Birth control today; 6; Birth Control Methods and the Future

A. WB AA presents birth control today. Freedom and responsibility. This is a series of programs about birth control and how it affects us and our society. Today we look into the pharmacists role in providing birth control information to the public and what methods are predicted for the future. Many methods of birth control are available to couples today just which one is right for you depends on many factors. You may obtain advice about the matter from your family doctor or minister but have you ever thought of your local pharmacist. He's well trained to help you and is interested in providing the service to the community. Let's join Dr. Robert

Challoner's from the Department of clinical pharmacy at Purdue as he talks with a local pharmacist Harold Beeman about the pharmacist role. Harold there are many methods of contraception available today for public use. What do you feel as a pharmacist appropriate role in providing information and advice to people on contraception. Well I feel that whether a person with a question about contraceptive will pose it to a pharmacist depends upon the kind of relationship that the pharmacy has developed with the clientele in a community pharmacy such as where I practice is where the pharmacist and the clerks demonstrate genuine interest and concern for the people that they serve. The pharmacist does more than just dispense drugs. He provides information on how to properly use a medication and he is often called Bowen as a health advisor to the customer. Now questions about contraception methods are very

personal and very important to that person and it has been my experience that not only young people but also some of the adults are not quite certain where to turn for the answers. The young person may be reluctant to ask his parents or a family physician and the dealt may not have a physician or he may be reluctant to ask his or her physician. In such a situation it may be the pharmacist in which the person turns. Now the pharmacist who makes himself accessible to set questions and is interested and concerned with the people can provide an important service to the community in such a situation. He may answer some of the questions directly but where the question really is asking for medical opinion or personal advice the pharmacist may be able to help that person establish a bridge of communication with either the doctor or the parent.

Maybe we can develop this point a bit further by taking a specific situation. The oral contraceptives. What advice and information might the pharmacist provide a woman who is taking oral contraceptives under a physician's care mama as with all prescription medication. The pharmacist should be certain the patient is fully aware of the proper use of the drug. The doctor should have explained this to the patient but the pharmacist should also review the directions to be certain that there definitely are no questions if the patient still has a question. For example she wonders what to do if she forgets to take her daily pill in the evening. How does a pharmacist respond here. Well this is a relatively common question and indeed eneral contraception is not impaired. If the Miss pill is taken oh say within 12 to 18 hours the usual time and the

next evening is dose taken at the regular time. However if the daily dose has been admitted all for a full day or longer she should continue taking the pill on schedule for the rest of that cycle but use some other method of contraception as an added safeguard until her next period. An important point relating to your question is the relationship of the pharmacist to the patient and her physician this question headers usually been the anticipated by the physician and the pharmacist concerned in answering any of these questions should really be to reinforce those instructions as the physician has already given the patient. Of course another type of question that might be asked of the pharmacist concerns the safety of oral contraceptives. The congressional hearings and newspaper and magazine articles really brought the idea of the risks of oral

contraceptive use into the public eye. How do you feel that the pharmacy should answer patients questions about possible undesirable effects of oral contraceptive use. Well as a pharmacist my attitude toward oral contraceptive medication is really basically no different than for any drug that can affect body function. If a drug is used properly under sedation professional supervision it has considerable benefit with minimal risk before prescribing an oral contraceptive. The physician makes a thorough examination of the patient including a pap smear to determine if there are any factors that may predispose her to undesirable flecks from the pill. For these points in mind the pharmacist can answer patients question without possible adverse effects. Of oral contraceptives by reassuring the patient

in some instances and other instances encouraging to discuss particular questions with the physician. It is important that the patient using an oral contraceptive have a follow up examination. All from six months to year intervals. Now the role of the pharmacist by keeping an accurate record of prescription refills can also provide assistance there reminding the patient to check with the physician for these follow up examinations. Now in light of the opportunities to provide information and advice on the proper drug used you might wish to comment on how the pharmacy students are being prepared to fulfill this role today. Well had all the required education to become a registered pharmacist as you know involves a five year course of study as well as a period of internship experience

and successful completion of a state Licensure Examination. An important objective of the education is to help the student develop a basis for the proper use of all drugs. This includes courses and anatomy physiology biochemistry designed to help a student understand how the healthy body normally functions. This is then followed by courses and principles of disease which at Purdue are taught by physicians to help the student understand how disease processes alter these normal body functions. Finally courses in pharmacology help the student understand drugs and their actions in alleviating these various disease conditions. Concerning the topic of contraception the student learn of the physiology of male and female reproductive cycles and the various ways in which drugs and devices can interfere with these processes to prevent con ception.

