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FDA May Let Patients Buy More Drugs Without Prescriptions
Hugh Pickens writes "The Washington Times reports that the Food and Drug Administration may soon permit Americans to obtain some drugs used to treat conditions such as high blood pressure and diabetes without obtaining a prescription. They may allow patients to diagnose their ailments by answering questions online or at a pharmacy kiosk in order to buy current prescription-only drugs for conditions such as high cholesterol, certain infections, migraine headaches, asthma or allergies. Some pharmacists embrace the notion that they should be able to dole out medication for patients' chronic conditions without making them go through a doctor. 'This could eliminate the need for a physician visit for certain meds that may have been prescription prior to this change,' said Ronna Hauser, vice president of policy and regulatory affairs for the National Community Pharmacists Association. 'However, there may be circumstances when a patient might need a physician visit and diagnosis and original prescription to start therapy but could continue on that therapy with pharmacist refill authorization capabilities.'" (Read more, below.)
Hugh Pickens continues: "Medical providers at public hearings to obtain input on a new paradigm urge caution, saying the government should not try to cut health care costs by cutting out doctors. 'Patients rely on physicians to provide sound diagnosis and treatment information and to help them meet their unique health needs,' says Peter W. Carmel, President of the American Medical Association. 'Expanding many prescription medications to OTC interferes with that important relationship without offering any real benefits to improve patients' health or reduce their costs.'" Other countries seem to do fine with pharmacists being closer to the front line of medicine recommendations; why couldn't the U.S.?"
I'm pretty sure the American Medical Association (made up of doctors) is going to go apeshit over even the suggestion of this.
What political party do you join when you don't like Bible-thumpers *or* hippies?
it would be great to not have to visit the doctor once a year just so I can keep breathing.
This is a great idea for asthma medication. A lot of poor people don't get decent asthma medication, and end up with ineffective and harmful over-the-counter stuff instead, because they can't go to the doctor. We've had that whole discussion here before.
for corporate drug pushers (aka "drug companies") and their shareholders.
The rest of you are fucked.
I am hugely thrilled at this prospect. It would mean that I can have more respect for my doctor, rather than looking at her as a person with a magic signature. For the past several years I have been going to a "Minute Clinic" which is a nurse-operated room, in which the nurse takes my vitals, reads questions off a computer screen and enters the answers, and then gives me a prescription. There is definitely room for medical judgment there, but mostly that judgment is used to send you to a doctor if the computer tells the nurse to do so. There's no reason for me to need to see a person for many types of illnesses when a questionnaire can suffice - no reason other than institutional inertia.
My mom used to tell me about the old days when you asked the pharmacist for medicine - told them what your problem was and they would give you the cure. There's another profession rooted in the old ways for no good reason. The pharmacy takes pills out of one container, counts them, puts them into another container, and sticks a label on it and bills my insurance. Takes 15 minutes and requires a highly trained pharmacist for reasons I cannot fathom.
I have a hard time believing people go into primary care medicine (or pharmacy, for that matter) to see jerks like me, who just want a piece of paper that says I can have my pills. Seems like this could be a benefit for all.
... are re-classified as no longer needing to be prescribed, insurance companies stop covering the cost of such drugs. Lots of expensive drugs (for allergies, for gatrointestinal problems) once covered by insurance are now totally NOT covered. A big win for insurance companies.
Credo quia impossibilis -- Tertullian
I just want to thank the FDA for allowing me to pee without permission.
Seastead this.
A few of my acquaintances are pharmacists, and one of their biggest contributions to the overall health and care of patients is drug interaction and reconciliation. Basically, what this means is that they check that a patient's drugs do not interact with each other in a negative way. They also help patients reduce the number of dependencies on medication. When you start to automate this process, you will need to have a centralized system that handles all patients' drug information as you have now removed the role of various trained medical professionals. A patient will not know that his need for a prescriptive drug may adversely affect his health because he is already taking another drug. That's sort of why we have pharmacists and doctors.
Soon, the government will further cut costs by removing all teachers from public education, and let citizens simply take online courses. How about we stop make cuts in places that don't need cuts, and cut out stuff like ridiculous travel expenses for congressmen?
TFA mentions the impact on Medicare for prescription drug costs, but it doesn't discuss the impact for non-seniors. My prescription drug plan doesn't cover over-the-counter medication. As of last year my flex pay plan won't let me buy over-the-counter medication with pre-tax dollars. Together, both of those mean that moving all these drugs to non-prescription will make them significantly more expensive to me and all the millions of other people who pay for them now through their insurance.
