Monday, September 28, 2009

Noncompliance

The Yasmin manufacturing company Bayer's troubles have multiplied rather quickly in the last few days. Now the Swiss medical authority Swissmedic is investigating the death of a woman who died from a blood clot ten months after being prescribed Yaz (the lower dose version of Yasmin). This story was all over the news, providing further fuel to the seventy plus law suits underway in the US.

The blood thickening effect of the birth control pill, and the consequential risk of blood clots, has been linked to the estrogen content since the first health scares of the 1960s. But Yasmin, and more so Yaz, contain low levels of estrogen and so the blood clots suffered by a number of women taking these pills have been blamed on the unique, and under researched, progestogen component, drospirenone.

Then today research was released stating that a blood clotting disorder that affects younger women - Antiphospholipid Syndrome - increases the risk 200 fold of blood clots developing in arteries and lungs if the woman is taking the pill. Women can be tested for this disorder, but until now it has only been discovered after a stroke or other medical problem has occured. All the women in the study with this syndrome who suffered a stroke or heart attack were taking the pill.

It is understood generally that the risk of blood clots from taking the pill is relatively small - that there's more to fear in crossing the road - but as the pill is prescribed so casually certain predispositions to blood clots go unconsidered. For example, we are as a race, in the rich countries anyhow, getting fatter and if a woman's BMI is over 35 she has an increased likelihood of developing a clot. Not yet widely publicised, there's an idea going around those in the research business that the pill might also be much less effective as a contraceptive in larger women. A BMI of 35 only suggests you are somewhat overweight.

Just to back up that remark about the pill being prescribed casually - I read on Marie Clair website that there's a pill about called Femcon Fe that's chewable and minty. They're handed out like sweets and now they are sweets. Because, well, all that swallowing is such a hassle, you actually have to pause and think for a second doing it.

http://www.femconfe.com/index.jsp

We've only known of the existence of hormones for the last 100 years, and here we are in 2009 chewing them.

I very much enjoy how whenever a reporter goes to a representative at Bayer to get a statement they always give the same answer, which amounts to: "What about pregnancy? That's way more dangerous, that'll kill you." Nothing much has changed since the 1920s when campaigners for contraception had to get the state of pregnancy labelled as a disease, so that they could 'treat' it with contraceptive devices and educate people about avoiding it.

Of course, if we can all be terrified of pregnancy we'll stay on the pill for longer, take it more studiously and not question our doctors. Even though the pill has never been thoroughly tested for it's longterm impact on women taking it for the ten plus years they do now as a rule. Back at the pill's beginning women would only take it when they had a boyfriend, and usually for only three years total. It wasn't taken continuously from early teens to 30 something. In fact, most of the research on the pill was undertaken on the older, first generation set.

There's something creepily called 'compliance' by the pharmaceutical companies which is of great concern to them. In terms of the pill, compliance is when women are given a pill, take it, and shut up. No, really, it's when women don't stop taking the pill, or their brand of pill, for any silly reasons like nausea, headaches or suicidal thoughts. Pharmaceutical companies are always on the search for ways to increase compliance. Hence why they come up with new 'natural' pills as we discussed earlier, and chewable pills.

They've got all het up recently because as we are in a recession and everyone has less money, or no job, women have reportedly started to take their pill every other day to spread out their $50 supply for longer than the month. Many women's insurance policies in the US, if they even have insurance, do not cover the birth control pill. They do, however seem to cover the contraceptive injection, patch and implant, or so I have heard - because I would assume it works out cheaper for them. So who knows if women are really spreading out their pills to save money, or whether that's just a way of herding us all towards these alternatives. A diaphragm, or a non-hormonal IUD, or even condoms and spermicide are cheaper - but these don't make near as much money for the pharmaceutical industry.

"Never in history have so many individuals taken such potent drugs with so little information available as to actual and potential hazards. We are embarking on a massive endocrinologic experiment with millions of healthy women."
Senator Gaylord Nelson, 1970

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