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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington. After a stalemate that lasted three years, the Food and Drug Administration announced last week that, come this fall, women over the age of 18 will be able to buy the morning-after pill, or Plan B, without a prescription. If taken within 72 hours after unprotected sex, the drug reduces the chance of pregnancy by 89 percent.

Neither side in this debate is completely satisfied. Supporters of the pill argue that emergency contraception ought to be available to younger women as well. Some antiabortion activists say Plan B is not emergency contraception but an abortion pill, while others worry that it might increase sexual promiscuity.

Before it was over, the fight over approval came to incorporate debates over science, ideology, religion and power politics as well. Later in the program, unrest in Pakistan over the death of a nationalist leader in the province of Baluchistan, plus all the news that's fit to whiff.

But first, Plan B. If you have questions about the science or about the political calculations on both sides, why this issue, why now, our number here in Washington is 800-989-8255, 800-989-TALK. E-mail is talk@npr.org.

To begin we turn to Julie Rovner, NPR's health policy correspondent, who's with us here in Studio 3A. Always nice to have you on the program, Julie.

JULIE ROVNER reporting:

Nice to be here.

CONAN: And why don't we start with the science because this is - the interpretation over some of the scientific issues really get at the heart of some of these other debates.

ROVNER: Yes, it's been a long and arduous scientific road. I think to start off with some of the basic science, Plan B is just high doses of regular birth control pills. In fact, as far back as 1997, the FDA was trying to encourage the use of this as emergency contraception by putting out itself a guide to how to take regular birth control pills as emergency contraception, and it actually urged manufacturers to package it in such a way that it would be easier, which is exactly what Plan B is.

It is not the abortion pill RU-486. In fact, the two don't work at the same time. Plan B can prevent a pregnancy. RU-486 can terminate one. But Plan B if it's taken after a pregnancy has established itself won't work. And RU-486 if it's taken too early won't work. So there's - they don't intersect at all.

CONAN: Yet - now we get to the heart of the issue, which is what is pregnancy? When are you pregnant?

ROVNER: And that is another issue that's come to pass in this. There are a number of pharmacists around the country who've said they don't want to dispense this because they believe that it's not a contraceptive, even though that's the way the FDA classifies it, but an abortifacient. And they make that claim based on the fact that there is some thought that Plan B can work by preventing a fertilized egg from implanting in a woman's uterus.

Now most evidence suggests that the way it works mostly is to prevent ovulation, so it prevents there from ever being a fertilized egg. But there is the possibility that if there is a fertilized egg and you take it afterwards that it might prevent it from implanting. These pharmacists consider that to be a form of abortion.

However, most doctors suggests that pregnancy starts - from a practical point of view - when you can measure it, and that would be after implantation. So really medically, pregnancy does not start until after implantation. If this were to prevent implantation, there would be no pregnancy for this to end.

CONAN: Mm-hmm.

ROVNER: So scientifically, this is definitely considered a contraceptive. But there are those who have their own opinions on the subject.

CONAN: And indeed there are those who have opinions over why it took the FDA three years to decide this case since, as I understand it, there's not a lot of argument over the safety of this drug.

ROVNER: No, in fact, there's no argument over the safety of this drug. Two FDA advisory committees met in late 2003. They voted 27 to 3, I believe it was, that it should be - that the drug should be made available over the counter to all age groups, and they voted unanimously that it was safe.

So there's - it's not a safety issue. It's mostly these political issues of the small minority who believe that it can work as an abortifacient and I think a larger minority who worry about the possibility that it would, you know, if not cause promiscuity, allow - encourage, you know, younger teens to have sex with impunity.

CONAN: Any evidence to back up that fear?

ROVNER: Actually, there really isn't. This is available - this drug is available over the counter in 41 countries. There have been a number of studies. There were obviously studies done here in the United States. It's available in nine states without a prescription, although from specially licensed pharmacists. And there really has been no evidence that it makes riskier - that there are riskier sexual practices associated with - ironically, it also doesn't do a whole lot for the pregnancy rate either.

