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Wednesday, March 28, 2012

A simple question about drugs

Is there any reason -- any at all -- why birth control pills require a prescription? Why can't they be over the counter?

OTC oral contraceptives would resolve a number of current controversies. And might well prevent some unwanted pregnancies, to boot.

In a response to a comment in a post below, I argued that more drugs should be OTC.

Hell, I even think we ought to be allowed to buy opiate pain relievers over the counter, in small yearly amounts. We're talking, what, the equivalent of maybe seven T3s each year. This system would result in a lot of black market sales, but so what? I can't see any great looming troubles: It's not as though seven pills are going to make anyone wealthy or increase the number of addicts. When a toothache flares up in the middle of the night, people should be capable of meeting the challenge.

Albenza (used for tapeworm) is OTC in other countries. Why not here?

Canada allows 400 mg doses of Ibuprofin over the counter; the US does not. Why not? Nothing stops you from taking multiple 200 mg pills. I've even had doctors tell me to do just that. If I have severe pain, I'll use 800, maybe even 1000 mg, even at the risk of becoming nauseous. It's my choice. (For toothache, I recommend Peppermint oil on the tooth combined with as much ibuprofin as you can take without making yourself upchuck.)

What if amoxicillin or other antibiotics were OTC? Yeah, stupid people would abuse those drugs. On the other hand, do I really need a doctor to tell me I have strep throat? I KNOW when I have strep.

Antivirals. Rogaine. Viagra. Instead of forcing people to spend hundreds of dollars on doctor's visits, why not give them plenty of education on side effects and so forth? Let them make their own decisions. True, doctors don't like to give Viagra to men with high blood pressure, but there are now testing devices in certain pharmacies. I just don't see the need for expensive professional consultations.
Comments:
"I just don't see the need for expensive professional consultations". Obviously you lack the vision thing or an AMA membership.

Shirt
 
You are right - 90% of prescription meds can be OTC - even narcotics - within limits. As a nurse practitioner I always thought it strange that a patient comes in to me and says they have heartburn, allergies or a urinary tract infection and I charge them to give them a prescription for the medicine they tell me works best for their condition. As far as antibiotic overuse - NO-ONE ever leaves an ER clinic of office without a script for one if they want it. The dirty secret in medicine is about 60-70% of primary care visits produce no "added value" beyond what the patient knew they needed or wanted.
 
It's a way to force unnecessary cervical screenings on women.

Now, these screenings can benefit women, especially women who have family histories of cervical problems, but I know more women who've suffered from a false positive and all the added stress, than I know who've been helped by them.

Requiring a script for BC is just one more thing in the arsenal to control women.
 
You need a prescription for many drugs because (1) doctors need to screen out people with conditions that might be worsened by taking the drug, even if they are only a very small percentage of the population; (2) the symptoms someone wants the drug for might indicate a serious condition that the doctor should evaluate; (3) making people come in to get renewals periodically lets the physicians observe whether the person might have other conditions and/or symptoms indicative of a serious condition that needs evaluation. So, BC pills shouldn't be taken by women with a tendency toward blood clots because they greatly increase likelihood of stroke. Not all women know whether they have a tendency toward blood clots, but if you can ask whether the woman has had unexplained pain in her calves that would make it less likely she will take a pill and die from it. Similarly, having the chance to find out whether breast cancer runs in a woman's family would eliminate women who shouldn't take the pill and prevent them from creating their own future problems by messing with their hormone levels (which are known to contribute to growth of certain cancers). Yes, this inconveniences the many women who do not have these conditions, but preventing deaths by inconveniencing normal women is a price many of us would willingly pay if we knew about the tradeoff. So you can trivialize and joke about this and make it into just another excuse to rant, but there is a real reason (not a business reason) for putting people in contact with their doctors more often.
 
There is nothing a doctor does in that appointment, that could not be replicated by a pharmacist, who probably knows more about the possible drug interaction than the doctor, and the pharmacy is also capable of discussing clot symptoms too. And before you start accusing me of trying to put more work on overworked pharmacists, the prescreen could even be done automatedly, and you'd get just as much out of the interaction as you would have from actually paying the co pay and visiting the doctor(I don't know about you, but my interactions with my doctor last about 5 mins after a 30-45 minute wait). Especially with the looming family doctor shortage, this is a situation that will only get worse.

More here
 
There's a perfectly reasonable argument why antibiotics should not be OTC (or used indiscriminately in livestock, for that matter). Antibiotic resistance is a real and growing public health problem - and we're approaching the point where some pathogens are resistant to pretty much *all* antibiotics. This is a problem that's been caused by indiscriminate use in the past. Making antibiotics OTC would only make it worse.
 
There is nothing a doctor does in that appointment, that could not be replicated by a pharmacist, who probably knows more about the possible drug interaction than the doctor, and the pharmacy is also capable of discussing clot symptoms too.

And the pharmacist would never have a financial interest in convincing me to select an expensive medication for a problem that could be resolved by an inexpensive one. ;-)
 
You can get amoxicillin mail order from Spain.
 
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