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12Jun 2013

Obsession with politics obscures the public-health significance of contraceptives.

Obsession with politics obscures the public-health significance of contraceptives.

On Monday, the Obama administration decided to drop its appeal of a judge's decision that the contraceptive known as Plan B One-Step should be available to women and girls of any age without a prescription.

The first question you might ask is: What effect will the availability of this medicine have on public health? Will it reduce the number of unplanned or teen pregnancies? Will it have any effect on sexual behavior? Could a reduction in unplanned pregnancies also lead to a reduction in, say, low birthweight babies or birth defects?

One could think of any number of important health-related questions raised by this story. 

But The Washington Post couldn't. Its story, by Brady Dennis and Sarah Kliffdescribes this in the lede as the end of a legal battle. It elaborates on the administration's decision, noting that Obama has not changed his opposition to over-the-counter sales of Plan B One-Step. It gets reaction from birth-control advocates, who say only that this is "a huge breakthrough for access to birth control." Uh, thanks; we got that.

Then the story reports on the criticism of antiabortion groups. Nowhere does the story address the public-health implications of the administration's action. It's all politics all the time. Memo to the Post: This is more than a political bargaining chip; it's  medicine intended to combat the serious problem of unwanted pregnancies.

I sought help at The New York Times, to see what I could learn about the public-health implications of Plan B One-Step. The story, by  Michael D. Shear and Pam Belluck, likewise failed to shed any light on the public-health implications of the medication's approval. 

David Pittman at MedPage Today did a story that answered many of my questions. It sought reaction from the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, the American Congress of Obstetricians and Gynecologists, and the American Association of Pro-Life Obstetricians and Gynecologists. Those groups and their representatives noted that the medication was safe but that doctors would have to continue efforts to make sure that adolescents know how to use Plan B and that contraception can be made available for those with limited resources.

Those are reasonable questions to address in this story--not only in the medical trade press, but in the Post, the Times, and other mainstream news outlets. There are probably a few such stories out there that do address these questions. I did find one, by way of Tabitha M. Powledge at On Science Blogs: A helpful post by Julie Rovner at NPR's Shots blog, which does indeed discuss the public-health consequences of the administration's decision. Powledge also links to The Emergency Contraception Website, operated by researchers and reproductive-health specialists, which also fills the gaps left by the Times and the Post and others. 

The politics of the Plan B decision are interesting; I'm a political junkie, and the Obama administration's sudden course change is fodder for endless conversation. But ephemeral political jousting, while it might be entertaining for some of us, isn't nearly as important as the medical issues.

Perhaps what we need, for the reporters who ignored the medical questions, is a drug to combat tunnel vision.

-Paul Raeburn

Comments

Thanks for the thoughtful comment. 

I agree that the legal issues should take precedence, because that is what has changed. The problem with the stories I cited was that they were all about politics--they didn't deal with legal issues in anywhere the depth you did in your comment. 

I argued that the stories needed to catch us up on the public-health consequences of the decision even if, as you point out, they hadn't changed. But the politics of the situation hadn't changed either; all the usual sources said the same things. Yet the stories were devoted almost entirely to the political implications of the news--not the legal or the public-health implications.

They should have said more about public health and, as you point out, more about the legal actions.

Paul, I think you are right in principal, but missing a significant point.

When we write stories about developments in legal cases, it's definitely important to contextualize them and to step back from the legal or political haranguing and explain what they mean.

But when it is a single non-dispositive development in an ongoing legal struggle,  that's harder. You have to cover the legal developments, because that's where the actual news was, and then you have to figure out how much of the context and implications to bring in. And how to do that without being repetitive.

For instance, on Monday, the FDA asked the District Court to confirm its understanding was correct. Today, Judge Korman entered a memorandum opinion/order that was six pages long explaining his thoughts -- why their understanding was sort-of right, and to the extent that it was wrong the error was not of significance, and also that it was important that the government strive to not mandate a period of marketing exclusivity to the drug company that developed the name-brand Plan B (Teva Pharmaceuticals), because that would have the effect of giving them a monopoly and thus raising prices on a drug that is already too expensive for many people who need it.

The public health landscape hasn't changed appreciably in two days. But the legal landscape has. So is it an error to devote the bulk of the limited word-count to the legal landscape?

I'm not sure, but I think it is a harder call than you make it out to be. (Though in fact, in this case, since Korman's memorandum taks about public-health issues — marketing exclusivity is definitely a public-health issue — there may be an "easy out." But I hope the principal I'm referring to is clear.)

Pam Belluck (an alum of the Knight Program, btw) is writing an article, or so I hear.  Maybe it will be more to your liking this time around :)

I don't think it's wrong to allow religious viewpoints in a story such as this, as long as they are identified as such. 

While Pittman did cite The American Association of Pro-Life Obstetricians and Gynecologists, their statement was negative.

Furthermore, am I the only one who thinks it's inappropriate to list a religion-based physician organization along with science-based organizations, as if they were equivalent?

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