For the life of me, I cannot make sense of this

I like to tell myself that, if I put my mind to it, I can make sense of the world.  Or maybe not The World, but most aspects of it when viewed discretely without too many confounding variables.  Perhaps it is a happy lie, but it is one I tell myself with enough frequency to give it the patina of truth.

So it was deeply unsettling to my sense of balance when I could find no even vaguely plausible explanation for this:

The Obama administration announced late Wednesday that it will challenge a decision by a federal judge to eliminate all age restrictions on over-the-counter sales of morning-after birth control pills — a continuation of a rare split with women’s rights advocates that has created unusual animosity toward a Democratic White House.


Late in 2011, Health and Human Services Secretary Kathleen Sebelius blocked the Food and Drug Administration’s effort to approve over-the-counter sale of the morning-after pill without age limits. President Obama supported her decision. Last month, Korman overturned the decision, accusing the administration of acting on the basis of politics and not science. Citing scientific data, he ordered that the pill be available to women and girls of all ages.

Late in 2011, you say?  Why, I wonder if I might have had something to say then!

Whether or not you think younger adolescents would use the medication right, one thing that is not open to serious question is whether the medication is safe: it is.  It is safer than a great many medications that are sold without a prescription, including Tylenol, Benadryl and aspirin.  If (as he said when defending the Secretary) the President is worried about selling medications to young girls that may “have an adverse effect,” he should probably start with those.  Having dispensed Plan B personally to hundreds of patients, I have never seen a single case of a serious adverse side effect.  By way of contrast, I have taken care of at least three cases of near-fatal Tylenol overdose.

Ms. Sebelius’s statement is a canard.  Gesturing toward the vanishingly small number of 11-year-old girls who would seek non-prescription emergency contraception (and who, assuming they were genuinely capable of becoming pregnant, have reproductive systems similar to older adolescent girls) is handy way of putting off this politically unpalatable decision until the 17th of Never.  Ms. Sebelius surely knows that getting a sufficient number of fertile 11-year-olds to power a high-quality efficacy and safety study is nigh impossible, as would be getting any institutional review board to approve a study of sexually-active 11-year-olds that didn’t also include lots of very complicated safeguards to determine why these girls were sexually active in the first place.

I see no reason to revise my previous opinion.  I believed then and believe now that the decision to keep an age limit on non-prescription emergency contraception was and is entirely political.  There is absolutely no scientific basis for questioning the safety of the medication for a thirteen-year-old but not a fifteen-year-old.  (In another transparently political compromise, the administration is allowing OTC sales for young women 15 and above.)

However, as unpalatable as I found Sec. Sebelius’s political calculations, I could at least understand them.  I could wrap my mind around not wanting to be seen as “allowing” teenagers to have sex with each other with a lower risk of unintended pregnancy.  As short-sighted and self-defeating as I found the logic, I could discern it.

What I simply cannot grasp is why the administration would fight this decision.  It seems to provide remarkably good political cover in a rare theoretical win-win.  The President can express some kind of half-hearted objection to the decision but shrug and say it’s out of his hands, and allow the medication to be sold as per the judicial order.  The people who most stridently object to emergency contraception, either because they (mistakenly) consider it an abortifacient or because they don’t like the idea of consequence-free sex for teenagers, aren’t going to support the President anyway.  And people like me who are ostensibly on his side and broadly in favor of expanded reproductive health choices for women will be glad to see unfettered access.

But no!  No, they’re appealing the decision.  And I really don’t grok why.  Perhaps I am too stupid to see the reasoning behind this move on the administration’s part, which seems like the political equivalent of striking out in T-ball.  If anyone would like to explain this to me in comments such that my pea-brain can understand it, I’d be all ears.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. If there had been an Act of Congress restricting the sale of the drug to minors, the Administration’s default position is and must be to defend that law barring an extraordinary showing of obvious unconstitutionality. Reading Judge Kornan’s decision, though, I do not see any mention of any statute. This is a strictly regulatory process; Congress has delegated to the President (by way of the Secretary of HHS) the ability to craft regulations regarding the sale of Plan B. So I can fashion three, not mutually inconsistent, quasi-explanations for your consideration.

