Interesting Links for 19-11-2023

[andrewducker]

1. The UK's economic assessment for vaccination eligibility is a masterpiece of fraud. (We bought the vaccines and then didn't give them to people it would have helped, even though it would also have helped others!)

(tags:vaccination UK OhForFucksSake )

2. Pharmacies prescribing the contraceptive pill will put women's mental health at risk

(tags:depression hormones women mentalhealth contraception )

3. Russell T Davies on the portrayal of disabled people (and facial scarring) and why they decided to change Davros

(tags:disability drwho evil TV society )

4. Evil Cripple - TV Tropes

(tags:disabilities society tropes TV )

Comments

[autopope]

The clickbaity "pharmacies putting women's mental health at risk" piece is an op-ed by a lifestyle journalist; there's no new research feeding it, it's alarmist in tone, and while her personal blog didn't ding my "danger: evangelical!" bell, it didn't not ding it. (Women on the pill don't get offered routine mental health check-ups anyway, whether prescribed by their GP or a pharmacist, so this comes over as an anti-contraception hit piece on some level, whether intended by the author or by the editors.)

[andrewducker]

There's no change in evidence, but there is a change in how medication is being prescribed.

I do agree with her that we *should* be monitoring people's mental health when giving them things that can affect it. I agree with you that we don't do enough of it already.

[autopope]

Pharmacists prescribing contraceptive pills was a live issue back when I was a pharmacist, in the second half of the 1980s. This stuff moves slowly.

(There's a very clear trend among American anti-abortion campaigners to extend their opposition to cover the morning after pill, and then hormonal contraception in general, and finally all forms of birth control. I'd be very cautious about taking any stories about contraception side effects at face value in the current media climate unless they're backed up by a peer-reviewed source, and even then I'd want to dig into the authors' funding and association.)

[andrewducker]

To be clear, I'm with you on this, and I'm not saying that we shouldn't do it. I just think that we should be aware of what the effects might be, so that if there's a sudden uptick in depression we know what's going on, and can put something in place to deal with it.

(And I know enough people whose mental health was fucked up by hormonal contraception despite assurances from GPs that there are no side effects to them, that I would view any arguments against that as not listening to women.)

[mountainkiss]

It’s also important to look at the counterfactual. What is the ease with which women are currently gaining access to contraception and how if at all will pharmacist prescription improve this? Both terminations and unplanned children are also not great for women’s mental health. (I have no idea what the data says, but in principle there are two sides to this.)

[andrewducker]

To be clear, I'm with you on this, and I'm not saying that we shouldn't do it. I just think that we should be aware of what the effects might be, so that if there's a sudden uptick in depression we know what's going on, and can put something in place to deal with it.

[mountainkiss]

And I don't disagree with that either. I think it would be good both for the system to scaffold (with what money?) and for women to know more about this (albeit that this too has a shadow side).

[nancylebov]

2. I think it should be "pharmacies prescribing the contraceptive pill will put women's health at more risk", considering that doctors are making the same mistake.

One of my friends noticed the side effect of depression long ago, and found that zinc solves it, but apparently zinc has its own problems.

Pharmacies prescribing the contraceptive pill will put women's mental health at risk

[jack]

I feel bad, I think I have a similar rant to yesterday.

I think the author is 100% right that indiscriminately recommending the contraception pill is a problem and the medical system doesn't acknowledge the problems a lot of people have.

But I think the current system amounts to "the GP will basically prescribe it to anyone without really having time to address any potential problems". The pill is sufficiently well known that just saying "anyone who wants it can just use it, anyone who doesn't want to", seems like it will basically work equally well, since seeing a GP doesn't really provide any extra safety.

I agree that it would be good if we DID have doctors checking in on people whether they have any of these problems (but could equally well be at a regular checkup for "anything that bothers most people"). But we don't. We have three choices: the current system with none of the benefit AND waste a lot of GP time rubber stamping prescriptions; allowing people more choice to choose for themselves which is currently proposed; or forcing people to go through a charade of pretending that the GP will have time to think about this and hoping that it will get sufficiently bad that we will fix the medical system and give GPs more time to pay attention to each patient individually.

