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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

#271

Post by PiggySpeed »

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'm a pharmacist, and I completely agree with your assessment. People are waaaaay over-estimating their abilities here.

I think there's a bit of Dunning-Kruger at play here. People think they can make their own judgements based on the drug monograph and simply checklist over the contraindications/interactions and call it a day. And there are others who share their pills with relatives/family members because "its worked for me before". There's another special group of people who think that piecing together a pharmacological narrative will bring about a clinically meaningful result (it works in theory, so it must work in practice!). Others think statistical significance == clinical significance.

The typical community pharmacist is absolutely not equipped with the tools, incentives, and workplace conditions to assume the role of a GP. We are trained in evidence-based drug therapy management, not diagnosis. I'm also deeply concerned about how retail pharmacy corporations will adapt to this. I imagine that there will be a new metric: prescriptions sold/visit that regional directors will be optimizing for. If not a prescription, then you need to sell an OTC product.

A lot of people think they can DIY medicine. It will be a disaster. I've worked in a very high-income area with a very professional clientele (business owners, health care workers, lawyers, finance), and many are completely swayed by false information or "studies" they read online (because they are intelligent professionals, after all).

We need better access to high-quality healthcare, but not through DIY medicine. This proposal is the result of people running out of ideas and giving up.

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

#272

Post by Lanthanide »

AngryData wrote: post #256
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…

Do you guys also allow drug advertisements? The only problem I see is our drug producers here using advertising to push people into buying and using drugs that they really shouldn't be using and inadvertently causing themselves a myriad of additional health problems. Im 100% for people being able to use whatever drug they wish, provided that they actually know what they are taking and what it does. Any half decent ad…

Not in the US style of drug ads, but not completely banned either; things like Tylenol and the various cold and flu drugs can be advertised. I’ve never seen ads for something that would be prescription-only in other countries except for Viagra and a coupe of other ED drugs, and that’s an edge case.

As far as I can see all drug advertisements (including things such as social media promotions) have to be approved by the Saudi FDA, and they don’t seem lenient at all in allowing ads for anything beyond the aforementioned meds.

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

#273

Post by Lanthanide »

avar wrote: post #248
Lanthanide wrote: post #201

Earlier quoted context omitted.

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.

Both. Anecdotally I’d actually say that the ratio of MTF surgeries to FTM ones is higher than usual over here.

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

#274

Post by pkkm »

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?

Yes, it's just very clean water with 0.9% of salt.

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

#275

Post by pkkm »

walshemj wrote: post #125
LinuxBender wrote: post #82

Earlier quoted context omitted.

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.

Yes well I am sure that's what the guy next to me when I was in hospital last year thought until he took supplements plus his prescribed meds and had 100% kidney failure.

Do you remember what supplements and meds he took?

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

#276

Post by raverbashing »

PiggySpeed wrote: post #271
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'm a pharmacist, and I completely agree with your assessment. People are waaaaay over-estimating their abilities here. I think there's a bit of Dunning-Kruger at play here. People think they can make their own judgements based on the drug monograph and simply checklist over the contraindications/interactions and call it a day. And there are others who share their pills with relatives/family members because "its work…

> A lot of people think they can DIY medicine. It will be a disaster

So, a person having an obvious anaphylactic shock and being denied an epipen (and dying) is not problematic to you because that would be "DIY medicine"

http://www.foxnews.com/health/2013/12/23/girl-dies-after-pha...

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

#277

Post by kbutler »

fjsolwmv wrote: post #227
kbutler wrote: post #140

Earlier quoted context omitted.

Personal experience: I was getting an annual physical from the doctor who had written a prescription that was expiring. We discussed the condition and agreed I needed a renewal. I was told I had to come back for a separate visit "because Obamacare required it" My translation: because he couldn't bill for writing out the prescription during well-check, and because he wanted/needed to charge for it. Oh, and blaming Oba…

Doctors have to wrestle with insurance companies as much as you do.

I'm sure he didn't think of it this way, but I'm on a high-deductible health insurance plan and will not meet my deductible, so he was directly asking for the money from my pocket to his office revenue, with all the overhead of the insurance company and an additional office visit thrown in (1.5-2 hours of my time), instead of a 1-minute "write the prescription while we are here."

It was directly the grandparent's case, of doctors requiring unnecessary visits to maximize their profit.

Even if I had no deductible or co-pay, where do you think the insurance company gets the money to pay for this extra visit? It's from the insurance premiums we all complain about (that is, from my pocket).

Again, I don't think the doctor thinks of it that way. He just thinks, "We have to separate well-patient visits from any other services", not, "If I make this patient pay $300 and spend 2 hours, I can pocket another $100 for 1 minute's work."

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

#278

Post by athenot »

neurotech1 wrote: post #156
athenot wrote: post #20

Earlier quoted context omitted.

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.

Thanks for clarifying that.

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

#279

Post by LinuxBender »

handsomechad wrote: post #129
LinuxBender wrote: post #82

Earlier quoted context omitted.

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 supplements, if you dont mind me asking? what what use? (if they are a medical condition and not health or "nootropic" feel free not to say)

It is a rather large list. I am reversing the cumulative damage to my body.

To add to the discussion however, I would include sub-components of supplements such as BioPerine which is just a commercial version of piperine. Several supplements I take have this and it changes how drugs are processed in the liver. Drugs that would normally have a small chance of minor side effects can suddenly have dramatic and unpredictable side effects.

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

#280

Post by vibrio »

mullingitover wrote: post #154
vibrio wrote: post #61

Earlier quoted context omitted.

...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.

I very much agree that live stock antibiotic use is a major issue, even with the recent regulatory advances, but I cannot agree that minimizing human misuse is trivial. Ignoring either issue leaves a flank wide open for attack.
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