No strings attached? (Guest Editorial).

For far too long, family planning practice has been driven, like other fields of medicine, by guidelines generated by "Delphi" panels made up of so-called experts who would gather at a hotel for a weekend and put together a document that reflected their personal preferences concerning clinical questions.

A better term for this consensus process might be BOGSAT: an acronym for Bunch of Old Guys/Gals Sitting Around a Table.

The problem with BOGSAT-style expert consensus is that the experts are, of course, so often wrong. Six hundred years ago the consensus was that the world is flat.

In a similar vein, alleged. experts have advised batteries of useless tests, such as glucose, lipid, and liver tests, as prerequisites for obtaining a prescription for oral contraceptives although no evidence exists to justify these needless hurdles.

Without considering the best evidence from clinical trials, we've gone along with such conventions: refusing to provide intrauterine devices for women who have had no children, for example, and requiring annual Pap smears before issuing renewals for prescriptions for oral contraceptives. While our motives in the latter case may have been pure, reflecting concern about cervical cancer, the practice is unjustifiable from any scientific standpoint.

As an abortion provider, I performed hundreds and hundreds of abortions during my career for women who were trapped into a pregnancy, because we health care providers held them hostage. We would not give them a pill refill until they came in for their Pap smear.

That is intellectually dishonest: a bait and switch tactic.