Foreign Correspondence

[Amaunet]

Women denied birth control partners turn to Viagra.

Literally how f---ed up can we possibly get?

The Bush administration has made clear its goal of overturning Roe v. Wade and denying women in this country and around the world access to safe, legal abortion at all stages of a pregnancy. What has been less visible, but equally deadly, is this administration's efforts to undermine access to birth control and effective family planning methods.
An emerging campaign against family planning is underway across the country and in international arenas, led by the Bush administration and its allies in Congress and state legislatures.
http://www.plannedparenthood.org/library/birthcontrol/031030_report_bc.html


Health providers make stand against birth control

Refusal to prescribe, dispense more common now on moral grounds

By Jeff McDonald
STAFF WRITER

August 8, 2004

In Alabama a few weeks ago, nine state health department nurses quit their jobs rather than dispense morning-after pills to women at family planning clinics.

In suburban Cincinnati, a pharmacist who considers abortion a sin regularly refuses to fill birth-control prescriptions. She cannot be a part of what she considers terminating human life.

At least two San Diego County physicians similarly reject pharmaceutical forms of contraception. These doctors contend that millions of American women are wrongly prescribed birth-control drugs when alternatives such as natural family planning are cheaper and carry fewer health risks.

Increasingly, health care officials are attaching personal beliefs to their professional duties and leaders in abortion-rights circles are paying close attention to the trend.

"It's a fairly extraordinary thing," said Mark Salo, president of the San Diego chapter of Planned Parenthood. "The overwhelming number of Americans not only supports birth control, but they use it."

A small percentage of physicians, nurses and pharmacists historically have steered clear of supplying contraceptives because of religious convictions. But now the concept of natural family planning – managing women's health and fertility through menstrual cycles and body signals – is gaining traction because a larger number now consider chemical birth control akin to abortion.

More than 400 health care providers traveled to Omaha, Neb., last month for the 23rd annual American Academy of Fertility Care Professionals conference, triple the number of attendees the previous year, organizers say.

Conference organizers say the increase is fueled by a combination of religious doctrines, what proponents say are important advances in drug-free contraception and fertility practices, and the Internet.

"We're seeing more organization and networking" by medical professionals who oppose abortion, said Sheila St. John, director of the California Association of Natural Family Planning, a nonprofit agency in Salinas. "People are more effectively collaborating."

The issue for these health care practitioners, not surprisingly, centers on when human life begins.

For many, a life starts the moment a sperm penetrates an egg; for others, it starts days later, once the fertilized egg is implanted in the lining of a woman's uterus. Still others believe life begins the moment a baby draws its first breath.

With such wide-ranging interpretations, the many forms of contraception can present difficult moral choices for health care practitioners. The morning-after pill, for example, prevents fertilized eggs from implanting in the uterus wall; birth-control pills suppress ovulation. Some medical experts wrestle over whether, and which, measures of contraception are ethical.


'Doors were slammed'
Dr. Arthur Stehly is an Escondido obstetrician and gynecologist who stopped prescribing birth-control pills in 1988 after a visit to the United States by Pope John Paul II. Up to then, he had turned to contraception only reluctantly as a way for married couples to prevent pregnancies.
"I rationalized myself into thinking I should be God in my office, judging who gets the pill or not," Stehly said recently. "I knew at home I could not use the pill. I had to do what the natural law says."

His decision had immediate consequences. Stehly's practice dropped; new patients left as soon as they heard about his stance. Half a year passed before he recouped the lost business.

"You lose a lot of the fancy people – the nurses, the doctors' wives. (But) I couldn't help it," said Stehly, who has practiced medicine for almost 40 years. "Doors were slammed. . . . It's tough for a doc who has these ideas."

The Catholic Church and other religious institutions have long preached against most forms of birth control beyond abstinence or the rhythm method, which calls for limiting sex to certain days of a woman's monthly menstrual cycle.

In San Diego, the number of couples enrolling in natural family planning classes has sharply increased. When the diocese began offering the courses several years ago, only a handful of couples signed up. Last year, more than 300 participated.

