Plan B and Public Health: Morning-After Problems We Can’t Easily Fix

Today I signed a petition to protest Kathleen Sebelius’ decision to override the recommendations of the FDA and the American Academy of Pediatrics by banning OTC availability of Teva’s Plan B morning-after contraceptive. I say that without intent to be provocative. I simply want to acknowledge right up front that I have no moral compunction about morning-after contraception -- although I tend, dispositionally, to prefer a pound of prevention to even an ounce of cure -- and I certainly don’t believe in subjugating science to religious principles. I was surprised at the Administration’s decision because it most assuredly wasn’t in the best interest of public health -- but neither do I know how to chalk up the political wins and losses on this for Obama, who was clearly willing to ignite a controlled burn on his left in order to avoid a firestorm on his right.

The petition I signed enjoined the President “not to put politics above science” -- a credo that sounds like the right slogan for the professional (and personal) world I inhabit. Still, I can’t help but note the irony that since all regulation of public health is inherently political, this distinction is forced and artificial. The FDA came down on what I happen to think is the right side of this issue -- public health and equal protection for those young teens who have, as a practical matter, limited access to all health resources. But the FDA, like all agencies charged with health policy oversight, is an instrument of politics. Public health is just a euphemism for politics. In fact, the whole public health sphere is becoming a house built by government and merely furnished by science.

I’m reminded of that fact when a client gets a thumbs-down decision on an NSAID because the FDA has decided to bar the gates to new branded (read expensive) NSAIDs that aren’t superior to what’s currently available.

I’m reminded of that fact whenever the FDA sets guidelines for how much life extension is required to justify a very costly drug. Or when I consider that routine PSA screening is now no longer deemed by some health authorities to be cost-effective, a term now used with more sanctimony and intellectual conviction than it probably deserves.

And I’m reminded of how health and politics cross-pollenate in even odder ways every time municipalities like the city of Philadelphia feel empowered to reach over the line and ban trans-fats, when personally I think they have better, healthier things to do. (Fix a playground or something.)

Let’s face it: religion is politics and, increasingly, health is politics. This problem is simply going to get worse as growing need and strained resources put law-makers in charge of health decisions. The rational among us had better get busy and work both sides of that equation in order to ensure that reasonable decisions get made.