasic sort (1994 edition, perhaps a bit long of tooth, but it was 2 bux at the used book store). I only got data on one out of the four so I looked up the manufactures official website for the remanding three.

Please note that I am without any formal medical training beyond the first aid merit badge and my CPR course. In other words, I am not a doctor or a pharmacist. Not intended to diagnose, treat, cure or prevent any disease. Please double check with a pro first.

Wal-mart was surprisingly busy, so much so that after waiting 5 minute in line without any progress, I gave up. I guess people were combining their pharmacy shopping with their cheap Chinese crap and their Winchester white box ammo purchases. Things were pretty busy at the Safeway grocery and pharmacy, but the attendant did give me one quote. At CVS, it was dead slow, and after I explained myself, I was provided with three good quotes.

Levora?, at CVS (not tri-phasic) for $30.59/21 active pills
Low-Ogestrel?, at CVS (not tri-phasic) for $30.79/21 active pills
Ogestrel?, at Safeway (not tri-phasic) $40.99/21 active pills
Ovral?, at CVS (not tri-phasic) $57.59/21 active pills

OK, so the first two brands, you should need 8 of the active pills, divided to make a dose. The second two have higher dose of hormones in each pill, so you only need 4 pills, divided for each dose of emergency contraceptive (see a pro for proper dosing instructions).

The winner here on the price point is Ogestrel?, at Safeway, which should provide 5 doses of emergency contraceptive at $8.20 a dose. Might I suggest you get together with a few friends and split the cost and tuck your share away for a rainy day?

Update: While I was composing this, SayUncle scooped me.

Update 2: Feministe also scooped me while I was composing this by about 48 hours.

Zuzu Says: Incidentally, for those of you who were nitpicking about the definition of ?commonly prescribed medication? in an earlier thread, note that the board?s decision was unanimous, and that the three women who brought the suit had argued that emergency contraception was commonly prescribed. So it?s safe to say the board agreed with them.

I like that, ?nitpicking?. Gee, I thought that was the core of the debate. Usually I prefer facts and data, but seven appointed people voting the way that might keep the person that appointed them happy is enough proof for me!

(Oh and Feministe people, what’s with the little girl in the excrement colored overalls playing with the pistol grip pump shotgun with the ejector set up for a left-handed person? Am I missing out on some kind of strange cultural reference?)