Talk:Emergency contraception/Archive 2

message: i think that wording is pov--tells people what to think; doesn't present info. the drugs in ecp have differences from and similarites to drugs used in chemical abortion (when they are the same drugs, and when they are similar drugs). whether or not the mechanism of action is the same is not the only issue viz the drugs--there are other issues such as side effects, etc.  should probably also be added that ecp has differences from and similarities to bc pills/pop-only contraception, since levo is same progestin. (i.e., side effects from levo in ecp are same as side effects from levo pocp, with differences in effect applying to duration of use/how strong the dose.)
Cindery 18:19, 29 August 2006 (UTC)
replies: text: Mifepristone has a different effect when taken before ovulation vs. after implantation, regardless of 10mg dose vs. 200mg dose.  There is widespread public confusion in the U.S. between chemical abortion (drugs taken with the intention of ending an already-implanted pregnancy) and emergency contraceptive pills (drugs taken with the intention of preventing pregnancy).  I like that the article tries to resolve this common confusion. Lyrl    Talk     Contribs   21:12, 14 September 2006 (UTC)
thread_title: "are not to be confused"

message: Where did that 11% number come from?  When it was in the text, it referenced this article (requires free registration) - but I can only read the abstract, and it does not say anything about an 11% effectiveness rate.  I have a vague memory of reading somewhere that ECPs had an 11% failure rate if taken within 24 hours of unprotected intercourse - is that where the number came from?
In any case, should that 11% number stay in the infobox?  Or should we put 25% - the failure rate when used according to package directions, which allow use up to three days after unprotected intercourse? Lyrl    Talk     Contribs   21:14, 19 September 2006 (UTC)
thread_title:  Infobox effectiveness 

message: The study referenced supports not only the statement that the low dosage is as effective with less side effects than the high dosage, and that the low dosage works by preventing implantation, it also mentions that mifepristone can make make the uterus hostile to implantation, so the study support 3 of the sentences in that paragraph. I don't know if that effects where we place the citation or not, but I noticed the citation was moved.--Andrew c 16:24, 23 September 2006 (UTC)
thread_title:  mifepristone as ECP reference 

message: i just updated the mifepristone article with a more current ref than gemzell which states that while some studies have found no dose efficacy diff, there have not been sufficient studies to make definite claims, and that a review finds not only dose efficacy diff, but a diff between low doses, such as 10mg vs 50mg.
Piaggio G et al (2003). "Meta-analysis of randomized trials comparing different doses of mifepristone in emergency contraception". Contraception 68 (6). .
Cindery 16:40, 23 September 2006 (UTC)
thread_title: mife dose efficacy

message: One possible measure of efficacy is a lowered abortion rate.  In countries where EC has been available for more than a decade, the abortion rate is not lower. The cited article only refers to Great Britain - one country, not multiple.  Also, the article strongly implies that the reason the abortion rate has gone up over the past twenty years is because of lack of use of appropriate contraception, emergency or otherwise.
Abortion rates are dependent on so many factors it seems nonsensical to use them as a measure of effectiveness of a single contraception method.  I support removing the quoted sentence from the article. Lyrl    Talk     Contribs   13:42, 24 September 2006 (UTC)
replies: text: It seems inappopriate to look at abortion rates as the ultimate measure of efficacy for EC. The number of things affecting abortion rates is astronomical. When a new antibiotic is approved, we don't demand a decrease in nationwide infection rates; we just demand that the antibiotic work in an individual patient. Similarly, the measure of efficacy for EC is its effectiveness in preventing pregnancy in an individual person - which is clearly demonstrated in the literature. That is, they do "fulfill their stated purpose". It would be great if it reduced abortion rates too, but that's a social issue much bigger than EC alone. The fact that abortion rates have remained constant or risen deserves mention, but not as some kind of condemnation of the effectiveness of EC. MastCell 19:26, 20 October 2006 (UTC)
thread_title:  abortion rate as a measure of EC efficacy? 