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CONAN: That's what I was going to ask. I've read various analyses suggesting that this is not going to - if you didn't know that this had been approved, you wouldn't be able to measure the difference statically.

ROVNER: That's probably true. I think one of the reasons its supporters will say that's the case is that so many women don't know about it, that even when it was - it's been available as a technique for years and years, used by rape crisis centers, used by some hospitals, used by some doctors, college health clinics, and yet it really is sort of a little-known way of actually protecting against pregnancy after the fact.

CONAN: I wonder, do you know anything about the marketing plans? They're advertising all sorts of embarrassing things on TV these days. Is this going to be on TV?

ROVNER: The company said last week it does not plan to advertise this or to have a major marketing campaign for it.

CONAN: And so for a lot of people, since this is not going to affect a huge number of cases, for a lot of people on both sides this was a slippery slope argument.

ROVNER: It was. And also this was a slippery slope argument about the FDA in general, about whether the FDA decisions are driven by science or by politics. And I think that's been one of the biggest issues here, that this was a decision - that there is much evidence that this decision was made not necessarily based on the scientific evidence. The senior scientists - the career scientists at FDA recommended its approval over the counter. Some of them recommended its approval over the counter only for teenagers 16 and over.

CONAN: Mm-hmm.

ROVNER: There was - and that was because - not because there was data suggesting it was not safe for those under that age, but because there simply wasn't very much data for those under that age. Again, the advisory committee voted overwhelmingly that it be made available, and yet there's a lawsuit that's pending. And they've been taking some depositions, and there's some fairly senior FDA officials who said they were told by political appointees that this was never going to be approved for those under the age of 18. So the whole last two years of will it be 16, will it be 17 was kind of kabuki theater, that in fact the FDA - the political-appointed FDA had made the decision as early as August of 2003.

CONAN: And that this - they were just spinning this out to spin it out?

ROVNER: That's certainly the way it looks. I mean, it got spun out through a number of FDA commissioner - it got wrapped up in a number of confirmations. The Bush administration has had a very difficult time finding someone to head the FDA. It's a very sensitive position. The FDA regulates a quarter of all products sold in the United States, or 25 cents of every dollar spent in the United States is on a product that's regulated by the FDA. And so it's inherently a political post, and indeed this issue has followed now three FDA commissioners through their confirmation processes.

CONAN: Well, we're going to hear from both sides on the politics of Plan B. First, we turn to Senator Patty Murray, a Democrat from the state of Washington. She joins us now by phone from Seattle in Washington. Senator, nice to talk to you again.

Senator PATTY MURRAY (Democrat, Washington): Nice to talk with you today, too.

CONAN: Now you along with Senator Hillary Rodham Clinton of New York blocked the nomination of the president's proposed commissioner of the FDA in order to push this to a yes or no decision.

Sen. MURRAY: That's correct. What my concern and Sen. Clinton's concern was that the FDA is a regulatory agency whose responsibility is to follow the science. And when they are requested by a pharmaceutical company to see if their product is safe for Americans to use, they have two criteria: is it safe and is it effective? Their scientific review panel said that Plan B was, yet they refused to move this out and onto the market, and it became a very political issue.

CONAN: Do you believe that at end of the day, as some have alleged, that ideology took place over science in this decision?

Sen. MURRAY: Well, clearly, when the scientific review panel overwhelmingly said that this drug was safe and it was effective, and yet FDA refused to make a decision on it, it was very clear that there was some other kind of decision-making going on from some other place.

And it was very disturbing to me because I, like every other consumer in the country, go to the pharmacy, and when we buy something off the shelf, we want to know if it works and if it's safe to use. And if the FDA is compromised by political decisions, it won't just affect Plan B or women's right to healthcare products, it could affect all kinds of pharmaceuticals. So for me this was both an issue for women's health but a much higher issue of making sure that the FDA kept its credibility for Americans.

