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.
U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
81–90 of 308 posts
Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
#82When 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.
Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
#83When 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…
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 to do the same with prescription drugs, if I want to. Yes, including eating a whole bottle of warfarin and dying messily. It's my body and my life, not yours.
Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
#84There 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…
Also, the doctor is aware of your health history Your doctor skims your notes in the 20 seconds between the receptionist calling your name and you entering her office, in handwriting she can barely read herself, and has forgotten you before you’re even back in the waiting room after spending 5 minutes talking to you while she’s really thinking about the new Audi. That’s as far as the awareness goes.
That is not at all the experience I have with my doctor, where the intake NP does a whole litany of the past several years worth of doctor visits before I’m seen.
I’m ok and I think glad that pharmacists don’t even have access to that information.
Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
#85Earlier quoted context omitted.
I'd be pretty shocked if the pharmaceutical industry is against this. I would bet they _lobbied_ for it. They can already advertise direct to consumers, now those consumers will be able to go directly to purchasing medication with no intermediary (no "ask your doctor if X is right for you"). This seems like it's GREAT for them. I would expect marketing budgets to go up dramatically in pursuit of these disintermediate…
I can't say you are wrong. But also remember the industry is lobbing against many things right now which have come around in the past few years, including the perception of opiate prescriptions where they are trying to moderate the discussion. Hence spending has gone up considerably. My personal logic is they typically have lobbied to keep most drugs regulated (or split) so to keep their reimbursements as high as pos…
It reads to me like these medications are _not_ going to be classified as "over the counter." Even though they will not require a prescription, that's the whole point.
I wonder if the regulations are written in some way to allow them to keep charging prescription prices without a prescription. The article definitely suggests it's a new "status", not merely making more things OTC.
From the OP:
> Finding a way to expand access to widely used prescription drugs has been a goal of regulators in recent years.
> The FDA explored the idea of a “behind-the-counter” designation in 2007 that would have required interaction with a pharmacist. The Government Accountability Office in a 2009 report on the proposal asked whether consumers would end up paying more for their drugs since nonprescription medications typically aren’t covered by insurance."
Note, since they aren't typically _covered by insurance_. A new designation that would be covered by insurance, fit into insurance schedules under "prescription", but not actually require a prescription -- hey, "everyone" wins!
From: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/u...
"Currently, nonprescription drugs can be marketed under either of two regulatory pathways: the Over-the-Counter (OTC) Drug Review (OTC Monograph Process) or the New Drug Application (NDA) process, and there are different requirements under each system. Today’s new FDA draft guidance, Innovative Approaches for Nonprescription Drug Products, applies to drugs under the NDA process and is intended to extend that NDA pathway to include therapeutic indications that have not, historically, been available for use without a prescription."
The (very brief) draft guidance itself: https://www.fda.gov/downloads/Drugs/GuidanceComplianceRegula...
Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
#86There 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…
Also, the doctor is aware of your health history Your doctor skims your notes in the 20 seconds between the receptionist calling your name and you entering her office, in handwriting she can barely read herself, and has forgotten you before you’re even back in the waiting room after spending 5 minutes talking to you while she’s really thinking about the new Audi. That’s as far as the awareness goes.
Thanks for speaking for the entire medical profession. That is in fact what a terrible physician does, and not what myself or other newly trained physicians aspire to do.
Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
#87How 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.
Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
#88Earlier quoted context omitted.
So ease access to the drugs and tighten the regulations around advertising. The fact we have consumer-driven ads for prescription drugs at all is like something you'd expect in a satire novel :P
The cynical view is that other countries have restrictions around drug advertising because if an expensive drug is demanded they have to pay for it through their single payer system. I can imagine not wanting the population to find out that there is cure for Hepatitis C but it costs the country 20k per person. Not all countries are as forward thinking as Australia: http://theconversation.com/australia-leads-the-world…
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 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).
Everyone involved in the process should be ashamed of themselves.
Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
#89Bravo. The AMA/FDA/insurance cartel cannot die soon enough. I don’t care if you want a free market, or you want socialized medicine, both are preferable to government-enforced racketeering.
You mean the AMA and FDA should stop preventing patients from taking contraindicated combinations or failing to understand the risks they’re taking on by self-medicating? Pharmacology is complicated and dangerous. Letting corporations go hog-wild will harm many people.
You realize that's why the FDA introduced the "behind the counter" classification, that requires pharmacist interaction - and frankly, I trust my pharmacist on drug combinations more than my physician.
Re: U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
#90Earlier quoted context omitted.
Many times they still charge more for the prescription med still. Great example I just saw. We all know ibuprofen has been available as an OTC for a long time. Cheap to buy too, The one difference in this example, the one 800mg pill is less harsh on the stomach than taking 4 of the 200mg pills. Which is the reasoning usually for this type of prescription, that and convenience for the patient.
> but insurance has paid $35 or more Insurance does not actually pay that much. Because of drug rebates (paid by the drug manufacturer), clawbacks, and Co-Pays, in total the drug manufacturer gets about the same as they would for the OTC drug. See here: https://money.cnn.com/2018/05/07/news/economy/drug-prices-re... (and that article barely scratches the surface). Destroying that entire money-network would be probabl…
> he's probably the only one with the actual ability, and desire to do something about it.
I'll believe he has either the ability or the desire when I see it.