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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

#261

Post by Engineering-MD »

wahern wrote: post #232
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…

> i think such a system makes pharmacists de facto community doctors, but without the time, training, or patient medical data to function correctly. 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 pha…

I was not belittling the pharmacist’s qualification, they often helped advise me and fit a specific role in the health care system. They are however trained for a different role (at least in the uk where I am based). General practioners are trained to deal with long term conditions. These conditions often require patients to be managed over a long period of time, and seem several times, hopefully by the same clinician. They also see them for the majority of their other illnesses. General practitioners allow a patient to develop a long term relationship with a doctor, and allow the doctor to become an expert in the patient.

I agree with you that a pharmacist is capable of dealing with many of these issues, but (at least in the uk) they are not primarily set up to deal with long term health conditions, and don’t develop that expertise in a single patient. If they become like GPs (which they feasibly could), it would work. But why do that when there is already a doctor who specialises in that? Maybe my arguments work less well in America, but my knowledge of that healthcare system is limited.

Ultimately though it seems we agree medications need some form of specialist oversight, rather than being freely available.

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

#262

Post by hrygolis »

medntech wrote: post #229
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.

"Some conditions are easily diagnosable and the side effects of the drugs are minimal." Sounds like a good time to see an NP/PA. Things should be triaged more effectively. Pharmacists PA/NP MD/DO.

That chain you're outlining is part of the problem with health care in the US.

It's not just pharmacists or PAs, it's psychologists, optometrists, dentists... The problem is we have this over regulated system that doesn't recognize the actual capabilities of many in the system that could be doing a lot more than they are, we're it not for professional lobbying around turf.

There are huge unrecognized bottlenecks to care that have everything to do with inaccurate regulatory assumptions about who can do what, starting with the consumer themselves.

I get a little upset about the idea of triaging down a chain, because the triage chain itself is a flawed idea. I dream of a much more competitive system where people get drug advice from professionals based on those professionals' training and expertise, regardless of specific training pathway or background.

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

#263

Post by PiggySpeed »

LinuxBender wrote: post #87
cimmanom wrote: post #70

How do they propose to deal with the potential dangers of drug interactions?

Today you can research drug interactions online just like many doctors do. I have to do this for the combination of supplements and the one prescription, since most doctors are not trained in this area.

In the majority of cases, online interaction checkers might be OK. But please be aware that there's more to drug interactions than using online checkers.

You can have a drug interaction that is red-flagged but can be deemed harmless depending the patient's medical background (QT prolongation). In other cases the interaction can be undocumented, and relies on the instinct and knowledge of the medical professional to piece together the pharmacology and make a judgement of the risk to the patient (co-sedating drugs, drugs that are processed by CYP2C19 vs CYP3A4 enzymes -- there's a big difference).

Also need to take into consideration the timeline of administration. Some drugs clear very slowly from the body, and simply taking one drug after the other is discontinued can be a dangerous assumption to make (antipsychotics).

There are a lot of other interactions that are flagged, but after careful appraisal of the evidence, they're not that much of a concern to the patient.

Also consider route of administration. Does taking a transdermal patch interact with an oral medication? What about eyedrops and inhalers? What are the absorption/distribution/metabolic/excretion characteristics of the drug? Peak drug concentration levels?

Some of these details are picked up online. But you need to be aware of fundamental gaps in your understanding of medicine. It's like being a self-taught developer. Sure you can learn enough on your own to be useful, but without the years of theory and fundamentals, you will hit a roadblock which can be costly.

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

#264

Post by cimmanom »

wu-ikkyu wrote: post #183
cimmanom wrote: post #70

How do they propose to deal with the potential dangers of drug interactions?

Could be as simple as having the user input any other drugs, foods, substances, etc. they are currently consuming and then checking for interactions on the back end. There are already many sites that do this.

"The little blue ones and the big yellow ones."

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

#265

Post by saiya-jin »

talltimtom wrote: post #255
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…

“ And I think they should remain so, because from what I've seen the damage from misusing those drugs against pharmacists' advice is far less than the damage from going without them due to the difficulties encountered in seeing a doctor.” When people start self prescribing antibiotics even for minor stuff, it’s not a problem because of the minor risks to them, but because of the major risk to the entire society. We a…

you didn't catch the part where he mentions antibiotics are still for prescription and went on a tirade about overuse of antibiotics (which is a topic on its own but unrelated to parent)

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

#266

Post by Engineering-MD »

raverbashing wrote: post #238
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…

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 did read the article. In future, please refrain from insinuating someone has not read the article, it is against the guidelines for comments:

>Please don't insinuate that someone hasn't read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that."

In particular, I was replying to Lanthanide’s comment on the system in Saudi Arabia.

I agree with IanCal, giving insulin to someone not already prescribed it is hard to justify. The risk of harm is much greater than the possible benefit, especially when they could just go see a doctor (routinely or as an emergency). I am from the UK so perhaps I live in what you would consider a nanny state, as guns are not freely available. As a point of information, in the UK antidepressants are not controlled more than any other prescription drug, I don’t know how that differs in the USA

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

#267

Post by amelius »

LinuxBender wrote: post #82
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…

I agree with this. Many of the supplements I get online are just as risky as anything a doctor can prescribe to me. I already know more about these chemicals and drugs than any doctor I have met. What's more, I have yet to meet a doctor that even cares about the supplements I take.

> What's more, I have yet to meet a doctor that even cares about the supplements I take.

Reminds me, some time ago I researched a supplement extensively before taking it. Then when it turned out to be helping me, I asked my doc if it was safe to continue taking it. He just Googled it, clicked on the first search result, and determined it was safe.

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

#268

Post by amelius »

ElixirIsCool wrote: post #254
cassowary37 wrote: post #163

I'm always struck by the intensity with which some HN folks hate their doc - reminded of this by the number of comments invoking conspiracy theories about docs scheduling extra appointments to bill more or push more generic drugs. Perhaps obvious but perhaps not: in the US and most EU countries I'm aware of, you can choose a new doc. You can shop around. Despite the flaws in online reviews, just as with Amazon, you c…

I suffered for almost 15 years with something that was supposed to be easy to fix. The medical industry incompetence and exploitation is not limited to a country. The problem is world wide.

The problem is not that one given doctor can't fix an issue (which can happen). The problem is the monopoly they have on our health, preventing us to seek different solutions, get extensive tests done, etc. In the US it is easier to get liposuction than to get some basic testing done if your doc thinks it is unnecessary.

For example, depression is usually "solved" by prescribing SSRIs, but if you do some research, you find that there are perhaps hundreds of possible causes for it, none of which are usually tested for.

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

#269

Post by ionised »

fjsolwmv wrote: post #222
ethbro wrote: post #212

Earlier quoted context omitted.

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.

Really? You don't see any difference between a banana and an anti-depressant for example?

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

#270

Post by Engineering-MD »

dalbasal wrote: post #246
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…

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…

I practice in the UK. The system is far from perfect, but does to a certain extent work in the idealistic system you propose. It is not true for all GPs, and some don’t practice holistic medicine, but the system is created to allow (and encourage) this method, and in my experience holistic medicine is practiced by GPs. Perhaps things differ in the USA, but this system works well in the UK.
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