HEALTH / Second Opinion

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DOCTORS argue that in terms of risks to health the oral contraceptive pill should be sold direct to women in vending machines, while cigarettes should be available on prescription. In many countries the pill is sold over the counter in pharmacies, but not in Britain or the United States. In the past month editorials in the Lancet and the American Journal of Public Health have called for oral contraceptives to be non-prescription medicines. What are the arguments?

Used by millions of women during the past 30 years, the pill is the most tested medicine of all time. The low-dose preparations used today are just as effective and much safer than the early pills, and any risk of abnormal blood clotting is virtually confined to women over 35 who smoke. Research has shown that the protection given by the pill against cancers of the ovary and uterus outweighs any slight increase in the risk of breast cancer in young women. Overall, the pill reduces a woman's risk of developing cancer. More women die each year from allergic reactions to penicillin than from disorders brought on by the pill. Taking the pill off prescription should remove any lingering doubts about its safety - using it is far less dangerous than becoming pregnant.

Five key questions decide whether a medicine should be kept on prescription, says the Lancet. Is there any difficulty diagnosing the condition for which the drug is to be used? Does the dose need adjusting for each individual? Are the risks and benefits closely balanced? Is overdose deadly? And is the drug addictive? The pill passes all these tests. Furthermore, the consumer knows her age and whether she smokes - the main reasons for caution.

Several other objections have been raised. Going to a doctor to get the pill means it is more likely that a woman will have checks on her blood pressure and tests such as cervical smears. Experience in other countries suggests this is not a problem. Second, doctors earn money by prescribing contraceptives and health examinations that go with it - but there seems to be no medical opposition to deregulation. Selling the pill direct to the public might cause financial hardship to women exempt from prescription charges. In practice, the likely outcome of deregulation would be that market competition would bring the price tumbling.

Oral contraceptives give the best protection against pregnancy but do not give any defence against sexually transmitted diseases. Might deregulation encourage young people to rely on the pill rather than using condoms? Not necessarily. The pill should be seen as the woman's protection against pregnancy, while the condom protects her against infection. In many circumstances sensible women should use both methods.

Despite the talk about safer sex, the facts are that in Britain in 1991 no fewer than 200,000 women had terminations; the total has grown steadily for the past 10 years; most estimates suggest at least half of these pregnancies were in couples who used no contraceptive at all. If the pill were taken off prescription, the same could be done for post-coital contraceptives - the 'morning after' pill. Both allow women to choose when they want to become pregnant.