VIEWPOINT:GETTING AWAY WITH MURDER

This month, we received a letter from a family planning doctor defending the use of the Pill (see Letters, p 8). It got me thinking about how this drug, more than any other, is getting away with murder.

So much symbolic baggage attaches to this particular chemical compound (sexual freedom and equality ) that it blinds most thinking people to its true implications upon the health of an entire generation of women.

To give you some idea, a few years ago, one of the national papers carried a big spread marking the 30th anniversary of the Pill. There were personal testimonials about how it changed people’s lives, for better or worse, but not one single line about the known, potentially fatal health risks.

Behind every argument I’ve seen justifying the Pill is the unacknowledged premise that pregnancy is a dangerous disease. “The reliability of the COC at providing reversible contraception for most women more than outweighs the theoretical risks itemized”, says our letter writer. This risk benefit equation only works if you believe that pregnancy is going to give you breast cancer, cervical cancer or a heart attack. It only works if you believe that it is better to get cancer or a stroke and possibly die than have an unplanned baby. It only works if you believe that it is better to risk a host of fatal illnesses than to use a condom.

Let’s be clear about one thing. We know the Pill is dangerous. We know it causes thrombosis and we think it causes cervical cancer. Most recently the largest and most detailed survey of oral contraceptives and breast cancer in younger women (The Lancet 5 May 1989) concluded that women taking the pill between four to eight years have an 40 per cent increased risk of breast cancer contracted by their mid 30s and 70 per cent risk after more than eight years of pill use. The joint study also concluded that wholesale pill use has nearly doubled the breast cancer risk. But as R W Shaw of the Royal Free Hospital in London, cautions (Br J of Ob/Gyn, August 1987): “. . . because some tumours (breast in particular) develop more often in later life . . . , it may be another decade before the true picture can be assessed. ”

Wholesale distribution of this drug is usually defended with the statement that medical tests will adequately pick out at high risk tests like cervical smears which can be wrong as much as 60 per cent of the time.

What bothers me most, though, is the patronizing inherent in arguments defending the Pill. The unspoken assumption is that adults, given proper guidance, won’t be able to figure out how to use safer, equally effective methods of contraception. A survey of 800 female staff members and volunteers in Planned Parenthood in the late Seventies showed that only 9 per cent of them took the Pill, compared to 70 per cent of their clients. Even then, it seemed, they knew something we didn’t.