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U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

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111–120 of 308 posts

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#111
I live in a country where this scheme is already the norm (Saudi Arabia) and I can say that while it's not necessarily ideal, I much prefer it to the alternative. It plugs some seriously annoying holes in the healthcare experience and frees up doctors' time for more patients.

As it is, the only medications that require a prescription to buy in Saudi are psychotropic ones, narcotics, and most recently, antibiotics. Things like insulin, birth control medications, hypertension medications, even antidepressants and anti-psychotics- they are all OTC. And I think they should remain so, because from what I've seen the damage from misusing those drugs against pharmacists' advice is far less than the damage from going without them due to the difficulties encountered in seeing a doctor.

The reason that this is the norm here is twofold; one, health insurance wasn't much of a thing here until a few years ago. The second reason (and the reason health insurance didn't factor in until recently) is that the socialized healthcare system here was (and still is) stretched thin; seeing a doctor to get prescriptions for every little thing becomes prohibitively difficult, with appointments taking months.

It's asinine to expect someone suffering from, say, an acute athsma attack to try to navigate ERs or try to see a doctor on short notice during a crisis, when a pharmacist would be able to dispense the exact medication needed, leaving the others free for more complex cases that need closer attention.

Edit: this actually created a bit of culture shock for an older friend of mine. He was traveling to an EU country for the first time and didn't do his homework- he thought he he could simply walk into any pharmacy and ask for a pack of his cholesterol medication, as he usually does back home. I don't envy the poor pharmacist that had to keep trying to explain the dispensing system to him and to emphasize that yes, they are aware that it's Lipitor, not morphine, it's just how the regulation is.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#112
post #46

Bravo. The AMA/FDA/insurance cartel cannot die soon enough. I don’t care if you want a free market, or you want socialized medicine, both are preferable to government-enforced racketeering.

You mean the AMA and FDA should stop preventing patients from taking contraindicated combinations or failing to understand the risks they’re taking on by self-medicating? Pharmacology is complicated and dangerous. Letting corporations go hog-wild will harm many people.

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Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#113
post #7

Yikes, my girlfriend is applying to med school as we speak. The medical industry is certainly a highly regulated, potentially overpriced service for decades now. When I see a headline like this, I have to seriously ask myself: "Is this when the bubble finally pops, or will it be status quo for another generation?"

It's just shifting to pharmacists who are also medical professionals, it was inevitable given the success of pharmacy based immunization programs.

I don’t think you understand the way the outrage on the internet game is supposed to work.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#114
post #73

Earlier quoted context omitted.

This is the most atrocious thing to do by not to letting people with Type 1 buy their Insulin medication. I just don't see a reason why this is so much regulated. Like some meds which are partially regulated, where you can request a Pharmacist and they can give you would be reasonable in this case.

Insulin is regulated because you can very easily die from using it improperly.

Older versions are available OTC in at least parts of the US.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#115
post #105

Earlier quoted context omitted.

> It's a trade off since Doctors have a habit of using their prescription power to force you to schedule unnecessary visits to boost profits and they are not immune from marketing pressure. Citation needed. I'm sure are a few doctors out there who do that, but I have a hard time believing that's so widespread that it's a "habit" of "doctors." For instance, my doctor will reissue my long-term prescription if I call hi…

For just one example: 33% of doctors always require a pap smear and pelvic exam to renew a birth control pill prescription. This is despite the fact that the WHO and ACOG both advise that the pills can be safely prescribed without the exams. 33% certainly counts as more than a "few" in my book. Citation: https://www.reuters.com/article/us-birth-control/women-seeki...

Well, birth control pills aren't really safe. I guess they're safe compared to a pregnancy, but they do have potentially serious side effects. It seems reasonable to have periodic checks for those, if you're taking them.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#116

Earlier quoted context omitted.

In my opinion, everyone should take the time to study the drugs that they are prescribed, as well as the interactions to foods and supplements. I believe this is more important that anything related to one's career or investments. You only get one body.

