There's a bit more nuance here. There is certainly a political angle, but there is a non zero risk with taking something like this that should be discussed with a doctor first, IMO. Bypassing a doctor does open up access, but there may be risks, especially if folks don't take the medicine correctly.

A lot of that ends up being bureaucratic wastes of time though. My partner was on birth control for years and had to jump through so many hoops

  - Had to go to yearly appointments to continue receiving it
  - Could not pick up more than a month at a time, which created logistical issues since they HAD to take it daily
  - Had to get the prescription renewed every three months or so, which often led to delays filling it

It led to a ton of needlessly frustrating situations since the pill is so dependent on taking it daily.

You are the first commenter to relate anything like even a secondhand real life experience with oral birth control.

This thread (edit: at the time I am posting this) is full of men with little real knowledge of this drug insisting on why it’s reasonable it took 50 years for this to be available OTC. I don’t think the contents of their explanations are likely to be accurate, but I think they still explain why it took 50 years to be approved.

Totally agree with your take here, although I would like to offer my perspective/speculation as someone who actually takes oral birth control daily:

It may be notable that the pill that got approved is a progestin-only pill that's been on the market for fifty years (so long enough to demonstrate safety/effectiveness) and, crucially, does not contain any estrogen. Because there are risks associated with estrogen-based birth control, to the point where I understand why the FDA might still recommend getting screened by a doctor first—most notably, there's an elevated risk of DVT if you're a smoker.

Granted, given the current, uh, situation in the US, I do think people should be able to make informed decisions about that risk for themselves without needing a doctor's approval. But a progestin-only pill mitigates a lot of that risk anyway while still being a reasonably effective contraceptive.

There is a lot of horrid comments in this thread ("Just have lots of kids!" and "Great, now people can live their addictions without worry"). It's a mix of ignorance, intolerance, misogyny and with a topping of "total lack of empathy".

I'm a bit mollified by the number of people responding to all of the horrid comments.

Also, a lot of people don't realize that oral contraceptives offer benefits beyond literal contraception. I've been on the pill since I was a teen because it's the only thing that keeps wicked endometriosis symptoms at bay (and coincidentally have had the best luck on a progestin-only pill similar to the one that just got approved). And this is despite being in a monogamous relationship with a cis woman for the past five years—zero pregnancy risk there :P

My first wife had to deal with "slut shaming" in her teens for being "on the pill" for exactly the same reason.

> And this is despite being in a monogamous relationship with a cis woman for the past five years—zero pregnancy risk there :P

Ha! I can't believe this is the first time this scenario occurred to me!

You're right that women ought to be the ones in charge of dealing with this sort of thing, but I don't think a bunch of guys presenting positions that are generally skeptical of the FDA restricting things that are generally considered safe from being sold OTC (even if not for the right reasons) are the reason that it took a long time for this to be approved to be sold OTC.

> You're right that women ought to be the ones in charge of dealing with this sort of thing,

That's pretty contrary to the typical diversity rationale that suggests out group people have valuable inputs. I think it makes a lot of sense to have society as a whole making decisions about how society as a whole operates. It's not just an individual's choice if they take a drug which may or may not end up being like thalidomide. At the very least it affects fathers, and those born with the side effects.

Of course women should have a voice in this area, but also should many other groups :)

everything in this reply espouses ideas and positions that are literal antitheses of a liberal society.

In liberal democracies, people have a right to get to have their say (on a soap box and at the ballot box) in matters that don't rationally concern them.

have a say but not dictate. so my point isn't that the response says things but that it advocates for policy/governance.

In a liberal democracy, a common citizen 'dictating' simply means saying something with a jackass commanding tone. Such advocacy for policy/governance is a protected right in liberal democracies.

It is my right to say: "I command you to dye yourself blue and dance for my amusement." And it's your right to tell me to fuck off.

read my words carefully: i didn't say anything about the words themselves, nor the act of speaking those words, i said the ideas and positions are antithetical.

The idea to which you responded was the assertion that people have a right to vote in matters that don't concern them. This is the central premise of liberal democracy.

> I don't think a bunch of guys presenting positions that are generally skeptical of the FDA restricting things that are generally considered safe from being sold OTC (even if not for the right reasons) are the reason that it took a long time for this to be approved to be sold OTC.

Well yeah, the men who prevented it from being OTC for so long didn't do it out of skepticism that it was safe; just like every other time women's rights have been restricted, it's about control. Concern over medical safety is just a convenient political distraction to avoid having to defend regressive social policies. If the people who rules like these actually cared about women's health, they would take into consideration that some women need medication like this for issues that aren't related to trying to avoid pregnancy when having sex. Even labeling medication "birth control" is just a way to ignore the fact that sometimes there are conditions that affect the reproductive system without a woman becoming (or trying to become) pregnant, and sometimes these medications can help with those.

This goes for other things on HN, too. If the topic doesn't involve programming, it's mostly just uninformed people talking shit.

Because, naturally, humans can only be informed about a single topic: their career. Therefore, programmers are only capable of being knowledgeable about programming. And doctors are only capable of being knowledgable about medicine. And plumbers are only informed about plumbing topics. Really?

Thanks for this... It's kind of funny considering I've probably done as much reading on nutrition science the past 5-7 years as I have programming (almost 30 years into this career). Mostly in that there's been so much mis/disinformation regarding food and nutrition over the past couple centuries, and I have a lot of health issues as a result.

I bring the above up, because even a lot of doctors are ill informed. Not to mention nutritionists that are institutionally trained in dogma first, for licensure. Australia is over a decade ahead of the US at this point, and EU is about half that ahead. US nutrition is too entwined with industrial agriculture.

On TFA, I don't have too much opinion on the specifics. Other than gatekeepers gonna keep gates. It's as likely big pharma ran the numbers that they'd make more with this medication being OTC today, where a few years ago it was better gatekept. And they just, finally, pushed for OTC from the FDA. That mostly comes from my general opinions around the incestuous relationship of the FDA and private industry (similar to USDA).

See this is a great example, you've studied this topic extensively but don't seem to know the absolute basics of the industry.

"Not to mention nutritionists that are institutionally trained in dogma first, for licensure."

Nutritionist is not a protected title in the US or Australia, and actually requires no training whatsoever. It does require training and licensure to become a dietitian, because it's a clinically focused role. In many cases dietitians have prescribing privileges and are prescribing recipes for intravenous or tube fed nutrition.