CONAN: The technique that you used, putting a block on a nomination, this is a blunt political instrument. It certainly got everybody's attention. Do you think in the end, the ends justified the means?

Sen. MURRAY: Absolutely. There's no doubt about it. And remember this has been going on for a while. Three years ago when the FDA refused to move forward on this, we were frustrated and concerned and kept saying what's going on? And a year and a half ago, when the FDA sent the previous - or when the administration sent the previous FDA administrator to us, Dr. Crawford, we held up his nomination.

And right before the Senate went out in August for a month, we were told by the administration that a decision was coming. We needed to get a nomination moved through. We said if the decision is coming by September 1st, we'll lift our hold. We'll let the nomination go through.

Well, no sooner did we do that and Dr. Crawford was put in place, they said, oh, sorry, no decision is coming. So this time around, after Dr. Crawford's resignation and a new nomination came forward, Dr. von Eschenbach, we were not going to lift our hold till a decision was made. And finally, this week, or last week, that did happen.

CONAN: And are you satisfied with the decision?

Sen. MURRAY: Well, I have concerns about the decision in terms of the age requirements, and I hope that the FDA can revisit that some time in the future. The scientific panel said that Plan B was safe and it was effective. But the 18-and-over requirement, and the requirement that women have to go ask a pharmacist for permission, to me is a concern. But we had said we want a decision, and they finally did make a decision. So because of that we've lifted our hold.

CONAN: Mm-hmm, and those other issues will be resolved maybe down the road.

Sen. MURRAY: I assume way down the road.

CONAN: OK. Let's see if we can get a caller on the line. This is Mike. Mike's calling us from Natick in Massachusetts.

MIKE (Caller): Hi, thanks for taking my call.

CONAN: Sure, Mike, go ahead.

MIKE: I believe my - it's more of a comment, actually. The purpose of the FDA - my understanding is the mandate of it is to keep our food, our drugs, you know, our things that we eat and drink, safe. And to put it into a political context, isn't that undercutting the absolute purpose of what the FDA is to do?

CONAN: Sen. Murray?

Sen. MURRAY: Well, that was my bottom-line concern, because some people would say, well, this is Plan B. It's just for women. It's a contraceptive. It's other things. But the fact is the FDA's role is exactly as your caller just said, to make sure that when we go to the pharmacy or the drugstore, we know that what we're buying is safe and it works. That's what FDA does. And if they compromise on this decision and fall to political winds, no telling what future decisions could as well. It could be based on - well, which company, which pharmaceutical company gave more money to a presidential campaign - on which drugs can get through? That's not what the FDA's role is, and we never want it to go there.

CONAN: Mike, thanks very much...

MIKE: And I think it's irresponsible to do that.

CONAN: All right, Mike, thanks very much for the call. We appreciate it. We'll have more when we come back from a break. Sen. Murray, we hope you'll stay with us. I'm Neal Conan. It's TALK OF THE NATION from NPR News.

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This is TALK OF THE NATION. I'm Neal Conan, in Washington. The FDA's decision to allow women older than 18 access to Plan B without a prescription did not end the political debate. As we've heard, supporters of Plan B want more access to the pill while some of those opposed worry that it encourages promiscuity, and some call it an abortion pill. Today, the politics of Plan B.

We're joined here in Studio 3A by Julie Rovner, NPR's health policy correspondent, and we're talking at the moment with Senator Patty Murray, a Democrat from the state of Washington, a supporter of the FDA's decision. In a few minutes, we'll get another side to this debate.

Right now we want to hear from you. If you have questions about the political power play that surrounded Plan B or about the science behind the pill, give us a call - 800-989-8255, 800-989-TALK. Our e-mail address is talk@npr.org. And Sen. Murray, you say you want younger women to have access to this as well. Where does that go from here?

