Posts from December 2003

EC OTC in OZ

Update: fixed typos and relocated the Extended Entry into the main text.

Here’s some more good news on the Emergency Contraception front: while the FDA process has advanced to the point where EC will probably be available over-the-counter sometime or another soon, Australia is quickly moving one step ahead of the United States: Emergency Contraception is set to become available over-the-counter in Australia tomorrow, January 1.

This isn’t to say that Australia’s EC situation is advanced over that of the United States in every respect. One major difference is that whereas the medical community in America largely supports the FDA’s move towards OTC availability, the medical community in Australia is at best nervous about the move, and in some cases directly opposed. The main issue for them, though, seems not to be the sort of religious Kulturkampf that flares around the American side of the debate. Rather, Australian doctors just seem to be more accustomed than American doctors to controlling the medical lives of their patients, and more jealous at giving up that power. For example, consider this Foucaultian bit of paternalism:

But Australian Medical Association president Bill Glasson said he was concerned that pharmacists were not legally required to record a woman’s visit.

I think that they really need to rediscuss how it is going to operate in the interest of good medical care, Dr Glasson said.

The pharmaceutical society’s national president, Jay Hooper, said many pharmacists would take it upon themselves to record each time a woman wanted the pill.

Not that American doctors don’t also sometimes engage in this tracking and scummy hectoring. At the Auburn University Student Health Center, for example, you could obtain EC–but they’d note when you got it, throw a bunch of red tape in your way, and if I recall correctly, they’d only let you have it once a semester. (The idea in both cases is for doctors to be able to lecture women that they decide are making unhealthy lifestyle choices. I am all for encouraging women to make healthy lifestyle choices, but I can’t imagine that an emergency situation to prevent a pregnancy is the appropriate time to do it, or that forcing women to listen by restricting access to EC until you’re done lecturing them is the appropriate way to go about it.) But the American medical community does not seem particularly squeamish about giving up that control if it means that women are more able to prevent unwanted pregnancies: the American Medical Association and the American College of Obstetricians and Gynecologists both lobbied for, and strongly supported, the FDA advisory panels’ decision. In Australia, however, the Australian Medical Association seems nervous and is ready to develop their own house guidelines to try to minimize the freedom it will offer women.

I don’t think, incidentally, that the attitude is a matter of misogyny, exactly. But it is directly connected to patriarchy–it’s a matter of the authoritarian sense of entitlement that modern doctors have always felt and acted out vis-a-vis their patients. The condition exists in Australia and America both, but with regard to over-the-counter pills the Australian medical community seems to have divorced itself from it less than their American counterparts. Consider: at the same time as EC becomes available over the counter for the first time in Australia, so will ibuprofen. And this has caused no small degree of consternation for the Australian Medical Association:

Also from Thursday stronger pain relief medication will be available in supermarkets, a move that has angered and confused doctors and pharmacists. Dr Glasson said the pain killer ibuprofen, contained in products including Nurofen, should only be sold under the supervision of pharmacists. It’s a dangerous move and it’s a backward step.

Patients have to look at the medical aspects of these drugs and get good advice that only the friendly pharmacist can give. Paracetamol is much kinder on the stomach.

Ibuprofen, an anti-inflammatory drug, was only available in pharmacies until the Government ratified the new regulations in October.

. . .

Products containing ibuprofen have been available in supermarkets in the US since 1984 and in Britain since 1996.

The teeming masses of Ozzies will now be able to buy Advil without a doctor’s learned advice! O tempora! O mores!

But however the doctors and pharmacists may whine, the women of Australia have every reason to celebrate. A happy New Year’s to the reproductive rights community in Australia — good show!

