Health: The unexpected return of the IUD
MOHLER’S MEDICATION MAXIMS
Stones in Camels?
Early IUDs. Nomadic traders who wanted to keep their female camels from getting pregnant during long treks across the desert, put stones into their animals’ uteri. That’s the story! When Arab gynecologists hear this story, they chuckle and retort, “Have you ever tried to put a stone in a camel’s uterus?”
Why should a billionaire businessman be passionate about a tiny T-shaped piece of plastic? And what does his concern mean in terms of independence for Colorado women?
This is a story about intrauterine devices, IUDs, not improvised explosive devices, IEDs, as my voice-recognition software wants to type. IUDs are tiny medical devices inserted via a straw-like tube through the cervix into the uterus. IUDs, both copper and hormonal types, work to prevent pregnancy by creating an environment that makes it more difficult for the sperm to reach the egg.
IUDs are extremely effective forms of birth control. All IUDs are more than 99 percent effective compared with oral contraceptives, 92 percent, or condoms at 85 percent. Once the IUD is in place, contraception is in place for three to ten years, without any action on the part of the woman. So why have IUDs not been a more popular birth control method?
Two barriers to IUDs
Remember the Dalkon Shield, that scary sea creature-like plastic device with 10 stubby arms? The design of the IUD string drew bacteria into the uterus, resulting in infections, infertility and pregnancies outside the uterus. Several women died. The Dalkon Shield disappeared in the mid-1970s as did all interest of pharmaceutical and technology companies to do further research.
The good news is that the redesign of IUDs has eliminated the disastrous side effects of the Dalkon Shield. Currently available IUDs are extraordinarily safe with no evidence of increased pelvic infections, pregnancies outside the uterus or loss of fertility. IUDs are safe and effective for women who have had babies and for those who have never been pregnant.
The second major barrier to IUDs, cost, remained. Today, Mirena, a hormone IUD, costs $810 for the device alone — totaling 100 hours of work for a woman making minimum wage. Although IUDs are cost effective when you consider they may remain in place for three to ten years, many women are not able to afford the up-front charges.
In February 2015, the FDA approved a new IUD, Liletta. There is nothing novel about Liletta’s design. Liletta is unique in its affordable price tag for poor women. Public health clinics can buy Liletta for $50! How did this happen in our greed driven pharma/tech industry? The answer is in two words — Warren Buffett.
Warren Buffett has been a long time benefactor for women’s health. His foundation funded the research, development and approval process for Liletta, but also required that the project be self-sustaining. So Medicines360, a non-profit company specifically developed for this purpose, designed an IUD almost identical to Mirena. Medicines360 partnered with Allergan, a for-profit Irish pharmaceutical company, who is selling Liletta at slightly below market rates to private providers, essentially subsidizing the lower prices for the public health sector.
Tax filings show that during the period 2008- 2013, the Buffett Foundation spent about $50 million in Colorado, with roughly half going directly to the state. The state has spent this money buying the IUDs and hiring and training clinicians to counsel and insert IUDs. In 2014 Gov. Hickenlooper released the results of this intervention, showing that the Colorado teen birth rate had dropped 40% from 2009 to 2013, and the teen abortion rate was down by more than one-third.
The Other Good News: The Affordable Care Act makes most forms of birth control available to insured women without a copay.
How can it be that in this richest, most technologically advanced country in the world that 50 percent of pregnancies are unplanned?
In 2011, the American College of Obstetrics and Gynecology updated its guidelines to support a broader use of IUDs. In 2014, the Centers for Disease Control (CDC) encouraged clinicians to teach their patients about birth control and to start by introducing the most effective ones, like IUDs.
The Family Planning Clinic at the Mesa County Health Department, 248-6900, has Liletta, and other forms of long acting, reversible birth control available.
Thank you, Warren Buffett.
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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