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

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

#131

Post by DenisM »

SloopJon wrote: post #100
rdiddly wrote: post #64

When you already know what drug you need and just need somebody to sign a prescription, it's a very silly and awkward process to find a doctor, make the appointment, wait for the appointment, show up to the appointment, fill out the history forms and so on, meet with the doc, tell them you've got [disease] and the drug for it is [drug], let them examine you until they agree with your "diagnosis" of [disease], and let…

I can certainly relate to this, as I have to see a neurologist every two years or so for cluster headaches. When a cycle starts, I need a prescription for medicine and oxygen immediately, because I'm getting very painful headaches every day for two months or so. The problem is, my neuros keep retiring, so I have to start over, begging for an appointment from a new one who doesn't have anything sooner than three month…

I was advised in a situation like this to ask the receptionist to connect you with the doctor's nurse. Nurse is more available than doctor, and is more competent than the receptionist. YMMV.

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

#132

Post by ars »

maxerickson wrote: post #120
ars wrote: post #16

Earlier quoted context omitted.

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.

That a different thing, name brand vs generic.

This is OTC vs. Prescription.

Although I bet your insurance company doesn't actually pay $200 if they cover it - they probably get rebates that cover the difference, and then make you pay a higher co-pay.

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

#133

Post by ars »

darpa_escapee wrote: post #45
ars wrote: post #14

Earlier quoted context omitted.

You have that 100% backwards. Insurance premiums will go down since OTC drugs are not covered by insurance. Pharmaceutical profits will also go down because people are much more price sensitive for OTC drugs, so they can't charge as much.

I could be wrong, but I was under the impression that some plans will cover OTC medication if a doctor "prescribes" them for you. According to the article, these drugs won't be considered OTC, they still need a pharmacists approval. I don't know how that will affect coverage, if at all.

> I could be wrong, but I was under the impression that some plans will cover OTC medication if a doctor "prescribes" them for you.

Yes, that is correct. But the idea here is to have a person decide to take it without having a Dr prescribe it, so insurance will not cover it.

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

#134

Post by bumholio »

Lanthanide wrote: post #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. Th…

I find it doubtful that Atorvastatin was not available for health/risk reasons. I can buy it cash in 5 minutes, no questions asked.

What tends to happen in some EU countries is that the retail drugs are heavily subsidized by the government, and then all kinds of kludges are put in place to prevent people buying bulk quantities and reselling them in some other EU country where the price is much higher - the export itself being 100% legal on the single market.

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

#135

Post by toast0 »

394549 wrote: post #107
shub wrote: post #83

Earlier quoted context omitted.

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…

> 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... The difference is there isn't a massive industry that will try to persuade consumers to do something as dumb as choosing to represent themselves pro se. There's no way for others to profit off that kind of stupidity. On the other hand, the drug industry already advertises to consume…

> The difference is there isn't a massive industry that will try to persuade consumers to do something as dumb as choosing to represent themselves pro se. There's no way for others to profit off that kind of stupidity.

Wouldn't you like to attend my seminar on the importance of representing yourself? Also, check out my book. And follow me on Twitter.

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

#136

Post by Engineering-MD »

Lanthanide wrote: post #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. Th…

I’m not I agree. The first reason is that many medications carry significant risks. For instance you mention insulin. For someone already prescribed insulin, yes it should be easy to access in case they should be able to get more (and that is the purpose of a repeat prescription). However, to provide insulin over the counter to someone never previously prescribed it could be incredibly dangerous, and indeed fatal. This is Similarly true for some cardiac medication.

Second, i think such a system makes pharmacists de facto community doctors, but without the time, training, or patient medical data to function correctly. Community doctors can make better decisions when they see the same patient multiple times, and have access to blood pressure readings, a list of other medical conditions etc. Buying over the counter makes a lot of this difficult and inefficient.

Third, I think it leads to a risk of encouraging patients to manage conditions without valid medical advice. For instance, depression is often treated best with psychotherapy. By buying antidepressives OTC, it prevents patients getting the holistic care needed. Similarly, patients may follow quack medical advice and do themselves significant injury by taking medications not needed (in the short term or long term).

Ultimately doctors offer a lot of value more than just prescribing medication, and often medicines need oversight to ensure the benefits outweigh the risk.

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

#137

Post by stochastic_monk »

vibrio wrote: post #61
stochastic_monk wrote: post #55

Earlier quoted context omitted.

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.

...that and we'd better start inventing some new antibiotics now. As it is now, physicans can barely prescribe them responsibly. If they are available as cold medicine antibiotic resistance will surge even harder than it is now. antibiotic resistance is a dramatically underappreciated problem.

That’s a good, simple example demonstrating a problem.

I also think pharmacokinetic effects are likely underappreciated by the general public.

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

#138

Post by WillPostForFood »

panzagl wrote: post #109
thatcat wrote: post #94

Earlier quoted context omitted.

If you live in a location that has poor selection of GPs then it should be your choice to opt out without denying yourself access necessary medication.

If you don't go to a doctor, how do you know it's necessary?

If you’ve been taking the same medication for 10 years, then on day 1 of year 11 you need a refill, pretty good chance you know it is necessary. I wouldn’t claim you never need to see a doctor, but it is equally absurd to suggest you always need to see a doctor. My experience has been that I ask for refills, and my doctor unquestioningly gives them. It would save the whole system money and time if I could just refill them myself.

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

#139

Post by WillPostForFood »

tptacek wrote: post #84
gaius wrote: post #80

Earlier quoted context omitted.

Also, the doctor is aware of your health history Your doctor skims your notes in the 20 seconds between the receptionist calling your name and you entering her office, in handwriting she can barely read herself, and has forgotten you before you’re even back in the waiting room after spending 5 minutes talking to you while she’s really thinking about the new Audi. That’s as far as the awareness goes.

That is not at all the experience I have with my doctor, where the intake NP does a whole litany of the past several years worth of doctor visits before I’m seen. I’m ok and I think glad that pharmacists don’t even have access to that information.

On your first visit or every visit thereafter? I think the issue is the overhead of unecessary repeat visits.

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

#140

Post by kbutler »

394549 wrote: post #105
thatcat wrote: post #91

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.

> 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…

Personal experience:

I was getting an annual physical from the doctor who had written a prescription that was expiring. We discussed the condition and agreed I needed a renewal. I was told I had to come back for a separate visit "because Obamacare required it" My translation: because he couldn't bill for writing out the prescription during well-check, and because he wanted/needed to charge for it. Oh, and blaming Obamacare because I live in a predominantly Republican area.

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