Provision of emergency hormonal contraception through community pharmacies in a rural area.

OBJECTIVES: The provision of emergency hormonal contraception (EHC) through community pharmacies was introduced in Hambleton and Richmondshire, North Yorkshire, UK in December 2001 to contribute to the Teenage Pregnancy Strategy. The study aimed to establish how well the service is used, whether it is reaching the original target group, why people use the service and where it is accessed. METHODS: This was a descriptive study conducted in a rural primary care trust. RESULTS: From 1 January 2001 to 31 December 2003, there were 1412 pharmacy consultations for EHC and 1260 courses of EHC provided. General practitioner (GP) prescribing of EHC decreased but there was an overall increase in provision of EHC from pharmacies, GPs, family planning clinics, and accident and emergency departments. By December 2003, community pharmacies had become the largest provider of EHC. CONCLUSIONS: The supply of EHC through community pharmacies provided clients with wider choice and improved access to services, which resulted in increased overall provision of EC in this rural area.

Normalizing the exceptional: incorporating the "abortion pill" into mainstream medicine.

Mifepristone, also known as RU-486, and in the US known as "the French abortion pill", finally received FDA approval in the United States in September 2000. This paper discusses the steps now in process to integrate this drug into mainstream healthcare and the sociological implications of those efforts. Each of the steps that is normally taken to introduce a newly approved medication in the US context is rendered highly complex in the case of mifepristone--because of the unique circumstances of abortion in both American culture generally, and medical culture specifically. The story of RU-486/mifepristone, as it is currently unfolding, can be understood as one of attempting to "normalize the exceptional". After offering a brief historical overview of the protracted struggle for FDA approval of mifepristone in the US, this paper discusses the typical processes for integration of a newly approved medication into mainstream medicine and contrasts this process with the special challenges posed by a drug that is associated with abortion. We outline the challenges to implementation, including both external and internal obstacles. We compare the traditional role of a pharmaceutical company in drug diffusion and the circumstances of the company that produces mifepristone in the US. We discuss such external obstacles as the conflict between the FDA-approved regime and an evidence-based alternative; the necessity for physicians to order and dispense this drug; the ambiguity over the need for ultrasonography; and insurance reimbursement, malpractice, and other legal issues. Internal issues addressed include "turf issues" between medical specialties and between physicians and advanced practice clinicians as well as concerns over "cowboy medicine", and patient compliance. This paper concludes with an exploration of the sociological implications of this effort to "normalize the exceptional".

Levonelle-2 for emergency contraception.

About 190,000 therapeutic terminations of pregnancy occur in the UK each year. Many of these could be prevented by the use of emergency contraception. We have previously discussed the use of combined hormonal emergency contraception. Now, a progestogen-only emergency contraceptive, levonorgestrel in the form of [symbol: see text]Levonelle-2 (Schering Health), has been licensed in the UK. The manufacturer claims that the treatment offers "unsurpassed efficacy in oral emergency contraception" with "significantly less nausea and vomiting than combined oral emergency contraception". We investigate these claims and discuss whether Levonelle-2 is an advance in emergency contraception.