Misplaced Pages

Revision as of 19:03, 2 November 2006

Please stay calm and civil while commenting or presenting evidence, and do not make personal attacks. Be patient when approaching solutions to any issues. If consensus is not reached, other solutions exist to draw attention and ensure that more editors mediate or comment on the dispute.

"are not to be confused"

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)

... in addition, the difference between levonorgestrel and mifepristone really needs to be made clear. if you read gemzell carefully, levo has no abortifacient potential, but mifepristone does (by necrotizing decidual tissue). and the dose available for mifepristone as ec--200mg--is the same dose widely used for chemical abortion based on the "evidence-based" protocols conducted by the WHO and practiced at planned parenthood, etc: you could say "levonorgestrel should not be confused with mifepristone," but it's not at all accurate to say that mifepristone should not be confused with mifepristone...

also: neither levo nor mifepristone is a "hormone"--they are both drugs. (we could say levonorgestrel is a hormonal drug. but mifepristone is an antihormonal drug...) Cindery 17:32, 14 September 2006 (UTC)

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 _Contribs 21:12, 14 September 2006 (UTC)

"Mifepristone blocks the effects of natural progesterone on the endometrium and decidua. This leads to degeneration and shedding of the endometrial lining, thereby preventing or disrupting implantation of the conceptus." the mechanism of action for mifepristone in ec and chemical abortion is exactly the same--it has a necrotizing effect on endometrial tissue. i think you should reread the gemzell more closely for the diff between mifepristone and levo. i realize that "intent" matters--one can't be sure that one has ovulated before or after taking mifepristone as ec, and if one intends to prevent conception rather than to abort, intent matters. i also realize that there's a big "implantation" controversy. but, the facts are the facts--intent doesn't change the drug's mechanism of action (or the possibility of aborting with mife rather than preventing conception). i think it's especially important to distingush levo from mife (because levo can't accidentally end a pregnancy someone merely wanted to prevent but wouldn't abort--the distinction supports your argument--for levo). Cindery 22:32, 14 September 2006 (UTC)

...maybe the simplest way to illustrate the difference is that, if someone miscalculated or didn't know when they ovulated (all the studies focus only on the unlikely incidence of every use of ec occurring exactly before or after ovulation--which brings up another issue--needless use of high dose hormones in the event that the ovulatory window isn't in effect, and what cumulative/repeated high doses could do) and they already happened to be pregnant, levo would have no effect on the pregnancy. but 200mg of mifepristone would be approx. %80 effective at inducing abortion all by itself at that dose. Cindery 23:31, 14 September 2006 (UTC)

Infobox effectiveness

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 _Contribs 21:14, 19 September 2006 (UTC)

mifepristone as ECP reference

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)

this is verbatim from the wertheimer/AFP ref: "Mifepristone inhibits ovulation and blocks implantation by causing a delay in maturation of the endometrium.3 It causes actual regression of the corpus luteum in 50 percent of women when given in the middle or late luteal phase...

Only mifepristone is effective once implantation has occurred, actually interrupting an early pregnancy. The effectiveness of these methods thus depends on the point in a woman's reproductive cycle at which emergency contraception is used."

Cindery 16:33, 23 September 2006 (UTC)

mife dose efficacy

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). PMID 14698075. Cindery 16:40, 23 September 2006 (UTC)

French Polynesia?

Out of curiosity, when listing the countries who allow EBC to be handed over without prescription, why is there "France" and then "French Polynesia" listed? French Polynesia is part of France, it's not a different country even if has a special status.

Or then, out of coherence, you'd have to mention Mayotte, Wallis-et-Futuna, and Saint-Pierre-et-Miquelon who have also have special legal status as "overseas collectivities" - collectivité d'outre-mer in French.

abortion rate as a measure of EC efficacy?

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 _Contribs 13:42, 24 September 2006 (UTC)

not a chance.

