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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

#241

Post by javadocmd »

shub wrote: post #83
madamelic wrote: post #74

Earlier quoted context omitted.

>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…

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…

The average adult can be quickly and reliably trained to use bleach appropriately: "Should I drink bleach? No. Always no."

On the other hand, the average adult requires six or more years of education and training to manage warfarin appropriately.

I'm being somewhat glib for effect, but do you not see a critical distinction there?

In the interest of public health, we make all kinds of laws to protect people from things they cannot be expected to do safely. Why is it unreasonable to protect people from dangerous medications?

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

#242

Post by raverbashing »

IanCal wrote: post #239
raverbashing wrote: post #238

Earlier quoted context omitted.

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 think allowing diabetics access to life saving medication is preferable, 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.

> My problem here is how someone knows they are diabetic.

Again, I don't really see why this would be the problem of the person selling it, unless you prefer living in a nanny state.

There are a multitude of OTC and other readily sellable stuff that if misused can cause death. Complaining about selling insulin freely and the dangers of it in a place where guns are sold like candy is a farce.

Make them sign a waiver and be done with it.

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

#243

Post by javadocmd »

flukus wrote: post #185
exabrial wrote: post #81

My pharmacist friends have long bemoaned the 'go to the doctor for everything' scheme. Some conditions are easily diagnosable and the side effects of the drugs are minimal. They'd much rather see the doctor as an escalation if treatment isn't responding or the patient has additional symptoms that could indicate something more serious. The behind-the-counter system is a great idea.

Yes, it's incredibly inefficient to have highly trained, expensive doctors acting as tier-1 tech support. But they have a powerful union, so they can keep being paid top dollar for their grunt work.

The kinds of doctors that work as "tier-1 tech support" -- that is, primary care -- are not being paid top dollar, believe me. After you account for the cost of education, delay of entry to the workforce, hours worked per week, and the fact that insurance compensation models are biased towards specialty care and procedures, and it starts to look like bad financial planning.

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

#244

Post by PhasmaFelis »

King-Aaron wrote: post #234
ScottBurson wrote: post #213

Earlier quoted context omitted.

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.

> She had to get a prescription for the saline. 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.

Isn't saline literally just salt water?

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

#245

Post by DanBC »

PhasmaFelis wrote: post #244
King-Aaron wrote: post #234

Earlier quoted context omitted.

> She had to get a prescription for the saline. 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.

Isn't saline literally just salt water?

This is saline that you're going to warm up and then inhale. And you're only going to do this if you're already ill.

I don't think you should need a prescription for saline, but it's a little more complicated than salt water.

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

#246

Post by dalbasal »

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…

I think it comes down to whether you are comparing to ideals, or regular life.

Yes, medications carry risk. But, "without a doctor's prescription" does not mean randomly. People still take advice from doctors and pharmacists, they just aren't required to have proof that a doctor has decided something. In any case, a pharmacist is a pharmacology specialist and probably more knowledgable about drug risk and safety than anyone.

>> makes pharmacists de facto community doctors.

Again, depends on the ideal you are comparing to. You are implying an ideal community doctoring setup, where a local doctor knows people and is accessible to them. An ideal that exists for maybe 1%-2% of the world. The problem that pharmacist/nurse led care solves is that this ideal does not exist. GPs are inaccessible, cost $75 for 10 minutes or don't have appointments available. A pharmacist probably sees someone every time they're sick. Doctors... only if it's bad.

I feel like this sort of issue comes up often, when discussing primary medicine. The comparison isn't fair. When listing the pros and cons of pharmacist or nurse led care, we get a laundry list of real life issues. When listing pros and cons of doctor led care, we get an idealisation. IRL, most GPs prescribing antidepressives do exactly as much "holistic care" as pharmacists would. Patient asks for ADs. Doctor spends 2-3 minutes going through a checklist. Done. Whether or not that's ideal has little to do with who writes the script.

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

#247

Post by morganherlocker »

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…

Generic insulins are already available over the counter at any pharmacy in the US. The newer insulin variants are significantly easier to use safely, since they require less frequent injections (long lasting insulin) and have a faster response time (short lasting insulin used when ingesting carbohydrates or correcting high glucose). These newer variants require a prescription that is typically only issued by an endocrinologist who will require a visit at least every 3 months. I’ve had type 1 diabetes for 20 years now, and have only had my prescription changed a couple times over the entire period. 100% of my medication-related complications have occurred during times where I was unable to acquire a prescription for these higher quality insulin variants, either due to a change in doctor or insurance. Pre-ACA it was common for people to be locked out of insurance coverage of these drugs for up to a year without covering impossible markup on specialist care, and protections for pre-existing coverage are back on the chopping block as we speak. Even today, travel away from my doctor can result in stressful prescription renewal logistics despite having no change in dosing for over a decade. After seeing a doctor nearly 4 times per year for 20 years with almost every visit boiling down to “ok, here’s your renewal, see you in 3 months”, I’m not sure I understand the value for me personally. If someone wants to abuse insulin (I’m not sure why they would), they already can with a bottle of humulin, available at their local Walmart for about $20.

I’ve absolutely benefited from my endocrinologists over the years, but 80 appointments for 2-3 prescription changes (prompted by my request each time) seems like excessive rent seeking.

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

#248

Post by avar »

Lanthanide wrote: post #201
api wrote: post #196

Earlier quoted context omitted.

Off topic but: birth control is OTC in Saudi Arabia? That busts a stereotype.

Aisle 5, right next to the condoms and lube bottles =) and Victoria Secret makes money hand over fist here. This would be off-topic here, but I think most people outside of the region would be stunned about the state of sex-change operations over here. They happen VERY frequently, albeit with a heavy veil of privacy.

Male -> female or female -> male? I have no desire to have a sex-change, but if I had to choose between living as a woman in Saudi Arabia and having invasive surgery and hormone therapy, I might choose the latter.

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

#249

Post by ant6n »

tptacek wrote: post #216
microcolonel wrote: post #204

Earlier quoted context omitted.

> 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 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.

It seems in the us, seeing a doctor already is a luxury.

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

#250

Post by m000 »

ethbro wrote: post #212
exolymph wrote: post #198

Earlier quoted context omitted.

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.

You are already on the slippery slope if you allow public "ask your doctor about" advertisements for anything more substantial than mild painkillers or flu symptom remedies.

This type of aggressive drug ads is pretty much unique to the US. It's your MD's job to stay up to date with drug developments and prescribe what would work for you.

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