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Independents' Day

What men say they want from their GP surgery

From Professor Hugh McGavock, visiting professor of prescribing science, University of Ulster, and course organiser of GP further clinical education, Northern Ireland, Cloughmills, Co Antrim

GPs have yet again been lambasted in the national press, this time for allegedly failing to inform women of the alternatives to oral contraception. This followed NICE's latest recommendation of routine use of long-term contraception ­ slow-release progestogen injections, implants, IUDs and IUS.

The BNF clearly shows all of those are indicated for special situations and that as a group they have the following consequences:

· Local reactions ­ common;

· Prolonged post-contraception infertility ­ common;

· Osteoporosis ­ less common but very serious, especially in the younger age group that NICE appears to have in mind;

· Breast cancer ­ a small but measurable extra risk;

· Adverse effects on HDL:LDL cholesterol ratios;

· Common side-effects ­ headache, weight gain, mood changes, acne and decreased libido.

GPs do read the BNF and are well aware that OC remains the method of choice for most women, apart from those with hypertension, heart-valve defects, diabetes and migraine.

GPs are also well aware that most of these alternative methods cost about 10 times more than OC. Fitting IUDs and IUSs requires special training.

As usual, the accumulated wisdom of daily medical practice will be shown to be superior to pronouncements of committees.

Unwanted pregnancies and STDs (including chlamydia and papilloma virus) are societal problems caused by the collapse of old values and mores and the resulting promiscuity.

It is not primarily a GP problem and its remedy lies outside the field of medical practice. It will not be solved by giving the wrong contraceptives to millions of young women.

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