Most of the time, Dr. Jen Gunter provides solutions, not questions.
A Canadian-born OB/GYN who now practices in San Francisco, Gunter is the creator of The Vagina Bible (2019) and The Menopause Manifesto (2021), whose plainspoken puncturing of the myths and misunderstandings concerning the feminine physique and reproductive system catapulted them to the higher echelons of the best-seller lists. Gunter is likely to be much more internet-famous for skewering the sucker-born-every-minute gross sales pitches of Hollywood actress Gwyneth Paltrow, who regales ladies with the wonders of steaming their vaginas and stuffing jade “eggs” into them at $66 a pop.
But she’s nonetheless awaiting a solution to the query she posed from her Twitter account, @DrJenGunter, on the afternoon of April 25.
“Hi @cvspharmacy,” reads the tweet, which Gunter additionally posted on her Instagram. “Can you clarify why your pharmacy in Florida refused to fill this prescription for misoprostol?”
The question is accompanied by a highlighted partial display screen seize of a physician’s prescription indicating that the order — a single 200-microgram pill of misoprostol to be taken “per vagina the evening previous to your process” associated to a prognosis of “stricture and stenosis of cervix uteri” — had been declined.
The motive: “FEDERAL JUDGE BANNED THIS MEDICATION RECENTLY.”
Hi @cvspharmacy are you able to clarify why your pharmacy in Florida refused to fill this prescription for misoprostol? pic.twitter.com/yIeeP9thE6
— Jennifer Gunter (@DrJenGunter) April 25, 2023
Reached by New Times, Gunter clarified in a textual content that “[t]his is not my affected person and I did not write the prescription. A health care provider simply requested me to make it public. I do know the particular person so I do know it is legitimate. All I do know is that they tried to get this for his or her affected person to assist with a GYN process and a CVS worker refused.
“I can say he’s an actual physician, and that is how we might write that prescription,” she added.
“One Tablet Per Vagina”
The tweet is temporary, the screenshot incomplete, however there was lots to unpack for the 4.5 million who’ve seen it.
First, and most obvious: The pharmacist’s be aware nearly actually refers to a pending case in Texas that challenges the U.S. Food and Drug Administration’s (FDA) approval in 2000 of mifepristone, half of a two-drug routine medical doctors prescribe to induce so-called medicine abortions. A Donald Trump-appointed federal choose revoked approval of mifepristone on April 7, however his order was placed on maintain and two weeks later the U.S. Supreme Court suspended the ruling till the Texas case is resolved.
In different phrases, the pharmacist could have been twice mistaken: Mifepristone is authorized, and the rejected prescription is not for mifepristone; it is for misoprostol — the opposite half of the two-drug routine.
Other commenters have been thrown off by the directions to be handed alongside to the affected person: “TAKE ONE TABLET PER VAGINA THE NIGHT PRIOR TO YOUR PROCEDURE.” The confusion prompted the OB/GYN so as to add her personal remark, by which she clarified that “one pill per vagina” is the technical manner of instructing the affected person to insert the pill into their vagina versus, say, consuming it by mouth.
Dr. Jen Gunter’s screenshot of a misoprostol prescription that was allegedly denied at a CVS pharmacy in Naples, Florida.
Then there was the prognosis: “Stricture and stenosis of cervix uteri,” a narrowing of the opening that connects the uterus with the vagina (the cervix), which may trigger ache and different issues.
“I write this [prescription] weekly for preop on my hysteroscopies for cervical stenosis sufferers,” a fellow OB/GYN commented beneath Gunter’s tweet. “I’ve caught hell of late. I’ve to name each pharmacy and swear in blood that my submit menopausal affected person with thickened endometrium is not making an attempt to abort. I’m so bored with this.”
Some sufferers shared that they too encountered resistance after being prescribed misoprostol for medical functions aside from abortion.
“I’m in Florida & was prescribed Misoprostol final week. I used to be grilled at Walgreens about it. I used to be capable of get it, however all people w/i earshot of the drive via is aware of extra abt my vagina than they in all probability wished to,” one confided.
Wrote one other: “I stay in Tampa they usually gave me a significant arduous time about this (for my endometrial biopsy!), it was infuriating.”
And a 3rd: “Texas right here. Had misoprostol for IUD insertion final December. Was grilled by a tech at Walgreens about why I used to be filling it regardless of it being on the label and my physician’s workplace calling to make clear verbally what the 2 tabs have been getting used for. Ugh.”
“Getting There Together”
As of 2016, in response to the National Women’s Law Center, 13 U.S. states had enacted legal guidelines or guidelines permitting pharmacists to say no to fill prescriptions on ethical or spiritual grounds. Seven of these states permitted refusals however required that the affected person be handed alongside to a different pharmacist or their prescription transferred to a different pharmacy. Six states particularly allowed refusals for spiritual or ethical causes with no strings hooked up. Eight states explicitly barred pharmacists from interfering with a affected person’s entry to prescribed medicine.
