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Freedom Pharmacy

This is another one of those magical times when the worlds of retail pharmacy and national politics collide violently with serious consequences for both sides.

Because when it comes to questions like whether pharmacists should have the freedom to refuse to fill birth control prescriptions and whether it is acceptable to market the morning-after pill without a prescription, there doesn't seem to be anywhere for pharmacy executives or politicians to hide. And that says nothing for Food and Drug Administration regulators who have given up plenty of skin in this scrap, too.

These issues, which, of course, really stem from the much larger abortion debate that rages on in this country, continue to polarize America.

It is a debate that has manifested itself in a number of ways that impact pharmacy and national politics, as:

* states consider shield laws that empower pharmacists to refuse to fill patients birth control prescriptions--or, theoretically, prescriptions for any drug they find morally objectionable.

* lawmakers consider legislation that would impose fines on pharmacies that refuse for personal reasons to fill legal prescriptions.

* the FDA has acted slowly to follow up on the recommendation of one of its advisory committees to make the morning-after pill available OTC.

* congress held up for several months the confirmation of Lester Crawford as FDA commissioner--only approving the longtime FDA vet on the condition that the agency come up with a definitive yes or no answer on Plan B in timely fashion. A decision is expected by Sept. 1.

* congress considers a replacement for Sandra Day O'Connor, which many fear could be the first step toward a reversal to Roe v. Wade.

And really, I think that retail pharmacy and politicians would do themselves wise to keep a low profile on, this one, too--particularly the men. These are inherently women's issues. For a man to enter this discussion is to assume some kind of moral high ground that, to be quite frank, our gender does not entitle us to occupy.

Here are some numbers to consider:

* Women, frequently credited as making up roughly 80 percent of all drug store customers, also tend to vote Democrat.

* Women outvoted men in general 54 percent to 46 percent, according to a CNN 2004 voters' poll

* In 2004, 51 percent of women voted Democrat versus 44 percent of men. In the 2000 election, the gender gap was even more pronounced, with a 10 percentage-point difference between the number of women who voted for Gore over Bush.

* Women tend to be pro-choice--49 percent to 42 percent.

* As many as one-half of all American women will experience an unplanned pregnancy in their lifetime.

Confounding matters more is the fact that in 2004, voters listed moral values as the most important issue in the election at 22 percent, ahead of the economy/ jobs (20 percent), terrorism (19 percent) and health care (8 percent). Moral values as defined by voters can mean anything from abortion and birth control, to poverty and world hunger.

The GOP really needs to pay attention here. I have little doubt that the future of the Republican Party are the moderates in the group--particularly Sen. John McCain, R-Ariz., and former New York City mayor Rudy Giuliani, who would beat any two other candidates in America tomorrow. There was a time when I might have put Govs. George Pataki, R-N.Y., and Mitt Romney, R-Mass., in the same class. It is expected that both will make a run for the presidency in 2008--they didn't help themselves with their recent vetoes of legislation passed in their states that would have made Plan B available without a prescription, as it is already in six other states.

Even if you want to split the difference and say that only half of women would bristle at the notion of a pharmacist deciding whether she has the right to receive her birth control as prescribed by her doctor, do you really want to run the risk of alienating half of 80 percent of your customers?

Sure, pharmacists have rights, and every American enjoys the civil liberty to practice whatever religion they choose--no law should ever change that. But pharmacy leaders need to play this one very carefully. Where does religious freedom begin and end as it relates to the job of the pharmacist? What about biotech drugs that are the product of stem cell research? Should pharmacists be able to refuse to fill those scripts, too? What about HIV drugs? Should a pharmacist be entitled to deny a person with AIDS the drugs that keeps that person alive because the pharmacist presumes that lifestyle inappropriate? And what about the unfortunate young woman who has just been raped? Does the pharmacist have the right to make her feel victimized again?

And pharmacy executives and politicians alike need to think long and hard before sticking their noses into this debate.

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