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Saturday, April 06, 2013

Restricted Access to Plan-B Morning-After Pill Overturned - The judge's acidly worded decision raises a broader question about whether a cabinet secretary can decide on a drug’s availability for reasons other than its safety and effectiveness.

From The New York Times:

A federal judge on Friday ordered that the most common morning-after pill be made available over the counter for all ages, instead of requiring a prescription for girls 16 and younger. But his acidly worded decision raises a broader question about whether a cabinet secretary can decide on a drug’s availability for reasons other than its safety and effectiveness.

In his ruling, Judge Edward R. Korman of the Eastern District of New York accused the Obama administration of putting politics ahead of science. He concluded that the administration had not made its decisions based on scientific guidelines, and that its refusal to lift restrictions on access to the pill, Plan B One-Step, was “arbitrary, capricious and unreasonable.”

He said that when the Health and Human Services secretary, Kathleen Sebelius, countermanded a move by the Food and Drug Administration in 2011 to make the pill, which helps prevent pregnancy after sexual intercourse, universally available, “the secretary’s action was politically motivated, scientifically unjustified, and contrary to agency precedent.”
 
Ms. Sebelius said at the time that she was basing her decision on science because she said the manufacturer had failed to study whether the drug was safe for girls as young as 11, about 10 percent of whom are physically able to bear children. But her decision was widely interpreted as political because emergency contraception had become an issue in the abortion debate and allowing freer access for adolescents would prompt critics to accuse the president of supporting sexual activity for girls of that age.
At the time, Mr. Obama was campaigning for re-election, and some Democrats said he was conscious of avoiding divisive issues that might alienate voters. He said then that he was not involved in the decision but supported it. “I think it is important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine,” he said.
 
Many groups that are part of Mr. Obama’s political base praised the decision to make the emergency contraceptive pill more easily available, saying the change would also make it easier for all women to obtain the pill because stores often keep it behind the counter or in pharmacy sections that may close at night.
Removing the restrictions is in some ways is more consistent with the administration’s position on other women’s reproductive health issues, including the free provision of contraceptives through Mr. Obama’s health care overhaul.
 
Scientists, including those at the Food and Drug Administration, have recommended unrestricted access for years, as have the American Medical Association, the American Congress of Obstetricians and Gynecologists, and the American Academy of Pediatrics. They contend that the restrictions effectively keep many adolescents and younger teenagers from being able to use a safe drug in a timely way to prevent pregnancy, which carries greater safety risks than the morning-after pill.
 
The judge’s decision, a rare case in which a court has weighed in to order that a drug be made available over the counter, could test the question of who gets the final say in such matters.
“Technically the secretary under the law has the right to make the decision,” said Daniel Carpenter, a professor of government at Harvard. “But there is other long-established law that says the decision is supposed to be based on the safety and efficacy of the drug.”
 
In his ruling, Judge Korman accused the federal government of “bad faith” in dealing with the requests over more than a decade to make the pill universally available.
“The F.D.A. has engaged in intolerable delays in processing the petition,” the judge wrote. “Indeed, it could accurately be described as an administrative agency filibuster.”
Plan B was approved in 1999 as a prescription-only product, and in 2001, the Center for Reproductive Rights filed a citizens petition for it to be made available over the counter or without a prescription. Scientists, including an expert advisory panel to the F.D.A., gave early support to that request. But top agency officials rejected the application because, some said later, they worried they would be fired if they approved it.
 
Several supporters of the judge’s decision on Friday, including representatives of women’s reproductive health groups and the American Academy of Pediatrics, said they believed that since the election was over, the Obama administration would have less of a political reason to oppose expanded access to the pill.

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