Under sure circumstances, pharmacists in Florida could — and could also be required by legislation to — refuse to fill a prescription. Those laws specify “managed substances” and, within the case of Florida Statute 893, “drug abuse prevention and management.”
Florida additionally supplies some statutory protections for healthcare employees who refuse to take part in abortions, together with a clause shielding them from legal responsibility for his or her refusal. And as New Times has beforehand reported, two related payments pending within the Florida legislature would broaden these protections and go as far as to permit healthcare suppliers (together with pharmacists) and insurers the precise to disclaim a broad vary of medical providers to sufferers on the idea of ethical, spiritual, and moral beliefs.
Pending laws would permit Florida pharmacists to disclaim prescriptions on the idea of ethical, spiritual, and moral beliefs.
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If the laws passes, suppliers may deny healthcare providers to a affected person due to a “conscience-based objection” stemming from a “sincerely held” private perception. Additionally, employers could be prohibited from punishing healthcare employees who cite such a “conscience-based objection” in refusing to carry out abortions and numerous different medical providers.
The ACLU of Florida described the measure as “surprising in its breadth, vagueness, and authorities overreach into the non-public sector and controlled companies.”
In the wake of final yr’s Dobbs choice, Amy Thibault, director of exterior communications for CVS — whose Twitter bio reads, “Bringing coronary heart. Prioritizing well being. Getting there collectively.” — confirmed to USA Today that firm coverage balances pharmacists’ rights with sufferers’ rights.
“Under federal legislation, we should fairly accommodate a spiritual conviction, and in sure states an ethical or moral conviction, that will stop a pharmacist or pharmacy technician from allotting particular medicines,” Thibault mentioned in a press release.
USA Today famous that “Thibault mentioned an objecting pharmacist should request an lodging from CVS forward of time and make preparations to make sure affected person care, both from a distinct pharmacist or elsewhere. Most states require that care suppliers who decline to supply providers or prescriptions should discover an alternate choice for sufferers.”
Under present Florida legislation, the affected person whose misoprostol prescription was rejected could file a grievance with the state’s Board of Pharmacy.
“Everyone Needs to Know This”
Several unspoken truths lurk beneath the floor of the CVS pharmacist’s alleged misattribution.
Though misoprostol has many different makes use of — together with “priming” the cervix — medical doctors have recognized for years that administering it alone, or together with medicine aside from mifepristone, is fairly efficient in inducing abortion.
Earlier this yr, Slate’s Christina Cauterucci spoke with Melissa Grant, chief operations officer at Carafem, which operates clinics in Atlanta, Nashville, Washington, D.C., and Chicago and likewise affords abortion medicine by way of mail order. “We now discover effectiveness charges with misoprostol by itself may be as excessive as 95 p.c,” Grant mentioned. “Mifepristone and misoprostol are about 98 p.c. So we’re actually speaking a couple of small distinction general.”
Gunter famous as a lot on her Substack weblog, The Vagenda, final yr.
“Mifepristone and misoprostol collectively is right, and whereas I feel everybody ought to have that choice, it might not be potential for everybody to entry. So it can be crucial that individuals know the way efficient misoprostol alone is and the place they will get it.” she wrote.
“There isn’t any manner any physician or nurse or police lab can decide in case you have taken it so long as you are taking it underneath your tongue or place the tablets towards your cheek,” added the OB/GYN. “Everyone must know this.”
“Everyone must know this.”
Gunter typed these phrases on May 5, 2022 — three days after the information web site Politico leaked a draft of the U.S. Supreme Court’s looming choice in Dobbs v. Jackson Women’s Health Organization, which signaled the tip of the federal assure to abortion that had endured for the reason that court docket’s 1973 ruling in Roe v. Wade.
Gunter’s submit was headlined, “Stop Talking About Coat Hangers and Start Talking About Misoprostol: Some ideas on the place we’ve got been and the place we go from right here from an OB/GYN.”
“The Prescription Has Been Filled”
Dr. Gunter was reluctant to elaborate on her April 25 tweet past confirming its authenticity and her relationship to the prescribing doctor. She did, nonetheless, share the situation of the CVS pharmacy that rejected the misoprostol prescription: 4890 Tamiami Trail East, simply outdoors the Naples metropolis limits.
A pharmacist who answered the cellphone there seemed to be conversant in the matter when requested a couple of latest prescription that had been refused. “The prescription has been crammed,” she mentioned earlier than declining to supply additional info, referring the matter to CVS Health’s company communications division.
“This was an remoted incident that was addressed and corrected on Tuesday [the same day Dr. Gunter’s tweet was published],” the division’s govt director, Mike DeAngelis, responded in an emailed assertion. “We perceive that the latest court docket choices didn’t affect entry to misoprostol and proceed to dispense the medicine as allowed by particular person state legislation.”