Now, of course, you might think that insurance providers would be happy to fund these drugs even while over-the-counter, since it's far cheaper to subsidize (for example) blood pressure or cholesterol-lowering medication for life than cover one emergency trip to the hospital and bypass surgery, but I really don't think most insurance providers think that way.
It doesn't hurt to be nice.
I'm sure some pharmaceutical organisations helped the FDA a little bit in coming up with this idea...
Privacy is terrorism.
Statins and albuterol are quite safe for most people, but letting the average guy decide to use them is pretty dangerous. To quote George Carlin: think of how stupid the average person is, then realize that half of them are stupider than that.
I think what makes a lot more sense is for long-term prescriptions - a kid with asthma is going to need an inhaler for years, and a kid allergic to bee stings or peanuts or something is going to need an Epi-Pen for the rest of his life. It makes a lot of sense to give a prescription for a year or two.
But on the other hand, the prescription is a good "timer" - my father has high cholesterol (even on a near-no cholesterol diet) so he's on Lipitor and will be for the foreseeable future. His prescription lasts almost exactly 3 months, at which time he goes to his cardiologist for bloodwork anyway. That makes sense to me - most of these conditions require some attention, and having the prescription run out is a good way to get it.
I have developed a truly marvelous proof of this comment, which this signature is too narrow to contain.
"Ask your Rx Kiosk Today about Effluvium DX."
"Effluvium. For Whatever You Have."
Patients taking Effluvium have reported Dry Mouth, Disorientation, and Spontaneous Testicular Detonation. Effluvium should not be taken before operating heavy machinery, using social media, driving or eating. Read and sign the Effluvium arbitration agreement and release from liability before taking Effluvium DX.
Don't worry, the EPA will take up where the FDA left off.
So I can self diagnose high cholesterol on the honor system at a kiosk, and yet, cough syrup and Pseudoephedrine have to be regulated...
"Patients rely on physicians to provide sound diagnosis and treatment information and to help them meet their unique health needs"
Has that guy ever been to a doctor? Every doctor I've ever had is extremely dismissive of any condition and very impatient to get the appointment over with. My experience with doctors has primarily been that they are roadblocks to efficient medical care. I can't count the number of times I have had to educate a doctor about my wife's Type I diabetes and insulin, or the number of times that I have received diagnoses that were completely out of line with symptoms.
I once went to a doctor with a high fever, persistent productive cough, and body aches. It was just like the flu but kept going into remission for two weeks and returning for over two months. The doctor sent me to a specialist who decided before he even saw me that I had asthma. His questions during the whole consult were steering me towards accepting asthma as a diagnosis. Finally, I broke down and asked how a high fever relates to asthma. "I don't know about that part," was his response.
About 15 years ago I drove myself to the emergency room because one side of my face went numb and didn't stop. The attending decided I was on drugs until a nurse bothered to take a urine sample and figured out I wasn't. Then the consulting neurologist accused me of faking the Babinski response (I thought reflexes were involuntary, which is why they're supposed to be a good diagnostic tool). Then they did a lumbar puncture and screwed it up and did it again. No one told me to stay lying down after that and they just sent me home with no diagnosis. Then the spinal headache set in while I was at work.
There are dozens more stories. Doctors are as stupid and bumbling as any member of the general public. I think this is a step in the right direction.
Oral contraceptives still remain RX only. Glad theology trumps science, no matter which party is in office.
Med student here. I know the reflex reaction might be, "Well, doctors are just trying to keep the patients to themselves." I can definitely understand this perspective.
However, I don't think the practitioners' group's MO is to maintain doctors as the middlemen between patients and prescriptions. A patient coming in for metformin for diabetes or atorvastatin for cholesterol needs to be asked about other medications that might cross-react with this one, other potential health risks, family history, drug allergies. The doctor also speaks to the patient about his lifestyle and can intervene where a computer can't - the doctor can urge a patient to try diet and exercise before using drugs to lower cholesterol and offer specific suggestions. No drug is without side effects.
A physician's visit can also address unrelated issues - say the patient came in for knee pain and informs the doctor that he smokes. In addition to addressing the knee pain, the doctor can also ask the patient if he'd like to quit smoking and offer resources to help him. A physician may even be the only avenue of intervention for patients who might be suffering from depression or domestic abuse; they come to the doctor for an unrelated problem, and the doctor notices some red flags and offers help and referrals. Preventive visits also go a long way in helping patients avoid a prescription or a kiosk like this entirely in the future. I don't think a kiosk can handle these considerations, and while pharmacists are experts in medications and drug interactions, a doctor's visit is also necessary.
