Support grows for an end to clinical control

WHY should a drug that is probably safer than aspirin and paracetamol not be sold in pharmacies without prescription? The oral contraceptive pill is the most intensively studied of all modern drugs and it has been used successfully by millions of healthy women. There is growing support from doctors and scientists to 'demedical ise' it and make it available over-the-counter (OTC), writes Liz Hunt.

Professor Malcolm Potts, president of International Family Health, says that women have, for too long, been treated for a disease called 'over-fertility' and not allowed to exercise real choice about contraception because of the strict clinical control of the Pill.

'The question is: do we respect women enough to let them make this decision for themselves? Teenage boys go off to get their condoms without any problems, but teenage girls must go off and get a prescription.'

The controlling medical influence over the Pill means that many women still view it as a 'problem drug', and more dangerous than childbirth, he argues. 'Women are used to having a vaginal examination, their blood pressure measured, and maybe a breast examination when they go for the Pill; that they are then told that it is this very safe drug is a contradiction in terms to them.'

In reality, the low-dose modern Pill is very safe. In America during 1988 five women died from using diabetic drugs; six died after taking penicillin, and more than 200 committed suicide with medicines they bought from pharmacies and supermarkets. There were no deaths related to Pill use.

Fears of an increased risk of breast cancer have been raised but the studies are contradictory and no definitive link has been made. There is no doubt that it protects against ovarian and endometrial cancer, and some doctors believe it should be given as a preventive drug for a year to all women.

It is difficult to find doctors who oppose the Pill being made available without prescription on safety grounds. Those who do object fear losing women to family planning services if they could buy the Pill from pharmacies.

Dr Martyn Walling, a GP from Boston, Lincolnshire, with an interest in contraception, says women would miss out on counselling about HIV and other infections, cervical smears, and blood pressure measurements. Alison Hadley, of the Brook Advisory Centre, says teenagers in particular would lose out.

At a conference at the Royal College of Obstetricians and Gynaecologists in London next week, Professor Potts will urge the Government to look again at making the Pill OTC.

A government report in 1976 had concluded that it 'did not rule out the possibility' of making oral contraceptives available over-the-counter if 'research indicates that the currently used pills containing less than 50 micrograms of oestrogen are significantly safer and as effective as the 50mcg pill.' Most Pills used today contain 35mcg or less.

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