Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

bloombergquint.com

Post reply on HN
Print view View original

211–220 of 308 posts

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

#211

Post by danieltillett »

toomanybeersies wrote: post #159

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 brea…

If you are in Australia you can get pseudoephedrine without a prescription - you just give the pharmacist your drivers license and ask for the stuff that works. How pharmaceutical companies can be allowed under our fair trading laws to sell phenylephrine I don’t know.

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

#212

Post by ethbro »

exolymph wrote: post #198
Engineering-MD wrote: post #136

Earlier quoted context omitted.

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. Th…

There are tradeoffs. My guess is that very few people will bother to abuse the drugs that can't get you high, relative to the benefits of increased accessibility.

Presumably the slippery slope would be the profit incentive for manufacturers.

Being able to go from "Ask your doctor about..." to "Try..." is a major shift.

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

#213

Post by ScottBurson »

Engineering-MD wrote: post #136
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. Th…

It gives me a bit of pause too, but I think things have gone too far in the controlled direction. My wife uses a nebulizer for her asthma, and recently was prescribed an albuterol refill. To her surprise, it came in a form where it has to be mixed with saline. She had to get a prescription for the saline. I'm sorry, that's nuts.

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

#214

Post by flyGuyOnTheSly »

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 have always thought that it was completely asinine and unnecessary that my female friends were having to visit a doctor to renew a prescription that rarely changed for years at a time.

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

#215

Post by StillBored »

RichEO wrote: post #121
bargl wrote: post #43

Earlier quoted context omitted.

100% agree. I'd love to see this in the US. most pharmacists have way more knowledge about drugs, their interactions and other issues that can crop up with prescription drugs. Given a diagnosis they are typically better at prescribing the correct medication than a general practitioner. It's also a lot cheaper than a doctors visit for insurance.

You handwave over “given a diagnosis” like it’s an irrelevant detail. You appreciate this is the largest part of the problem, surely?

I would be interested to know what percentage of prescriptions are for things which can't be diagnosed by a pharmacist (or are just requests for a refill of an existing medication).

I think this is the point of the nurse practitioners that CVS (or was it walgreens/etc?) had in some of their stores a few years ago. When my kids were in day care and got frequent ear infections, I could tell by their behavior it was time to check their ears and.. well i'm not a doctor but I can probably tell if you have an ear infection with my cheazy/plastic over the counter otoscope I impulse purchased from said drug store. Going to the doctor to get the same prescription I had filled two months previously is just silly.

Same thing with my poison ivy...

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

#216

Post by tptacek »

microcolonel wrote: post #204
mirimir wrote: post #197

Earlier quoted context omitted.

I can't imagine safely prescribing anti-hyperlipidemia and anti-hypertension drugs without medical advice. Sure, we can all measure our own blood pressure. But choosing which anti-hypertension drug to use, or which combination, is nontrivial.

> But choosing which anti-hypertension drug to use, or which combination, is nontrivial. Then why not consult a doctor? It is already an immense legal risk to recommend starting a course of drugs like this without seeking medical advice, I don't see why it would be any different if you could technically self-administer an anti-hypertension drug.

The basic argument is that when you make seeing a doctor to get access to a drug optional, you also make it a luxury; it changes patient expectations and thus behavior.

Most people don't go to the doctor before taking Claritin or Sudafed; when you go to the doctor and get a "script" for Sudafed, that's your signal that you wasted yours and the doctor's time.

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

#217

Post by gehwartzen »

csdreamer7 wrote: post #164
refurb wrote: post #4

Similar to this idea, the province of Alberta in Canada allows pharmacists to write prescriptions for patients with only the only limit that they can't prescribe controlled substances.

I like this, with the exception of anti-biotics because misuse would spread immunity.

You can already buy most standard antibiotics without a prescription if you don’t mind taking fish medication ;) amoxicillin, ciprofloxacin, penicillin, etc are all readily available through amazon and are identical to the human version.

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

#218

Post by tengbretson »

svrtknst wrote: post #117
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…

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 meas…

What exactly do you think constitutes an "accident"? Have you ever accidentally purchased a drug that required an over-the-counter interaction and consumed it?

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

#219

Post by pessimizer »

vageli wrote: post #122
mobilefriendly wrote: post #47

Earlier quoted context omitted.

Incorrect. 200 mg Ibuprofen is 2 cents a pill at Walmart. https://www.walmart.com/search/?query=ibuprofen%20200mg%2050...

Pointing at a single data point is not enough evidence to show that an upwards trend does not exist.

The single data point is the exact same single data point mentioned in the comment as the only evidence that an upwards trend existed in the first place.

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

#220

Post by madhadron »

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…

> There's a generalized problem in medicine that it takes a long time for new standards to trickle into common practice.

In the US, where we have no standards of care, this is true. In centralized systems like France, doctors receive updates to expected standards of care annually based on analysis of the latest evidence.

This has interesting effects. My father did the statistical work for a set of expert consensus guidelines in psychiatry. He found an interesting pattern: the European practitioners produced basically the same decision tree, from Sweden to Spain (that is, physicians practicing in completely independent healthcare systems). American practitioners were so scattered that sometimes you couldn't extract guidelines.

This is also why you can have an operation done safely in a rural hospital in Italy, whereas in a rural hospital in the US, the only thing you should let them do is put a bandage on you and transfer you to a real medical center in a major urban area.

Post reply on HN