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This question originally appeared on Quora. Answer by Claire J. Vannette.

Oral contraception has upsides and downsides. When a medication has plusses and minuses, and you want to assess its overall impact on health, you weigh the good and the bad. This is inherently subjective.

Obviously, some assessments will be so lopsided that pretty much anyone would agree on the result. But many will be more evenly balanced, so different people may arrive at different assessments.

For example, the pill is thought to increase the risk of some cancers while decreasing the risk of others. [1] How do you balance that? Do you consider only mortality? Do you try to factor in cancers that don't lead to death? If so, how many of them “equal” a death? Do you consider relative risk or absolute risk? That's the difference between saying, “Drug X increases the risk of cancer by 100%,” and, “Drug X increases the risk of cancer from 0.01% to 0.02%.”

What about risks that are bigger for some people and smaller for others? And what about weighing the risks of taking the drug against the risks of not taking the drug — in this case, the risks of pregnancy, childbirth, or abortion?

Personally, when I weighed the risks and benefits of oral contraception, I arrived at the conclusion that they did me more good than harm. Others arrive at a different conclusion about their pros and cons. As long as we're all working from accurate information, this is normal. After all, every drug has contraindications, or conditions that put a thumb on the scale to increase the cons or decrease the pros for particular people. For example, it is not recommended that smokers take oral contraceptives, because they face additional health risks. [2]

I will point out that in the United States, we have a government agency and indeed an entire industry trying to answer the question, “Is this drug too dangerous to prescribe?” [3] Most drugs that begin the approval process do not complete it. [4]Most don't even clear the initial safety evaluation. [5] So the process isn't a rubber stamp. If something ends up getting approved, then based on the information they had at the time, and their assessment of the pros and cons, some very smart people who actually give a damn thought it was not negative overall. I generally start from the assumption that an approved drug is at least good for somebody under some circumstances.


[1] Oral Contraceptives and Cancer Risk

[2] Who shouldn't take the pill? - Student Health Center

[3] How FDA Evaluates Regulated Products: Drugs

[4] The High Price Of Failed Clinical Trials Time To Rethink The Model

[5] Low Success Rates Persist for Clinical Trials

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