Looking for a contraceptive that's convenient — and tasty?

That's how the news story on chewable birth control pills began.

I can't help thinking WHY? What, other than having a new pill, is the fucking advantage of chewable minty freshness? The write up is all about making it easier to take the pill (correctly). The drug’s site references this. "Research has shown that compliance still impacts oral contraceptive failure rates, and anything we can do to make it easier for our patients to maintain a daily regimen is a notable advancement," said Laurent Delli-Bovi, MD, Medical Director, Women's Health Services at Chestnut Hill Family Planning Facility in Boston, Massachusetts.

While I may feel cantankerously skeptical about the worth of a chewable pill, I do know that medication compliance is certainly nothing to be sneered at. For example, a staggering majority of people being treated for Hepatitis C will not complete the entire course of treatment because the side effects are just so horrible. Less treatment means lower chances of clearing and kicking the virus. Similarly, if you miss just a few birth control pills (bcps) in a month, you lose a significant amount of efficacy. Less effective means more chance of preggers. It also means a change in the risk/benefit ratio and when a medication's risks are just barely outweighed by the medication's benefits, it doesn't take much to tip the scales so the drug is too risky to take. Hormonal contraception has plenty of hefty inherent risks to weigh against. In the category of inherent risk, I’m including only the ones that exist even when we don't consider factors like interactions with other medications. Some of just the short term inherent risks of bcps are weight gain, mood changes, loss of libido, and death. (For the full list look under the heading "side effects and possible adverse events" or somesuch, printed in the tiniest font imaginable on the insert which has been folded into an impossibly small but quite dense packet, glued shut, and jammed in with your pills.)

It seems women who choose to use bcps perceive the apparent risks to be outweighed by the apparent benefits, where the big benefit presumably is the increased freedom from and control over one's reproductive cycle and where death should be considered the most obvious and serious immeidate inherent risk. I think, though, that such a comparison of medical risks and benefits is not as integral to the decision of what contraceptive to use as it should be. If it were, the favored option would be condoms. Condoms are not just the best bet in terms of lower inherent risks. They won't give you a stroke or make you fat, and they will keep you not preggers if you use them right. Pills? They'll keep you not preggers if you use them right. Also, condoms have the added attraction of being good for you by limiting exposure to several nasty diseases like HPV, HCV, HIV, plus all the good old fashioned ones. Obviously, if the decision were only or even primarily in terms of health benefits and risks, condoms win. But they don't. Why not? Compliance.

Because condoms are not user friendly and they are not user sexy. A condom is a latex wrapper which requires a certain degree of practice if not skill and a kind of shamelessness which in some contexts can be seen as unappealingly wanton. Using condoms might raise unspoken questions about how much roll is left at the bottom, an issue which for some people could affect The Mood. Condoms can necessitate a higher level of lighting, especially for folks who haven't had tons of experience putting them on. All of these spell out a kind of encounter that is highly incompatible with what seems to be typical, vanilla, het US sexuality.

That pills come in at all should suggest that the issue of compliance isn't just about risk/benefit, side effects, or efficacy. It's not about health related issues. It's about userfriendliness and also usersexiness. We live in a culture where long standing norms mandate that feminine (sexual) availability and desirability to a man universally trump the woman’s health and wellbeing. So in terms of the user friend/sexy aspects of compliance, birth control pills, although they can kill a woman in a couple of ways (or leave her forever dribbling into a drool cup) are a far better contraceptive. I find this revolting. However, it's a choice people are allowed to make, not just the eventual choice of specific contraception, but the decision of how to assess the available options.

In light of this, I can see that it makes sense to improve bcps as a form of hormonal contraception. I can even see that there is some benefit of focusing on increasing compliance in terms of making them more user friendly/sexy since this seems to be an aspect which carries a lot of weight in people's decisions about what to use and how to use it. And still, I can't quite see how making chewable mint flavored pills will make them better in ANY way. Of course being chewable or mint flavored makes them no more effective or less dangerous. Would chewable pills increase patient compliance in terms of user friendliness or user sexiness and thereby at least give more women the full 99% efficacy to weigh against the full set of health hazards associated with pill use? Not really.

According to the story, the new chewable mint flavored bcps will address the pressing needs of
A) Women who "don't like swallowing pills"
B) Women who "want to take their birth control with them"
C) Women who "sometimes forget to take their pills"
There is so much wrong here.

Let's start with B. So the chewable pills are easier to take with you? They are no easier to take with you than the nonchewable counterpart pills. Loestrin(fe), the old school nonchewable counterpart of the new pills, comes in a pack that is credit card sized. According to the AP story, the new improved chewable pills come in a credit-card sized dispenser kept inside a velvet pouch. The velvet pouch cannot possibly make that big a difference. If the dispenser is too much, you can pop one or two pills out and stash them all sorts of places (e.g., the bitty front pocket on jeans, in a compact). But you can do this regardless of whether the pill is chewable or not. In fact, the nonchewable might have the advantage here since who wants to chew up some pocket lint with their bcp? Before I got all the way through the article, I remember thinking “it might be nice for when you don’t have access to water or liquid and you need to take your pill within the next two hours or something to avoid feeling ill when you wake up” (that was always an issue for me when I took them…the timing was critical or I’d wake up hurling). Then I got to this part: Women must drink 8 ounces of water with the tablet. The chewables are as fucking portable or not portable as the nonchewable counterparts are. Both still require access to water to take. No advantage here.

And then there's C. This was just insultingly illogical. How the fuck would making the pill chewable make it easier to remember? No advantage here.

That leaves A. It’s for women who don’t like swallowing pills. This at least logical, but it's pretty damned weak. I've had to take some antibiotics which I thought perhaps I should use a fork and knife on, and generally I'm not someone who's got swallowing issues (hey don't go reading into that). But I hadn’t realized that this is, was, or could be a significant issue in compliance with this particular type of pill. Have you ever seen how small the nonchewable bcps are?

While I know there are some people who have problems swallowing pills, I have a hard time believing that this is a major reason why women might not take their bcps correctly. The drug company may as well have just changed the color. So clearly this innovation is just a ploy, and given how seriously shitty for you bcps are, it's a disgusting ploy. It's also a stupid ploy. If compliance in contraception use comes down to how user friendly/sexy it is, then they're gonna need something other than chewable minty freshness. If the drug companies can't get their heads around making safer hormonal contraception, maybe they should at least rethink the whole makes you fat, angry, and unarousable part.