Of course, drugs that have demonstrated, through widespread use over a long period of time, that they are safe enough to be sold over-the-counter, well those obviously should be considered for kiosks like this. But we already have a system in place for that. I am skeptical of a push to circumvent doctor's visits in order to obtain medications that haven't yet proven to be safe for over-the-counter dispensation.
Anyway, just wanted to offer this perspective on why a physician's visit is about much more than a prescription, and why there's more to this practitioners' group's opposition than may be evident on the surface.
This could also affect how you pay for your medications, as of right now, where I live in NC if you have a Health Savings account or a Flexible Spending account for your medical payments, you can no longer use them to pay for non-prescription medications, I think this is a good idea, as long as it isnt a ploy by insurance companies to get out of having to pay for the medications
It's all about the possibilities!
Lisinopril. It's one of the most common prescription medications on earth, and is so inexpensive that it's easily affordable without insurance. Yet doctors hold your refills hostage to expensive monthly office visits, which consist in their entirety of a nurse practitioner taking your weight and blood pressure, measurements anyone with high blood pressure already takes at home. This nonsense must stop.
Oliver's law of assumed responsibility: If you're seen fixing it, you will be blamed for breaking it.
The point of prescription drugs is to prevent unauthorised purchase. This system can be easily tricked.
as allowing allergy medicines OTC and the great success of combat meth logs. It was much easier with a prescription, and I didn't feel like a criminal for having allergies.
But mostly a lose for patients.
The reason it's a win for doctors is that in our "fee for service" system they don't make much on a simple office visit, especially if they have to take the time to write a prescription. There's also ongoing overhead for prescriptions - whenever you run out of refills the pharmacy has to reauth, which takes up staff time. (This last is why the office where my son works has additional staff on hand on fridays, which is the day that everyone does their refills.) It may also reduce liability, although exactly how that will play out is harder to predict.
It's an obvious win for insurance because most OTC stuff isn't covered. And likewise for drug companies, who will sell more product, a lot of it to people who don't really need it.
The big losers will be patients. Sure, some people will have easier access to the meds they need. But costs will overall be higher, and some of the meds they are talking about aren't all that safe. Statins, for example, may be great at treating high cholesterol, but over time they can cause liver damage. Most of the antihypertensives are reasonably safe when taken at the correct dose, but take a bit too much and things like positional vertigo can occur. And as others have pointed out, the inability to track OTC meds can result in serious drug interactions or overdoses. Indeed, this is already a serious problem with acetaminenophen - so many different products contain it that it's easy to get an overdose, and boom goes your liver.
This is going the same way that investments did. Started off where you basically needed a professional to get you a lot of things, and over time it's become easier for the individual layperson to participate.
Basically, if you want solid advice you find a good financial professional (same for a doctor of course). However, you can TRY to do it yourself. A few succeed, but many do a sub-optimal job. Personally, I think this will increase business for doctors in the long run as people come to them having screwed up their body, or not treated things that should have been.
OTOH... my doctor is a lazy ass, which is why I'm getting a new one. Too many professionals seem to feel entitled to their clients/patients, don't keep up with the times, and quite frankly don't do a very good job providing what they ought to. In that regard I can see how people would want to stop having to go to their doc once a month or every three months just to get a stupid medication. On top of that, it seems like every time I go to the doc he doesn't know shit about anything when it comes to medications anyway. He just says,"Well, it's your choice. Which one would you like to try?" This is the reason I suspect they're putting this legislation out there: It's just the crap shoot we've known all along. Taking medications is just a game of roulette, and it's been a way for doctors to rake in the bucks for a very long time by getting people to think that they should go to the doctor every time they get a headache or get sick. They just don't need to, but that's only if they actually know how to treat it themselves.
I *assume* the legislation will say that a doc needs to diagnose you with a condition once, then you can get medications for that indefinitely. Otherwise I suspect we could see a boom in the snake oil industry again. Caveat emptor.
Personally? It also sounds like a way for big pharma to cash in some more AND jettison responsibility for drugs they create. They'll put the decision square on the shoulders of the consumer instead of on doctors/theAMA.
Shades of gray, pros/cons, etc etc etc
-
There are some things that are obvious, e.g. conjunctivitis.
But, I fear that this may cause abuse of antibiotics by those who do not know the difference between bacteria and viruses.