Sen. MURRAY: Well, I think what most of us would like is for the FDA to follow its own scientific review panel which did say that prescription - Plan B, sold over the counter - was safe for all women to use. And now we have a restriction put in place that you have to show ID to a pharmacist behind a counter, which is - can be seen as a barrier.

The importance of Plan B, coming from just the drug itself, is that it's only effective within the first 72 hours. So if there are barriers in the way of women's access - if you're 40 years old and your birth control doesn't work, and all of a sudden you have to go find a pharmacist who's willing to give you this drug, that's a barrier. And I'm hoping that someday that barrier won't be in place.

CONAN: Sen. Murray, thanks very much for your time. We appreciate it.

Sen. MURRAY: Absolutely.

CONAN: Patty Murray, a Democrat from Washington, joined us today by phone from Seattle. Here's an e-mail we got from Amber in Ann Arbor, Michigan. I'm confused about the controversy over morning-after pills. I was under the impression that they work the same way as birth control pills do. Am I wrong in thinking this? And if I'm not wrong, why is there such a controversy over morning-after pills but not regular birth control pills? Julie Rovner?

ROVNER: No, the caller is not wrong. Actually, these are - Plan B is a progestin-only birth control pill, and which is less common than the combination birth control pills. But there are progestin-only birth control pills. They're usually called mini-pills. And in fact, some of the same pharmacists who don't want to dispense emergency contraception also don't want to dispense the progestin-only birth control pills. We've seen an increasing number of pharmacists who are expressing those exact same concerns about regular birth control pills, so I think that's the source of the confusion.

CONAN: And let's see if we can get a caller on the line. This is Garrett(ph). Garrett's with us from Denver.

GARRETT (Caller): Hi, I just was wondering if someone could tell me what's going to keep fathers, boyfriends, older brothers, men from going in and purchasing the pill and then turning around and giving it to the woman who needs it, say an underage woman?

ROVNER: As far as I can tell, nothing. This is something that I've not been entirely clear on. I've been trying to find out in these, you know, marketing requirements that basically this will be kept behind the counter.

So Sen. Murray is right. If there's - if the pharmacy is open and you're a 40-year-old woman and you need this, it's going to do you no good if the pharmacy counter is closed. So there does have to be a pharmacist on duty. And basically, the rule is you have to present either a prescription or proof of age.

Now one would presume that would be a woman buying it for itself, or perhaps a woman buying it for her little sister, or sorority sister, or whatever. But I don't know that it, in fact, if a man over 18 goes into buy it that - I think they'll have to sell it to him.

GARRETT: It just kind of seems to make the whole age thing moot, at that point.

ROVNER: That's certainly been the complaint of a lot of people who are against this.

GARRETT: Well, thank you for your time. Appreciate it.

CONAN: OK, Garrett, thanks very much for the call. Now is there as far as you know, Julie, an effort to take this the next step, to have it - a legislative step? Or how - what's the next move for those who want it available to younger women?

ROVNER: I think the next - the general feeling, I think, among those who I've talked to who want it available to younger women - and as Senator Murray pointed out, to have it more available to older women, too, since it's not quite as free as just going in and taking it off the shelf - is I think they think is probably the next administration. I think there's not a lot of thought that the FDA itself under any conceivable FDA commissioner is likely to make this change.

Although as I mentioned before, there is a lawsuit that is seeking to force - basically, what it charges that FDA has not followed the science and is seeking to force it to follow the science and therefore make it available to all age groups.

CONAN: And let's get Laurie(ph) on the line. Laurie's calling us from Grand Rapids in Michigan.

LAURIE (Caller): Hi, I had a comment for Senator Murray.

CONAN: Well, she's left us but - I'm afraid - but go ahead.

LAURIE: Oh, OK. I guess my comment is, you kind of look at the FDA and you say, OK, the FDA, they need to make sure that it's safe, physically.

CONAN: Mm-hmm.