"one possible measure of efficacy" is too weak, actually--it should probably be the measure of accuracy for EC. (i notice no one objected to the listing in "misc facts and figures" that half of all US pregnancies are unintended (as an implied argument in favor of ECPs; lending the clear implication that they could lower this number). if ECPS were useful, there would be lower abortion rates in countries where they have been widely available for a long time. (but it's not surprising--the abortion rate has remained stable in france despite the contraceptive pill, as well. pills are not magic, and should never be uncritically promoted as if they are or could be.)

anna glasier (the doctor whose work is summarized in the forbes article) is the same ECP expert whose work is excerpted by permission in the wertheimer/american family physician article. (meaning: i don't think her work should be selectively presented-- depending on whether or not it is favorable to ECPs.)

and glasier specifically mentions not just the Uk, but france and sweden as well.

i think the doesn't-lower-abortion-rate should be emphasized more--there should probably be a bulleted pro-con/advantage/disadvantage section to neatly summarize/for comparison. any disadvantages of ECP are really buried in this article right now; it's not neutral at all. getting ECPs approved has been constructed as a holy war/political battle in the US, which has obscured the fact that they are for-profit pharmaceutical drugs. "like all drugs," they have advantages and disandantages. and if they only fulfill their stated purpose in theory, that's more than notable. Cindery 14:50, 24 September 2006 (UTC)

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)

relevance?

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

"In 1998, Washington was the first state to allow women to get emergency contraception directly from a pharmacist, without first going to a doctor. Doctors and pharmacies collaborated and set up criteria that women were required to meet in order to receive emergency contraception. There were almost 35,600 prescriptions filled from February 1998 until the trial expired in June 2001."

pregnancy rate vs. reduction in pregnancy rate

I think the effectiveness section is misstated now - it seems to be confusing the pregnancy rate (actual number of pregnancies) with the reduction in that rate caused by ECPs (the change in the number of pregnancies).

To illistrate, consider the same comparison of pregnancy rate from unprotected intercourse (25%) to effectiveness of Yuzpe regimen (57%, therefore 43% failure) - it would seems that the ECPs actually dramatically increased the number of pregnancies. Lyrl _Contribs 19:23, 25 September 2006 (UTC)

...the "change" in the number of pregnancies/reduction of rate cannot be conclusively established for ECPS--only estimated and guessed at. (because there is no way to confirm if any pregnancies were actually averted. probable pregnancies--based on "conception probabilities"--factors involving unprotected sex, date of LMP, etc are all that ECPs can address. i would be in favor of reworking the section/striking the retro-comparsion of yuzpe/levo, or making it clear that that study wasn't designed to give a general picture of ECP efficacy. i think that was a poorly designed retro-analysis, that gives a confusing picture. the study designers were responding to criticisms that ECP studies overestimate the efficacy of ECPS because the study participants are more likely to have unintended pregnancies than general populations. so they tried to configure a "control group"--yuzpe-takers. "at least %50 effective but probably higher in comparison to yuzpe-takers, if yuzpe efficacy were zero" is just weird and confusing. a hypothetical pregnancy reduction rate based on conception probabilities calculated in comparison to same hypotheticals to yuzpe isn't designed to show a general efficacy rate--it's making a point about efficacy via a control group. in the context of the section in wikipedia, it does look weird--because we already have a control group not addressed in that study--the %25 pregnancy rate with unprotected sex. only in that context, could you say %57 represents an increase in pregnancies (which it does not--it would represent a hypothetical decrease in hypothetical pregnancy reduction).

i would recommend this:

• find the %11 perfect use citation to compare against %25 (because %25 is the same as unprotected sex without ECPS) or find a citation that says unprotected sex without ECPS results in higher rate than %25
• move weirdly designed yuzpe-levo comparison down, as counterpoint to a citation i will supply about ECP efficacy is overstated via use of high-risk study participants.
• clarify that the efficiacy rate is calculated by conception probabilities--hypotheticals which can't definitively establish ECP efficacy (and that the same hypotheticals apply to takers of ECPS, when they are trying to make a decision...)
• make clear that in theory, if used correctly, and with luck at calculating hypotheticals through calendar method fertility awareness (which is the method all the studies seem to refer to for purpose of calculating conception probabilities) ECPs could prevent an unwanted pregnancy. (but no studies have established their usefulness at actually accomplishing that in practice.)