You are patrially correct, sir.
I went through Pharmacy School for a clinical doctorate that I do not use. At that time, pharmacists were just starting to give things like Flu Shots and outpatient lipid profiles. In many states, even those SIMPLE services were controlled so tightly that Pharmacists needed written prescriptions from patients' Physicians to even give a flu shot. Why not just drop by the Physician's office to get a shot if it's going to be that complicated?
Many chain stores saw futility in the approach of paying someone well into six figures to administer flu shots (which an MA or LPN could do for a quarter of the cost, and with better technique). Other stores used it as a tool to get people in the door, and many "forced" pharmacists to become trained and certified in administering flu shots even though many Pharmacists had no desire to do anything directly "to" a patient. School was full of very smart chemists, physiologists, engineers, and others who took the most pride in the technical aspect of medicinal chemistry, antibiotic mechanism of action and combating resistance, or drug discovery. It was *NOT* full of touchy-feely types who wanted to sit in an assembly line of "stick needle here, repeat" flu shot "cliniics".
Meanwhile, Pharmacists were lobbying for some type of limited prescribing ability. While they were almost certainly met with a "no, never thanks for asking", newer types of "professional extenders" were busy actually gaining prescribing rights - mainly Physicians Assistants and Nurse Practitioners. Even OD's (Optometrists)gained limited prescribing rights. Back at the pharmacy, many pharmacists got a new ancillary job (which nobody wanted): policing the sales of pseudoephedrine.
So, basically I'm predicting that if there is some sort of new way to use pharmacists to actually give patients broader and less expensive access to healthcare, it will be very quickly gobbled up with regulation and some type of "lick and stick" automation that will allow the retail giants of the world to make a buck out of it, regardless of how the actual pharmacists feel about such opportunity.
Of course, there are many different positions for Pharmacists outside of outpatient, retail pharmacy. There are interesting careers in teaching, inpatient, and nuclear pharmacy. There are very interesting clinical positions with the VA (the one place that I know that Pharmacists actually DO get some prescribing authority within the US government). There are opportunities to add another degree (typically PhD) and do research. But, the fact that Walgreens will offer a recent grad 125k fresh out of school with no additional degree or internship means that most pharmacists do end up in retail.
TL:DR The big chain stores will find a way to work this into their profit model for nobody's benefit but the bottom line.
For some drugs, allergies (some of which have gone OTC) and mild-asthma treatments but no way in hell should patients or pharmacists be allowed to give out Blood Pressure, Cholesteral or Diabeties medication without the supervision of a doctor. These medications, most of which should be used in the short-term to treat a symptom while the patient works with the doctor on lifestyle modifications to correct the underlying problem. Also, these drugs are not side-effect free. Lipitor requires regular bloodwork to make sure it isn't destroying your liver, no doctor should continue to perscribe it without getting regular blood work from the patient... I doubt that actually happens though.
If we made the drugs a bit harder to get, say harder than eating a bit better and a bit of excercise, maybe we wouldn't be spending $190,000,000,000 a year on obesity related issues.
Just saying.
You don't need prescriptions because the federal government has no legitimate authority over what you put in your own body.
I still cannot fathom why I have to have a prescription to order new eyeglasses or contact lenses. Yes, you should get your eyes checked out regularly, but a 2-year old prescription is still way better than no glasses at all!
Surely they aren't really going to let people start new drugs without talking to a physician. It makes *some* sense if you're talking about continuing a prescription without constantly consulting your doctor, but even that's doubtful in most cases. I can understand inhalers for someone with asthma. That's something you don't use unless you really need it. Stuff like statins are pretty closely monitored though. You're constantly having bloodwork done to make sure your muscles aren't deteriorating. And surely we don't need to hand out antibiotics any faster than we already are. I know plenty of people that go to the doctor every time they have a scratchy throat to bitch and moan until they get azithromycin. Let's not make it any easier for those assholes to doom our species.
Seriously. If I want an extra strong foot cream, I have to take the time off work, go the physician, pay the physician, and then pay for the foot cream. Tell me again how this isn't a racket?
Please do not read this sig. Thank you.
I do know that having antibiotics in a field emergency kit is important. IF you are 3 days from civilization and impale yourself on something you really need to start taking an antibiotic to avoid infection. This would go a log way to making it easier to build a full civilian first aid field kit than having to do it "illegally" by scavenging unused pills for the kit.
I know that the majority of civilians are too stupid to self medicate with things like that, but anyone with advanced field first aid training would welcome the aded tools to keep people alive and in better shape for when you get them to a hospital.