"Every month, there's a new honeymoon effect," said Katie Zeunges, a Clairemont mother who teaches some of the classes. "It really helps marriages rather than hurts them."

Twelve million women across the United States rely on hormonal contraceptives, which require a prescription, to keep from getting pregnant – second only to sterilization among all methods of birth control.

But the number of physicians and other medical professionals who believe that using birth control and morning-after pills are the same as abortion appears to be increasing.

A Holland, Mich.-based group called the American Association of Pro-Life Obstetricians and Gynecologists claims about 2,500 members nationwide. An Internet-based network called OneMoreSoul.com counts 450 doctors among its members.

Such groups have gotten the attention of abortion-rights supporters.

"The war on choice is not just about abortion anymore," Gloria Feldt, the president of Planned Parenthood Federation of America, said recently in Prevention magazine. "It's about our right to birth control."

Feldt and others are worried that access to prescription contraceptives could disappear as more health care providers choose not to dispense them.

In rural communities, where the number of doctors and pharmacists can be limited, patients may have to drive miles out of their way to obtain or fill a prescription. Wal-Mart, a presence in many such communities and the world's largest retailer, dispenses birth-control pills but refuses to sell emergency contraception.

The San Diego office of Planned Parenthood allows patients to sign up over the Internet for the morning-after pill, which has to be taken within hours of intercourse to be fully effective.

"Trying to force your beliefs on others is not only arrogant, it breaks the American covenant, which is tolerance of other people," said Salo, the local Planned Parenthood executive.


Religion and regulation
There are few rules that spell out when physicians, nurses, pharmacists and others may refuse to treat patients on religious grounds. Most of the regulatory boards allow health care professionals to opt out of certain treatments for moral reasons as long as they arrange alternatives for their patients. So do the majority of trade associations.
"We do respect the pharmacist's right to conscientious objection," said Chris Woo of the San Diego County Pharmacists Association. "However, they also have a duty to refer that patient to someone who can help them."

In Wisconsin, pharmacist Neil Noesen is facing a disciplinary hearing next month for declining to fill a prescription for birth-control pills two years ago. State licensing officials were more concerned that he refused to transfer the prescription to another pharmacy.

The woman was able to refill her supply of pills a few days later, but she filed a formal complaint with regulators. Noesen decided against paying the $250 fine to settle the case.

At least 20 states have bills pending that would recognize the rights of physicians and pharmacists to deny prescribing birth control, according to the California Association of Natural Family Planning, but such legislation has only become law in one – South Dakota.

"We don't have an inalienable right to every pill," St. John said. "Doctors are not merely there to provide us with every therapy we've read about."

Private employers set their own policies. Some companies allow workers to refuse service to customers, and others do not. Indiana pharmacist Karen Brauer says she was fired from Kmart in 1996 for refusing to dispense a birth-control prescription. Now she works near Cincinnati.

"I don't feel like it's a matter of a choice," said Brauer, the president of Pharmacists for Life International, a group that opposes abortion. "I don't want to be willfully killing any human."

Membership in the Ohio-based association has swelled to more than 1,500 in recent years. Other druggists who believe birth control clashes with God's laws have not joined the group because they fear losing their jobs, Brauer said.

"There are pharmacists who are coming under fire and losing their jobs because they're not dispensing," she said. "I've lost income."

Brauer rejects the notion that access to birth control may be eroding. "There's mail-order pharmacies and there's FedEx," she said. "These women can get whatever they want, anytime they want."

The American Medical Association similarly grants physicians the freedom to reject performing any treatment that conflicts with their moral ideology. But according to some physicians, the medical establishment – schools and teaching hospitals in particular – has been slow to embrace alternatives to chemical contraceptives.

"I don't think we're giving women what they deserve," said Dr. Nicholas Jauregui, a family-practice physician in Escondido. "We're basically shutting down their natural cycles."

Like Stehly, Jauregui has decided against prescribing the pill. Instead, he relies on women's menstrual cycles, body temperatures and other symptoms to treat infertility and avoid pregnancies.

"It's superior treatment, with less side effects," he said.

Jauregui, a San Diego County native and 1995 graduate of the UCSD School of Medicine, said there is a strong resistance to natural family planning among many of his colleagues.