Signs and Portents for EC OTC

Good news this month for women’s reproductive freedom! The widespread availability of emergency contraception (EC) is one of the main breakthroughs for women’s reproductive freedom in the past 10 years. So it’s even better to see that two advisory panels of the FDA recently voted to recommend that EC be made available over-the-counter without the need for a doctor’s prescription. You need to take EC within 72 hours of unprotected sex for it to prevent an unwanted pregnancy, and it gets less effective as time goes on; waiting around for a doctor and a pharmacy are not always a viable option. And there is no possible case to be made that it fails the FDA requirements for over the counter availability. Drugs are supposed to be made available OTC when (1) it is safe to use without a doctor’s supervision, and (2) the instructions are simple enough for self-medication based on the included instructions. That EC is safe, and doesn’t need close observation from a doctor, has been made obvious by all the scientific data and by the past 30 years of experience with both off-label uses of conventional oral contraceptives, and dedicated morning-after pills like Preven and Plan B. How about the simplicity of use? Well, here I’ll defer to Connie Schultz, who investigated the matter for the Cleveland Plain Dealer:

Still, . . . I thought it only fair that I try to decipher them for myself. The kind folks at Planned Parenthood of Greater Cleveland gave me a sample packet. To make it as difficult as possible, I imagined being a sexually active teenager who had abstinence-only sex education.

Would I, could I, understand what I was reading?

Instruction No. 1: Take the first tablet as soon as possible within 72 hours of unprotected sex.

Instruction No. 2: Take the second tablet 12 hours after you take the first tablet.

I think we women can handle it.

This is some great news. Unfortunately, it is only a promissory note for things to come: the FDA nearly always follows the recommendations of its advisory panels, but even if it is pretty sure that it will make EC over the counter, it is entirely unclear when it will do so. The Bush Administration’s FDA has a long record of foot-dragging on this issue, and it has taken two years of untiring activism to get to this point — quite in spite of the fact that the petition obviously meets all the relevant criteria. But the most recent events are a victory to be celebrated, and the light at the end of the tunnel is now in sight.

Now, here’s a question: chemically, Emergency Contraception is indistinguishable from a large dose of conventional oral contraceptives; dedicated EC drugs were developed based on a good 30 years’ worth of doctors’ off-label recommendations for using OCs. (If a patient needed emergency contraception, the doctor would offer a prescription for OCs and suggest that the patient take several at once.) So if safety and ease-of-use arguments show that EC meets the FDA’s requirement for over the counter drugs, then a fortiori they ought to show that the good old birth-control pill meets those requirements too. So while we work towards getting the government out of women’s medical decisions for the morning-after pill, why shouldn’t we also start thinking about a campaign to get the government out of women’s medical decisions for the conventional birth-control pill too?

Belated Birthday Presents for the Bill of Rights

It’s been a rough century for the Bill of Rights. It started out with Woodrow Wilson’s totalitarian Espionage and Sedition Acts, proceeded through Franklin Roosevelt’s mass jailing of dissidents and the Vietnam era’s brutal COINTELPRO, and has ended up with Bush Jr.’s USA PATRIOT Act, suspension of habeas corpus, and periodic attempts to push through even more totalitarian surveillance legislation. My intent, however, is not to retell the rather disgusting tale of assaults on civil liberties during wartime (that tale is retold nicely enough by Justin Raimondo, in the context of the John Walker Lindh trial). Rather, I want to wish a belated happy birthday to that good old parchment barricade against tyranny. December 15, 2003 was the 212th anniversary of the passage of the first ten Amendments to the Constitution.

The Executive Branch has not been very kind to the Birthday Bill. Consider, for example, that most famous of amendments:

Amendment I

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.

And another Amendment, less frequently cited but no less important, which the Founders considered absolutely essential to preventing monarchial tyranny from the Executive:

Amendment IV

The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no warrants shall issue, but upon probable cause, supported by oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

Consider, on the other hand, the conduct of the FBI — and not just the conduct, but the overwhelming sense of entitlement — in pissing all over both of these barricades for liberty:

What a completely surreal evening I had last night. As I’d mentioned, I reluctantly dropped John off at the airport around 4pm or so. I went with him to the baggage counter and waited while he filled out the paperwork to declare his firearms, walked with him to the security line, and kissed him goodbye. I thought I might need some distraction, so I had agreed to meet some friends for dinner at 7pm. I went home, changed, and then headed to the restaurant. Just as I pulled into the parking lot, my cell phone rang.