Do not look at laser with remaining good eye.
I recall one wag claiming Lipitor should be given away with every fast food meal. Sad to see it is still being held hostage by the ultimate drug dealer: Big Pharma.
...I wouldn't have to pay a $138 office visit for $10 worth of blood pressure medication?
And then you have the other side of the coin, where not enough testing is done, and retesting must be ordered. Often, this means redoing previous tests to give relevant context to the new tests. It would be cheapest to order the right amount of tests the first time.
All this talk about unnecessary testing, while important, has some doctors a bit gun-shy. This too, is bad, and leads to more expensive care.
(I'm not knocking your comment. You're right. You just brought up the context, and I'm playing off it.)
I won't join Slashcott. OTOH, If Beta goes live, I just won't be back until it's fixed. Sorry Dice.
I give my asthmatics a year supply of refills for this reason. Where do you live that you have to visit the doctor every month for an advair refill
What about birth control? If 90% of women are using it, why can't we just get it over the counter without having to pay for a doctor's visit first?
Parent may be AC, but he's 100% right. I've heard of nurse practitioners who are better than the doctors they work with. This isn't to say that they're qualified to do everything that a doctor can, but they are qualified to take most of the workload that we give doctors. And yes, they can frequently diagnose on their own and write prescriptions (or ask for consultation when they can't).
I won't join Slashcott. OTOH, If Beta goes live, I just won't be back until it's fixed. Sorry Dice.
How will this work with insurance, or is that point? Once these are available without prescription, insurance plans don't need to pay for them and the patient pays 100% of the cost?
This is a very bad idea! There is a reason that doctors go through all of that training and we go to see doctors for our ailments: because it is neither a good idea nor within our abiliyt and training to diagnose ourselves. Even doctors never self-diagnose, they go to other doctors for a diagnosis. I am sure that Big Pharma would positively drool at the opportunity to be able to easily push more pills on us. I don't trust some computer kiosk to do that for me. Computers follow a black and white algorithm whereas practicing medicine is something done with "outside of the box thinking."
So, medical kiosk, I'm sleepy and my back hurts and I have trouble staying asleep, please give me some rittalin, some morphine and some xanax.
640k ought to be enough for anyone.
the world is not run by bigoted cowards like you, but rather civilized adults.
Not that I'm against this necessarily, but it is interesting to note that these drugs which are currently prescription-only and which do have side-effects might be available over the counter, along with aceteminophen (Tylenol) which causes approx 400 deaths in the US per year, which can be purchased by children... ...but the feds just closed the medical cannabis dispensary nearest me despite it having won awards from the city and being backed by the Chamber of Commerce, having tight security, etc... because although it's over 600 feet from a school (state law) at 960 feet it's less than 1000 feet from a school for the blind by 40 feet... so it had to be shut or the landlord would face criminal charges and asset seizure.
There's a Walgreens on the corner. Sells tylenol, etc. Also a whole isle of candy bars for the kids.
Interesting.
This space available.
Any medical professional will be able to tell you of the grave risks of such a stupid idea.
Why not nationalise all healthcare in the United States instead? It might help infant mortality rates catch up with is neighbours, like Cuba.
The un-doing of all Progressive Era reforms isn't done until you can buy Heroin (TM) at the grocery store. You know, it's better for you than Morphine and it'll help with that sore back you got from sorting coal when you were 11. At least, that's what the company told me...
As someone who had high blood pressure and triglycerides and was put on medications for both, I will tell you that the kind of monitoring the doctor did was minimal and could easily be replaced.
My "monitoring" was a couple of lipid panels run by the lab in his office, which could easily be outsourced to any place with lab techs who can draw blood. The rest of the monitoring was me taking my own damn blood pressure and charting the results in Excel.
The doctor's value was near zero as far as I can tell, and less than zero if you add in the work I did changing my diet and losing a bunch of weight (all of which I did in spite of his advice), which lowered my blood pressure and totally altered my lipid profile.
IMHO, what's needed is a new, "basic doctor" type degree that has the power to prescribe most meds and monitor most medical conditions but doesn't 8-10 years of education and training costing the GDP of a small country.
We have a doctor "shortage" because it costs $250k to become a doctor, the people who actually get the degree specialize where the easy money is (high level of non-insurance reimbursed business which is paid in cash, up front, no on call hours, etc, like dermatology) and nobody wants to practice in high-voume, low-margin areas like being a GP.
