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Should Most Common Prescriptions Be Over the Counter?

In a move generating some expected controversy the Obama administrations health wizards are contemplating releasing many common prescription medications to over the counter status.  

FDA may let patients buy drugs without prescriptions…

Various hypertension, diabetes, cholesterol, migraine, an…

  1. Fred Cole

    I’m going to stake out the extreme end of the debate.  I don’t think the state has any business telling people what they can and cannot buy, and what people can and cannot sell to people.  (I’ll add to that must and must not.)

    It seems like pharmacists, being professionals, can determine their own business practices, and patients can make their own choices without the mommy state telling people they need a permission slip from a grown up before they can buy something.

  2. Mendel

    In theory, this is a great step.  If primary care physicians are in such short supply in America, it is perverse not to tap into the underutilized expertise of pharmacists.  Many of them have doctoral degrees in pharmacy yet do little more than tell you what time of day to take a pill: an utter waste of resources.

    What disturbs me is that this move reeks of nothing more than a cost-cutting measure to save Medicare.  Incremental market liberalization is worse than useless if the core market is still horribly slanted by government intervention.  In other words, making prescription drugs OTC (and thus not covered by most insurance) will only work if there is an open market for primary care as well.

    In a comprehensive health care reform, access to medications without a doctor’s visit will be very beneficial.  But this move is little more than government rationing, pushed onto the consumer to make it look like “free choice” and keep their own hands free of blood.

  3. DocJay

    I agree with you Fred, but who will the people sue when their kidneys fail?

    To counter the full measure of your argument I am pretty sure some of the powerful drugs of abuse need to be kept away from the oxycontin addicts of the world.  Until we get to the point where vehicular manslaughter under the influence is replaced by murder 2 and life in jail I have little comfort turning my scheduled drugs over to the masses.  One of the controls on misuse and abuse of narcotics etc is us.  The level of danger for these meds are dramatically under appreciated and deaths are fairly common due to misuse.

  4. Guruforhire

    Of course we should have some OTC medicines for common items.  I think we should rely on pharmacists more for proper dosages of routine medications.

    I dont think that this would end the routine work for the doctors, it would just change the nature of the work.  We would go from a system of advise and gatekeep to one of advise.

    I think a cortiosteroid, Adderall, an antibiotic, and birth control would cover most routine stuff and reduce a huge amount we overspend on medicine.

    I worry about cholesteral medication because it drove my grandpa insane (yes lipitor made my grandpa lose all connection to rationality) but I dont know the wider context.

    I dont appreciate on principle the idea that I have to pay gatekeepers. I am perfectly fine with paying for advice, but the idea that I have to pay someone to give me permission to buy something I already know I need is maddening.

    You know the idea that I could call a doctor and get them to work for free is not something that has ever crossed my mind.

  5. Mendel
    Fred Cole:

    It seems like pharmacists, being professionals, can determine their own business practices, and patients can make their own choices without the mommy state telling people they need a permission slip from a grown up before they can buy something.

    I agree with you in theory, but in this situation we need to look at the context. 

    Most of the drugs in question here are for chronic conditions.  I imagine that a patient needing these medications might also desire the occassional small lab work by his doctor to see whether he even needs the medication anymore, and if so at what dose.

    In an unregulated medical market, this might be a fairly inexpensive proposition.  However, in our Medicare-dominated world, getting some simple bloodwork done is time-consuming for the patient, expensive for the third-party payer, and barely lucrative for the MD.

    Healthcare involves multiple markets acting in coordination.  As long as the caregiver side of the equation is in a regulatory straightjacket, providing more free choice to the pharmacy side of the equation will do little to improve the situation.

  6. DocJay

    Well Guru, the cholesterol meds have some sneaky side effects that I think are under reported yet you put an amphetamine in your list, :) , which is harsher than lipitor by a mile.   People get a hold of those and use it like meth, often staying awake for days and going insane.   Those with legitimate adhd issues are less prone to go nuts with such meds.  

    To count on average people, including the ignorant masses, to use controlled substances properly is a pipe dream.  The cons outweigh the pros here for me but I could deal with it.  Of course I’d need a spot blood/urine  check on anyone driving my kid to feel OK and employers would need to test pre hire and everyday of work for legal reasons….it get’s complicated.

  7. DocJay
    Mendel

    Fred Cole:

    It seems like pharmacists, being professionals, can determine their own business practices, and patients can make their own choices without the mommy state telling people they need a permission slip from a grown up before they can buy something.

    I agree with you in theory, but in this situation we need to look at the context. 

    Most of the drugs in question here are for chronic conditions.  I imagine that a patient needing these medications might also desire the occassional small lab work by his doctor to see whether he even needs the medication anymore, and if so at what dose.

    In an unregulated medical market, this might be a fairly inexpensive proposition.  However, in our Medicare-dominated world, getting some simple bloodwork done is time-consuming for the patient, expensive for the third-party payer, and barely lucrative for the MD.

    Healthcare involves multiple markets acting in coordination.  As long as the caregiver side of the equation is in a regulatory straightjacket, providing more free choice to the pharmacy side of the equation will do little to improve the situation. · 2 minutes ago

    A very astute set of points Mendel.

  8. Fred Cole
    DocJay: I agree with you Fred, but who will the people sue when their kidneys fail?

    Depends on the circumstances.  If I were to take a mess of Tylenol and wash it down with a tall glass of Jack Daniels, and were to suffer some horrific damage, then I have no one to blame buy myself.

    Some of it falls into the category of caveat emptor.  