    The first is a desire to robustly defend the autonomy of the regulation-drafting process: “Congress gave us the ability to write these regulations as we see fit, and we will do so as we see fit so as to exercise this power.” For no reason other than that they wrote the regulation to begin with, right or wrong, the regulation must be defended. Perhaps for the reason that the political influences on the ultimate decision are so naked, the Executive Branch wishes to preserve for itself the discretion to make politically-motivated decisions even if that produces sub-optimal policy. In other words, the power itself may be an objective.

    The second is that the age restriction regulation is thought to have a political benefit. Rightly or wrongly, it is thought by many people to be an abortifacient. By agreeing to make Plan B available at all, the Administration satisfies a large portion of pro-choice of voters; by agreeing to restrict its availability to minors, it makes itself less unpalatable to at least “moderate” pro-life voters. This carves out a “moderate” bloc of voters thought to be a majority, or at least contributing to the formation of a political majority.

    The third is that Secretary Sibelius (and by extension, President Obama) believe that the population as a whole is that given Plan B’s reputation as an abortifacient, it will take time for the existence of the drug to become accepted and woven in to the culture and therefore not a subject of substantial controversy for people to use. Condoms were once an embarrassing and shameful thing to buy, but there is now much less stigma associated with them and consequently, greater cultural willingness to give teenagers access to them. Perhaps Sibelius contemplates a similarly-gradual integration of Plan B into the culture.

    None of this apologizes for the policy. I agree with you that the regulations are somewhere between “silly” and “harmful.” If your struggle is to understand why the Administration would go to such efforts to defend a bone-headed set of regulations when a judge points out in a detailed, fifty-seven page opinion, just how crassly political, logically unprincipled, and counter-productive those regulations really are, maybe I’ve been able to offer some hints.

    • From browsing at the judge’s memo and order, I gather that this is a District Court judge remanding a case to the agency with an order to reverse or revise the agency’s (i.e., the secretary’s) earlier decision with regard to the Citizen Petition. Query: would this order by the District Court judge be effective for those outside the Eastern District of New York?

      If DOJ appeals the decision to the Second Circuit, and the Court of Appeals affirms the District Court (and I expect they would, although there are no guarantees), then the Court of Appeals ruling might have greater geographic scope than the District Court decision. (I could be wrong about this, especially if Judge Korman’s decision does have national effect.)

    • If there had been an Act of Congress restricting the sale of the drug to minors, the Administration’s default position is and must be to defend that law barring an extraordinary showing of obvious unconstitutionality.

      Honest question that I wondered about throughout the DOMA-Prop 8 episode a month or so ago, but getting to an answer on it was above my head: was this your view of the administration’s decision not to defend DOMA as well? Did you feel that the extraordinary showing of unconstitutionality had been made there, or did you feel that this was just a straightforward act of politically-motivated abdication of a governing responsibility by the administration? I realize that decision (obviously) went back rather far before the case that eventually made its way to the Court was in the headlines this year, so perhaps you wrote on it at length, maybe even before you came to the League, in which case I’d love to read what you had to say on the question, if you’d be so kind as to provide a link.

  2. He’s trying to keep the cement from drying around a compromise that he doesn’t like:

    I’m tentatively with him, even. I think.

    It’s an interesting debate to me for reasons of rhetoric and economics. Will Plan B increase the amount of teenage sex, on the margin? Of course it will.

    But that’s something only one side in this discussion gets to say freely. The other side (mistakenly) thinks that has to pretend that it won’t. Rather than, say, talking about elasticity in decisionmaking, or harm reduction, or less-bad alternatives to a given scenario.

    • So more teens might have sex. So? Do I believe that a statistically significant number of otherwise-abstinent teens under 15 would cease to be because of access to emergency contraception? Not really. But so what if they are?

      You are tentatively in support of the government using its regulatory powers in an attempt to coerce the behavior of some of its citizens? That strikes me as oddly inconsistent with your political ideology as I understand it.

      • I think Jason thinks it’s a rational political decision, not that it’s okay government behavior generally.

    • I’m curious about the idea of Plan B increasing teenage sex. The foundation of the argument seems unsound.

      If we presume that teenagers are being so thoughtful about their sexual choices as to say, “Hey, I can take Plan B tomorrow if I have unprotected sex tonight so, yea, let’s go for it!” why would we not also presume that that same, thoughtful, reasoned teenager would say, “Well, if my goal is to have sex but avoid pregnancy, I’ll just use a condom”?

      My hunch is that Plan B will be most utilized by people who have unplanned, unprotected sex. I don’t think it will serve as a substitute for other forms of safe sex.

