Rethinking Healthcare

Can science end the contraceptive wars?

Posting in Science

Misoprostol's use as a "morning after" pill was pioneered in Brazil, but it has other uses, like fighting ulcers, inducing labor, and dealing with the effects of a miscarriage.

Now science is on a path to end the battle over contraceptives with a simple ulcer medicine.

It's called misoprostol, created by G.D. Searle. Searle first gained financial prominence as the maker of Enovid, the first oral contraceptive.

(I got the picture here from an Internet pharmacy which has the drug for sale under Searle's brand name, Cytotec.)

Misoprostol's use as a "morning after" pill was pioneered in Brazil, but it has other uses as well. In the U.S., for instance, it is frequently used to induce labor. (The illustration shows its use against ulcers, frequently caused by over-use of NSAIDs like aspirin.)

Misoprostol is often taken alongside mifepristone, also known as RU-486, as a "morning after" pill. Because mifepristone has no other uses, however, it's not a real revolution.

Nor, for that matter, is Plan B, recently approved for over-the-counter use by the FDA, or even ella, recently approved for prescription use, which may be effective for several days after sex.

You may argue over whether such "emergency contraceptives" or "medical abortions" are ethical. That is not the issue. The issue is that they are private. Some can be obtained from a clinic, others from a pharmacy.

Misoprostol may be the most important of these drugs because of its other uses, one of which is to help avoid complications from naturally-occurring miscarriages.

Plus, as Nicholas Kristof noted recently in The New York Times, misoprostol is cheap. In India it can be had for just pennies per pill, as opposed to $5 for a blister pack with mifepristone.

Enovid is about 50 years old, thus there are many editorial celebrations going on about it right now, including a PBS special. It was a revolution for people in America and the West, because it let women decide when they might have children. The sexual revolution followed.

But the pill is far from universal adoption. It must be taken daily, and many women forget. Many Americans oppose it, though the 1965 decision in Griswold vs. Connecticut -- usually cited as a privacy case, it was really about an 1879 law outlawing contraception -- means there is little they can do about it.

Except there is. Pharmacists can refuse to sell the pill. They can refuse to sell RU-486 and even refuse to sell misoprostol. Again, that's an American story.

Misoprostol is not an American story. It's not being dispensed solely by pharmacists. It's not only useful for this purpose. And women who treat other women are being encouraged to see this as a sound way to save the lives of their patients.

In effect, it is one way that the debate over contraceptives is resolving itself.

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Dana Blankenhorn

Contributing Editor

Contributing Editor Dana Blankenhorn has written for the Chicago Tribune, Advertising Age's "NetMarketing" supplement and founded the Interactive Age Daily for CMP Media. He holds degrees from Rice and Northwestern universities. He is based in Atlanta. Follow him on Twitter. Disclosure