That's why they're so heavily regulated my dude, I promise you clinically focused dietitians are not using the kind of industry research you're talking about. They are following protocols established over decades of clinical practice.

And if you're wondering why doctors are ill informed, it's because they're not typically trained in nutrition outside of the basics (outside of gastroentorology). Modern medical teams rely on a ton of support staff, one of those being clinical dietitians. Your doctor's job is to know who to consult.

So, because I displaced the term dietician with nutritionist conversationally you side step into a diatribe. You do realize that a lot of people have learning disabilities that make it difficult to remember specific terms in their place? It's kind of like a mental block in trying to remember. I have this when it comes to proper names all the time. It doesn't mean that I don't have an understanding of the conceptual base.

So, dieticians never suggested limiting cholesterol, and cutting out all saturated fat?

People mix up the title all the time, it's no big deal. I'm mostly focused on the fact that you were upset by the licensing requirement. I took that as evidence that you were not aware that dietitians are often a clinical facing role, with clinical responsibilities such as writing prescriptions.

Was I incorrect in that assumption? Or do you genuinely want to relax the licensure requirement for people who write IV prescriptions?

I'm not upset about the licensing requirement... I'm upset that said licensing is based more around establishment dogma (standard of care via USDA) than actual known nutritional science.

You're misunderstanding. It's not that they can't know things outside of programming (which is your strawman), it's that they usually don't make the real effort to learn, and think reading a few blog articles makes them knowledgeable about a subject.

At what point does one cross this arbitrary barrier to being proficiently knowledgable in a subject outside their profession?

I'm a self taught developer with nearly three decades of experience, still spending 10+ hours a week expanding my craft (reading/experimenting). But in the past 5-7 years have spent twice that time on food and nutrition science study. Part of that understanding research quality, not just quantity, and the value of different types of testing vs study.

So you believe all of that time you put in suggests that you know more about the subject of food and nutrition?

To put it another way: if you could have acquired all of that knowledge without spending so much time and effort, then why didn't you?

Yes, I believe all that time I put into learning means I do know more than most. And no, I didn't suggest that I'd have that knowledge without the time, effort and study, never did.

I'm not sure what you are asking exactly. The initial response above seems to indicate that a person shouldn't speak on something outside their primary career. So my question is, at what point is one able to pass the bar of being able to speak to a subject materially?

To be honest, it seems like we mostly agree, so I don't see what the issue is.

>The initial response above seems to indicate that a person shouldn't speak on something outside their primary career.

Already addressed this in the very comment above that you replied to. This is incorrect.

Regarding where the "bar" is exactly, that is of course subjective. But I reject any idea that its subjectivity implies that all opinions are valid or whatever it is you're suggesting, because they're not. Some opinions are uninformed, and I have no problem saying so.

Your comment is at the top of the thread, so thank you for pointing this out before I waded further into the comment section. I'm sure you saved me some grief.

> This thread (edit: at the time I am posting this) is full of men with little real knowledge

That’s almost every reply on HN that isn’t specific enough to let someone shine through with their tech experience. It’s been like this as long as I’ve been here.

And then when you try to point it out they pearl clutch/gasp and accuse you of having an agenda/over-interpreting their words. It’s very frustrating.

Just in general, people on the whole are idiots about drug culture and history. Most people have no idea their drug scheduling system makes no sense, that they have a bunch of dumb cops (DEA) that came up with and maintain that system rather than actual medical experts, that there were racist and economic interests at the root of all this nonsense rather than genuine concern for their well-being, etc. Also the idea that you can use control of a drug as a proxy to control and disempower various marginalized demographics.

That sounds shockingly similar to what's required to get ADHD stimulant medication.

Which is fucking silly for birth control.

You can add to that list

- Have to get pap smears before being granted a prescription

Doctors will withhold birth control to coerce women to get regular pap smears, just because it's a lever they have available, not because it's related to the prescription.

I have to take both ADHD meds and birth control, and while it is much easier to get prescribed birth control, it's a similar level of stress of making sure my medication is regularly available, especially for someone who struggles with staying on top of timely tasks.

Do they still do that? HPV vaccine is on its way to eradicating cervical cancer.

Yeah they do that, way too often. My wife went in to a 32 week OB appointment and the hospital staff were trying to force her to get one, she just left and got a new OB clinic.

Do you use a smaller pharmacy or a chain? Would highly recommend getting setup with a smaller pharmacy that will value the endless recurring business and work with you to iron out all the seams. It should not be such a big deal to handle these basic things. Some even offer home delivery so you don't even have to lift a finger...

Flashbacks to the pharmacy I used to frequent whose head pharmacist consistently failed to autofill my ortho-tricyclin and was shocked when I kept calling in to request new fills.

"You mean you have to take this every month?"

"...Yes?"

(And I wasn't even taking it for contraceptive purposes, thank god, but can you imagine if I had been?)

> but there may be risks, especially if folks don't take the medicine correctly.

This describes every over-the-counter drug that has ever been sold. Keeping contraception prescription-only has always been about politics.

The FDA regulates both risks and efficacy. The efficacy of hormonal birth control plummets if not taken consistently, which for progestin-only pills (like this) includes the same time of day[0]. Talking to a doctor ensures that people really understand this.

The downside of forgetting to take more advil in time is short-term pain. The downside of not understanding that your birth control isn't working is a child.

As we've seen with patients stopping antibiotics early, even though they're prescription!, people make uninformed choices with medication. Depending on what it's for, there are more or less risks of making it OTC.

All of that said, I agree that this has mostly been politics.

[0]: https://www.plannedparenthood.org/blog/is-the-birth-control-...

Conversely, the downside of forgetting when you can take Tylenol is maybe needing an organ transplant or dying. Which...is 100% efficacy on pain reduction, I suppose.

So hey, the OTC medicine gods giveth and taketh.

> Talking to a doctor ensures that people really understand this.

This seems antiquated at best. They could've approved some kind of app or process to streamline this. I'm sure it's not the only kind of medication this situation applies to.

I'm not sure the point you're making here.

The potential danger of forgetting to use a condom or misusing one (like a condom that's too old) is also a child. Condoms are currently sold in truck stop bathrooms.

I really see no distinction between a condom and a birth control pill. Even with misuse, making the pill more widely available will almost certainly be a social good. It will prevent more unwanted children.