What Expect do oral contraceptives to students just become thoroughly familiar with the actions of these drugs to regulate the mescal cycle and prevent development and release and the actions of these drugs and the other tissues in the body as well to account which accounts for some of the side effects. With this kind of background then we expect the graduate pharmacist to be able to field questions by the patient and exercise judgment on which questions he can appropriately answer and which one should be referred to a physician. In this regard do you recommend any particular method of contraception to your customers Carol. Well not in our particular pharmacy it being a community pharmacy. We feel like we're part of a large community family. However many times we will get the man and the wife together and we'll find out who is to assume the responsibility.

Naturally if the man is to assume the responsibility we will recommend a good prophylactic. However most of the time the woman assumes the responsibility and we feel it is our particular duty to refer her to their family physician where she will get a good physical examination and then the physician either will prescribe a device or an oral contraceptives and only oral contraceptives Naturally we fill the prescription and keep a record for future use. Now in our particular pharmacy bought the majority of the prescriptions are for the oral contraceptive or the pill. You have a prediction for the future when it comes to birth control methods. I might preface that prediction by emphasizing that the goal of birth control or preventing conception is not only effectiveness

but also freedom from undesirable effects as well. The oral contraceptives available today consist of two types of drugs or hormones one and estrogen and the other a progesterone Jen. And when these are taken as directed for 20 to 21 days by the woman the main contraceptive effect is preventing egg development and egg release by the ovary. At the doses used however this pill does have minor actions on other tissues in the body too. As we mentioned before some patients do have a greater susceptibility to these actions and these actions may aggravate some underlying disorder such as diabetes Melitus or tendency to blood clotting. Research today then is aimed at finding drugs with even more specific actions and altering reproductive functions with minimizing side effects. Two variations of the pill are presently being studied. One has

been dubbed the morning after pill which consists of relatively large doses of estrogen taken daily for four to five days after intercourse. The effect is to alter the uterus lining so that a fertilized egg cannot become a planet. The other variation of the pill which is under study is a progestin given in low doses each day continuously without interruption. The amount of progestin Jen is quite low and does not interfere with egg development as it does with the present oral contraceptive. But it does cause a glance at the opening to the uterus that is the cervix to produce a thick mucus which prevents sperm entry during intercourse until adequate clinical studies have been completed however and the safety of these forms of contraceptives have been demonstrated. They will not be available for prescription use. Other

studies are often aimed at discovering effective and safe drugs to prevent sperm development in males. Experimentally at least it's possible to stimulate male animals to produce antibodies against their own sperm much as our body develops antibodies against bacteria. These procedures and drugs for use in males are still quite a long ways from being adequately developed for you know human use however. Just which of these newer possibilities will become available for human use to challenge the popularity of today's pill. Depends on the results of the effectiveness and safety studies now underway. Just how long it takes to determine if a new contraceptive method is safe and effective varies. It took centuries of experimentation with the IUD and development of antibiotics and new plastic materials before the intrauterine device was distributed widely. Whereas the pill was discovered just a short time ago in 1050 and is still a subject

of controversy regarding safety. Research is developing new types of pills though that are minimizing some of the negative side effects. Dr. loyal corms student health center director describes some of these new pills in certain countries today. They're using what they call the many fill and I think. Some people believe that will be in use in this country within a year. And this is where they have. Taken out the estrogen all together and given very minimal doses of progesterone timing it inwith in the Mistral cycle so that will prevent obvious lation. This has been used in Latin America and in some other South American countries and and apparently with pretty good effect. They feel that with a reduction of or an elimination of the estrogens and a reduction of the progesterone the synthetic eschews and progesterone that there's a reduction in side effects and complications with use of the pill. Also there has.

Been a pill now that's a long acting pill. Take it once a month and it has a long acting estrogen with a short acting progesterone. This isn't available in this country. Yet I mean whether it will be or not I don't know but it's anticipated it will be. Also there. Has been some research done and some positive research done that there may be an implantation of a ballot so that. You're going to see the doctor once every two or three years and he implants a felon under the skin. And there is a slow absorption from this pellet or repair it of yours for contraceptive reasons we have done this in certain hormone deficiency is like Addisons disease we have implanted some some pellets under the skinless loves Arjun and I imagine. That's where the idea came from. But this also and there is even some research being done on vaccine.