"It's almost a hostility," he said. "They don't even want to hear it. . . . (But) this will be a trend that you're going to see more and more across the country."

Jeff McDonald: [phone]; [e-mail]

http://www.signonsandiego.com/uniontrib/20040808/news_1n8pill.html



Recreational Use of Viagra on the Increase

Thu Aug 5, 7:02 PM ET

By Kathleen Doheny
HealthDay Reporter

THURSDAY, Aug. 5 (HealthDayNews) -- After Viagra became the first impotence pill on the market, former U.S. Sen. Bob Dole, now 81, became its most famous pitchman, sharing his sexual dysfunction problems on national TV.

But Viagra is no longer the drug of just the geriatric set: Its use by younger men has grown more than threefold since it was launched in 1998, according to a study appearing in the Aug. 5 issue of the International Journal of Impotence Research.

The most surprising finding, said study author Tom Delate, is "the fact that there was less use for medical necessity." Many younger users, he suspects, are simply trying to enhance normal performance. While Viagra is not dangerous for these men, Delate wonders about the wisdom of spending health-care dollars on what amounts to recreational use of a prescription drug.

Delate, former director of research for Express Scripts, a pharmacy benefit management company, and his team undertook the study to evaluate the use of Viagra and other so-called lifestyle drugs. "We wanted to look at who is receiving them, if there is an increase in use among age groups, who is prescribing them, and do they have a medical need for these medications," Delate said.

Viagra, which helps men get erections by increasing blood flow to the penis, has been joined by two other prescription drugs for erectile dysfunction, Cialis (tadalafil) and Levitra (vardenafil), also heavily advertised to consumers.

Delate's team examined nearly 163,000 prescriptions for Viagra dispensed to nearly 49,000 patients over five years. Once those facts were obtained, he said, those who manage pharmacy benefits can decide better about coverage, Delate said. "With the cost of health care going up, are we willing to pay for lifestyle drugs for some?" he asked.

Overall, use by men increased and by women decreased (Viagra is not indicated for women). But use among younger men has escalated faster than in older men, Delate found. It use increased 312 percent in men ages 18 to 45, while it rose 216 percent among men 46 to 55 years old, he said.

However, men 56 and older continued to receive the majority of prescriptions for Viagra, Delate said.

When Delate's team looked at claims for drugs that might trigger erectile problems, they found the proportion of users who had two or more claims for that medicine had decreased, leading them to assume much of the use was for enhancement.

"It's a safe drug, particularly for young, healthy men," said Dr. Ira Sharlip, a San Francisco urologist and a spokesman for the American Urological Association. In a healthy population, he said, side effects are usually minor and temporary, such as headache, facial flushing, stuffy nose, and blurred vision.

In combination with nitroglycerin medication for heart problems, however, Sharlip said Viagra can cause a dramatic drop in blood pressure and, if the user has undiagnosed coronary artery disease, there is a risk of heart attack.

But Sharlip said many healthy users with normal erections expecting the drug to give them very lengthy erections are apt to be disappointed. "It might reduce the refractory time," he said, referring to the time lag between erections.

Many physicians, including Dr. Stephen Ross, a family medicine physician at Santa Monica-UCLA Medical Center in California, say they won't prescribe Viagra or similar drugs for healthy men who just want to enhance their performance.

"I have no trouble prescribing it for someone with a psychological problem [or] with erectile dysfunction," he said. He has prescribed it, for instance, for divorced men who have a new partner and have problems getting an erection.

But in healthy young men, the drug can backfire, Ross said. He recalls a healthy 25-year-old patient who obtained a Viagra tablet from a friend. Anticipating a romantic evening, he took the pill, soaked in a hot tub and enjoyed a glass of wine.

But when he got out of the hot tub, he fainted and ended up calling Ross, who examined him and concluded that the combined blood vessel dilating effects of the hot tub, wine, and Viagra were probably the cause of the fainting spell. The man was soon feeling fine, Ross said, but his evening didn't end as planned.


http://story.news.yahoo.com/news?tmpl=story&cid=97&ncid=751&e=7&u=/hsn/20040805/hl_h....