Well you should, hormonal pills and latex are entirely different.

They are absolutely different, so we should discuss the actual risks of the pill and not the risks of misusing a contraceptive in general.

Which is why I don't get the point I responded to. "You might get pregnant if you misuse this" isn't something to consider when talking about OTC contraceptives. It's practically a tautological statement "If you misuse a contraceptive, you might get pregnant"

In the United States, there are two quite distinct aspects.

1) Health. Agree that talking to a doctor -- or a nurse, or a midwife, or a well-trained community health advocate -- is quite useful when understanding the practicalities of taking hormonal birth control. Talking to someone helps people understand this; I think you may overestimate the efficacy of an MD per se here.

2) Insurance as gatekeeper. The narrow windows to get a limited supply, whether you can get it locally or must mail order it or can't mail order it or can or can't get a refill -- none of this is medical. It's all insurance bureaucracy. I find no benefit to this bureaucracy.

Good education about the full range of options would be great (from pill to ring to IUD to condom). Universal health care availability would be a good mechanism by which to deliver that, it's hard to accomplish when it's all gatekept by insurance.

I got laid off recently & had a routine physical that took place 2 days after my health insurance thru Company ended, went anyway, got a bill for $552. This is for conversation only, haha, but the type of conversation one would need to get an annual renewal for birth control controlled by prescription.

How do you think the two are equivalent? Hormone medications can have a profound impact on a person across the spectrum from mental to physical health. Secondly, taking BC wrong may lead to a false sense of security and subsequent unwanted pregnancies. I wouldn't be surprised if there was a, smallish, correlated increase in STDs, as well.

Neither of those are a thing someone buying tylenol has to worry about. Disingenuous or poorly considered to think it can _only_ be about politics imo.

>Secondly, taking BC wrong ... Neither of those are a thing someone buying tylenol has to worry about.

Taking Tylenol wrong kills you.

"I wouldn't be surprised if there was a, smallish, correlated increase in STDs, as well."

I would highly doubt it. Contraception is already abundantly avaliable, including in online visits. I could see people switching from Rx to OTC. But I really don't think you could have a big enough increase in non-users to OTC to have any significant data.

"Acetaminophen toxicity is the second most common cause of liver transplantation worldwide and the most common cause of liver transplantation in the US. It is responsible for 56,000 emergency department visits, 2,600 hospitalizations, and 500 deaths per year in the United States."

Emerg docs giving out NAC like candy for acetaminophen overdoses. It would never be approved if released today, but we've got a long history with it being OTC, so I don't see that changing.

Let's get big government nanny state out of the way here. People can make their own decisions. It's not like you can't consult with a physician when taking contraceptives over the counter anyway.

Everything you said here you can apply to other behaviors, ranging from alcohol/marijuana consumption, to eating fast food, to skydiving.

OTC here is a result of politics specifically because access is being restricted or in the midst of being restricted. The reason this wasn't OTC was because there just wasn't a need to bother with it. Now there is.

> I wouldn't be surprised if there was a, smallish, correlated increase in STDs, as well.

This is really unsubstantiated and it would be nice if you didn't say things like this in the context of this conversation here unless you're going to provide a legitimate source. Even then if this were true I'm going to guess that an infinitesimal and unsubstantiated risk of higher STD rates is nothing compared to unwanted pregnancies from a public health standpoint.

>This is really unsubstantiated and it would be nice if you didn't say things like this in the context of this conversation here unless you're going to provide a legitimate source.

Condoms and the pill are the most used contraceptive methods in the US, by far. Given that condoms prevent STDs, it would actually be a surprise if, everything else equal, those who use the pill didn't have slightly more STDs.

Sure, and being poor is probably linked to higher rates of STDs too. Oh and alcohol use... and... and...

The problem with the unsubstantiated claim (besides the fact) is that it ignores the broad public health picture (what's worse, 5 more people/year get herpes or 5 unwanted babies in trash cans?) and injects, frankly, useless information and FUD into the conversation.

It's done so intentionally to attach negative externalities that are truth-y to a topic when their relevance and impact are quite trivial.

What I mean here is that this may cause an increase (again on the OP to substantiate this claim) of .0001% in general STD contraction, but in a given paragraph the "fact" is given much more weight than it otherwise deserves precisely because the numbers aren't provided - each piece of the claim has equal grammatical weight.

Cognitively, without the numbers (and probably with them even), you associate birth control negative externalities with "INCREASE IN STDS11!!" and now all of a sudden you find that since you are opposed to increases in STD contraction now you are sort of on the fence and maybe opposed to birth control.

"Just use a condom" (until we find some problem with those) and then it becomes "just don't have sex unless you want a baby".

This may seem conspiratorial but these are very specific debate and discussion tactics used by others to slowly chip away at rights and freedoms that we enjoy which is why it's important to call out items like this and require that if someone is going to make a claim they should provide factual evidence supporting that claim.

Until that's done, I'm going to claim that birth control decreases STD rates.

So you would rather make unsubstantiated claims yourself, taking part in precisely the thing you took a few paragraphs to denounce, because you consider yourself to be right?

Well I know I’m right about the general topic and requiring sources for the unsubstantiated claims.

It’s confusing that you’d focus on that specific point versus everything else I wrote though. It should be obvious that the point was to show that I can make equally valid unsubstantiated claims, not that I was making one - the claim which would be irrelevant here anyway.

> Secondly, taking BC wrong may lead to a false sense of security and subsequent unwanted pregnancies.

This is the political angle I mentioned. You're suggesting that easier access to birth control will result in more unwanted pregnancies than limiting access to birth control. It's so silly it doesn't really warrant a response, but I did want to highlight that logic this flimsy typically only serves political positions.

Also...it's not in FDA's remit to regulate the number of pregnancies in the US. This is really reaching.

More generously, the unwanted pregnancies can result from assuming your birth control works but actually it doesn't because you didn't read the instructions properly. At the extreme this can be "I didn't realise I need to take the pills every day even when I'm not planning to have sex". A relatively brief consultation can fix that.

In my country abortion access isn't under threat, except in the loose sense that of course there are people who insist it's immoral and would like to ban it and some of them try to intimidate patients. Nevertheless the pill isn't an OTC medication. Emergency contraception (the "morning after pill") is available from a pharmacist but I believe the pill requires a prescription.

