U.S. to make More Drugs Easily Available, Cutting Role Doctors Play • Hacker News Board

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

#141

Post by kbutler » Tue, Jul 17, 2018, 11:31 PM UTC

tssva wrote: post #127

394549 wrote: 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…

My experience is that I don't even need to call to get my prescriptions refilled. I login to my doctor's EMR portal, select medication from the menu on the left, select the check boxes next to the medications I need refills of and click the refill button. A few hours or the next day at the latest my Walgreens app alerts me that my prescriptions are ready.

The prescription is probably good for some limited number of refills.

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

#142

Post by nanagull » Tue, Jul 17, 2018, 11:33 PM UTC

darkerside wrote: post #128

nanagull wrote: post #106

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...

There's a generalized problem in medicine that it takes a long time for new standards to trickle into common practice. It often doesn't fully turn over until an older generation of doctors retires. It seems to me that, of many imperfect systems, one where doctors have control is more preferable. They are legally and duty bound to serve their patients. The same can't be said of pharma company marketers, not by a long…

Please see this report by the American College of Obstetricians and Gynecologists : https://www.acog.org/Clinical-Guidance-and-Publications/Comm...

It discusses a series of studies on the "ability of patients to self-screen for birth control pill eligibility", and determines that patients are good enough at self-screening that the medication may as well be over-the-counter.

It sounds like, from the initial article, that the FDA is taking a similar approach: "Drug companies would have to submit data to the FDA that shows consumers are capable of accurately assessing their need for a medication and their ability to use it correctly."

Obviously we'd need to wait to see what the FDA actually approves/disapproves for these purposes, but it actually seems quite likely the approved drugs will, in fact, be restricted to cut and dry ones, such as birth control pills.

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

#143

Post by mrfusion » Tue, Jul 17, 2018, 11:33 PM UTC

madamelic wrote: post #74

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…

>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…

But medicine is dealing with your own body and I would argue that you’re the world expert on your own body.

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

#144

Post by dragonwriter » Tue, Jul 17, 2018, 11:38 PM UTC

ams6110 wrote: post #115

nanagull wrote: post #106

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.

> 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.

Pap smears and pelvic exams, however, are not checks for the potential serious side effects of birth control pills.

It's about like being forced to have a colonoscopy before being allowed to get NSAIDs, because NSAIDs have potentially serious side effects.

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

#145

Post by Broken_Hippo » Tue, Jul 17, 2018, 11:41 PM UTC

ams6110 wrote: post #115

nanagull wrote: post #106

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.

Lots of things that are generally considered safe can have potentially serious side effects. Some of these are available over the counter. This doesn't mean they aren't really safe, it means that some folks have bad experiences.

It isn't just that it is safer than being pregnant. It is seriously better for some folks to take birth control because of the severity of their monthly cycle.

Some folks can't take tylenol. Ibuprofen can cause ulcers. Folks take heartburn pills (such as Prilosec) without being diagnosed. A body can form a dependence on certain laxatives. This doesn't mean they aren't generally safe for folks when used properly. Having some of these only available after talking to a pharmacist shouldn't shouldn't be a big deal, especially if you have to get the first dose with a prescription from the doctor.

What isn't reasonable is folks having to have an actual visit to the doctor every time a prescription runs out. It isn't reasonable to force people to have unnecessary pap screens to get birth control either - so long as your tests are normal and you aren't having other issues, there is no reason to have one every year even. Every 3 years tends to work out just fine.

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

#146

Post by matt4077 » Tue, Jul 17, 2018, 11:43 PM UTC

xamuel wrote: post #39

rsynnott wrote: post #23

> Patients could answer questions on a mobile-phone app to help determine whether they should be able to access a medication without a prescription. Day 2: Websites showing the correct answers to get anything you want show up. This is an absolutely bonkers idea.

As opposed to the alternative where people buy said meds from a dude in an alleyway?

By that logic, I should already be able to buy medication from back-alley dudes.

While I could quite easily get ahold of Marijuana and other illegal drugs on the street or the dark side of the net, I have never seen an offer for non-narcotic prescription drugs.

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

#147

Post by maxerickson » Tue, Jul 17, 2018, 11:45 PM UTC

ars wrote: post #132

maxerickson wrote: post #120

Earlier quoted context omitted.

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.

It's not completely different, the branded drug faces pretty stiff competition and hasn't cut prices.

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

#148

Post by phil21 » Tue, Jul 17, 2018, 11:54 PM UTC

Beyond time. I find it pathetic that living in the "land of the free, home of the brave" I need to travel out of the country to be able to pick up basic medications without a permission slip from the authorities. I utterly refuse to pay $100+ so I can get a signed hall slip from a doctor to get what I knew I already needed.

This perhaps will save me some travel costs every few years when I go to restock the personal pharmacy.

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

#149

Post by ilaksh » Tue, Jul 17, 2018, 11:58 PM UTC

kian wrote: post #66

majewsky wrote: post #44

Earlier quoted context omitted.

I would be interested in this as well. I feel like my asthma got worse since I moved to an apartment next to a busier road.

I can't speak for JumpCrissCross, but there are 3 things that improved my asthma: 1) Eating better. Low level inflammation is terrible for people with auto-immune disorders, to which the trio of asthma, eczema, and allergies belong. 2) Moved closer to the ocean - salt air is great for the lungs, and really has a way of helping deal with any allergies you might have to local pollen 3) RUN! seriously, aerobic exercise…

Not everyone's asthma is like yours. For example, trying to run for 45 minutes would kill me these days. My asthma is triggered by exercise and even when I used to exercise quite a lot and was on more medication it was a struggle. So don't assume everyone's condition is the same as yours.

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

#150

Post by [deleted] » Tue, Jul 17, 2018, 11:59 PM UTC

15155 wrote: post #73

srameshc wrote: post #57

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.

[deleted]