message: i don't understand why this was there/what point it is supposed to make? 
Cindery 16:57, 24 September 2006 (UTC)
thread_title: relevance?

message: this is the last time i am going to make it clear that there was NO non-ecp control group for that study. everyone had access to ecps. there was no "traditonal care."  the point of the study was to prove that younger adolescents don't have more risky sex than slightly older people when they all have access to ecps.  the other study didn't address ecps+ risky sex at all--it merely mentioned it.  the point of that study was drug safety profile in comparison to oral contraceptives.  whomever the anon is who apparently hasn't read either of these studies and keeps incorrectly summarizing them--i'm just going to put an accuracy tag if you revert again. 
Cindery 20:57, 29 September 2006 (UTC)
thread_title: darney study

message: :To me, it makes most sense to have technical information at the top of the article (what is currently available as emergency contraception - including IUDs! - how do they work, how effective, etc.)  And then discuss less technical aspects.  I thought the order of "History" -> "Effect on society" (sexual behavoir, unplanned pregnancy, abortion, etc.) -> "current controversy" produced the best flow.  I wanted all of these sections after the IUD section, because these three sections all apply to all types of EC, including IUDs, and so make best sense if they appear after the "types of EC" section.
:The Darney/Raine study showed that ready access to ECPs did not increase risky sexual behavoir above that of women with prescription access to ECPs.  No, this is not related to populations that have no access at all to ECPs.  But it does say something about ECP effect on sexual behavoir, and is relevant to the section on sexual behavoir, unplanned pregnancy, abortion, etc. which is currently titled "Abortion rates".
:A section getting too long for the main article is practically the reason for Wikipedia:Summary style - This guideline in a nutshell: When articles grow too long, longer sections should be spun off into their own articles and a several paragraph summary should be left in its place.  In Wikipedia, topics most interesting to editors are developed first, regardless of importance.  So early Wikipedia, for example, was largely about Star Wars, due to high volume of science fiction fans among editors.  Interest in Star Wars was so high amoung Wikipedia editors, that they created their own Wiki:  Wookieepedia.  And controversial topics in America get undue attention because most editors are American and have knowledge on those topics thrown at them, as opposed to having to do research.  This tendency has been noted as a shortcoming of Wikipedia in every major third party discussion I have read.  I do not understand why this natural growth pattern of Wikipedia ("reiteration of what has most recently been in the news") is viewed as a deliberate effort to hide (minimize, whatever) other information.
:The same characteristic of Wikipedia means many editors are unaware than Plan B is not the only form of EC. Mifepristone is actually a recent introduction to the EC article; before the edits by Calair in July, I myself had never heard of such a use for mifepristone.  I think it inevitable that it will take time to update all the remaining parts of the article written when Plan B and Yuzpe were still the only regimens included.
:The history section was based on my search of PubMed.  I find the research history of hormonal ECPs, not just which drugs were approved, very interesting.  However, if other editors agree that only the approved drugs are interesting or relevant, and that all mention of researched but never approved drugs should be deleted, fine.  Including mention of herbal methods as first EC and having a history section hatnote linking to the abortifacient article actually sounds like a good idea. The spermicide article also has a reference to an article that discusses various post-coital methods (all ineffective) used in early 20th century (Lysol was actually the most popular, above Coca-Cola). That information also sounds like a good candidate for incorporation in the history section. Lyrl    Talk     Contribs   01:32, 6 November 2006 (UTC)
replies: text: If no other editor has raised the concern that the section is too long, then rather than an oversight on their parts, it may be that your opinion is not shared by other editors. The controversy over approval is part of that social impact of EC. There doesn't seem to be enough there to warrant its own article, so at present it should stay here. It's toward the bottom and unobtrusive. I'm happy to take a shot at shortening it for better readability. I think the history section is worthwhile and can be expanded, especially if Lyrl has already done some background on this. MastCell 05:11, 6 November 2006 (UTC)
thread_title: Subsection for readability