My daily pills (my thyroid gland is gradually dying) require a prescription too. I hit "renew" in the app every couple of months, I get two more one month packs, pick them up from a self-service machine a week or so later - rinse, repeat. Seems reasonable.

And 90% of women have taken hormone contraceptives at some point in their lives and that's not even counting the people who take hormone treatments for PCOS or menopause.

These medications are safe for everyone. There is noting a doctor does to evaluate whether you're healthy enough to take them. They literally just write the script and explain how to take it. Medications where the doctor visit is a formality should just be OTC with maybe an informed consent paper given to you by the pharmacist.

The opposition is just politically-religiously motivated concern trolling.

>The opposition is just politically-religiously motivated concern trolling.

Then why do European countries require a prescription too?

The UK allowed the pill OTC in 2021 https://www.bbc.com/news/health-57384096 which only requires a consultation with the pharmacist.

France still requires a prescription but it's theater since the doctor can't deny you. There's just been little appetite for to reclassify birth control because going to the doctor isn't that much of a burden and most countries have laws against disclosing contraceptive use to parents. But now there's momentum.

There are non hormonal options out there like IUDs (and condoms) that may be a better option though. Speaking as a parent, I would rather have my kids come talk to me /my wife about this stuff and work with us and a doctor to figure out what's best for them long term. I recognize not every kid has that kind of relationship with their parents and the benefit of purchasing it directly.

As much as this is coming from a good place with good intentions, some things are human rights[1] that parents shouldn’t be able to withhold.

[1] https://theweek.com/articles/470330/birth-control-human-righ...

That doesn't contradict what the parent is saying. Having access to non-hormonal options still fulfills the UN stance.

This being a "human right" seems like a matter of opinion.

Your article talks about an annual report, then links another article written 3 years before the one you link, said article doesn't link to the report.

So I search for the report itself: https://www.unfpa.org/sites/default/files/pub-pdf/AR%202012%...

And the claim is nowhere near the one you are making. What the UNFPA (who can't even declare anything a human right, by the way) is saying is:

>Family planning is anchored in respect for human rights, women’s empowerment, and social justice and quality.

And

>In October, UNFPA published its annual The State of World Population report, which made the case that family planning is a basic human right that unlocks unprecedented rewards for women in terms of health, economic power and gender equality.

Putting medical barriers to access the pill is by no means whatsoever a violation of human rights.

> There are non hormonal options out there like IUDs (and condoms) that may be a better option though.

Whether one agrees or disagrees with this, the argument is not strong enough to warrant a prescription requirement.

(Also and separately: human bodies are complex. If you talk to a few women you might discover that IUDs are not universally tolerated and condoms are not an acceptable substitute for a variety of reasons. There are good reasons many women choose to take oral contraceptives, even though they have a daily use requirement.)

This isn't just about kids, it's also about the inconvenience and added cost (to pay for the doctor visits) placed on all women who use oral contraceptives. I'm not sure how it relates at all to this announcement.

Attempting to get an IUD installed was the most physically painful experience in my life to date.

IUDs don't have great track records for safety. [1]

The pill is simply one of the safest options on the market. It's not perfect, but it's generally super well tolerated.

[1] https://www.consumersafety.org/medical-device-lawsuits/miren...

s/politics/misogyny/

To be fair you can’t even get dick pills in the states without a script (though these days you can get them expensively online via nonsense e-consultation).

Meanwhile in Mexico you can buy generic Cialis and all sorts of drugs over the counter for $20/mo. Insulin and epi pens too.

If men could get pregnant every time they had sex, we'd have drastically different laws on the books.

Good time to remind people that tylenol dosages as written on the bottle are just within the safety window to avoid toxicity[1]. Having done the math myself, you can't even take the extra strength stuff at the recommended timing without skipping a dose each day. Drugs, even OTC ones, have very real risks, and gatekeeping BC is laughable given the risks of not having it freely available.

[1] https://www.health.harvard.edu/pain/acetaminophen-safety-be-...

Tylenol/paracetamol/acetaminophen also barely works. It increases the effectiveness of an aspirin and caffeine combo to relieve headaches (but not migraines). It’s generally ineffective against chronic pain, back pain, and severe pain. It’s a weak fever reducer.

It’s one of the most popular medications in the world and its use isn’t especially supported by science. To the point of this thread, don’t mistake official policy for rational behavior.

> It’s a weak fever reducer.

Anecdotal, but acetaminophen has been my goto for fever reduction. I've never had a problem with it (and it's taken me from 103->98 fairly frequently).

And, unlike most NSAIDs, it's safe(ish) for younger kids.

That said, I've never really noticed the pain killing effects.

Could you give me some sources on acetaminophen effectiveness? I’m really interested in this.

This article links to a bunch of studies: https://theconversation.com/whats-the-point-of-paracetamol-6...

Here’s an NIH meta analysis: https://pubmed.ncbi.nlm.nih.gov/33786837/

There are lots of studies out there, throw whatever symptom + acetaminophen effectiveness into Google for more. Just make sure that is a study is making a big deal about stat sig to check the actual treatment effect.

> It’s a weak fever reducer.

That is what it is supposed to do.

I keep it in my first aid kit, since it works some amount for fever reduction and can be used in some cases where ibuprofen is contraindicated (like with dengue).

I also do not like how toxic tylenol is, but I'll echo the other (probably parents) posters pointing out that dropping a fever from 104.2 down to 100.9 is... pretty awesome when you have a screaming 6 month old and panicking mother. Arguably it's best feature is mild fever reducer. I love that feature. My child will peacefully go back to sleep within an hour of taking it and we can go get prescribed antibiotics for her ear infection first thing in the morning, rather than jumping through a bunch of hoops during a midnight run to the ER.

Ibuprofen is in almost all ways a better drug overall for parents/home use, but because of some rare reaction to it, it's not suggested until 6 months, so most parents assume Tylenol is "safer" and never switch over.

My first paragraph lumped together a bunch of pros/cons. Tylenol definitely reduces fever and eases mild headaches. It doesn’t do some other things that it’s prescribed for.

The thing about the weak fever reducing is it’s useful for reducing the suffering from the fever itself, like letting your baby sleep. It’s surprisingly ineffective at reducing febrile seizures. I think it’s that it doesn’t have much against a fever that bad.

104.2 F is a severe fever FYI, a medical emergency.

https://en.wikipedia.org/wiki/Fever#Hyperpyrexia

Yep, if you call the nurse hotline generally they will advise you to dose Tylenol and then if if it doesn't come down, go into the ER. We have not yet had to do the second step.

