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Appeals Court Panel Says Pharmacists Must Distribute Emergency Contraception Under Washington State Regulation

A three-judge panel of the U.S. Circuit Court of Appeals for the 9th Circuit on Wednesday unanimously ruled to lift an injunction blocking Washington state officials from penalizing pharmacists who refused to dispense the emergency contraception pill Plan B, the Los Angeles Times reports (Williams, Los Angeles Times, 7/9). The panel said the district court judge who issued the injunction refused to consider women"s need for EC (Egelko, San Francisco Chronicle, 7/9). The panel"s ruling is part of a larger case before the district court involving the constitutionality of a 2007 state regulation requiring pharmacies to stock and dispense EC. Joyce Roper, an assistant attorney general for Washington state, said the appeals court ruling means that the 2007 regulation will take immediate effect.The plaintiffs in the case, Stromans -- a supermarket pharmacy owner -- and two pharmacists employed elsewhere, argued that the state regulation requiring pharmacists to stock and dispense EC violated their First Amendment right to freedom of religion (Los Angeles Times, 7/9). The regulation said that pharmacies must stock and fill legally prescribed prescriptions but allowed individual pharmacists to object on moral or religious grounds if another pharmacist was available, in person or by telephone, to fill the order (San Francisco Chronicle, 7/9). The plaintiffs argued that the regulation would force them to choose between following their religious beliefs and keeping their jobs. They contended that EC prevents implantation of a fertilized egg, which they equated with abortion. The U.S. District Court in Seattle awarded the plaintiffs the temporary injunction in November 2007, pending trial on the constitutionality of the regulation (Los Angeles Times, 7/9). Plan B contains a high dose of a drug found in most birth control pills that generally prevents ovulation or the fertilization of an egg. Recent research suggests that it does not prevent a fertilized egg from implanting in the uterus (Woodward, AP/Seattle Post-Intelligencer, 7/8). FDA in April lowered the age limit for nonprescription purchase of Plan B from 18 to 17 (San Francisco Chronicle, 7/9). Appeals Panel Returns Case to District CourtThe appeals court panel ruled that the freedom to exercise one"s religion "does not relieve an individual of the obligation to comply with a valid and neutral law of general applicability." The panel added, "Any refusal to dispense -- regardless of whether it is motivated by religion, morals, conscience, ethics, discriminatory prejudices or personal distaste for a patient -- violates the rules" (Los Angeles Times, 7/9). The panel ordered the district judge to reconsider the 2007 regulation under Supreme Court standards that allow states to pass neutral laws that may affect religious practices. According to the panel, the regulation does not aim to interfere with religious practices or beliefs and is intended to promote patients" health. In addition, the panel said the district court judge did not consider how the injunction would affect "sexually active women of childbearing age who will be denied reasonable access to Plan B" (San Francisco Chronicle, 7/9). According to the Times, the panel"s ruling could foretell future judgments in the case, including that a patient"s right to timely medication surpasses a pharmacist"s personal beliefs (Los Angeles Times, 7/9).
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Smoking Increases Potential For Metastatic Pancreatic Cancer

Smoking has once again been implicated in the development of advanced cancer. Exposure to nicotine by way of cigarette smoking may increase the likelihood that pancreatic ductal adenocarcinoma will become metastatic, according to researchers from the Kimmel Cancer Center at Jefferson. Their study was published in the August edition of the journal Surgery.