      • On the margins, I think Jason’s correct. It would lead to a statistically measurable number of increased sexual intercourse activity.

        That doesn’t mean “a lot”, though, in terms of the overall number of teens who engage in sex. In absolute numbers, it might even be a lot, but in comparison to “those who do” vs. “those who don’t”, it’s small.

        • Where I see most of the changes happening are in whatever we’re calling “VD” these days.

        • My point is that anyone with the forethought to say, “I’ll have sex tonight because I can take Plan B tomorrow,” should similarly be assumed to have the forethought to say, “I want to have sex tonight; I’ll go buy a condom.”

          It’s not perfect, but I don’t think we’re going to see teenagers who otherwise wouldn’t be having sex suddenly start knocking boots because they can take a bill that prevents pregnancy (and ONLY pregnancy) the next day.

          I’m curious… what is a bigger deterrent to teenage unprotected sex: STD/Is or pregnancy?

          For some reason, I remember being more afraid of the former, though I wasn’t engaged in the practice (safe or otherwise). When I became sexually active, in college, pregnancy was the concern. I wonder if that is developmental, contextual, or what.

          • I don’t think we’re going to see teenagers who otherwise wouldn’t be having sex suddenly start knocking boots because they can take a bill that prevents pregnancy (and ONLY pregnancy) the next day.

            I think you will, sure. It’s just a matter of how many. Some.

            I mean, *I* didn’t engage in sex as a high schooler for exactly this reason. Pregnancy risk removed, I probably wouldn’t have, because I was a highschooler right when the AIDS epidemic was in its most public phase.

            Nowadays? I can see it, sure.

            Again, this isn’t a “lot”, but it’s going to still be measurable, I’d guess.

          • I’m of the opinion that the number of under-14s whose behavior would be meaningfully swayed by this would be very low. I just don’t see the availability of the morning-after pill to be decisive in that way. For a few? Sure, maybe. But, as has already been noted by Kazzy, if you’re savvy enough to know about this medication and seek it out, you’re savvy enough to known about condoms.

            In any case, I really don’t think the government’s role should be as schoolmarm in chief. If the goal is to prevent unintended pregnancy, restricting access to anyone who might need it to do so is just plain dumb.

          • Oh, I agree with you, Doc. 100% Any rational evaluation of Plan B is that it reduces a potential evil well outside of its possible encouragements of lesser evils.

          • “Some” seems reasonable to suspect.

            Until, of course, one of their friends embarks on such a journey only to find out that the local pharmacy doesn’t carry Plan B. Or is out of stock. Or that it costs $25 (I have no idea what it costs). Or for whatever reason doesn’t secure it.

            I just don’t think it is justifies the pearl clutching we’re likely to see.

          • I believe EC usually retails at $50. There is also a push to make a much cheaper generic version more readily available.

          • I just don’t think it is justifies the pearl clutching we’re likely to see.

            I don’t either. And I’m certain that Jason doesn’t think so, either.

            “However, denying that it’s the case at all actually gives a more credible shield to the pearl-clutchers than tackling it as it actually is” is Jason’s point, I believe.

          • Duly noted, Patrick, and I agree. Waving off the impact on sexual frequency amongst teenagers doesn’t do much good either. Recognizing it properly AND responding to it appropriately (which might include not responding) is the proper course.

      • Kazzy,
        I think we have multiple venues to think about:
        1) Incest (both paternal and fraternal) — I don’t see the incidence of this increasing or decreasing because of the pill.
        2) Sexy Relationships — ditto. Either they’re going to have sex (frequently), or they’re not.
        3) Non-Sexy Relationships — umm… yeah, the type of folks who have sex only after Prom, are still going to have sex only after prom. Because “everyone’s doing it”

        which only leaves
        4) Hookup sex at parties (with a subset of: “nonconsensual sex at parties”). Perhaps some guys might be inclined to have sex with a girl (presumed virgin) without a condom, if their thought is “she can fix it later”.

        I can see it… but… I don’t think the percentages are all that high.

        • Kim,

          I don’t think it is impossible that we’ll see some teenagers change their behaviors. I’m just not sure we should be A) that worried about it or B) making policy based on it.

      • The thing is that Plan-B doesn’t require forethought or planning. Condoms do.