Cindery 20:48, 25 September 2006 (UTC)

To address the bulleted points above:

• I had already put a note on the talk page (#Infobox effectiveness) asking where that 11% number came from.
• The Yuzpe-levo study seems to be the closest to a controlled study of effectiveness that exists. It is the only one that does not rely on hypothetical fertility rates, but rather compares actual pregnancy rates between two groups of women seeking emergency birth control. I view it as a very important study in confirming the effectiveness of ECPs in preventing pregnancy.
• I tried to explain the uncertainties involved in calculating effectiveness of ECPs when I wrote ...determining the risk of pregnancy from a single act of intercourse is extremely difficult. For this reason, it is challenging to conduct rigorous studies to determine the effectiveness of emergency contraceptive pills. Feel free to reword to make the language more accessible.
• Studies have definitively shown that ECPs frequently prevent ovulation. Many studies have concluded that ECPs reduce pregnancy rates. I understand the uncertainties in calculating exact effectiveness rates, but I'm not grasping the reasoning of saying they do not work at all.

Also remember, that 25% pregnancies-from-unprotected-intercourse number is for multiple acts of intercourse throughout the month/menstrual cycle, and is the actual pregnancy rate (25 out of 100 women pregnant). The ECP failure rate is for a single act of intercourse. Say (for arguments sake) the chance of pregnancy from that one act of intercourse was 8%. If the woman took ECPs, and reduced her risk of pregnancy by 75%, she would have reduced her risk of pregnancy to 2%. So (in this hypothetical) a 25% failure rate would equate to a 2% pregnancy rate (2 women out of 100 pregnant). Comparing the failure rate of ECPs to the pregnancy rate for multiple acts of intercourse is not a valid comparison. Lyrl _Contribs 23:00, 25 September 2006 (UTC)

i see what you're saying--based on clinical trials in which people had a single act of intercourse--and in which the risk of pregnancy from a single act of intercourse was estimated to be %8--ECPs supposedly reduced the risk to %1-2. the problem comes in two places: 1) the %8 is outrageously faulty--the risk of getting pregnant isn't a steady %8 all month, as you point out, it fluctuates extremely 2) people don't have a single act of intercourse--they have sex all month. i think this should be explained in the article--that instead of saying "it is very difficult to calculate the efficacy, etc..." we should explain what the circumstances of "perfect use" are--a single monthly act of intercourse, during the 72 hour ovulatory window. multiple acts, miscalculation of ovulation can drastically reduce the efficacy rate; and there is an extremely high chance of spending money/taking a dangerously high dose of hormones for nothing. (in fact, the chances of taking the drugs needlessly are greater than the chance of taking them to prevent pregnancy.) Cindery 01:08, 26 September 2006 (UTC)

darney study

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)

Related Statistics and Studies

Hey Cindery. First of all, sorry about commenting on your personal talk page, as a newbie I thought you were referring to this when you said to refer to the "talk" page (plus I did look at the talk page and I never saw a discussion on any of our issues). Anyways, I wasn't trying to be inflamatory.

In regards to your comments, I can tell you that "control groups" are not always a group that has never received any treatment at all. For instance, if I am running an experiment where I'm injecting a drug into the brain, the control group would be a group that I inject saline into the same area (as opposed to injecting the drug). As a result, I "control" everything except for the thing I'm interested in. For instance, the actual surgery could cause problems on its own unrelated to the adminstration of drug. Therefore, I'm controlling for everything except for the drug I'm injecting. In the same way, the study I'm referencing controls for everything except for the fact that they have easy access to ECPs as opposed to people who are in a situation in which they can recieve ECPs only by prescription (the control group in this situation is a person who can only receive ECPs via prescription as opposed to a person in which ECPs are available readily). Therefore, the group receiving traditional treatment is a better control (as opposed to a contrived group having little relevance to the question in hand). Based on this information, unfortunately, your idea of a control group is completely wrong

