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Opinion,
Comment & Reviews
Contraception |
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Advice
on pill safety that led to the 1995 pill scare is reversed
By Maxine Lattimer
Government health advisers effectively made a U-turn in their
advice on contraceptive pills, which had sparked a major health
scare four years ago. Thousands of women immediately stopped
taking certain types of the pill in October 1995 after the
Government warned that a range of the latest 'third generation'
contraceptives carried twice the risk of blood clots forming
in the legs than other products. Doctors were told by the
Government's Committee on Safety of Medicines (CSM) that they
should switch women from the low dose third generation contraceptives
to higher dose second generation pills. Medics and manufacturers
criticised the way the advice was given to the media before
they were told and was based on yet-to-be-published research.
The makes of third generation pill affected by the health
scare were Mercilon and Marvelon (manufactured by Organon),
Semodene and Triadene (manufactured by Schering), and Minulet
and Tri-Minulet (manufactured by Wyeth). The scare led to
a surge in unwanted pregnancies and a 9% rise in the number
of abortions.
At a press conference held at the Department of Health Dr
Jeremy Metters, the Deputy Chief Medical Officer, issued new
advice effectively advising doctors that they could prescribe
third generation pills as a 'first line' contraceptive. Doctors
had previously been told only to prescribe third generation
pills if women were intolerant to other contraceptives and
were told of the extra risk. From June this year, information
leaflets contained in all packets of third generation pills
will inform women of the slightly increased risk of deep vein
thrombosis compared to older forms of the contraceptive. The
Government still did not admit their mistake that led to the
1995 pill panic. Dr Metters said 'The Committee on Safety
of Medicines gave the advice that it thought was right at
the time, based on the data that was available. Since then
a lot of work has been done and the data has been extensively
worked over. The advice of the CSM in 1995 was that the increased
risk was sufficient that women should be switched from third
generation contraceptives to second generation contraceptives.
The advice from the Medicines Commission now is that if women
are fully informed that there is a greater risk with third
generation pills and they have discussed that with their doctor,
then third generation contraception should be provided.'
Dr Metters said that the scientific findings had not changed
since 1995 and there was still a slightly increased risk of
deep vein thrombosis from third generation pills. The risk
of thrombosis for women not taking any oral contraceptive
is around five cases per 100,000 women per year. The incidence
in users of second generation pills is about 15 per 100,000
women per year of use, compared to around 25 in users of third
generation pills. Dr Metters said 'We are still talking about
tiny risks. Women should not think that this is any great
risk, but they have a right to be aware of the data.' When
asked if the advice given to doctors and women in 1995 was
wrong, he said 'We would have been criticised if we had sat
on the data. Contraception is a very personal thing and women
have a right to all the information that is available.' When
asked if he regretted that the scare led to a surge in the
abortion rate, Dr Metters said 'Of course I regret unnecessary
abortions. Any abortion and any unwanted pregnancy is a matter
of regret.'
A spokeswoman for the British Medical Association said 'GPs
were critical in 1995 of the way this whole issue was handled
and it was a nightmare, with increased abortions and unwanted
pregnancies. We now seem to be getting back to a situation
where doctors can prescribe the contraception that they feel
is best for their patients on the basis of their medical history
and discussing it with women. This is a liberalisation of
the issue and we welcome it. The new advice is being sent
out to doctors today and the extra information showing the
comparable risks will appear in packets of third generation
contraceptives from June.'
The fact that safe, low dose third generation pills can now
be returned to first line use to be welcomed, but frankly
this is four years too late. The advice given by the CSM in
1995 that these pills should not be prescribed was unnecessary
and alarmist. The pill scare that followed was a disaster
that should never have happened. It caused a massive increase
in the rates of unintended pregnancies and undermined general
confidence in the safety of the pill. It reversed a downward
trend in the number and rate of abortion. Abortions to women
resident in Britain rose by 9 per cent in 1996 and has remained
at an increased level. Where I work at the British Pregnancy
Advisory Service we are still seeing women requesting abortions
who wrongly believe the pill is dangerous and so miss out
on a very safe and extremely effective method of contraception.
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