I would like more resources for GPs!! I would like anything that helps with that. But that's being voted on. And I don't think gatekeeping the contraceptive pill will make that any more likely, so there's no benefit to doing it. (Unless the bad effects are so prevalent that MOST people should avoid it, which I think we don't have evidence of yet.)

I am conflicted because I think some of the push to "let pharmacies do this" comes from the current government trying to patch over the parts of the system that are systematically under-resourced, and that that does have problems of "this would be ok in theory but it's going to lead to this treatment being taken less seriously" for some of the things. But in cases where I think people could mostly choose for themselves equally well, I don't see any reason to prevent it.

[bens_dad]

2. Are pharmacies or *pharmacists* prescribing the pill ?
Or are they available over the counter ?

Pharmacies dispense three sorts of medicine: the ones you can take from the shelf for the teenager on the counter to sell you; the ones behind the pharmacist that they may sell you after you answer some questions; and those for which you need a prescription from a doctor.

I presume that the contraceptive pill is moving from 3 to 2.
If you choose not to talk to the pharmacist in the consulting booth, it would be a literal over-the-counter transaction, but so is handing in a paper prescription and getting a box of pills. So take "over-the-counter" means just 1.

Pharmacists are pretty hot on side effects; my GP surgery has one (or more) to review my medicines every year, rather than have the GP do it.

[marymac]

Pharmacists are also much better at side effects and interactions, having been actually trained to spot them, whereas GPs aren't.

(Friend is a community pharmacist in an area where the demographic means a solid third of his work day is spent phoning GPs and going "I am not filling this script, it cannot be prescribed with X Y and Z! Can you not read?!")

[vivdunstan]

Re RTD and Davros the response has been quite mixed on the Gallifrey Base Doctor Who forum. Including from wheelchair users like myself. Yes some have experienced or witnessed bullying inspired by Davros and are concerned by the evil cripple trope. But others found RTD's words in the Doctor Who Unleashed documentary patronising and virtue signalling. One father also wrote about his daughter (11 or 12 years old I think) who is a wheelchair user, and was extremely upset by what RTD said and this change. She had always found Davros a strong character to look up to. And I think it's fair to say that one of the worst offenders in this area in the past has been RTD himself. Which makes his about turn understandable. But doesn't stop it being viewed by some wheelchair users as patronising and unwelcome. So it's complicated.

[dewline]

"Complicated" is a good word for it.

[calimac]

4) TV Tropes has irritated the heck out of me by listing Sauron under "Evil Cripple" and putting it under "Literature." No, it's only in the movie that Sauron is an eyeball; in the book he has a body. But even in the movie he's not intended to be thereby a cripple. The idea of Sauron as a helpless sac of vitreous fluid is a violation of the intent of both book and movie. Sauron seems all-powerful! He's terrifying! He's not the hapless comic relief that these theories seem to paint him as.

[teaotter]

Re: Davros

Haven't we had this conversation before? I thought we'd agreed that the answer wasn't to get rid of the minorities we do have, but to add more with a broader range of portrayals?

[andrewducker]

I agree that more wheelchair users would be the ideal approach. Hopefully we'll get that too.

But I can understand that when pretty much every equivalent in Doctor Who has been evil that if there's an easy way to change that then it's not a bad thing to do.

(I believe we had a positive example in Good Omens season 2)

[teaotter]

I can't speak for wheelchair users or other people with mobility aids. But as a queer person, I preferred the eras when I could see people like me onscreen, even if they were only the villains or the comic relief. Even villains got a human moment every once in a while, and I was happy for those scraps rather than being completely erased from the world. So that really shapes my opinion here.

I guess I hope they don't *stop* here, in trying to remedy the problem.

[andrewducker]

Forgot to come back and agree with you! I do think we need a wider range of portrayals, rather than cutting them out entirely.

[movingfinger]

1. Seems pretty clear that thinning the herd is the point of this policy.

[dewline]

A policy intended to kill, right?

[simont]

On Davros and disability: I suspect if you asked Davros himself, he wouldn't say that it's a disability that he has to use the bottom half of a Dalek instead of his humanoid legs. From his point of view, that's an improvement – he thinks Daleks are superior beings. He'd be sad that he's the wrong shape to put on the top half too and have a death ray!