I said hello, and a polite stranger asked if I was [my name], identified himself as a police officer, then asked if I was safe and okay. My forehead wrinkled, and I said I was. The officer then asked if I knew John, and whether he had (a) been staying with me this past week and (b) brought firearms with him for the purpose of shooting at the local range. I said yes to both, and jumped to the conclusion that John must’ve not cleared each and every gun — I know I’m obsessive about checking mine when I travel — it wouldn’t be unreasonable for him to have left one magazine in when dealing with the number of guns he brought with him. So the officer then asked if I’d mind coming to the airport to talk to him.

. . .

They told me that John was in a little trouble. They dodged my questions at first, and then said he had brought a firearm with him that he had not declared. The way in which they said it implied that he had a gun I hadn’t seen, that it was loaded, and that it was on his person. They didn’t outright say any of those things — but they very adroitly led me right to that conclusion. Then they started asking me questions. Who was I, how did I meet John, what were our political views, did we meet with others who might have similar political views on his visit… lots of things that were clearly leading right to the idea that he was some sort of militia nut who was here on a recruiting mission or some such.

They started out treating me like some poor stupid femme who’d been unknowingly lured into some sort of illicit affair with a Very Dangerous Fellow. On top of that, both were extremely flirty. They seemed to think that I didn’t know John had any guns with him. When I said I did, they wanted to know how many and what types. Then whether I knew that he had illegal high capacity magazines with him. I said that so far as I knew, all of his high-cap mags were pre-ban and thus not illegal. They asked if I knew he’d made modifications to his guns. I said sure, he’d put a new trigger in his Glock while he was here. Stupid, stupid questions calculated to make me think he was some sort of maniac.

Then they moved on and asked me if I knew what kind of literature he had with him.

Fortunately, this is not just a jeremiad about the decline and fall of civil liberties in America. The Executive branch is not the only branch of government there is (gee, it’s almost like they designed the Constitution with this sort of thing in mind…), and the news is not all doom and gloom. In particular, two federal courts have given the Bill of Rights a belated birthday present, by striking down the Bush administration’s assaults on habeas corpus and the Fourth Amendment in the case of Abdullah al-Mujahir (nee José Padilla) and the internment camp at Guantanamo Bay.

The Bush administration, of course, is not about to take this lying down, and they are planning to appeal this up to the Supreme Court if they have to. Good — let the battle be joined, just in time for an election year when the Left and civil libertarians need to mobilize. In the meantime, take a moment to celebrate. Give the Bill of Rights a reading, and say a thank you to the Second and Ninth Circuit Courts of Appeals. Happy birthday Bill of Rights — and here’s hoping for many happy returns.

For further reading:

And I didn’t even have to mug anyone in a Gandalf suit…

Blogging today has been postponted. Also sidelined have been academic concerns (revising an essay on Hume) and even the important task of getting the apartment cleaned up into a livable condition. Why?

I’m going to Trilogy Tuesday.

Yes, L. and I got advance tickets–I called ahead, to avoid the lines and the campers–and we will be spending the next 14 hours or so reveling in Tolkien goodness, rendered in marvellous Peter Jackson spectacle.

I love the world.

Let the Bloviating Begin

The global jubilation at capture of Saddam Hussein has brought out the predictable party crashers: no sooner had the cheers died down than the bloviating from triumphalist Right-wing pundits began. David Frum, for example, opines that what the capture shows us is that — and I quote:

… it’s becoming increasingy difficult to doubt that God wants President Bush re-elected.

Turning from theodicy to more mundane politics, Jim Geraghty argues that Saddam Hussein’s capture may finally succed in shutting up the whining of the antiwar Left, by proving the war a success and knocking down their last argument to the contrary:

Since about April 2003, this question has been the cheapest, easiest way to take a shot at the Bush administration:

So why haven’t we captured or killed Saddam Hussein?