As patients we should be able to monitor ourselves, we should be able to do research into our conditions ourselves. We need doctors for sophisticated treatments, expensive diagnostic exams, and specific information about our conditions. We don't need doctors appointments for asthma if we know what medication we are on and have had a prescription in the past. We don't need mandatory appointments for GERD if acid reflux medication is OTC and we can afford it. We don't need doctors appointments for blood glucose monitoring, cholesterol monitoring, and other blood tests as these should be something we can do from the Pharmacy.
Basically we shouldn't need a doctor's permission to do a blood test or any test we are willing to pay for and we shouldn't require a doctor for a diagnosis. This would lower costs and reward people who would prefer to take matters into their own hands. Cholesterol, glucose, iron, blood pressure, and virtually all diagnostic tests could be performed in any lab and should not require a permission slip from any doctor. The majority of people in this country are going to be affected by the same illnesses, will need statins, will need to wear glasses, will need drugs for stomach acid, constipation, allergy, I think this is a positive step by the FDA.
The next step would be to develop the technology to allow for better self monitoring, or perhaps real time monitoring, and better remote diagnosis.
Thanks for raising all our insurance rates. Nothing like unnecessary testing.
If Insurance rates are too high then let people test themselves with their own money. A blood test only costs 60 bucks and a comprehensive test is maybe 200 bucks max. You should be able to walk into CVS or Walgreens and buy a blood test on the spot and have your blood analyzed at a lab. You shouldn't have to ask your doctor for a blood test.
Testing is something the patient should be able to pay out of pocket for. If the patient wants a test for anything and is willing to pay for it then the test should take place.
DNP, you will be seeing them, the problem is you loose a lot of valuable knowledge. There is a reason that your doctor trains for 8-10 years through brutal conditions (residency hours are capped at 80 but this is a lie, I routinely did 100+). Also the doctor probably should have been monitoring your liver function along with the lipid panels. If your doctor is just asking what you want and handing you a script then you are being done a disservice.
Bigots like him do run an awful lot of places.
Liberty in your lifetime
Doctors are busy enough they don't need to do things just "to make more money." We have a shortage of doctors in the USA, ever try to get an appointment with a specialist who doesn't have a several week wait?
Fact is these are serious chronic conditions that need some monitoring by doctors. This is backed up by the evidence. So please stop with the "docs are greedy" bull shit.
Why can't a computer or electronic devices do the monitoring? I would think a computer could monitor glucose levels, blood pressure, heart rate, oxygen levels, weight, body fat percentage, temp, and a bunch of other stuff in real time.This could be continuously updated and uploaded to the internet and then forwarded to the doctor upon complications.
go to planned parenthood
http://www.personalabs.com/howitworks.php
I just googled for "order my own lipid panel"
To-do List: Receive telemarketing call during a tornado warning. Check.
for some stuff online is better and works better for some people as well.
Anyone have the answer key for glaucoma?
neither are people, this won't end well, starting with the list of drugs (and food they call drugs)
I eat enough cows to offset my "carbon emissions".
I really hope they do this for Amoxicillin. I hate having to waste $20 on a Doctor's visit when I know damn well that i've got an ear infection from a cold, and all the doctor is going to do is prescribe Amoxicillin anyways. Thankfully, my Mom usually has some around since she gets it prescribed regularly for ongoing issues. Ear infections to me like migraine headaches are to women.
OTS = Off The Shelf
Good. That should cut down on the workload of the doctors somewhat, enabling the patients, who really need the doctor's attention, to have it.
Now if we can just swing the pharmacy back to the rules / regulations prior to 1930, I can get my migraine meds (although the article lists migraines as something they are considering for the prescription-less environment, my meds are unlikely to be in the category that is easily made prescription free) without having to bother the doctor every month.
I am John Hurt.
This is just the tip of the iceberg in terms of what needs to be done.
The elephant in the room with health care that almost no one is talking about is lack of competition in provision of services.
I sympathize with the idea that "somethings are too dangerous to not require a prescription," but also think it's logically incoherent if you start thinking about it, and also financially unsustainable.
There are plenty--plenty, plenty, plenty--of substances you could kill yourself with easily, and they are not all that controlled--nor should they be. The possibility of unintentional self-harm should not be a reason to deny someone the right to care for their own bodies in health in the way they see fit.
This is especially true when the US doesn't have the ability to finance an government-sanctioned monopoly over drug supply through prescriptions. By not freeing up medications, you're essentially denying someone care that they might require, either financially or practically. I've seen this in hospital settings, over and over and over again, where people go to the ER just because the outpatient clinic was so inaccessible they couldn't get their prescriptions refilled.