        “Hey, I can take Plan B tomorrow if I have unprotected sex tonight so, yea, let’s go for it!” why would we not also presume that that same, thoughtful, reasoned teenager would say, “Well, if my goal is to have sex but avoid pregnancy, I’ll just use a condom”?

        Or nobody brings a condom because planning for sex is wrong. But then you want to have sex anyway. This happens, and I suspect “There’s a solution sitting on the counter that will take care of everything” will make it happen more, by some increment or another.

        Or, there’s my case. I would have lost my virginity earlier than I did, to someone else. But I didn’t because I didn’t have a condom and didn’t want to risk pregnancy. Honestly, I didn’t really want to, as beta as that sounds, and I purposefully didn’t bring a condom to that end. Plan B would have deprived me of my maneuvering. Maybe, of course, I would have found the gumption to say “no.” But no, I wouldn’t have. I know of other people who didn’t have sex due to a lack of a condom. To the extent this happens, the existence of a post-incident alternative will affect behavior.

        As Patrick says, it’s a question of the frequency with which it occurs. Ideologically, I have a hard time throwing up barriers to EC for a host of reasons. That it wouldn’t have an effect on sexual behavior, though, isn’t one of them. (That I don’t think it’ll be frequent enough to negate the upsides is. If I thought it would have a huge effect on sexual behavior, I would probably appraise the situation differently.)

        As a general rule, the more methods of protection you have, the less worried you’re going to be, the more likely

        • Plan-B requires at least a little forethought or planning. There are considerable gatherings of young people where the ability to find/purchase Plan-B is deliberately nil (also condoms and other forms of birth control).

          That these gatherings result in a relatively higher pregnancy rate should surprise no one.

        • I think you’re missing a key component of the teenage mind: They don’t care about pregnancy.

          Well, scratch that. They do care. They (generally) don’t want to be. They just don’t think it will happen to them.

          Intellectually, they realize unprotected sex is risking pregnancy. Heck, intellectually many (depends on the parents and school system for this) will admit it’s possible even with protection, and how a suspenders-and-belt strategy would be even better.

          But where the rubber meets the road, it’s the last thing on their mind, and they will rationalize away the risk even if it crosses their minds. “What are the odds?” they will think. Or “You can’t the first time” or “She’ll be on top” or whatever bit of idiocy teenagers spread amongst themselves (and as a teen I heard all three, and my wife the teacher says those and many more are alive and well today).

          Teenagers are not rational adults. They’re not even close. I’m not talking lack of life experience, I’m talking actual biology and brain chemistry. They’re wired to feel everything like it’s turned up to 11, they’re wired to be risk takers, they’re wired to flat-out assume best-case scenarios. The bits of their brains that actually DO things like attempt to accurately model risks don’t kick in until after the high school years.

          (The teenage brain is, in fact, a work in progress. Stuff is being taken on and offline, developmentally, as the whole thing is basically still in early beta).

          Plan-B adds another rationalization, sure. But the odds of them even using it as teens are slim enough, because you need to use it within what — 48 hours? And the teens screwing without condoms aren’t even going to THINK they might be pregnant within that time frame. The ones that do, that happen to be further along the developmental curve?

          They’d already have condoms and probably be on BC anyways.

          Sure, edge cases and whatnot. In a country of 300 million, it’s probably a fairly big raw number.

          But all this rigamorole about how teens think about sex always assumes teens think about sex the way adults do. They don’t. They’re even stupider about it.

          • “The bits of their brains that actually DO things like attempt to accurately model risks don’t kick in until after the high school years. ”

            Stuff and nonsense. They’re there before the age of adolescence.

          • Of course, if the rubber does meets the road, the issue becomes mostly moot.

          • I touched on this somewhere… but I wonder what concerns teens more about unprotected sex: pregnancy or STD/Is? For me, it was the latter. I can’t explain why. But I remember thinking AIDS and herpes were really, really scary. Pregnancy just didn’t seem real.

          • Kazzy,
            hmm… I think it has something to do with “Is my partner a virgin?” (and also your confidence in answering said question…)

          • Kimsie: You should recheck your adolescence development.


            However, the frontal cortex, the area of the brain that controls reasoning and helps us think before we act, develops later. This part of the brain is still changing and maturing well into adulthood.

