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, and asthma medications are being considered and pharmacists are excited about the expansion of their roles. Many primary care doctors are not happy about this potential move though.
Pharmacists and other non physician practitioners have the knowledge and skill to address mild and moderate issues which will result in cost savings to the feds. They also do not have the experience to appreciate potentially deadly issues at the same level as MD's. The convenience to patients will be offset by the probable increased cost of these meds and the insurance companies will not cover many of them anymore. I mostly agree with this pharmacist here,
"We think it’s a great development for everybody — for pharmacists, for patients and the whole health care system,” said Brian Gallagher, a lobbyist for the American Pharmacists Association. “The way we look at it is there are a lot of people out there with chronic conditions that are undertreated and this would enable the pharmacists to redirect these undertreated people back into the health care system.”
The article also quotes internal medicine physicians and I agree with this statement.
“The problem is medicine is just not that simple,” said Dr. Matthew Mintz, an internist at George Washington University Hospital. “You can’t just follow rules and weigh all the pros and cons. It needs to be individualized.”
Here's how I see this for primary care. One of the few ways private docs survive is the easy meat of medicine. A common cold, routine medication checks, follow up blood pressure/diabetes/cholesterol etc. The infirmed and elderly take far more time (and time is all we have to charge for unlike many specialties) and the compensation is just abysmal for a lengthy consult, often not even covering the overhead of the office let alone any profit. People buying OTC meds for serious issues will often expect a doctor to pick up the phone for free and talk to them about it, fat chance in our brave new world, and people will be lucky to even get a secretary to acknowledge a question and put it in the pile of 100 daily issues that the doc will never get to. Primary care will end up all government, hospital or insurance employees if they have no entrepreneurial spirit or go full private no insurance and charge what the market will bear. The last scenario is what I do now but the feds are always threatening to shut us outside the box people down even though we still are out earned by all the subspecialties, especially procedural based ones. The feds just cannot stand anyone in medicine beyond their control. If this happens then getting to a doctor for any routine item will be impossible as no one but a pure masochist would ever enter the worst paying field (with the most paperwork also) of medicine.
So we have pros and cons regarding this bold step. On many levels I am for the move. Of course the administration never dreams of real tort reform which would generate a 15% savings at a minimum, but that topic is for another day.
- Comment (76)
- · Quote
- · UnfollowFollow (6)
Comments:
Mar '11
Re: Should Most Common Prescriptions Be Over the Counter?
Doug Kimball: I think America is overmedicated. ...
Very few medications should be OTC. No narcotics, anti-biotics, mood enhancers, relaxants, stimulents stronger than coffee, diet pills, ADHD drugs, depressants, anti-depressants or drugs with significant side effects or risks of interaction. We need to wean people off prescription drugs, not open up the Pharmacy to self-medicators. · 28 minutes ago
Edited 18 minutes ago
Every drug has a risk of interaction. You suggest we to bar Americans from choosing for themselves what they want to do.
Following your principle, we could do what they do in the UK - take children away from obese parents because the children are likely to also end up fat. It is for their own good, no?
May '10
Re: Should Most Common Prescriptions Be Over the Counter?
And you think someone is only going to visit one pharmacy 100% of the time? And that your pharmacy is not going to get busier with people trying to use a pharmacist as a physician?
Of course they'll push for a national database. And then when your pharmaceutical list becomes available to your employer...
Aug '10
Re: Should Most Common Prescriptions Be Over the Counter?
EJHill
And you think someone is only going to visitonepharmacy 100% of the time? And that your pharmacy is not going to getbusierwith people trying to use a pharmacist as a physician?
Well, the choice of pharmacy is surely up to the consumer to decide, and busier pharmacists might potentially mean more pharmacists. It depends on how else the Obamacrats want to regulate pharmacists. You know they aren't going to increase liberty without curtailing it elsewhere.
Nov '10
Re: Should Most Common Prescriptions Be Over the Counter?
One small side effect of this bill that the rest of you may not have noted: not only does this shift the cost of a lot of drugs to you, because your insurance won't cover them any more, but also you would probably have to pay with after-tax dollars. This is because medical reimbursement accounts used to cover OTC meds, but don't any more. So the government likes this for all sorts of reasons that have to do with the insurance company and the government getting more money and you spending more.
Aug '11
Re: Should Most Common Prescriptions Be Over the Counter?
iWc
Doug Kimball: I think America is overmedicated. ...
Very few medications should be OTC. No narcotics, anti-biotics, mood enhancers, relaxants, stimulents stronger than coffee, diet pills, ADHD drugs, depressants, anti-depressants or drugs with significant side effects or risks of interaction. We need to wean people off prescription drugs, not open up the Pharmacy to self-medicators. · 28 minutes ago
Edited 18 minutes ago
Every drug has a risk of interaction. You suggest we to bar Americans from choosing for themselves what they want to do.
