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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

#151

Post by phil21 »

aesclepius wrote: post #86
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.

Thanks for speaking for the entire medical profession. That is in fact what a terrible physician does, and not what myself or other newly trained physicians aspire to do.

You may not aspire to it, but you likely will have to do it if you want to remain employed in many areas.

I have multiple friends who made it all the way through residency and have since stopped practicing within years of "graduating. The OP describes the profession much better than you do, as a whole.

Double booking patients, requiring certain revenue targets, massive amounts of useless paperwork, etc. Considering the varying ranges of where they took up residency I'd say this is endemic industry-wide. Also jives with my personal experiences with the medical field.

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

#152

Post by refurb »

athenot wrote: post #19

I have mixed feelings about this, especially considering the US is the only first world country where direct-to-consumer marketing is allowed for medications. Bypassing the prescription requirement is of course of significant value to drug companies, who expend quite a bit of resources to sway doctors with free lunches, conferences and soft persuasion tactics. Usually I welcome the freedom to chose but this doesn't i…

What you’re talking about goes far beyond what the FDA is proposing.

The drugs the FDA wants OTC are drugs that have already gone generic like statins. There is very little financial incentive to push consumers to buy drugs they don’t need.

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

#153

Post by jdietrich »

Communitivity wrote: post #69

There are better ways to go about this. As others have noted, there must be a mechanism for a continual prescription to be easily filled, e.g. insulin, metformin, etc. I could see a long term prescription that has to be renewed each year and is good at any pharmacy. For the short term prescriptions though, cutting the doctor out of it makes people much more susceptible to marketing (instead of 'ask your doctor if you…

For what it's worth, the UK has had a three-tier system of medicine licensing (prescription-only, pharmacy-only and general sale) since 1968. In 2006, pharmacists with additional training gained the right to independently prescribe any prescription-only medicine within their clinical competence. Repeat prescriptions can be requested online and sent electronically to a pharmacist of the patient's choice. Obviously YMMV.

https://www.nhs.uk/common-health-questions/medicines/what-is...

https://www.pharmacyregulation.org/education/pharmacist-inde...

https://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/P...

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

#154

Post by mullingitover »

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.

Isn't human misuse of antibiotics a drop in the ocean compared to the livestock feed? Pretty sure we could completely stop all human misuse and we'd accomplish nearly nothing toward the goal of stopping antibiotic resistance.

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

#155

Post by toomanybeersies »

mkl wrote: post #99
athenot wrote: post #19

I have mixed feelings about this, especially considering the US is the only first world country where direct-to-consumer marketing is allowed for medications. Bypassing the prescription requirement is of course of significant value to drug companies, who expend quite a bit of resources to sway doctors with free lunches, conferences and soft persuasion tactics. Usually I welcome the freedom to chose but this doesn't i…

> the US is the only first world country where direct-to-consumer marketing is allowed for medications. Not quite. It's allowed in New Zealand too. There have been many calls to change that, but so far it's still allowed.

It's not quite as bad in New Zealand as the states though, since most of the time if you go to the doctor they'll prescribe you generic, state subsidised medicine.

I've never really noticed much direct-to-consumer marketing, except for Viagra and Cialis.

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

#156

Post by neurotech1 »

athenot wrote: post #20
seanmcdirmid wrote: post #18

Nurse practitioners are already great for when you just have an infection and need some anti-biotics. They have little clinics with them in many drugstores these days.

NPs can already prescribe drugs (just not narcotics, iirc).

Nurse Practitioners can prescribe Class II narcotics in most states, if their supervisor physician allows it.

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

#157

Post by mullingitover »

aaavl2821 wrote: post #31

looks like this is a draft guidance document, so it may not actually come into effect for a while. something like this seems like it would be massively controversial, and thered probably be a lot of debate on both sides. overall though the idea is very interesting. something like 20% of US health spend is on outpatient care. i dont know how much of that relates to medication management, but id imagine a lot does. PCP…

> i personally am sort of disappointed to see doctors becoming even more sidelined. doctors really do an important job of filtering info for patients, advocating / negotiating with insurance companies, and looking out for them

Tell that to my doctor, who on a routine checkup sent me to the lab for lab work without clearing it with my insurance company. I got a nice $600 bill for the lab work that the insurance company didn't agree was 'preventative.' After calling the insurance company they ended up waiving it, but told me that in the future I should clear every single thing the doctor orders with them, because the doctors won't do it.

The supply of doctors in the US is artificially constrained, and physician care costs more here than anywhere else in the world. Anything that removes them from the equation, especially for basic things like prescriptions, is a plus in my book.

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

#158

Post by phil21 »

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.

This is why I feel only antibiotics should require a prescription - because of the tragedy of the commons.

And yes, I mean only antibiotics. You popping Vicodin for fun doesn't directly affect me, so it's none of my damn business.

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

#159

Post by toomanybeersies »

Interesting that they mention Naloxone.

In Australia (VIC at least), Naloxone is available for free over the counter at the pharmacy. Needles are also readily available (and I'm fairly sure they're free).

It doesn't really make sense for Naloxone to be prescription. Smack users aren't going to go to the doctor for a prescription. You can't get high off the stuff, all it can do is take you off a high and keep you breathing until an ambulance arrives.

On the other hand, if I want painkillers with opioids like panadeine (codeine + acetaminophen), I need to get a prescription. Same if I want cold medicine containing psuedaephidrine, because I might make methamphetamine with it.

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

#160

Post by darkerside »

nanagull wrote: post #142
darkerside wrote: post #128

Earlier quoted context omitted.

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, t…

Thanks for the link. I'd like to see intelligent changes to the system in these cut and dry cases where we are unlikely to do harm through action. The problem is, I don't think statins, the first drug in the article, fall under that category.

BTW, the 33% number you cite in parent comment doesn't include responses to the pap smear question, only the pelvic exam, and is specific to family doctors.

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