            Teenagers do not think like adults. They are not minature adults. They do not make rational decisions, not even to the same low standard that passes as ‘rational’ for adults. They are risk takers, they discount future consequences, and basically have a whole lot of interesting stuff going on mentally that makes a lot of “THINK OF THE CHILDREN” claims a bit laughable. Children are not tiny adults.

            Promoting policy that only works, even in theory, if children are adults-in-minature is kinda pointless.

          • Teenagers may be a lot less rational than adults because certain brain-functions are still under development, but that’s a different thing than saying that they aren’t rational.

            Honestly, the entire motivation behind sex-ed is that they are some degree of rational. That we can influence behavior by pointing out different levels of risk. That they are, in fact, worried about pregnancy. If what you say is true, then what’s the point?

            I don’t know how many kids would be affected by this new layer of protection. Neither do you. I just know that the number is not zero, which a lot of people act like it is. I think it’s higher than you do, though I still doubt it’s high enough to erect barriers to Plan B.

  3. To the extent that abortion is a morally significant (and problematic*) act and the morning after pill is an abortificant and minors by default lack the right to make certain significant decisions preventing minors from purchacing abortificants (even safe ones) is only consistent and reasonable.

    *Whether or not abortion is morally justified or not, it is problematic and as such we should be leary of leaving such decisions in the hands of people who may not be sufficiently mature to handle it.

    • If a 9 year old has the right to carry a baby to term (against her parents wishes), then she ought to have the same right to purchase the pill.

      • Does a 9 year old have the right to carry a baby to term against her parents’ wishes? I would think that even if it is her body, she is 9 yrs old and therefore not of sufficient maturity to make the decision. Her parents or whichever competent aganet has been appointed on behalf of her are the ones to make the decision for her.

        • Even in a ghastly circumstance like a pregnant 9-year-old, I would not force her to get an abortion against her will.

          • Why? We are paternalistic about other things when it comes to 9 year olds right? What if the pregnancy carried serious risk of harm? (AFAIK 9 year old bodies are not sufficiently developed to handle pregnancies)

          • I think forced abortion is an absolute wrong, unless (in this case) it would be a genuine threat to the life of the mother.

          • Isn’t pregnancy dangerous for most barely pubescent girls?

          • Murali,
            I am not a doctor, but my brief perusal of this:
            suggests that it was much more of a problem before C-sections.
            (and that it’s more a problem of endangering the child than the mother).

            This is not to say that having a baby (particularly not knowing you are pregnant,
            as occurred in a distressing number of these cases), is not bad for a girl’s health.

      • Doesn’t plan B prevent zygotes from implanting?

          • Regarding 2), that is interesting. I didn’t know that. Are there any other presumed facts concerning pregnancy and abortion that are in fact myths?

            Regarding 1) that is one a lot of pro-lifers are concerned about. The zygote is considered a distinct human entity. Of course this is a problematic view (identical twins, spontaneous abortions etc) but whether it counts as an existing pregnancy is besides the point and not what their outrage is about.

          • Murali,
            If that’s the case, god is killing many many more babies than we are.

          • Are there any other presumed facts concerning pregnancy and abortion that are in fact myths?

            You mean besides zygotes are human beings?

          • Are there any other presumed facts concerning pregnancy and abortion that are in fact myths?

            That other common forms of birth control (e.g. IUDs, the Pill) work by preventing implantation rather than fertilization. This has no basis in fact, but is commonly quoted by anti-contraception groups who try to label them as “abortificants”.

  4. Is this one of those things that a father of two daughters might say?

    I mean, maybe we’re overthinking this.

        • You can think it, but don’t you dare say it out loud.

          • I don’t know. I have a daughter (she’s no longer a teenager), and I can certainly see that in the purely hypothetical event, I’d want her to come to me rather than thinking that at 11 she could handle things all on her own. I’m not sure I’d want to use the force of the law to make that happen.

          • My daughter is also no longer a teen; had she at any point during her teen (or pre-teen) years needed access to an emergency contraceptive, I would have wanted her to have unrestricted access to it.

    • I think it is one thing for him to think or say; it is quite another for him to organize the forces of the US Government to enact.

      But, hey, crazier things have happened.

  5. Legally, most states have an age of consent. Below that age, sexual relations would be considered statutory rape.

    I would have no problem pinning OTC sale of the morning after pill to that age. Because, presumably, the residents of that state have decided that below this specific age, the state’s legal interest in the minor’s potential pregnancy would be triggered.

