I’m curious to see where this development is heading. If birth control becomes an over-the-counter drug, I wonder whether prices will increase or decrease. Frankly, I don’t see why a pharmacist, as opposed to a doctor, can’t explain the health risks. Maybe such a move would also alleviate tension between liberals and conservatives when it comes to whether or not birth control should be included in heath-care coverage. I guess time will tell.
Allowing contraceptive drugs to be sold over the counter could result in patients not receiving crucial drug education and possibly skipping important preventive procedures such as Pap smears and pelvic exams, some delegates said during reference committee testimony.
Delegates were discussing a resolution that calls for the AMA to support OTC access to oral contraceptives. Testimony on the matter was mixed as some delegates said making access to contraceptives easier would address a public health concern, as 50% of pregnancies are unintended. Others said allowing women access to birth control without an exam and prescription could create unintended consequences.
Kenneth Crabb, MD, a delegate for the Minnesota Medical Assn. and an ob-gyn in St. Paul, testified on his own behalf against the resolution in virtual testimony. But during live testimony, he said he had since changed his mind after learning that the benefits outweigh the risks. He said the potential health risks of pregnancy were higher than possible side effects from birth control pills.
Kira Geraci-Ciardullo, MD, a delegate for the Medical Society of the State of New York, spoke on her own behalf against the resolution. She questioned the possible precedent that might be set by allowing the resolution to move forward.
“I am shocked, frankly, at the abrogation of the physician in this discussion,” said Dr. Geraci-Ciardullo, an allergist and immunologist in Mamaroneck. “How many medications are we going to allow over the counter so that the pharmacist and the nurses are the ones doing the education and advice for medication use? If we send these prescriptions over the counter to patients, who is going to advise them? Where is the value of the relationship between the physician, particularly on ob-gyn, and her patient?”
In other debate Delegates considered a report that recommends the AMA support tighter restrictions on compounding pharmacies.
According to the Food and Drug Administration, the practice, “if done properly, can serve an important public health need if a patient cannot be treated with an FDA-approved medication.”
The report recommends that the Association support efforts to subject compounding facilities to state board of pharmacy oversight and comply with current United States Pharmacopeia and National Formulary compounding regulations regarding uniformity, quality and safety of compounding medications. Several ophthalmologists testified in opposition to the resolution, saying tighter restrictions could prevent them from keeping compounded medications in their offices, which they frequently use on patients with glaucoma and macular degeneration. Tighter restrictions could delay treatment, which could lead to sight loss, some delegates said.
The committee also considered a report that calls for the AMA to oppose discrimination that is based on a patient’s genetic information. If adopted, the Association would oppose genetic discrimination, support legislation intended to strengthen protections against such discrimination, and endorse education for physicians and patients about federal and state laws protecting a person’s genetic information.
In virtual reference committee testimony, forensic pathologist J. Scott Denton MD, a delegate for the National Assn. of Medical Examiners, speaking on behalf of the Pathology Section Council, supported the recommendations spelled out in the report.
“The medical community must take a leadership role in alleviating patient fears and concerns about how results from genetic testing might be used by third parties,” Dr. Denton said. “Physician involvement in legislation to provide comprehensive protections will ensure that those protections will be drafted to protect against discrimination but not interfere with providing appropriate medical care to patients.”
Dr. Denton said the council believes patients would forgo molecular testing that could aid diagnosis and appropriate medical management for fear of being discriminated against.
Delegates also testified in support of a proposed change to AMA policy regarding neonatal male circumcision to reflect the American Academy of Pediatrics’ revised policy. The AAP policy says the benefits of circumcision outweigh the risks. The resolution before the House of Delegates also calls on the AMA to support state Medicaid coverage for the procedure.