Finally, in regard to your comment, "funded by the population council--which has a finacial stake in mifepristone", I can tell you that the publishing of a paper in which a company has a financial stake in any drug does not automatically make the study irrelevant. In fact, it is common for a drug company to publish papers in support (or against) their drug. The way the scientific community handles this issue is that any publication in a repudible journal has to fill out a "conflict of interest" form. When such a form is filled out affirming such a position, I can tell you they are scrutinized much more carefully. Hence the scientific and ethical conflicts are dealt with by anonymous ethical reviewers (almost invariably with an opposing view) who unbiasedly review the article. The simple fact that this respected journal accepted the article is evidence that the scientific process is maintained. Certainly, I believe this process is abused by non-scientists. As evidence, I refer to the article that is commonly referenced by anti-abortion web sites and, ironically, by this wikipedia page previously . The "expert", who happened to be a business professor who is an expert in the economics of cricket, wrote a very scientific looking article three years ago that has yet to get it published in a peer reviewed journal. In conclusion, all the references I've listed have maintained the highest standards in terms of the scientific principal. I would expect you to respect this process.

...WP:NOT wikipedia is not a soapbox. try to be more succinct. again, sign your posts with four tildes. for your information, i am the one who deleted the "businessman" study from the EC article, because it was not a WP:RS.

for the summary of the darney study: the study analyzed different age groups, all of whom had access to ECPs, to determine if younger people with access to ECPs would behave any differently than older people with access to ECPs. they did not. no part of the group did not have access to ECPs. therefore no assessment which implies a comparison between people who have access to ECPs and people who do not have access to ECPs is accurate. the only accurate summary reflects the point of the study: no difference between age groups who all have access to ECPs. Cindery 13:57, 30 September 2006 (UTC)

RegisA 21:34, 30 September 2006 (UTC) Hey Cindery, OK, I finally understand what you mean by four tildes. Once again, sorry I'm a newbie.

In terms of the other issues you brought up previously, I will assume you consider them settled as they were not mentioned in your reply. Therefore I wont comment on them.

In terms of the businessman article, I was the first person to realize this article was not published in a peer reviewed article and I was the one who appended this fact in the text. My problem with you removing it is that you replaced it with a summary of another article (i.e. the Swedish article) that was clearly misleading. Once again I had to append text which portrays the article fairly. Either you did not take the time to even read the abstract of the paper or you were obviously trying to spin the results unfairly. Regardless, even a newbie knows both of these things are bad etiquette on wikipedia.

This leaves the Darney study. I still don't think you actually took the time to read the study. You are correct in that they compared differences between age groups but this is one of numerous comparisons made in the article. Much of the current debate is centered on the effects of converting ECPs from prescription to over-the-counter in the United States. As a result, this is the focus of the article. Based on this information, a non-ECP control group is irrelevant as, at the very least, people in the real world (in the US prior to ECPs being available over the counter) have access to ECPs via prescription. You are focusing on a point (i.e. ECP group verses a non-ECP group) which is irrelevant. What is more relevent is a comparison between people who can only get ECPs via prescription (just like in the US before ECPs went over-the-counter) verses people who have ECPs readily available (the advance provision group). Therefore, we control for everything else except the fact that ECPs are more readily available. Established experts in the field have used this specific study to bolster the contention that making ECPs more readily available (i.e. over-the-counter) is safe (see below for text from Lancet article). Considering this exact question is debated extensively, this study is deserving of being in the ECP article.

