Saturday, March 28, 2009 - Posts
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sponsorship
Last night I went to the pharmacy to see if I could pin down something that would speak to Abby's worry that Plan B might change teenage sexual behavior if/when it becomes available OTC to 17-year-olds. That would be the price. I knew the morning-after pill was expensive, and it's been my assumption that a contraceptive for which teenagers have to shell out a lot of money is not a contraceptive that is going to radically change teenage lifestyles. Turned out it is even more expensive than I thought: $49.50, according to the CVS pharmacist leaning discreetly toward me at the "consulting" alcove. "For a single dose?" I kept asking, my voice getting louder so that the man in the other alcove began to look alarmed. One might argue that the real danger of the morning-after-pill is that, at half the price of a pair of Uggs—OK, a third the price—teenagers won't use it at all. It's a little less expensive in some other stores, I think, but not much.
I've always thought Plan B is an important addition to the contraceptive array, because it does something no other pill or device does: contracept after the fact, rather than before. It's the only contraceptive that can stave off unintended pregnancy after a mishap has occurred, forestalling a lot of difficult decisions. This seems distinctive and invaluable—maybe especially for teenagers. The younger a girl is when she has sex, the more likely the sex is coercive rather than consensual, so younger teenagers might have particular need of this. If they can get that kind of money.
But I should also say that the pharmacist provided a gloss that might revive Abby's concerns. When I told her I was writing about girls younger than 18 having easier access, she said, "I think a lot of them are already getting it." She said she sees a number of males 18 and over buying it for their younger girlfriends, "sometimes more regularly than I would like." She thought it would be better if the girls got a prescription for the pill. When I voiced surprise that young men would pay $50 over and over for emergency contraception, she said maybe they were old enough that it didn't seem so much. I am way older than they are, and that sticker price certainly gives me pause. I think it would be interesting to report out how the price affects use.
As for Gardasil, like Megan I am bemused by the fact that sex educators and public health experts worry less about promiscuity among boys. In a way, boys have always seemed to me more vulnerable than girls. If a girl gets unintentionally pregnant, she, at least, has some control over the outcome. If a boy gets a girl unintentionally pregnant, he has none. I'm not saying he should have control, but the consequences, for him, are profound. Maybe that's why those 18-year-old boys are paying big bucks for those pills.
In answer to Jessica's question, I'm not sure whether Gardasil should be mandatory. I am not yet convinced that it should. I do have a problem making it mandatory too young. And I think that doctors who administer it should have some training in how to talk to the really still quite young children they are thinking about administering it to. As the parent of kids who have just recently survived their yearly dose of Family Life Education, I have always believed in erring on the side of too much information: When they come home looking shellshocked I listen, explain, correct, commiserate, whatever. But my frankness is nothing compared to the gory detail that one pediatrician went into when my daughter, who was barely older than 12, went for her last checkup. The doctor brought up the topic of Gardasil and when my daughter asked what it was, I was prepared to say simply that it is a shot that can prevent cervical cancer, which seemed to me, as her parent, really all she needed to know just then. But helpful Doc took this opportunity to go into an excruciating level of detail about genital warts, multiple sex partners, and how it would be good if you were always monogamous, but we all know how things work in reality, and my daughter's eyes kept getting bigger and more horrified, and I wanted to take one of those vaudeville crooks to TMI Doc's neck. I kept expecting the good doctor to add something like, "And then there are the nights when you get so drunk you don't even remember his name in the morning."
It's true that all these good innovations do have unforeseen consequences, in the case of Gardasil the possibility that young girls given the vaccine may end up scarred, in other ways, even as they're being protected. Their mothers, too.