231–240 of 308 posts
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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.
So? We don't require a prescription for fruits and sandwiches.
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…
A U.S. Pharma.D is a professional doctorate degree. They don't just study organic chemistry, but also little things like treatment indications and counter-indications, patient management, etc.
Having access to the patient's medical history is a solvable problem. Some pharmacists already have access to and make use of such information.
Regarding patient time, there are more pharmacists in the U.S. than primary care physicians--roughly 290,000 versus 250,000. (See https://www.statista.com/statistics/185723/number-of-pharmac... and https://www.ahrq.gov/research/findings/factsheets/primary/pc...)
The problem today is that we waste our physicians' expertise on trivial stuff. It's an inefficient allocation of resources. Pharmacists have traditionally always been on the front-lines. The past half century in the U.S. has been anomalous in how underutilized are our pharmacists. Fortunately their training is still quite rigorous. They regularly catch physician errors, including a significant portion not related to drug interactions. (See https://www.sciencedirect.com/science/article/pii/S131901641...)
As long as the lines of communication are kept open, what's the issue? An M.D. or O.D. doesn't make one omnipotent. And U.S. pharmacists are better trained than the pharmacists in many other countries who enjoy greater independence and authority. The sky isn't falling in those places, AFAICT.
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…
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…
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.
Probably due to people previously being able to buy saline over the counter, and using it to inject themselves with etc. Misuse of things by people generally ends up with knee-jerk responses by regulators.
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They should start their own practice and set their own rules. Good practices/doctors in my area are so in demand most aren't accepting new patients.
Is it even possible to set up an individual practice these days? Most individual practices were established decades ago. Most new physicians will work with an established group practice on contract.
Big companies have more people doing billing alone than doctors themselves. Pretty clear cut case that regulation is the enemy of efficient markets.
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…
They can and do. See, e.g., https://www.sciencedirect.com/science/article/pii/S131901641...
Pharmacists in the U.S. are highly trained medical professionals. A Pharm.D is a professional doctorate. Their expertise extends beyond chemistry, and more importantly are trained well enough to know when to seek the advice of, or refer a patient to, an M.D.
It's not that pharmacists aren't trained well enough to do these things. The real issue is that most electronic medical records are locked behind proprietary walled gardens. Outside HMOs and similar vertically integrated medical systems, pharmacists don't have reliable access to medical histories. This is a solvable problem, though.
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> 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.
The tragedy of the situation is that most prescriptions aren't as effective as marketing campaigns lead people to believe. For example, statins are good for improving patients' cholesterol lab #'s, but make them achey, and only prevent a handful of heart attacks for every 100 patients treated (statins have a poor 'number needed to treat' [0] ratio).
[0] https://en.m.wikipedia.org/wiki/Number_needed_to_treat (the section titled "simple example" says ~98 people had to take the studied cholesterol drug for 3.3 years to prevent one cardiac event.)
Number needed to harm is another important factor. All patients were harmed by DES [1], before it was withdrawn...
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…
I think allowing diabetics access to life saving medication is preferable, even if there's some moron that's going to kill himself by injecting something he has no idea about (and they do that already)
The proposal wouldn't allow the sale of controlled medication like antidepressants
The rest just sounds like undue gatekeeping
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…
Read the article, it will have a questionnaire to determine if people should be given the drug I think allowing diabetics access to life saving medication is preferable, even if there's some moron that's going to kill himself by injecting something he has no idea about (and they do that already) The proposal wouldn't allow the sale of controlled medication like antidepressants The rest just sounds like undue gatekeep…
I don't think anyone is arguing for diabetics to not have access.
My problem here is how someone knows they are diabetic.
But I saw little in the article actually describe what the process would be for deciding what can be sold like this, I know diabetes is not mentioned.
Earlier quoted context omitted.
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.
You have a very good point about patient expectations. But patients have been trained to expect a prescription for magic pills from the doctor, and the doctors do their best to oblige, even when they ought to recommend a lifestyle intervention... As you note, people think they've wasted their time (and money) if they only get a recommendation that doesn't need a prescription. The tragedy of the situation is that most…
>>> Americans may soon be able to get cholesterol-lowering medications
Going to the doctor to get such a medication is one more occasion to be reminded to check your diet before jumpin' on pills...
For the newly available medication, I'd suggest to raise their price by half the price of going to thte doctor to get the script. That money would then be given back to social health care system :-) So the patient pays less, have more flexible access to the medication and healthcare system benefits too :-)