YMMV but acetaminophen is extremely effective for me. I refuse all opioid/etc prescriptions even after surgeries, and acetaminophen makes this tolerable. It doesn't magic the pain away but it takes the edge off with no risk of addiction.

My understanding is that for chronic pain the evidence is sparse, but for postoperative pain it definitely works.

Do you also refuse intraoperative opioids?

No, but I refuse to have such drugs placed in my custody to me for me to be responsible for. The doctors can dose me with whatever they think is appropriate while I'm under their supervision, but I won't take that stuff home with me.

Tylenol is a crazy drug to me. Every medicinal chemist I worked with told me it would not be approved today due to toxicity conferns.

> Bypassing a doctor does open up access, but there may be risks, especially if folks don't take the medicine correctly.

In related news, it is shockingly easy to get messed up real bad by Tylenol. But you can get it in a 500-pill bottle from Costco.

My cousin is a toxicologist and he was talking about this in the 1980s - that the public had no idea how incredibly toxic Tylenol is and how easy it is to over dose on it and cause significant damage to your liver and other organs.

The worst is that if you "OD" on tylenol, you won't die right away, but instead slowly and increasingly painfully over time, perfectly aware of what's going on.

Depends on the country. In the UK people typically are aware of the dangers of acetaminophen, and you can't buy giant bottles.

That's pretty much a USA thing, though. In Europe you'll usually only come across blister packs, and they don't really go beyond 50 / box. It is a lot harder to accidentally OD when you have to individually remove every single pill from a blister pack, rather than just chugging a fistful straight out of the bottle.

Sure, but the context here is why it took so long for the US to allow otc bc pills, the same country that allows 500 pill bottles of acetaminophen

I'm seeing this point repeatedly through the thread, and it's like there is an implied "And we wouldn't want to put barriers to that, would we?"

And I'm thinking, maybe? Maybe if you can think of a medication that can wreck you that easily, the problem lies on that medication too?

Should every substance which doesn't mess you as hard as Tylenol be OTC?

I think you overplay how much people actually listen to their doctor. I contend people listen to packaging and doctors about equally well.

The risks of pregnancy are much worse! Pregnancy is really tough and can lead to eleventy zillion health complications

Also, ~40% of children born into poverty remain in poverty [1], and it costs $310k per child from 0-18 (excluding daycare and college costs) [2].

Broadly accessible reproductive healthcare is about as impactful as vaccines from a value delivered for the cost perspective. You want to avoid as many both unintended and unwanted pregnancies as possible (which ["unintended"] stands at about half of all US [3] and global [4] pregnancies annually).

[1] https://www.pbs.org/wgbh/frontline/article/how-poverty-can-f...

[2] https://news.ycombinator.com/item?id=33991744

[3] https://www.guttmacher.org/sites/default/files/factsheet/fb-...

[4] https://www.unfpa.org/press/nearly-half-all-pregnancies-are-...

Helping poor people who do not WANT kids not HAVE kids is not Eugenics but rather their basic human rights in a world that invented birth control.

When you're doing it explicitly because 40% of their offspring will be poor, I think you've at least entered a gray area. Aligning with the interests of eugenicists is hardly an argument against a policy though.

The point is that an individual CHOOSING to not have a child because they don't want that child to stay poor is NOT EUGENICS, and this policy will not force birth control on anyone who doesn't want it. In fact, all this does is make it easier for people who DON'T WANT KIDS to NOT HAVE KIDS. Enabling personal family planning like that is basically the opposite of eugenics?

Eugenics and choice are not exclusive; eugenics does not have to be administered through force. Singapore subsidized sterilization of poor and uneducated people and that was eugenics, even though people were still able to choose whether they wanted kids. And, to get ahead of 'poor people don't have a choice because they need money to live', Singapore changed tracks and started incentivizing reproduction for educated women, and that is also eugenics. If I don't reproduce because I have a genetic disease that I don't want to pass down, I'm practicing eugenics.

Eugenics doesn't by definition mean all of the horrible abuses that have arisen from it in practice. It's just about 'improving' the human gene pool, and any method of achieving that goal qualifies.

Wait, what exactly has a zero risk? Drinking water has a non zero risk. Breathing air has a non zero risk. I once looked up at the sky. Pretty sure the risk wasn't zero.

I think you would be amazed how many people don't "have a doctor" and simultaneously are the same people who would benefit from this.

I'm pretty sure you don't have to "have" a doctor for this. MinuteClinics and such can provide this. I would guess there are websites you can get Rx through too.

That’s still a needless barrier. If you are poor every dollar counts and being required to pay for a medical professional to rubber stamp a prescription does more harm than good.

I'd like see the data that supports that. If true, we would do away with the prescription process altogether for most drugs.

That women find getting birth control a hassle? Ask anyone.

No, that the prescription process is providing more harm than good.

Having a doctor rubber stamp a prescription does more harm than good. If the argument is that getting a prescription is such a simple task it should cost almost nothing and be done instantly, then it likely doesn’t need to exist as a barrier at all.

"Having a doctor rubber stamp a prescription does more harm than good."

The question was how/why, not to simply restate it as fact wilit supporting data.

"If the argument is that getting a prescription is such a simple task it should cost almost nothing and be done instantly, then it likely doesn’t need to exist as a barrier at all."

That's not the argument. The argument is that the current system already meets the needs, so what real benefit does OTC provide? It's mostly a counterpoint to someone claiming that it's an overly complicated process. Even if it is cheap and fast, the benefit to an Rx is that someone reads the 6 or so questions off the Epic screen (or the user answers them on online) to ensure there are no interactions or elevated risks.

I'm not saying OTC is the wrong answer, but I'm not seeing any real arguments for real added net benefit from it.

Net benefit is the enormous hassle a woman has to go through to get an approved treatment.

Annual checkup, prescriptions only good for three months, and then typically only allowed to pickup one month dose at a time. That is a huge logistical burden being put on people. Maybe if a prescription was annual and included a year of pills, that would make the OTC case marginally less compelling. Given the status quo, OTC would be an improved quality of life for many.

Those are not restrictions under the Rx process. One can easily access hormonal Rx birthconrtol online - virtual appointment and mailorder pharmacy with auto renew. If people are unhappy with their service, there are other providers able to provide a convenient experience.

