Why the fuss over disclosure of physician billings?

720 CMAJ, July 14, 2015, 187(10) ©2015 8872147 Canada Inc. or its licensors Right now, a woman turned away from her pharmacist has only one option for emergency contraception: getting a copper IUD inserted into her uterus by a physician. Copper IUDs are more than 99% effective at preventing pregnancy, but they can be expensive (up to several hundred dollars) and finding a doctor to insert the device within the recommended 120 hours can be difficult. One American study shows 85% of clinicians never recommend the device for emergency contraception, and 93% required two or more visits for an insertion. The intimate nature of insertion, and the fact that IUDs can cause heavier, longer and more painful periods, also means the device isn’t appropriate for everyone, says Guilbert. A new emergency contraceptive drug, ulipristal acetate, will become available in Canada under the brand name Ella in the fall this year. The drug is currently available as an emergency contraceptive in Europe and the United States. There’s evidence it’s also more effective than levonorgestrel for women with a BMI over 30, says Guilbert. “The risk of unintended pregnancy is much less, like 2.5%, compared to almost 6% for women using levonorgestrel.” However, the introduction of Ella won’t dramatically improve access to emergency contraception for heavier women, as the drug will only be available by prescription. “It could take one or two years before it can become over the counter,” explains Guilbert. In the meantime, “Health Canada should withdraw their recommendations regarding weight and levonorgestrel.” — Lauren Vogel, CMAJ