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Politics and medicine intertwined again in the battle over the so-called morning-after pill, or Plan B, which is designed to prevent pregnancy from occurring if taken within 24 to 72 hours of unprotected sex. Religious conservatives object to the drug, seeing it as abortion by chemistry and likely to encourage sexual activity among kids. The pill was made available by prescription in 1999, and in 2003 the manufacturer sought Food and Drug Administration (FDA) approval to make it available over the counter. Three FDA panels and an outside advisory committee recommended that the agency okay the change--usually all that is required. But the FDA gave it a thumbs-down.
Pro-choice groups charged that ideology was driving health policy, and a newly released report by the Government Accountability Office suggests that the fix may indeed have been in. Then FDA chief Mark McClellan and other FDA officials reportedly informed subordinates in 2004 that the Plan B application would be rejected, no matter what.
The FDA found itself in an even more difficult spot concerning the question of when to place safety warnings on prescription drugs--an issue that draws heat no matter what the agency decides. The twin revelations that the hyperactivity drug Strattera could increase suicidal thoughts and the painkiller Vioxx could double the risk of heart attack and stroke led to charges that the agency had failed to protect the public. The FDA responded by announcing that it would change the standards it uses for placing warnings on drug packaging, adding new or beefed-up labels when there is merely evidence--not proof--that a medication may be dangerous. To date, the agency has issued more than a dozen health advisories this year pertaining to drug risks compared with just two in 2003. For its pains, the FDA is now being charged with crying wolf.
If medical issues got muddled in the U.S., where health care is at least generally available, the situation improved in the developing world, where too often it is not. In 2003 a polio epidemic broke out--eventually reaching 17 African and Asian nations--when Muslim leaders in northern Nigeria banned the polio vaccine, claiming that it could spread AIDS or sterilize girls. After a year's hiatus, the government lifted the ban, and this year the World Health Organization and Rotary International, with a grant from the Bill & Melinda Gates Foundation, began an aggressive revaccination campaign, chasing polio out of 11 of the countries in which it had newly taken hold.
The Gates Foundation also took the lead in battling malaria, which kills 1 million people each year. The foundation increased its already generous grants for research by $258 million, which means that it will soon provide more than a third of the world's entire malaria-research budget. Elsewhere, an experimental vaccine created by pharmaceutical giant GlaxoSmith Kline has been shown to reduce severe malarial episodes almost 50% in some types of cases and to remain effective for at least 18 months. That's far from lifetime immunity, but it's closing in on the goal.
Against such crises, U.S. health worries can seem frivolous--particularly our preoccupation with our waistlines. But the American obesity epidemic remains serious. An estimated 65% of us are overweight or obese, including 16% of children ages 6 to 19.