Here is some text from the highly respected scientific journal The Lancet (The Lancet Volume 365, Issue 9472 Pages 1668-1670) Please note that in the text below the reference to the Tina Raine article is the same as the Darney study mentioned above (Raine is the first author whereas Darney is the last author on this article)

"Despite its undisputed safety and efficacy, enhancing women's access to emergency contraception has been controversial. Some of this controversy is related to the anomalous position of emergency contraception in the family-planning repertoire: anomalous because it is used after sex. At the same time, some developments in emergency contraception, aimed at combating teenage and unwanted pregnancy, have been reported in particularly lurid terms by the mass media, conflating concerns about sexual morality, inappropriate use of contraception, and the spread of sexually transmitted infections. Against this background, it is interesting to note the findings from a recent study providing evidence of the broader effects of emergency contraception on key public-health issues. Tina Raine and colleagues randomly assigned 2117 young women aged 15–24 years to either pharmacy access to emergency contraception without a prescription, advance provision of emergency contraception, or usual care (requiring a visit to a clinic). Over the 6-month follow-up, the authors report that women in the advance provision group were almost twice as likely to use emergency contraception (37•4%) than those who had pharmacy access (24•2%) or usual care (21%). Interestingly, pregnancy rates and rates of new sexually transmitted infections were similar in all the groups. Furthermore, easier access to emergency contraception did not appear to affect regular contraceptive use or risky sexual behaviours.

Like Litt, we believe this is important new evidence. Data from a recent study in Scotland reached similar conclusions. In that study, women aged 16–29 years were provided with five courses of emergency contraception to keep at home (advance supply), which they obtained when accessing general practices, family-planning clinics, or accident and emergency departments. The study concluded that advance supply was viewed positively by women and that concerns about repeated use of emergency contraception, as well as links between easier access to such contraception and risky sex or changed contraceptive behaviours, appear to be unfounded. Clearly, both studies should reassure those worried about these issues."

Clearly the conclusion of the experts in this article is that the Darney study bolsters the position that transitioning from ECPs being available through prescription to being available over-the-counter is safe.

RegisA 21:34, 30 September 2006 (UTC)

again, read WP:NOT. how many times do i need to repeat this? READ WP:NOT. do not write lonf paragraphs expressing your personal opinions. your opinion of whether or not a control group is necessary is not relevant. all that matters are the facts. the facts are that the comparison was between age groups. period. this is an encyclopedia; all that matters are the facts. Cindery 22:47, 30 September 2006 (UTC)

RegisA 00:47, 1 October 2006 (UTC) If you write back please at least talk about the points I have made as I have done for you point by point. In addition, if you think something I've mentioned is personal point it out. The statements I'm making directly refer to the legitimacy of including these papers and a summary text in the ECP article. Therefore, I don't see how they could be any more relevant (as opposed to personal). I think people can see that for themselves. You are correct in saying that one of the comparisons was between age groups but this was one of many. There was also a comparison between study groups (see Table 2 and Table 3 of paper) which is the basis of the argument that transitioning from prescription only access to over-the-counter is safe (this is a fact, not personal). This should be obvious if you had taken the time to read the entire article or read my comments. RegisA 00:47, 1 October 2006 (UTC)

Gentle aside: Remember wikipedia is not the place to actually debate out an arguement, but only to report on debates which have already occured outside in the real world. So if a study is flawed in its execution or the conclusions it draws from its own data, we can not ourselves so interpret and add into wikipedia, however "true" (see WP:NOR). Instead one must WP:CITE from external WP:Reliable sources that have made such points.

Hence "the legitimacy of including these papers" is not ours to make, if studies are substantial then they may be included, if they are problematic then cite an external source that so states. If the paper, despite being flawed, is substantial or influential (even if for "incorrect" reasons) then it probably should still be included with the opposing POV then covered: the phrasing in wikipedia might be along the approach of: "X looked into A and concluded B. Criticism of the study by Y suggest C".David Ruben 02:53, 1 October 2006 (UTC)

RegisA 16:15, 2 October 2006 (UTC) You stated that wikipedia is not the place to actually debate out an arguement. While this is true for the actual wikipedia article, I'm debating in the talk page (which is one of the main reasons the talk page exists) so I don't understand your point.