message: Sorry, but I disagree...and I think it's obvious on the face of it--the OTC controversy is the longest section in the whole article, longer than than any section on EC itself. "Undue weight" isn't just about location, but length, and how much detail is given. The OTC section is a detailed, narrative account. It's slightly longer/more complicated than the "beginning of pregnancy" controversy section--and that controversy is complicated to summarize, and has existed longer/involves more people, worldwide.  The OTC controversy, as I said, is a fascinating story, but peripheral to the subject of emergency contraception in general, and could probably have its own article. But in the EC article, it should be summarized, briefly, under "US legal controversies, etc"--in summary form, it would still appear as chief US legal controversy. (In "availability," its summary would require even more brevity to be comparable to info given for other countries--became available in such and such year.
Cindery 21:34, 5 November 2006 (UTC)
thread_title: OTC controversy

message: *I moved the "International availability" section to the bottom of the page (right above the "Footnotes" section).
*I added a history section.  Some of the information I added (based on searches through PubMed), other information was moved from the "Types of ECPs" section.
*The reference link in the IUD section was broken due to PP's website reorganization.  I could not find a comparable page in the new website, so changed the reference to a journal article I found through PubMed.  I changed the wording in the IUD section to match the new reference.
*I renamed "Related statistics" to "Social impact" and moved it up above the controversy section.
*In the "Controversy" section, I changed a "see also" directive at the end of the section to a template at the beginning of the section.
In the "Effectiveness of ECPs" section:
**I deleted the reference to a single act of intercourse, and changed the phrase "each use" to "single use" to attempt to clarify what is meant.  I believe specifying a single act of intercourse in one menstrual cycle/month is not necesarily relevant.  If a couple has intercourse many times with an ongoing contraceptive method, and then has a condom break during one act of intercourse - they may use ECPs and expect the normal effectiveness rate, even though they had intercourse multiple times that menstrual cycle/month.  Also, if a couple has unprotected intercourse multiple times in a 3-day period, they can still use ECPs in accordance with the package directions (i.e. begin treatment within 72 hours of unprotected intercourse), and would seem to be able to expect the same effectiveness rates as couples who used the pills after only one act of intercourse.
**The characterization of the studies on levonorgestral ECPs seemed to be inaccurate.  First, the article stated that only two studies had been done.  A PubMed search with the terms "levonorgestral emergency contraception" gives 211 results.  While not all of those studies give effectiveness rates, it seems unlikely that only two of them address effectiveness.  Second, the article stated that women in the studies had intercourse only once that month.  The studies actually do not report how often the women had intercourse, only that they presented requesting postcoital contraception.  
**I broke out the section on variable fertility rates and tried to explain it a bit more in relation to ECP effectiveness rate calculation.  I also removed references to coital frequency of study subjects.
**I used User:Diberri's PubMed tool to convert a journal reference to the citejournal template.
**I deleted a duplicate sentence on effectiveness range.
**I moved the section on abortion rates to the "Social impact" section (renamed from "Related statistics").
Lyrl    Talk     Contribs   02:26, 1 October 2006 (UTC)
thread_title:  My edit of 30-Sept 