LAURIE: But, you know, the doctors and nurses and healthcare are kind of going towards more holistic medicine where you're looking at the whole person - you know, how's your spirituality, the emotional, the physical - and I wondered, you know, is there any point in the FDA saying, you know, could this be harmful emotionally to someone, you know. I'm not saying I'm against this. I'm not saying I'm for it. I'm just saying, you know, if it can stop, you know, a fertilized egg from being implanted, you know, might a woman that, you know, she's desperate but maybe she's against abortion. But, you know, everyone gets in these situations.

CONAN: Mm-hmm.

LAURIE: And could, you know, she use it, and then could she feel guilty later? I'm just wondering...

CONAN: Is that something the FDA looks at, Julie?

ROVNER: I don't think there's anything about that in the Food, Drug, and Cosmetic Act, which is the statute that the FDA has to follow. But something the caller's saying is something that the FDA did talk about, which is that it's more than simply safety and efficacy, it's can this be used safely and effectively by younger teenagers? Can they, you know, follow the, you know, the directions and use it appropriately. And I think that was part of the concern that they considered, that at least Dr. von Eschenbach and some of the senior officials said was part of the science in trying to restrict it by age - was more than simply about is it safe and is it effective - but is it safe and effective...

LAURIE: Yeah, I see the...

ROVNER: ...and can it be used safely?

LAURIE: Yeah, I see the age restrictions as kind of good because, you know, if they can go to their mother when they're younger and say listen, mom, is this right for me? You know what I mean? I realize not everyone has that kind of relationship with their mother.

CONAN: Yeah.

LAURIE: (unintelligible)

CONAN: Difficult conversations even if you do.

LAURIE: Yeah.

ROVNER: Although the younger teens will still need a prescription.

LAURIE: Oh, they - yeah.

ROVNER: Although I suppose the mother could go in and...

CONAN: And do it for them, yeah.

LAURIE: And one point, too, you know, if they do have to go up to the pharmacist - I think the good point of that is that, you know, that they have an opportunity to ask questions. Maybe the pharmacist can open that door to say, hey, listen, you know, do you know - you know, just to open the door to questions and conversation that they might necessarily not have.

CONAN: Laurie, thanks very much for the call. Appreciate it.

LAURIE: Yeah, thank you.

CONAN: Let's bring a voice in from the other side of this debate. Rick Duncan is a professor of law at the University of Nebraska in Lincoln. He joins us from the studios of Nebraska Public Radio Network in Lincoln. Good to speak with you today.

Professor RICK DUNCAN (Professor of Law, University of Nebraska): Good afternoon, it's good to be here.

CONAN: I wonder, do you think, ultimately, did the administration blink on this?

Prof. DUNCAN: Well, I'm not sure. I - obviously, they were under great pressure because of the tactics used by the Senate Democrats.

CONAN: Mm-hmm.

Prof. DUNCAN: And so to that extent, I suppose they did. But I think most people - I'm not a scientist, I'm a constitutional law professor, and right now there's really not much of a constitutional law issue here. So, I'm more speaking today as sort of a concerned and a reasonably well-informed citizen and as a father of three daughters, including one who's 13 years old, and a loving father of those three daughters.

And I think the primary issue, for me at least, is the issue involving younger children, involving those teenage girls who are facing a really difficult life decision, a major life decision. And I think it is good that there be some, as Sen. Murray said, barriers. I don't think these are substantial barriers, but I think that it is good that - that it not be too readily available to teenage girls, because after all children are still children, and this is a major life decision.

And regardless of how we define pregnancy, it is clear that this drug occasionally operates, not by preventing conception, but rather by preventing the implantation of a fertilized egg. And for many people, that means that life has already begun and that makes it an abortifacient.

CONAN: And in that context, had the administration wished to, the president could have named his new commissioner of the FDA on a recessed appointment and just whistled at the Democratic Senate.

Prof. DUNCAN: Right. Well, my guess is this issue is not as big an issue as some others may be on the agenda for the president, and you have to use those recess appointments rather sparingly because they come with a great political cost. You might be more likely to do it with a judge than with a - than in the FDA.

