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New pills for the 21st century

WITH THE many, mostly passionate responses, to my Aug. 12 piece (“There are 100 million of us now”), which argued that a full-blown population program is now crucial for our national well-being, a report on recent breakthroughs relevant to the issue, especially as these have gone strangely unreported in the local press, will be useful.

Whether we, the government or the Catholic Church like it or not, these developments could very well overwhelm religious, cultural and even government restrictions on the use of artificial contraceptives in our Catholic-dominated nation. Indeed, humanity’s history is marked by sharp twists when theoretical or religious debates were suddenly resolved by some scientific breakthrough. For instance (and closer to our topic), oral contraceptives, which was introduced to the American public half a century ago, allowed many US Catholic women, even if secretly, to defy Catholic dogma that sex is moral only if undertaken solely for procreation’s sake.

But then, without government support, the poor will still be left out even with these new discoveries, as they do not have both information and cash to avail themselves of these new products of science. The government will have to step in.

The well-researched The Economist, in a special millennial edition, called oral contraceptives (nearly reverently termed “The Pill”) the greatest science and technology advance of the 20th century as it made pregnancy a choice for women, thus ending women’s yoke of unwanted births, allowing them to join the workforce, and providing the accessible tool to prevent a runaway population growth.

Two new recent medical products could make up the new Pills for this century. One is a drug which only several days ago, on Aug. 14, the US Food and Drug Administration approved. It is a new and better morning-after contraceptive pill called Ella (Ulipristal acetate), manufactured by the French firm Laboratoire HRA Pharma. Ella is better than the existing “emergency contraceptives” since its effectiveness can last five days after unprotected sex or failure of the more traditional contraceptives, longer than earlier emergency contraceptives’ efficacy period of only three days.

The European Union’s counterpart of the FDA, the European Medicines Agency, has approved it as “EllaOne” more than a year ago. It has become a best-selling emergency contraceptive, and is even sold over the counter in the United Kingdom by the big chain stores, Boots and Tesco.

The US FDA’s approval of the drug is significant for two reasons. First, the US and Europe are obviously humanity’s two biggest, and advanced civilizations, and the drug’s approval by their scientific institutions means a near universal acceptance of the medicine’s purported goal and safety. What better imprimatur can one reasonably require?

Secondly, next to the Catholic Church, the Filipinos’ mind-set is basically molded by US culture and consumer products, due to a large part to our over three million migrants in the US. With Ella now available in the US, expect the drug to soon trickle into the country, followed by approval by our local drug-regulatory agency—unless the Church manages to block it.

What could be the second “Pill” for this century, and which would be probably more relevant to developing countries like ours, is a drug called misoprostol, marketed by Pfizer under the brand name “Cytotec.” While developed as a drug to prevent stomach ulcers, researchers have found out that, combined with another but more regulated drug, mifepristone, it induces miscarriage more than 95 percent of the time in early pregnancy. Taken solely, however, misoprostol’s effectiveness drops to as low as 63 percent, although its efficacy could still be as high as 93 percent in early pregnancy.

It is much, much safer and more effective than surgical abortions, which is said to kill 70,000 Filipino women a year. Even by itself, misoprostol causes uterine contractions and the ripening of the cervix more effectively than other drugs used for labor induction.

Misoprostol is, in effect, the scientific counterpart of the herbal abortifacients Filipino women have been using for centuries, concocted by our arbularyos. These curiously are commonly sold outside churches, most famously at the Quiapo church, perhaps as a subliminal message that taking it is not a sin. The big difference, of course, is that misoprostol’s effectiveness is proven through rigorous scientific method and not in the hit-or-miss manner of concocting what is euphemistically called menstruation-inducing herbal concoctions.

International Herald Tribune columnist Nicholas Kristof has ventured the prediction that misoprostol will trigger “a gynecological revolution” in our time. The drug is cheap (about $1 each) and freely available, even through the Internet. It can be taken in the privacy of the home, a world away from the frightening illegal abortion “clinics” in our country.

The fact that its abortifacient effect is indistinguishable from a natural miscarriage is crucial in countries where abortion is a crime for which the woman can be prosecuted. It is also important culturally and psychologically when a woman seeks help at a hospital to ensure that no complications occur.

Although there have been claims that misoprostol is unsafe, the World Health Organization, which is by its structure a cautious organization, in March 2009 included the drug on its “Model List of Essential Medicines,” or medicines efficacious and cost-effective for the indicated condition and essential for basic public health.

From the Philippine Daily Inquirer