Is the Lancet really trying to wind up the Pope just as he approaches one of his busiest times of the year? The venerable medical journal today publishes a call from respected Australian researchers calling for nuns to be put on the pill.
Not for the purpose of contraception, you understand; rather, the idea is to protect them from the scourges of uterine and ovarian cancer.
The reasoning seems sound: for obvious reasons, nuns tend not to bear children. Women without children (nulliparous) have higher risk of dying from cancers of the breast, ovary or womb than women who produce young. Those who take the contraceptive pill, on the other hand, have reduced overall mortality (from all causes) and are also less likely to die from ovarian and uterine cancer – we’ll leave aside the question of breast cancer for now.
The authors – Dr Kara Britt, of Monash University, Melbourne, and Professor Roger Short of the University of Melbourne – reckon that nuns should therefore be given the pill for health, rather than contraceptive reasons.
Their argument is that studies have shown that overall mortality in women using the contraceptive pill is 12 per cent lower than those who have never used it. The risk of developing ovarian and endometrial cancers falls by 50–60 per cent compared with never-users; this protection lasts 20 years, showing a long-term benefit.
“The Catholic Church condemns all forms of contraception, as outlined by Pope Paul VI in Humane Vitae in 1968,” the authors write. “Although Humane Vitae never mentions nuns, they should be free to use the contraceptive pill to protect against the hazards of nulliparity since the document states that ‘the Church in no way regards as unlawful therapeutic means considered necessary to cure organic diseases, even though they also have a contraceptive effect’.
“If the Catholic Church could make the contraceptive pill freely available to all its nuns, it would reduce the risk of those accursed pests, cancer of the ovary and uterus, and give nuns’ plight the recognition it deserves.”
Now I’m no expert on Catholic doctrine – far from it – and as a person who described herself as “no religion” in the recent census, I am coming at this from a secular perspective; but I see a few problems here. The first is that I’m not sure why nuns are being singled out (unless for maximum Vatican-annoyance impact).
Many women don’t take the pill, many don’t have children and even those who do aren’t necessarily maximising their protection against developing cancer – indeed, as the authors acknowledge, women who have children decrease their risks of these cancers if they have their first child at a young age, bear more children, and breastfeed.
So, if we followed the logic of the authors’ argument, the contraceptive pill should be pressingly offered to any woman who didn’t follow that particular life plan.
Personally I have a problem with that, and it doesn’t have anything to do with religious belief. The pill is a drug, and it’s far from risk-free: (a useful summary of the risks and benefits it confers as regards cancer can be found here). Breast cancer is a particularly problematic area. While an analysis published in 1996 suggested that women who were using, or who had used, the pill were at slightly higher risk of developing breast cancer, the Women’s CARE study, published in 2002, indicated that current or former use of oral contraceptives did not significantly increase the risk. A National Cancer Institute-sponsored piece of work published the following year muddied the waters further, suggesting that risks were higher for those – particularly younger women – who had used the pill within five years prior to diagnosis.
But if the evidence around breast cancer is cloudy, it’s much clearer on deep vein thrombosis. Women taking the pill, particularly the third-generation pills, have a slightly higher risk of developing these blood clots – which can be fatal – although it must be stressed that the risks are still extremely small and certainly wouldn’t – didn’t – stop me taking it.
The authors of the Lancet publication acknowledge this, and suggest that “the possibility of health risks, such as venous thromboembolism, associated with use of the combined pill should not be forgotten, and women’s medical history should always be considered”.
I also have a problem with the idea of mass medication (no, not that kind of mass) as a general rule. There is a huge difference between prescribing a drug – the pill, or anything else – which is therapeutic (ie, it will treat what ails you) and prescribing one which may treat what might ail you – maybe, at some point in the future (if the side-effects don’t get you first). The Catholic Church, as I understand it, wouldn’t have a problem with members of its flock taking the pill for an actual, existing health problem (eg polycystic ovarian syndrome). The only thorny issue would be if a Catholic woman was taking the pill for health reasons, and actually used it as contraception too – and, let’s face it, that’s not likely to be the case with nuns.
No, the idea of doling out the pill as a matter of course to anyone, along with their daily bread – or perhaps even baked into it? – is ethically dodgy, to say the least.
Because where does it stop? Statins have been shown to decrease the risk of heart attacks and strokes; should everyone be given a daily dose? (Yes, I’m aware that they can have awful side-effects too; it’s partly my point.) Last week an Irish psychiatrist suggested putting lithium in the drinking water to prevent suicides. Others advocate folic acid into flour to prevent birth defects (although actually I’m rather in favour of that), while the fluoride-in-water debate continues.
I’m faced with the vision of a convent, nay, a world, where the daily repast is not so much food and drink, but a veritable cornucopia of pharmaceuticals.
Does that seem right?
I can’t agree in the slightest with the Vatican’s views on the use of contraception, be it the pill or anything else – indeed, I think the teachings of Humane Vitae do a great deal of harm, particularly in the developing world.
But on the issue of nuns and the pill? I’m probably with the Pope.
– A free abstract of the paper can be found here.