As a contraceptive. Measure. Most scientists say that's 20 or 30 years away. The idea that women may someday be vaccinated against pregnancy seems farfetched but theoretically it should be possible to develop a vaccine made from sperm or sperm like substances from animals that would cause the production of antibodies in sufficient numbers to prevent conception over a long period of time. Such a situation has existed in normal marriages where doctors have found that wives can't conceive because they are allergic to their husbands sperm. These women develop antibodies that attack and reject the sperm making conception impossible. It has also been theorized that prostitutes who are overexposed to sperm tend to develop antibodies against it accounting for their low pregnancy rates even when no birth control methods are used. The vaccination technique has been tried on guinea pigs and worked for about eight months but then wore off the discovery of an easily manufactured serum is needed that could be controlled and

reversed when desired. Another method that will soon be developed for national use is monthly injections of hormone compounds. Women who can take the pill will also qualify for these injections on the eighth day of the menstrual cycle the woman goes to her doctor's office for a single injection usually in the hip. The doses injected into the muscle and slowly absorbed into the bloodstream in the same amounts as if the woman were taking the oral pill each day. The cost for a monthly shot will be about the same as a pack of pills. However the doctor's office call would be extra. A woman will have to decide if the convenience of a one shot and forget it is worth the additional money. The dosage of the shot is expected to be adjusted so that eventually a woman would need an injection every three or six months. Another method of the future involving the female is the development of a drug that would activate the fallopian tube muscles working the same way the IUD does to speed over through the tube so they can't be fertilized or to prevent implantation of fertilized ovum in the uterine

wall. Contraceptive pills for men are still in the very experimental stage. Dr. Edward Tyler of Los Angeles found a male pill that eliminated sperm after two or three weeks. However severe side effects occurred when combined with alcohol consumption. A single glass of beer produced vomiting and intolerable rash and giddiness in 1989 the U.S. National Institute of Child Health and Human Development awarded scientists about three million dollars to explore possibilities of producing a male pill or injection. The newest idea involves the capacity process. This is the way which sperm cells develop the ability to fertilize the female egg. The process occurs after the sperm are formed and partly after they have entered the female reproductive tract under some conditions sperm can't penetrate the ovum. If this process can be identified possibly a specific part of it can be interrupted. Who will take the responsibility for birth control. Male or female. Partly depends on what methods

are developed in the future. All of this research for a new perfected contraceptive techniques may eventually help to overcome worldwide population problems. And that's where the real need is. Professor E.J. aims Archer of the University of Colorado raises the question in regard to population growth. Where are we going. The information center on population problems responded where we are going is as far as our numbers are concerned. Today we are well past the 200 million mark in the neighborhood of two hundred ten million by 1970 when the next census is taken the American headcount may approach to 115 billion. We add each year between 2 and 3 million to our population a number about the size of the city of Philadelphia. If that rate remains constant we will be a nation of approximately 300 million at the end of this century. Thirty two short years away that right may not remain constant

almost a third of our nation is below the age of 15. That's more than 60 million boys and girls. Almost all of those 60 million will grow to manhood and womanhood. Almost all of them will marry. Almost all of them will have children. Will they have on average one child two three four perhaps more. The answer to that question is not merely an exercise in arithmetic. It's the formula of disaster or of survival. It's hard to believe that the decision to have one extra child could trigger a national disaster. But in fact the difference between an average American family of three children and an average American family of two children is the difference between a population that will double in size in 50 years and a population that will remain the same. The difference between the United States of America more than 400 million when a baby born today reaches his 50th birthday. Or a nation that will remain at its present size a little more than 200 million.

Do we really want to be a nation of three or four hundred million. Professor in company with many other distinguished social scientists thinks that 200 million plus we may have already passed the limit of a desirable population size. He points out that America has added 70 million to its population in less than 37 years. Here are the words Professor Archie used to tell how he feels about that population growth. With this enormous growth we have polluted our air streams lakes and sea shores to a degree that in some cases they have been irreparably spoiled. We are consuming natural resources faster than they can be replaced and we're putting impossible pressures on our recreational facilities ecologically we seem hell bent on creating as degraded an environment as possible for those future generations who might survive us if man is going to live in an environment of high quality. He

must learn to be a part of his environment interacting with it and not just consuming and in some cases destroying it. Dr. Joseph Beasley eminent obstetrician and gynaecologist and professor of population and public health at Harvard University also believes we have a domestic population problem. The reason I think we have a calculation problem is that we had about 60 million children. Fourteen years in and one of the major research institutions made a study in any case did it. They predicted at this rate the number of children in the United States 14 years was going to increase to somewhere around 90 to 100 million children by the year 2000. Thirty two years now we are currently running ahead of this prediction. 1960. And we have one thing that we haven't thought about. There were a large number of babies born after World War Two. A baby boom between 1945 and in

