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.