It sounds to me as if you're failing to grasp just how difficult that is to do for at least 80% of the population.

If not the Hacker News crowd, who remains to think of the 20% for whom systematic paternalism is an enormous net drag?

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#117
post #83

Earlier quoted context omitted.

>it's a very silly and awkward process to find a tech person, make the meeting, wait for the meeting, show up to the meeting, tell them your issue and the solution for it is [solution], let them examine your problem until they agree with your "diagnosis" of [problem], and let them recommend and prescribe [solution]. It makes you feel sorry for the tech person almost. There is a reason why we have specialists. Yes, yo…

One can represent themselves. It might be dumb, but people should have the right to be dumb when they're the only ones getting hurt. That's why I have no problem with engineering requirements: when a bridge, airplane, whatever falls down and goes boom, it's not only the owner who's affected. I'm an adult. It's legal for me to buy and drink bleach. It would be very stupid of me to do that, but I can. I should be able…

I'm willing to bet that very few people accidentally consume bleach or warfarin under the belief that it is beneficial.

However, it's far more likely that a layman gains cursory information about a drug and its effects, while lacking the specialized knowledge required to safely prescribe it.

In short, it's far easier to accidentally poison yourself with prescription medication that it is with bleach, and we have measures in place to prevent such accidents for a reason.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#118

Earlier quoted context omitted.

For just one example: 33% of doctors always require a pap smear and pelvic exam to renew a birth control pill prescription. This is despite the fact that the WHO and ACOG both advise that the pills can be safely prescribed without the exams. 33% certainly counts as more than a "few" in my book. Citation: https://www.reuters.com/article/us-birth-control/women-seeki...

Well, birth control pills aren't really safe. I guess they're safe compared to a pregnancy, but they do have potentially serious side effects. It seems reasonable to have periodic checks for those, if you're taking them.

As the GP pointed out, pap smears and pelvic exams are not medically necessary prerequisite to a birth control prescription and adding those procedures don't make prescribing birth control pills safer. They are an artificial barrier to access birth control.

Pap smears (when done at the recommend intervals - most doctors overtest) are extremely beneficial screening tool and they save lives, but they have nothing to do with birth control - the purpose of a pap smear is to screen for cervical cancer.

In fact, the current recommendation is to wait until a women turns 21 before starting pap smears, yet many (most?) women will require contraceptives before 21.

It's also false that "birth control pills aren't really safe." - "potential to have serious side effects" is not even remotely the same thing as "not really safe." Oral contraceptives are not more dangerous than NSAIDs like ibuprofen. Both The American College of Obstetricians and Gynecologists [1] and The American Academy of Family Physicians [2] recommend over the counter access to oral contraceptives based on the availabile evidence

[1] https://acog.org/Clinical-Guidance-and-Publications/Committe...

[2] https://www.aafp.org/about/policies/all/otc-oral-contracepti...

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#119

How do they propose to deal with the potential dangers of drug interactions?

> How do they propose to deal with the potential dangers of drug interactions?

My guess is greater reliance on pharmacy systems.

Drug interaction problems happen now; the current scheme fails to prevent this. Can you provide evidence that the proposed change will be significantly worse?

As some point the parade of horribles we're confronted with whenever any change is offered becomes preferable to the reality we're actually living.

Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play

#120
post #16

Earlier quoted context omitted.

I'd be pretty shocked if the pharmaceutical industry is against this. I would bet they _lobbied_ for it. They can already advertise direct to consumers, now those consumers will be able to go directly to purchasing medication with no intermediary (no "ask your doctor if X is right for you"). This seems like it's GREAT for them. I would expect marketing budgets to go up dramatically in pursuit of these disintermediate…

It's not as great as you think for the pharmaceutical industry. They can't charge as much for OTC drugs because people won't pay for it. If the drug (or a similar in class competitor) is available OTC then they also can't charge as much via prescription. So both ways, prices go down.

I dunno, the name brand for a generic I took costs ~$200 a month.

The generic is $7.

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