The bitter pill.

To cite: Cox L. J Fam Plann Reprod Health Care 2015;41:81–83. A FRENCH PILL SCARE The opinion of Marion Larat is that “nobody, but nobody should take the thirdand fourth-generation pills”. This view is not surprising as she suffered a devastating stroke at the age of 18 years. A subsequent enquiry linked her cerebral vascular accident to Méliane, a 20 μg pill containing gestodene that she had been prescribed for contraception. In December 2012, Marion Larat successfully sued the manufacturer, Bayer, and the French drug regulatory board Agence national de sécurité du médicament et des produits de santé (ANSM) for damages. Her case was widely publicised in the media and 30 similar lawsuits soon followed. In January 2013, the Minister for Health, Marisol Touraine, announced that France’s social security system would no longer reimburse prescriptions for thirdand fourth-generation pills. At the time around half of the five million French women on the combined pill were taking such pills, which cost more to the state than older formulations. Plans were made to strip midwives and nurses of their pill-prescribing powers. The ANSM advised that thirdand fourth-generation pills should never be used as first-line contraception and should only be prescribed if an older formulation had not been tolerated. The ANSM then referred the matter to the European Medicines Agency (EMA) for further investigation.