We’re now fifty years into the history of oral contraceptive pills, and we’ve learned an enormous amount. We’ve learned about various therapeutic uses of the Pill and unanticipated risks. We’ve learned to adjust the amount of medication to a lower effective dose. We’ve given women the opportunity to very effectively control their own fertility in a safe, private, and effective manner. But we haven’t ended the controversy.
Leaving aside idiotic moralist rantings about the Pill, the alternative medicine movement has treated it harshly. The decision to use or avoid any intervention involves a balance of risks and benefits. Science helps quantify many of the risks and benefits, but a certain component will always be subjective. I can’t demand that a patient choose to take a certain dose of morphine for cancer pain because the patient has to decide what level of pain and side effects are acceptable. Oral contraceptive pills (OCPs) have few but real risks: they can increase the risks of significant blood clots, especially in smokers and women over 35. At the same time, it decreases the risk of certain cancers.
What OCPs do is give women the ability to control whether or not heterosexual intercourse is likely to lead to pregnancy, without having to ask their partner “permission”. Another blogger has brought up one of the gaps in recent stories about the Pill—the fact that contraception has a history that extends much further back than fifty years, and is not just about technology. The history of contraception is also the history of misogyny, control, and womens’ health (but I’ll have to pick up a copy of the book she referred to because my ignorance of the topic is vast).
The alternative medicine movement has a punitive character to its approach. In addition to making up scientifically impossible interventions (such as homeopathy), they disregard inconvenient facts. Yes, many type II diabetics would benefit from changes in diet and exercise habits, but does their failure to make these changes mean we shouldn’t treat them with the best available medical therapy. But reading the altmed literature, you’d think that there is no appropriate time to use science-based medical therapy for anything.
When hunting the altmed world for bone-crushing stupidity, it’s always good to stop at Joe Mercola’s site. His latest screed about the Pill is so blindingly idiotic my eyes are still burning. In his battle against this particular pharmaceutical that he cannot profit from, Mercola exaggerates the known risks of OCPs while explicitly denying the real benefits. In addition to falsely stating the level of risk of the Pill, Mercola (intentionally or otherwise) misses the whole point of OCPs and of medicine in general. The first quote about the Pill that Mercola seems to love is:
It was the first medicine ever designed to be taken regularly by people who were not sick.
There is nothing about this statement that isn’t wrong. Pharmaceuticals, both scientifically proven and otherwise, have been used for millennia for people who are sick, well, and anything in between. People consume kilo after kilo of vitamin supplements daily (many advocated by Mercola) despite the absence of illness and lack of benefit. And what is sick? People take tylenol for headaches. When you have a headache, are you “sick”?
Medications that alter physiology can be used to achieve many different ends, and it is the desirability of these ends and the risks and benefits of achieving them which makes a drug effective or ineffective. Whether it’s taken regularly, and whether or not you’re “sick” is a foolish distractor.
The second idiotic quote contains one phrase which isn’t wrong.:
In my opinion this is a tragedy, as the Pills’ major benefit – convenience — is largely outweighed by serious health risks.
If you said that the correct part was “in my opinion” you got it right. It is not up to Mercola to decide what the Pill’s major benefit is or to decide if the risks outweigh these benefits. I’m pretty certain that Mercola has not had to worry about controlling his fertility. If he wants, he can spread his little duckies all over the globe and never have to worry about getting pregnant. I’m sure the Pill seems convenient to him, but for a woman interested in controlling her own fertility, convenience might be only one factor she considers. And if convenience is important to her, and the minimal risks don’t concern her, then it isn’t up to Mercola or anyone else to tell her what is acceptable.
The one thing Mercola does right is recommend the use of latex condoms, although he doesn’t really stress the other reason for their importance—the prevention of sexually transmitted infections.
Folks like Mercola like to decry the paternalistic attitudes of those of us who practice science-based medicine, but statements like this tell the real story:
Because the risks are so high, and other safer options exist, nearly all patients who visit my Natural Health Center are asked to stop hormonal contraceptives like birth control pills as soon as possible.
In his own words, Mercola says that his advice is based on his own biases, and not on the science and the needs and desires of his patients. This is paternalistic, condescending, and wrong.