You can't get a year of pills at one time. These pills expire 1 year from the manufacture date.

You're talking about a theoretical "one" that can easily get birth control. In practice, this does act as a significant barrier for a large portion of the population. It's easy to forget this in an Amazon/Doordash/Instacart world, but online ordering doesn't work for everyone. For example, 4.5% of US households are unbanked.

That seems like a poor argument given that demographic is most likely to qualify for free or reduced cost healthcare either through Medicaid or ACA.

No, it's a great argument because it disproves your claim "One can easily access hormonal Rx birthconrtol online". It seems you have a new claim that this doesn't matter because they likely qualify for free or reduced healthcare. I don't find that very convincing. "Likely" isn't enough here and a doctor's appointment, even for free or reduced cost, is still a significant burden.

No, the point is that you can get birthcontrol online using Medicaid or insurance without needing a bank account.

'"Likely" isn't enough here'

Why wouldn't it be - just because you say so? Keep in mind the alternative is that they make too much to qualify, which gives them other options.

Keep in mind your definition of unbanked is only about checking and savings accounts. It has nothing covering credit cards or prepaid cards, which are also options. So saying people are unbanked and would likely be burdened isn't enough.

I can walk into a drug store and choose from aisle after aisle of prescription-free drugs, so I think we have already done that.

This is false equivancy. We would need to view that on an individual basis. Just because we have done it for one type of drug, doesn't mean the concerns are the same for another type. This is especially true when considering alternatives during evaluation.

What evidence do you have that they didn't properly consider this for this one specific drug when we trust them to do it for hundreds of other?

In my opinion, they are not taking a systems thinking view when considering the alternatives. They mention risks associated with cancer recurrence, but then say it is unknown how high the risk is. There doesn't seem to be any mention of the probable increase in risk of developing certain cancers, like gliomas. They mention that STD rates will go up if condom usage decreases, yet didn't measure if there was an increase or decrease in condom usage associated with the product. They also seem to ignore that making the pill OTC may influence some people to rule out higher efficacy prescription options like IUDs. They talk about almost half of pregnancies being unplanned, yet there was no real analysis on how many of those would be prevented by this OTC pill.

It feels to me like there wasn't much investigation or thought involved in the overall process. They're just going to use the safety study from 1973 and a small nonprescription study to bring back a pill that was uneconomical for the company to sell as Rx. Seems a lot like the notorious 510k process they use for medical devices. So I'm not saying it's the wrong thing to do, but I'm skeptical of the benefits. They don't have any compelling reasoning to make me believe there will be a bet benefit when they fail to quantify several of the risks and only provide a comparative analysis with OTC only products of the potential failure rates without any impact analysis on the desired metric of unintended pregnancies.

No one is suggesting doing this with every drug, only this one. Straw man.

See the context please. Someone was claiming that we've already done away with prescriptions for most meds.

> If true, we would do away with the prescription process altogether for most drugs.

That might not be a bad idea. In theory, a prescription means that a doctor who has an intimate knowledge of the patient's health works with the patient to make a carefully-considered mutual decision about medication.

In practice, much of the time the process is just a formality which imposes a huge time and financial cost on some patients as well as reducing the time the doctor has for patients who really need more attention. In the past, when access to information was more difficult, this might have been necessary.

In the modern world, a simple automated flowchart on a pharmacy website or in-store terminal can do as good a job selecting appropriate medications, avoiding drug interactions, screening for side effects, and informing patients how to take the drug correctly than a doctor. Of course, not every condition can be treated by merely dispensing pills, nor is this appropriate for medications that require more in-depth monitoring or have severe public health consequences.

Advertising drugs should probably be more restricted than it is now to put such a system in place.

I agree. Most of the "flow charts" systems already exist and are used today by the doctors and pharmacists. The only real barrier to opening these up to the public is they would need to be translated to layman terms and provided detailed definitions. WebMD and Drugs.com do this, but perhaps not well. We would also need some sort of guidance or check by the pharmacy just a to rule out the classic "WebMD says I'm dying" panick, or to order/interpret diagnostic tests.

What is your point? Eating fast food everyday has a non zero risk. Arguably a really high risk. Do you want a prescription for what you can eat as well?

That's true, but there are also very large risks with becoming pregnant. Historically, I believe it is by far the single largest cause of death for young women. Things have improved, but it is still quite risky.

Everything in life involves risks, but I believe on net this reduces risk.

>there is a non zero risk with taking something like this that should be discussed with a doctor first, IMO.

Nonsense. I can walk into any store in the country and buy enough Tylenol to kill myself for $5 no questions asked. This is an unqualified good thing.

I agree, and I see a lot of false equivalence comparing BC to the dangers of Tylenol/acetaminophen/paracetamol in this thread.

Yes, both are drugs and can be misused with disastrous or even fatal consequences. The important distinction is that you can use oral contraceptives correctly and still have seriously negative, life-altering side effects. There are alternatives which may be preferable and ideally every woman should have access to a medical expert who can guide them to make the best choice.

Access to an appropriate medical resource is in the other issue, in the absence of a completely safe and effective option. And that seems to outweigh the risks in the the US. I can only hope that, when given the option, women continue to consult medical professionals even though there is now an over-the-counter option available.

Sure, and you can use NSAIDs correctly and experience the same. For instance, if you're taking methotrexate.

At some point you need to have a new avenue for disseminating that type of information, especially when doctors visits are becoming more inconvenient and expensive.

I think that it's really shitty that one can take hormonal birth control with perfect responsibility and encounter negative side effects. I also think it's really shitty that the US has the highest infant and maternal mortality rates in the developed world. I've had to deal with both sides (taking hormonal birth control, with some side effects; having a "high risk" pregnancy and being confronted with forced surgery that would increase my mortality burden, against empirical medical evidence but for insurance reasons). My philosophy is consistent: given that the hand of cards is shitty, I want to choose how I play the cards.

Ideally, as you say, folks should have full access to knowledgeable medical experts who can help guide them. Again, our mechanisms for delivery of care in the US don't allow that, and unfortunately our physician and nurse training doesn't facilitate that either. A lot of medical professionals insist that hormonal BC doesn't have side effects, many insurance companies don't cover experimentation to find the best method for a particular person, non-hormonal woman-controlled methods are underused in the US. Since medicine in the US is built around making money & defending against lawsuits, care gets lost.

