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this post was submitted on 05 Oct 2023
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She's not pregnant, but doctors try to avoid long-term prescription of teratogenic drugs to patients who might become pregnant while taking them.
Which is super not ok. You get that, right?
No, I don't get that. If a drug might result in birth defects, it should only be used as a last resort. And that's not just me or some random NY docs saying it, it's the WHO and European Medicines Agency
Do you see the problematic thinking in that line of thinking, though? You are saying a woman can't be trusted to use a medication if it might cause a birth defect. She can't be trusted not to fall pregnant, she can't be trusted to think for herself. She can't be trusted to keep up with birth control. She can't be trusted when she says she doesn't want kids ever. What the first consideration is for, is the *possible child, foremost. Not the person, the actual patient. And you're quoting American healthcare?
I'm quoting the World Health Organization and a European agency, neither are American health care.
This is a universal approach taken by health care in the US, EU, and across the world. Doctors in general are pragmatists, and only concerned with outcomes. Which means acknowledging that no matter how often patients say "Trust me", they know a certain number will have a bad outcome. The doctor's job is to reduce that number.
It's the same reason why doctors increasingly urge their patients to not keep firearms at home. Even when the patient says they can be trusted with a firearm. It's not a matter of trust, it's a matter of statistics.
Firearms and medication aren't even slightly in the same ballpark. What you are arguing for is that all women of child baring age should never be allowed to mitigate their own risks. And the *potential possible for a fetus, has more consideration that the actual person. If you want to talk firearms. Firearms aren't banned outright. This drug has been completely and utterly denied to a person because of the *potential to crate another human. So if you compare that to firearms, that's like saying only women can't be trusted with firearms, even if they have safe measures to keep them at home. Like a gun safe. I live in Australia, we have guns here, I can go and buy a gun, and there's safety measures I have to abide by. That's not what's happening here. That's not what you're arguing. It's problematic to assume that one gender is incapable of mitigating risks, at all. She can prevent herself getting pregnant while on the drug and says she's child free, never wants kids. The potential for that to fail is still held in higher regard than the actual harm be caused an actual person, not an imaginary person that doesn't exist (if you want to call a cluster of cells a person, spoiler it's not). This would be like you going to the doctors and the doctor won't give you medication to relieve agonising pain to the extent it commonly causes suicidality, and the doctor says, no you just have to suffer in this pain when nothing else is helping, because you might cause a pregnancy in a woman, and you tell he doctor you promise to use protection and that you're gay and don't even sleep with women, and he still doesn't care, because the potential for damage to someone who doesn't even exist is more important than you and your actual lived existence. There is a medical rule that has caused people who it applies to harm, and those people are speaking out. You aren't able to imagine or consider their situation. This is an issue in the USA. So using medical advice from other sources doesn't really apply. This is happening because of the medical issues in that region specifically, the banning of essential health care for women, which is having huge roll on effects.
Doctors are expected to mitigate risks, too. Valproate-induced spina bifida is a real problem, and doctors share a responsibility to prevent it when it won't harm their patients. They share this responsibility because they previously tried making patients entirely responsible for mitigating their risk, and that approach has failed.
Nobody said the woman in the article "has to suffer". They didn't refuse to give her any medicine, they refused to give her a particular medicine. There are plenty of alternatives, and in fact the doctor in this article wrote the woman a prescription for a different medicine. But of course, some people only want what they can't have.
Despite what patients often think, doctors are not drug dispensaries. It's not their job - and never has been - to give patients the latest drug they read about online, or the drug that worked for their friend, or the drug that someone said "ask your doctor" about. If there is a less risky drug that can treat the patient, they will prescribe that instead of what the patient wants.
To take another example, vancomycin is an antibiotic of last resort. Bacteria have not yet developed widespread resistance to it, so it is reserved for patients who have antibiotic-resistant infections, like MRSA. If it is used too much, theoretically bacteria can finally develop resistance to it. And theoretically, people in the future with MRSA may suffer.
Next time you get antibiotics, try telling your doctor "No, I want a vancomycin prescription". You will be disappointed. They are going to give you what they think will get the job done without incurring unnecessary risks, for you or other people.
It is okay if there is a non teratogenic alternative that treats the targeted disease. Why risk teratogenicity when you can altogether avoid it?
You are assuming a few things, you're assuming she hasn't tried anything else and jumped straight to the deep end. And you're assuming that it's ok to say to one group of people they're incapable of mitigating risks for themselves, and need that to be decided for them. Taking away their autonomy entirely. She's been to many doctors. She's tried everything already. This causes people to feel suicidal because of the levels of pain on a frequent basis. And she's told she just has to live with the pain, her pain is inconsequential in comparison to an imaginary non existent person.