Your statement "the legitimacy of including these papers" is not ours to make could not be more wrong. Everytime you eliminated certain articles and included others were you not making such a choice? Misplaced Pages is a collaborative effort in which you or I can make such decisions. If the "legitamacy of including a paper" is not ours to make, then wikipedia would not exist. Think about it, if we can't make this decision than this discussion is pointless.

Now can we please debate the merits of the paper. If you think its flawed then how about discussing that. If you think the conclusions are in question, then talk about that. I agree a legitimate POV should be included if it is valid. Unfortunately, up until this point, you have not given any rational legitimate alternative POVs. The point of this entire discussion is to decide whether or not to include the descriptions/summaries into the article. I am saying that the article is not flawed (an opinion shared by experts and supported by other replicating studies) which is an opinion you differ with. This should be the point of the discussion we should be having. Your previous statements have offered nothing toward this end and have devolved to the point where you don't even directly refer to the paper anymore. Lets move foreward. RegisA 16:15, 2 October 2006 (UTC)

It seems like you have confused David Ruben for Cindery, and that you have not read closely what David Ruben has said. He specifically said: if studies are substantial then they may be included, if they are problematic then cite an external source that so states. If the paper, despite being flawed, is substantial or influential (even if for "incorrect" reasons) then it probably should still be included with the opposing POV then covered Which I took to mean that Cindery's criticisms needed to be referenced, and that these studies are probably substantial enough to be included, and if necessary/possible rebutted by other substantial studies. I agree strongly with David's understanding of policy and this situation. I hope this clears things up. As for debate, please read the disclaimer in red on the Talk:Creationsim page. We cannot do original research and reach conclusions here, we can only assess if sources meet the wikipedia guidelines for reliable sources.--Andrew c 16:25, 2 October 2006 (UTC)

RegisA 06:06, 4 October 2006 (UTC) Thanks Andrew, your right in that I did confuse Ruben with Cindery but at the same time I would have not altered my statements. Rubin (or Cindery) has not presented a valid alternative POV and I could tell this discussion was degrading to the point that the merits (or demerits) of the study were no longer being discussed. If they did, I would be fine talking about these points. Neither has offered an alternative POV or listed any external sources furthering such a point. At the same time, I have referenced other independant, expert, scientific, peer-reviewed commentary in support of this article. In addition, I have also pointed out other independant scientific studies converging on the same point. It is for this reason I fealt that Rubin's comments did not offer substantially to this discussion. Although I agree with his comment in general, I feel that this policy was not violated in this case and therefore irrelevant. Therefore, I think it is pertinant that either Cindery or Ruben state their alternative POV clearly and concisely. Otherwise, there is no reason for this discussion. RegisA 06:06, 4 October 2006 (UTC)

So what is the status of this dispute? It's been 2 weeks with no comments (but it also doesn't seem like Cindery has been on wikipeida at all this month). What needs to be done (if anything) for us to be comfortable removing the factual accuracy tag?--Andrew c 18:12, 20 October 2006 (UTC)

...sorry, i was called away by real world concerns. i haven't even read the newest version of the article yet, but having re-waded through the wordiness here, i'd summarize that:

the results of the studies show that the more access there is to EC (available over the counter etc) the more they are consumed--that's all. consuming more of them has not been shown to be of any value in and of itself (except presumably for the drug comapnies who profit from more consumption...) the darney/raine study was sorta hijacked after-the-fact to make argument that easy-access doesn't increase STDs/promiscuity, etc after the rightwing morality claims that access would increase promiscuity/STDs--frankly, i could care less about that (and probably too frankly, since my well-known position around the birth control-abortion articles is that i'm to-the-left of the left) i just find it irritating when criticism of pharmaceutical drugs is met with what appear to be assumptions that i am on the right/aligned with woodcock's moral "they'll have orgies if we give them EC!" position:-) so, my argument is that the darney raine study clearly shows more access=more consumption. it doesn't show that easy access means more consumption= good. and it doesn't show easy-access/more consumption results in less promiscuity/less STDS--because there was no non-EC control group. it shows only that there was no promiscuity/STD difference between age groups. my interest in making that plain--aside from factuality and neutrality--is that i think it's another misleading marketing claim that helps hype drug consumption/pharma profits. the "should be over the counter!" argument was hotly politicized--and for no good reason that benefits the public health/women. there's no benefit to over-the-counter availability, except that more drugs are consumed and sold--it hasn't lowered abortion rates, etc. (and darney is on the payroll at drug companies which manufacture levo--i've already complained elsewhere that his financial conflicts of interest viz levo are great enough that he shouldn't be cited as a source without that disclosure...)

