The pharmacist in me

My heart is so heavy these days as I ponder how millions of women have been and are currently being duped and lied to.

If ever I go back to practicing pharmacy in any way, shape or form, I could never ethically/morally dispense oral contraceptives (OCs).  And ... its not just the Catholic girl in me speaking here.  Medically speaking, I can tell you that we, as women, have been blatantly misled.  We have been told that OCs are so safe.  They are not.  Theologically speaking also, they are not safe, for your soul. But that's for another post.

In pharmacy school, I sat through "contraceptive workshops," where we played with foam, sponges, condoms and other creative barriers; discussed and debated the different types of hormones packaged up in pretty pink plastic cases, feminine and discreet. And whenever the "rhythm" method of birth "control" was mentioned, how we all laughed, even the professors.  'Cause that was for the poor uneducated folks who had not yet been enlightened in scientific methodology of present day.

Imagine my surprise when, ten years later, I did a google search on Natural Family Planning, and the Billings Ovulation Method of avoiding pregnancy and found hundreds of hits. Lots of medline studies to support its efficacy.  In every single other area of pharmacy we are taught to first consider non-drug measures to promote health and treat disease. Always. But not here, in the area of reproduction.  In the area of female reproduction we laugh in the face of those non-drug methods. And that was the first time I felt I had been ... misled by my pharmacy professors.  Weren't they setting the course material?

In pharmacy school, the actual mechanism of action of OCs was glossed over.  We were taught the primary method of action was to prevent ovulation.  No ovulation, no baby.  And if, by some *small* chance that failed, well, then its abortifacient effects would take over.  Because the pill will not let your tiny little baby implant safely into the uterine lining, but will ensure your tiny little baby will get washed away at the end of the monthly cycle without you ever having known it.  And because this particular mechanism of action is listed as secondary, the pill itself is not formally labelled as an abortifacient.  Nice, hey? I would think that, when the pill was first marketed in the 1960s, had it been properly labelled as a little abortion pill in a bottle, there would have been a public outcry and outrage against its use, since we were somewhat more of a moral nation then.  Oh, and did I mention, wasn't it nice that science "agreed" that pregnancy begins at implantation, not at fertilization?  They were clever enough to leave the question of when life begins, to theologians. But pregnancy, well that was an easy definition.  Oh, the pretty pink plastic packaging, feminine and discreet.

All that aside, the pill is a known cancer-causing agent, and women, you have every right to be concerned about it increasing your risk of breast cancer. Well, the big players would have you believe otherwise and will minimize this dirty little effect, as they have done for many years now. They will go so far as to tell you even the opposite, that it actually prevents certain types of cancer, and will cite several medical trials supporting such findings. They will 'soft-eye' it so to speak.  Makes us all feel a little better. But as we enter into the 5th decade of OC use, its going to be harder and harder to perpetuate the lie, because those early users of the pill are now entering those later years in life when breast cancer tends to appear.  There is good scientific data out there, and I'd encourage you to pass the word on to your sisters and brothers in Christ, alike. Our men have every right to this truth as well, you know.

If you do a medline search using key words 'oral contraceptives and breast cancer,' you will get no less than 2,925 citations of research in the area.  Here is a little taste.  I chose this study because its from the Mayo Clinic (credible), its a meta-analysis (credible way of combining lots of smaller studies to get a truer picture of the data), and it specifically focused on a previously (strategically) neglected segment of the population - the women who are only now premenopausal and *shouldn't* have an increased risk of breast cancer.  These are the women who may have been using the pill since their teens. Since it takes at least 20 years for a cancer to grow and manifest itself, we would expect to now be seeing an increase in breast cancer in women in their 40s and 50s. And ... we are.  Despite the exorbitant amounts of money we raise for breast cancer research, our rates of breast cancer have not decreased.

The Mayo Clinic meta-analysis clearly showed, in premenopausal women, a 'general' increase in the risk of breast cancer in pill users by 19%.  And looking at specific interest groups of these premenopausal women is important:

• pill user but never had a baby in their life - 24% increased risk of breast cancer
• pill user but has had at at least one baby - 29% increased risk of breast cancer
• pill user specifically prior to having first baby - 44% increased risk of breast cancer
• pill user for >4yrs specifically prior to having first baby - 52% increased risk of breast cancer compared to the normal 'baseline' risk

Scary, isn't it.  To help make some sense of the data, consider that the typically quoted national average is about 12%, or 1 in 8 chance, over a lifetime.  Premenopausal women have a much lower incidence of breast cancer than 1 in 8 though, so while the 52% increased risk in long-term OC users seems awful (and its not good), it also doesn't mean your chances of getting cancer have just jumped to 1 in 4 rather than 1 in 8.  The stats are more complex than that.  But it does mean a significant increase in risk for users of the pill.  And that's the main idea here.

The reason why women who have used the pill prior to ever having had a baby have an increased risk, is that their breast tissue is still developing, and pregnancy somehow matures that tissue development.  You mess with it by adding hormones, especially at an early age in life, you alter the breast cells themselves.

Unfortunately, though, for every study that cites an association between the pill and cancer, you will find another one that reassures us that all is, indeed, well.  That OCs are safe. Well-tolerated.  Not carcinogenic. Yup. But really, do you think that all the stakeholders (medical journals, medical associations who haven't been upfront from the get-go, pharmaceutical companies, I could mention others) are going to tell women to get off the pill? The stakes are too high, financially, legally, you name it.  Women have long accepted the increased risk of stroke and other cardiovascular disease that comes with the pill.  Would they just accept this risk, too?  

Chances are, at least one of you out there in blog-reader-land, has used the pill.  Maybe you are even a current user now.  I don't mean to scare you, really.  Sadly and with MUCH regret for MANY reasons, I too, fall into the category of a previous user.   But I want you to know that there is enough research out there suggesting a link - enough research for you to be concerned - despite how your physician may gloss this over or reassure you otherwise.  Most physicians probably don't even know the details of the link with breast cancer.  They are out on the front lines prescribing a product that has been used for over 40 years, without question.  Or the drug reps come in and shout about the latest study that showed no link to cancer. So most of them probably don't even give it a second thought.  But women, you need to take better control of your health and wellness in this area, and don't trust it to chance.  Even if you are using the pill for what you may regard as a valid medical indication, I would encourage you to probe deeper into alternatives.  You may have a valid reason, but then again you may not.  And if you are using the pill for birth 'control,' I would encourage you to get off the pill or injectible or implantable hormone!  And I would encourage you, no, beg you to more closely examine the ethical and theological issues surrounding this.  God really truly has a more beautiful plan for your marriage and family life!  A great place to start would be here,  here and here.

So, I don't know what the future holds when it comes to this complex issue.  I know that we are all hungry for truth.  And truth, my friend, does not come in a pretty pink plastic packages, feminine and discreet ... THAT is only a cover.



Edited to add: The book Fatherless by Brian Gail, which I'm currently reading, was part of the inspiration for this post.  He presents much of this issue in the context of a fictional story; I encourage you to read it.  However, the link between oral contraceptives and breast cancer  is one that most pharmacists and other health care professionals have been following for a very long time. Reading the book got me angry again, angry enough to want to write about it myself, in my own little way.  I'm not currently a practicing pharmacist, and I don't pretend to be a statistician. But it doesn't take a rocket scientist to see there is a link.  It is particularly for situations like this, that I want to raise children who will know how to think. Know how to question carefully when the powers of this world are telling you one thing but you suspect another.  Because the truth must be sought, its not going to fall on our laps wrapped in a pretty bow.  Thanks for reading.