Walking across the street is a risk. Should I be required to discuss it with my doctor first?

If you're concerned, you can talk to your doctor first. No need for everybody to live their lives by your whims.

We saw this with Theranos. They lobbied really hard to stop doctors from being gatekeepers to blood tests.

What's the problem? Theranos committed fraud and their founder is in prison. Meanwhile, you can order blood tests. Early in the COVID pandemic I thought I had it at the very start. I got myself an antibody test and found that I didn't. Good data, and I didn't need to go wait in a doctor's office with a bunch of COVID patients.

> there is a non zero risk with taking something like this that should be discussed with a doctor first, IMO.

This costs money in the US. And it costs time and effort everywhere in the world, with doctors frequently using this as a hook to force you to visit them regularly and bill you or your insurance for that. And it's just disempowering bureaucratic bullshit when the risk is far less consequential than most other risks we take in life. Do you have a permission slip from your doctor for sitting in front of the computer all day? That's far worse to your health than oral contraceptives.

There are a lot of OTC meds that are literally more dangerous or side effect heavy or have objectively worse risks, or are more damaging with long-term use than their superior prescription-only counterparts. Even within prescription medications, it is ironic that they often schedule more leniently based on the potential toxicity+lack of abuse potential (stick+ lack of carrot).

Maybe it's time for the FDA to just do quality checks but otherwise screw off. I'm tired of having to order 100% safe drugs from Indian pharmacies. No question they are colluding with Big Pharma. Is there any reason the "Farmacia" model of Latin American countries, where you go in and pay per-pill for whatever you want wouldn't work here?

The plant in India’s southern Tamil Nadu state produced eyedrops that have been linked to 68 bacterial infections in the U.S., including three deaths and eight cases of vision loss. Four people have had their eyeballs surgically removed due to infection. The drops were recalled in February by two U.S. distributors, EzriCare and Delsam Phama.

https://www.pbs.org/newshour/health/fda-finds-sterility-issu...

There have been comments on previous discussions here that indicate the safety culture in Indian drug manufacturing is shockingly bad.

If you have ever lived in, been to, or even seen videos of life in India, then this would not be shocking.

The people living there, and especially working the low paid jobs in these factories and whatnot, have bigger risks to worry about than safety in drug manufacturing.

Regulatory capture is a real problem, but are you suggesting we'd be better off if the same Big Pharma could just market and sell whatever it pleased?

Out of curiosity (and ignorance), what kind of things are available in India that are gatekeeped here?

For the longest time, something as simple as Voltarin was not available OTC in the US, but could easily be obtained from other countries. It's an anti-inflamatory cream used for joint pain that you don't have to eat, so lower risk of side-effects to stomach, liver, and kidneys.

Sunscreen! Korea and Japan have great sunscreens that don't feel oily or icky on your skin because they're able to use more modern ingredients. The FDA hasn't approved new sunscreen ingredients since 1999.

This is important for people (commonly women) who regularly use skincare treatments that make their skin extra sensitive to the sun. They want daily facial sunscreen that doesn't feel greasy. We end up buying it on eBay because it's not allowed to be sold in the US.

Modafinil is one.

> Is there any reason the "Farmacia" model of Latin American countries, where you go in and pay per-pill for whatever you want wouldn't work here?

It seems that, at least in Mexico, this model leads to massive overuse of antibiotics as people self medicate colds/flu and other things that don’t need them.*

Facing increased antibiotic resistance, letting people decide for themselves when they need antibiotics seems like a mistake, especially given that many Americans already “shop” between doctors until one will prescribe the antibiotics they think they need (prompted in some cases through the perverse incentives of patient satisfaction surveys).

Never mind the decision making around which specific medication may be most effective for a particular condition in light of potential side effects that the average person may not know much about, for example the potential for long term disabling damage from fluoroquinolones–see people preemptively asking their doctor for a Cipro prescription “just in case” they get diarrhea while traveling.

* https://www.thenation.com/article/archive/mexicos-discount-h...

I dont know what "Famarcia" model you refer to, but in Argentina isn't like that, but the contrary. You need a prescription from your doctor to buy most of the meds. Last time I was in NYC, I was surprised by the meds section, a lot of choices without prescription. I wish we had something like that in here, the only thing that doesn't need a prescription is ibuprofen*

[* I am exagerating but you get the point...]

In Mexico, Colombia and Peru I have bought individual pills, exactly as many as needed. I’ve done this for stomach issues and antibiotics (yes, I had a bacterial infection). In Mexico, I saw a doctor in the same building as the pharmacy after a 10 minute wait to get a prescription for something else.

Was there really any gatekeeping going on for this in the first place? Seems more like just about everyone who asks recieves it.

Its more about needing the Dr appointment. A Dr appointment isn't cheap if you are poor and lack insurance, and many places have wait time of a year to get an appointment.

You can get birth control from places that don't require insurance like MinuteClinics and online for a cost of about $20 for the visit. I'm pretty sure the online option does not have long wait times.

This is 3 hours of minimum wage work to get a rubber stamp to get it. Interesting.

Likely much more if you consider the actual cost of the medication.

Last time i had to pay out of pocket (because insurance won't cover more than 3 months at a time and I was going out of the country for 6) my GENERIC BC was 89.99 per month. The brand name is something like $189. I can't take cheaper forms because they have negative interactions with my brain chemistry that make me suicidal. BC is offensively expensive and needlessly difficult to obtain.

As an aside, the amount of patronizing in these comments along the lines of "but these women will clearly take the medicine wrong or fail to understand the consequences of their actions if we don't have them speak to a doctor first!" is just... really telling.

One of the routine problems I see around this place is how the folks who flock to "intellectual" spaces are both the intellectual and the ignorant who fancy themselves the former's equal.

I'm terribly sorry to have read your experience. I empathize deeply, though my situation is different (migraine medication vs birth control), in my experiences in having dealt with doctors and insurance companies to get both the medication I need and in an amount that will get me through.

I hope this change and others like it help bring you comfort and safe, affordable access to medicine you need.

In some states in the US, sure. But that requires you to both be in a state that is served by the service, know that it exists and is available, and still pay out of pocket.

Availability and discovery are absolutely massive to health services. Most people don't know about their options, and many more don't even have the option in the first place.

Having this be OTC is a massive step in that regard.

Let's make people go to a clinic to get any medicine then. If it isn't such a hassle, you won't mind?