barest summary: no control group means the only valid conclusion viz darney/raine study is there was no difference between age groups--it simply does not support the claim that EC use doesn't increase STDs/promiscuity in general. my moral position--irrrelevant, and i don't feel i should even have to state it but whatev, perhaps at least it will help regisA understand--is i could care less if it increased promiscuity. as far as i'm concerned, that would be cool if it did. bummer if it increases STDs. i think the "morality" firestorm was very contrived on both sides. (and the liberal position is more and more aligned with/usurped by drug company agendas). my position is I'm insisting that the results of that study be represented factually --because it's wikipedia policy. my ulterior motive/bias/POV is to undercut the drug company pro-consumption marketing...(and no, the long term effects of repeated high doses of levo as EC haven't really been adequately studied...) Cindery 09:01, 2 November 2006 (UTC)

I mentioned this before in reference to an earlier thread, but again: it seems inappopriate to focus on 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. We don't demand that any other method of contraception lead to a decrease in abortion rates nationwide. Similarly, the measure of efficacy for EC is its effectiveness in preventing pregnancy in an individual person - which is clearly demonstrated in the literature. 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 or argument against OTC status. MastCell 19:03, 2 November 2006 (UTC)

My edit of 30-Sept

• 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 _Contribs 02:26, 1 October 2006 (UTC)

Social impact - Sweden

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. PMID 12407239

• 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). PMID 12954524

• 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).

• Reported genital chlamydia infections in Sweden decreased from 38,000 in 1988 to 14,000 in 1994 then increased to 33,000 in 2005 before decreasing in 2006.

68.253.189.186 21:07, 5 October 2006 (UTC)

Types of ECP -- Clarification

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)

Planned Parenthood's "financial interest"

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)

Rilly? I always find it kind of funny when people make ad hominem arguments (i.e., putting fact in does not equal "obsession.") As an aside, "Non-profit" org is pretty meaningless--there are plenty of ultrarich nonprofit orgs and NGOs (my faves are the corp shell companies like the Population Council--fat with Rockefeller oil cash.) "Requiring" donations is not proof of financial need. The IRS "requires your donations," too. Planned Parenthood is not a moral-value, it's just an org. (For which, like all hulking corporate entities, money is power--including power to make political endorsements.) Misplaced Pages WP:NOT place for my 100 page screed on why PP is Mcdonald's of women's healthcare--suffice to say I'd rather see more actual community-run women's clinics than PPs for the same reason I don't shop at Walmart. Cindery 18:45, 2 November 2006 (UTC)

Availability in the U.S.

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)

"social impact"

pls forgive me if i've missed where justification for renaming "related studies..." as social impact was given, and am not responding directly to the argument made. but, the huge prob with that is that the implication that ECP could have the social impact of reducing unintended pregnancies (the implication given by stating the number of unintended pregnancies, as if that had anything to do with ECP at all) is that it's conjectural. there has been no proven "social impact" --the actual data shows the opposite. since relating the US unintended preg stats with ECPS is utterly conjectural, i actually don't think the unintended preg stats should be in article at all--but i suppose a minor argument could be made that it's a minorly relevant tertiary stat. but certainly not a "social impact." Cindery 18:30, 2 November 2006 (UTC)

1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?orig_db=PubMed&db=PubMed&cmd=Search&term=%22Lancet%22%5BJour%5D+AND+365%5Bvolume%5D+AND+1668%5Bpage%5D)