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?)