by Karan Chhabra –
Pill 1: This pill, less than 5 cents a pop, has been in use for thousands of years as a pain and fever reliever. We have long known its benefits to heart health, and are learning that a daily dose can slash the risk of common cancers from anywhere between 20% to a whopping 46%. But we also know that it isn’t for everyone: in some, it can cause serious episodes of bleeding, and for them the risks of taking this pill outweigh the benefits. Some also believe that certain patients are biologically resistant to it. It’s widely available over-the-counter in both branded in generic forms.
Pill 2: This pill, at best about 30 cents a day, mimics the body’s own natural secretions to improve quality of life in a broad range of ways. Like Pill 1, it decreases the risk of certain common, highly invasive cancers by up to half. It may also increase the risk of several cancers marginally and temporarily, as well as the risk of blood clots. But its benefits to bone health, acne, and other measures are very well-understood, and it can even cure other non-cancer diseases. This pill is available by prescription in both branded and generic forms, though some are calling for it to be offered over-the-counter.
So here we have two time-tested treatments that we know can have dramatic effects on people’s overall health. Best of all, they’re ridiculously cheap. But we also know that they’re not for everyone. Pill 1 is the right call for anyone with a history of cardiovascular disease, but might not be for people with a history of bleeding issues. Pill 2 is a good bet for healthy patients, but (to oversimplify somewhat) those with a risk of cardiovascular disease and/or breast cancer may want to think twice.
So have you Googled what these pills are yet? Maybe you skipped ahead because the suspense was killing you. Anyway, for those of higher mental fortitude, Pill 1 is aspirin, and Pill 2 is birth control. Everything in those descriptions is true and documented at the end of this post (didn’t want to spoil the surprise).
Why in the world am I comparing aspirin and birth control? Isn’t one for old men, and the other for sexually active women? Actually, no: and those misconceptions are probably at the root of the question I eventually want to ask. First, aspirin is certainly not just for men–it benefits women as well–and as I mentioned above, there are important risk factors that should make both men and women reconsider a daily regimen. Second, birth control is certainly not just for sexually active young women: as I hinted above, it is prescribed to preserve bone health in older women, to prevent acne, pelvic inflammatory disease, and anemia, and to treat many of the symptoms of the menopausal transition as well as polycystic ovary syndrome (an increasingly common, often devastating disease). Both Bobby Jindal and the American College of Obstetricians and Gynecologists, though for different reasons, have supported its availability over-the-counter. And though I don’t know from personal experience, it is known to make a couple days of each month a whole lot better. But like I said, women with certain histories may want to reconsider being on it. Finally, both Pill 1 and Pill 2 have the potential to reduce our nation’s healthcare cost burden. Aspirin and birth control: they are the best of pills; they are the worst of pills.
So, finally, the question I’m trying to raise here: for two pills with such similar considerations, why is our national dialogue on each so different? Both have huge sets of health benefits alongside a few significant risk factors, yet from our political and social discourse you’d think Pill 1 is the fountain of youth, and Pill 2, bootleg liquor. “Aspirin for everyone!” on one side; on the other, a holy war on whether employers can refuse to cover it.
No, despite my youthful appearance, I wasn’t born yesterday. I know the answer, and you do too. The problem is that Pill 1 is associated with the noble act of disease prevention, but Pill 2, the dirty deed of sex. Okay, but monogamous, married women use Pill 2, and it’s prescribed for uses (PCOS, menopause, etc.) that really don’t have anything to do with sex. I’d also argue that sexual activity is more natural than ischemic heart disease, and can virtually guarantee that more of our Paleolithic ancestors were having sex than having heart attacks. At any rate, no one’s fighting over prescription coverage of Viagra. But these are arguments for another time.
My argument for today is that the national conversation on birth control should look a lot more like ours on aspirin. When we talk about aspirin, we talk about about whether it’s right for you. When we talk about birth control, we get one-size-fits-all generalizations, political chaos, and name-calling. Something is wrong. These are individual, medical questions that demand individual, medical answers. Ethics have a place in medicine; faceless bickering and moralism do not.
Karan is a first-year student at Robert Wood Johnson Medical School who previously worked in strategic research for hospital executives and graduated from Duke University.
Follow him on Twitter @KRChhabra.