This logic becomes even more problematic when you ask this question: assuming that people aren't skilled enough to prescribe themselves, why not allow more health care professionals to prescribe (with appropriate training for doing so)? Why not pharmacists, RNs, LPNs, psychologists?
That has gotten so much pushback from MDs it's ridiculous. The arguments are total nonsense, too.
The article quotes someone as complaining that "the FDA hasn't demonstrated this would be safe." To me, the onus is the other way around: that people should be able to provide for their own care in whatever way they see fit, and that the necessity of restrictions need to be conclusively identified, to a very high standard.
The whole medical system is crippled by drug prohibition, enforced through draconian prescription laws that create an unnecessary monopoly by MDs.
The economy cannot continue to sustain the current lack of competition in health care provision.
As a physician, I have to admit there are certainly a subset of patients who don't need to see me to get refills of common medications. However, overall I don't think this proposal makes for good public policy.
Most areas of medicine are not as simple as making a diagnosis and taking a pill. For example, high blood pressure medications often need adjustment as people age, and high blood pressure medications can sometimes cause problems with electrolyte levels and kidney function. Diabetes medications also require almost constant adjustment. Part of my job as a physician is to help weigh the risks and benefits of each medication, and monitor for problems with laboratory tests when appropriate. Sometimes this is a very cookbook type process that could be easily automated. Most of the time it is not.
I can certainly understand the frustration of many people with the level of service available from many primary care docs. However, when you apply a policy like this across the entire population there will be some people who will clearly benefit, but there will also be a substantial number of people harmed.
Great, another lovely excuse for my insurance company to not pay for something.
While we shouldn't have to be protected from our own stupidity and while doctor-issued prescriptions, maybe, should not be required for a huge number of drugs that are less dangerous than some OTC's, if we take that leap and don't have to have doctor-issued prescriptions for common items, the insurance companies have such an easy out to make more profit. Premiums wouldn't come down, after all, who would force them to? Insurance isn't traditional supply-and-demand, it is protection-money collected by fear. Fear is the never-ending demand that guarantees the insurers always have a customer-base.
If you're a low to low-middle income earner who relies upon your insurance (to whom you pay ridiculous premiums) to keep your maintenance drugs like your heart medication coming in, the thought of it becoming available without a doctor's prescription is bound to be frightening. That leaves even more people in a position of deciding between their medicine and other life necessities.
I'd bet a sharp rise in heart-related illness and death would be seen as a result of EVEN MORE people (than already) deciding they can't afford their medication.
If our insurance industry and our pharmaceutical industry weren't so mafia-movie-like ('Oh, you can afford to pay me $200 a month for protection? Well, then, I'm sure you can afford to pay me $225 next month'), this wouldn't be an issue.
Why not instead fix what's already in place? Stop the current vicious cycle with some carefully-planned, responsible, common-sense legislation.
Should a hospital be able to charge $23 for a $1.50 eyeglass repair kit that a patient (who does not wear glasses) didn't get and the doctor didn't request? No. Should a doctor be able to charge $350 for a routine office visit in which no tests are run, the patient talked to the nurse 5 minutes and the doctor 3 minutes, and didn't even require a prescription or further referral? No. Should the exact same acetaminophen/paracetamol you can buy over the counter cost $1.50 per pill just because you're in the hospital? No.
Should the insurance company limit the doctor to charging them $65 for that visit I mentioned earlier? No. Should the insurance company have it in their contract that the doctor must eat the cost of any injectables and charge $0? No. Should the insurance company be able to say that they know more about what medication or treatment the patient needs than that doctor who has at least physically seen the patient for 3 minutes more than the insurer who has never seen or touched them? No.
Oh, wait, we can't have 'carefully-planned', responsible, common-sense legislation. That doesn't exist. So, we are where we are.
And if anyone claims that the kiosk move would bring insurance premiums down and thus balance out for the common citizen, you're truly naive and I hope for your sake you stay clear of carnival game barkers and nigerian princes.
I've had chronic constipation for years now, although it's been especially bad in the last sixth months - like not going for a couple of weeks at a time, not going when using stimulant laxatives, and requiring frequent enemas to stay unplugged. I take docusate sodium, a stool softener, every day. I eat fiber, exercise, drink lots of water (30+ oz a day), drink prune juice on a daily basis, and take magnesium supplements. I've also tried regular mineral oil (before sleep) and it didn't help, either. I've also tried minimizing my amitriptyline dose and that hasn't helped as I need some minimum amount of it to go to sleep at night.
