The risks of prescription-free birth control are real

STOP: prescription-free birth control is NOT a good idea

A poll conducted by the Des Moines Register shows that 79% of Iowans support Governor Kim Reynold’s proposal to make prescription-free birth control available to women over the age of eighteen.

Pulse Life Advocate’s executive director, Maggie DeWitte, testified before the legislature on our objections to the bill. Most Iowans are unaware of the real risks associated with hormonal birth control in the best of circumstances, much less when unsupervised by a doctor.

We reached out to a medical doctor for a “second opinion” on this issue: Thanks to Shannon Hood DO for a doctor’s perspective on the downside of over-the-counter, prescription-free birth control.

Physicians and pharmacists need to be in sync

Below is my opinion of Iowa Bill HSB642 coming to subcommittee soon:

During my 25 years as a Family Practice Physician at Mercy Clinics in Ankeny, I worked side by side with pharmacists.   We were a team.    However, during those years, a large pharmacy in town had an incentive to start patients on medications such as statins and Ace inhibitors (cholesterol and blood pressure lowering medications) due to new guidelines in the management of Diabetes.  The pharmacists would tell my patients that they needed to change their meds without consulting with me.  It created confusion and distrust on both sides.   Many times, there were reasons why the patient was not started on a new medicine, such as elevated kidney or liver labs, allergies, or previous failures on the medicines.     For good reason the pharmacy program eventually ended. 

Well-defined responsibilities

Both pharmacists and physicians are part of the healthcare team with well-defined responsibilities.  Pharmacists are trained to prepare, dispense and educate patients about medications.    Physicians (including mid-levels) are trained to obtain medical history and diagnose problems using physical exam and review of medical records.   In the proposed Iowa Bill’s situation, we would use diagnosis code ICD-10 Z40 for the initiation of contraceptive management.  There are algorithms and relative risk charts to review surrounding this diagnosis. 

The 4 problems with prescription-free birth control 

Problems I have with the Bill HSB642

1. Blood Pressure is measured at first visit.    Will it be measured periodically during the standing order potentially lasting 27 months?     The hormonal birth control can raise blood pressure.  
2. If a woman has a side effect with the first hormonal birth control, will the pharmacist continue to try another medication or refer to health care?   
3. Key preventive care may be missed in the 27 months during the standing order.  This makes me think of the loss in preventive care during COVID. 
4. Health is dynamic and constantly changing.   Over time a woman may find a breast mass, develop liver disease, start smoking, develop migraines with aura, gain significant weight, or have a primary relative die of a pulmonary embolism, thus making the hormonal birth control offered in this bill contraindicated.   Who is responsible for stopping the medication?  With this bill the pharmacists are not legally responsible if no action is taken and morbidity occurs.  

I do not agree with this Iowa Bill HSB642.    Primary healthcare providers diagnose and treat.   The treatment includes preventive care (the key to quality) and corrective action using the risk vs benefit problem solving model.    The Pharmacist model of education is complementary and important, but not the same.