  9. DocJay
    thelonious: Isn’t this just a way for pharmaceuticals to get rid of the middle man in this case doctors and sell directly to the consumer?  At the end of the commercial they always suggest “ask your doctor about fill in the blank drug.”   Derugulate the process of having to get a prescription and you’ll get more use of the drugs that are advertised.  · 23 minutes ago

    Here’s the rub.  The OTC ones won’t be the newer designer ones.  Those drugs will be Dr ordered only but with 5 pages of pre-authorization and justifications.  If I want to order Dexilant ( an acid pill superior to prilosec or prevacid OTC) then you first must prescribe, then receive a denial, then file an appeal, then receive the appeal form, then fill it out at great time expenditure, then have it denied anyway, then call them up and get put on hold for 20 minutes, then get the RN and I pitch the case and maybe they say yes or no depending on whether or not Their criteria are met.  Sometimes the answer is never no matter how much documentation.  It often  takes hours of uncompensated time per medication.

  10. Guruforhire

    I think quibbling over what should be on such a new theoretical list does not do much to advance the cause of why such a list is a good or bad idea.

  11. DocJay

    Good point Guru, that was the idea of the original post.  I am really looking for some of the passionate to chime in about the actual article.  You and Fred had valid points about some of the serious drugs( him more so in the pure libertarian sense….surprise!) and I felt I’d be remiss in not responding.

    I know your feelings on the matter which is generally in support of this measure. 

    I mostly agree with the concept put forth in the proposal but tried to think of the usual unintended consequences.  

    Our system is going bust.  No minor tweaking will save it and obamacare accelerates the demise.  Radical change is needed and sometimes taking a chance and seeing the results over time is the solution.  

    Tort reform is the no brainer that will never happen by the way. 

    Getting the government out of the way will save the system but access will change for the negative and those unable to care for themselves will be in a world of trouble (as they will be under the obamacare model in due time as well)

  12. The King Prawn

    If Walmart and other super stores are still doing $4 or $5 generics I don’t see the consumers suffering too much financially.

    Maybe I’m simply detached from the issue. Is it normal to hit 40 with zero chronic health prescriptions?

  13. EJHill

    Get your new bumper stickers!

    ABA.jpg

  14. Guruforhire

    I am passionate.  We talk about how much americans spend on health care, and I know how much time my doctor is going to spend with me after I wait 2 hours because he is behind, to engage in an act that is solely for the purposes of gatekeeping.

    I think a good theoretical starting point with our winnowing forks, is probably drugs which are taken appropriately in which the not extremely unlikly side effects stop when you stop taking the drug.  For instance cortiosteriods make me sick, when I stop taking them I stop being sick.

    Drugs which have serious side effects which do not stop after taking the drug normally, should probably be gatekeeped.

    Drugs that are part of the treatment of an extreme medical condition.  For instance one isnt going to goto the doctor for morphine to take care of a condition.  You are going to get morphine because you had your arm ripped off by some machinery, and its use will be part of a larger treatment scheme.

  15. Misthiocracy

    Depends on which drugs.

    Antibiotics? Probably not.

    Narcotics, like Adderall (amphetamine)? Probably not.

    Viagra? Hmm…

  16. DocJay

    KP, those $4 ones may fall by the wayside.  Keep exercising and eating well and you’ll stay clear of our poisons.

    EJ Hill, every place you enter here is a ray of sunshine.  

  17. Misthiocracy
    Guruforhire: I think quibbling over what should be on such a new theoretical list does not do much to advance the cause of why such a list is a good or bad idea.

    The list already exists. Some drugs are by prescription, others aren’t.

    The whole debate is merely quibbling over which drugs should be on which list.

    Unless one believes that all drugs should be over-the-counter.

  18. Mendel
    DocJay:   I am really looking for some of the passionate to chime in about the actual article.

    I’ve already given my 2 cents, but this issue riles me up enough to give the other $3.65:

    Allowing most drugs which are not addictive, do not cause drastic alterations in consciousness, and do not promote microbial resistance to be sold OTC (or with a pharmacist’s approval) is a great idea. 

    The problem would be implementing this change now.  Our Kafkaesque maze of payment structures is crowding out what should be the most cost-effective type of doctor in any healthcare market: the primary care physician.

    Letting PCPs keep one monopoly (writing prescriptions for common medications) because we have artificially removed their other sources of revenue is a poor solution at best.  But I fear that driving the last PCPs into extinction will make any shift to a liberalized healthcare market even more difficult if and when comprehensive reform ever occurs.

    I would love to be proven wrong on this.

  19. EJHill
    DocJay:  EJ Hill, every place you enter here is a ray of sunshine.  

    It’s the law of unintended consequence. Let’s face it, the first time a drug causes an unwanted side-effect or death the pharmacist will be sued. 

    “Are you trained to diagnose and dispense drugs, Mr. Doe?”

    “No sir, I did not make the diagnosis.”

    “Then why did you sell the victim these drugs? Did you know what other medications the late Mr. Smith was on?”

    “No, sir.”

    “Did you know that Mr. Smith had a history of low blood pressure and that the dosage of that medicine could kill him?”

    “But the federal government….”

    “The federal government did not authorize you to kill Mr. Smith! Ladies and Gentlemen of the jury…”

    Who-Died.jpg

  20. DocJay

    I doubt you are wrong Mendel.  I think drugs for many common conditions should be more available too which may be on the other side of most docs.  I suppose the PCP’s will have to find a way to roll with the punches once more.   Just because their (my former) lives are in trouble does not justify not implementing a potentially dramatic cost saving measure.  That’s too much protectiveness for my liking.

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