Following your principle, we could do what they do in the UK - take children away from obese parents because the children are likely to also end up fat. It is for their own good, no? · 1 hour ago
I wrote "significant risk of interaction." We can't let our libertarian instincts overwhelm common sense. One century ago there were no constraints, and pills had to be dosed with nasty tasting additives to keep people from poisoning themselves. I'm not suggesting we tighten FDA rules, I'm suggesting we consider human nature before we loose the restrictions and let too many people self medicate. History is a good teacher.
Mar '11
Re: Should Most Common Prescriptions Be Over the Counter?
Doug Kimball
iWc
I wrote "significant risk of interaction." We can't let our libertarian instincts overwhelm common sense. One century ago there were no constraints, and pills had to be dosed with nasty tasting additives to keep people from poisoning themselves. I'm not suggesting we tighten FDA rules, I'm suggesting we consider human nature before we loose the restrictions and let too many people self medicate. History is a good teacher.
Just because medications are OTC doesn't mean a patient can't get a doctor's recommendation before taking them.
There are plenty of products which are "OTC" yet most people still hire a specialist to implement them: think car repair or home construction.
The article talked about deregulating medications for chronic illnesses. I imagine most people would still consult a doctor for a few hundred dollars before embarking on a drug treatment which could cost them tens of thousands. However, by loosening restrictions on access to the drugs, hopefully some competition would lower prices.
Dec '11
Re: Should Most Common Prescriptions Be Over the Counter?
Jumping in mid-conversation.
The problem with freedom is you have irrational people. If everyone was able to make sane rational choices freedom would be wonderful. For myself, would I be able to know the difference between treating the symptoms and treating the disease. Would I use the drugs to kill the pain or find out what is causing the pain?
When I look at the way that Americans are not able to make wise dietary decision, I have little hope that the same people will make wise pharmaceutical decisions.
My questions to everyone is,
What percentage of the population is rational and prudent and what percentage of the population is irrational and unwise?
What is the real world like?
Does the benefits outweigh the costs?
Edited on May 1, 2012 at 3:14amNov '10
Re: Should Most Common Prescriptions Be Over the Counter?
Guess what: prescriptions are not terribly complicated. I can't stand calling up my doc, making an appointment, going in, getting charged $30 (and lord knows how much more my insurance is paying him) so that he can sign off on a prescription for whatever it is I already know I need.
I see no reason why a well informed person with a Physician's Desk Reference and access to the internet shouldn't be able to self-prescribe anything save antibiotics.
This is a step in the right direction, which is why it will never happen. The AMA still has too much money to throw around Washington.
Edited on May 1, 2012 at 3:19amDec '10
Re: Should Most Common Prescriptions Be Over the Counter?
I read this while on the elliptical. Lab work for my physical is Friday, we'll see where things stand then.
Jun '10
Re: Should Most Common Prescriptions Be Over the Counter?
While I understand that big changes are necessary and will happen regardless of anyone's opinion, the transition will be horrible. I've hoped that our elderly Sisters would not have to go through this. At the moment they are enrolled in Medicare Part D, a state run drug plan for seniors, and a Medicaid related program which takes into account income, but not resources. This last program is absurd, (enrollment is automatic, it messes up your physician billing, and even the pharmacists do not understand how it works) but reduced our cost of Lipitor (for which there is no generic) from more than $300 for 90 days to $2.60.
Many of the drugs they take are monitored closely for side effects with lab work. What would happen in this case?
I'm confused about other posts accepting that antibiotics should not be OTC. My pediatrician gave my RN mom penicillin to inject as needed years ago - saved lots of office visits. Why is this a given that they should not be OTC? Thank you for your reply.
Dec '11
Re: Should Most Common Prescriptions Be Over the Counter?
Sister:
I'm confused about other posts accepting that antibiotics should not be OTC. My pediatrician gave my RN mom penicillin to inject as needed years ago - saved lots of office visits. Why is this a given that they should not be OTC? Thank you for your reply. · 10 minutes ago
If antibiotics are overused, the disease forms a resistance to them and a new drug is needed to combat it. If there is no new drug to combat it, we are back to the pre-antibiotic days which would be a nightmare.
Edited on May 1, 2012 at 4:21amNov '11
Re: Should Most Common Prescriptions Be Over the Counter?
Totally drug resistant tuberculosis, for one example. It used to tick me off whenever I had to go to the ENT when I already knew I had a sinus infection - and I actually discovered a way to buy antibiotics without a prescription, which I won't mention here. But I understand the logic behind not making them OTC.
Jun '10
Re: Should Most Common Prescriptions Be Over the Counter?