You see, once that question is asked, the issue is no longer the broad goals of the war on terror, or bringing new ideas and human rights to the Arab world, or confronting evil head-on instead of coming up with excuses not to. The question confuses the difference between a goal not yet accomplished and a failure. It declares the efforts of the United States and its allies a failure. And it’s about painting President Bush as, to use Richard Gephardt’s favorite words, a miserable failure.

(Our sources, incidentally, offer no word on whether it will shut up the antiwar Right or Libertarians.)

One of the common conceits behind all of these is that the capture of Saddam Hussein proves, after these long months in the wilderness of despair, that the war really was righteous after all, that the neo-cons had it right all along and the whiny peaceniks just refused to see how evil could be defeated. Part and parcel of this is a stirring little moral fable, which goes something like this: the United States went into Iraq to bring peace and prosperity to the whole world by rooting out the terrorists and tyrants who hate our freedom. First we threw Saddam out of Baghdad and liberated Iraq from is ghastly Ba’athist regime; then we worked to build democracy and defend it against terrorist remnants that long for the old order; and finally, now that we’ve got our hands on the old snake himself, the Iraqi people will be able to bring their tormentor to justice. God Bless America.

The conceit behind all discussions of this sort — whether in the rarefied air of know-it-all punditry or in the popular cant of Getting Saddam — is that the ends of the State can be carried out without any particular means: as if there were some trap door that the CIA installed underneath Saddam Hussein, so that all the President needed to do was “take action” by pressing a button somewhere, and then evil would be vanquished. In reality, of course, very few people other than the Ba’athists themselves thought that Saddam Hussein ought to remain in power; the question was one of means – a question that the War Party systematically likes to blank out. Ludwig von Mises skewered this fallacy in the realm of domestic legislation when he wrote, in Human Action:

It is important to remember that government interference always means either violent action or the threat of such action. The funds that a government spends for whatever purposes are levied by taxation. And taxes are paid because the taxpayers are afraid of offering resistance to the tax gatherers. They know that any disobedience or resistance is hopeless. As long as this is the state of affairs, the government is able to collect the money that it wants to spend. Government is in the last resort the employment of armed men, of policemen, gendarmes, soldiers, prison guards, and hangmen. The essential feature of government is the enforcement of its decrees by beating, killing, and imprisoning. Those who are asking for more government interference are asking ultimately for more compulsion and less freedom.

An updated version of von Mises’s formulation is called for, since the 20th and early 21st century have seen this fallacy brought into service, for a gruesome series of “humanitarian” wars. In a nice bit of synchronicity, an article from Publio delievered just such an updated version to my mailbox today:

It is needless to say that a move towards open and pluralistic democracy is a welcome change by any rational citizen, but if change means invasion, occupation by foreign forces, tragic deaths of innocents by the thousands (called “collateral damage” in the American lexicon), burning national libraries, looting museums, pillaging government buildings, destroying documents and national records, sending the army and police officers home packing, leaving scores of civilians defenseless against robbery, crime and rape, losing electricity and running water, threatening territorial integrity, installing a puppet ruling council with mandate from the occupation force, coping with daily car bombs, and in short, single-handedly canceling one’s country only to invite large foreign corporations to rebuild it later, then it is not evident what kind of a rational citizen would want to bring this calamity on herself.

I agree whole-heartedly with Jim Geraghty that we need to look at the whole context of the war, rather than just insipidly focusing on Saddam Hussien. I recommend this course of action to the Right as well as to the Left; and I only wish that Jim Geraghty would look up from his neo-con talking points and consider the real costs that Mr. Bush’s crusade has inflicted on the people he claimed to be liberating — costs that were collected, not in dollars or dinars, but in pounds of flesh.

Oh, by the way, some dude in Pakistan was almost killed and the Taliban is back in Afghanistan. Congratulations to President Bush on his stirring progress in the war on terror.