message: Removed the following inaccurate and misleading statement that misrepresents its reference:
:: In Sweden, teen pregnancy and sexually transmitted disease infection have increased since emergency contraception has been available over the counter. 
* Emergency contraception (Norlevo) first became available without a prescription in Sweden in April 2001 (behind-the-counter from pharmacists at launch, subsequently dispensed over-the-counter in some pharmacies).  
* The teen abortion rate in Sweden rose from an all-time reported low of 16.9 per 1,000 women in 1995 to a cyclical high of 25.5 per 1,000 women in 2002 and has subsequently declined for three consecutive years to 24.3 per 1,000 women in 2005 (the rate declined from an all-time reported high of over 30 per 1,000 women in 1976 to a cyclical low of under 18 per 1,000 women in 1984 before rising to a cyclical high of 24.9 per 1,000 women in 1989).
::Note: the source cited here is completely in Swedish, but you can locate the database it links to and read summaries in English. Anon has left out the 2005-2006 data, which states:
::Abortions in Sweden 2005. January-june
::Preliminary report
::The rate of induced abortions per 1,000 women during the first six months of 2005 was constant (20.3) compared to the same period 2004. However, the rate among teenagers increased by four per cent from January through June 2005 compared to the first six months of 2004.
::Abortions in Sweden. January-june
::Preliminary report
::Summary
::The total number of induced abortions performed during the first six months of 2006 was 17,910 compared to 17,499 during the same period last year. That means that the rate per 1,000 women increased by 1.5 per cent. The rate among teenagers increased by close to two per cent from January through June 2006 compared to the first six months of 2005.
::Regarding cyclicity, what the Swedish source states is:
::"There has been considerable change in the age distribution among women who obtain abortion after 1975. The number of teenage abortions decreased markedly between 1975 and 1985. After 1985, teenage abortions increased, but after 1989 teenage abortions decreased again, up until 1995. A small increase started in 1996, which has now accelerated to a more serious increase in 2002."  --that means that the huge increase coincided precisely with OTC EC availability in Sweden,  declined only slightly from serious high for two years, then resumed its present increase.
Cindery 11:00, 4 November 2006 (UTC)
thread_title:  Social impact - Sweden 

message: Under Types of ECP, Plan B, Levonelle, and NorLevo appear to be incorrectly labeled as combined ECPs containing both estrogen and progestin. From my knowledge (and by no means am I an expert) Plan B, Levonelle, and NorLevo are progestin-only ECPs. Can anyone confirm this error?—The preceding unsigned comment was added by Tonytnnt (talk • contribs) 10:07, 10 October 2006.
:You are correct, Plan B, Levonelle and NorLevo are progestin-only ECPs. The reference to these progestin-only products was accidentally moved to the combined estrogen-progestin Yuzpe regimen paragraph in the Oct 1 Lyrl edit. I moved the reference to progestin-only products back to the progestin-only paragraph and restored information about recently discontinued dedicated Yuzpe regimen ECP products: Preven, Schering PC4, Tetragynon to the Yuzpe regimen paragraph.
:68.77.148.27 15:27, 10 October 2006 (UTC)
thread_title:  Types of ECP -- Clarification 

message: I always find it kind of funny when people obsess over PP's "financial interests," like their counselors get a bonus if they sell so many abortions or something.  People, Planned Parenthood is a non-profit institution.  It certainly isn't getting rich off of the morning after pill.  All Planned Parenthood chapters require donations and other forms of assistence to even cover their operating costs.  I suppose that by getting pills at a discount from the manufacturer they're selling them at less of a loss, but I'm still willing to bet they aren't turning a profit off of them. --Jfruh (talk) 17:33, 20 October 2006 (UTC)
replies: text: OK, cooling off and ignoring issues of ideological purity as requested and merely tackling the logic here of the importance of PP's "finacial interest" -- surely making Plan B over the counter will reduce sales of the drug at Planned Parenthood?  I mean, if you can walk into any CVS or Rite Aid and get Plan B, why would you need to find a Planned Parenthood location, since they're nowhere near as thick on the ground?  The great advantage (to the patient) of going to Planned Parenthood for Plan B is that there is generally a doctor/nurse practitioner on staff there who can write a scrip and someone who can dispense it -- one stop shop.  Make it over the counter and you largely remove the incentive to go there for your EC needs, unless you happen to live next door to one or something. --Jfruh (talk) 21:26, 2 November 2006 (UTC)
thread_title:  Planned Parenthood's "financial interest" 

message: I've added a little to the section on the tumultuous history of OTC Plan B in the U.S, specifically the sworn testimony of a couple of FDA officials that the drug was held up on political, rather than scientific, grounds in the FDA. MastCell 19:21, 20 October 2006 (UTC)
thread_title:  Availability in the U.S. 