CONAN: So from your vantage point at least, this was not priority number one in terms of right-to-life issues.

Prof. DUNCAN: Well, I think that's always been true. We have a number of Republican presidents who have run as strong right to lifers - but when push comes to shove - it's their views on taxes, or their views on security, or their views on, you know, business - deregulation of business - that really are the ones that motivate them. And the pro-life issues are ones that have almost always been secondary, that even was true of President Reagan who was probably the most pro-life president we've had in my lifetime.

CONAN: Let's get another caller on the line. This is Craig. Craig's calling us from Charlotte, North Carolina.

CRAIG (CALLER): How are you, Conan?

CONAN: I'm well, thank you.

CRAIG: Neal, rather.

CONAN: Yes, that's ok. I'll answer to either one.

CRAIG: Thank you for the talk about this debate. I'm a practicing ob-gyn doctor in Charlotte, North Carolina. I do have a teenage daughter that just enrolled in college. These issues are very much on the forefront for me, along with the cervical cancer vaccine and all those things. But, you know, it really does come down to not only is the morning after pill measurable that is - excuse me, is it safe and effective. Yes, it's safe. Yes, it's effective.

But the other question that really needs to be asked, that the Senator has not brought up, is that is it ethical? And that's where the other speaker mentioned, you know, if you go into the in vitro infertility lab and you watch the sperm fertilize the egg and then it is measurable that the egg does start to divide and life does begin, in my view, at that point - long before it reaches the uterus, long before it's implanted.

So, you know, I think the Bush administration was right to try to keep this barrier in place, because it is important, I think, to talk to the patients that come in that need this about whether it's safe, whether it's effective, and whether it's ethical.

CONAN: And now that the barrier's there and if a woman under the age of 18 wants this she would need a prescription - would you, after discussing it with her, prescribe it?

CRAIG: I would not prescribe it. But I would have the discussion and, you know, some of my partners or the other doctors that I know would be willing to prescribe it. And if she wanted it and I think that that, you know, she would be able to get it from one of them.

Prof. DUNCAN: I think…

CONAN: So - go ahead, I'm sorry.

Prof. DUNCAN: I was going to say - I think you asked one of the other callers whether there might be, you know, some additional legislation that we might need in this area, and one thing that I'd like to consider is some kind of a parental notification for minors under - for young girls under the age of 18.

I think that, you know, as the doctor points out the ethical decision is really not a medical decision, it's really a decision that is based upon, you know, the family, and the girl and her parents - their understanding of faith, their understanding of life, their understanding of ethics.

And I think it's important that - one of the reasons why I think it's helpful to have a prescription here, is to give girls an opportunity to understand how this works, to understand that it doesn't just operate by preventing conception, but sometimes it does operate by, in effect, terminating a fertilized - a new life, an embryo - terminating a fertilized egg.

CRAIG: Exactly.

Prof. DUNCAN: And for some children that's an abortion in their minds. And they're buying into a bill of goods that this prevents pregnancy, that it's not an abortifacient. But if you define life as beginning at conception then here's a girl who will accidentally be having an abortion. A girl who may live the rest of her life and regret that abortion and she's doing it…

CONAN: Except that she would never know, would she?

Prof. DUNCAN: Well, she might find out later. I know we've had people who have come to us and say why didn't you tell us that even the birth control pills…

CONAN: She might find out the theoretical possibility, but as a practical matter, she will not know which if any of those things was effective. She might not have been pregnant at all.

Prof. DUNCAN: She will know that there's a chance that she's had an abortion and if she's used this pill on a number of occasions she'll know that it's a reasonably good chance. And she may live the rest of her life regretting that. And so it's good to go in with complete knowledge.

Yes, let's do follow the science and let's make sure the girls understand the science. Let's make sure the girls understand that this is not an easy issue about preventing pregnancy, that this can be a very difficult issue about terminating the life of a new embryo that's already been created.