    *note that I’m of the opinion sex offender registries are a huge problem, and another minor should not be placed on a registry for having sex with someone below the age of consent.

    • I would have no problem pinning OTC sale of the morning after pill to that age. Because, presumably, the residents of that state have decided that below this specific age, the state’s legal interest in the minor’s potential pregnancy would be triggered.

      This… well, this is problematic. I can’t see this working out any other way than having any purchase of Plan B (or for that matter, any contraceptive device) requiring an investigation for possible statutory rape.

      • Which brings to light all sorts of questions, really. Both you and Zic bring up interesting points here.

      • Well, if there’s an age of consent, and someone below that age needs the morning-after pill, then there’s been, by legal definition of that state, a rape. And rape should be investigated. Far too many of them go ignored.

        And if that investigation is too costly, too likely to sweep men up on its net who don’t want an investigation, then the age of consent should be changed; and with it, access to the morning-after pill.

        But if we’re going to have such laws in the first place, tying access to forms of contraception to those laws only seems logical. And if that connection discomforts; there’s something else going on here; mostly a willingness to ignore criminal rape of minors or stupidly high ages of consent.

        • I think this actually gets at a key problem.
          Daddy can buy a condom, but his daughter (age 9, if we want to be squicky about it) can’t get Plan-B. (not only that, but she can’t get it for her older sister, who’s at camp and can’t leave to get it…).

          I feel like tying contraception to rape charges really, really ups the ante for getting contraception.

          … now I gotta ask… am I actually for statutory rape, at all? My gut says that it’s an imperfect law, that doesn’t address half of the rapes that it ought to (it’s basically there so that older folks don’t take advantage of knowledge disparity). So I guess I’m tentatively for the law (bearing in mind that I know someone who was active sexually at age 11, in a fully consensual relationship).

    • zic,
      Oh, I would. I really really would.
      I can certainly see girls who don’t want their daddy getting in trouble for “raping” them
      (consider that something that starts out as “rape” may in fact become consensual…),
      still wanting Plan-B. (and also being really afraid to tell anyone they’re pregnant. What
      if daddy wants his precious daughter to have his baby? Concocts a crazy story about how
      the swimming pool got her pregnant…)

    • Sorry, zic. I would have a very, very hard time with this.

      Some states set the age of consent at 18, and lack so-called “Romeo and Juliet” exceptions by which a somewhat older boyfriend can have sex with his somewhat younger girlfriend without penalty. For example, from what I can see an 18-year-old having sex with his 17-year-old girlfriend in Arizona or Idaho could go to jail for at least a year. Sixteen-year-olds have sex with their 18- or 19-year-old boyfriends, and if purchasing this medication would trigger a criminal investigation then it’s a total non-starter for me.

      • But that’s a problem with not having Romeo and Juliet exceptions right?

          • Russell, I actually agree, I think any woman old enough to be sexually active (by her free choice) is old enough to have access to contraception, no questions asked.

            But we live in a world where those things are often determined by the state. Even worse, we live in a world where little girls and budding young women are the subject of desire and coercion, and the result can be pregnancy (not to mention STD).

            So my view is like alcohol: once you’re legally old enough to drink, you’re also old enough to purchase.

            Now if that causes problems for people who are having sex with girls not old enough to consent, then there’s either a problem with the laws governing the age of consent or the folks having that sex with underage girls are committing a crime. I don’t have much problem with either issue — bad law or criminal activity — receiving public scrutiny.

            But this does bring up a question: You’ve got a 13-year-old in your office, and she says she needs the morning after pill but won’t disclose who the partner was. She’s below the age of consent by every legal standard the state holds. And you’re a mandated reporter. What do you do?

          • “…I think any woman old enough to be sexually active (by her free choice) is old enough to have access to contraception, no questions asked.”


            An honest question… what does it mean to be “old enough to be sexually active”? Does it mean capable of becoming pregnant? Because that would seem to create a Catch-22… any girl who would need Plan B is by definition beyond the age of consent. And any girl below the age of consent would not need the pill. Or is there some other criteria? I’m not sure what it means to be “old enough to be sexually active”? I can think of some other, far more lurid and graphic definitions, but I barely comfortable thinking of them, letting alone typing them.

            But I do think your hypothetical for Russell is a really interesting one. I’m curious what the professional ethics and/or his personal sense dictate the response ought to be.