Thank you, 10 cents. I do realize that that is the reasoning. But for me, what I hate going to the doctor's for is antibiotics and cough medicine. We have pharmacies with nurse practitioners now. Last year the pharmacist gave me my flu shot. So, I guess we'll see more of this. And, maybe they'll be doing the strep tests as well.
I remember reading years ago that pharmacists were the most trusted of all professionals, more so than doctors or clergy. It is interesting that of the 10 fields of study most likely to result in a paying career in that field the only non-engineering field is pharmacy. However, our PCP recently said that soon it will only require a 4 hour course to dispense drugs.
Edited on May 1, 2012 at 4:44amFeb '12
Re: Should Most Common Prescriptions Be Over the Counter?
What about prescribing via email? My doc asks his patients if they want to pay him $250/yr for which they get access to him via email with a 24 hr turnaround. I like the idea of my doc deciding what Rx I should have and what dose, but I don't want to have to sit in his office. I consider myself well educated in health science, but not so much that I would know which diuretic or antibiotic to choose. And I would need some convincing that the pharmacist could diagnose and prescribe. If that becomes routine ,watch their liability insurance go up.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Ah Mothership_Greg, you got them from overseas, the vet, farming, or the fish store. Antibiotic resistance is a huge issue and their are some seemingly educated folks that run for the z pack the moment they get a viral illness. Doug Kimball has some valid points about our overmedicated society but that would not change much with this idea here, its more a cultural phenomena. Amy Schley, monthly visits for zoloft are a joke and yes many pharmacists are better at spotting drug/drug interactions, especially with busy docs. Misanthiocracy, yes they'll curtail freedom elsewhere. EJ Hill, you're darn right a national database is the long term goal from this admin. 10 cents, I suspect about 2/3 of our society is rational and prudent, we shall see come November though. Sister, Lipitor became generic just this year. Your sisters will be fine with their doctor appointments provide we still have primary care docs.
Nov '11
Re: Should Most Common Prescriptions Be Over the Counter?
Rearranging deckchairs!
This rough cut comes after two years receiving intense doctoring:
50% of doctors are incompetent jerks who care more about their egos and their earnings than about their patients' well-being. Spot these doctors or you can get a lot worse before you get better.
30% are barely competent, but are decent human beings who care more about their patients' well-being than than their own egos. Watch them carefully, make them explain what they're doing, and don't let them get in over their heads.
10% are highly competent jerks who could take decent care of you if their egos didn't get in their way. They feud with other doctors, with nurses, cafeteria servers, everybody. They're vindictive. If you question them, they will make you suffer, and are smart enough to get away with it. Many have great PR and big titles. Their mistakes are always pinned on others, including their patients. You are grist for their mills. Avoid them like plague.
10% are competent doctors and decent human beings who care more about their patients than about their own egos. Few have brilliant careers . . . they're too busy taking care of their patients.
Edited on May 1, 2012 at 1:01pmApr '11
Re: Should Most Common Prescriptions Be Over the Counter?
Controlled substance regulations are just ham-handed government punishing citizens in an effort to protect them from themselves.
Thanks to these laws in order to get my legally prescribed medication once a month I have to leave work early to make a pointless trip to my doctor to physically pick up a prescription for a medication I've taken for 6 years. This costs me in time, lost wages and co-payments (plus needless costs for the insurance company). I then schlep to the pharmacy - I can't even call ahead to have the RX prepared. The whole ordeal takes hours. And that's if all goes smoothly. For the slightest problem - a date is off or a box isn't checked - the pharmacist can't simply call the doctor. Nope, I have to go all the way back to his office and start over.
It's one thing for me; but I can't imagine how a disabled or elderly person deals with such nonsense.
I understand the desire to curb abuse, but the undue burden of these regulations is overwhelmingly carried by ordinary citizens. This is government at it's worst and it's downright criminal.
Apr '11
Re: Should Most Common Prescriptions Be Over the Counter?
Meanwhile, if I wanted any recreational drug I could have it delivered to my door within the hour with one phone call.
Nov '11
Re: Should Most Common Prescriptions Be Over the Counter?
You can blame the government, but more specifically, you should blame the doctors and the pharmacists (and the insurance companies and drug companies, too) because they are the ones who control this system and profit from it.
Doctors complaining about problems in the healthcare system is like lawyers complaining about high legal fees . . . except for these two differences: (1) Lawyers are too modest to complain about it. (2) If they did complain, they wouldn't blame the problem on doctors.
Apr '12
Re: Should Most Common Prescriptions Be Over the Counter?
The FDA should justifiably be focused on safety questions. There are a number of commonly prescribed medicines which are safer than aspirin with fewer dangerous side effects. Those medicines in my opinion should be over-the-counter. The efficacy question is certainly more complicated particularly in the medical device area....it is much easier to get a medical device onto market in europe than it is here. This certainly deters medical device innovation, but there are multiple recent examples of medical device that should have been scrutinized more closely prior to approval.