CRAIG: And Neal, you know, I must say that if someone comes into me and desires this and they understand how it works and they want it, you know, I as a physician will not impose my morality on them. I just want to make sure that they understand the whole process of what's happening.

CONAN: So you would consider prescribing it for somebody under 18?

CRAIG: No, I would not personally prescribe it, but I would not block their access to it.

CONAN: Block their access to it, I see, I understand. All right. There's the distinction. Craig thanks very much for the call.

CRAIG: Thank you very much, Neal.

CONAN: Bye-bye. And let's thank Rick Duncan for his time. Rick Duncan, professor of law at the University of Nebraska, joining us today from member station NPRN in Lincoln, Nebraska. Thanks very much for your time.

Prof. DUNCAN: It was a pleasure. Thank you.

CONAN: And we're talking about the politics of Plan B. You're listening to TALK OF THE NATION from NPR News.

And one thing that we sort of overlooked in all this conversation, Julie Rovner, is what happens to the president's nominee? Is that now going to go ahead?

ROVNER: Well, certainly that's what we would anticipate. This was the only big thorny issue that came up in the confirmation hearing that he had in July. Although, there is the possibility that some of the right-to-life members of the Senate could now put a hold on the nomination.

Senator Coburn of Oklahoma was unhappy with this decision. I don't know that it would cause him to try to block the nominee. But, you know, there is the possibility of that. There's every anticipation, however, that von Eschenbach will probably be confirmed fairly easily when the Senate comes back next week.

CONAN: Just to point out, any senator can put a block on any nomination for any reason that they'd like. And the administration, whoever, usually has to figure out a way to make them happy if they want to get it through.

ROVNER: That's the way it works.

CONAN: Power politics. Let's see if we can get one more caller in. This is Steve. Steve calling us from San Jose.

STEVE (CALLER): Hello. I have a question about the licensing of pharmacists. Do they - are they required to be licensed and if they chose not to, you know, override a doctor's decision to prescribe something or to just do whatever they can to obstruct access to these perfectly legal medications, can they have their licenses pulled for practicing their job incorrectly?

CONAN: Different in different states, isn't it Julie?

ROVNER: Pharmacists are all licensed around the country. They are licensed by the individual states and this is a debate that's going on in many states right now, about when pharmacists can exercise their own ethical sort of - their matters of conscience in filling or not filling prescriptions. So it varies from state to state.

CONAN: And some states have passed laws that say it's ok for pharmacists to express their conscience and not do things. And other states have passed laws that say if a doctor prescribes it, the pharmacist has no choice and must dispense it.

ROVNER: That's exactly correct. So we've got both sides. And then most of the pharmacy groups try to sort of steer this middle course where they say if the pharmacist - the pharmacist shouldn't have to do anything that pharmacist believes is ethically wrong, but they shouldn't stand in the way of the patient getting it. So as the doctor who was just on the phone was saying if they feel they can't do it they have an obligation to find someone who can.

CONAN: And this is mostly an issue, I would think, in rural areas. It's where you don't - New York City you've got a pharmacy every other corner, not the case in the wilds of Minnesota.

ROVNER: That's right. That's been the big concern has been where there are pharmacies and they're open. And as we mentioned with this drug in particular, which we've talked about the 72 hour window, it's most effective the sooner you take it. In fact, it's more effective if you take it within the first 24 hours than it is if you take it within that 72 hours. So obviously it's important to be able to find a place to get it and to find a pharmacist who's willing to give it to you.

CONAN: Steve, good question. Thanks for the call.

STEVE: Thanks. Bye.

CONAN: Bye-bye. And Julie Rovner, we appreciate your time, as always. NPR's Health Policy Correspondent Julie Rovner with us here in Studio 3A. When we come back from a short break: Pakistan kills an armed tribal leader and it's described as a disaster, with repercussions, possibly for the war on terror. Plus, the New York Times finds the right nose for the job. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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