          • Kaz,
            ” I can think of some other, far more lurid and graphic definitions, but I barely comfortable thinking of them, letting alone typing them.”
            this is why we have the Tanner Scale (coworkers of mine had to measure kids on the scale)!

            We could probably say that there’s one threshhold for emergency contraception (either “probably/possibly sexually mature” — age 11?, or a doctor’s note, if the kid’s age 5 and way up on the Tanner Scale).

            And another for “legally allowable sex”… (though we may wish to define this differently for males/females (egads, the feminists will lynch me!), or for same-aged versus older/younger intercourse)).

      • BTW: I didn’t say an underage person’s attempt to purchase the morning-after pill should trigger an investigation; I said that if an underage person needs it, there’s also an interest for the state because a law has been violated. I didn’t make any sort of judgement what should be done in that case; I don’t know. But the state creates that interest when it sets the age of consent; and in setting that age, the state should also have mechanisms for dealing the law’s violation. An underage person attempting to purchase the morning after pill would be just one of a plethora of things that might indicate a statutory rape.

        It’s not the investigation aspect that matters here; it’s the legal right to contraception: if you’re old enough to have sex, you’re old enough to legally access contraception; hence tying the two together.

        • Zic,

          Would that mean the pill could not be purchased by men? Otherwise, a 40-year-old guy could purchase it for his 12-year-old rape victim and not trigger an investigation. The 12-year-old would need to go buy it herself or have another female (who I assume would be more likely though not guaranteed to report the crime the the assailant himself) do so.

          What this might do is lead to more 12-year-old pregnancies. It’d seek a weird balance… we might catch more rapists, but in doing so, we might saddle more of their victims with unwanted pregnancies (even if they are ultimately able to abort, that is a far more difficult process for a young girl to go through than Plan B, I assume).

          • According to the CDC’s 2010 figures, the rate of pregnancies in the 10-14 range is ~0.5 per 1000 women. If you look at the 15-19 range, it’s ~35 per 1000 women.

            So, I can understand why they’re wanting to include the younger demographic – even though they have a fraction of the pregnancies of their older cohort group, the fact is there ARE still pregnancies in that age group which COULD possibly have been prevented with the use of emergency contraception.

  6. I have taken care of at least three cases of near-fatal Tylenol overdose.

    Not your main point, but does that mean they’d destroyed their livers?

    • I read somewhere that tylenol would have a seriously hard time being accepted as an OTC medicine these days, exactly because the difference between “the dose you should take” and “the dose that will end up with you dead or hospitalized” is way closer than the FDA likes for unsupervised drugs these days.

      • Well, part of the problem with acetaminophen induced liver injury is the presence of it in a number of OTC cold syrups, etc.

        People have a cough, so they take some NyQuil. They have a headache, so they take some Tylenol. They’ve effectively doubled up on their dose (or more, depending on how often they take the syrup and the pills).

        Folks aren’t paying attention to the ingredients, and that’s what’s causing liver injury.

      • Given the existence of much safer alternatives, I do not understand why that stuff is legal.

        • Which compounds were you considering safer? Naproxen Sodium or another NSAID?

  7. I’ve been going ’round and ’round with a friend of mine regarding this very subject. He’s vehemently opposed to the idea of OTC emergency contraceptives, stating that “offering ‘Plan B’ OTC to all women of all ages is absolutely not correct.”

    He then trotted out a canard about whether or not I thought his daughter (11) should be able to purchase an OTC medication when he (a mature, responsible adult) cannot have unrestricted OTC access to Sudafed.


    My bottom line is simple: if a female is having consensual sex, she should not be restricted from accessing emergency contraceptives. Period. Age does not matter. Parental knowledge does not matter.

    While I’d prefer that 11 and 12 year olds were NOT having sex (as do most folks), the fact is it DOES happen, and pregnancies DO occur. This is the very extreme bottom of the ‘what if’ barrel, to be sure.

    We all try to instill values and mores in our child(ren). We do the best we can. Our child(ren), however, have minds (and bodies with raging hormones) of their own, and they will make their own decisions. They won’t always be the BEST decisions, but that’s part of life. Having an unwanted pregnancy should not be a repercussion of a poor decision.

    • ..and a bit more about the exchange. He’s just said that, if any of his children deny him access to their medical records or speak to their Dr without him present, they’d be on their own and responsible for their own welfare.


      • Parents that controlling usually have a hard time when the kids hit 18.

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