I have a feeling you might be the type of person to think government should get out of the way of most things. Why is it not such a big deal in this case?

I generally am in favor of government getting out of the way. I'm not necessarily against this being OTC either. I think a lot of the arguments being made here are not applicable and this won't be as big of a deal as people are making it out to be. I'm skeptical that this will bring any real net benefit over the current state.

That said, I do believe there is a massive overuse of hormonal contraception which is partially contributing to several negative factors in society right now. This should be addressed through education and informed consent (the Rx process isn't really doing this either, so...).

You are letting one ideological belief conflict with another and yet you don't realize it. When you feel strongly about something, don't excuse it like "I think a lot of the arguments being made here are not applicable and this won't be as big of a deal as people are making it out to be."

First of all: are you the person affected by this change? If you aren't, try and imagine being a person that was. If you cannot empathize at all with the other side, perhaps it isn't something you should be arguing for or against.

Second: does this vibe with how you would treat someone you normally would disagree with politically, if the position were flipped? Say there is something you think government shouldn't have a say in (apparently not family planning, but you can think of something... guns? business?) then have them argue 'it isn't such a big deal to have to jump through this bureaucratic hoop and the reasons we make you do this is are obviously not as overt as we pretend'. How would you feel about that argument?

Yes there is a lot of gatekeeping happening across the board. From my wife's experience living just outside of Portland Oregon:

- Prescription has been cancelled twice for no real reason.

- Pharmacists have refused to give more than one month at a time more than once.

- Even if everyone is on board and not hostile she's only able to get a few months at a time so she has to do this multiple times a year.

I can't imagine how it'd be if we lived in a more conservative state or in a more rural area.

I've had some prescription issue for other meds as well. Usually an issue of the insurance or pharmacy, not a political motive. They don't like to give long term supplies given the expiration is 1 year from manufacture.

At least once she's been lectured about starting a family by pharmacists when trying to pick up her prescription which caused us to switch to a different pharmacy.

It's possible it's all imagined, but I don't really understand why a pharmacist would only give one month when the prescription is for multiple months, or why the prescription can't be for longer as to require less doctors visits / bills. We certainly haven't had the same experience picking up other prescriptions.

"why the prescription can't be for longer as to require less doctors visits / bills."

They aren't just renewing your prescription? Most places see you once, or once per year, and then just keep renewing it.

Most insurances/pharmacies even have partner mail order services where you can turn on auto-renewal and auto-refill. That might be a good option to look into.

Your original question was whether there were barriers. Now you're clarifying you mean political barriers determined by the intent of the provider, which is of course opaque to us. Is it possible under these constraints to describe a barrier you'll accept?

Generic issues are not barriers, especially if they are not universal. There are online services that can cheaply provide these services conveniently. Just because someone uses a provider that provides poor service is not a barrier when alternatives exist.

Well, yes, that's the point. They don't want kids at this time, though.

Stopping contraceptives when you want kids isn't a eureka moment for most couples.

The one month at a time thing is coming from insurance companies not the pharmacy.

Not necessarily. Pharmacies have arbitrary power.

My doctor gives me a three month prescription for a scheduled substance and I've had a couple pharmacies reject it because it's "sketchy". Of course, they never offer to call my doctor to confirm anything. They just smirk and cross their arms.

Well what do you really expect from pharmacies, when failure to exercise such discretion can get them sued for millions or even billions of dollars? Blame lawmakers and lawyers.

https://www.nbcnews.com/news/us-news/cvs-health-agrees-5b-se...

https://www.npr.org/2021/11/23/1058539458/a-jury-in-ohio-say...

https://www.nytimes.com/2021/11/23/health/walmart-cvs-opioid...

Even OTC amphetamines have purchased limits, some imposed by law depending on the state.

I guess you're suggesting that they rejected my prescription because of supply issues, they openly said it was because it was suspicious (3-mo in cash), and also Vyvanse hasn't had shortages like generic amphetamine in 2022-2023.

Also, I think you mean OTC amphetamine alternatives since amphetamine is sched I.

These pharmacists have very real personal liability if they end up getting fingered as being a supplier of components used to make illegal drugs. That's why they look askance at this prescription.

Not supply issues, meth manufacturing suspicion. Yeah, precursors to their manufacture.

Amphetamine (Dexedrine) is schedule II, not schedule I. Doctors cannot generally prescribe schedule I substances like LSD. Pseudoephedrine is a substituted amphetamine so referring to it as "an OTC amphetamine" is technically reasonable although potentially misleading.

Spotted the person who's never been without health insurance.

You still require payment for OTC. You can get birth control from places that don't require insurance like MinuteClinics and online for a cost of about $20 for the visit.

Correct. We, the high-tech HN crowd, often forget about third world countries with terrible healt care.

Yes. I have had several friends who saw providers at a local Catholic hospital system and had those providers refuse to prescribe birth control.

Ok, I can see that case. Why not use the online services for $20/visit then?

You are a teenager who needs oral contraceptives because you are sexually active. You don't want your parents to find out. Since you're a teenager, you have a few constraints:

- you have no car, how do you get to your doctor's appointment without asking parents for a ride?

- you are a minor, do you have any guarantee that your doctor won't tell your parents? You can't risk them finding out, they are very conservative

- you may not have ever made a doctor appointment for yourself before, maybe don't have access to insurance information etc

Planned Parenthood provides BCPs at a price you can afford with your teenager job (also guarantees privacy) but the closest one is hours away...

What do you do?

Same story with home pregnancy tests: https://www.nytimes.com/2016/07/31/opinion/sunday/could-wome...

What's odd is that in most of the middle east all non abusable drugs are over the counter . Not sure why it's not a thing in the US . Insulin was recently non otc because body builders abuse it ( deaths )

We also don't have to worry about pharmacist denying people (mostly women) birth control because they have moral objection to it.

When you refer to the doctors as gatekeepers is it because they are doing something other than ensuring you have a safe experience with the drug, or is it more a comment on inability to access doctors due to US private medical system?

yes

You, sir, are an idiot who cannot see beyond the next ejaculation. Cannot wait for your kind to finally go extinct because, believe it or not, it will.

We've banned this account for breaking the site guidelines, not just with this personal attack but in plenty of other places. That's not cool.

Please don't create accounts to break HN's rules with—it will eventually get your main account banned as well.

https://news.ycombinator.com/newsguidelines.html