Live data from Hacker News

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

bloombergquint.com

291–300 of 308 posts

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

#291
post #132

Earlier quoted context omitted.

That a different thing, name brand vs generic. This is OTC vs. Prescription. Although I bet your insurance company doesn't actually pay $200 if they cover it - they probably get rebates that cover the difference, and then make you pay a higher co-pay.

It's not completely different, the branded drug faces pretty stiff competition and hasn't cut prices.

> and hasn't cut prices.

They have - they are [often] the same ones who make the generic.

They make both, and if someone is willing to pay them extra for the brand name, they'll take it.

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

#292
post #149
post #66

Earlier quoted context omitted.

I can't speak for JumpCrissCross, but there are 3 things that improved my asthma: 1) Eating better. Low level inflammation is terrible for people with auto-immune disorders, to which the trio of asthma, eczema, and allergies belong. 2) Moved closer to the ocean - salt air is great for the lungs, and really has a way of helping deal with any allergies you might have to local pollen 3) RUN! seriously, aerobic exercise…

Not everyone's asthma is like yours. For example, trying to run for 45 minutes would kill me these days. My asthma is triggered by exercise and even when I used to exercise quite a lot and was on more medication it was a struggle. So don't assume everyone's condition is the same as yours.

Ilaksh, I seem to have touched a bit of a nerve here. I know, I used to respond the same way to similar advice. I wasn't assuming anything about anyone's condition - I was giving personal advice based on my experience. I say this as a person who grew up with extremely exercise-induced asthma - I used to run a slower mile than I walked (due to collapsing multiple times), went to the hospital multiple (6+) times a year (from ages 8-20), etc. Also, running in dry and not-salty humid climates is still a bad idea for me, or around certain kinds of trees. Running for 45 minutes was something I worked up to around the age of 25 - started with 5 or ten minute periods, interspersed with walking, until I was able to do another brief run, etc. When I stopped running for a few years, my issues came back, with multiple hospitalizations from 28-30, until I started up again around 30.

Part of the issue with exercise-induced asthma, for me personally, was also general nutrition and health - I found that as I earned more income, and switched to a diet higher in fats and vegetables and lower in carbohydrates, my condition significantly improved, providing a positive feedback loop with the exercise that eventually has brought me to being nearly symptom-free today (34). Your mileage may of course vary.

The main reason I focused so much on the running is because for most of my life I thought it would kill me, and always told myself that the reason that I didn't run is that it was bad for me. In the end it was exercising more and eating better (in a better environment) that saved me. Hopefully you'll find the trick for you - living with asthma is really unpleasant, to understate it.

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

#293

Earlier quoted context omitted.

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…

> They are legally...bound to serve their patients. In the US, with the cost of attorney-mediated access to the judicial system, this is not really a protective constraint for the bottom 90-95% of the population against exploitation by unethical medical providers. I'm interested in discussions about data transparency: anonymized, aggregated data about the patient population seen, the outcomes, and the amount spent, p…

I don't agree. It is a protective constraint because of the legions of trial lawyers who are happy to bring a malpractice suit, albeit mostly for their own benefit and not the patient's, due in part to the general lack of financial awareness in the poor.

It doesn't come close to making anybody whole when things go wrong, but the threat of litigation certainly modifies the way medicine is practiced.

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

#294
post #292
post #149

Earlier quoted context omitted.

Not everyone's asthma is like yours. For example, trying to run for 45 minutes would kill me these days. My asthma is triggered by exercise and even when I used to exercise quite a lot and was on more medication it was a struggle. So don't assume everyone's condition is the same as yours.

Ilaksh, I seem to have touched a bit of a nerve here. I know, I used to respond the same way to similar advice. I wasn't assuming anything about anyone's condition - I was giving personal advice based on my experience. I say this as a person who grew up with extremely exercise-induced asthma - I used to run a slower mile than I walked (due to collapsing multiple times), went to the hospital multiple (6+) times a year…

But there is still the implication that my disease is the same as yours and that I just need to run out of it. I was extremely active throughout my youth including intensive training for wrestling and less intensive training for two other sports and in no way did exercise diminish my asthma throughout many years. So although I do look forward to becoming more active again, I will need to increase my medication dosage and use a rescue inhaler every day and I will never be symptom free. I am not like you.

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

#295
post #294
post #292

Earlier quoted context omitted.

Ilaksh, I seem to have touched a bit of a nerve here. I know, I used to respond the same way to similar advice. I wasn't assuming anything about anyone's condition - I was giving personal advice based on my experience. I say this as a person who grew up with extremely exercise-induced asthma - I used to run a slower mile than I walked (due to collapsing multiple times), went to the hospital multiple (6+) times a year…

But there is still the implication that my disease is the same as yours and that I just need to run out of it. I was extremely active throughout my youth including intensive training for wrestling and less intensive training for two other sports and in no way did exercise diminish my asthma throughout many years. So although I do look forward to becoming more active again, I will need to increase my medication dosage…

FWIW, I did not interpret kian's account as suggesting that it works for everybody. I'm well aware that chronic diseases can have lots of different causes and mechanics depending on the person (especially true for my other chronic condition, atopic eczema).

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

#296

Earlier quoted context omitted.

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.

I live in Dublin, so not that far. GPs here are generally private, though kids, older people and lower income people are subsidized or free. Some other parts of the medical system are more like yours. It's an eclectic system.

Anyway, I don't have a problem with the way primary care works here. It works well. I didn't mean any of this as a slight on the job doctors do. But... I also think pharmacists and other trained people can prescribe medication, tests and such. There is value in accessibility. If they can (as I think some of these ideas take as premise) provide walk in service, there is good reason to do it.

I know people prescribed antidepressants from GPs, in the UK as well. 10 minute appointments several times per year.

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

#298

Earlier quoted context omitted.

While I applaud cynical views in general, since most of the rest of the world has restrictions on the prices of prescription drugs this idea doesn't work in most cases. There is a more cynical view, and you should definitely take it. Less doctor involvement means more people taking prescription drugs (the pharma companies hope). As an aside, I cannot tell you how angry our direct-to-consumer drug advertisements make…

> As an aside, I cannot tell you how angry our direct-to-consumer drug advertisements make me. Especially the ones that are marketed to people with terminal diseases offering them hope (but in the small print offering perhaps 3 months longer life, not guaranteed). After reading an related article ( http://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ ) a few weeks ago, it's no surprise that the market has ans…

thanks for the link, it was a good read.

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

#299
post #294

Earlier quoted context omitted.

But there is still the implication that my disease is the same as yours and that I just need to run out of it. I was extremely active throughout my youth including intensive training for wrestling and less intensive training for two other sports and in no way did exercise diminish my asthma throughout many years. So although I do look forward to becoming more active again, I will need to increase my medication dosage…

FWIW, I did not interpret kian's account as suggesting that it works for everybody. I'm well aware that chronic diseases can have lots of different causes and mechanics depending on the person (especially true for my other chronic condition, atopic eczema).

I appreciate that. Something that might be interesting for you - I used to have horrible eczema between my fingers when I was younger. more fat in my diet (Along with switching to grass fed beef and eating more and fattier fish like salmon), paying attention to which foods made me feel ‘bloat’, and reducing allergen stress triggers (ocean air being a big part of mitigating those I couldn’t avoid) helped my eczema much more than exercising did.

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

#300
post #297

Great for business, bad for people. Welcome to the US of A.

Would you mind please posting more substantive comments? https://news.ycombinator.com/newsguidelines.html

I thought we were able to take care of self-policing.

Can we delete the parent (my original comment) ?

Post reply on HN