message: --that was me--sorry Wiki logged me out while editing. "Abortion rates and EC" section "under construction," not intended as complete (nor should it be 3.0, but subsection of 2?)
Cindery 23:43, 4 November 2006 (UTC)
thread_title: "external validity" and variables

message: Responding here to David, since "abortion rate" thread so long, and conversation about it continues into "social impact" section--
As far as I understand, the compromise reached was that abortion rates would have own section directly following efficacy, and discuss:
1. the standard arguments made in favor of/arguments for necessity of EC that it could reduce abortion rates (See, for example, here--Trussell's entire conclusion is that EC could/would lower abortion rates: Trussell J, Stewart F, Raymond E. Emergency Contraception: A Cost-Effective Approach to Preventing Unintended Pregnancy.  A regularly updated review of the current literature, published online at Princeton University.)
2. the data from Europe and China on increased EC use/no decrease in abortion rates.
As far as a consumer use value/decision goes as a kind of rebuttal to the China/Europe data, I think it is fine to cite source (like one of the editorial letters to BMJ in repsonse to Glasier, or Glasier's quote itself which Mastcell quoted re individual use value/public health intervention value), but that after that is the place to note that "individual decicion" as opposed to "public health intervention" is not necessarily defined as "single use," and the opposite appears to be the case, as demonstrated by the increase of use from the OTC studies (and the China/Europe data.) Individual user decisions are not just for single use, but apply also to individual consumer use decisions to have an advance supply of EC on hand etc and use it multiple times. Nowhere is it specified by a source that "individual decisions"  refer only to a single use or must be defined as a single use--single use is only specified as a variable used to calculate efficacy in the efficacy studies. (I think there's kind of a semantic argument going on in the pro-EC literature/current product insert to obscure that the annual failure rate is 20-24%, same as doing nothing. It makes sense that EC access would not result in fewer unwanted pregnancies--the failure rate is the same as doing nothing, and can only be obscured by claiming an efficacy rate for single use and implying it has no relationship to the annual failure rate. (Although Trussell notes that for Plan B, and only during ovulation, it is slightly better than doing nothing--but that by the same probability calculations, Yuzpe results in a higher failure rate than doing nothing. The likelihood that Yuzpe increases pregnancies, as Lyrl pointed out, is silly. But it doesn't refute the relationship, it shows that the numbers/pregnancies are hypothetical.) Meanwhile, even the "directions for use" do not say, must only be used once. They say, do not use as regular contraception. In between, is the place where studies have shown users use EC--multiple times per year, with the frequency being greater with greater access.
Cindery 21:03, 5 November 2006 (UTC)
replies: text: Annual pregnancy rate of using no form of birth control is 85%.  That's over three times as high as 24%. Lyrl    Talk     Contribs   01:43, 6 November 2006 (UTC)
replies: text: I agree behavioral risks should be separate from the abortion rates section. About the measures of efficacy, I think we're veering into an area where we're trying to rewrite the prescribing information. Let's focus on summarizing the available efficacy data with the appropriate sources. If we find criticism of the methodology of various studies amongst the many reliable sources out there, we can include that also. Right now the data indicate that EC is effective in preventing pregnancy in individual cases. However, greater access and use have not been shown to lower pregnancy rates nor abortion rates. Let's keep such things clear. We can include a quote from someone (say, Glasier) whom we can agree is untainted by the sulfurous smell of pharmaceutical company influence, to the effect that such a dichotomy exists and has implications for invidivual use vs public health use. Our opinions about the wording of the package insert, or the relative importance of "individual use" vs. "societal" arguments, are best kept out of the article, except insofar as we can quote reliable sources making such points. MastCell 06:24, 6 November 2006 (UTC)

text: No, I agree that we should go beyond repeating the prescribing information; that's why I think the sections on abortion rates, approval controversy, etc are appropriate. I just think that we're getting into territory where we're evaluating the studies/stats and glossing them based on our own views of their validity. This is a useful exercise for life in general, but for Wikipedia purposes I think we're in danger of straying from sourceable critiques and issues toward presenting our own interpretations of which statistics are most important, how the stats should be applied, etc. My point was just that perhaps we should go back to the sources a little more closely. MastCell 18:36, 6 November 2006 (UTC)
thread_title: Current consensus re abortion rate section