HIDDEN COSTS OF 1UD CONTRACEPTION

In a pamphlet printed for the user of the Dalkon Shield the A. H. Robins Company assures the patient that "in the long run, an IUD is less expensive than other available methods of contraception."

But if the true costs were know, it might be found that IUD contraception is, in fact, expensive contraception. How 'so? After a woman pays for her IUD there are usually more costs to

come.

For a simple start, I will mention the added expense of menstruating. Now I realize that the vast majority of IUD inventors and inserters are males who rarely-if-ever buy such menstrual aids as tampons or perineal pads. But these do cost money. The average [UD user bleeds over twice the amount each month than the normal woman. This means that her monthly tampon or perineal pad bill is twice that of normal women.

That same IUD user might use iron pills to keep up with her doublenormal monthly blood loss. Those pills cost money also. And imagine that this patient must also take occasional or regular pain medicine for her IUD induced cramps. That costs. And, if as recommended in even the most overly optomistic IUD advertising, spermicidal foam contraceptive is on occasion used as an adjunct to the IUD, then that is an additional cost.

In the case of even a mild IUD induced or exacerbated pelvic infection the cost of a full course of antibiotics can easily be 20 dollars.

What about expulsion of the IUD? That involves another visit to the doctor and possibly another IUD insertion or the starting of another form of contraception. And when studies have shown one year expulsion rates of up to 38 per cent for commonly used devices, the above added expense is not uncommon.

What happens when a patient comes in claiming that she can not feel the IUD string but that she never noticed her IUD fall out? Often an x-ray is taken in order to verify that the IUD is either still in her uterus and has not perforated into her abdomen. Regardless of where her IUD is, that x-ray costs from 15 to 35 dollars. That can pay for many birth control pills.

What if that mislocated IUD has perforated the uterus and is in the abdomen? The costs of surgical removal and hospitalization covering that event could easily run to 1,000 dollars. The same could be said for an IUD associated tubal pregnancy or incomplete niscarriage.

It is interesting to me that most people or organizations which promote IUDs because of their inexpensive nature are universally unknowing or unconcerned about these common and major added expenses. The reason for this lack of concern is obvious. They

are not involved with the expenses of aftercare. The expenses of IUD complications are either borne by the patient in the case of iron, tampons, pain pills, or antibiotics, and by either insurance companion or state welfare medical budgets in the case of the all-to-common gical complication.

In other words, a drug company only concerns itself with its profits. The 10 Inventor views his royaltics and a Planned Parenthood clinic can simply concern itself with the expense of inserting one thousand I verses the expense of keeping a thousand women on birth control pills for one year (12,000 packets of pills). But that same Planned Parenthood clinic rarely sees its own major IUD related complications let alone foots any of the bill for the treatment of those complications.

I am certainly not the only gynecologist, whose patients have found that IUD contraception can be very, very expensive.

THERE IS MORE THAN ALTRUISM IN THE SALE OF 1UDS

I have pointed out that the actual cost of IUD contraception might

be almost astronomical if the costs accrued through the treatment of IUD complications were considered.

Disregarding that for the moment I will attempt to bring basic IUD economics into focus. I hope that this analysis will show that within the multimillion dollar business which is. IUD contraception there are no monetary reasons for the lack of quality and concerned studies of IUDs by those companies reaping the profits from their sales.

Based on information supplied to me from a managerial friend within the medical device industry I can say that it costs a company 35 to 40 cents to manufacture, sterilize, and package an IUD when the unit volume is sufficient, say 100,000 units. Most IUDs are then sold to the physician for a unit price of 3.00 to 3.50 dollars. For example, the Saf-T-Coil sells to the physician for 21.00 dollars per box of 6 IUDs.

That is, let it be understood, a mark-up for Julius Schnid Pharmaceuticals of about 10 times (or "1,000%") over production costs. And that mark-up has come with little or no expenditure by the manufacturer for medical testing.

IUD INVENTION, PRODUCTION, AND PROMOTION

To place the current state of IUDs into prospective one could

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conjecture a new drug being put on the market without even notifying the FDA. Also conjecture that this new drug had been despite rather small studies and profit inspired optimism already proven to cause death, sterility, hemorrhage leading to anemia, disabling pain, unwanted pregnancy, miscarriage, ruptured tubal pregnancy, thousands of major surgical procedures, massive infection, blood transfusion, and untold numbers of x-rays to the ovarics of young women: Presume also that this new drug is only prevented from killing hundreds of persons a year because it is backed up therapeutically by antibiotics, surgery, and blood replacement. Would a drug causing those problems be allowed uncontrolled distribution, misleading advertising, and uninformed patient usage? A preposterous assumption. Yet, that is exactly the case with intrauterine contraceptive devices.

Digitalis comes from the lovely flowering plant. IUDs are born in the minds of gynecologists. Be they social humanitarians, calculating money-grabbers, or just plain doctors hunting for the perfect mouse trap, the number of gynecologists who have dreamed over the perfect IUD must mount into the thousands. Of these dreamers, several hundred have carved and twisted various metals, plastics and fibers into objects which they have then inserted into the depths of trusting patients. And virtually