1982 1960. Now there are a larger number of girls who are coming into maturity and are getting married. The number of marriages is increasing the number of girls who are now 18 to coming in the form families getting married is increasing and will be increasing over the next certainly over the next 15 years. So how many children we have and how rapidly we grow depends on how many children these families decide to have. If they continue to reproduce the way we have in the last 20 years I think we're going to have a very severe population problem. The reason is not only we're going to have to deal with the problems that we have now developing the potential of our children. Fourteen years in terms of their health their education and their motional situation. But we're going to have to provide facilities. For almost twice as many children

14 years and under as we currently have. And we're going to have to do that. And at the same time improve all of our tremendous deficiencies that we have now and especially deficient in the care of children in the poorer families. We've got to do that in a space of thirty two years. We're also going to have to do it at a time cost in terms of human and in terms of money. What is going on. So if I take that to mean the country to be the basis of any good babies and raising them to good citizens so we're going to do this job well and do it so much larger number of children that unless we change some of our guidelines some of our priorities and are willing to put a greater investment in the development of the potential of our children and of a large number of children. I think we're going to have a population problem. Hopefully the idea will start catching on that yes even the United States has a population

problem. The role of family planning will have to have some priority in our thinking if we want to solve our expanding growth rate. In 1980 the expectant mother will be older than she is today. She'll be better educated she'll have married later. She'll hold a job and live in a giant urban complex and she will plan her pregnancies and space her babies farther apart. The maternity center Association is a voluntary organization that concerns itself with the health of mothers. The Association recently marked its 50th birthday with a professional seminar at Princeton University one of the leaders of that seminar was Dr. Seymour Romney chairman of the Department of Obstetrics and Gynecology at the Albert Einstein College of Medicine and a member of the associations medical board. A population crisis reporter asked Dr. Romney what role he saw for family planning in the marriage of the future.

I would ask that very readily by suggesting that. The woman. Should have probably the opportunity to terminate pregnancies that she would venture into. If you were affected. Female has the responsibility for the nine months of pregnancy she is entitled to and probably must to vigorously express her wishes in wanting a family. Planning your family and indeed exercising the contraceptive influence into a marriage. Do you foresee any changes in contraception. Well I can I can assume there will be developments which will allow the male to assume as much responsibility for contraception as the female. The inclination at the present time has been to vigorously develop techniques which protect the female. But I think the evidence is clear that there's no need to exclude the suggestion that the male will have to

exercise as much responsibility for a matter of fertility regulation. The seminar predicted five million babies born in 1980. That's against three and a third million born last year in 1967. And this would be the largest number of babies born in any one year of our history and it seems to support the fears of those who worry about our rapid population growth. Are you worried about our population growth. There's no question that rapid population expansion is the population. In this thread which is the equivalent or perhaps even greater than the threat of the atomic explosion in the next breath the evidence is that man is a very resourceful and ingenious individual and that solutions will be forthcoming. I think the projections in terms of absolute population in some instances have not come into it as much as we've been anticipating since we've become to the threat. Of uncontrolled population growth. There's no

question that the problem of population explosion crept up on us. On the other hand now that man is supplying itself with some diligence to bring some solution into the problem I believe can look forward to some degree of optimism to achieving greater restraint or greater control in this area. Dr. Alan Guttmacher director and president of Planned Parenthood in New York City has been quoted as saying We're still on the horse and buggy stage of contraception but man has shown resourcefulness in other areas. Now is the time for him to direct this initiative toward solving his very own reproduction rate so that the life has not only quantity but quantity. This has been birth control today and responsibility. The next programme in this series will discuss the pros and cons of family planning special guests today were Dr. Robert Chalmers from the Department of clinical pharmacy at Purdue.

Mr. Harold Neiman local pharmacist and doctor lawyer Combs produce student health center director. The series was written and produced by Colleen Gary narrated by David Brody recording engineers Morris Morgridge and also Roger priest the series is presented through the instructional radio division of WBA at new university West Lafayette Indiana. This is the national educational radio network.