The main culprit is amitriptyline, which I am prescribed to control my sleeping patterns and as an anti-depressant (along with Bupropion). It has anticholinergic activity.
I went to see a doctor last week about it. I explained all of my issues and what I've tried so far. I suggested lactulose, because a friend of mine's father is also on amitriptyline and has the same constipation issues, and that's what he was prescribed. I went and looked it up at the time (I know, shouldn't be an armchair physician) and was surprised to read about how effective it was, how it's not a stimulant laxative so there's no concern about laxative dependency. It's a sugar alcohol and apparently extremely effective.
Wikipedia says of Lactulose, "Lactulose is sold over the counter (without prescription) in most countries in the world. In the United States and Austria, it requires a prescription over unfounded fears that it could be dangerous to diabetics. However, it is an indigestible sugar and has been proved to be safe even for them."
So when I talked to the doctor (a GP that I had never met before; I have no family doctor), she refused to prescribe it to me, saying that it can lead to vitamin deficiency and she didn't want to put someone on Lactulose without them being in a serious medical condition. She told me to just keep taking stimulant laxatives whenever I need them and didn't seem to be aware that laxative dependency even exists at all. I had to walk out afterwards with nothing, looking at the long weeks and months ahead where I'm going to be very uncomfortable on a regular basis and it's a considerable source of anxiety for me.
If they would sell Lactulose OTC I would be very grateful. I'm not looking forward to having to continue to deal with this problem, but I have no choice.
The minute that a drug becomes non prescription most insurance policies will not cover it at all. This would be a disaster. For many seniors it would be tens of thousands out of pocket every year. It would also cause a lot of deaths and it also would increase the costs because law suits of pharmacies would raise prices for everyone. doctors would take a big hit as many office visits would be lost and that means that those that must see a doctor will be paying through the nose to make up for loss of visits from others. All in all this seems like a really bad idea.
how about we legalize the things that might be good for us?
How about we just legalize it all and quit trying to run people's lives at gunpoint?
Some states NPs can serve in a way the OP wants: diagnose, write prescriptions, have their own practice, etc. But some states are a bit behind: they have to work under a doctor, can't write prescriptions, etc.
...And all of them, no matter what state, have to deal with the same cluster fuck of a legal/government/medical system, which similarly drags down the rest of the economy. These leeches take our tax dollars and spend it on their lavish accommodations, then have the fucking BALLS to act like times are just as tough in D.C. and they need more money?
The level of bureaucracy in this country has just gotten way, way too goddamn large and out of control. We need to abolish EVERYTHING and start over from scratch. Evacuate DC, then drop nukes from orbit just to be sure.
Other countries seem to do fine with pharmacists being closer to the front line of medicine recommendations; why couldn't the U.S.?"
What countries are those?
Here in Belgium, the restrictions are actually higher. Lots of drugs you can buy over the counter in the US are only available here through doctors. If you want to reduce costs for health care there are much better ideas.
change the insurance companies; their profit should no longer come from handpicking the customers they want, but from providing the best help and prevention to the customers they have. Keep your customers healthy and your profit will rise.
Less lawsuits; doctors pay huge money for a malpractice insurance, because you all sue over the slightest things asking ridiculous sums for it each time at that.
Pricing; As I understood previously prices are set to be negotiated down by insurance companies? What the hell? Skip all that negotiating crap, it's health care, just pay the costs (including wages). No hospital or organization related to health care should even be allowed to be for profit. That doesn't mean they aren't allowed to pay their employees good money.
A final thought is product prices, force doctors and pharmacists to give the cheapest working product, unless valid medical reasons warrant otherwise. That medical decision can be reviewed by the patient and another doctor of his choice. That'll reduce much of the cost as well.
This is just another end run for O'Bama care. IE an way for insurance company to no longer pay for medically necessary prescription drugs. Just as always the working stiff gets stiffed again.
So it must be good for America.
What could possibly go wrong ?
At some point the public is going to become aware that the FDA, the drug companies, and their doctors, are NOT their friends.
Of course, health plans, medicare included won't pay for them if they're over the counter. and for drugs that treat blood pressure or diabetes, etc. which are basically lifelong, that's not small change., As a dessert, health saving accounts currently will no longer let you use them to pay for over the counter drugs either, which effectively moves the cost from before tax to after tax