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.
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Comments:
Mar '11
Re: Should Most Common Prescriptions Be Over the Counter?
The FDA should be able to "approve" drugs, so people know they pass the FDA hurdles. But people should be able to procure non-approved drugs by waiving their rights to sue if things go wrong. Think of it as enabling clinical trials for new drugs, especially for patients who are out of options.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Redneck Desi, funny how the latest and greatest devices we get often have a proven record in Europe. Common sense would dictate that we'd be the leaders given the high quality of our docs and facilities. I have always wondered how corrupt the FDA is since Vioxx by the way.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Oh please astonishing, that seems a bit broad brushed. I know you've had some tough experiences and I am sorry you've met folks that affected your opinions so negatively.
Edited on May 1, 2012 at 6:47pmAug '10
Re: Should Most Common Prescriptions Be Over the Counter?
Not if they were legal!
Feb '12
Re: Should Most Common Prescriptions Be Over the Counter?
Cutlass, along those lines ...
http://heterodoxy.cc/meowdocs/pseudo/pseudosynth.pdf
How to make Sudafed from meth, given the latter is more easily obtained than the former ...
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Cutlass, the point of the article is that some people have to go monthly for common drugs and have to deal with about 50% of your hassle for a blood pressure med they've been on for 15 years without problems.
The heavier stuff is a different and trickier item.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Not that many will read this now but my nurse is on the phone trying to increase a testosterone dose since the man's levels were so low. She has been at it for 25 minutes and paused to say to me, " I hate India now". Yes that is where we need to call to get a drug approval for whatever useless drug plan this fellow has. I have heard her say the same story ( justifying the need 3 times in the last 15 minutes also as she is routed from one to another).
Oh now she's done. 30 minutes of an RN's time. What a joke.
Dec '10
Re: Should Most Common Prescriptions Be Over the Counter?
This is a tax increase, pure and simple, because OTC stuff isn't covered by medical savings accounts or flexible spending accounts. If you have a prescription you can use these accounts tax free. Revenue generator, nothing more, nothing less. They want to abolish MSAs and FSAs altogether.
Nov '11
Re: Should Most Common Prescriptions Be Over the Counter?
DocJay
Astonishing . . . a rough cut . . .
50% of doctors are incompetent jerks who care more about their egos and their earnings than about their patients' well-being. . . .
30% are barely competent, but are decent human beings who care more about their patients' well-being than than their own egos. . . .
10% are highly competent jerks who could take decent care of you if their egos didn't get in their way. . . . Many have great PR and big titles. . . . You are grist for their mills.
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.
. . . I know you've had some tough experiences and I am sorry you've met folks that affected your opinions so negatively
Oops! I forgot to mention patronizing . . . but it was a rough cut.
Contrary to your sugggestion, my observations aren't merely anecdotal. I conduct experiments and record results--like just now when I noted (again!) the inclination to patronize. Next we shall investigate the medical sense of humor, if we can find a live specimen.
(I'm not negative: 10% good is dern good!)
Apr '11
Re: Should Most Common Prescriptions Be Over the Counter?
Amy Schley: Cutlass, along those lines ...
http://heterodoxy.cc/meowdocs/pseudo/pseudosynth.pdf
How to make Sudafed from meth, given the latter is more easily obtained than the former ... · 6 hours ago
Exactly, so the government response is, of course, to place even more burdens on ordinary people. In New Jersey you have to show ID to buy cough medicine and in some cases you can't buy it unless a pharmacist is on duty, etc, etc.
Meanwhile, people who want to get high will move on to something else and the vast majority of people are stuck dealing with onerous regulations.
I'm not saying there shouldn't be laws, just that there has to be a sense of proportion.
Apr '11
Re: Should Most Common Prescriptions Be Over the Counter?
DocJay: Cutlass, the point of the article is that some people have to go monthly for common drugs and have to deal with about 50% of your hassle for a blood pressure med they've been on for 15 years without problems.
The heavier stuff is a different and trickier item. · 6 hours ago
I understand. However, if this is under discussion I think it's important that we no dismiss the legitimate issues regarding controlled substances. Your reaction that it is trickier implies that it shouldn't be part of the discussion.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Cutlass
DocJay: Cutlass, the point of the article is that some people have to go monthly for common drugs and have to deal with about 50% of your hassle for a blood pressure med they've been on for 15 years without problems.
The heavier stuff is a different and trickier item. · 6 hours ago
I understand. However, if this is under discussion I think it's important that we no dismiss the legitimate issues regarding controlled substances. Your reaction that it is trickier implies that it shouldn't be part of the discussion. · 6 minutes ago
Early on I discussed in some detail. I see pros and cons re controlled substances. I was more interested in the less lethal and addicting items the FDA is considering in the article.
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
Astonishing:
DocJay
Astonishing . . . a rough cut . . .
50% of doctors are incompetent jerks who care more about their egos and their earnings than about their patients' well-being. . . .
30% are barely competent, but are decent human beings who care more about their patients' well-being than than their own egos. . . .
10% are highly competent jerks
. . . I know you've had some tough experiences and I am sorry you've met folks that affected your opinions so negatively
Oops! I forgot to mention patronizing . . . but itwasa rough cut.
Contrary to your sugggestion, my observations aren't merely anecdotal. I conduct experiments and record results--like just now when I noted (again!) the inclination to patronize. Next we shall investigate the medical sense of humor, if we can find a live specimen.
(I'm not negative: 10% good is dern good!) · 1 hour ago
Perhaps if you have an assay you could begin core biopsies. Very little cannot be reached by a motivated person with a 5 inch 18 gauge needle.
I only patronize the mentally ill and even then I save it for the truly delusional.
Nov '11
Re: Should Most Common Prescriptions Be Over the Counter?
DocJay
Astonishing:
DocJay
Astonishing . . . a rough cut . . .
50% of doctors are incompetent jerks who care more about their egos and their earnings than about their patients' well-being. . . .
30% are barely competent, but are decent human beings who care more about their patients' well-being than than their own egos. . . .
10% are highly competent jerks
. . . I know you've had some tough experiences and I am sorry you've met folks that affected your opinions so negatively
Oops! I forgot to mention patronizing . . . but itwasa rough cut.
Contrary to your sugggestion, my observations aren't merely anecdotal. I conduct experiments and record results--like just now when I noted (again!) the inclination to patronize. Next we shall investigate the medical sense of humor, if we can find a live specimen.
(I'm not negative: 10% good is dern good!) · 1 hour ago
. . . I only patronize the mentally ill and even then I save it for the truly delusional.
If you're implying I'm mentally ill, the only honest answer is, "Aren't we all!?!" The important thing is to have the right kind of delusions, timely ones, such as, for example, "Romney is a small government conservative."
Jul '11
Re: Should Most Common Prescriptions Be Over the Counter?
I was implying that I was not patronizing you yet disagree with your conclusions. The only way I would patronize is if you were bat ass crazy and only in person then.
Nov '11
Re: Should Most Common Prescriptions Be Over the Counter?
Well then, you were very kind to humor me. But the proper term is "batcrap crazy." Has a nicer ring to it.